Dysmenorrhea

Overview

What is are menstrual cramps?

Dysmenorrhea is the medical term for pain with your period (menstruation) or menstrual cramps. There are two types of dysmenorrhea: primary and secondary.

Primary dysmenorrhea is the name for common menstrual cramps that come back over and over again (recurrent) and aren’t due to other diseases. Pain usually begins one or two days before you get your period or when bleeding actual starts. You may feel pain ranging from mild to severe in the lower abdomen, back or thighs.

Pain can typically last 12 to 72 hours, and you might have other symptoms, such as nausea and vomiting, fatigue, and even diarrhea. Common menstrual cramps may become less painful as you get older and may stop entirely if you have a baby.

If you have painful periods because of a disorder or an infection in your female reproductive organs, it is called secondary dysmenorrhea. Pain from secondary dysmenorrhea usually begins earlier in the menstrual cycle and lasts longer than common menstrual cramps. You usually don’t have nausea, vomiting, fatigue or diarrhea.

Symptoms and Causes

What causes painful menstrual cramps?

Menstrual cramps happen when a chemical called prostaglandin makes the uterus contract (tighten up). The uterus, the muscular organ where a baby grows, contracts throughout your menstrual cycle. During menstruation, the uterus contracts more strongly. If the uterus contracts too strongly, it can press against nearby blood vessels, cutting off the supply of oxygen to muscle tissue. You feel pain when part of the muscle briefly loses its supply of oxygen.

How does secondary dysmenorrhea cause menstrual cramps?

Menstrual pain from secondary dysmenorrhea is a result of problems with the reproductive organs. Conditions that can cause cramping include:

  • Endometriosis: A condition in which the tissue lining the uterus (the endometrium) is found outside of the uterus. Because these pieces of tissue bleed during your period, they can cause swelling, scarring and pain.
  • Adenomyosis: A condition where the lining of the uterus grows into the muscle of the uterus. This condition can cause the uterus to get much bigger than it should be, along with abnormal bleeding and pain.
  • Pelvic inflammatory disease (PID): An infection caused by bacteria that starts in the uterus and can spread to other reproductive organs. PID can cause pain in the stomach or pain during sex.
  • Cervical stenosis: Narrowing of the cervix, or the opening to the uterus.
  • Fibroids (benign tumors): Growths on the inside, outside or in the walls of the uterus

What are the symptoms of menstrual cramps?

If you have painful periods, you may have:

  • Aching pain in the abdomen (pain may be severe at times).
  • Feeling of pressure in the abdomen.
  • Pain in the hips, lower back and inner thighs.

Diagnosis and Tests

How can you tell if the pain of your menstrual cramps is normal?

If you have severe or unusual menstrual cramps or cramps that last for more than two or three days, contact your healthcare provider. Both primary and secondary menstrual cramps can be treated, so it's important to get checked.

First, you will be asked to describe your symptoms and menstrual cycles. Your healthcare provider will also perform a pelvic exam. During this exam, your provider inserts a speculum (an instrument that lets the provider see inside the vagina). The provider is able to examine your vagina, cervix and uterus. The doctor will feel for any lumps or changes. They may take a small sample of vaginal fluid for testing.

If your provider thinks you may have secondary dysmenorrhea, you may need additional tests, such as an ultrasound or a laparoscopy. If those tests indicate a medical problem, your healthcare provider will discuss treatments.

If you use tampons and develop the following symptoms, get medical help right away: over 102 degrees Fahrenheit.

  • Fever.
  • Vomiting.
  • Diarrhea.
  • Dizziness, fainting or near fainting.
  • A rash that looks like a sunburn.

These are symptoms of toxic shock syndrome, a life-threatening illness.

Management and Treatment

How can you relieve mild menstrual cramps?

To relieve mild menstrual cramps:

  • For the best relief, take ibuprofen as soon as bleeding or cramping starts. Ibuprofen belongs to a class of drugs called non-steroidal anti-inflammatory drugs (NSAIDs). They reduce the output of prostaglandins. If you can’t take NSAIDs, you can take another pain reliever like acetaminophen.
  • Place a heating pad or hot water bottle on your lower back or abdomen.
  • Rest when needed.
  • Avoid foods that contain caffeine.
  • Avoid smoking and drinking alcohol.
  • Massage your lower back and abdomen.

Women who exercise regularly often have less menstrual pain. To help prevent cramps, make exercise a part of your weekly routine.

If these steps don’t relieve pain, your healthcare provider can order medications for you, including ibuprofen or another anti-inflammatory medication in a higher dose that is available over the counter. Your healthcare provider might also suggest oral contraceptives since women who take oral contraceptives tend to have less menstrual pain.

If testing shows that you have secondary dysmenorrhea, your provider will discuss treatments of the condition causing the pain. This might mean oral contraceptives, other types of medications, or surgery.

What types of alternative therapies might help with menstrual cramping?

Women who have painful periods often try to find natural ways of dealing with the pain. Studies on alternative or complementary methods have not been conclusive about results. Remember that most supplements are not regulated by the FDA. Other methods that you might find useful include:

  • Yoga.
  • Massage.
  • Acupuncture and acupressure.
  • Relaxation or breathing exercises.

Prevention

Can you prevent menstrual cramps?

The answer is “probably not.” However, eating a balanced diet and getting regular exercise may help stop cramps from being as intense.

Living With

When should you contact your healthcare provider about menstrual cramps?

Bad cramps keep some women from working and going to school. You don’t have to suffer and you don’t have to put your life on hold. Contact your healthcare provider if you have painful periods.

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

Your provider will probably ask you when you started getting your period, how long they last, if you are sexually active, if other women in your family have problems with their periods and what kinds of treatments you might have tried already.

A note from Cleveland Clinic

Menstruation is normal. You might get cramps, but you don’t have to suffer silently with them. There are ways to make painful periods less painful. Make sure you talk to your healthcare provider about painful periods.

Last reviewed by a Cleveland Clinic medical professional on 11/20/2020.

References

  • Office on Women’s Health. Accessed 11/20/2020.Menstrual Cycle. (https://www.womenshealth.gov/menstrual-cycle)
  • American College of Obstetricians and Gynecologists. . Accessed 11/20/2020.Dysmenorrhea: Painful Periods (https://www.acog.org/patient-resources/faqs/gynecologic-problems/dysmenorrhea-painful-periods)
  • InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. 2008 Feb 22 [Updated 2019 Aug 1]. Accessed 11/20/2020.Period pain: Overview. (https://www.ncbi.nlm.nih.gov/books/NBK279324/)
  • Fisher C, Adams J, Hickman L, Sibbritt D. The use of complementary and alternative medicine by 7427 Australian women with cyclic perimenstrual pain and discomfort: a cross-sectional study. BMC Complement Altern Med. 2016;16:129.
  • Nagy H, Khan MAB. [Updated 2020 Jul 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Accessed 11/20/2020.Dysmenorrhea. (https://www.ncbi.nlm.nih.gov/books/NBK560834/)

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