“Dysmenorrhea” is the medical term for painful periods (menstruation) or menstrual cramps. In addition to cramping, you might have other symptoms, such as nausea, fatigue and diarrhea. It’s most common to have menstrual cramps the day before or the day you start your period. For most people, symptoms subside after about two or three days.
Mild to moderate menstrual cramping is normal. But some people have such severe pain during their period that it interferes with their day-to-day life and prevents them from doing things they enjoy. Medication and other treatments can help with painful periods.
There are two types of dysmenorrhea: primary and secondary.
Primary dysmenorrhea
Primary dysmenorrhea is the name for menstrual cramps that come back every time you have get period, but aren’t due to another medical condition. Pain usually begins one or two days before you get your period or when the bleeding actually starts. You may feel pain ranging from mild to severe in your lower abdomen, back or thighs. The pain usually subsides within two or three days. Primary dysmenorrhea is the more common type of dysmenorrhea.
Secondary dysmenorrhea
If you have painful periods because of a condition or an infection in your reproductive organs, it’s secondary dysmenorrhea. Pain from secondary dysmenorrhea usually begins earlier in your menstrual cycle and lasts longer than typical menstrual cramps. For example, you may experience cramping several days before your period and the pain may last until the bleeding completely stops. Secondary dysmenorrhea is less common.
It’s normal to have some pain during menstruation. About 60% of people with a uterus have mild cramps during their period. About 5% to 15% of people report period pain that’s so severe that it affects their daily activities. However, this number is likely higher, as healthcare providers believe many people don’t report menstrual pain.
In most cases, painful periods become less painful as you get older. They may also improve after giving birth.
Menstrual cramps happen when a chemical called prostaglandin makes your uterus contract (tighten up). During menstruation, prostaglandin levels are higher, which means your uterus contracts more strongly. This is the cramping and discomfort you feel. These contractions help shed your uterine lining, which is the blood and tissue that comes out of your vagina during your period. Prostaglandin levels rise right before menstruation begins. Levels decrease once you get your period, which is why cramping tends to ease up after a few days.
What you’re feeling is a tightening and relaxing of your uterus. The muscles in your uterus contract in order to shed your uterine lining. Experts aren’t entirely sure why some people have more painful periods, but they think it may be because they have higher levels of prostaglandins. There also may not be a clear explanation other than everyone’s body is different.
If you have painful periods, you may feel:
In most cases, the pain begins in the 24 to 48 hours before your period and subsides within 48 hours of getting your period.
Menstrual pain from secondary dysmenorrhea is a result of a condition affecting your reproductive organs. Conditions that can cause cramping include:
Endometriosis: A condition where the tissue lining your uterus (the endometrium) grows outside of your uterus. Because these pieces of tissue bleed during your period, they can cause swelling, scarring and pain.
Adenomyosis: A condition where the lining of your uterus grows into the muscle of your uterus. This condition can cause your uterus to get much bigger than it should be, along with abnormal bleeding and pain.
Fibroids (benign tumors): Noncancerous growths on the inside, outside or in the walls of your uterus.
Pelvic inflammatory disease (PID): An infection caused by bacteria that starts in your uterus and can spread to other reproductive organs. PID can cause pain in your stomach or pain during sex.
Cervical stenosis: A condition where your cervix narrows due to surgery, treatment or other condition.
Congenital conditions: Certain conditions you’re born with can cause painful menstruation. This may include an irregularly shaped uterus or other conditions affecting your ovaries or fallopian tubes.
You may be more likely to have painful periods if:
Menstrual cramps themselves usually don’t cause complications, other than disrupting your daily life. But if a medical condition is causing painful periods, there can be complications. For example, conditions like endometriosis or pelvic inflammatory disease can lead to infertility or ectopic pregnancy. This is why it’s important to see a healthcare provider so they can rule out an underlying cause for your period pain.
If you have severe or unusual menstrual cramps or cramps that last for more than three days, contact an IWI team member. Both primary and secondary menstrual cramps are treatable, so it’s important to get checked.
First, we will ask you to describe your symptoms and menstrual cycles. A pelvic exam is part of the evaluation. The goal of the exam is to determine if a medical condition is causing painful periods.
However, if there is a concern you may have secondary dysmenorrhea (caused by another health condition), you may need additional tests. Imaging and other diagnostic tests allow your provider to get a better look at your uterus and other reproductive organs. We may recommend:
Ultrasound: Ultrasound uses sound waves to create images of your uterus, ovaries and other reproductive organs.
Hysteroscopy: Your provider uses a thin, lighted device to see inside your uterus. The device transmits images of your uterus to a screen.
Laparoscopy: Your provider makes tiny incisions in your abdomen and then uses a laparoscope (a thin tube with a light and camera at the end) to view your pelvic organs.
If those tests show you have a medical condition causing painful menstruation, your IWI team member will discuss treatment with you.
There are several things you can do to help relieve painful periods like:
NSAIDs and other pain relievers — Pain relievers called nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first treatment for dysmenorrhea. These include medications like ibuprofen or naproxen, which you can buy at your local drug or grocery store. They work by reducing the amount of prostaglandins in your body. It’s best to take these as soon as cramping begins. If you can’t take NSAIDs, you can take another pain reliever like acetaminophen.
The IWI team can also prescribe medications for you, including ibuprofen or another anti-inflammatory medication at a higher dose than is available over the counter.
Hormonal medications — We might also suggest hormonal birth control as a treatment. People who take hormonal medications tend to have less menstrual pain. This could include birth control options like the pill, patch or vaginal ring.
There are several treatments for menstrual cramps that don’t involve medication. Some of these are:
If testing shows that you have secondary dysmenorrhea, your provider will discuss treatment for the condition causing you pain. This might mean oral contraceptives, other types of medications or surgery.
People who have painful periods often try to find natural ways of dealing with the pain. Studies on alternative or complementary methods haven’t been conclusive about results. Some natural methods for relieving period pain include:
No, you can’t prevent it. However, eating a balanced diet and getting regular exercise may help stop cramps from being as intense.
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