Period cramps are very common. Up to 90% of people who menstruate report painful periods at some point in their life. Cramps are just a minor inconvenience for some, feel relatively painful for others or can be so debilitating that they prevent us from doing daily activities. But are all cramps created equal? What makes some cramps worse than others? And why do cramps often start before bleeding? We’re exploring all things related to cramps, including what causes them, how to get relief and when to ask for help.
Period Recap
In order to understand cramps, we need to understand what’s happening during a period. Periods are the time when the lining of the uterus refreshes itself. This usually happens on a cycle and is a response to hormonal signals from the brain and the ovaries. The period process takes about 3-7 days and happens every 28 days or so.
During a period, the uterus sheds its top layer. As the top layer slowly comes off, some blood vessels also open up and cause bleeding. The tissue and blood come out of the vagina – this is a period. But in order to get all of the blood and tissue out, the uterus (which has muscles in it) needs to squeeze. This is what causes cramps! This is also why cramps often start before bleeding. The uterus needs to squeeze in order to get things moving.
Cramp Signaling
In the day or two leading up to a period, the body releases molecules (small signaling messengers) to make the muscles in the uterus contract. These molecules are called prostaglandins. Prostaglandins are produced by the uterus, for the uterus. Studies have shown that the higher your level of prostaglandins the more severe your cramps may be.
Menstrual cramps that are felt in other locations, like in the back, thighs or buttocks, are also caused by prostaglandins. The prostaglandins that are released by the uterus can spread to other body parts around the uterus and cause those muscles to cramp. (This is even why some people have diarrhea with their period – it’s because of prostaglandins!) Taking period medication can help reduce the pain and discomfort produced by prostaglandins.
What Makes Cramps Worse?
The most severe menstrual cramps are reported in younger women (usually in their early 20s), those who smoke and during times of stress. Experiencing painful periods can also be hereditary, meaning if your mother had bad cramps you may have them as well.
Sometimes painful cramps can be a sign that something else is going on. Secondary dysmenorrhea is the medical term used to describe cramps that are caused by a specific condition like endometriosis or uterine fibroids. These severe cramps usually develop later (like in your 30s) and do not improve with typical cramp treatments.
What Makes Cramps Better?
Menstrual cramps often improve with minimally-invasive interventions. Use of a heating pad on the abdomen or back can relax muscles and reduce cramping. TENS (Transcutaneous Electrical Nerve Stimulation) devices can be placed over your lower abdomen and send small electric signals that reduce the feeling of pain. Daily exercise has also been shown to improve cramps over time, and some women even feel relief of bloating and pain by consuming caffeine.
When these methods don’t work (or when they don’t treat all of the pain), the most effective way to reduce period cramps is to take period medication. Over-the-counter pain relievers like ibuprofen can reduce the amount of prostaglandins produced and, therefore, reduce cramps. Research also suggests that if you take your medicine the day or two before you start your period, you may experience even better cramp relief!
When desired, a prescription period medication can be used to control heavy periods, which can lead to fewer and less painful cramps. Birth control pills and other methods of contraception can improve many aspects of a menstrual cycle. However, hormonal methods are not recommended for everyone, and many people wish to avoid hormone prescriptions. In these cases, doctors might prescribe a stronger pain medication or discuss other lifestyle interventions that may help.
What If My Cramps Don’t Get Better?
Research has shown that a number of medical interventions are effective in managing cramps. However, when the methods above (including over-the-counter or prescription period medication) do not improve pain, there may be another cause of your cramps.
If this is your experience, or if you notice that your cramps are getting worse over time, consider talking with your doctor. There are tests and imaging studies that can be done to look into your cause of cramps and if a different type of treatment is needed. In these cases, doctors may recommend a specific type of period medication or other therapies for long-lasting cramps. Painful cramps do not need to be a normal part of a period.