Dysmenorrhea (Menstrual Cramps)

What is dysmenorrhea?

“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.

Types of dysmenorrhea

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.

Is having dysmenorrhea normal?

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.

What is the main cause of painful periods?

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.

Why are period cramps so painful?

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.

What are the symptoms of painful menstrual cramps?

If you have painful periods, you may feel:

• Aching, throbbing pain in your abdomen (pain may be severe at times).
• Feeling of pressure in your abdomen.
• Pain in your hips, lower back and inner thighs.
• Other symptoms like nausea, dizziness and headaches.

In most cases, the pain begins in the 24 to 48 hours before your period and subsides within 48 hours of getting your period.

How does secondary dysmenorrhea cause menstrual cramps?

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.

Who is more likely to have dysmenorrhea?

You may be more likely to have painful periods if:

• You got your first menstrual period before age 12.
• You’re younger than 20.
• Your periods are heavy or last longer than seven days.
• You smoke cigarettes.
• You have a biological parent who has dysmenorrhea.

Can there be complications of painful periods?

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.

How do I tell the difference between normal cramps and dysmenorrhea?

If you have severe or unusual menstrual cramps or cramps that last for more than three days, contact a healthcare provider. Both primary and secondary menstrual cramps are treatable, so it’s important to get checked.

First, your healthcare provider will ask you to describe your symptoms and menstrual cycles. They’ll perform a pelvic exam by placing gloved fingers into your vagina. During this exam, your provider will also insert a speculum into your vagina. This allows them to get a better look at your vagina and cervix. They may take a small sample of vaginal fluid for testing. The goal of the exam is to determine if a medical condition is causing painful periods. If there isn’t an apparent cause, your provider will diagnose you with primary dysmenorrhea.

However, if your provider thinks 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. Your provider 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 healthcare provider will discuss treatment with you.

How can you relieve menstrual cramps?

There are several things you can do to help relieve painful periods.

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.

Your healthcare provider 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

Your healthcare provider 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.

Other ways to reduce menstrual cramps

There are several treatments for menstrual cramps that don’t involve medication. Some of these are:

• Using a heating pad or hot water bottle on your lower back or abdomen when you have cramps.
• Getting extra rest.
• Avoiding foods that contain caffeine.
• Avoiding smoking cigarettes and drinking alcohol.
• Massaging your lower back and abdomen.
• Exercising regularly. People who exercise tend to have less menstrual pain.

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.

What types of alternative therapies help with period cramps?

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:

• Yoga.
• Acupuncture and acupressure.
• Relaxation or breathing exercises.
• Eating anti-inflammatory foods like leafy green vegetables, ginger and nuts, and drinking green tea.
• Taking supplements like vitamin D or magnesium, which may help reduce inflammation.

Can I prevent dysmenorrhea?

No, you can’t prevent it. However, eating a balanced diet and getting regular exercise may help stop cramps from being as intense.

When should you contact your healthcare provider about menstrual cramps?

Contact your healthcare provider if you have painful periods that prevent you from doing your normal tasks. Mild cramps are normal. But severe cramping and pain that prevent you from going to school or work may mean you need treatment.

It may be helpful to keep track of your periods and the days on which pain is the worst so you can tell your provider. If you notice other symptoms, like headaches or heavy bleeding, you should keep track of those, too.

Your provider will probably ask you when you started getting your period, how long your symptoms last, if you’re sexually active or if other people in your biological family have problems with their periods.

A note from Cleveland Clinic

Minor aches and pains during menstruation are normal. If you get extremely painful periods — dysmenorrhea — you don’t have to suffer silently. There are ways to make menstrual cramps less painful. Make sure you talk to your healthcare provider about painful periods so they can help you.