These are not just bad PMS

Cramps suck. But they're nothing if not consistent. That's why it can be so alarming when your cramps suddenly feel different. Maybe what was once tolerably painful is now incapacitating. Or the stabby feeling you're used to continues even after your flow is over.

Or you're bleeding more – way more. Whatever the shift is, the fact that something has changed is a red flag you shouldn't ignore, says Dr Alyssa Dweck, gynae in Mount Kisco, New York and author of V Is for Vagina. If you notice any kind of change, don't blow it off. Let this guide give you insight into what your cramps are trying to tell you.

You could have: uterine fibroids. These benign growths stem from inside or outside the muscular uterine wall.

What causes them is unclear, but fibroids are super common, especially in women in their thirties and forties. The actual pain you feel, which Dweck describes as “off the charts”, can be triggered by inflammation or simply the fibroid itself pressing against your uterus.

What to do: Check in with your gynae and tell her your symptoms, recommends Dweck. She'll likely run some scans, which can identify if you have a fibroid and better determine whether you should have it removed. That will depend on many factors, including where it's located and how big it is (these buggers can be as small as a button or as large as a grapefruit). In the meantime, since fibroids are sensitive to oestrogen, getting a prescription for birth control pills can help dial back the pain.

Low-grade constant pain

You could have: pelvic inflammatory disease (PID), a serious infection of the uterus, ovaries, and/or fallopian tubes. An untreated STD such as chlamydia or gonorrhoea, both of which often have no symptoms, typically causes PID.

“It's kind of an indolent pain, and it's not usually sharp or stabbing, but it's not comfortable,” says Dweck. And when you get your period and your usual cramps get going, the pain from PID will feel even worse.

What to do: Make an appointment with your gynae pronto. While PID is not usually an emergency, says Dweck, your doc will want to test you to find out the exact cause and get you on antibiotics ASAP. The infection is totally curable, but if left untreated for too long, scar tissue could form in your reproductive tract and mess with your fertility.

Sharp pain on one side

You could have: an ovarian torsion. An ovarian torsion happens when something (like a cyst) causes your ovary to twist, choking off its own blood flow, says Dweck. “It's a super intense, knock-your-socks-off kind of pain and a real medical emergency,” she says, that could result in loss of function in that ovary.

What to do: Hightail it to the ER. Doctors there will want to do an ultrasound and other scans. If they diagnose torsion, you'll need emergency laparoscopic (a.k.a., minimally invasive) surgery to untwist it. “Sometimes the ovary can be untwisted and saved, however if the ovary looks black or nonviable it would need to be removed,” says Dweck. “Luckily the other ovary will take over with ovulation and oestrogen production if this occurs.”

Painful cramps that meds don't help

You could have: endometriosis, a condition that causes uterine tissue to migrate to other organs such as the ovaries and fallopian tubes, where it adheres. Over time, the runaway tissue can develop into benign cysts. Up to 10% of women are thought to have endometriosis, according to the American College of Obstetrics and Gynaecologists, though it can take years to diagnose because most women assume their killer cramps are normal. “It's the kind of pain that can really interfere with day-to-day activities,” says Dweck. And depending on where it is in your pelvis, it can also make sex painful.

What to do: See your doctor and relay your symptoms. She'll likely schedule you for imaging tests and give you a sense of what your options are. Because endometrial tissue is hormonally sensitive, going on oral contraceptives or other hormonal meds can cut back the pain. But the only way to truly diagnose endometriosis is to undergo laparoscopic surgery, during which your doc may try to remove as much of the tissue as possible. (It can come back, unfortunately.)



Significant cramps post-IUD

You could have: an ill-fitting copper (non-hormonal) IUD. In the first three months after your ob-gyn inserts this tiny T-shaped device into your uterus, some cramping is considered normal as your body adjusts.

What to do: “If this is persistent or new after having had no problem with your IUD, it warrants a follow-up exam and probably an ultrasound to insure good position,” says Dweck. Odds are there isn't anything seriously wrong. But your doctor will check things out and adjust the way it fits.

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