Menstrual cramps are a common period symptom for many. They usually start a day before your period and come and go over the next few days.
Painful, frequent, and debilitating cramps, however, are not normal. Dysmenorrhea is the medical term for this type of severe menstrual pain and frequent cramps during menstruation (a period). This pain can last anywhere from a few hours to a few days, and it is often accompanied by symptoms like nausea and vomiting. You may find the symptoms uncomfortable and difficult to manage.
Primary dysmenorrhea refers to severe pain and cramping that started when you first got your period. Often, it continues throughout your life.
Causes of dysmenorrhea
Primary dysmenorrhea results from an excess of a chemical known as prostaglandin in your uterus. Your uterus releases prostaglandin as it sheds its lining, and it causes inflammation and contraction of the uterus’ blood vessels and muscles. These uterine contractions help push out menstrual blood and tissue. However, strong contractions can push against nearby blood vessels and temporarily cut off the uterus’s blood supply. When this happens, you experience severe period pain.
Secondary dysmenorrhea is caused by an underlying health condition that leads to pain during your period.
Common causes of secondary dysmenorrhea include:
- Endometriosis: This is a condition where tissue from your uterine lining grows outside of your uterus. It continues to respond to the hormones that drive your period, but the blood has nowhere to go. This usually leads to pain and scarring.
- Adenomyosis: This condition is when tissue from your uterus lining grows into the wall of your uterus, causing your uterus to be larger than it should and leading to heavy bleeding.
- Pelvic inflammatory disease: This disease happens when an untreated infection causes inflammation and scarring in your pelvis.
- Uterine fibroids: Fibroids are non-cancerous growths in or on the uterus. While most fibroids are asymptomatic, some can cause heavy menstrual bleeding and pain during your period.
- Uterine cancer and cervical cancer can both cause dysmenorrhea symptoms.
Risks for painful periods
Anyone can have painful periods. But your risks for experiencing dysmenorrhea increase if you:
- Are under 20 years old. Primary dysmenorrhea tends to affect young people the most.
- Are overweight or obese.
- Drink alcohol during your period.
- Have never been pregnant.
- Have a family history of dysmenorrhea, endometriosis, or adenomyosis.
- Have previously or repeatedly had pelvic infections like STIs.
- Have never given birth.
- Smoke cigarettes.
- Started your period early (before age 11).
Dysmenorrhea symptoms vary from person to person. However, the most common symptoms include:
- Cramping or aching in the lower belly.
- Feeling pressure in the lower abdomen.
- Heavy menstrual bleeding (menorrhagia)
- Hip pain.
- Lower back pain.
- Pain in the lower belly.
- Pain spreading down the legs.
- Passing large blood clots.
Cramps are a normal part of periods. However, if your cramps get in the way of your daily activities or are accompanied by fever, nausea, or vomiting, you should talk with your healthcare provider.
How are painful periods diagnosed?
Your healthcare provider will ask about your medical and family history and your overall health. They will also ask you about your normal menstrual cycle, when you started menstruating, and what symptoms you experience.
From there, you will receive a pelvic exam. Your doctor will examine your uterus, cervix, and vagina for any lumps, changes, or abnormalities that may be causing your symptoms.
Your doctor may also order other tests, including:
- Hysteroscopy. Using a viewing instrument inserted through the vagina, your healthcare provider can see the cervix and the inside of the uterus.
- Laparoscopy. This minor procedure uses a laparoscope, a viewing instrument with a light, to see your uterus and pelvis. The laparoscopy is inserted through a small incision in your belly. This procedure is generally performed under general anesthesia in a hospital.
- MRI. This test uses a large magnet, radio waves, and a computer to make 2-D images of an internal organ or structure.
- Ultrasound. This is an ultrasound test using a small tool (transducer) that is pressed against your belly or placed in the vagina. The ultrasound uses high-energy sound waves to produce an image of your uterus and other organs on a screen.
Getting a proper diagnosis for dysmenorrhea can sometimes be challenging. You may be dismissed by healthcare providers who are not familiar with the condition and don’t know what to look for. You may want to consider getting a second opinion if your symptoms do not respond.
Treatment for dysmenorrhea depends on many factors, including your overall health, the severity of your symptoms, and the underlying cause. You may need to work closely with your healthcare provider to find a treatment regime that works for you.
Lifestyle can be a big part of managing dysmenorrhea symptoms. Some lifestyle changes and habits you should consider practicing include:
- Stop smoking. Smoking is linked to worse period pain and cramps, among many other health consequences. If you smoke, you may want to join a smoking cessation program. If you do not smoke, don’t start.
- Reduce alcohol consumption. Alcohol can cause menstrual cramping to continue for longer than normal. During your period, try to avoid alcohol.
- Avoid triggers. Some people find that caffeine-containing foods, like coffee and chocolate, can make contractions worse. Try to avoid these and see if it makes a difference for your symptoms. You may also want to keep a journal that tracks things like your periods, symptoms, food and drink intake, and exercise. This can give you a better idea of what triggers may be causing you problems.
- Exercise has been linked to a decrease in painful menstrual cramps. Exercise also releases pain-killing chemicals called endorphins. Try incorporating exercise into your daily routine. Start slow and then work your way up to more exercise.
- Choose a rich and varied diet, full of whole grains, fruits, and vegetables, to ensure you get the nutrients you need. Additionally, consider reducing your intake of refined sugars, which may trigger more inflammation and may worsen symptoms. Opt for natural sources of sugar like fruits and yogurt instead.
- Manage stress. Managing your stress is certainly easier said than done. However, stress is linked to more painful periods. Stress can also throw your menstrual cycle off, which can make dysmenorrhea symptoms worse. Consider trying mindfulness meditation or yoga. Alternatively, try to tap into your support network or friends and family to help you cope with stress.
If you have mild cramps, you can always try some safe home remedies to ease symptoms. These include:
- Heating pads and hot water bottles. Placing a heating pad or hot water bottle on your lower back or abdomen can help your uterine muscles relax and improve blood flow.
- Hot bath or shower. The heat from a bath or shower can have a similar effect as a heating pad. Plus, hot showers can be a good way to reduce stress.
- Massage. You may want to try massaging your lower back or abdomen. This helps relax muscles and improve blood flow.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). Medications like naproxen and ibuprofen help block prostaglandins, which makes them effective for fighting pain associated with dysmenorrhea. However, you should always read the instructions carefully, as taking too much can lead to side effects and other health problems.
Medications for dysmenorrhea
If home remedies and lifestyle changes aren’t enough to manage your pain, you should talk to your doctor about medications.
- Birth control pill (hormonal contraception). “The pill” is commonly used to treat dysmenorrhea, menorrhagia, and endometriosis. Hormonal contraceptives reduce the amount of prostaglandin in your uterus and often make your periods lighter.
- Hormonal intrauterine device (hormonal IUD). An IUD is a small device placed directly in your uterus to prevent pregnancy. Hormonal IUDs prevent pregnancy by releasing the chemical progestin, which can lighten periods or stop them altogether. This makes hormonal IUDs an effective way to manage dysmenorrhea. Hormonal IUDs are also sometimes used to treat endometriosis and menorrhagia. Additionally, IUDs can last from 3-7 years, depending on the brand.
- Stronger pain relievers. If over-the-counter pain medications are not effective for you, your doctor may prescribe you a stronger version.
- Supplements. Some people say that taking vitamin supplements – specifically vitamin B1 and magnesium – can help with dysmenorrhea. However, there is not a lot of research proving their effectiveness. Additionally, supplements aren’t regulated the same way as other medications, and the dosing may not be appropriate for you. If you are interested in taking a supplement, you should always talk to your doctor first. They can advise you on the risks and benefits of supplements and which ones might be appropriate for you.
Treating secondary dysmenorrhea
If you are experiencing secondary dysmenorrhea, you will have to treat the underlying condition to resolve your symptoms. This may require that you take hormone therapy (like an oral contraceptive or hormonal IUD) or, in some cases, have surgery. Learn more about treatments for common causes of secondary dysmenorrhea:
American College of Obstetricians and Gynecologists. Dysmenorrhea: Painful Periods (https://www.acog.org/womens-health/faqs/dysmenorrhea-painful-periods)
National Center for Biotechnology Information (NCBI): National Library of Medicine. Dysmenorrhea (https://www.ncbi.nlm.nih.gov/books/NBK560834/)
MedlinePlus: National Library of Medicine. Period Pain (https://medlineplus.gov/periodpain.html)