Menstrual cramps can range from a mild nuisance lasting a day or two to several days of unbearable pain that interferes with everyday activities. They’re one of the most common causes of pelvic pain and many experience them just before and during their period.

The pain is caused by uterine contractions that happen just before or during the onset of your period. But what makes the pain more severe for some people?

Read on to learn more about the potential causes of severe cramps and how to manage the pain.

Menstrual cramps feel like a throbbing or cramping pain in your lower abdomen. You may also feel pressure or a continuous dull ache in the area. The pain may radiate to your lower back and inner thighs.

Cramps usually begin a day or two before your period, peaking around 24 hours after your period starts. They typically last for two to three days.

Menstrual cramps can be accompanied by other symptoms, including:

Typical menstrual cramps are painful, but they usually respond well to over-the-counter (OTC) pain relievers, including ibuprofen.

Severe cramps, however, tend to begin earlier in the menstrual cycle and last longer than typical cramps do.

signs of severe cramps

Not sure if your cramps are typical or severe? Generally, severe menstrual cramps:

  • don’t improve when you take OTC pain medication
  • interfere with your daily activities
  • are often accompanied by heavy bleeding or clotting

During your period, your uterus contracts to help shed its lining. These contractions are triggered by hormone-like substances called prostaglandins. Higher levels of prostaglandins are associated with more severe menstrual cramps.

Some people tend to have more severe menstrual cramps without any clear cause. For others, severe menstrual cramps may be a symptom of an underlying medical condition.

Endometriosis

Endometriosis is a condition that causes the tissue that usually lines your uterus to grow in other parts of your body, outside your uterus.

Pelvic pain is the most common symptom. Others include:

Polycystic ovary syndrome (PCOS)

PCOS is a common hormone disorder affecting approximately 1 in 10 women of childbearing age. Higher levels of androgens, which are male hormones, and irregular periods are common symptoms.

Other symptoms of PCOS include:

Fibroids

Fibroids are noncancerous growths that develop inside or outside of the uterus. They range in size from as small as a seed to large masses that can cause an enlarged uterus. You can have one or more fibroids, often without symptoms.

When fibroids do causes symptoms, the symptoms vary depending on the number of fibroids, their size, and location.

In addition to severe mensural cramps, fibroids can also cause:

Pelvic inflammatory disease (PID)

PID is a bacterial infection of the female reproductive organs. It’s usually caused by sexually transmitted infections (STIs), such as chlamydia and gonorrhea. Other infections that aren’t sexually transmitted can also cause it.

Pelvic pain is the most common symptom of PID. Other symptoms include:

Cervical stenosis

Cervical stenosis, which is also called a closed cervix, happens when the opening of your cervix is narrow or completely closed. You can be born with a cervical stenosis or develop it later.

A closed cervix can prevent menstrual blood from exiting your body, making your periods very light or irregular. It can also lead to fertility issues.

Adenomyosis

Adenomyosis is a thickening of the uterus. It occurs when the endometrial tissue that lines your uterus grows into the muscles of your uterus.

The tissue continues to function as it usually would throughout your cycle — thickening, breaking down, and exiting your body. This causes your uterus to grow two to three times its normal size.

Adenomyosis doesn’t always cause symptoms. When it does, you may notice severe menstrual cramps that get increasingly worse, as well as heavy or prolonged menstrual bleeding.

Intrauterine device (IUD)

An IUD is a small birth control device that’s inserted into your uterus. There are different types of IUDs available, some containing hormones while others are hormone-free.

They’re safe for most people, but they can occasionally cause side effects, including:

  • severe menstrual cramps
  • irregular periods
  • heavy menstrual bleeding

There’s also a small risk of the IUD perforating your uterus during insertion or bacteria entering your uterus during insertion, causing PID. Expulsion is another rare possibility, which is when the IUD moves out of place. All of these can cause severe pelvic pain.

If you have very painful menstrual cramps or cramps that last longer than two or three days, make an appointment with your healthcare provider.

They’ll likely start by reviewing your medical history and performing a physical exam, including a pelvic exam. They may also give you a Pap test.

Depending on your other symptoms, they may recommend additional tests, including:

  • an ultrasound to check the size and thickness of your uterus as well as detect fibroids or cysts
  • a CT scan, which can provide a detailed view of your reproductive organs
  • gynecologic laparoscopy, a minimally invasive surgical procedure, to confirm a diagnosis of endometriosis

Severe menstrual cramps are typically hard to treat on your own, but these tips may help while you work with your healthcare provider to narrow down an underlying cause:

  • Get regular exercise. Results of a 2015 study showed that doing 30 minutes of aerobic exercise three times a week significantly reduced the severity of menstrual cramps over the course of 8 weeks.
  • Use a heating pad. There’s evidence that heat may be as effective as ibuprofen for relieving menstrual cramps. Place a heating pad on your lower abdomen for relief.
  • Manage your stress. Work and general life stress has been linked to menstrual cramps. Breathing exercises, yoga, and spending time doing things that you enjoy can help keep your stress down.
  • Soak in a hot bath. Soaking in a hot bath soothes your lower abdomen and back. It’s also relaxing and a great way to relieve stress.
  • Take supplements. Certain supplements may help reduce the severity of menstrual cramps. These include omega-3 fatty acids, magnesium, and vitamins B-1 and B-6.
  • OTC pain medication. OTC pain relievers, such as ibuprofen and acetaminophen, often aren’t enough to completely eliminate severe menstrual cramps. If you take them a day before you usually start to experience cramps, they may be more effective.

You don’t have to power through severe menstrual cramps. If your pain interferes with your ability to go on about your day or lasts longer than two or three days, talk to your healthcare provider. They can help you get to the bottom of what’s causing your severe cramps and recommend a plan to keep the pain under control.