Fibroids and Menstrual Cramping
Menstrual Cramps are Common
Several days before a woman's period arrives she may experience cramping and discomfort in her abdomen, and she may develop a serious character change. This is known as PMS, or premenstrual syndrome. The cramping felt during this time is not the same as menstruation cramps, although it might linger long enough to meld with period cramps when menstruation begins. PMS and menstrual cramping are common among 50 percent of women who have menstrual periods. The intensity of the cramping can range from slight pressure all the way to over-the-top, doubled-over, can't-stand-up pain. Regardless whether the cramping is mild or severe, the condition is known as dysmenorrhea or, more commonly, menstrual cramps.
In most cases, there are no underlying issues that cause the cramping, such as endometriosis or pelvic inflammatory disease. The common type of cramping, referred to as primary dysmenorrhea, may appear on the scene within six months to a year of menarche (the first period). The ovulatory cycle has to begin before cramping actually starts, which means that a young girl who is just beginning her menstrual cycles will usually not experience cramping for some time after menarche.
Causes of Cramping
Cramps result from the release of prostaglandins that cause the uterus to contract as it expels the lining of the uterus that is unnecessary if there is no implantation of a fertilized egg. Estrogen and progesterone levels drop; the lining swells and begins to break down. In order to move the old lining out of the uterus, prostaglandins are excreted which cause the uterus to contract. The contractions of the muscles of the uterus squeeze the blood supply, cutting the endometrium off from being fed. The tissue dies and the contractions move the tissue out through the cervix in the menstrual flow. Leukotrienes that are involved in the inflammatory response are elevated at this point, which could be a contributor to period cramps.
There are some anatomical situations that can contribute to cramping such as a very narrow cervical canal that makes the flow of menstrual blood and tissue difficult to pass; a retroverted uterus, which is when the uterus is tilted backwards; lack of exercise; and often emotional stress can contribute to cramping as well.
Some women experience intense and severe menstrual cramps - beyond what is deemed normal. Normal cramping will begin just before menses and peak about 24 hours into it, then it will recede. When cramping exceeds this time frame and is very intense, it is called secondary dysmenorrhea and it is usually caused by other conditions.
One condition that causes heavy bleeding and intense menstruation cramping is fibroid tumors. In fact, fibroids may account for cramping in many women because about one in five women have fibroids during their childbearing years and fully 50 percent of all women have had them by the time they are 50 years old.
Nobody seems to know what causes fibroids. However, there is a link to estrogen. A fibroid will continue to grow as long as a woman is menstruating, although the growth is slow. Fibroids range in size from miniscule - where they need to be seen through a microscope - all the way to filling the entire uterus and weighing several pounds.
The description of fibroid tumors is determined by their location in the uterus:
· Myometrial - in the uterine muscle wall
· Submucosal - just under the surface of the lining of the uterus
· Suberosal - just under the outside covering of the uterus
· Pendunculated - either inside or outside of the uterus on a long stalk
Symptoms of Fibroids
Sometimes there are no symptoms of fibroids, but often there are and the symptoms can be very painful, most of them occurring around menstruation.
· Menorrhagia (heavy menstrual periods) sometimes with blood clots
· Longer than normal menses
· Pelvic cramping and/or pain with periods
· Bleeding between periods
· Pain during intercourse
· Frequent urination
· Pressure in lower abdomen
Fibroids can be difficult to diagnose in overweight women. However, a pelvic exam done by the healthcare provider can determine a change in the shape of the uterus. An ultrasound or MRI may be used to confirm a diagnosis of fibroids.
Treatments and Complications
There are various treatments for fibroid tumors that include birth control pills; IUDs that release progestin which helps to reduce bleeding and pain; iron supplements to prevent anemia when bleeding is heavy; NSAIDs for cramping and pain; hormone injections on the short-term. Surgical procedures are sometimes used to treat fibroids as well.
Possible complications of fibroids such as severe pain or excessive bleeding may require emergency surgery. Surgery may also be necessary is the fibroid twists and creates a blockage in a blood vessel. Urinary tract infections and anemia are other associated complications of fibroids.
If there are changes in your periods, increased cramping or heavy bleeding, a sense of fullness in your lower belly area or bleeding between periods, check in with the doctor to see if you have fibroids.