FIRST MENSTRUAL CRAMPS

What is dysmenorrhea?

The medical term for menstrual cramps is dysmenorrhea. There are two types of dysmenorrhea, primary and secondary.
In primary dysmenorrhea, there is no underlying gynecologic problem causing the pain. This type of cramping may begin within six months to a year following menarche (the beginning of menstruation), the time when a girl starts having menstrual periods. Menstrual cramps typically do not begin until ovulatory menstrual cycles (when an egg is released from the ovaries) occur, and actual menstrual bleeding usually begins before the onset of ovulation.
Therefore, an adolescent girl may not experience dysmenorrhea until months to years following the onset of menstruation.
In secondary dysmenorrhea, some underlying abnormal condition (usually involving a woman's reproductive system) contributes to the menstrual pain. Secondary dysmenorrhea may be evident at menarche but, more often, the condition develops later.

What causes menstrual cramps?

Each month, the inner lining of the uterus (the endometrium) builds up in preparation for a possible pregnancy. After ovulation, if the egg is not fertilized by a sperm, no pregnancy will result and the current lining of the uterus is no longer needed. The woman's estrogen and progesterone hormone levels decline, and the lining of the uterus becomes swollen and dies. It is then shed and will be replaced by a new lining in the next monthly cycle.

When the old uterine lining begins to break down, molecular compounds called prostaglandins are released. These compounds cause the muscles of the uterus to contract. When the uterine muscles contract, they constrict the blood supply (vasoconstriction) to the endometrium. This contraction blocks the delivery of oxygen to the tissue of the endometrium which, in turn, breaks down and dies. After the death of this tissue, the uterine contractions literally squeeze the old endometrial tissue through the cervix and out of the body by way of the vagina. Other substances known as leukotrienes, which are chemicals that play a role in the inflammatory response, are also elevated at this time and may be related to the development of menstrual cramps.

Why are some cramps so painful?

Menstrual cramps are caused by the uterine contractions that occur in response to prostaglandins and other chemicals. The cramping sensation is intensified when clots or pieces of bloody tissue from the lining of the uterus pass through the cervix, especially if a woman's cervical canal is narrow.
The difference between menstrual cramps that are more painful and those that are less painful may be related to a woman's prostaglandin levels. Women with menstrual cramps have elevated levels of prostaglandins in the endometrium (uterine lining) when compared with women who do not experience cramps. Menstrual cramps are very similar to those a pregnant woman experiences when she is given prostaglandin as a medication to induce labor.

Can menstrual cramps be measured?

Yes. Menstrual cramps can be scientifically demonstrated by measuring the pressure within the uterus and the number and frequency of uterine contractions. During a normal menstrual period, the average woman has contractions of a low pressure (50-80 mm Hg), which last 15-30 seconds at a frequency of 1-4 contractions every 10 minutes. When a woman has menstrual cramps, her contractions are of a higher pressure (they may exceed 400 mm Hg), last longer than 90 seconds, and often occur less than 15 seconds apart.

What other factors influence menstrual cramps?

As mentioned above, an unusually narrow cervical canal tends to increase menstrual cramps. Another anatomical factor thought to contribute to menstrual cramps is a backwards tilting of the uterus (a retroverted uterus).
Lack of exercise is now recognized to contribute to painful menstrual cramps.
It has long been thought that psychological factors also play a role. For example, it is widely accepted that emotional stress can increase the discomfort of menstrual cramps.

What are the symptoms of menstrual cramps?

Menstrual cramps are pains that begin in the lower abdomen and pelvis. The discomfort can extend to the lower back or legs. The cramps can be a quite painful or simply a dull ache. They can be periodic or continual.
Menstrual cramps usually start shortly before the menstrual period, peak within 24 hours after the onset of the pains, and subside again after a day or two.
Menstrual cramps may be accompanied by a headache and/or nausea, which can lead, although infrequently, to the point of vomiting. Menstrual cramps can also be accompanied by either constipation or diarrhea because the prostaglandins which cause smooth muscles to contract are found in both the uterus and intestinal tract. Some women experience an urge to urinate more frequently.

How are menstrual cramps diagnosed?

The diagnosis of menstrual cramps is usually made by the woman herself and reflects her individual perception of pain. Once a woman has experienced menstrual cramps, usually with the adolescent onset of her menses (monthly menstrual flow), she becomes well aware of the typical symptoms (by Melissa Conrad Stöppler and William C. Shiel Jr).

Home remedies for menstrual cramps

	Heat.  Take a warm bath. The warmth will relax you and help to relieve menstrual cramps. You can also use an old-fashioned hot water bottle or a heat pad at night to keep your abdomen warm.
	Bananas. All cramps, including menstrual cramps, are worsened when you have Vitamin K deficiency. Eat a banana a day to make sure you are getting enough Vitamin K and relieve menstrual cramps.
	Aloe gel and Black pepper. This is an ancient remedy used by Indians in South America. Take 3 to 4 teaspoons a day.
	Black Cohosh. You can find this is a natural food store. This is an herb which  has been used for centuries to treat for menstrual and menopausal symptoms. A 2005 clinical trial of 304 women found that black cohosh significantly reduces the severity of menstrual cramps.
	Raspberry tea. There are several teas which are particularly  effective in treating menstrual cramps and PMS. Raspberry tea is one of the best. Raspberry tea contains a compound called pycnogenol, which reduces uterine contractions. Researchers speculate that this is how raspberry tea helps menstrual cramps.
	Ginger. Ginger, used in teas or just eaten directly with sushi, can help to relieve menstrual cramps and PMS.
	Primrose Oil.  If you suffer from PMS, chances are that your body lacks an essential acid called GLA (gamma-lineolic acid). In your body, GLA is converted into a hormone-like compound called prostoglandins, which reduce inflammation and muscle contractions. Primrose oil has been used in Europe for decades to treat symptoms of PMS (bloating, tender breasts) and menstrual cramps.
	Exercise. Researchers have found that women who exercise regularly have less severe PMS and menstrual cramps. Do cardiovascular exercise at least 4 times a week. Walking, playing soccer, basketball, tennis, skating, dancing - anything that makes  you sweat.

Medication for menstrual cramps

Midol.  This is the most popular over the counter remedy for menstrual cramps.
Anaprox. Some girls and women suffer cramps so severe that Midol and over-the-counter medications don't work. Anaprox does help many of these women. See your gynecologist about the suitability of a prescription.