Menstruation is a monthly occurrence for women in which the body sheds the lining of the uterus (womb), which is then passed through a small opening in the cervix and out through the vaginal canal.
Some pain, cramping, and discomfort during menstrual periods is normal. However, excessive pain that causes you to regularly miss work or school is not.
The medical term for painful menstruation is dysmenorrhea. Primary dysmenorrhea occurs in women who experience pain just before and during menstruation, but who are otherwise healthy. Women who have had normal periods that later become painful may have secondary dysmenorrhea. This condition is usually accompanied by a problem affecting the uterus or other pelvic organs.
There may not be an identifiable cause of your painful menstrual periods. Certain women are at a higher risk for having painful menstrual periods. Risk factors include:
- being under age 20
- having a family history of painful periods
- having heavy bleeding with periods
- having irregular periods
- never having had a baby
- having experienced early puberty, which is puberty before the age of 11
Hormone-like substances called prostaglandins trigger muscle contractions to help your uterus expel its lining each month. These contractions can cause pain and inflammation. Women with higher levels of prostaglandins may experience more severe menstrual cramping and pain. (Mayo Clinic)
In some cases, such as with secondary dysmenorrhea, painful menstrual periods can be the result of an underlying medical condition, such as:
- premenstrual syndrome (PMS)
- endometriosis (a painful medical condition in which cells from the lining of the uterus grow in other parts of the body)
- fibroids in the uterus (noncancerous tumors)
- pelvic inflammatory disease, an infection of the uterus, fallopian tubes, or ovaries often caused by sexually transmitted infections
- sexually transmitted infections (STIs)
- adenomyosis, a rare condition in which the uterine lining grows into the muscular wall of the uterus
- cervical stenosis, a rare condition in which the cervix is so small it slows menstrual flow (NLM)
Certain types of birth control, specifically intrauterine devices (IUDs) made of copper, are associated with increased pain during menstruation.
If menstrual pain is interfering with your ability to perform basic tasks each month, it may be time to talk to your gynecologist about your symptoms. Talk to your doctor if you experience any of the following:
- pain after IUD placement
- painful menstrual periods that have lasted longer than three months
- passing blood clots
- cramping accompanied by diarrhea and nausea
- pelvic pain when not menstruating
Sudden cramping or pelvic pain could also be signs of infection. An untreated infection can cause scar tissue that damages the pelvic organs and may lead to infertility. If you have symptoms of an infection, seek prompt medical attention. Symptoms include:
- severe pelvic pain
- sudden pain, especially if you may be pregnant
- foul-smelling vaginal discharge
Home care treatments may be successful in relieving painful menstrual periods. Home treatment includes:
- using a heating pad on your pelvic area or back
- massaging the abdomen
- taking a warm bath
- regular physical exercise
- eating light, nutritious meals
- practicing relaxation techniques or yoga
- taking an anti-inflammatory medication such as ibuprofen several days before your expected period
- taking vitamin B-6, vitamin B-1, vitamin E, omega-3 fatty acids, calcium, and magnesium supplements while reducing your intake of salt, alcohol, caffeine, and sugar to prevent bloating
- raising your legs or lying with your knees bent
If home treatment is not successful in relieving your menstrual pain, there are a number of medical treatment options. Treatment will depend on the severity and underlying cause of your cramps. If your pain is caused by PID or STIs, these need to be treated. Your doctor will prescribe antibiotics to clear the infection. Your doctor may prescribe a medication to help with the pain. These medications include:
- non-steroidal anti-inflammatory drugs (NSAIDs)
- pain relievers, such as narcotics
Your doctor may also suggest that you try hormonal birth control. Hormonal birth control is available in the form of a pill, patch, vaginal ring, injection, or implant. Hormonal birth control uses hormones to prevent ovulation, which can control your menstrual cramps.
Surgery is an option if your pain is caused by endometriosis or uterine fibroids and other treatment options have not been successful. Surgery will be done to remove any endometriosis implant, uterine fibroids, or cysts.
In very rare cases, a hysterectomy (surgical removal of the uterus) is also an option if other treatments have not worked and pain is severe.