Editing Menstruation (section)

===Cramps===
In most women, various physical changes are brought about by fluctuations in hormone levels during the menstrual cycle. This includes muscle contractions of the uterus (menstrual cramping) that can precede or accompany menstruation. Many women experience painful cramps, also known as [[dysmenorrhea]], during menstruation.<ref name="The prevalence and risk factors of">{{cite journal | vauthors = Ju H, Jones M, Mishra G | title = The prevalence and risk factors of dysmenorrhea | journal = Epidemiologic Reviews | volume = 36 | issue = 1 | pages = 104–113 | date = 1 January 2014 | pmid = 24284871 | doi = 10.1093/epirev/mxt009 | doi-access = free }}</ref> Among adult women, that pain is severe enough to affect daily activity in only 2%–28%.<ref name="The prevalence and risk factors of"/> Severe symptoms that disrupt daily activities and functioning may be diagnosed as [[premenstrual dysphoric disorder]].<ref name="WH2020">{{cite web|date=12 July 2017|title=Premenstrual syndrome (PMS)|url=https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome|access-date=3 January 2020|website=womenshealth.gov|language=en|archive-date=8 December 2016|archive-url=https://web.archive.org/web/20161208172815/https://www.womenshealth.gov/publications/our-publications/fact-sheet/premenstrual-syndrome.html|url-status=live}}</ref> These symptoms can be severe enough to affect a person's performance at work, school, and in everyday activities in a small percentage of women.<ref name="AFP2011" />

When severe pelvic pain and bleeding suddenly occur or worsen during a cycle, this could be due to [[ectopic pregnancy]] and [[miscarriage|spontaneous abortion]]. This is checked by using a pregnancy test, ideally as soon as unusual pain begins, because ectopic pregnancies can be life‑threatening.<ref>{{cite web|title=Ectopic Pregnancy Clinical Presentation: History, Physical Examination|url=http://emedicine.medscape.com/article/2041923-clinical|url-status=live|archive-url=https://web.archive.org/web/20130329020606/http://emedicine.medscape.com/article/2041923-clinical|archive-date=29 March 2013|website=emedicine.medscape.com|df=dmy-all}}</ref>

The most common treatment for [[menstrual cramps]] are [[non-steroidal anti-inflammatory drugs]] (NSAIDs). NSAIDs can be used to reduce moderate to severe pain, and all appear similar.<ref name="Dysmenorrhoea">{{cite journal | vauthors = Latthe PM, Champaneria R | title = Dysmenorrhoea | journal = BMJ Clinical Evidence | volume = 2014 | pages = 390–400 | date = October 2014 | pmid = 25338194 | pmc = 4205951 | doi = 10.1016/j.ajog.2017.08.108 }}</ref> About 1 in 5 women do not respond to NSAIDs and require alternative therapy, such as simple analgesics or heat pads.<ref>{{cite journal | vauthors = Oladosu FA, Tu FF, Hellman KM | title = Nonsteroidal antiinflammatory drug resistance in dysmenorrhea: epidemiology, causes, and treatment | journal = American Journal of Obstetrics and Gynecology | volume = 218 | issue = 4 | pages = 390–400 | date = April 2018 | pmid = 28888592 | pmc = 5839921 | doi = 10.1016/j.ajog.2017.08.108 }}</ref> Other medications for pain management include aspirin or paracetamol and combined oral contraceptives. Although combined oral contraceptives may be used, there is insufficient evidence for the efficacy of intrauterine progestogens.<ref name="Dysmenorrhoea"/>

One review found tentative evidence that acupuncture may be useful, at least in the short term.<ref>{{cite journal | vauthors = Woo HL, Ji HR, Pak YK, Lee H, Heo SJ, Lee JM, Park KS | title = The efficacy and safety of acupuncture in women with primary dysmenorrhea: A systematic review and meta-analysis | journal = Medicine | volume = 97 | issue = 23 | pages = e11007 | date = June 2018 | pmid = 29879061 | pmc = 5999465 | doi = 10.1097/MD.0000000000011007 }}</ref> Another review found insufficient evidence to determine an effect.<ref>{{cite journal | vauthors = Smith CA, Armour M, Zhu X, Li X, Lu ZY, Song J | title = Acupuncture for dysmenorrhoea | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 4 | pages = CD007854 | date = April 2016 | pmid = 27087494 | pmc = 8406933 | doi = 10.1002/14651858.CD007854.pub3 }}</ref>