Overview

The process of your uterus shedding its lining every month is called menstruation. However, some discomfort during your period is common, but intense or crippling pain that interferes with your life is not.

Having painful periods is a condition called dysmenorrhea. Furthermore it’s the most commonly reported menstrual disorder: Although, more than half of menstruating women report pain for at least one or two days every month.


Types of Periods

Painful periods can be classified into two types:

  • Primary dysmenorrhea usually starts soon after the first period. It’s often caused by prostaglandins, which naturally occur in the body.
  • Secondary dysmenorrhea typically occurs later in life and often stems from a reproductive disorder.

Also, no matter which one you’re experiencing, there are ways to address and alleviate the pain.


Causes of Pain During Your Period

A variety of painful symptoms may accompany menstrual periods. Sometimes symptoms can occur shortly before your period actually starts. They typically taper off during the first few days of your period.

It’s not always possible to identify the cause of painful menstrual periods. However, some people are just at a higher risk of having painful periods.

These risks include:

  • A family history of painful periods
  • Being under age 20 
  • Heavy bleeding with periods
  • Having irregular periods
  • Never having had a baby
  • Reaching puberty before age 11
  • Smoking

Prostaglandins

Cramps are caused by the hormone-like lipids called prostaglandins that make your uterus contract to help get rid of its lining.

Prostaglandins are also involved in the inflammation and pain responses. They reside in the uterine lining and are also released from this lining.

Once released, they increase the force of the contractions during the first couple days of your period. The higher the level of prostaglandins, the more severe the cramping is.

Very high levels can also cause nausea and diarrhea. As the lining is shed, the levels of prostaglandins in your body is lowered. This is why cramps typically subside after the first couple of days of your period.

Underlying Medical Conditions

Painful menstrual periods can also be the result of an underlying medical condition, such as:

  • Adenomyosis: This is a rare condition in which the uterine lining grows into the muscular wall of the uterus, causing inflammation, pressure, and pain. It can also cause longer or heavier periods.
  • Cervical stenosis:  Cervical stenosis is a rare condition in which the cervix is so small or narrow that it slows menstrual flow, causing an increase of pressure inside the uterus that causes pain.
  • Endometriosis: This is a painful medical condition in which cells from the lining of the uterus grow in other parts of the body, usually on the fallopian tubes, ovaries, or tissue lining the pelvis.
  • Fibroids in the uterus: Fibroids are noncancerous tumors that can put pressure on the uterus or cause abnormal menstruation and pain, though they often don’t cause symptoms.
  • Pelvic inflammatory disease (PID): PID is an infection of the uterus, fallopian tubes, or ovaries often caused by sexually transmitted bacteria that cause inflammation of the reproductive organs and pain.
  • Premenstrual syndrome (PMS): PMS is a common condition that’s caused by hormonal changes in the body occurring 1 to 2 weeks before menstruation begins. Symptoms typically go away after bleeding begins.

Other Causes

Other possible causes of menstrual cramps include the following:

  • Cervical stenosis
  • Endometriosis
  • Fibroids
  • Pelvic inflammatory disease

Pain relievers like ibuprofen (Advil) can help relieve cramps. But if the pain isn’t lessened at all with an over-the-counter pain reliever, talk with your doctor about whether hormonal treatment is an option.


Estrogen and Progesterone

Estrogen and progesterone are hormones that help regulate the menstrual cycle. They can also affect chemicals in the brain that are associated with headaches. Right before your period starts, there are lowered levels of estrogen in the body, which can trigger headaches.

As soon as you feel a headache coming on, it’s best to treat it early. The sooner treatment starts, the more likely you’ll get relief. Make sure you’re drinking enough water. If possible, lie down in a dark and quiet room.

You might also want to place a cold cloth on your head or do some deep breathing for relaxation. Over-the-counter medications like ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen (Aleve) might also provide relief.

Fluctuating hormone levels can also cause breast pain and tenderness, which can be very uncomfortable for some women. Estrogen enlarges the breast ducts, and progesterone makes the milk glands swell. This results in breast tenderness.

The breasts might also feel “heavy.” Many times, NSAIDs can be effective in easing premenstrual breast tenderness or pain. If the pain is severe, prescription hormonal treatment might be an option for you.

Home Treatment

At-home treatments can be helpful in relieving painful menstrual periods. Types of things to try at home include:

  • Doing regular physcial exercise
  • Eating light, nutritious food
  • Massaging your abdomen
  • Taking a warm bath
  • Practicing relaxation techniques or yoga
  • Taking anti-inflammatory medications such as ibuprofen several days before you expect your period
  • Using a heating pad on your pelvic area or back
  • Taking vitamins and supplements such as:
    • Vitamin B-6
    • Calcium
    • Vitamin B-1
    • Magnesium
    • Omega-3 fatty acids
    • Reducing your intake of salt, alcohol, caffeine, and sugar to prevent bloating
    • Vitamin E
    • Raising your legs or lying with your knees bent

When to seek Medical Help?

If menstrual pain is interfering with your ability to perform basic tasks each month, it may be time to talk to your gynecologist.

Talk to your doctor about your symptoms and if you experience any of the following:

  • At least three painful menstrual periods
  • Continuing pain after IUD placement
  • Passing blood clots
  • Cramping accompanied by diarrhea and nausea
  • Pevic pain when not menstruating

Sudden cramping or pelvic pain could 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:

  • Fever
  • Severe pelvic pain
  • Sudden pain, especially if you may be pregnant
  • foul-smelling vaginal discharge

Diagnosis

When trying to find out what the underlying cause of painful menstruation is, your doctor will likely take your medical history and perform a physical exam. This will include a pelvic exam to check for any abnormalities in your reproductive system and to look for signs of infection.

If your doctor thinks an underlying disorder is causing your symptoms, they may perform imaging tests. These can include:

Depending on the results of your imaging tests, your doctor may order a laparoscopy. This is a test in which a doctor makes small incisions in the abdomen into which they insert a fiber-optic tube with a camera at the end to see inside your abdominal cavity.


Treatment

If at-home treatment doesn’t relieve your menstrual pain, medical treatment options exist.

Treatment will depend on the severity and underlying cause of your pain. If PID or sexually transmitted infections (STIs) are causing your pain, your doctor will prescribe antibiotics to clear the infection.

Your doctor may also prescribe medications that include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). You can find these drugs over the counter or get prescription-strength NSAIDs from your doctor.
    • Other pain relievers. This includes over-the-counter options like acetaminophen (Tylenol) or stronger prescription pain medications.
  • Antidepressants: Antidepressants are sometimes prescribed to help lessen some of the mood swings associated with PMS.

Your doctor may also suggest that you try hormonal birth control. Hormonal birth control is available as a pill, patch, vaginal ring, injection, implant, or IUD. Hormones prevent ovulation, which can control your menstrual cramps.

Surgery can treat endometriosis or uterine fibroids. This is an option if other treatments haven’t been successful. The surgery removes any endometriosis implants, uterine fibroids, or cysts.

In rare cases, a hysterectomy (the surgical removal of the uterus) is an option if other treatments haven’t worked and pain is severe. If you have a hysterectomy you will no longer be able to have children. This option is usually only used if someone isn’t planning on having children or is at the end of their childbearing years.


Summary

While some pain or discomfort with your period is normal, severe or debilitating pain, or pain that interferes with your life or daily activities, is not normal. But treatment is available.

Here are some ways to help reduce pain associated with your period:

  • Try home remedies to help ease menstrual cramps.
  • For breast swelling and tenderness, some lifestyle changes can help minimize your symptoms.
  • If headaches related to hormone levels are an issue during your period, here are some ways to find relief and prevent them from occurring.

You don’t have to simply accept painful periods. No matter what the origin, there are treatments for your pain.

If home remedies, complementary therapies, and lifestyle changes aren’t enough to mitigate menstrual pain, talk with your doctor. They can help you get relief.

Start tracking your pain, and bring your log to your appointment. A pain log can confirm your symptoms are indeed tied to your periods and provide some validation. It will also help your doctor understand what’s going on.

Be sure to note in your log:

  • When the symptom occurred
  • Severity and duration of symptom
  • Type of symptom

You can print one out or make your own.

Sometimes more intensive treatment might be necessary, like birth control pills or other medications to help with hormone fluctuations. Your doctor might want to run tests to rule out any other condition that might be causing your symptoms, too.

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