[46F] With recurrent premenstrual stomach and lower back cramps

Patient Description

A 46-year-old female reports experiencing stomach and lower back cramps that feel like menstrual cramps. These cramps occur off and on a couple of weeks before her period, lasting for a day, then going away for a couple of days before returning. She rates the severity of her cramps as 2 or 3 out of 10. Physical activities like working out and doing cardio, as well as taking ibuprofen, seem to help relieve the cramps. She has not noticed any changes in bowel movements, blood in the stool, sudden severe abdominal pain, heavy vaginal bleeding, nausea, vomiting, or changes in her menstrual cycle. She has no family history of gynecological conditions such as endometriosis, fibroids, or ovarian cysts. Her past medical history is unremarkable, and she is not taking any medications other than occasional ibuprofen. She also drinks Advocare energy teas and has no known allergies to medications.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

  • Premenstrual Syndrome (PMS): PMS is a common condition that affects many women in the weeks leading up to their period. Symptoms can include cramps, bloating, mood swings, and fatigue. Your description of cramps occurring off and on a couple of weeks before your period is consistent with PMS.

    • Treatment: Over-the-counter pain relievers like ibuprofen can help manage the pain. Regular exercise, a balanced diet, and stress management techniques can also be beneficial.
  • Ovulation Pain (Mittelschmerz): Some women experience pain during ovulation, which occurs about two weeks before their period. This pain can be felt in the lower abdomen and back.

    • Treatment: Pain relief can be achieved with over-the-counter pain medications like ibuprofen. Applying heat to the affected area can also help.
  • Endometriosis: Although less likely given your normal pap smear and lack of other symptoms, endometriosis can cause similar cramping and pain. It involves the growth of endometrial tissue outside the uterus, leading to pain and sometimes infertility.

    • Treatment: Treatment options include pain relief medications, hormonal therapies, and in some cases, surgery. A healthcare provider can help determine the best course of action.

What you can do

  1. Continue with Ibuprofen: Since ibuprofen helps alleviate your cramps, you can continue to use it as needed. Just make sure to follow the recommended dosage instructions.
  2. Exercise: Regular physical activity, especially cardio, can help reduce the severity of cramps.
  3. Heat Therapy: Applying a heating pad or hot water bottle to your lower abdomen and back can help relieve cramps.
  4. Diet and Hydration: Maintain a balanced diet and stay hydrated. Reducing caffeine and alcohol intake may also help.
  5. Monitor Symptoms: Keep a symptom diary to track the frequency, duration, and severity of your cramps. This information can be useful for your healthcare provider.

What you should look out for

While your symptoms do not appear to be life-threatening, you should seek medical attention if you experience any of the following:

  • Sudden, severe abdominal pain
  • Heavy or unusual vaginal bleeding
  • Blood in your stool
  • Persistent nausea or vomiting
  • Significant changes in your menstrual cycle

Remember, while this information can be helpful, it is not a substitute for professional medical advice. If you have concerns or if your symptoms worsen, please consult a healthcare provider for a formal diagnosis and appropriate treatment.

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7 mo ago

People Also Ask


What are common symptoms of Premenstrual Syndrome (PMS)?

Common symptoms of Premenstrual Syndrome (PMS) include cramps, bloating, mood swings, fatigue, headaches, and breast tenderness. These symptoms typically occur in the weeks leading up to a period.


What is ovulation pain and how can it be managed?

Ovulation pain, also known as Mittelschmerz, is a discomfort some women feel during ovulation, about two weeks before their period. It can be managed with over-the-counter pain medications like ibuprofen and applying heat to the affected area.


How can exercise help alleviate menstrual cramps?

Exercise, particularly cardio, can help alleviate menstrual cramps by increasing blood flow and releasing endorphins, which are natural pain relievers. Regular physical activity can also reduce stress, which may help lessen the severity of cramps.


When should I seek medical attention for menstrual cramps?

You should seek medical attention for menstrual cramps if you experience sudden, severe abdominal pain, heavy or unusual vaginal bleeding, blood in your stool, persistent nausea or vomiting, or significant changes in your menstrual cycle.


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