Period Cramps and Pains: Causes, Relief Methods and When to See a Doctor

Written By: Dr. Katherine Cheng

Period cramps, or menstrual cramps or dysmenorrhea, are a common experience for many individuals during their menstrual cycle. These cramps can range from mild to severe and can disrupt daily activities.

Understanding Period Cramps

What causes period cramps? Period cramps are related to the following factors:

Prostaglandins: The release of prostaglandins, hormone-like substances, triggers uterine solid contractions and inflammation, leading to period cramps
Hormonal Imbalances: Imbalances in hormone levels, notably higher estrogen and lower progesterone can contribute to more intense and painful cramps
Endometriosis: This condition occurs when the tissue lining the uterus grows outside of it, leading to severe pain and cramping during periods
Adenomyosis: Adenomyosis is characterised by the abnormal growth of endometrial tissue within the muscular walls of the uterus, causing intense period pain

Relief Methods for Period Cramps

Heat Therapy: Applying a heating pad or taking a warm bath can help relax the uterine muscles, alleviate pain, and increase blood flow to the area
Over-the-Counter Pain Relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen sodium can effectively reduce pain and inflammation associated with period cramps
Exercise: Engaging in light activities, such as walking or gentle yoga, can stimulate endorphin release, improve blood circulation, and ease menstrual cramps
Dietary Adjustments: Consuming a balanced diet that is rich in fruits, vegetables, whole grains, and lean proteins while minimising caffeine, alcohol, and processed foods may help reduce inflammation and ease cramps
Relaxation Techniques: Practices like deep breathing exercises, meditation, and gentle stretching can promote relaxation and reduce the intensity of period cramps

Does Chocolate Help with Period Cramps (Dysmenorrhea)?

Dark chocolate has long been a popular comfort food during menstruation, and recent research suggests that it may help alleviate period cramps. A study published in 2023 compared the effectiveness of dark chocolate, coconut water, and ibuprofen in managing period pain and found that dark chocolate significantly reduced menstrual pain intensity, providing benefits comparable to ibuprofen.

How Does Dark Chocolate Help with Period Cramps?

Magnesium Content: Dark chocolate is high in magnesium, which plays a crucial role in relaxing muscles and reducing uterine contractions. The study found that 35 grams of 70% dark chocolate contains 59.5 milligrams of magnesium, which can help reduce the intensity of menstrual cramps. Magnesium is known to inhibit the production of prostaglandins—hormones responsible for causing inflammation and pain during menstruation. This muscle-relaxing effect is comparable to that of ibuprofen, which works by inhibiting prostaglandins as well.
Flavonoids and Antioxidants: Dark chocolate is rich in flavonoids, natural compounds that have anti-inflammatory properties. These flavonoids help reduce inflammation in the uterus, which can lower the severity of period cramps. The anti-inflammatory action of dark chocolate can also be linked to the way it modulates prostaglandin production, offering relief from cramping pain.
Endorphin Release: Consuming dark chocolate can trigger the release of endorphins, the body’s natural painkillers. Endorphins help improve mood and decrease pain perception, providing emotional and physical relief during menstruation.

Moderation is Key

While dark chocolate can offer relief from menstrual cramps, it’s important to consume it in moderation. The 35-gram portion used in the study is suitable for gaining the benefits without overloading on sugar, which could exacerbate inflammation. Stick to dark chocolate with at least 70% cocoa content to maximize the health benefits.

What Type of Chocolate is Best for Period Cramps?

To maximise the benefits, it’s best to choose dark chocolate with at least 70% cocoa. The higher the cocoa content, the more magnesium, iron, and beneficial antioxidants it contains. While milk chocolate or white chocolate may satisfy cravings, they are typically lower in beneficial nutrients and higher in sugar, which could contribute to inflammation and worsen period symptoms.

Types of Period Cramps

Concerning the types of period cramps, it is essential to note that there are no distinct categorisations of menstrual cramps. However, the severity, duration, and characteristics of period cramps can vary from person to person. Here are some common ways in which individuals may describe their period cramps:

Mild Cramps: Some individuals experience mild and tolerable cramps during their menstrual cycle. These cramps are often described as a dull, achy sensation in the lower abdomen and may not significantly impact daily activities

Moderate Cramps: Moderate period cramps are characterised by a more noticeable discomfort that may require over-the-counter pain relievers. These cramps can cause some disruption to daily routines but are generally manageable

Severe Cramps: Severe period cramps can be intense and debilitating, significantly affecting a person's quality of life. Sharp, shooting pains may accompany these cramps and require more potent pain medications or interventions for relief

Spasmodic Cramps: Some individuals experience intermittent or spasms-like cramps during their menstrual cycle. These cramps can be sudden and intense, causing a gripping or squeezing sensation in the lower abdomen

Back Pain: Menstrual cramps can also manifest as lower back pain for some individuals. The pain may radiate from the lower abdomen to the back, making it uncomfortable to sit or stand for extended periods
Pre-Menstrual Cramps: Pre-menstrual cramps, also known as premenstrual syndrome (PMS) cramps, occur in the days leading up to the start of the menstrual period. These cramps can vary in intensity and may be accompanied by other PMS symptoms such as bloating, mood swings, and breast tenderness

Period Cramp Location

It’s important to distinguish the location of period cramps from other types of pain to better understand if what you’re experiencing is typical menstrual discomfort or something that requires medical attention.

Where Are Period Cramps Typically Felt?

Lower Abdomen: The most common location for period cramps is in the lower abdomen, just above the pubic bone. This area is where the uterus contracts to shed its lining, which causes the characteristic cramping sensation. The pain can feel like a dull ache, a squeezing sensation, or sharp, stabbing pain.
Lower Back: Some individuals experience period cramps as lower back pain. This occurs because the pain from uterine contractions can radiate to the lower back, making it uncomfortable to sit or stand for extended periods. This is often due to referred pain from the uterus.
Inner Thighs and inguinal area: In some cases, menstrual cramps can radiate down into the inner thighs and groins. This is due to the way nerves in the pelvic region interact, causing pain to extend beyond the lower abdomen.

Why Do I Have Cramps but No Period?

Experiencing cramps without a period can be a source of confusion and concern. Several factors can contribute to this phenomenon, including:

Ovulation: Some individuals may experience cramping during ovulation, typically occurring approximately two weeks before their next period. This is known as mittelschmerz, a German term for "middle pain." Ovulation cramps are usually mild and occur on one side of the lower abdomen. They are typically short-lived and may be accompanied by other signs of ovulation, such as changes in cervical mucus

Implantation: If you are sexually active and trying to conceive, you may experience cramping due to implantation. Implantation occurs when a fertilised egg attaches to the uterine lining, and it can cause mild cramps and spotting. These symptoms typically occur around 6-12 days after conception

Hormonal fluctuations: Fluctuations in hormone levels throughout your menstrual cycle can cause uterine changes and cramping. Estrogen and progesterone levels rise and fall during different phases of the menstrual cycle, leading to mild cramping even in the absence of a period

Pelvic inflammatory disease (PID): PID is an infection of the reproductive organs, such as the uterus, fallopian tubes, or ovaries. It can cause abdominal pain and cramping, even without a period. Other symptoms of PID may include abnormal vaginal discharge, pain during intercourse, and fever. If you suspect you have PID, it is crucial to consult a doctor for diagnosis and treatment

Endometriosis: Endometriosis is a condition where the tissue that usually lines the uterus grows outside. This can cause pelvic pain, cramping, and discomfort, even outside of the menstrual period. Endometriosis often requires medical evaluation and treatment
Adenomyosis: Adenomyosis occurs when the tissue lining the uterus (endometrium) grows into the muscular wall of the uterus. This condition can result in heavy, prolonged periods, cramping, and pelvic pain, which may occur even when you're not menstruating

When to See a Doctor

While period cramps are a normal part of the menstrual cycle for many individuals, there are instances where it is advisable to consult a doctor:

Severe or Debilitating Pain: If your period cramps are severe and significantly impact your quality of life, it is important to seek medical attention to rule out any underlying conditions
Irregular Menstrual Cycles: If your periods are irregular, accompanied by excessive bleeding, or if your cramps suddenly become more intense, it may be necessary to consult a doctor
Symptoms of an Underlying Condition: If you experience additional symptoms like heavy bleeding, prolonged periods, pain during intercourse, or difficulty conceiving, it is important to discuss these with a doctor

Period cramps, though often uncomfortable, can be managed effectively with various relief methods, such as heat therapy, over-the-counter pain relievers, exercise, dietary adjustments, and relaxation techniques, which can provide significant relief. Everyone's experience with period cramps is unique, and finding the right approach to managing them may require trial and error.

If you experience period cramps and are concerned about your symptoms, it is advisable to consult with a doctor.