What are the causes of body cramps in women?

Causes of Body Cramps in Women

Body cramps in women arise from multiple distinct mechanisms including hormonal fluctuations (menstrual cramps), medication effects (particularly diuretics), electrolyte disturbances, pregnancy-related changes, and musculoskeletal conditions, with the specific cause requiring targeted evaluation based on cramp location, timing, and associated symptoms.

Menstrual-Related Cramps

• Primary dysmenorrhea involves involuntary abdominal skeletal muscle activity that precedes cramping pain episodes, occurring in approximately 20-50% of reproductive-aged women 1
• Women with primary dysmenorrhea experience abdominal muscle activity-associated pain at rates of 10.8 ± 3.0 episodes per hour during menses, compared to 0.9 ± 0.6 episodes in healthy controls 1
• This cramping mechanism responds well to NSAIDs like naproxen, with only 13% of women continuing to have episodes after treatment compared to 45% before treatment 1
• Women without this abdominal muscle activity pattern often have secondary dysmenorrhea or chronic pelvic pain, exhibiting widespread pain sensitivity with lower pressure pain thresholds (16.1 ± 1.9 N vs 22.4 ± 3.0 N in primary dysmenorrhea) 1

Medication-Induced Cramps

• Diuretics are the strongest medication-related cause, particularly in patients with ascites or heart failure, and should be reviewed immediately when cramps develop 2
• Calcium channel blockers and lithium also contribute to nocturnal leg cramps and require medication review 2
• Drug-induced cramps are common and reversible, making critical medication review essential in any woman presenting with new-onset cramps 2

Pregnancy-Associated Cramps

• Leg cramps affect approximately 5.9% of pregnant women, becoming more common as pregnancy progresses and especially troublesome at night 3
• Pregnancy-related cramps show no relationship to pregnancy complications or unfavorable fetal outcomes 3
• Oral magnesium supplementation (magnesium bisglycinate chelate 300 mg daily) demonstrates significant benefit, with 86.0% of treated women achieving 50% reduction in cramp frequency versus 60.5% with placebo (P=0.007) 4
• The evidence supports magnesium lactate or citrate at 5 mmol in the morning and 10 mmol in the evening for pregnancy-related cramps 5
• Breast pain and tenderness during pregnancy and breastfeeding are common, usually short-duration, and resolve spontaneously 6

Electrolyte Imbalances

• Hypokalemia (low potassium) and hypomagnesemia (low magnesium) exacerbate cramps and require checking and correction 2
• Check electrolytes, renal function, thyroid function, calcium, and HbA1c to identify metabolic derangements contributing to cramps 2

Musculoskeletal and Chest Wall Causes

• Costochondritis (Tietze syndrome), pectoral muscle strains or spasms, fibromyositis, fibromyalgia, myalgia, and rib fractures can cause chest wall cramping perceived as body cramps 6
• Nerve entrapment (lateral cutaneous branch of third intercostal nerve) and spinal nerve root syndromes (cervical or thoracic) cause referred pain to the chest and breast areas 6
• Post-surgical pain from scar tissue, nerve regeneration, or focal nerve injury occurs more commonly after postoperative infection, hematoma, or when surgical incisions cross Langer lines of tension 6
• Breast implants, especially subpectoral placement, associate with pain and cramping sensations 6

Associated Medical Conditions

• Liver disease with cirrhosis, particularly in patients on diuretics for ascites, increases cramp frequency 2
• Neurological conditions causing lower limb weakness, abnormal gait, or tremor contribute to nocturnal leg cramps 2
• Screen for sleep disorders including obstructive sleep apnea, which may coexist with nocturnal leg cramps 2
• Assess for peripheral edema and examine for neurological signs including lower limb weakness, abnormal gait, speech disturbances, or tremor 2

Cardiac-Related Cramping Pain in Women

• Women presenting with chest pain or cramping are at risk for underdiagnosis of cardiac causes, which must always be considered 6
• Women with acute coronary syndrome commonly present with accompanying symptoms including palpitations, jaw and neck pain, back pain, nausea, fatigue, and dyspnea alongside or instead of typical chest pain 6
• Traditional risk score tools often underestimate cardiac risk in women and misclassify them as having nonischemic chest pain 6
• Women with diabetes have higher prevalence of angina than men with diabetes, despite lower incidence of obstructive coronary artery disease 6

Systemic Causes

• Coronary ischemia, esophageal disease (achalasia, hiatal hernia), pulmonary disease (pleurisy, pulmonary embolus), gallbladder pathology, peptic ulcer disease, gastroesophageal reflux, shingles, and sickle cell anemia can all cause cramping pain referred to the chest or body 6

Clinical Evaluation Priorities

• Review all medications critically, as drug-induced cramps are common and reversible 2
• Check electrolytes (potassium, magnesium), renal function, thyroid function, calcium, and HbA1c 2
• Assess timing relative to menstrual cycle to distinguish primary dysmenorrhea from other causes 1
• Evaluate pregnancy status, as pregnancy-related cramps have distinct treatment approaches 3, 4, 5
• Examine for peripheral edema and neurological signs 2
• In women with chest cramping, obtain history emphasizing accompanying symptoms more common in women with acute coronary syndrome 6