Lower abdominal cramps and pain below the umbilicus are normal for most women and a normal part of their menstrual cycle. Implantation, the attachment of the embryo to the uterine lining, can also be associated with cramps and may signal a first pregnancy sign.

Possible reasons for cramps and cramping

Uterine cramps or cramping in the lower abdomen can have many possible causes. Mild cramps are often normal, but occasionally cramps can be a sign of bigger problems. When you have cramps, you should first ask yourself: "Am I pregnant?" A negative pregnancy test usually excludes a pregnancy. Uterine cramps are too non-specific to assume that you may be pregnant. Uterine cramps before you miss your period are rarely if ever, a reliable sign of pregnancy. Typical uterine cramps without being pregnant or before your menstrual period are usually caused by an increase in prostaglandin hormones, chemicals that increase shortly before your menstrual period. In general, among the many causes for cramps are:

• Implantation of the embryo
• Ovulation pain ("Mittelschmerz")
• Swollen ovaries after Clomid or other fertility medications
• Your period is about to come (PMS or premenstrual syndrome)
• Endometriosis
• Ectopic pregnancy
• Leiomyoma Uteri (uterine fibroids)
• Pelvic Inflammatory Disease (PID)
• Appendicitis
• Constipation
• Colitis
• Ovarian cysts
• Torsion of the ovary

To assess the possible cause of cramps, you should be able to answer the following questions:

1. Do I have a condition explaining the cramps?
2. Where are the cramps (very low, high, or above the uterus)?
3. Are the cramps located more in the middle, more on one or the other side, or all over?
4. Are they mild, moderate, or severe?
5. Are they rhythmic (for example, every 3-4 minutes or so)
6. How long do they last (minutes, hours, days)?
7. Do they happen only on certain days of the menstrual cycle (keep a diary)?
8. Do they typically go away when the menstrual period begins?

If in doubt, have your doctor examine you to find out what it could be.