Why does menstrual cramps return on the fourth day of menstruation?

The return of dysmenorrhea on the fourth day of menstruation may be related to factors such as fluctuations in hormone levels, incomplete endometrial shedding, pelvic congestion, abnormal uterine contractions, primary dysmenorrhea, etc. It can be improved through hot compresses, drug relief, diet adjustment, moderate exercise, and traditional Chinese medicine conditioning.

1. Fluctuations in hormone levels

The decrease in progesterone levels in the late menstrual period may stimulate increased secretion of prostaglandins, leading to increased contraction of uterine smooth muscle. This type of dysmenorrhea is often manifested by a feeling of distension in the lower abdomen, accompanied by soreness and weakness in the waist. You can use ibuprofen sustained-release capsules, acetaminophen tablets and other drugs as directed by your doctor to inhibit prostaglandin synthesis, and avoid irritation from raw or cold foods.

2. Incomplete shedding of the endometrium

If endometrial fragments remain in the uterine cavity at the end of menstruation, they may cause inflammatory reactions and cramping pain. Common menstrual blood is dark red in color with blood clots, and the pain becomes paroxysmal. It is recommended to use local hot compress to promote blood circulation. If necessary, the doctor may prescribe short-acting contraceptive pills such as drospirenone and ethinylestradiol tablets to regulate the growth of the endometrium.

3. Pelvic congestion

The continued expansion of pelvic blood vessels during menstruation will cause tissue edema to compress nerves, and the pain is usually a persistent dull pain that radiates to the inner thigh. You can take the knee-chest lying position to relieve pressure, and use Guizhi Fuling Capsule to activate blood circulation and remove blood stasis. Avoid sitting or standing for long periods of time, and taking a sitz bath with warm water for 15 minutes every day can help improve circulation.

4. Abnormal uterine contractions

Uncoordinated contractions of the myometrium may cause menstrual blood to flow backwards, irritating the peritoneum and causing a tingling sensation. This type of pain is often sudden and severe, and may be accompanied by nausea and vomiting. Doctors may recommend phloroglucinol injection to relieve spasms, or use Yuanhu Zhitong Dropping Pills to regulate qi stagnation and blood stasis. It is especially important to keep the abdomen warm during menstruation.

5. Primary dysmenorrhea

Patients with congenital uterine dysplasia or cervical stenosis will still experience progressively worsening colic in the late menstrual period, and the pain may continue until the end of the menstrual period. The diagnosis needs to be confirmed by ultrasound examination. For long-term management, Sanjie Analgesic Capsules combined with low-frequency electrical stimulation can be used, and a menstrual diary can be established to record the pain pattern.

During menstruation, you should keep your abdomen warm, drink brown sugar ginger tea every day to promote the discharge of menstrual blood, and avoid strenuous exercise and heavy physical labor. Choose warm and tonic foods such as red dates and longan in your diet, and limit caffeine and salt intake. If the pain continues to worsen or fever or abnormal secretions occur, timely gynecological consultation is required to rule out organic diseases such as endometriosis. Record the duration, intensity and accompanying symptoms of each dysmenorrhea to provide reference for doctors' diagnosis.