“8 Powerful Explanations Why Do Period Cramps Hurt So Bad And How To Heal Faster?”

“Why do period cramps hurt so bad?” is a question many people ask. During your period, your uterus contracts to help shed its lining, and these contractions can be very painful as a result period cramps pain happens and hurt so bad because the muscles in the uterus tighten and push out the lining.

Hormones called prostaglandins control these contractions, and higher levels of them can make the cramps feel stronger. Blood flow to the uterus is reduced during these contractions, which can cause a lack of oxygen and make the pain worse. Some people experience worse cramps due to conditions like endometriosis or hormonal imbalances.

8 Powerful Explanations: Why Do Period Cramps Hurt So Bad

Here’s a detailed study of why do period cramps hurt so bad with 8 powerful explanations:

1.Uterine Contractions and Period Cramps

What Are Uterine Contractions? 

Uterine contractions are type of rhythmic tightening and relaxing of the uterine muscles. These contractions occur naturally during various stages of life, including: 

– Menstruation: It helps to shed the uterine lining. 

– Labor: To assist in childbirth. 

– Ovulation: Mild contractions guide the egg through the fallopian tubes.

During menstruation, uterine contractions play a central role in expelling the uterine lining, which results in period cramps.

How Uterine Contractions Cause Period Cramps 

During your period: 

1. Prostaglandins Trigger Contractions: 

   – Prostaglandins, hormone-like substances, are released in the uterine lining. 

   – These chemicals cause the uterine muscles to contract to shed the endometrium (uterine lining). 

   – Higher levels of prostaglandins lead to stronger, more painful contractions.

2. Restricted Blood Flow: 

   – Intense contractions can compress blood vessels in the uterus. 

   – Reduced blood and oxygen supply to the uterine muscles result in pain or cramping sensations.

3. Nerve Involvement: 

   – The uterus has a dense network of nerves. 

   – As it contracts, these nerves send pain signals to the brain, intensifying the sensation of cramps.

Why Are Some Contractions More Painful Than Others? 

– Prostaglandin Levels: Higher levels lead to stronger contractions and more severe cramps. 

– Uterine Size and Sensitivity: A smaller or overly sensitive uterus may cramp more painfully. 

– Underlying Conditions: Conditions like endometriosis, fibroids, or adenomyosis can make contractions more painful. 

– Stress and Hormonal Imbalances: These can heighten sensitivity to pain.

Consult a healthcare provider for evaluation and treatment options.

2.Endometriosis and Its Effect on Period Cramps 

Endometriosis is a type of chronic condition where tissue similar to the lining of the uterus (endometrium) sometimes grows outside the uterus. This tissue can attach to the ovaries, fallopian tubes, outer surface of the uterus, or other organs in the pelvic region. Despite being outside the uterus, this tissue responds to hormonal changes during the menstrual cycle, leading to inflammation, scarring, and pain.

How Endometriosis Affects Period Cramps

Endometriosis can significantly worsen period cramps for several reasons: 

1. Inflamed Tissue 

   – Endometrial-like tissue outside the uterus thickens and breaks down during menstruation. 

   – Unlike normal uterine tissue, this displaced tissue cannot exit the body, causing inflammation, irritation, and severe pain. 

2. Adhesions and Scarring 

   – Repeated inflammation can lead to scar tissue (adhesions) forming between organs. 

   – These adhesions can “stick” organs together, making menstrual cramps more intense and persistent. 

3. Prostaglandin Overproduction 

   – Endometriosis is often associated with high levels of prostaglandins, which exacerbate uterine contractions and increase the severity of cramps. 

4. Nerve Involvement

   – Endometrial-like tissue can grow near or on pelvic nerves, directly irritating them and amplifying pain signals during menstruation. 

5. Pelvic Congestion

   – Chronic inflammation may lead to a sensation of fullness or heaviness in the pelvic area, worsening cramps during menstruation.

Symptoms of Endometriosis-Related Cramps 

Cramps caused by endometriosis are typically more severe and may present as: 

– Pain starting several days before the period and lasting longer than usual. 

– Sharp or stabbing pain that is more intense than typical menstrual cramps. 

– Pain during bowel movements or urination, especially during the period. 

– Pain radiating to the lower back or legs. 

-Diagnosis of Endometriosis

Diagnosing endometriosis requires a thorough medical evaluation, which may include: 

– Pelvic Exam: To detect abnormalities. 

– Imaging Tests: Ultrasound or MRI to visualize the pelvic organs. 

– Laparoscopy: A minimally invasive surgical procedure to confirm the presence of endometrial-like tissue.

Endometriosis is a leading cause of severe period cramps, but with proper treatment and management, its impact on quality of life can be significantly reduced. Always consult a healthcare provider for an accurate diagnosis and personalized treatment plan.

3.Period Cramps and Fibroids 

Fibroids, or uterine leiomyomas, are noncancerous growths that develop in or on the uterus. These growths can vary in size and location, and while they are often asymptomatic, they can significantly worsen period cramps and other menstrual symptoms for some individuals. 

How Fibroids Contribute to Period Cramps 

1. Increased Uterine Contractions

   – Fibroids can make the uterus work harder to expel its lining during menstruation. 

   – This increased effort leads to stronger uterine contractions, resulting in more severe cramps. 

2. Obstruction of Blood Flow 

   – Large or multiple fibroids can interfere with normal blood flow in the uterus. 

   – This restriction can cause ischemia (reduced oxygen supply), leading to pain during menstruation. 

3. Hormonal Influence 

   – Fibroids are in most cases estrogen- and progesterone-sensitive. Hormonal fluctuations during the menstrual cycle can stimulate fibroid growth, causing additional pressure and discomfort. 

4. Inflammation 

   – Fibroids can trigger localized inflammation in the uterus, which may heighten cramping and discomfort during periods. 

5. Pressure on Surrounding Organs 

   – Fibroids can press on nearby structures like the bladder or bowel, exacerbating pain and contributing to symptoms such as bloating or pelvic discomfort. 

Symptoms of Period Cramps Associated with Fibroids

– Severe cramps that are more intense than usual. 

– Pain radiating to the lower back or legs. 

– Sometimes Prolonged periods lasting more than seven days. 

– Heavy menstrual bleeding (menorrhagia), often accompanied by blood clots. 

– Pelvic pressure or a feeling of fullness. 

– Pain during intercourse or bowel movements, especially around menstruation. 

Types of Fibroids and Their Impact on Cramps

The location of fibroids can influence how they affect period cramps: 

1. Submucosal Fibroids: Located beneath the uterine lining, these can distort the uterus, causing heavy bleeding and severe cramps. 

2. Intramural Fibroids: Embedded in the uterine wall, they increase the uterus’s overall size and contraction intensity, worsening cramps. 

3. Subserosal Fibroids: On the outer surface of the uterus, they may cause pressure on nearby organs but typically don’t contribute as much to cramping. 

4. Pedunculated Fibroids: Attached to the uterus by a stalk, these can cause sharp pain if the stalk twists. 

Fibroids are a common cause of intense period cramps, but with appropriate treatment, symptoms can be effectively managed. Early diagnosis and intervention are key to improving comfort and overall quality of life.

4.Adenomyosis and Period Pain 

Adenomyosis is a condition where the tissue lining the uterus (endometrium) grows into the muscular wall of the uterus (myometrium). This condition can cause the uterus to become enlarged, tender, and inflamed, leading to severe period pain and other menstrual issues. 

How Adenomyosis Causes Period Pain

1. Uterine Enlargement and Sensitivity 

   – The invasion of endometrial tissue into the uterine muscles causes the uterus to thicken and enlarge. 

   – This makes the uterus more sensitive to contractions, amplifying pain during menstruation. 

2. Increased Uterine Contractions 

   – To shed its lining, the uterus contracts harder, especially in cases of adenomyosis. 

   – These stronger contractions lead to more intense cramps. 

3.Inflammation and Swelling 

   – The embedded tissue responds to hormonal signals, thickening and breaking down during the menstrual cycle. 

   – This process causes inflammation and swelling within the uterine wall, contributing to pain. 

4. Trapped Blood 

   – Blood from the misplaced endometrial tissue gets trapped within the uterine muscles, causing localized pressure and pain. 

Symptoms of Period Pain Caused by Adenomyosis

– Severe, cramp-like pelvic pain during menstruation. 

– Pain that starts several days before the period and persists after it ends. 

– A feeling of heaviness or pressure in the lower abdomen. 

– Pain that radiates to the lower back or thighs. 

– In some cases Heavy or prolonged menstrual bleeding (menorrhagia). 

– Painful intercourse (dyspareunia) or pelvic discomfort. 

-How Adenomyosis Differs From Other Causes of Period Pain 

While adenomyosis shares some symptoms with conditions like endometriosis and fibroids, it is distinct in its location and impact: 

– Adenomyosis involves the uterine muscle itself, whereas endometriosis occurs outside the uterus. 

– Unlike fibroids, which are localized growths, adenomyosis causes a diffuse thickening of the uterine wall. 

Adenomyosis is a significant cause of severe period pain, but with the right treatment, symptoms can be effectively managed. Early diagnosis and personalized care are essential for improving quality of life. Always consult a healthcare provider if you suspect adenomyosis.

4.Pelvic Inflammatory Disease (PID) and Period Cramps

Pelvic Inflammatory Disease (PID) is a type of an infection of the female reproductive organs, in which includes the uterus, fallopian tubes, and ovaries. It is often caused by untreated sexually transmitted infections (STIs) such as chlamydia or gonorrhea but can also result from other bacterial infections. PID can cause significant pelvic pain, including worsening period pain.

How PID Contributes to Period Pain

1. Inflammation 

   – PID causes inflammation in the reproductive organs, which can lead to heightened sensitivity and pain during menstruation. 

2. Scar Tissue Formation

   – Chronic PID can lead to scarring and adhesions in the uterus, fallopian tubes, and ovaries. 

   – These adhesions may restrict normal uterine contractions, causing more intense cramping during periods. 

3. Worsened Blood Flow 

   – Inflammation and scarring can impair blood flow during menstruation, leading to more severe pain. 

4. Infection-Related Discomfort 

   – Active infection during menstruation can exacerbate pain and other symptoms like pelvic pressure, bloating, or lower back pain. 

Symptoms of PID-Related Period Pain 

– Severe pelvic or lower abdominal pain, especially during menstruation. 

– Pain that is constant and worsens with movement or during intercourse. 

– Abnormal or heavy menstrual bleeding. 

– Painful urination or bowel movements during menstruation. 

– Fever, fatigue, or chills if the infection is active. 

– In some cases Vaginal discharge with an unusual odor. 

Complications of PID-Related Period Pain 

If left untreated, PID can lead to: 

– Chronic Pelvic Pain: Persistent pain even outside of menstruation. 

– Infertility: Scarring of the fallopian tubes can block them, preventing conception. 

– Ectopic Pregnancy: One can experience the Scarring increases the risk of a fertilized egg implanting outside the uterus. 

– Abscess Formation: Infected fluid pockets can form in the ovaries or fallopian tubes, causing severe pain and complications. 

Pelvic Inflammatory Disease can significantly worsen period pain and lead to long-term reproductive health complications if not treated promptly. If you experience symptoms of PID or severe period pain, consult a healthcare provider immediately for diagnosis and treatment.

5.The Role of Stress in Period Cramps 

Stress can significantly impact the severity of period cramps, also known as dysmenorrhea. While period pain is primarily caused by uterine contractions and prostaglandins, stress can exacerbate these symptoms by affecting hormone levels, pain perception, and overall body functioning.

How Stress Worsens Period Cramps

1. Hormonal Imbalances 

   – Stress increases the production of cortisol, the body’s primary stress hormone. 

   – Elevated cortisol levels can interfere with the balance of reproductive hormones like estrogen and progesterone, leading to more intense uterine contractions and worsening cramps.

2. Heightened Pain Sensitivity 

   – Stress affects the brain’s processing of pain signals. 

   – Chronic or acute stress lowers the pain threshold, making menstrual cramps feel more severe.

3. Increased Prostaglandin Production

   – Stress can indirectly raise levels of prostaglandins, hormone-like chemicals responsible for uterine contractions and inflammation. 

   – High prostaglandin levels are associated with stronger cramps and pain.

4. Muscle Tension 

– Stress often causes tension in the pelvic muscles, which can worsen cramping and contribute to discomfort in the lower abdomen, back, and thighs.

5. Digestive Issue 

   – Stress affects digestion, potentially leading to bloating or constipation, which can exacerbate period pain.

6. Immune System Suppression 

   – Prolonged stress weakens the immune system, potentially worsening inflammation during menstruation and prolonging recovery.

Symptoms of Stress-Exacerbated Period Cramps 

– More intense and prolonged cramps. 

– Pain spreading to the back and thighs. 

– Increased irritability or emotional sensitivity. 

– Accompanying digestive issues like bloating or nausea. 

– Heavier or irregular periods due to hormonal imbalances.

Managing Period Cramps Aggravated by Stress

1. Stress-Reduction Techniques

   – Meditation and Mindfulness: Calm the nervous system and reduce cortisol levels. 

   – Deep Breathing Exercises: Help relax pelvic muscles and alleviate cramps. 

   – Yoga: Combines physical stretches with relaxation to reduce both stress and pain. 

2. Physical Activity 

   – Exercise releases endorphins, natural painkillers that reduce stress and improve mood. 

   – Even light activities like walking or stretching can be beneficial. 

3. Sleep Hygiene 

   – Poor sleep worsens both stress and period pain. Need to take 7–9 hours of restful sleep each night. 

4. Balanced Nutrition 

   – Reduce caffeine, sugar, and processed foods, which can amplify stress and inflammation. 

   – Include magnesium-rich foods (nuts, leafy greens) and omega-3s (salmon, flaxseeds) to support muscle relaxation and hormone balance. 

5. Hydration 

   – Staying hydrated can prevent bloating and reduce the severity of cramps. 

6. Therapeutic Practices 

   – Heat Therapy: Use heating pads to relax muscles and reduce stress-induced tension. 

   – Massage Therapy: Focus on the lower abdomen or back to relieve cramping and stress. 

7. Professional Support 

   – If stress is chronic or severe, consider therapy or counseling to develop effective coping mechanisms.

When to Seek Medical Advice 

– Period cramps become unusually severe or interfere with daily activities. 

– Stress is leading to irregular periods or other health issues. 

– Over-the-counter pain relief and stress management techniques are ineffective. 

Stress is a key factor that can amplify period cramps. Addressing stress through lifestyle changes, relaxation techniques, and professional support can significantly alleviate both stress and menstrual discomfort, improving overall well-being.

6. Nerve Sensitivity In Why Do Period Cramps Hurt So Bad

The uterus is rich in nerves that can amplify pain signals. 

– During menstruation, hormonal changes can make these nerves more sensitive, intensifying the perception of pain. 

– Some people are genetically predisposed to have a heightened sensitivity to pain, making cramps feel worse.

7. Period Cramps And Inflammatory Response

The production of prostaglandins is part of the body’s inflammatory response. 

– A higher inflammatory response can lead to excessive prostaglandin production, increasing the intensity of uterine contractions and associated pain. 

8. Lifestyle Factors

Certain lifestyle factors can also contribute to the severity of period cramps: 

– Poor Diet: High intake of processed foods, caffeine, or sugar can worsen inflammation and cramps.

Foods to Avoid

Certain foods can aggravate menstrual symptoms, making cramps more intense.

• Salt: Excessive sodium can lead to water retention, causing bloating and discomfort. Reducing processed foods like chips, fast food, and packaged snacks can help mitigate these issues.
• Sugar: High sugar intake can contribute to inflammation and worsen cramps. Refined sugars found in sugary snacks, sodas, and processed foods should be limited.
• Caffeine: Caffeine is a stimulant that can constrict blood vessels and worsen bloating and cramping. Limiting caffeine-rich drinks like coffee, tea, and energy drinks can reduce discomfort.

Supplements

In addition to whole foods, some people find that certain supplements can help manage period cramps:

• Fish oil: Taking omega-3 supplements may help reduce inflammation and pain.
• Calcium: Calcium helps reduce muscle cramps and balance hormones. It can be found in dairy products, leafy greens, or taken as a supplement.
• Vitamin D: Some studies suggest that vitamin D can reduce the intensity of period cramps by reducing inflammation and muscle pain.

Overall, maintaining a balanced diet that includes anti-inflammatory foods, magnesium, omega-3s, and vitamins like B6 and D can significantly ease the severity of period cramps.

– Lack of Exercise: Physical inactivity can reduce blood circulation, which might aggravate cramps.

While it might seem counterintuitive to engage in physical activity during menstruation, research and many personal accounts show that exercise can be highly beneficial for managing menstrual discomfort.

1. Improving Blood Circulation

Exercise helps increase blood flow and oxygen to the uterus and surrounding tissues. This improved circulation can help relieve cramps by promoting the relaxation of the uterine muscles, which are often in a contracted state during menstruation.

2. Releasing Endorphins

Physical activity stimulates the release of endorphins, the body’s natural painkillers. Endorphins not only help improve mood but also act as analgesics, reducing pain perception and promoting a sense of well-being.

3. Reducing Inflammation

Regular physical activity has been shown to reduce inflammation in the body, which is a common cause of pain and cramping.

4. Releasing Muscle Tension

Exercise helps reduce muscle tension throughout the body. Activities like stretching, yoga, and Pilates can target the lower abdomen and pelvic area, promoting relaxation of the muscles that might be contributing to cramping.

5. Improving Mood and Reducing Stress

Menstrual cramps can be exacerbated by stress and anxiety, which are common during menstruation due to hormonal changes. This improved mental state can make it easier to cope with pain and discomfort.

6. Type of Exercise

Not all types of exercise are equally beneficial during menstruation. Low-impact exercises such as walking, swimming, cycling, and yoga are generally recommended during your period.

Incorporating exercise into your routine during menstruation can significantly reduce the severity of period cramps.

Why the Pain Varies

– Some people experience minimal cramps due to lower prostaglandin levels or a less sensitive nervous system. 

– For others, severe cramps may indicate higher prostaglandin levels, underlying health conditions, or increased sensitivity to hormonal changes.

Period cramps hurt due to a combination of biological, hormonal, and lifestyle factors. Understanding these causes can help in managing and reducing the pain effectively. If cramps are unusually severe or disrupt daily life, seeking medical advice is essential.

How to Relieve Period Cramps 

Period cramps, or dysmenorrhea, can range from mild to severe and disrupt daily life. Fortunately, there are several effective remedies to alleviate the discomfort and to relieve bad period cramps. Here’s a comprehensive guide to relieving period cramps:

1. Home Remedies 

a. Heat Therapy 

– Apply a heating pad, hot water bottle, or warm compress to your lower abdomen or lower back. 

– Heat relaxes uterine muscles and improves blood flow, reducing cramping. 

b. Hydration 

– Drink plenty of water to reduce bloating, which can make cramps feel worse. 

– Warm beverages like herbal teas (e.g., chamomile, ginger) can soothe pain and reduce inflammation. 

c. Gentle Exercise 

– Light activities like walking, yoga, or stretching increase blood circulation and release endorphins, which are natural painkillers. 

– Specific yoga poses like the child’s pose or cat-cow stretch can help relieve pelvic tension. 

d. Massage Therapy 

– Gently massage your lower abdomen in circular motions with essential oils like lavender, peppermint, or clary sage. 

– Massage increases circulation and reduces muscle tension. 

e. Adequate Rest 

– Prioritize sleep and rest, especially during heavy cramping days. Elevate your legs or lie on your side in the fetal position to ease discomfort. 

2. Over-the-Counter Medications 

a. NSAIDs 

– Nonsteroidal anti-inflammatory drugs (e.g., ibuprofen, naproxen) reduce inflammation and block prostaglandins that cause pain. 

– Take them at the onset of cramps for best results. 

b. Acetaminophen 

– Can be used if NSAIDs are not suitable but is generally less effective for period pain. 

3. Hormonal Birth Control 

– Birth control pills, patches, injections, or hormonal IUDs regulate menstrual cycles and reduce the severity of cramps by stabilizing hormone levels. 

– Consult a healthcare provider to determine the best option for you. 

4. Dietary Adjustments

a. Anti-Inflammatory Foods 

– Incorporate omega-3 fatty acids (salmon, walnuts), leafy greens, and antioxidant-rich fruits (berries) to reduce inflammation. 

b. Reduce Trigger Foods 

– Avoid caffeine, alcohol, salty foods, and processed snacks, which can worsen bloating and discomfort. 

c. Magnesium-Rich Foods 

– Foods like spinach, almonds, and bananas may help relax muscles and reduce cramping. 

5. Alternative Therapies

a. Acupuncture 

– Stimulates specific points to improve blood flow, reduce inflammation, and alleviate cramps. 

b. Aromatherapy 

– Using calming scents like lavender or eucalyptus can reduce stress and muscle tension associated with cramps. 

c. Herbal Remedies 

– Herbal teas like ginger, cinnamon, and fennel have natural anti-inflammatory and pain-relieving properties. 

6. Long-Term Management

a. Maintain a Healthy Weight 

– Excess weight can worsen period cramps by increasing inflammation and prostaglandin levels. 

b. Regular Exercise 

– Routine physical activity boosts circulation and helps manage hormone levels, reducing cramps over time. 

c. Stress Reduction 

– Practice mindfulness, yoga, or deep breathing to reduce the impact of stress on menstrual pain. 

When to See a Doctor 

– Cramps are so severe that they interfere with daily life. 

– Over-the-counter medications and home remedies provide little to no relief. 

– You experience additional symptoms like heavy bleeding, fever, or unusual discharge. 

– You suspect an underlying condition like endometriosis, fibroids, or pelvic inflammatory disease.

By combining these remedies and preventive measures, you can effectively reduce period cramps and improve your overall menstrual experience. Always consult a healthcare provider for personalized advice if symptoms persist.

FAQ 

1. What causes period cramps to be so severe?
Higher levels of prostaglandins can cause stronger contractions, leading to more intense cramps. Conditions like endometriosis, fibroids, or hormonal imbalances can also make cramps more painful.

2. Are period cramps normal?
Mild to moderate cramps are common during menstruation, but severe pain that interferes with daily life may signal an underlying health issue, like endometriosis or uterine fibroids.

3. Why do some people experience more pain than others?
Genetics, the presence of health conditions like endometriosis, and hormonal differences can affect the severity of period cramps. Some may experience them more intensely based on these factors.

4. Can period cramps be prevented?
While it’s not always possible to prevent period cramps, maintaining a healthy lifestyle, managing stress, and using hormonal birth control may help reduce their severity. Regular exercise and a balanced diet can also ease symptoms for some people.

5. Are there any natural remedies for period cramps?
Natural remedies like herbal teas (ginger or chamomile), acupuncture, or yoga may help alleviate period cramps. Additionally, magnesium supplements and consuming anti-inflammatory foods could provide some relief.

6. When should I see a doctor for period cramps?
If cramps are extremely painful, last longer than usual, or are accompanied by heavy bleeding or other unusual symptoms, it’s important to consult a healthcare provider. This could indicate conditions like endometriosis or fibroids that need treatment.

7. Can diet affect period cramps?
Yes, what you eat can impact period cramps. Foods help with period cramps are a diet rich in anti-inflammatory foods, like fruits, vegetables, and omega-3 fatty acids, may help reduce pain. Avoiding excess salt, caffeine, and processed foods can also prevent bloating and worsen symptoms.

8. Do period cramps get worse with age?
Period cramps can vary for each person. Some may experience more intense cramps as they age due to conditions like fibroids or endometriosis, while others may find their cramps decrease over time, especially after giving birth or during perimenopause.

9. Where are period cramps located?

Period cramps are located in the lower abdomen, just below the belly button. They can also radiate to the lower back, hips, and thighs. The intensity of the pain varies, with some experiencing sharp, throbbing sensations or a dull ache as the uterus contracts during menstruation.

10. What is a period flu?

Period flu refers to the flu-like symptoms some individuals experience before or during menstruation. These symptoms can include fatigue, headaches, body aches, chills, nausea, and mood swings. It is believed to be linked to hormonal fluctuations, particularly changes in estrogen and progesterone levels during the menstrual cycle.

11. How to treat period flu?

To treat period flu, manage symptoms with over-the-counter pain relievers like ibuprofen or acetaminophen for headaches and body aches. Stay hydrated, rest, and use a heating pad for cramps. Eating balanced meals and light exercise can also help alleviate discomfort. Consult a doctor if symptoms worsen.

Conclusion

 Thus “Why Do Period Cramps Hurt So Bad” can be intensely due to the contraction of the uterus as it sheds its lining, a process driven by hormone-like substances called prostaglandins. High levels of these substances can lead to stronger contractions and reduced blood flow, intensifying the pain. Factors such as hormonal imbalances, underlying health conditions like endometriosis, and individual pain sensitivity can also contribute to the severity of the cramps. Understanding the causes behind this discomfort can help in managing and alleviating pain through various treatments, ranging from lifestyle adjustments to medical interventions.

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