Your Menstrual Cramps Might Not Be From PMS

Illustrated by Isabel Castillo Guijarro.
Plenty of us have experienced it at one time or another: a pain — typically throbbing or dull and achy — in our lower abdomen. Often times, this pain comes with our periods, and if we’re lucky, a painkiller or hot-water bottle does the trick. But what about when that doesn’t work? For some, cramps can signal something else is going on. In fact, some cramps might have absolutely nothing to do with PMS.
In an effort to better understand what our cramps are telling us about our bodies, we talked to Carolyn Alexander, FACOG. Ahead, Dr. Alexander breaks down six reasons you might be experiencing abdominal cramping and when it's time to see a medical professional.
If you ever have concerns about your health or something that doesn’t “feel right,” always reach out to a doctor for professional advice.
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Illustrated by Isabel Castillo Guijarro.
Menstrual Cramps

What They Are: These cramps are a dull aching pain caused by uterine contractions during menstruation. The location may vary from person to person. "Sometimes [the cramping] is in the middle [of the lower abdomen]. Other times, pain can be on the sides near the ovaries," Dr. Alexander says.

When You Should See A Doctor: "If the cramps are catching a person's breath [or] if someone has severe nausea or vomiting with cramps," Dr. Alexander says, it’s time to see a doctor, who will likely do an ultrasound evaluation.
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Illustrated by Isabel Castillo Guijarro.
Ovulation Pain Or “Mittelschmerz”

What It Is: This short-lived pain occurs during ovulation rather than during menstruation. While the official cause is unknown, doctors speculate the pain is caused by anything from simple irritation to contractions in the fallopian tube and smooth muscle cell.

When You Should See A Doctor: For most people, the pain lasts at most a few hours, and medical attention isn’t necessary. But if the pain persists, there could be something more severe causing it. “One emergency that can happen is when the ovary flips, which can cut off its blood supply,” Dr. Alexander says. This is considered an ovarian torsion. “It can catch [you] off guard — especially after an activity that was jarring like jumping on a trampoline, riding a rollercoaster, or having [penetrative] intercourse.” In this rare instance, you may experience on and off gassy, crampy pain as well as nausea and vomiting. Seek a doctor or visit the emergency room immediately.
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Illustrated by Isabel Castillo Guijarro.

What It Is: This condition is caused by uterine-like tissue that grows on the outside of the uterus. The tissue acts just like uterine tissue does during menstruation, but it becomes trapped and irritated when it has no way to leave the body — causing severe cramping pain. Other symptoms of endometriosis may include nausea, heavy periods, and/or pain during or after penetrative intercourse.

When You Should See A Doctor: Take note of pain levels during your period. If you experience severe pain that’s more intense than run-of-the-mill menstruation cramps, make an appointment with a doctor.
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Illustrated by Isabel Castillo Guijarro.
Sexually Transmitted Infections (STIs) & Sexually Transmitted Diseases (STDs)

What They Are: STIs and STDs are spread through sexual activity. The symptoms vary depending on the disease/infection, but oftentimes, they involve more than just abdominal cramping. Depending on what it is, there could be pain during urination, genital burning, abnormal vaginal discharge, spotting between periods, fever, and/or jaundice.

When You Should See A Doctor: If you suspect you might have an STI or STD — or if you have had unprotected sex — see a doctor to get tested.
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Illustrated by Isabel Castillo Guijarro.
Ovarian Cysts

What They Are: “Sometimes when we're stressed out, we don't ovulate properly. We can get what's called an unruptured follicle, which is an [egg] that got stuck and didn't rupture,” Dr. Alexander notes. “It becomes a cyst that either starts to leak or expand to the point where it hurts a lot.” This pain will come in the form of sharp aching on the right or left side.

When You Should See A Doctor: Some cysts aren’t as bothersome and will go away on their own. On the other hand, if you have severe cramp-like pain that persists — and/or a fever and nausea — seek immediate medical attention. In these cases, doctors will give patients medication and monitor the pain until the cyst resolves.
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Illustrated by Isabel Castillo Guijarro.

What They Are: These benign tumors develop from mutations in uterine wall muscle cells. The exact cause is unknown, but doctors believe hormones and genetics play a part. For some, fibroids can cause serious cramping, depending on where they form. According to Dr. Alexander, menstruation contractions can elicit cramping if the fibroid is blocking the tissue evacuation path. Others might have constipation if their uterus tilts back and the fibroid pushes against the colon.

When You Should See A Doctor: Although these tumors are benign, you should keep an eye on potential symptoms. “If a person is soaking a pad an hour during their menstrual period or if they're getting anemic from their periods, we tend to be suspicious of fibroids,” Dr. Alexander says. If you have an inkling that you might have fibroids, talk to a doctor.

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