Period pain (dysmenorrhea) and its causes

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Period pain is pain that occurs just before or during a menstrual period.

Every person’s experience of period pain is different, but it can cause:

• a cramping sensation in the abdomen
• burning pain in the abdomen
• pain that may feel like trapped gas
• pain that radiates to the back, hips, or legs

Some people also experience digestive symptoms alongside period pain, such as:

• nausea or vomiting
• bloating
• diarrhea
• constipation

Other symptoms associated with dysmenorrhea include irritability and headaches. Period pain and cramping can vary from mild to intense.

There are two types of period pain: primary and secondary.

Primary dysmenorrhea

Primary dysmenorrhea occurs as a result of menstruation alone. This means another condition does not cause it.

Researchers believe that prostaglandins are what cause primary dysmenorrhea. Prostaglandins are hormone-like substances that control inflammation.

As a period begins, the body releases prostaglandins. This triggers contractions in the uterus, prompting the womb lining to shed.

These contractions are at their strongest during the first 2 days of a period. But before a period begins, progesterone levels drop, which could also cause an increase in prostaglandins before the period begins.

The amount of prostaglandins the body releases correlates with the intensity of these contractions, and so the severity of period pain. People with primary dysmenorrhea also often experience longer, heavier periods.

Certain risk factors may contribute to the condition, including:

• smoking
• stress
• anxiety or depression
• having excess weight
• trying to lose weight
• beginning periods at an early age
• never having been pregnant
• a family history of painful periods

Secondary dysmenorrhea

Secondary dysmenorrhea occurs as a result of another medical condition. Examples of conditions that can cause secondary dysmenorrhea include:

• Endometriosis: This is a condition that causes uterine tissue to grow outside of the womb. Painful periods are a key symptom.
• Uterine growths: Fibroids, cysts, and polyps can cause increased pain during periods, along with abdominal pain that occurs outside of menstruation. Bloating, constipation, and lower back pain can also be symptoms.
• Adenomyosis: This condition occurs when the womb lining breaks through the muscle wall of the uterus, causing cramping, pressure, and bloating before periods.
• Pelvic inflammatory disease (PID): This is serious inflammation of the uterus and pelvic organs, often as a result of an infection, such as a sexually transmitted infection.
• Structural differences: Some people are born with structural differences in their womb that may cause more difficult periods.
• Intrauterine device (IUD) use: Some people report more period pain with an IUD. People who use IUDs are also at an elevated risk for PID.

It is possible for a person to have primary dysmenorrhea and then to develop secondary dysmenorrhea, making the existing pain worse.

There are a number of approaches people can try to reduce period pain. Coping strategies can reduce current pain, while others may help reduce the likelihood of dysmenorrhea overall.

Coping with period pain

Some strategies that may help relieve period pain when it occurs include:

• nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
• heat therapy, such as a heating pad, hot water bottle, or warm bath
• transcutaneous electrical nerve stimulation (TENS), which people can use at home, work, or school via portable TENS machines
• having an orgasm, either alone or with a partner
• gentle exercise
• acupuncture or acupressure

Preventing period pain

Some approaches that may reduce or help prevent dysmenorrhea include:

Rest and stress reduction

Some research suggests that stress can increase the likelihood or severity of period pain and PMS.

An older 2008 nationwide survey in Hungary found that females in more stressful work environments experienced more severe period pain, particularly those with low job security and a lack of support from coworkers.

It can be difficult to avoid stress, but learning how to manage it may help. Ideas for this include:

• breathing exercises, meditation, yoga, or tai chi
• engaging in self-care by getting enough sleep or eating balanced meals
• expressing emotions through journaling, talking to a friend, or creative hobbies

Learn more about stress, its causes, and how to manage it here.

Birth control

Some forms of hormonal birth control may help to reduce the severity of period pain. Some forms can also stop periods entirely. Examples of methods that may do this include the pill, the implant, and the injection.

Hormonal IUDs can also reduce or stop periods, but the insertion process may cause cramping. People with conditions that can cause dysmenorrhea, such as PID, may want to avoid hormonal IUDs.

Exercise

A 2018 clinical trial found that regular exercise has an impact on period pain. Out of 70 students, those who did 30 minutes of aerobic exercise three times per week saw a reduction in dysmenorrhea symptoms after 8 weeks.

But this study was small and only focused on younger females. Other studies have concluded that there is no association between exercise and period pain reduction.

Managing underlying conditions

In cases of secondary dysmenorrhea, identifying and managing the cause is essential for reducing period pain. For example, a person with a uterine growth or endometriosis may benefit from surgery to remove growths that are causing pain.

Dysmenorrhea is a common condition that has a significant impact on public health.

A large 2019 study conducted in the Netherlands found that during a 4-month timeframe, nearly 14% of respondents missed work or school due to their period. In fact, 3.4% missed school or work in every or almost every menstrual cycle.

Despite this, people with dysmenorrhea can face difficulty getting medical care. This is partly due to the belief that painful periods are normal. Another component is prejudice as a result of sexism, racism, and other sources of bias.

According to a 2018 literature review, women are more likely to experience chronic pain conditions than men. But doctors are also more likely to blame that pain on mental illness or malingering, resulting in a “struggle” for women to be believed.

This can result in people being unable to get a diagnosis or treatment. For example, an older article notes that while around 10% of females have endometriosis, it takes 8–12 years on average to get a diagnosis.

These barriers are even more significant for women of color. Several studies show doctors are less likely to prescribe pain medication for Black women, while a 2016 study showed that 47% of medical residents and students underestimated pain in Black people.

Being aware of these barriers is important for both healthcare professionals and for patients, who may avoid seeking help for severe pain after negative experiences with doctors.

While mild period pain is common, nobody should have to endure severe or debilitating pain. A person should speak with a doctor if:

• their periods become much heavier or more painful than normal
• their periods frequently cause them to miss work or school
• over-the-counter pain medications, such as NSAIDs, do not work

People should also speak with a doctor if they have painful periods along with other symptoms, such as:

• pain during or after sex
• bleeding between periods
• frequent need to urinate
• bad-smelling or grey discharge

If a person faces difficulty getting a diagnosis, there are things they can do to advocate for themselves. For example:

1. Describe or write down a concise list of symptoms to show doctors.
2. Be honest about the level of pain, giving specific examples of its impact.
3. Ask what else could be causing the pain, if a doctor is dismissive.
4. Ask what the doctor will do if the pain continues or gets worse.
5. Ask the doctor to memorialize their decision not to investigate or treat the pain in the person’s chart.
6. Seek an opinion from another doctor or move to another healthcare center.

Some people may feel a benefit from having someone else accompany them to appointments for support.

Period pain, or dysmenorrhea, is a common condition that can lower a person’s quality of life. Home care can treat mild or occasional period pain. But if a person has severe and disruptive periods, it is important for doctors to investigate the cause and treat the pain wherever possible.