Menstrual Cramps

Medically reviewed

Medically reviewed by Brenda G., MD | Written by SheCares Editorial Team | Updated: Aug 16, 2019

Natural contractions of the uterus during menstruation are commonly accompanied by pain or cramps for many women. The degree of pain can be influenced by an imbalance of hormones that control the menstrual cycle. Sometimes the pain is so bad that it interferes with daily life.

The good news is that menstrual pain caused by a hormonal imbalance can be managed during all stages of life. Continue reading to find out more about menstrual cramps, its causes, risk factors, signs and symptoms, prevention, and treatment options.

Menstrual Cramps


Quick Facts about Menstrual Cramps

  • Menstrual pain is the number one reason for missing school or work among women under 20.
  • 50-75% of women experience some degree of painful periods.
  • Cramps tend to lessen or stop after a woman's first pregnancy until she reaches menopause.

Menstrual cramps are pelvic pain - whether dull, sharp, intermittent, or constant - that a woman experiences during her period. The pain can radiate to neighboring areas, namely the lower back and thighs. During menstruation, the uterus contracts in order to shed its lining. Sometimes, these contractions can cut off blood and oxygen flow to nearby muscles, which causes cramping. The contractions are regulated by hormones. So, an imbalance can make the cramps more noticeable or painful.

Pain can occur during other times of the menstrual cycle as well. In particular, pain during ovulation - which is sometimes referred to by the German term mittlelschmerz, or middle pain - is experienced by some women. It typically occurs around 14 days into the cycle when the egg is released from the ovary. The expansion of the ovary as the egg-storing follicle grows can cause discomfort, usually brief and mild.

Hormone levels can fluctuate greatly during the various stages of female reproductive life: puberty, pregnancy, post-partum (including breastfeeding), and menopause. These changes can affect cramps, which can be a hindrance to everyday activities.

Identifying Menstrual Pain

The degree of pain and cramping can vary greatly from woman to woman; some individuals may not have any cramping at all while others experience pain so severe that they cannot go to work or school. Painful periods, or dysmenorrhea, are classified as primary and secondary. In addition, there are three criteria that can help in identifying menstrual pain: frequency, duration, and intensity.

To learn more about the causes of menstrual cramps, including both hormonal and non-hormonal causes, continue reading the next section.

About Menstrual Cramps


In order to manage and treat menstrual cramps, it is helpful to know a little bit about the processes that cause them. While an underlying disorder could worsen menstrual pain, cramps are most commonly caused by hormonal fluctuations and imbalances that can occur throughout the menstrual cycle. Even though some cramping and soreness occurs naturally as part of menstruation, a hormonal imbalance can make pains worse.

Read on to find out more about the hormonal and additional causes of painful periods.

Hormonal Causes of Menstrual Cramps

At the start of menstruation, a hormone produced in the uterus called prostaglandin induces contractions in order to shed the lining of the uterus. While these contractions are a necessary part of menstruation, they can constrict blood vessels and blood flow, meaning less oxygen reaches the tissues. When body tissues are deprived of oxygen, they release pain-triggering chemicals that result in cramps. (This is the same reason muscles can cramp after running or another exercise.)

A buildup of prostaglandin can trigger more intense or prolonged contractions, which make cramps more severe. An imbalance of hormones - especially when the sex hormone progesterone is out of proportion with estrogen - can also cause increased production of prostaglandins and, thus, more painful periods.

Likewise, hormonal fluctuations that occur during a woman's reproductive life can cause pelvic cramps, even if they aren't directly related to menstruation. See the boxes below to find out more about cramps during different stages of the female reproductive life: puberty, pregnancy, post-partum, and menopause.

Puberty is the stage in which the body begins producing reproductive hormones and is also the time when a young woman gets her first period, which is often accompanied by some degree of cramps.

Pregnancy is a time when hormone levels fluctuate heavily in order to accommodate the growing baby. While of course a woman does not menstruate during pregnancy, she may experience cramps and pelvic pain due to other causes, such as digestive problems and muscle stress.

Post-partum, the time after birth when a mother breastfeeds, is another stage in which hormones are not at their normal levels, which can cause cramps among other symptoms. While some cramps are a natural part of post-delivery, they can still be painful and unpleasant.

Menopause is the stage in which reproductive hormones begin to decline, and periods become more sporadic. During this time, hormonal levels are typically imbalanced, which can cause cramping and other symptoms.

Other Less Common Causes of Menstrual Cramps

In the majority of cases, menstrual pain is caused by a hormonal imbalance. However, in some rare cases, menstrual and pelvic pain may be due to an underlying disorder, such as endometriosis or uterine fibrosis.

Continue reading to learn more about risk factors and triggers that can influence menstrual pain.

Causes of Menstrual Cramps

Risk Factors and Triggers

Risk Factors for Menstrual Cramps

Some women are at greater risk than others when it comes to menstrual cramps due to possible risk factors that make them more prone to painful periods. These factors relate to age, genetics, other menstrual issues, and behavior.

Triggers of Menstrual Cramps

Though cramps go hand-in-hand with monthly menstruation, some external triggers can cause cramps during otherwise pain-free cycles; it is best to avoid triggers as much as possible to prevent cramping, especially for women at risk for dysmenorrhea. These triggers include stress and dietary factors.

Keep reading to find out more about the symptoms of menstrual cramps and to be able to choose a treatment best suited to its cause.

Menstrual Cramps - Risk Factors and Triggers

Signs and Symptoms

Not all women will experience menstrual cramps, but the majority of women do feel some pain associated with menstruation during their lifetime. However, they may experience different symptoms to varying degrees.

Common Symptoms of Menstrual Cramps (Dysmenorrhea)

  • Cramps, aches, or pains in the pelvic region during menstruation
  • Pain that radiates to the thighs or lower back

In addition to the basic symptoms that nearly all women with menstrual cramps experience, some may suffer additional symptoms alongside the cramping and aches. These symptoms, such as headaches and dizziness, can vary depending on the hormone imbalance and if there is an underlying disorder behind the cramps.

Signs of Menstrual Cramps

Menstrual cramps have no distinct medical signs, or measurable criteria assessed by a doctor or gynecologist while diagnosing the disorder. Instead, a doctor may look for other signs of hormonal imbalance:

  • Discomfort during or directly prior to the times of heaviest bleeding
  • Pelvic abnormalities (growths, etc.)
  • Abnormal levels of reproductive hormones in the bloodstream
Menstrual Cramps - Signs and Symptoms

Diagnosis of Menstrual Cramps

To identify the symptoms of menstrual cramps and then diagnose the disorder, a doctor or OB/GYN will typically ask about the patient's medical history, perform a pelvic exam, and order additional tests when necessary.

Complications of Menstrual Cramps

In rare cases, painful menstruation can lead to complications, especially if it is caused by an underlying disorder. In short, the causes of secondary dysmenorrhea have their own complications. Menstrual cramps can sometimes cause personal and social problems when they are so severe that they interfere with daily life. Some of the complications include infertility and internal scarring, but these only happen in very rare cases when there is an underlying condition. Fortunately, these conditions have some specific warning signs; they can often be detected alongside menstrual cramps before they become more severe.

Women who experience cramps and painful periods, especially ones that impede daily activity, may want to learn how to treat and prevent them. Continue reading to find out more about some techniques and habits that may help to prevent or manage cramps.

Prevention and Management

There is no single guaranteed method to prevent menstrual cramps entirely, just as there is no way to halt the body's natural hormonal processes. Nonetheless, women can take some steps to reduce the chances of having cramps, especially severe ones.

In terms of prevention, lifestyle changes regarding diet, exercise, and healthy habits may help a great deal. In addition, a woman may have an interest in complementing lifestyle adjustments with herbal supplements that enhance the endocrine system - thus easing a potential underlying hormonal imbalance that can cause cramps.

Prevention may not be possible for women who already have cramps regularly. In that case, some of the many ways to manage menstrual pain may help reduce the intensity or duration of cramps. Read on to learn some tips for managing painful periods.

Managing Menstrual Cramps

There many techniques for effectively managing menstrual cramps; each woman has the method that works best for her. A number of simple activities can help to ease the pain and get a woman back on her feet.  These general tips - such as using a hot compress or relaxation techniques - can be used by women of all ages to help reduce cramps.

Menstrual Cramps - Prevention and Management

Alternative Management Tips for Menstrual Cramps

For some women, alternative management methods may also help reduce painful menstruation, though they do not address the underlying hormonal cause behind many severe cramps and pains. These alternative techniques include acupuncture, Mayan massage, and chiropractic treatment.

All of these methods may help reduce menstrual pain and temporarily relieve cramps, but they do not treat the root causes, which is many times an underlying hormonal imbalance. However, several natural treatments that can address hormonal causes of menstrual cramps are available. Continue reading to find out more about treating menstrual cramps via different approaches.


Menstrual cramps, which are commonly caused by a hormonal imbalance, can often be painful and can interfere with daily life. Fortunately, there are effective treatments for menstrual pain that can help.

Three Approaches to Treat Menstrual Cramps

Treatments for menstrual cramps can be categorized into three levels of approaches: (1) Lifestyle Changes, (2) Alternative Medicine, and (3) Pharmaceutical and Surgical Options.

Women are recommended to start with the least risky approach to treating menstrual cramps: lifestyle changes. If that is not effective, they should then try the next level. Medical treatment is usually not necessary to treat painful periods, but some women do not experience a reduction in cramps from lifestyle adjustments and alternative treatments alone. In such cases, a woman may want to consider pharmaceutical options after fully assessing the risks that go along with such treatment.


Lifestyle Changes for Menstrual Cramps

The first level of treatment entails the least amount of risk, though also the highest level of self-discipline. Simple lifestyle changes - such as improved diet, exercise, and healthy habits - may help reduce or eliminate menstrual cramps.

These lifestyle changes may help reduce menstrual cramps, but they do not directly address the hormonal imbalance that causes or worsens many women's menstrual pains. So, additional treatment may be called for. Alternative medicine has proven to be a great way to safely and naturally treat menstrual cramps associated with a hormonal imbalance.


Alternative Medicine for Menstrual Cramps

With little to no risk, alternative supplements and medicines can be a highly efficacious way of treating menstrual pain. For herbal supplements, there are two main kinds: phytoestrogenic and hormone-regulating herbal supplements.

Phytoestrogenic herbal supplements

Plant estrogen supplements, such as ginseng, can complement estrogen deficiencies, which are especially prevalent in menopausal women. They help balance hormones, which may relieve cramps if estrogen levels are low.

These are mainly effective for women who have estrogen deficiencies, such as many menopausal women. They may not be appropriate for women in all stages of life, such as puberty.

Hormone-regulating herbal supplements

These supplements, such as Macafem, stimulate natural hormone production by nourishing the endocrine system as a whole, helping the system to produce the right hormones more efficiently. This results in a balance of all hormones, not just estrogen.

Since these supplements treat the underlying hormonal imbalance, they can be taken throughout a woman's life. They can be considered the safest and most natural treatment.

Additionally, there are other types of supplements that can also alleviate painful periods, or at least make them easier to manage, including vitamins and other herbal supplements.

Combining the various approaches - lifestyle changes and alternative medicine together - is usually the most effective way to treat menstrual cramps. However, some women will experience such severe pain and symptoms that they may need to seek medical treatment.


Pharmaceutical and Surgical Options for Menstrual Cramps

Treatment at the third level involves the highest risk and many times the highest costs as well. Some treatments may not be suitable for women at all life stages, and many of them require a prescription. It is highly recommended to consult a licensed medical professional before beginning pharmaceutical treatments for menstrual cramps.

There are three types of pharmaceutical treatments: hormone-regulating medication, painkillers, and surgery. It is important to note that surgery is only sometimes used in cases of secondary dysmenorrhea, or painful periods caused by an underlying condition; it is not an option for primary dysmenorrhea, or menstrual pain caused by normal hormonal fluctuations.

The three levels of treatment - lifestyle changes, alternative medicine, and pharmaceutical options - are not mutually exclusive. A woman may choose to use different approaches at different times or a combination thereof, depending on the symptoms. Many women find that their symptoms are best relieved using a combination of healthy lifestyle changes and alternative treatments.

Menstrual Cramps Treatments