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| |    Menstrual Cramps by Marjorie Greenfield, M.D. reviewed by Laura Jana, M.D., F.A.A.P. Believe it or not, there was a time not that long ago when menstrual cramps were thought to be entirely psychosomatic, caused by some inner conflict in a woman's femininity. People believed that cramps ran in families because girls were taught by their mothers to expect pain, and that periods were a bad thing. Fortunately, things have changed since those Freudian days, and scientific advances--as well as social progress--have led to a better understanding of menstrual pain. Scientific experiments using pressure monitors (like the ones put inside the uterus during labor) found that women who experienced bad cramps actually had measurably stronger uterine lincontractions than women who did not feel much menstrual discomfort. (In some cases, these spasms of the uterus created as much pressure as labor contractions!) These contractions are caused by hormones called prostaglandins, which appear at higher levels in women who suffer menstrual cramps. Treatment with medications such as ibuprofen can decrease the production of prostaglandins and result in measurably weaker and less frequent cramping (or contractions) of the uterus. However, it's still not known why some people suffer from this common condition so much more than others. What do normal menstrual cramps feel like? Cramps usually start after menstrual cycles become regular and involve ovulation, usually a year or two after the first period. The pain most commonly begins the first day of the period, although it may start the day before, and usually lasts a few days. Most people experience the cramps as low abdominal or low back pain, sometimes radiating down the thighs. The pain can range from mild to severe and can disrupt normal activities. Many girls and women experience nausea, vomiting, diarrhea, or headache associated with the pain. Who should seek treatment for menstrual pain? Menstrual cramps are extremely common and when left untreated, can cause much suffering. School and work attendance may suffer as a result. But this pain is treatable, so no one should have to miss her normal activities because of painful menstrual cramps and the other associated symptoms. Most girls and women can benefit from medications designed to alleviate these symptoms. Even the nausea and diarrhea that some people experience goes away simply by treating the cramps. How can you tell if the pain signals something serious? Most of the time, menstrual cramps that start before the age of 19 are the garden-variety kind, medically known as primary dysmenorrhea. Even if the cramps are severe, they're not associated with any abnormalities in hormones or anatomy. Secondary dysmenorrhea is the term used for pain caused by an underlying problem, such as endometriosis or fibroids. While secondary dysmenorrhea is more common in middle-aged women than in teens, endometriosis is one cause of secondary dysmenorrhea that can be found in teenagers. The signs of secondary dysmenorrhea in teenagers include pain that starts many days before the period, pain that also occurs at other times of the month, and cramps that are not helped by the usual treatments.
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