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Menstrual Cramps

“Menstrual cramps” are nagging pains which many women have to endure. If you have had no first-hand experience, you may not understand the agony.

“Menstruation or period” concerns every woman. “Menstrual cramps” are nagging pains which many women have to endure. If you have had no first-hand experience, you may not understand the agony.

10 things you should know about menstrual cramps

  1. Are menstrual cramps common in women?
    Yes, they occur in 50-90% of women of reproductive age, particularly in young women. Usually menstrual cramps become less painful as you get older. If symptoms are more severe as you age, it may indicate underlying conditions. Please seek medical advice.
  2. What cause menstrual cramps?
    Menstrual cramps are caused by prostaglandins which regulate the process of inflammation, blood flow, blood clot formation and childbirth labor. Prostaglandins are secreted by the inner lining of the uterus during menstruation.
  3. What are the pain qualities of menstrual cramps?
    The pain qualities of menstrual cramps, arisen from uterine contraction, are characterized by:
    • Irregular pain pattern
    • Frequent uterine contraction at 4-5 times every 10-minutes
    • Progressive pain from mild to intense
    • Similar to labor pain but less severe
  4. What are the risk factors for severe menstrual cramps?
    Smoking and stress.
  5. How many types of menstrual cramps are there?
    Medically, menstrual cramps or dysmenorrhea are categorized into 2 types.
    • Primary dysmenorrhea
      • Occurs during menstrual period only
      • Occurs briefly and resolves within 12-72 hours
      • Pain stronger at younger ages and become less severe as you get older
    • Secondary dysmenorrhea
      • Starts before menstruation or persists afterwards
      • Pain progressively more severe when you get older.
      • Often accompanied by other symptoms such as irregular menstruation, pain outside of menstrual period, nausea, vomiting, headache and infertility.
      • This type of pain often has an underlying condition such as endometriosis. In this case, please seek medical attention.
  6. Do menstrual cramps signify any underlying diseases?
    If the pain is primary dysmenorrhea, no medical attention is required.
    But if it is secondary dysmenorrhea or you never experience the pain before and you start to feel the pain as you get older and the pain worsens, there may be underlying conditions such as:
    • Endometriosis of the ovaries, also known as chocolate cyst
    • Endometriosis of the uterine muscle
    • Uterine fibroid
    • Pelvic Inflammatory Disease (PID), etc.
  7. What kind of pain killer is suitable for menstrual cramps? Are there any side effects from long-term use?
    Common medications for menstrual cramps are:
    • Paracetamol
      • It is a universal pain killer for any types of pain including menstrual pain.
      • It can relieve 50 % of the pain.
      • If not overdosed, there rarely are side effects.
      • The recommended dosage is 500 mg (1-2 pills, depending on your weight), every 6 hours.
    • Non-steroidal anti-inflammatory drugs (NSAIDs)
      There are many types of NSIADs, but the recommended one is mefanamic acid.
      • Mefenamic Acid
        • The recommended initial dosage is 500 mg, followed by 250 mg every 6 hours if needed.
        • Take Ponstan during your menstruation but not longer than 3 days.
        • Possible side effect is inflammation of the stomach; hence, it should be taken after meal.
      • COX-2 Selective Non-steroidal Anti-inflammatory Drugs (NSAIDs)
        • Suitable for people with gastritis.
        • The downside is the high cost.
  8. Can oral contraceptives help relieve menstrual cramps?
    Oral contraceptives can help relieve menstrual cramps.
    • Combined hormonal contraceptives (estrogen and progestin)
      • Suitable for those who suffer from menstrual cramps (and do not yet want to be pregnant). This type of hormonal contraceptive is the first recommended option for menstrual cramps.
      • Available in many forms such as pills, vaginal ring and patch
    • Progestin-only hormonal contraceptives
      • There could be side effect of spotting.
      • Only available in injected form.
        It is not recommended to use contraceptive implants or hormone releasing IUDs for the sole purpose of relieving menstrual pain.
  9. Is menstrual cramp associated with infertility?
    Yes, it is, but not always.  Those who suffer from menstrual cramps caused by endometriosis or pelvic inflammatory disease usually have more difficulty conceiving.
  10. When menstruation cramps are severe, what should I do? What are the treatment options?
    • Please see a doctor for proper diagnosis to ensure that there is no underlying conditions.
    • Diagnostic examinations include pelvic examination and pelvic ultrasound.
    • Pelvic ultrasound (or lower abdominal ultrasound) can be performed through the abdomen. However, transvaginal ultrasound can provide clearer images, and can detect other abnormalities or adhesion within the pelvis.
    • If underlying diseases are detected, treatment is advised based on the disease found. For example:
    • Ovarian endometriosis (chocolate cysts): Surgery is recommended. If the cysts are small, hormonal therapy can be considered first.
    • Uterine fibroid: If symptoms interfere with your daily activities of living or medication treatment is not effective, surgery should be performed.
    • If no underlying conditions are detected, you can take pain relievers or hormonal medications under doctor’s care. If medications do not relieve your symptoms, a laparoscopy may be required to diagnose lesions or pelvic adhesion.




Article by
Dr Asama Vanichtantikul
Gynecologist specializing in Gynecologic Oncology and Minimally Invasive Surgery
Doctor profile