Between menstrual periods, your uterine lining tissue builds up to prepare for a possible pregnancy. In the absence of conception, this tissue breaks down and passes in your menstrual flow. Menstrual cramps occur due to contraction of involuntary muscle tissue your uterine wall that help expel the uterine lining tissue. Menstrual-like stomach cramps that occur outside the expected time frame based on your menstrual flow also typically represent involuntary muscle contractions of your reproductive or other nearby organs. These cramps often represent a normal biological response but sometimes signal an underlying health concern.
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Intermenstrual pain occurs at or around the time of ovulation. According to the medical text _Bonica's Management of Pain_, approximately 50 percent of women experience this pain at some point during their childbearing years. The exact cause of intermenstrual pain, also known as mittelschmerz, remains incompletely understood. Some experts suggest the pain occurs due to spasms of the muscular tissue of the uterus, ovarian tube and/or bowel. Others believe irritation of the intrabdominal tissues near the ovary around the time of ovulation gives rise to the pain. Intermenstrual pain is normal, does not require treatment and typically lasts a few minutes to 48 hours.
Among sexually active women of childbearing age, menstrual-like cramps might represent an early miscarriage. Many women remain unaware of a pregnancy for several weeks to a month or two. This might be due to irregular periods or assuming infallibility of one's chosen contraceptive method. During an early miscarriage, women typically experience menstrual-like cramps followed by bleeding that resembles a period but often heavier and/or more prolonged. As during a menstrual period, the cramps associated with an early miscarriage arise from contractions of uterine muscle tissue to discharge the lost pregnancy tissue from the body.
Several intestinal conditions can cause crampy abdominal pain that might mimic menstrual cramps.
Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is a common intestinal disorder that affects large bowel function without any obvious, detectable signs of damage or disease. Recurring abdominal pain, commonly in the form of cramps, is the hallmark symptom of IBS. The pain is related to passing stool and associated with a change in the frequency of bowel movements and/or the form of the stool. Most people with IBS predominately experience constipation or diarrhea while others report both.
Inflammatory Bowel Disease
With inflammatory bowel disease (IBD), including Crohn disease and ulcerative colitis, chronic inflammation occurs at specific sites of the digestive tract. Diarrhea and abdominal pain and/or cramps are characteristic of both types of IBD. Other common symptoms with Crohn disease include fever, weight loss and poor appetite. An urgent need to move the bowels and bloody stool often point toward a diagnosis of ulcerative colitis. With both IBD types, symptoms tend to occur episodically during disease flareups.
With a bowel obstruction, food and fecal material fail to move through the intestines normally. Small bowel obstructions occur more frequently than those affecting the large bowel. Bands of scar tissue called adhesions that often develop after abdominal or pelvic surgery lead the list of bowel obstruction causes. Abdominal cramps occur with this condition as the bowel balloons behind the blockage and cyclic intestinal contraction add to the pressure. Other common symptoms include nausea, vomiting, bloating and constipation.
Other Considerations and Causes
Everyone experiences and describes pain differently. Therefore, the personal meaning of menstrual-like stomach pain likely differs from one woman to another. From a medical perspective, crampy pain refers to a gradually increasing sensation of discomfort that peaks and then diminishes. However, some women's menstrual cramps might more closely resemble pressure, sharp pain or a dull ache. Therefore, other causes must be considered depending on the specific nature and location of a woman's pain. Some of the more common additional considerations include:
- Reproductive or abdominal organ growths
- Pelvic inflammatory disease
- Gallbladder disease
- Stomach ulcers
- Urinary tract infection or stone
- Pelvic or abdominal scar tissue
Next Steps, Warnings and Precautions
Occasional mild stomach cramps often indicate a minor temporary issue, such as indigestion or eating something that didn't agree with you. Persistent or recurring menstrual-like stomach cramps, however, might signal an underlying medical condition and should be evaluated by your healthcare provider, especially if accompanied by other troublesome symptoms. See your doctor right away if you might be pregnant or if are postmenopausal and experience vaginal bleeding. Seek urgent medical care if your pain is accompanied by any warning signs or symptoms, including:
- Severe or rapidly worsening abdominal or pelvic pain
- Rapidly increasing abdominal bloating
- Fever, chills or clammy skin
- Persistent nausea and vomiting
- Dizziness, lightheadedness or fainting
- Human Reproductive Update: What We Know About Primary Dysmenorrhea Today: A Critical Review
- Bonica's Management of Pain, 4th Edition; Scott Fishman, Jane Ballantyne and James P. Rathmell
- International Journal of Women's Health: Optimal Management of Chronic Cyclical Pelvic Pain: an Evidence-Based and Pragmatic Approach
- American College of Obstetricians and Gynecologists: Practice Bulletin, Early Pregnancy Loss
- United European Gastroenterology Journal: Irritable Bowel Syndrome Diagnosis and Management: A Simplified Algorithm for Clinical Practice
- Merck Manual Professional Version: Overview of Inflammatory Bowel Disease
- StatPearls: Bowel Obstruction
- American Family Physician: Evaluation of Acute Pelvic Pain in Women