context: Menstrual cramps are pains in a woman's lower abdomen that occur when her menstrual period begins (or just before) and may continue for two to three days. They may be throbbing or aching and can be dull or sharp. Symptoms can range in severity from a mild annoyance to severe pain that interferes with normal activities. Menstrual cramps are the leading cause of absenteeism in women younger than 30. Although over half of women who have menstrual periods experience some discomfort, 10% are temporarily disabled by symptoms. The following circumstances may make a woman more likely to experience menstrual cramps: She started her first period at an early age (younger than 11 years). Her menstrual periods are heavy. She is overweight or obese. She smokes cigarettes or uses alcohol. She has never been pregnant. Prostaglandins are chemicals a woman's body produces that cause many of the symptoms associated with menstrual discomfort. The tissue that lines the uterus makes these chemicals. Prostaglandins stimulate the uterine muscles to contract. Women who have high levels of prostaglandin may experience more intense contractions of their uterus and more pain. Prostaglandins may also be responsible for vomiting, diarrhea, and headaches that accompany painful periods. Other menstrual-type cramps can be caused by conditions of the reproductive tract, such as the following: Endometriosis -- uterine tissue that appears outside the uterus Fibroids and adenomyosis -- noncancerous (benign) growths in the uterus Infections in the reproductive organs Abnormal pregnancy, such as an ectopic pregnancy (pregnancy in the tubes, outside the uterus) IUD (intra-uterine device) used for birth control Ovarian cyst Narrow cervix If a woman has had menstrual pain ever since her periods started, the condition is classified as primary dysmenorrhea. If a physical condition such as pelvic inflammatory disease or endometriosis has developed and is causing the pain, this is called secondary dysmenorrhea. Once the medical condition is treated, the menstrual pain usually goes away. In addition to cramps in the lower abdomen, a woman may also experience some of these symptoms with menstrual cramps: Lower back pain Leg pain, radiating down the legs Nausea Vomiting Diarrhea Headaches Irritability Weakness Fainting spells (in extreme cases) Most women have significant improvement with home care. However, a woman should call her health care provider in these situations: Menstrual cramps continue to be painful for longer than usual. The pain is suddenly worse or different from what she may have experienced before. Bleeding is excessive, requiring more than one pad or tampon per hour. Signs of infection, such as fever, chills, and body aches, are present at the time of the period. The woman suspects she may be pregnant and any of these symptoms occur. The woman's doctor can help her manage most symptoms. However, she should go to a hospital's emergency department if any of the following problems occur: She faints. She experiences repeated dizziness when standing up. A sudden, intense pelvic pain causes her to double over. Tissue is passed in the menstrual flow. Tissue often appears silvery or grayish. She is pregnant and has severe menstrual-type pain. The doctor will ask for medical history details, as well as questions about the menstrual pain and symptoms. Be prepared to discuss these details: The timing of the cramps in relation to the start of the period Type of pain Age when the cramps first started Any recent change in the pain Irregular periods Vaginal discharge Pain with intercourse Infertility History of pelvic infections Age when first period occurred Current medications What things seem to improve or worsen the pain The doctor will perform a pelvic exam to check for any problems. If there are concerns about a possible infection, cervical cultures and a blood test will confirm the diagnosis. Additional tests may be ordered. The doctor may order a pregnancy test if the periods are irregular or the woman is not using birth control regularly. An ultrasound exam is necessary if the doctor discovers any abnormal masses during the pelvic exam or there is a new onset of menstrual pain. A doctor may recommend a laparoscopy, which is a minor surgical procedure allowing the doctor to look directly into the pelvic cavity with a fiber-optic scope. This is an outpatient procedure using very small incisions. A hysteroscopy is another possible procedure. By inserting a hysteroscope (thin lighted tube) through the vagina, the doctor can see inside the cervix and the inside of the uterus without incisions. This can be done in a doctor's office or a hospital. The best way to relieve painful menstrual cramps is to take an anti-inflammatory medication. Ibuprofen ( Advil, Motrin), ketoprofen ( Orudis), and naproxen ( Aleve, Naprosyn) are available without a prescription and are effective at blocking the effects of prostaglandins. These drugs work better if taken before the start of menstruation and can be continued as long as needed. If one type does not relieve the pain, try another, because these medications do not work the same in everyone. Anti-inflammatory drugs like this can be harsh on the stomach. If there is a history of kidney problems or stomach problems (such as ulcers or reflux), consult with your health care provider before starting this type of medication. Taking the pills with meals may help prevent upset stomach. Starting some form of hormonal birth control is another option to control or stop menstrual cramps. This can be a pill, an injection, a transdermal patch, or a hormone-containing IUD. These methods can reduce or eliminate the menstrual flow leading to less pain. If anti-inflammatory medicine is not an option or if additional relief is needed, the following strategies may help relieve menstrual cramps: A heating pad to the pelvic area Massage to the back and lower abdomen Exercise, especially prior to the start of a period Thiamine (100 mg daily) Low-fat vegetarian diet Calcium (1,200 mg daily) Surgery can be used to treat some causes of menstrual cramps such as fibroids, polyps, ovarian cysts, or endometriosis. D& C: This procedure is used to remove uterine polyps. Laparoscopy: This procedure is used to treat pelvic endometriosis or ovarian cysts. Endometrial ablation: This procedure destroys the lining of the uterus. Hysterectomy: This surgical procedure completely removes the uterus. If taking hormonal birth control is not an option because of health problems or the woman is among the 10% of women who do not respond to this treatment, there are some other alternatives. Acupuncture Wearing a TENS (transcutaneous electrical neural stimulation) unit, a small electrical device that interferes with pain signals as they travel to the brain Prevent painful menstrual cramps with these techniques: Keep a normal body weight. Don't smoke. Don't drink too much alcohol. Exercise regularly. Often, it is possible to eliminate menstrual cramps effectively. Anti-inflammatory drugs are 80% effective. Hormonal birth control decreases the pain 90% of the time. Cramps also tend to decrease in intensity as a woman ages. Cramps may disappear after a woman's first pregnancy.