Cramping during menstruation can be quite intense sometimes and some women may even experience extremely painful cramping. The painful cramping felt around the time of your period is the uterine wall in spasm.
What Causes Menstrual Cramps?
The muscle in the uterine wall creates the cramps to expel stale, stagnant blood. A healthy, fresh lining is required during each cycle to promote implantation. Painful cramping is a sign that this is not happening. Severe cramping, also called dysmenorrhea, can be counter-productive for conception. A hormone called prostaglandin triggers muscle contractions in the uterus that expel the lining. These contractions can cause pain and inflammation. The level of prostaglandin rises just before menstruation begins.
Prostaglandins help in the regulation of inflammation, cell growth, regulation of body temperature, and smooth muscle constriction and dilation. If the levels of prostaglandins are very high, they can trigger uterine contractions that are more intense. When uterine contractions are especially strong, oxygen supply is temporarily blocked to parts of the muscle causing painful period cramps.
There is no single identifiable cause of painful menstrual periods. Some women are at a higher risk of having painful menstrual periods. These risks include:
- Age less than 20
- Family with a history of painful periods
- Smoking
- Heavy bleeding with periods
- Irregular periods
- Never delivered a baby
- Attained puberty before age 11
Painful Menstrual Cramps And Fertility
Intense menstrual cramps can occur because of many diseases that negatively impact fertility. Some of these diseases may take years to develop. Such causes include,
1. Endometriosis
Endometriosis is infamous for causing not just bad period cramps but also infertility. The endometrium is the mucous membrane that lines the inside of the uterus (womb). The endometrium undergoes changes throughout the menstrual cycle. It becomes thick and rich with blood vessels to prepare for pregnancy. If a woman does not get pregnant, part of the endometrium is shed, causing menstrual bleeding.
Endometriosis is a condition in which tissue that normally grows inside the uterus grows outside it. According to some estimates, around 50 percent of women who struggle to conceive may have endometriosis. Many years may pass before this condition is diagnosed and infertility occurs in almost 50 percent of the affected women. About 25 to 50% of infertile women have endometriosis, and 30 to 50% of women with endometriosis are infertile.1
2. Fibroids
Fibroids are the most common benign gynecological tumors in the reproductive age group affecting 20–50 % of these women. Fibroids differ to a large extent in terms of their size, location and number and so do the mechanism by which they may cause infertility. They are an abnormal mass of tissue that grows inside the smooth muscle of the uterus and is almost always non-cancerous.
Many women never realize that they have fibroids. However, fibroids are known to occasionally cause pain and possibly increase the risk of miscarriage. But, the evidence regarding the effect of fibroids on infertility and reproductive outcomes is weak and mostly inconclusive.2
3. Pelvic Inflammatory Disease (PID)
PID is another possible cause of painful menstrual cramps that can impact fertility. PID occurs because of an infection in the reproductive organs. It can cause the formation of scar tissue, which appears like webbing between the ovaries, fallopian tubes, and uterus. PID is the most common cause of blocked fallopian tubes. The high rate of postinfection infertility found was probably related to a combination of tubal damage before and during the index episode of PID. In one study, 19 of the 48 women who did not use contraception were involuntarily infertile after the index episode of PID.3
PID decreases subsequent fertility despite providing treatment for sexually transmitted diseases (STD). These findings suggest that a part of female infertility is attributable to subclinical PID and indicate that current therapies for STDs are inadequate for preventing infertility.4
4. Adenomyosis
Adenomyosis is a medical condition in which we find an abnormal presence of endometrial tissue (the inner lining of the uterus) within the myometrium (the thick, muscular layer of the uterus). On the contrary, if the endometrial tissue is present completely outside the uterus, it results in a similar but distinct medical condition called endometriosis. Both conditions may occur together in many cases, but often occur independently. Adenomyosis also causes painful menstrual cramps. Although no direct evidence exists, indirect data are available and provide ample information on the association between adenomyosis and infertility.
The occurrence of adenomyosis begins to rise from the mid-thirties. More importantly, many women are delaying their first pregnancy until later in their 30s or 40s. Consequently, adenomyosis is diagnosed more frequently in the fertility clinics. As it does not cause pathognomonic signs, symptoms or physical findings, it is difficult to diagnose adenomyosis before surgery.5
Many reports show that medical, surgical, or combined treatment can restore fertility in women with adenomyosis. This is an indirect proof of an association between adenomyosis and infertility. Another study conducted on baboons shows that adenomyosis is associated with lifelong primary infertility.6
A better understanding of adenomyosis has helped experts realize that adenomyosis may affect young women and can have a great impact on their fertility through different mechanisms.7
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