Painful periods
It is not uncommon for women to be told that pain and cramping with periods is just a normal part of life. This is a common misperception and periods should not produce more than minor discomfort. If you are experiencing severe pain with your periods, it’s a good idea to talk to a health provider as there may be a reason behind your pain. Some causes of painful periods are not serious and are easy to treat, but others are more serious and can be a sign of an underlying serious medical condition. A trained and certified women’s health provider can help determine which tests might be necessary to diagnose the cause of your painful periods, and recommend an appropriate course of treatment.
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About painful periods
Painful periods (dysmenorrhea), including severe cramping, affect approximately half of all menstruating women. The pain results from chemicals released to breakdown the lining of the uterus, and is most common just before the start of a period and continuing for the first few days of the cycle. The pain with periods that begins when young women begin menstruation and continues monthly is called primary dysmenorrhea. For many women with primary dysmenorrhea, the pain gets better over time, improving with age or after childbirth.
Secondary dysmenorrhea occurs when there is a disorder of the reproductive system that is causing pain during periods. This pain may start before a period begins, and often continues throughout the cycle and for several days after menstruation ends. The pain tends to get worse over time. This pain is stronger than menstrual cramps and can be painful enough that it keeps women from being able to participate in work, school, exercise, or other activities in life. Sometimes, women “curl up in a ball” and are unable to leave their bed for a few days during their menstrual cycle. Some conditions that can cause secondary dysmenorrhea are:
- Endometriosis: 1 progressive disorder in which the tissue inside the uterus—the endometrium—is found outside the uterus.
- Adenomyosis: a type of endometriosis where the lining of the uterus grows within the muscle wall of the uterus.
- Fibroids: noncancerous growths in the muscle tissue of the walls of the uterus.
Lifestyle tips
Keep track of your menstrual cycle and the pain associated with it. Note the dates, length, type of flow you experience (light, medium, heavy or spotting), and amount of pain you are having in order to determine what is normal for you and to keep track of any changes. This information is helpful to bring to your appointment. Several smartphone apps are now available to track menstrual cycles.
Drink plenty of water, especially when you are menstruating. Upping your water intake during heavy flow can help with fatigue and prevent dehydration.
Exercise regularly, for 30 minutes or more, at least three times a week. Regular exercise can help control estrogen and other hormones that regulate the menstrual cycle.
Get plenty of rest. Taking time to rest whenever possible is important—especially just before, during and after your period.
Relaxation techniques can curb stress that interferes with a woman’s natural cycle. Some proven techniques include deep breathing, guided imagery, mindfulness meditation, progressive muscle relaxation and yoga.
Some women get relief from using a hot water bottle or heating pad to the pelvic area. Be careful, as prolonged use and/or high temperatures can cause burns to the area where the heat is placed.
Treatment options
At your visit, your doctor will discuss your history with you and may perform a pelvic examination or pelvic ultrasound to help determine the cause of your painful periods. Treatments for painful periods and severe cramping vary, depending on the cause of the pain, your age and whether you want to have children. Medical therapies are usually the first line of treatment, and there are surgical procedures to treat some of the conditions that cause painful periods.
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- Nonsteroidal anti-inflammatory drugs (NSAIDs): These drugs, which include ibuprofen and naproxen, help relieve menstrual cramps by targeting and lessen the chemicals released during the menstrual cycle. NSAIDs work best if taken just before or at the first sign of your menstrual period or pain. It is typically recommended to take them for only 1 or 2 days. Women with bleeding disorders, asthma, aspirin allergy, liver damage, stomach disorders, or ulcers should not take NSAIDs.
- Hormonal birth control: Birth control pills, patches, the vaginal ring, injections, and the contraceptive implant contain hormones that can help regulate the menstrual cycle and decrease painful periods.
- Intrauterine device (IUD): A small device that is inserted and left inside the uterus to prevent pregnancy, an IUD can also reduce menstrual pain.
- Conservative surgery: If you have endometriosis and are trying to get pregnant, surgery to remove the abnormal tissue while preserving your uterus and ovaries may be recommended. This procedure is usually done laparoscopically, inserting a thin laparoscope through a small incision to remove endometrial tissue.
- Abdominal myomectomy: This procedure is most commonly used to treat multiple fibroids or very large fibroids. Fibroids from the uterine wall are removed through an incision in the abdomen. Scarring after surgery may affect future fertility.
- Hysterectomy: The surgical removal of the uterus may be performed for dysmenorrhea if other treatments have not worked and if the disease causing the pain, such as fibroids, endometriosis or adenomyosis is severe. This procedure normally is the last resort. Most of the time, this procedure can be performed with minimally invasive surgery that removes the uterus through small incisions in the abdomen. After the uterus is removed, a woman can no longer get pregnant and will no longer have periods.
Frequently asked questions
More than 50% of women have minor discomfort during their periods that can be relieved with rest or occasional use of over the counter pain relievers. However, periods should not disrupt your life. If your periods are becoming more painful over time or are keeping you from doing the things you want to do in life—it’s a good idea to follow up with your health care provider.
The lining of the uterus releases prostaglandins at the time of the menstrual cycle that causes menstrual cramps. When these cramps go from being a minor discomfort to causing pain before, during or after menstruation, there can be a disorder in the reproductive system causing the painful periods. Endometriosis, adenomyosis, and fibroids are the most common conditions causing painful periods.
Some conditions that cause painful periods may progress over time if left untreated and negatively impact fertility, such as endometriosis and fibroids. If you have any questions about whether or not your menstrual pain is normal, it’s a good idea to be seen by a provider for evaluation.
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