Menstruation occurs when the uterus sheds its lining once a month. The lining passes through a small opening in the cervix and out through the vaginal canal.
Some pain, cramping, and discomfort during menstrual periods is normal. Excessive pain that causes you to miss work or school is not.
Painful menstruation is also called dysmenorrhea. There are two types of dysmenorrhea: primary and secondary. Primary dysmenorrhea occurs in women who experience pain before and during menstruation. Women who have had normal periods that become painful later in life may have secondary dysmenorrhea. A condition affecting the uterus or other pelvic organs, such as endometriosis or uterine fibroids, can cause this.
There may not be an identifiable cause of your painful menstrual periods. Some women are at a higher risk for having painful menstrual periods. These risks 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
- reaching puberty before age 11
A hormone called prostaglandin triggers muscle contractions in your uterus that expel the lining. These contractions can cause pain and inflammation. The level of prostaglandin rises right before menstruation begins.
Painful menstrual periods can also be the result of an underlying medical condition, such as:
- premenstrual syndrome (PMS): a group of symptoms caused by hormonal changes in the body that occur 1 to 2 weeks before menstruation begins and go away after a woman begins to bleed
- endometriosis: 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: noncancerous tumors that can put pressure on the uterus or cause abnormal menstruation and pain
- pelvic inflammatory disease (PID): an infection of the uterus, fallopian tubes, or ovaries often caused by sexually transmitted bacteria that causes inflammation of the reproductive organs and pain
- adenomyosis: a rare condition in which the uterine lining grows into the muscular wall of the uterus and can be painful because it causes inflammation and pressure
- cervical stenosis: a rare condition in which the cervix is so small it slows menstrual flow, causing an increase of pressure inside the uterus that causes pain
Home care treatments may be successful in relieving painful menstrual periods and can include:
- using a heating pad on your pelvic area or back
- massaging your 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, and reducing your intake of salt, alcohol, caffeine, and sugar to prevent bloating
- raising your legs or lying with your knees bent
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:
- continuing pain after IUD placement
- at least three painful menstrual periods
- passing blood clots
- cramping accompanied by diarrhea and nausea
- pelvic 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. Symptoms include:
- severe pelvic pain
- sudden pain, especially if you may be pregnant
- foul-smelling vaginal discharge
Your doctor will first take your medical history to check for the underlying causes of your painful menstrual periods. They will also perform a physical examination. 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 may include:
- ultrasound: a handheld device that sends out sound waves is moved over the skin to see inside your body
- CT scan: a noninvasive detailed imaging test that uses X-rays to see inside your body
- MRI: a noninvasive detailed imaging test that uses magnetic fields and radio waves to see inside your body
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.
If home treatment does not relieve your menstrual pain, there are some medical treatment options. 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 infections.
Your doctor may also prescribe medications that include:
- nonsteroidal anti-inflammatory drugs (NSAIDs): You can find these drugs, such as Tylenol, over the counter, or get prescription-strength NSAIDs from your doctor.
- pain relievers: These can include over-the-counter options like ibuprofen (Advil and Motrin IB) or naproxen sodium (Aleve).
- antidepressants: Antidepressants can 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, or implant. Hormones prevent ovulation, which can control your menstrual cramps.
Surgery can treat endometriosis or uterine fibroids. This is an option if other treatment options haven’t been successful. The surgery removes any endometriosis implants, uterine fibroids, or cysts.
In rare cases, a hysterectomy (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 in women who aren’t planning on having children or who are at the end of their childbearing years.