What Causes Menstrual Cramps?

I hope everyone had a great week. This week we are moving on from the menopause topic and have a question that I think all of you struggle with (some of you more than others, but I know it is a common problem).

Dear KnowYourV, what causes menstrual cramps, and is there anything I can do to help make them better?
Thanks, Alison!

Well, Alison, dymenorrhea is the medical term for the painful cramps that occur before or during your period. Most women feel cramps in their lower abdomen and lower back. Because they can start the day before your period, they can last up to 3 days and can be mild to extremely painful.

Cramps are caused by contractions in the uterus, which is a muscle. The uterus is a hollow, pear-shaped organ where a baby grows, and it contracts throughout a woman's menstrual cycle. If the uterus contracts too strongly, it can press against nearby blood vessels, cutting off the supply of oxygen to the muscle tissue of the uterus. Pain can result when part of the uterine muscle briefly loses its supply of oxygen. This is similar to how a side ache feels when you run too far without stopping to rest. Your side aches and cramps because of a build up of something called lactic acid in the muscle due to lack of oxygen. It hurts when that happens! That's what's happening in your uterus when it's cramping.

Some of the best remedies to help alleviate the pain and cramping are simple things like aspirin, Tylenol, Motrin or other over-the-counter pain relievers. Sometimes prescription strength pain relievers can be used, but either way it is best to start pain medications the day before your cycle, as this blocks the onset of the cramps altogether and may even help reduce menstrual blood flow. Please always discuss the use of any medications with your doctor or other healthcare professional.

You can also use heating pads or hot water bottles on your lower back and abdomen, or a hot bath if it helps. Massage of the lower back and abdomen can also be helpful. Some women find that avoiding caffeine, alcohol and smoking during this time can help. Women who exercise regularly often have less menstrual pain.

If these steps don't help your pain, or if you've already tried them and they haven't helped, you may need to make an appointment with your gynecologist for a thorough evaluation. You could have endometriosis, fibroids, interstitial cystitis, diverticulitis, adenomyosis, cervical stenosis or pelvic inflammatory disease.

So as you can see it can get more and more complicated. I hope this has helped you begin to get an understanding of yourself so you can begin to feel better!

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Pap Smears During My Monthly Cycle?

This question worries more patients coming in for their pelvic exams and pap smears than any other general question we get when they come in for checkup.

Different doctors may have different policies on whether to do pap smears during the menstrual cycle. So if you start your cycle prior to your appointment call your gynecologist‘s office to get advice about rescheduling.

It is a very intimate exam and can be stressful because they worry about having to undress and be examined, and hope it won't hurt or uncomfortable. Hygiene is a big concern. Most of us in this country are very clean, but many women also make sure they have their legs and underarms shaved and all other areas trimmed or waxed, according to personal preference, and a lot of patients feel uncomfortable being examined during their cycle. It is always a patient’s choice to reschedule if she is uncomfortable.

What has changed for doctors? It used to be that if a woman started her cycle she had to reschedule because the pap sample was smeared on a slide and then sprayed with fixative. The pathologist would then have to examine the slide under the microscope. So if there was a lot of blood & mucous it would obscure their ability to see the cervical cells and make a correct diagnosis. Today we obtain the sample exactly the same, but instead of smearing it on a slide the entire sample goes into fluid. Once the pathologist receives it, the bottle is placed upside down in a centrifuge to separates the blood, mucous, and discharge from the cervical cells. Once separated those cells can be placed on a clean slide to be thoroughly examined.

That said it is usually best to reschedule if you are having your period. The pap test is the most effective screening tool for cervical cancer, and hormonal changes that occur during the time of the menstrual cycle can cause cell changes which make it slightly more difficult for the pathologist to interpret the sample. The changes would not be mistaken for cancer, but could cause the pap test to be reported in such a way that a repeat may be needed to clear up the confusion. I'm sure we all agree that one pap test a year is enough! So why go through that trouble and worry.

The best time during the cycle for a pap test is, day 10 to day 20 if possible. Day one is the very 1st day that blood is seen, even if it starts as spotting. You should also stay away from vaginal intercourse, douching, tampons, vaginal foams and jellies, vaginal inserts, and any sprays or deodorants 48 hours prior to the appointment. These can interrupt an accurate reading of the sample.

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Can You Get Pregnant During Your Period?

A woman CAN become pregnant if she has intercourse during her menstrual cycle. This topic has been debated for many years, and most of us have heard stories from relatives or friends about someone getting pregnant during a period. In fact, I believe my own mother said she got pregnant with me during her cycle - I obviously was not planned!

While menstruation may be the least likely time of the cycle for conceiving, many studies, including one funded by the NIH (National Institute of Health), suggest that women have the potential to get pregnant at virtually any time during menstruation. Just like every woman is different, so are her hormonal balances and timing of her menstrual cycles. Any women using 'natural' birth control, like the rhythm method or checking basal body temperatures, knows how varied one’s own physiology can be from month to month. The basic rule is that there is no predictable time during the month when the risk of pregnancy is totally absent.

So let's talk about the menstrual cycle. A woman's cycle begins on the first day of menstruation, which is counted as day 1. Most cycles that are discussed are calculated on a 28-day cycle. A woman is typically most fertile on days 10-17, with ovulation usually occurring on day 14. However, only 30% of all women fit this model, and even fewer have regular periods. Even the women with the most predictable cycles do not always ovulate at the same time each month.

The fertile period in a woman lasts for about 4-6 days each month. Men are always fertile, as they have sperm readily available, and sperm can survive inside the woman's cervix for up to 4-5 days. The egg is viable for 48-72 hours after ovulation. All of these variables can create a wide range of days for pregnancy to occur. If the sperm is deposited early, it can wait around as the period finishes and conditions become perfect for conception. During lower fertile periods, a woman is most likely to become pregnant if sexual intercourse occurs at the end of her cycle, just prior to ovulation.

Unfortunately, women are under more stress now than ever, which can cause irregular bleeding during menstruation and especially at ovulation. This can be mistaken for a period, causing confusion and miscalculation of cycle length and ovulation. Stress can also lengthen the duration of bleeding, and ovulation can actually happen before the bleeding stops.

So my advice for all of you is: if you do not want to become pregnant, always use a reliable form of birth control even during your period.

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What Causes Irregular or Missed Periods

Most women have between 11 and 13 menstrual periods each year. You may be different.  You may have more or fewer.  Missed or irregular periods must be looked at in terms of what is normal for you.    Menstrual periods may also be very irregular during menopause, which occurs when it has been 12 months since you have had a menstrual period.       

Menstrual periods are often irregular during the first few years after menstruation starts. It may take several years for the hormones that control menstruation to reach a balance.  Once cycles are established, it is very rare for a woman to have irregular cycles.  This is why most women will seek medical attention for irregular cycles - as menstruation is one way we evaluate our own health status.

If you are not pregnant, other causes of missed or irregular periods include:

-          Excessive weight loss or gain. Although low body weight is a common cause of missed or irregular periods, obesity can also cause menstrual problems.

-          Increased exercise. Missed periods are common in endurance athletes.

-          Emotional stress.

-          Illness.  Diseases such as irritable bowel syndrome, diabetes and liver disease that can cause missed or irregular periods.    

-          Travel.

-          Medicines such as birth control methods, can cause lighter, less frequent, more frequent or skipped periods (or no periods at all).

-          Hormone problems. This may cause a change in the levels of the hormones that the body needs to support menstruation. Menopause and PCO (polycystic ovarian syndrome) are the most common.

-          Problems with the pelvic organs , such as imperforate hymen, polycystic ovarian syndrome, and Asherman's Syndrome.

-          Breast-feeding. Many women do not resume regular periods until they have completed breast-feeding, which, again, is a hormone issue.   Estrogen levels must be very low in lactating women in order to produce breast milk.  Low estrogen creates a state of amenorrhea, or lack of menstruation.

It's amazing how many things can disrupt our menstrual cycles.  The worst culprit today is all the added hormones that are being put into our meat and dairy products.  These are causing a phenomenal amount of weight gain in our children and young adults, and with this comes the expected hormone and menstrual irregularities.   

It is unknown what other impact the added growth hormones given to dairy animals, as well as the other hormones given to chicken and cattle are having on development of cancer or other diseases and menstrual irregularities and infertility.  Until we know, it will be difficult to understand how to control many of the health problems we see today.

If you've skipped a period, try to relax. Restoring your life to an emotional and physical balance can help. Many women miss periods now and then. Unless you are pregnant, chances are your cycle will return to normal next month.   

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