Primary Dysmenorrhea (Menstrual Cramps)

Primary dysmenorrhea is the medical term for menstrual pain that occurs in the absence of any other underlying disease. It is generally more common in younger individuals and tends to taper off with age. Menstrual cramps affect roughly two-thirds of young women worldwide.^[1][2]

Menstrual cramping or pain usually begins a couple of days before the onset of menstruation and generally lasts for a few days after.^[2][3]

These symptoms include:

• Sharp cramps in the lower abdomen that sometimes radiate to the lower back and down the legs.
• Nausea
• Sweating
• Headaches
• Dizziness
• Fatigue
• Diarrhea

Menstrual cramps are generally diagnosed via a focused medical history and a routine pelvic exam that shows a lack of abnormal findings. ^[3] Secondary causes, such as endometriosis, can be evaluated with ultrasound but sometimes require further testing or evaluation by a specialist.^[2] Visit the American College of Obstetricians and Gynecologists to learn more about diagnosing primary dysmenorrhea and reducing menstrual pain.

Over-the-counter Nonsteroidal anti-inflammatory drugs (NSAIDs) are the go-to treatment for menstrual cramps as they lower prostaglandin production and thus reduce cramping.^[4] Check with your healthcare provider before taking NSAIDs.

For patients with significant primary dysmenorrhea (cramps not caused by another disease process), occasionally oral contraceptive pills may be recommended by a doctor as they may reduce episodes of cramping as well.

Seek medical help if menstrual pain is not relieved by NSAIDs or other self-care practices, cramps happen when you are or may be pregnant, cramps suddenly become worse, you are over 25 years of age and get severe cramps for the first time, cramps are accompanied by a fever, or you experience pain not around the time of menstruation.^[2]

Several supplements have been used to treat menstrual cramps including cinnamon, ginger, chamomile, fennel, omega-3 fatty acids and fish oil, Vitamin D, Vitamin E, calcium, magnesium, zinc, and boron.^[5][6][7]

Dieting to lose weight, skipping meals, and a low intake of antioxidants have been associated with a greater risk of menstrual cramps.^[8] Higher intakes of fiber, fruits, and vegetables, and dairy products have been associated with reduced risk.^[8] It should be noted, though, that studies vary in the way they assess dietary habits and in their methods for measuring menstrual pain, so more evidence is needed to support specific diets and foods for dysmenorrhea.

Some self-care practices may be helpful to ease menstrual pain. These include using heat, like a hot water bottle or a heating pad on the lower abdomen, exercising, taking a hot bath, or relaxing by doing yoga or meditation.^[2]

Elevated prostaglandin concentrations triggered by the drop in progesterone before menstruation are thought to be the main cause of menstrual cramps. There is some less certain evidence that elevated vasopressin concentrations may also play a role in this condition.^[9]