Do I Need to See My Doctor for Menstrual Cramps?

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It is perfectly normal to experience mild cramps during your period. These mild cramps are a normal part of your menstruation. Typically mild to moderate menstrual cramps are relieved with non medical treatments or over the counter pain relievers. If you get relief from your cramps with one of these approaches you probably don't need to see your healthcare provider.

So, when do you need to see your healthcare provider?

No relief from non medical treatments or over the counter pain medication

If you can not get relief from your menstrual cramps with non medical treatments or over the counter pain medication you need to discuss this with your healthcare provider. Your healthcare provider will ask you questions and maybe order some tests to try and determine if you have an underlying cause for your painful periods. You may need some medical treatment to help manage your menstrual cramps.

Menstrual-like cramps at times other than during your menstruation

Menstrual-like cramping outside of your period can be a sign of an underlying problem with your uterus. Uterine fibroids can be a common cause of this type of pain. If you are using an IUD for contraception, this type of cramping can be a sign that the IUD is displaced.

Increased menstrual bleeding or blood clots

If you are having painful periods associated with a heavy menstrual flow and blood clots it is likely you have an underlying condition.

Your healthcare provider will perform a physical exam and likely order an ultrasound to better evaluate your uterus. Both uterine fibroids and adenomyosis are common causes of painful and heavy menstrual periods. Your healthcare provider will probably check your hemoglobin level as well. Anemia is common if you have had a few heavy menstrual cycles in a row.

It is possible that you may need to have an endometrial biopsy to evaluate the lining of the uterus. Another cause of painful heavy periods is a chronic inflammation of the lining of the uterus called endometritis. This condition is best diagnosed by an endometrial biopsy. 

New onset severe menstrual cramps

Any abrupt change in the amount of pain associated with your period needs medical attention. The amount of pain and other associated symptoms will determine how urgently you need to seek medical care. Nausea and vomiting, difficulty breathing or a rapid heart rate in addition to acute onset severe menstrual pain can be a sign of a gynecological emergency such as:

Ovarian torsion

Ruptured ectopic pregnancy

If you think you may be experiencing a gynecologic emergency you should seek immediate medical attention.

Fever or vaginal discharge

If you have a fever associated with new onset menstrual cramps it may be a sign of a pelvic infection. This is even more likely if you are also having an unusual or foul smelling vaginal discharge.

This discharge may have started in the days or weeks before your period. Having a new sexual partner also increases the risk of a pelvic infection. It is very important to seek urgent medical attention if you are having these symptoms. Untreated pelvic infections or PID can result in damage to your fallopian tubes which can affect your future fertility. 

As always, be sure to discuss any questions about your health or changes in your menstrual period with your healthcare provider. 

Updated by Andrea Chisholm MD

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