Menstrual cramps – symptoms, causes and risk factors

menstrual cramps symptoms and causes

Menstrual cramps are painful sensations which are affecting many women before and during a menstrual period. Menstrual cramps are also known as dysmenorrheal or period pains. They are cramping or throbbing pains in the lower abdomen and the lower back. This type of pain can range from dull and annoying to severe and extreme. Menstrual cramps tend to begin after ovulation when an egg is released from the ovaries and it travels down the fallopian tube. Many women experience menstrual cramps during their menstrual periods or just before their menstrual periods. For some women, this discomfort is merely annoying. For other women, menstrual cramps can be severe and they can interfere with the everyday activities in a period of a few days and this is happening every month [1]. Menstrual cramps can be caused by identifiable problems such as uterine fibroids or endometriosis. The key for reducing the pain is the treatment of underlying cause. Menstrual cramps which are not caused by underlying condition tend to lessen as the woman is getting older and often they improve once a woman has given a birth. [2] Usually menstrual cramps begin one to two days before menstruation and they last from two to four days.

Symptoms of menstrual cramps

These symptoms include:

  • Pain that radiates to your lower back and thighs
  • Dull, constant ache
  • You can feel throbbing or cramping pain in your lower abdomen that may be intense

Also some women can experience:

  • Dizziness
  • Headache
  • Loose stools
  • Nausea

If you have started menstruating within the past few years and have menstrual cramps, chances are your menstrual pain is not a cause for concern. If have noticed that your menstrual cramps disrupt your life every month or if your symptoms progressively worsen or if you are older than 25 and you just started having severe menstrual cramps, then you need to visit your doctor as soon as possible.

menstrual cramps symptoms and causes

menstrual cramps causes

During the menstrual period of woman, the uterus contracts to help expel its lining. Hormone – like substances (prostaglandins) that are involved in inflammation and pain trigger the uterine muscle contractions. When women have higher levels of prostaglandins, then this means they will have more – severe menstrual cramps. [3] Severe contractions can constrict the blood vessels which are feeding the uterus. This pain can be compared with the chest pain which is happening when blocked blood vessels starve portions of the heart of food and oxygen. Menstrual cramps can be also caused by:

  • Cervical stenosis: There are some women in which the opening of the cervix can be so small that it impedes menstrual flow which is causing a painful increase of pressure within the uterus. [4]
  • PID (Pelvic inflammatory disease): This infection of the female reproductive organs is usually caused by sexually transmitted bacteria. [5]
  • Adenomyosis: In this condition, the tissue which lines the uterus is beginning to grow into the muscular walls of the uterus. [6]
  • Uterine fibroids: These noncancerous growths in the wall of the uterus may be the cause of the pain. [7]
  • Endometriosis: In this painful condition, the tissue that lines your uterus becomes implanted outside your uterus, most commonly on your fallopian tubes, ovaries or the tissue lining your pelvis. [8]

Risk factors: You can increase your risk of getting menstrual cramps if:

  • You are a smoker [9]
  • You have a family history of dysmenorrhea
  • You have never given birth
  • You have irregular menstrual bleeding (metrorrhagia)
  • You have heavy bleeding during periods (menorrhagia) [10]
  • You started puberty early, at age 11 or younger
  • You are younger than age 30 [2]

Complications: Menstrual cramps are not causing any other medical complications but they can interfere with social activities, work and school. There are some conditions which are associated with the menstrual cramps and which can have complications. Endometriosis can cause woman problems with the fertility. [8] Pelvic inflammatory disease can scar her fallopian tubes, increasing the risk of a fertilized egg implanting outside of your uterus (ectopic pregnancy).


[1] Schoep ME, Nieboer TE, van der Zanden M, et al. The impact of menstrual symptoms on everyday life: a survey among 42,879 women. American Journal of Obstetrics and Gynecology. 2019;220(6):569.e1-569.e7

[2] Grandi G, Ferrari S, Xholli A, et al. Prevalence of menstrual pain in young women: what is dysmenorrhea? Journal of Pain Research. 2012;5:169–74.

[3] Barcikowska Z, Rajkowska-Labon E, Grzybowska ME, et al. Inflammatory markers in dysmenorrhea and therapeutic options. International Journal of Environmental Research and Public Health. 2020;17(4):1191.

[4] Koyama S, Kobayashi M, Tanaka Y, et al. Complete cervical stenosis after conization: Timing for the minimally invasive reconstructive surgery. Gynecology and Minimally Invasive Therapy. 2014;3(2):57-60.

[5] Mitchell C, Prabhu M. Pelvic inflammatory disease: Current concepts in pathogenesis, diagnosis and treatment. Infectious Disease Clinics of North America. 2013;27(4):10.1016/j.idc.2013.08.004.

[6] Vannuccini S, Petraglia F. Recent advances in understanding and managing adenomyosis. F1000 Research. 2019;8:F1000 Faculty Rev-283.

[7] Zimmermann A, Bernuit D, Gerlinger C, et al. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Women’s Health. 2012.

[8] Bloski T, Pierson R. Endometriosis and chronic pelvic pain
unraveling the mystery behind this complex condition. Nursing for Women’s Health 2008;12(5):382–95.

[9] Qin LL, Hu Z, Kaminga AC, et al. Association between cigarette smoking and the risk of dysmenorrhea: A meta-analysis of observational studies. PLoS One. 2020;15(4):e0231201.

[10] Gokyildiz S, Aslan E, Beji NK, Mecdi M. The effects of menorrhagia on women’s quality of life: A case-control study. International Scholarly Research Notices. 2013.


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