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Menstrual Cramps: Causes & How to Get Relief

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Medically reviewed by
OBGYN at Mercy Health - St Elizabeth Youngstown Hospital
Last updated October 25, 2022

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Care Plan

1

First steps to consider

  • Mild to moderate cramps can be treated with OTC medications.
  • Ibuprofen (Advil, Motrin) and naproxen (Aleve) can often relieve cramps.
2

When you may need a provider

  • Severe cramps
  • Your cramps are interfering with your life.

Menstrual cramps cause mild to severe abdominal pain before and during your period and can usually be helped by taking OTC pain medications. But severe cramps may need to be treated by a doctor.

What are menstrual cramps?

Menstrual cramps, also called period cramps, are muscular cramps in the lower abdomen or back that girls and women can get just before and during their period. It is caused by the release of a hormone called prostaglandin, which makes the uterus contract.

If you have mild pain, you can usually treat it with at-home care and OTC pain relievers. But if you have moderate to severe pain, you may need prescription medications or other treatments.

Pro Tip

Some people stop having painful periods after years of suffering while other people suddenly start having painful periods when they hadn’t had them before. —Dr. Jessica Katz

Symptoms

Menstrual cramps start with your period or a few days before your period begins. The pain is usually at its worst 24 hours after your period starts and lasts for 2–3 days. It can be longer if you have your period for more than 7 days.

The pain is usually in the lower abdomen, but it can radiate to the back or the legs. Menstrual cramps can cause different types of pain, including:

Some women may have other symptoms like headache, nausea, vomiting, diarrhea, and upper abdominal pain.

Normal vs. severe menstrual cramps

Many people have cramps during their period. Often, the pain is mild or moderate, and can be treated with OTC medications or a heating pad.

Severe menstrual cramps are so painful that they disrupt your life. You might not be able to get out of bed and may have to miss school, work, or activities. The pain may feel like constant stabbing, sharp, or shooting pain. You may also have nausea, vomiting, diarrhea, headaches, irritability, weakness, and even fainting. If you have severe pain with these symptoms, you should see your doctor to improve your quality of life.

Pro Tip

People often think that you have to suffer through menstrual cramps because they are normal and everyone gets them. But there are so many treatment options with high success rates. —Dr. Katz

Causes

After the hormone prostaglandin is released in the body, the uterus tightens, or contracts. As the uterus contracts, blood vessels are compressed, which cuts off the supply of oxygen to the uterine muscle tissue. When the muscle momentarily loses its oxygen supply, you feel cramps.

Painful periods (dysmenorrhea) are either primary or secondary. In primary dysmenorrhea, the cramps are caused only by your period.

In secondary dysmenorrhea, they’re caused by a disorder or infection. The pain usually begins earlier in the menstrual cycle and lasts longer than common menstrual cramps.

These disorders include endometriosis (when the  tissue that lines the uterus is outside the uterus), uterine fibroids, adenomyosis (when the cells of the uterine lining grow into the muscle layer of the uterus), and pelvic inflammatory disease.

You may be at higher risk for menstrual cramps if you:

  • Are younger than 30 years old
  • Started puberty early (before age 11)
  • Have heavy bleeding during periods
  • Have irregular menstrual bleeding
  • Have family members who had menstrual cramps
  • Smoke
  • Are overweight
  • Have never been pregnant

Dr. Rx

An important question to ask your doctor: What are some alternative treatments to medication? —Dr. Katz

Treatment

There are many options for treating menstrual cramps, including OTC and prescription medications. Some women may need surgery to treat underlying conditions.

At-home care

OTC medications

  • Menstrual cramps can usually be treated with anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) or naproxen (Aleve). Either start taking the medication at the beginning of your period or as soon as you have symptoms. Continue taking NSAIDs for 2 to 3 days or when the pain stops. Taking NSAIDs the day before you expect your period to start may help prevent cramps. NSAIDs can often irritate an empty stomach so try to have with food.
  • Some OTC medications combine several ingredients. Popular ones include:
    • Midol products combine Tylenol, an antihistamine, and caffeine or ibuprofen, a diuretic, and a sedative antihistamine for night use.
    • Pamprin products combine a diuretic, Tylenol, and an antihistamine, or Tylenol, aspirin, and caffeine.

Lifestyle and home remedies

  • Get regular exercise
  • Use a heating pad, hot water bottle, or take a hot bath
  • Drink plenty of water when you have your period
  • Certain supplements may help, including vitamin E, omega-3 fatty acids, thiamine, vitamin B-6, and magnesium.
    • Magnesium may have some muscle-relaxing effects
    • B vitamins (thiamine and B-6) can dilate blood vessels, which help muscles relax
    • Omega-3 fatty acids help inhibit prostaglandin, the hormone behind the cramps/pain.
    • Vitamin E provides antioxidant properties and has been shown to decrease various types of muscle cramps.
  • Reduce stress by trying deep breathing, meditation, and yoga.
  • Avoid certain foods that cause bloating and water retention, like fatty foods, alcohol, carbonated drinks, caffeine, and salty foods. Bloating and water retention adds to the discomfort of having painful cramps.
  • Herbal supplements that contain anti-inflammatory and antispasmodic compounds (pycnogenol, fennel, chamomile tea, cinnamon, ginger and dill) may help too.

Medical care

When OTC medications don’t decrease the pain or other symptoms such as nausea, talk to your healthcare provider. They may do a pelvic exam to check for any medical conditions. They may also want to check for fibroids, an ovarian cyst, or adenomyosis with an ultrasound.

If you test positive for a sexually transmitted infection, you’ll be prescribed an antibiotic.

Treatments for severe cramping include:

  • Hormonal birth control. These prevent ovulation and can thin the uterine lining, reducing the severity of menstrual cramps. Birth control pills are the most common type, but other types include injection (Depo Provera), NuvaRing, patches, implants, and hormonal IUDs.
  • Prescription pain relievers. Rarely, your provider may prescribe stronger prescription pain relievers. But this is not a permanent solution and these types of medications should not be prescribed on a regular monthly basis. Muscle relaxers may also be prescribed, but this depends on what’s causing your cramps.
  • Surgery. If your menstrual cramps are caused by fibroids, endometriosis, or adenomyosis, you may need to have a surgical procedure. These surgeries are typically minimally invasive like a laparoscopy (a scope inserted through tiny incisions in your pelvis) or a hysteroscopy (a small scope inserted through the vagina and cervix into the uterus). Both procedures can remove tissue such as fibroids and endometriosis. The last resort is a hysterectomy, which is surgical removal of the uterus.

Alternative treatments

  • Acupuncture uses thin needles to stimulate specific points on the body to change how the body reacts. It has been shown to reduce menstrual cramps.
  • Acupressure (rubbing circles on your calf, four fingers up from inner ankle) can relieve period pain.
  • Transcutaneous electrical nerve stimulation (TENS) sends gentle electrical pulses through pads placed on your abdomen. It treats pain by releasing endorphins, relieving muscle pain, and regulating uterine contractions.
  • Massaging the lower back or abdomen with essential oils (lavender, peppermint, rose, fennel, clove, sage).

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OBGYN at Mercy Health - St Elizabeth Youngstown Hospital
Dr. Katz is a board-certified OBGYN, who is thrilled to have fulfilled a life-long dream of becoming a physician and helping women of all ages and backgrounds be in the best health possible and get access to top level care. She received her undergraduate degree in anthropology from the University of Michigan (2006) and graduated from Des Moines University of Osteopathic Medicine and Surgery (2011)...
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