Abdominal (Stomach) Pain and Menstrual Cramps

Stomach cramps or cramping abdominal pain can be due to a vast number of causes, some easily manageable while others may be life threatening, requiring immediate medical attention. Often stomach cramps are mistaken for menstrual cramps in women and vice versa. This can hamper the diagnosis of other conditions responsible for the pain and cramping or even cause women to prevent seeking medical attention by attributing their abdominal cramps to menstrual pain.

Causes of Stomach (Abdominal) Cramps

  • Appendicitis
  • Infection of gall bladder (cholecystitis), with or without gall stones (cholelithiasis)
  • Bowel obstruction
  • Chronic constipation
  • Viral gastroenteritis (stomach flu)
  • Excessive gas, heartburn or indigestion
  • Gastritis
  • Ulcers
  • Irritable bowel syndrome
  • Food allergy or food poisoning
  • Urinary tract infection
  • Kidney or ureteric stones
  • Crohn’s disease
  • Ulcerative colitis
  • Twisted ovarian cyst
  • Dysmenorrhea or menstrual cramps
  • Endometriosis
  • Mittelschmerz or mid-cycle menstrual pain
  • Ectopic pregnancy
  • Spontaneous abortion
  • Uterine fibroid
  • Uterine cramps during pregnancy
  • Pelvic inflammatory disease
  • Abdominal muscle strain

Menstrual cramps (Dysmenorrhea)

While, in a woman, any of the above causes for abdominal cramps may be present, dysmenorrhea or menstrual cramps is one of the most common and debilitating cause. Itt may occur on a regular basis and may interfere with her daily routine, depending on the severity and duration.

Types of Dysmenorrhea

  1. Primary dysmenorrhea is menstrual pain without any underlying abnormal condition and it may start soon after menarche (first menstrual cycle).
  2. Secondary dysmenorrhea may be due to  some underlying gynecological problem (such as endometriosis, fibroid, or pelvic inflammatory disease) is associated with this type of pain and it usually develops later on. The pain may occur on its own or be accompanied by other signs and symptoms, like vaginal discharge with or without a bad vaginal odor, excessive bleeding or large clots during menses.

Causes of Menstrual Cramps

  • Every month, the inner lining of the uterus (endometrium) is prepared for possible pregnancy by the action of hormones such as estrogen and progesterone. If pregnancy fails to occur, the estrogen and progesterone levels fall, leading to break down of the endometrium, which is shed during menstruation. When the endometrium breaks down, compounds called prostaglandins are released, which cause contraction of the uterine muscles, resulting in menstrual cramps. Depending on the level of prostaglandins, cramps may be mild or severe.
  • Narrow cervical canal, causing difficulty in passage of the dead endometrial tissue during menstruation.
  • Retroverted or backwards-tilted uterus.
  • Other factors such as lack of exercise, chronic constipation, and emotional stress are also associated with menstrual cramps.

Treatment of Menstrual Cramps

  • Adequate rest
  • Regular exercise, such as walking
  • Avoiding constipation
  • Heating pad or hot water bottle applied to the abdomen
  • Ideally, medicines should be started before the pain becomes severe, or in anticipation of the pain, it may be started one or two days before the onset of menstruation, to give best results. For mild pain, aspirin or acetaminophen can be used, but for moderate to severe pain, medicines such as ibuprofen, ketoprofen, naproxen, or mefenamic acid are more effective.
  • Low-dose oral contraceptives and insertion of IUD containing small amounts of the progesterone levonorgestrel may be effective in managing severe cramps.
  • Dilatation and curettage (D and C), or endometrial ablation (burning away of the endometrial lining).
  • Hysterectomy or surgical removal of the uterus is the most extreme measure to get relief from menstrual cramps.
  • For secondary dysmenorrhea, the underlying cause should be identified and treatment done accordingly.

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