Period cramps so bad

What Causes Period Cramps?

What are period cramps?

The medical name for period cramps is Dysmenorrhea. They happen due to a hormone-like substance, prostaglandins, which causes the uterus walls to contract and then shed its lining, resulting in your period. If prostaglandin levels are higher, more pain is often associated with the cramps. This varies from woman to woman, but cramps are likely to become less painful as you get older, or after childbirth.

There are a few other conditions that can cause cramps. Treating these conditions will help stop the symptoms. These conditions include:

  • Endometriosis: when the lining forms outside of the uterus, for example in the fallopian tubes and can cause a more chronic pain than regular period cramps
  • Uterine fibroids which presents as non-cancerous growths on the uterus wall that can sometimes cause pain in the affected area
  • Adenomyosis, when the tissue lining the uterus begins to grow into the uterine walls
  • Pelvic inflammatory disease, an infection of a woman’s reproductive organs, usually caused by bacteria transmitted through sex
  • Cervical stenosis, when the opening of the cervix is smaller and restricts the flow of menstrual blood – this can cause a painful increase of pressure in the uterus

In most cases, period cramps are a sign of a healthy body reacting to the natural shedding of the uterus wall. However, if menstrual cramps are disrupting your life every cycle, if your symptoms get worse, or if you begin to get severe cramps after you’re 25 years old, you should speak to your doctor.

Saying goodbye to hormones is a great way to get to know your body better. Natural Cycles is 100% hormone-free and is scientifically proven to be effective. Sign up today to try the world’s first birth control app.

What do period cramps feel like?

Since every woman is different, she’ll experience symptoms in different ways. Typically the cramping pain starts in the lower abdomen one to two days before menstrual bleeding begins. It then peaks after 24 hours and may last for a further two to three days after that. Some women can also experience nausea, an upset stomach or dizziness, as well as pain in their lower back and thighs. For other women, period cramps may feel like a mild yet constant pain. Those with irregular cycles or heavy bleeding are more likely to experience severe period cramps.

Tracking and treating period cramps

If you have mild period pain, aspirin or ibuprofen can provide pain relief. Heat treatment like taking a warm bath or placing a hot water bottle on the back or stomach can also help soothe symptoms. Preventative measures such as avoiding alcohol, caffeine and tobacco in the days leading up to your period may also reduce the symptoms of menstrual cramps, while regular exercise is proven to reduce period pain.

We hope you now understand what causes period cramps and why they are a healthy part of your menstrual cycle. Here at Natural Cycles, we’re on hand to help you learn about your cycle so you can predict and prepare for symptoms such as PMS, menstrual cramps and more. With our birth control app, it’s easy to document symptoms and keep track of your unique cycle.


What is dysmenorrhea?

Dysmenorrhea causes severe and frequent cramps and pain during your period. It may be either primary or secondary.

  • Primary dysmenorrhea. This occurs when you first start your period and continues throughout your life. It is usually life-long. It can cause severe and frequent menstrual cramping from severe and abnormal uterine contractions.

  • Secondary dysmenorrhea. This type is due to some physical cause. It usually starts later in life. It may be caused by another medical condition, such as pelvic inflammatory disease or endometriosis.

What causes dysmenorrhea?

Women with primary dysmenorrhea have abnormal contractions of the uterus due to a chemical imbalance in the body. For example, the chemical prostaglandin control the contractions of the uterus.

Secondary dysmenorrhea is caused by other medical conditions, most often endometriosis. This is a condition in which endometrial tissue implants outside the uterus. Endometriosis often causes internal bleeding, infection, and pelvic pain.

Other causes of secondary dysmenorrhea include the following:

  • Pelvic inflammatory disease (PID)

  • Uterine fibroids

  • Abnormal pregnancy (miscarriage, ectopic)

  • Infection, tumors, or polyps in the pelvic cavity

What are the symptoms of dysmenorrhea?

The following are the most common symptoms of dysmenorrhea. However, each person may experience symptoms differently. Symptoms may include:

  • Cramping in the lower abdomen

  • Pain in the lower abdomen

  • Low back pain

  • Pain radiating down the legs

  • Nausea

  • Vomiting

  • Diarrhea

  • Fatigue

  • Weakness

  • Fainting

  • Headaches

The symptoms of dysmenorrhea may look like other conditions or medical problems. Always consult your health care provider for a diagnosis.

What are the risk factors for dysmenorrhea?

While any woman can develop dysmenorrhea, the following women may be at an increased risk for the condition:

  • Women who smoke

  • Women who drink alcohol during their period (alcohol tends to prolong menstrual pain)

  • Women who are overweight

  • Women who started their periods before the age of 11

  • Women who have never been pregnant

Consult your health care provider for more information.

How is dysmenorrhea diagnosed?

To diagnose dysmenorrhea, your health care provider will evaluate your medical history and do a complete physical and pelvic exam. Other tests may include:

  • Ultrasound. This test uses high-frequency sound waves to create an image of the internal organs.

  • Magnetic resonance imaging (MRI). This test uses large magnets, radiofrequencies, and a computer to make detailed images of organs and structures within the body.

  • Laparoscopy. This minor procedure uses a laparoscope. This is a thin tube with a lens and a light. It is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic and abdomen area, the doctor can often detect abnormal growths.

  • Hysteroscopy. This is the visual exam of the canal of the cervix and the inside of the uterus. It uses a viewing instrument (hysteroscope) inserted through the vagina.

How is dysmenorrhea treated?

Specific treatment for dysmenorrhea will be determined by your health care provider based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Cause of the condition (primary or secondary)

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Treatment to manage dysmenorrhea symptoms may include:

  • Prostaglandin inhibitors, such as nonsteroidal anti-inflammatory medications, or NSAIDs, such as aspirin and ibuprofen (to reduce pain)

  • Acetaminophen

  • Oral contraceptives (ovulation inhibitors)

  • Progesterone (hormone treatment)

  • Diet changes (to increase protein and decrease sugar and caffeine intake)

  • Vitamin supplements

  • Regular exercise

  • Heating pad across the abdomen

  • Hot bath or shower

  • Abdominal massage

  • Endometrial ablation (a procedure to destroy the lining of the uterus)

  • Endometrial resection (a procedure to remove the lining of the uterus).

  • Hysterectomy ( the surgical removal of the uterus)

Key points

  • Dysmenorrhea is characterized by severe and frequent menstrual cramps and pain during your period.

  • Dysmenorrhea may be primary, existing from the beginning of periods, or secondary, due to an underlying condition.

  • Symptoms may include cramping or pain in the lower abdomen, low back pain, pain spreading down the legs, nausea, vomiting, diarrhea, fatigue, weakness, fainting, or headaches.

  • Treatments may include NSAIDS, acetaminophen, birth control pills, hormone treatment, dietary changes, vitamins, exercise, heat, or massage.

  • In extreme conditions, surgery may be needed.

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.

  • Bring someone with you to help you ask questions and remember what your provider tells you.

  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.

  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.

  • Know how you can contact your provider if you have questions.

Key Facts

  • Dysmenorrhea means difficult or painful periods.
  • The most common symptoms are cramps in the lower part of the belly and/or lower back pain during your period.
  • If you have pain, talk to your health care provider. Dysmenorrhea can be treated.

It’s common for many girls to have mild pain with their periods a couple of days each month. However, if your pain is not relieved with over-the-counter pain medicine, and you miss school or doing things with your friends because of it, you may have “dysmenorrhea” (pronounced: dis–men–o–ree–a).

Dysmenorrhea is a medical term that means “difficult or painful periods”. There are two types of dysmenorrhea; primary and secondary.

  • Primary dysmenorrhea is the most common kind of dysmenorrhea. Cramping pain in the lower abdomen (belly) can start from 1–2 days before your period begins and can last 2–4 days. The pain is typically similar from one period to the next.
  • Secondary dysmenorrhea is when cramps are a result of a medical problem such as endometriosis. Endometriosis is a condition that occurs when tissue similar to the lining of the uterus is found outside its normal location. This usually causes pain before and/or during a young woman’s menstrual period.

The cramps you feel as a result of dysmenorrhea are caused by uterine contractions (when your uterus tightens and relaxes, allowing blood to leave your uterus). The lining of your uterus releases special chemicals called “prostaglandins” (pronounced: pross–ta–glan–dins). These chemicals are released from the lining of the uterus and increase the strength of the contractions, especially during the first couple of days of a woman’s menstrual cycle (when levels are high). High levels of prostaglandins may also cause nausea, diarrhea and lightheadedness.

Most young women who have dysmenorrhea have lower back pain and cramping in the lower area of the abdomen during their periods. This pain can range from dull to throbbing. Some girls may have other symptoms during their period such as nausea, vomiting, loose bowel movements/diarrhea, constipation, bloating in the belly area, headaches, and/or lightheadedness, all of which can be mild to severe.

Is it normal to have cramps during your period?

Yes, it’s normal to have mild cramps during your period, because of uterine contractions. The uterus is a muscle that tightens and relaxes. This can cause jabbing, or cramp–like pain. However, if the discomfort is not relieved with over-the-counter medications (such as ibuprofen) or causes you to miss school or other daily activities, it could mean that there is another reason for your symptoms.

Some or all of these problems may start a day or two before your menstrual period and can last for part or all of your menstrual period. These signs could be caused by other medical conditions and therefore it’s important to tell your health care provider about all of your symptoms. If your pain interferes with your daily life activities, you should see a health care provider to evaluate further.

Is it okay to exercise when I have my period?

Generally, it’s fine to exercise when you have your period, and it’s a great way to stay fit and healthy. Some girls like to exercise when they have their period; other girls are uncomfortable exercising during their period. Talk to your coach or gym teacher if exercising is uncomfortable during your period.

Are menstrual cramps the same as PMS (Pre–Menstrual Syndrome)?

Menstrual cramps are not the same as PMS. Symptoms of PMS such as mood swings, breast soreness, and bloating happen before a woman’s period begins and get a lot better when it starts. On the other hand, with dysmenorrhea, cramps are usually worse the first few days of a woman’s period and have a different cause and treatment.

How is dysmenorrhea treated?

  • Anti-inflammatory medication– If your menstrual cramps are painful, you may want to take an over–the–counter nonsteroidal ant-inflammatory (NSAID) medication for 1–2 days of your period. If your pain is severe, you may want to begin taking an NSAID 1-2 days before your period starts. These medications are “anti–prostaglandins” (pronounced: an–tee–pross–ta–glan–dins), meaning that they work to stop the cramping effects of prostaglandins. They help to relieve discomfort, make your flow lighter, and cause your uterus to cramp less. Try over–the–counter medicine with ibuprofen or naproxen sodium in it. Make sure you read the label so you know how much and how often to take it. You should not take these medications if you are allergic to aspirin–like medications or if you have stomach problems (such as ulcers). Remember to always take these medications with food.
  • Hormonal treatment – Oral contraceptive pills (OCPs), also called birth control pills, as well as other hormonal treatments (patch, vaginal hormonal ring, Depo-provera, IUD and hormonal implants) are often prescribed because the hormones thin out the lining of the uterus which lessens the blood flow and cramping. These medications are sometimes prescribed continuously so you don’t get a period.

Is there anything else I can do to help my dysmenorrhea?

  • Heat – Natural remedies such as a microwavable heating pack or a heating pad placed on your lower abdomen may help. Be sure to check that the heating pad is not too hot, as it can burn your skin.
  • Soaking in a warm bath may also help to relieve cramps.
  • Acupuncture is a complementary therapy that may be recommended to treat dysmenorrhea.
  • Yoga is a type of exercise that has shown to help lessen menstrual cramps for some girls/women.
  • Regular exercise has been known to lower pain.
  • Track your menstrual cycle with our period and pain tracker to see if there is a pattern to your pain–when it begins and ends.

What is a Period and Pain Tracker?

This is a tool to help you keep track of your menstrual cycle and any pain you may have; when it comes, where it hurts, how long it lasts, and what relieves it. It’s a good idea to keep track of your pain for about 3 cycles. Be sure to bring your completed Period and Pain Tracker with you when you have appointments with your health care provider or gynecologist.

Do I need to have any tests?

If comfort measures such as using a heating pad, exercising and taking over-the-counter medicine and/or hormonal treatment are not helpful, or the pain gets worse, make an appointment to see your health care provider (HCP) or gynecologist. Your HCP will decide if you need to have any tests such as a pelvic ultrasound. If you are sexually active, your HCP may test you for sexually transmitted infections (STIs). If you still have pain after 2-3 months of taking OCPs and mild pain medication, your HCP may talk to you about seeing a gynecologist. Your gynecologist may discuss another procedure called laparoscopy to find out the cause of your pain.

Dysmenorrhea can be challenging, especially if painful periods get in the way of important things in your life. Learning how to track your periods and pain will help you see if your pain happens more than just 1-2 days a month. Your pain should never make you feel disadvantaged compared to other young women. If you continue to have pain, you should make an appointment with your health care provider to discuss causes and treatment.

Download Clue to track your menstrual pain.

Top things to know

  • Menstrual cramps are most likely caused by an excess of prostaglandins—compounds that are released from the uterine lining as it prepares to be shed. They are a necessary part of the process, but in excess, they cause pain.

  • Take the edge off with a heat compress and a common anti-inflammatory pain medication, like ibuprofen

  • For prevention, consider a magnesium supplement. This mineral may be effective in lessening menstrual pain over time, and reducing the need for pain medication.

You’re probably familiar with period cramps: uterine cramps around the time of your period, which are typically felt in the abdomen, back, or thighs. You might also experience pain in the middle of your cycle during ovulation.

Menstrual cramps are very common: In Clue, about 3 in 4 people report experiencing cramps just before or during their period.

Most people first notice menstrual cramps about 6 months to a year after getting their first period (1). At first, they may come and go, and then happen in all or most cycles (as ovulation happens more frequently).

People typically feel their cramps just before or at the time when bleeding begins each cycle. They usually last about one to three days. They may start strong and feel better as the hours pass, or come and go more randomly. Cramps can be barely noticeable, or quite painful or severe (2). 1 in 10 people experience pain levels that can affect their daily activities for 1-3 days each cycle. Moderate to intense pain is more common 2 to 3 years after your first period (menarche) and usually gets better after age 20, or after pregnancy and birth (2).

Menstrual cramps that are severe are usually associated with medical conditions like endometriosis or adenomyosis. Female pain is often overlooked and/or under-treated in comparison to male pain presentation (3). It’s common for a young person suffering from severe menstrual pain not to talk about it with their doctor (4). When it comes to menstrual cramps, it’s important to advocate for yourself and communicate your pain levels to a healthcare provider. Keeping track of your pain with an app, like Clue, can be helpful.

over 115k ratings

over 115k ratings

Getting familiar with the basics of menstrual cycle-related pain can help you understand if your pain might be something to talk to your healthcare provider about.

So what exactly causes, and relieves, cramps?

What causes period cramps?

Note: Menstrual cramps can be “primary” or “secondary”. Primary dysmenorrhea (the clinical word for painful periods) is pain caused by the period itself. Secondary dysmenorrhea is period pain with another root cause, such as a health condition like endometriosis. This article discusses primary dysmenorrhea.

Menstrual cramps are most likely caused by an excess of prostaglandins—hormone-like compounds that are released from the uterine lining (the endometrium) as it prepares to be shed. Prostaglandins help the uterus contract and relax, so that the endometrium can detach and flow out of your body. They are a necessary part of the process, but in excess, they cause pain if the uterus contracts strongly, blood flow is reduced, and the supply of oxygen to the uterus muscle tissue decreases, causing pain (5).

For most people with period cramps, it’s still unknown what predisposes them, and not others, to painful menstruation. Inflammation may play a role. The production of prostaglandins is related to inflammation, and inflamed tissue tends to produce more prostaglandins (6). People who experience more menstrual pain have also been shown to have higher levels of inflammatory markers in the blood, even after adjustment for factors related to chronic inflammation, like BMI, smoking, and alcohol consumption (7). Inflammation has also been linked to the worsening of other premenstrual symptoms, including mood changes.

People are more likely to have painful periods if they have heavy or long period bleeding, if they started menstruating early in life, or if their periods are irregular (8, 9). Other factors that have been associated with painful periods include smoking, being thin, being younger than 30, having a pelvic infection, and being sterilized (8).

Research done by Clue with Oxford University also found that Clue users with undiagnosed sexually transmitted infections (STIs) were more likely to experience certain premenstrual symptoms, including cramps, than those without STIs (10).

How do I relieve my period cramps?

If your periods are heavy, irregular, or extremely painful, trying to find and treat the cause of your irregularities may be important for your health. Other approaches to relieving cramps, like hormonal birth control, act by preventing the building and shedding of the endometrium.

All methods of cramp relief do at least one of the following:

  • Reduce inflammation

  • Limit prostaglandin production

  • Block pain

  • Increase uterine blood flow, or

  • Treat an underlying condition, like endometriosis

Methods you might try include:

  • Medication

  • Heat

  • Transcutaneous Nerve Stimulation (TENS)

  • Diet changes

  • Supplementation

  • Stress relief

  • Quitting smoking

  • Exercise

  • Sex

  • Self-care

Medication for period cramps

Anti-inflammatory painkillers are an effective way to get relief from period pain (11). NSAIDs (non-steroidal anti-inflammatory drugs), like ibuprofen, inhibit the production of prostaglandins and inflammation. Other types of over-the counter painkillers may reduce pain, but tend to be less effective for treating menstrual cramps (12). NSAIDs are also used in reducing heavy bleeding (13).

Some people may choose to use hormonal contraceptives, such as the pill or the hormonal IUD, to relieve and prevent menstrual cramps. The synthetic hormones in these methods block ovulation, and/or prevent the typical growth and shedding of the uterine wall. This reduces or eliminates the associated build-up of prostaglandins, muscle contractions and cramps (14).

Heat for period cramps

Your grandmother’s hot water bottle is nothing to scoff at—heat is a low-fi, but tried and true method of relieving pain from menstrual cramps, and it’s cheap and has no side effects. Heat has been shown to be as effective as NSAIDs and aspirin for menstrual cramp pain (15-17).

If you want to copy the regime of one of the studies on heat and cramp relief, try using a “continuous low-level topical heat therapy” from a heated patch, pad, or water bottle.

Transcutaneous nerve stimulation and period cramps

Transcutaneous nerve stimulation (TENS) is an approved treatment for menstrual cramps. It uses a small machine to deliver low-voltage electrical current to the skin, possibly raising a user’s pain threshold and stimulating the release of the body’s natural endorphins (5).

TENS can also be combined with other methods, like heat and medication.

Diet for period cramps

As more is learned on the relationship between inflammation and period cramps, we may see recommendations for cramp-prevention diets. So far though, the data on this is limited but promising, and there are no formal clinical recommendations.

One clinical trial of 33 women with menstrual pain found that women had less menstrual pain when they followed a low fat-vegetarian diet than when they were taking a placebo dietary supplement pill (18).

A survey of 127 students found that those who reported consuming 3-4 servings of dairy had less menstrual pain than those consumed no dairy at all. This is possibly due to the intake of calcium, and maybe also vitamin D, but more research is needed—a trial on vitamin D found that very high doses were required to make a difference, which some (but not all) practitioners would consider unsafe (19-21).

Deficiency in magnesium, which is associated with anxiety and stress, has also been linked to more intense menstrual cramps (22).

Supplements for period cramps

The evidence for supplements to treat menstrual cramps isn’t well established, but you may find something that works for you if you’re open to experimenting. Check with a nutritionally-trained practitioner before taking a supplement—like any medicine, they can have side effects and interfere with levels of other nutrients in the body. Here are the top-evidenced supplements for period pain:

Ginger, it seems, may be as effective as common painkillers. Two systematic reviews of ginger for menstrual pain found that the root was likely more effective than a placebo for reducing pain (23,24). Clinical trials of more than 100 students with moderate to severe period pain found that pain was similarly reduced in students taking ginger, as students taking the NSAIDs Ibuprofen or mefenamic acid (25,26). One ginger group took 250mg capsules of zintoma ginger extract, from the start of their periods, and then every 6 hours, until their pain was relieved. The other took 1000mg of “ginger rhizome powder” daily (divided over 4X per day) for the first three days of their period.

Learn about your body and women’s health

Hi, I am Steph! I’ll send you both educational and entertaining stories about women’s health and share tips and tricks to get the most out of your Clue app!

Magnesium (and magnesium deficiency) may play an important role for some people in dysmenorrhea (27). A systematic review that included three studies on magnesium found that it was effective in lessening menstrual pain better than a placebo and may be helpful in limiting the need for pain medication (28). Magnesium carries few side effects, but can cause loose stools, so you may need to ease into it. The three studies used different doses of magnesium, so you may want to talk to a practitioner to get a recommendation—our collaborator Lara Briden recommends starting with 300mg taken daily.

Zinc supplementation may be effective for a similar reason as magnesium, but more research is needed (29-32). In a randomized control trial of 120 women, the duration and severity of period cramps was significantly improved in those taking zinc, compared to those taking a placebo (32).

Vitamin B1 has been shown to be effective in reducing period pain. One large trial found that people taking 100 mg daily had less menstrual pain than those taking a placebo (35).

Other dietary supplements have also been researched for a possible role in easing cramps, such as vitamin E, B6, and high doses of vitamin D, as well as agnus castus, and 3+ months of fish oil (1,20,34). Results thus far are promising, or mixed.

Stress and period cramps

Stress relief may help ease period cramps in some people. Preliminary research has found that people with high levels of stress are more than twice as likely to report having painful menstruation (35). Stress during the follicular phase (the first part of the cycle) may be more likely to lead to painful menstruation than stress in the luteal cycle (the second part of the cycle, after ovulation) (35).

Smoking and period cramps

People who smoke have an increased risk of experiencing painful menstrual cramps (36). The risk increases with time, as someone continues smoking. Second-hand smoke has also been shown to increase menstrual cramps (37).

Exercise and period cramps

Exercise can likely help in easing cramps, at least in part by increasing blood flow to the abdomen. A recent meta-analysis of 11 trials found that exercise, including aerobic exercise, stretching, and yoga, is likely to help decrease the intensity of menstrual pain, and may also shorten its duration (38). Exercise can also help in reducing stress, which can contribute to pain. If doing yoga, you might try focusing on poses that stretch and stimulate the abdomen, like the cobra, cat and fish poses (39).

Sex and period cramps

There is antecdotal evidence that sex and orgasms can help with menstrual cramp relief.

Subjects of sex research pioneers Masters and Johnson reported using masturbation to relieve their cramps, and a survey of American women found that 1 in 10 reported the same (40). If exercise and TENS machines work in part by releasing endorphins and increasing blood flow, it’s plausible that sex could do the same. Additional pluses to period sex include lower chance of pregnancy and more natural lubrication (if you don’t have a tampon in just beforehand).

Self care and period cramps

Talking about your cramps with a parent, friend, or healthcare provider seems to bring a lot of comfort for people. Other coping strategies people use are staying in bed, watching television, and other distractions like special foods, drinks, and exercise (41). Having a trusted friend or partner give you an abdominal or back massage with a good-smelling oil (lavender, perhaps?) may also be helpful, if not just really nice (42).

What kind of menstrual pain is “normal”? When should I see a healthcare provider about my cramps?

If your cramps are bad enough that they are not eased by a typical painkiller, and if they affect your ability to work, study or do any other everyday activities, it is best to talk to a healthcare provider. You should also see your healthcare provider if your cramping is suddenly or unusually severe, or lasts more than a few days.

Severe menstrual cramps or chronic pelvic pain could be a symptom of a health conditions like endometriosis or adenomyosis. The pain experienced by people with endometriosis is different from normal menstrual cramping. Advocating for yourself about pain can be tough, but will help you to feel heard and to get the treatment you need.

Tracking pain with Clue throughout the cycle for several cycles will help you determine which symptoms, if any, recur at specific times.

Article was originally published on March 18, 2018.


Dysmenorrhea is the medical term for pain with menstruation. There are two types of dysmenorrhea: “primary” and “secondary”.

Primary dysmenorrhea is common menstrual cramps that are recurrent (come back) and are not due to other diseases. Pain usually begins 1 or 2 days before, or when menstrual bleeding starts, and is felt in the lower abdomen, back, or thighs. Pain can range from mild to severe, can typically last 12 to 72 hours, and can be accompanied by nausea-and-vomiting, fatigue, and even diarrhea. Common menstrual cramps usually become less painful as a woman ages and may stop entirely if the woman has a baby.

Secondary dysmenorrhea is pain that is caused by a disorder in the woman’s reproductive organs, such as endometriosis, adenomyosis, uterine fibroids, or infection. Pain from secondary dysmenorrhea usually begins earlier in the menstrual cycle and lasts longer than common menstrual cramps. The pain is not typically accompanied by nausea, vomiting, fatigue, or diarrhea.

What causes dysmenorrhea (pain of menstrual cramps)?

Menstrual cramps are caused by contractions (tightening) in the uterus (which is a muscle) by a chemical called prostaglandin. The uterus, where a baby grows, contracts throughout a woman’s menstrual cycle. During menstruation, the uterus contracts more strongly. If the uterus contracts too strongly, it can press against nearby blood vessels, cutting off the supply of oxygen to the muscle tissue of the uterus. Pain results when part of the muscle briefly loses its supply of oxygen.

How does secondary dysmenorrhea cause menstrual cramps?

Menstrual pain from secondary dysmenorrhea is caused by a disease in the woman’s reproductive organs. Conditions that can cause secondary dysmenorrhea include:

  • Endometriosis – A condition in which the tissue lining the uterus (the endometrium) is found outside of the uterus.
  • Adenomyosis – A condition where the lining of the uterus grows into the muscle of the uterus.
  • Pelvic inflammatory disease – An infection caused by bacteria that starts in the uterus and can spread to other reproductive organs.
  • Cervical stenosis – Narrowing of the opening to the uterus.
  • Fibroids (benign tumors) – Growths on the inner wall of the uterus.
  • Aching pain in the abdomen (pain may be severe at times)
  • Feeling of pressure in the abdomen
  • Pain in the hips, lower back, and inner thighs

Share Facebook Twitter LinkedIn Email Get useful, helpful and relevant health + wellness information enews

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

7 Reasons You Have Period Pain

What causes menstrual cramps? Most women ask this question at some time in their life. It seems that when it comes to that time of the month, mild cramps, bloating, and irritability — although nuisances — are all to be expected. However, crippling period pain, heavy bleeding, serious fatigue, and other symptoms that affect your quality of life are not.

With menstrual cramps, mild to intense abdominal cramping begins within 24 hours of the start of your period and continues for days. Symptoms of period pain include:

  • Dull, constant ache
  • Menstrual cramps that radiate to your lower back and thighs
  • Throbbing or cramping pain in your uterus during the period

Some women also experience:

  • Dizziness
  • Headache
  • Loose bowels
  • Nausea

But what causes cramps during your period? Menstrual cramps are generally categorized as “primary dysmenorrhea,” which is caused by the elevated production of prostaglandins, hormones produced by the uterus that cause it to contract. When you have strong uterine contractions, the blood supply to the uterus is momentarily shut down, depriving the uterus muscle of oxygen and setting up the cycle of menstrual cramps and pain. Some studies show that women with severe menstrual cramps have stronger uterine contractions than others do when giving birth.

According to Mayo Clinic, certain conditions such as endometriosis and pelvic inflammatory disease are associated with menstrual cramps. Endometriosis can cause fertility problems. Pelvic inflammatory disease can scar your fallopian tubes, which increases the risk of an ectopic pregnancy, in which the fertilized egg implants outside your uterus. Other risk factors include use of an intrauterine device (IUD), uterine fibroid tumor, and sexually transmitted diseases.

If you have period pain, here are some home-care treatments to consider:

  • Dietary supplements Some findings report that natural dietary supplements containing omega-3 fatty acids and magnesium may reduce period pain.
  • Relaxation While emotional stress may increase your period pain, meditation and relaxation exercises can reduce their severity.
  • Exercise Physical activity, particularly yoga, may ease the pain of menstrual cramps.
  • Heat Try using a heating pad or microwaveable warm cozy on your abdomen during your period. Some find great period pain relief with a soak in a hot bath or shower.
  • Stop smoking and avoid alcohol. Both substances have been found to make menstrual cramps much worse.

A study published in October 2017 in the Journal of Bodywork and Movement Therapies concluded that women who practiced yoga 30 minutes per day, two days a week, for 12 weeks at home had a significant improvement in menstrual pain and physical fitness over the control group. Another study, published in January 2017 in the Journal of Alternative and Complementary Medicine, found that Hatha yoga practice was associated with a reduction in levels of chronic pelvic pain in women with endometriosis.

If your periods are causing you significant pain, consult your doctor, because menstrual pain can be a sign of a serious problem. Here are seven conditions known to cause painful menstrual cramps.

Period pain (dysmenorrhoea)

Some women experience minimal or mild discomfort during menstruation, but others suffer from severe, debilitating pain that prevents them from doing their day-to-day activities. None of us knows what another woman’s pain is like, so it is useful to understand what periods should feel like and then decide if all is normal. Some women might have always experienced painful periods; others might develop pain. Period pain is more common in adolescents and women in their 20s, but can also occur in older women.

Period pain happens when the muscles in the uterus contract or tighten. Pain can include cramping and heaviness in the pelvic area, as well as pain in the lower back, stomach or even legs. Some women also experience nausea, vomiting, paleness, diarrhoea or loose bowels. Women who experience painful periods can have higher levels of prostaglandins – a natural body chemical that causes contractions of the uterus, bowel and blood vessels.

Period pain is the most common cause of pelvic pain.

What is normal period pain?

Period pain is only considered ‘normal’ if:

  • the pain is there only on the first one or two days of your period
  • the pain goes away if you take period pain medications or use the contraceptive pill
  • your ability to do your normal activities is not impaired.

If the pain is not like this, it is not normal.

What causes period pain?

Painful periods can be due to:

  • pain in the uterine (womb) muscle (myometrium), especially if the pain is on the first one or two days of a period
  • pain from endometriosis and/or adenomyosis, especially if the pain is present for more than one to two days before the period starts.

Many women with strong period pain have both these problems, and women with adenomyosis have a more painful uterus than other women, even if it looks normal.

Adenomyosis is a condition in which the cells that normally form a lining in the uterus also grow in the muscle wall of the uterus.

Endometriosis is a condition in which cells similiar to those found in the lining of the uterus (endometrium), grow outside the uterus. It used to be thought of as an uncommon problem of women in their 30s and 40s. We now know it is a common problem that usually starts in the teens (see our webpages on endometriosis).

Symptom relief for painful periods

Apply heat on the belly or lower back

Helps relax muscles


Releases endorphins (natural feel-good hormones)

Relax with rest, warm baths or meditating

Relieves stress

Complementary therapies

Acupuncture, or discuss taking fish oils and magnesium with a qualified naturopath

Pain relief: ibuprofen, naproxen or diclofenac

Take period pain medications at the onset of pain, and take regularly during the days you normally have pain. All these medications can cause stomach irritation, so they are best taken with food. Discuss the pros and cons of using them with your doctor.

The oral contraceptive pill (OCP)

Ask your doctor about:

  • a pill with more progestogen than oestrogen for the best effect
  • planning a period only every 2-3 months, or not at all.

Mirena® intrauterine device (IUD)

Currently the most effective treatment for pain from the uterus; lasts up to five years.

It slowly releases a progestogen medication to the uterus that makes periods lighter and less painful. It is also a contraceptive.

It is common to have irregular bleeding and cramp pains during the first few months of use, but these problems usually settle.

It can be inserted in the doctor’s surgery or under a general anaesthetic.

If simple treatments for period pain don’t help, see your doctor to discuss the possible causes and what might be best to do in your individual case.

  1. Willman EA, Collins WP, Clayton SG. Studies in the involvement of prostaglandins in uterine symptomatology and pathology. Br J Obstet Gynaecol. 1976;33:337.

  2. Marjoribanks J, Proctor M, Farquhar C, Derks RS. Non-steroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev. 2010;CD001751.

  3. Wong CL, Farquhar C, Roberts H, Proctor M. Oral contraceptive pill for primary dysmenorrhoea. Cochrane Database Syst Rev. 2009;CD002120.

  4. Bahamondes L, Petta CA, Fernandes A, Monteiro I. Use of the levonorgestrel-releasing intrauterine system in women with endometriosis, chronic pelvic pain and dysmenorrhoea. Contraception. 2007 Jun;75:S134-9.

Last updated 04 November 2019 — Last reviewed 10 July 2018

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at July 2018.

How to Handle Severe Menstrual Cramps

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 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:

  • heavy periods
  • periods that last longer than seven days
  • bleeding between periods
  • gastrointestinal pain
  • pain with intercourse
  • painful bowel movements
  • trouble getting pregnant

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:

  • heavy periods
  • prolonged periods
  • excessive facial and body hair
  • weight gain and trouble losing weight
  • acne
  • thinning hair or hair loss
  • multiple skin tags
  • dark patches of skin, especially in the creases of the neck and groin


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 pressure
  • lower back pain
  • leg pain
  • heavy periods
  • periods that last more than a week
  • constipation
  • frequent urination
  • difficulty emptying the bladder

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:

  • painful intercourse
  • bleeding during or after sex
  • foul-smelling vaginal discharge
  • burning sensation when urinating
  • fever
  • spotting between periods

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 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.

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *