Pelvic pain that occurs in a pattern of increasing and decreasing
intensity is considered a "cramp". Cramps may be caused by a
number of conditions. The relationship of the cramps to the
menstrual cycle helps your doctor determine the cause of your

Cramps that occur with the menstrual cycle (
dysmennorrhea) can
be caused by an obstruction or narrowing or the cervix, growths
within the uterus (polyps,
fibroids or myomas, or adenomyosis),
endometrial or uterine lining tissue outside of the uterus
endometriosis), or for no discoverable reason (idiopathic).

Cramps that occur in the middle of the menstrual cycle
(Mittleschmertz) are due to the opening or rupture of the normal
ovulation cyst. Sometimes there will be more fluid in the cyst than
is average or the cyst will open near a blood vessel causing more
bleeding than average, resulting in pelvic pain. This pain usually
lasts from a few hours to 1-2 days.

Cramps that are unrelated to the menstrual cycle may be related
to an infection, bowel  problems such as constipation,
diverticulosis, or food allergy, or scar tissue in the pelvis.

Your doctor will use a combination of  your history, physical
exam, and  lab or radiologic tests to determine the cause of your
cramps. Sometimes a surgery such as hysteroscopy  or
laparoscopy will be needed to determine what is causing your
pain. Once the cause has been determined you and your doctor
will be able to go over the options for treatment and decide on
the best course for helping you relieve your pain.