How To Know If Your Menstrual Cramps Are Abnormal, and What You Can Do To Make PMS Less Terrible

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We at Bustle love giving you tips for how to tap into your sexual potential and troubleshoot when things aren’t going your way in the bedroom. But what about finding solutions to those stressful health issues that inevitably come with being a grown woman? Emma Kaywin, a Brooklyn-based sexual health writer and activist, is here to calm your nerves and answer your questions. This week’s topic: How to know whether your cramps are abnormal — and what you can do to ease menstrual pain.

Q: I know that everyone complains about hurting during their period but it seems like my cramps are much worse than most of my friends. Everything just hurts for days before and during, and it's driving me insane! Is there something wrong with me? Can I do anything to make this go away?

A: For most female-bodied folks, cramps are an unpleasant side effect of being born with a uterus. However, if your cramps are really — let’s just get this pun out of the way, shall we? — cramping your style, there may be something else going on.

"Uterine cramps are irregular contractions of the uterine muscle that happen during the process of menstrual flow," Dr. Adeeti Gupta, founder of Walk In GYN Care, a gynecological urgent care clinic, tells Bustle. "Prostaglandins, and other hormone like substances are released which may be involved in the shedding of the lining. It's complex process."

If your cramps incapacitate you every month, there may be something more medically serious going on than normal PMS. "When NSAIDs or ibuprofren can’t relieve pain, your flow is abnormally heavy, you’re experiencing nausea and vomiting, any gas, diarrhea and painful bowel movements, unusual pelvic pain, and fatigue, it’s time to seek medical attention," Dr. Gupta says. Dysmenorrhea is what the doctors call painful menstrual cramps, and it’s no joke. If your cramps are beyond painful, ask your doctor about these three potential culprits.

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Culprit #1: Uterine Fibroids

Uterine fibroids are noncancerous growths that set up shop inside your uterus. They are extremely common — around 75% of women experience them at some point in their lives, according to the Mayo Clinic. Most of the time, these wee growths are asymptomatic, so you don’t even know you have them. However, they can make your cramps more painful, in addition to making your period heavier and last longer. Uterine fibroids are picked up via ultrasound, so if you’re worried that you might have one, talk to your doctor. If it turns out you have symptomatic fibroids that are really messing with your lifestyle, there are a number of things you can do, including taking medication that alleviates pelvic pain, or opting for surgery to get those little buggers removed.

Culprit #2: Endometriosis

Endometriosis is a disorder wherein the lining of your uterus decides to take itself out on an adventure to see the wide world of your innards and grows outside your uterus. Since it maintains its identity as endometrial tissue, it thickens and bleeds with your menstrual cycle — but the blood has no place to go! The result? Irritated tissue that develops into scar tissue or adhesions, according to the Mayo Clinic, causing severe pain.

The good news is that, once you know you have it, you have options for managing your condition. Pain medication can help as needed. Hormone therapy, such as taking birth control, can also help, since hormones control the waxing and waning of all endometrial tissue. If you’re experiencing severe symptoms, you can opt for surgery, more intense hormones that put your body effectively into early menopause, or even a hysterectomy. Unfortunately, endometriosis can come back, so it’s important to maintain whatever solution you choose and work with your doctor in the long term.

Culprit #3: Pelvic Inflammatory Disease

Pelvic inflammatory disease, or PID, is what the doctors call it when your reproductive organs get infected. This usually occurs from sexually transmitted bacteria like chlamydia or gonorrhea, although it can also happen from bacteria getting into you in other ways, such as through the unclean insertion of an IUD. While your PID may be asymptomatic, if you feel it, your pelvic area may hurt, penetrative sex may hurt, and you may experience unusual discharge and/or bleeding at weird times in your cycle.

If you have a PID for a while, it can result in scar tissue or pockets of infected fluid that grow all up in your reproductive space, which not only can cause you pelvic pain but can mess with fertility or result in an ectopic pregnancy, a dangerous situation in which a fertilized egg implants in your fallopian tube instead of in your uterus. Luckily, most PIDs are treatable with antibiotics, so if you think you may have one, talk to your doctor ASAP. The sooner you catch this culprit, the better.

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Solutions For Typical Menstrual Pain

Barring the above medical conditions, menstrual cramps often occur when your body makes too much of the hormone prostaglandin. While this is very common, it can just as totally suck. Luckily, if this is what’s happening to you, there are a number of things you can do to mitigate menstrual pain and discomfort. "To reduce bloating, and fluid retention, limit salty foods," Dr. Gupta says. "Calcium may help with irritability and anxiety. Probiotics can help calm and upset tummy. Drinking more water, warm fluids, probiotics, and magnesium supplements may help" even non-period related cramps, too. Here are some other tried-and-true solutions:

Heat

Muscles like warmth. Try taking a warm bath or snuggling up with a heating pad, hot water bottle, or my new best friend, a stick-on heat patch (you can buy them at your local pharmacy).

Exercise

As you may know from the phrase "runner’s high," exercise releases endorphins, which make you feel fantastic and feel no pain so you can run FOREVER, or so the athletes tell me. Exercise also helps your body burn prostaglandins, so it can help with any overproduction of those chemicals your body may be engaged in.

Meds

Over the counter anti-inflammatory drugs like ibuprofen and aspirin can not only kick that muscle hurt you’re feeling (remember, that your uterus is a muscle), but can also decrease overproduction of prostaglandin.

Acupuncture

As with herbs, Western medical research hasn’t done the best job of assessing the utility of acupuncture. However, the literature does indicate that acupuncture can mitigate menstrual pain, and more importantly, people have been using acupuncture therapy for just this purpose for hundreds of years.

Orgasms

While you might not be in the sexiest of moods during your bleed, research shows that orgasming can help relieve cramps. That’s because orgasming results in muscle spasms that relieve tension. And if you’re not comfortable calling up a cutie when you’re on your moon, you can always do your own thing.

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The Bottom Line

If you are experiencing painful periods, that pain isn’t necessarily something you have to endure, and it doesn’t make you the strong woman you are. By way of explaining that last statement, let me tell you a very personal story: I had mind-meltingly horrific menstrual pain from the moment I started bleeding at age 12. From talking to my female-bodied family members and friends, I knew my pain was significantly higher than average. I tried some solutions here and there when I was in school (pain meds, oral contraceptives), but at some point in my early 20s, it became clear that I probably had endometriosis, which as we all now know requires minimal surgery to actually diagnose. I sat on this knowledge for YEARS, without consciously knowing why I was waiting. And then one day, I had a revelation: some part of me liked being the strongest, most pain-enduring woman I knew. The pain had become an integral part of the way I defined my personal womanhood, even as it hindered me from being able to work, play, and effectively live my life.

Since that understanding, I have completed the surgery and gotten an IUD to help manage my endometriosis. My cramps still really suck, but I don’t have to battle my body for between a quarter and a half of my waking life, and I still feel like the badass human with a uterus I know myself to be. So, if you are experiencing severe menstrual pain, talk to your doctor! If you aren't sure where your pain falls on the normal to problem spectrum but know it's hindering your life, TALK TO YOUR DOCTOR! Because there's no reason whatsoever to be in any more pain than you need to be.

This post was originally published on November 11, 2014. It was updated on June 21, 2019.

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