The Doctor Is In: Why Do I Get Period Cramps (and What Can I Do About Them)?

Find out how much you actually know about why your periods are painful.
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Find out how much you actually know about why your periods are painful.

When it comes to taking care of our health, asking questions never hurts. But is it always worth a visit to your doctor? We’re asking experts to weigh in on your burning questions—from feminine to general health and everything in between—so you can get advice from a pro before you go. The doctor will see you now.

While the menstrual cycle is a truly amazing thing, we can’t deny the discomfort of menstrual cramps. Sore thighs, throbbing muscles, sharp pain—you know how it goes.

It’s easy to chalk it up to Mother Nature doing her thing, but do you know exactly what’s going on? Understanding the specific mechanisms can help you get in touch with the nuances of your menstrual cycle to understand why your cramps are happening and what you can do to help alleviate the pain.

Dr. A. Nicky Hjort, M.D., OB-GYN, at Peninsula Primary Care in California gives us the lowdown on these pesky muscle contractions based on the most common questions she fields from her own patients.

Q. What causes menstrual cramps?

While it’s easy to shake a fist at Aunt Flo, the real culprit is behind the scenes. Prostaglandin, an inflammatory chemical mediated by your hormones, is the compound responsible for discomfort and cramps, Dr. Hjort says.

“Every month, the uterus and ovaries work together, expecting pregnancy,” Dr. Hjort explains. “In anticipation, the uterus lining builds up. But when pregnancy doesn’t happen, the uterus discards it. This is when the period starts and the prostaglandins kick in.”

Dr. Hjort says that this chemical accomplishes the uterus’ mission to toss the uterine lining by stimulating a pumping action that pushes the blood out of your body. The result? An inflammatory response that manifests into what many of us know as menstrual cramps.

Q. How long do menstrual cramps typically last?

"Commonly, cramps last three to five days. Anything much longer than that is unusual," Dr. Hjort says.

Q. Could something else be making my cramps worse?

Severe cramps can also be due to anatomical abnormalities. “If I have a patient with painful periods without irregular or heavy bleeding, I’d be thinking more about endometriosis or adenomyosis,” says Dr. Hjort. Endometriosis develops when tissue inside of the uterus grows outside of it, while adenomyosis is essentially the opposite: the glands lining the uterus grow too deep, causing pain.

If the pain is coupled with heavy or irregular bleeding, Dr. Hjort advises that this warrants investigating a possible hormonal imbalance because these problems can trigger prostaglandin production.

Either situation should prompt a good and thorough physical exam by a gynecologist possibly followed by hormone blood work. This will help your practitioner zero in on potential anatomical or hormonal issues. "The physical exam provides clues that guide our next steps," says Dr. Hjort. "A good doctor who provides evidence-based medicine tries to do all the testing necessary to determine the most accurate diagnosis and thus lead therapy, yet simultaneously not order unnecessary tests—either imaging or blood—that increase costs without improving outcomes."

Q. Why do some women experience worse cramps than others?

“Cramps are a very varied experience from one woman to the next,” Dr. Hjort says. “Interestingly enough, sometimes I’ll see patients who are clearly in distress. Then I’ll have patients who have abnormally mild cases.”

Part of it comes down to pain perception. “Some people will experience a mild cramp as severely painful, while others experience terrible cramps as very mild,” Dr. Hjort says. Much like how every woman handles stress and anxiety differently, pain management differs from one woman to the next.

Q. How can I tell if my pain is severe or not? What if I just have a low pain tolerance?

“That is a difficult question to answer objectively” Dr. Hjort says. “Since only the patient can rate their pain, a one to ten scale is what we commonly use. One is a minor annoyance and a ten would be the worst pain ever experienced (like labor or breaking bones). A seven or higher is severe. No health care provider should accuse their patient of having a low tolerance. Pain should be managed, not dismissed. But personally, if my patient feels that her pain severely affects the quality of her life and/or her ability to function (e.g., you miss work or school), that is severe by my standards."

If your cramps feel like a nightmare, make an effort to experiment with various self-management methods such as taking pain relief medication or using a heating pad. Pay attention to what treatments are most effective for you. Meanwhile, make an appointment with your gynecologist and share your concerns; your cramps could be an indicator of a more complicated condition.

Q. What can I do to help with the pain?

Four words: NSAIDs, heat, stretching, exercise.

“Because prostaglandins are inflammatory-mediators (compounds naturally made by the body as part of the inflammatory process), non-steroidal anti-inflammatory drugs (NSAIDs) are really quite effective,” Dr. Hjort advises. “The generic names are ibuprofen and naproxen sodium.”

NSAIDs are low-risk drugs that are very effective for decreasing the inflammation caused by period cramps. Dr. Hjort notes, “They’re generally considered to be safe for most people if used for short periods of time.” Taking NSAIDs before and during your cycle can dramatically reduce cramping.

Heating pads and mild stretching can also help. “They increase blood flow and clear out the prostaglandins,” Dr. Hjort explains. “As a result, the cramps subside and you start to feel better.”

Fortunately, you can take advantage of these options at home. Store-bought heating pads are available in electrical and microwavable forms. If you're looking for a little extra zen, try making your own microwavable heating pad with rice and dried lavender filled into an old sock and sewn or tied closed. For best results, apply the pad to your stomach, pelvic region, and lower back for a comforting wave of relief.

While unraveling from your bed in the midst of a cramping sesh may seem daunting, stretching to flush out prostaglandins is be worth it. YouTube is the perfect source for relieving moves designed specifically to ease menstrual cramps.

“Exercise can take relief to the next level,” Dr. Hjort adds. “It’s all thanks to the drug-like endorphins released during exercise, offering a pain-relieving process within the body.” You don’t have to run a marathon to reap the benefits. Simply taking a walk around your house or around the block can ease the pain. Consider it as an excuse to finally get the mail.

Share your holy grail solutions for easing menstrual cramps in the comments below. And feel free to leave a question for Dr. Hjort to tackle in an upcoming column of The Doctor Is In.

Photo Credit: Tina Sosna