Why aren't my heaviest periods the most painful? (TMI,obviously)

My periods are usually about the same from month to month, no major problems, but a couple of times a year I have ones that come with much more painful cramps, and ones that are considerably heavier than usual. But they’re not the same ones. The heaviest ones are usually the least painful, but there’s no reverse correlation, since the most painful are no lighter than normal. So…any idea why the heaviest ones come with the fewest cramps? Is this typical?

Doesn’t cramping = ovulation, whereas the ‘heaviest’ issue is shedding of the uteris lining, which doesn’t necessarily coincide with ovulation precisely?
I other words, moving the egg along is the issue of pain, whereas shedding the lining happens too, but that isn’t the pain source.

(I’m a guy, and wanted to take a stab at it)

Sorry, dude. Stick to explaining your own package… :smiley:

The ‘egg’ is a single tiny cell. Moving it along through the tubes doesn’t hurt. When it is released from the ovary, there might be a little bit of pain, but that’s a couple of weeks before menstruation and the actual ‘cramps’ that women complain about.

After the egg has hung around for a couple of weeks, and the uterus has prepared itself for the fertilized egg to arrive, if there’s no fertilization you have your period. (I’m not sure when the actual egg goes out of the system, but I think it’s around the same time.) The lining of the uterus falls away, and it bleeds because the lining had blood flow in it (this is the stuff that would have ended up as the placenta if the egg had been fertilized and implanted).

I’m not sure about the actual cause of the cramps, though. Are there enough nerves in the uterus or in the lining that it actually hurts when the lining comes off? I was under the impression that the cramps were just the muscles getting tired from expelling the lining and blood. (If that’s the case, the cramps would probably be worse when there’s a lot of lining to get rid of, while if there’s little lining and lots of bleeding it won’t be as much work.)

Menstrual cramps are thought to be related to a hormone-like naturally occurring substance called prostaglandins which causes the uterus to contract. If a woman does not ovulate it is unlikely that she will encounter cramps during her period, for this reason physicians often prescribe oral contraceptives to ease painful periods. However, you should be aware that birth control pills cause abnormal bleeding in some women.

Try this forum:
http://www.obgyn.net/english/forums/forums.asp

BodyTeen has a good article here:
http://www231.pair.com/grpulse/bt/sefeme.html
Their advice for relieving the pain I wouldn’t post here.

One person suggests the sometimes problem could be diet at:
http://nj.essortment.com/dysmenorrheatre_rcwm.htm

This site has many articles:
http://www.geometry.net/health_conditions/dysmenorrhea_page_no_2.php

This site supports Philster:
http://xtramsn.co.nz/health/0,,8065-1669822,00.html

Thanks to those who have taken a stab so far, but I’m not really asking why one has cramps, or how to make them less painful, I know that stuff. I’m trying to figure out why my heaviest periods are the least painful.

Could it be because cramping relates to shedding, so when your period is heavier things are happening faster and easier, so there is less need to cramp?

Which then begs the question: why is it heavier some months and not others?

My total IANAObGyn WAG.

For me, cramps can be very bad one month, and not so bad the next. I have heard so many different explanations as to what actually causes the cramps, it’s difficult to get an accurate answer. One of the reasons I have heard is that it is due to changes in the hormonse in that area of the body. Pesky hormones!

wayTMI
um, clots?
technically clots indicate that things are moving faster than they should be. mentrual blood is supposed to clot inside the uterus, the clots are broken down, and THIS is period blood. so if you get clots it means that the blood is flowing out before it gets a chance to be broken down.

are the more painful periods asscoiated with more clotting?
or less?
or no difference?

Cite? BCPs do moderate cramps for many women, but cramping certainly still occurs.

The reason is related to what Philster said: Cramping is related to prostaglandin release (also the reason why ibuprophen helps (from Midol or Advil) because it blocks prostaglandin production). I am not aware of prostaglandins having much effect on the proliferation and subsequent shedding of the endometrium, it is more hormonally mediated (think FSH, LH, estrogen, progesterone). So the cut and dry answer to your question is: they are unrelated physiologically.

uscdiver, that is the textbook answer, but after 20 years of practice, I recognize that the complaints don’t always match the textbook answers. BCP’s and prostaglandin inhibitors do ameliorate many women’s cramps, but not all. Other factors and mechanisms, which are poorly understood as yet, are involved and the whole issue cannot be settled with the simple Cut & Paste function lifting material from womenshealth. (Naughty Philster for that unattributed cite).

In short, there’s no one correct answer to the OP’s question or others raised here, and that unique individual physiology further muddies the waters.

Thank you for the consult QtM.

The explanation we got in an introductory bio class was this: The estrogen levels in the blood rise and fall during the menstrual cycle. When the estrogen (or was it progesterone, maybe?) levels fall dramatically at the end of a cycle, the change causes the blood vessels in the uterine wall to contract, cutting off the blood flow to the endometrium. The tissue dies and sloughs off easily.

Sometimes, however, the hormone levels don’t fall as rapidly, and the vessels don’t contract as much. When the dead bits of the endometrium slough, they’re ripping loose living tissue too. According to my professor, the ripping is what causes the pain and the big clot-like clumps some women experience. Since birth control pills cause a huge artificial drop, the vessels are more likely to contract properly and all the tissue dies and sloughs more easily.

This could be a load of hogwash, but he had assloads of stuff to back it up. He also claimed that cramps felt like someone taking a GardenWeasel to your guts, which is actually 100% correct, so I tend to believe the man.