More than one half of women who menstruate have some pain for 1-2 days each month. Usually, the pain is mild. But sometimes the pain is so severe it keeps them from normal activity. The medical name for painful periods is dysmenorrhea.
The Menstrual Cycle
A menstrual cycle starts with the first day of vaginal bleeding, and ends with the first day of vaginal bleeding of the next period—an average cycle of 28 days.
During the cycle, two hormones (estrogen and progesterone) are made by the ovaries. The hormones cause growth changes in the lining of the uterus so the uterus will be ready for a possible pregnancy. On about day 14 of the cycle, an egg is released from one of the ovaries. This is called ovulation.
The egg then moves into one of the two fallopian tubes connected to the uterus. There, it can be fertilized by the sperm. If this happens, pregnancy occurs. If the egg is not fertilized, the levels of hormones decrease. That signals the uterus to shed its lining, which is when the menstrual period begins. For some women this menstrual bleeding causes mild cramps; for others, it can cause severe pain.
The normal age range for your menstrual cycle is 12-51 years on average. Any significant change in bleeding after age 40 or vaginal bleeding after menopause needs prompt evaluation.
Causes of Menstrual Pain
Like all muscles, the uterus can contract and relax. During your period you can feel cramping pain due to your uterus contracting more strongly.
The uterine muscles contract when chemicals called prostaglandins are produced by the lining of the uterus. On the first day of your period, the level of prostaglandins is high. As you menstruate and shed the lining of the uterus, the level goes down. This is why pain tends to lessen after the first few days of the period.
Symptoms of Dysmenorrhea
Primary dysmenorrhea is pelvic pain that comes from having your period and the natural production of prostaglandins. Often it begins soon after a preteen or teen starts having periods. It can cause severe and frequent menstrual cramping from abnormal uterine contractions.
Secondary dysmenorrhea has causes other than menstruation and the natural production of prostaglandins. It may begin later in life than primary dysmenorrhea. This type of pain often lasts longer than normal cramps. For instance, it may begin long before your period starts. The pain may get worse with your period and not go away after your period ends. Some of the most common causes are:
Is there anything I can do to feel better?
To ease discomfort, try one or more of the following tips:
Medications called NSAIDs (non-steroidal anti-inflammatory drugs) block the body from making prostaglandins. This makes cramps less severe. These drugs also can prevent some symptoms, such as nausea and diarrhea. Most NSAIDs, such as ibuprofen & naproxen, can be bought over the counter (without a prescription).
NSAIDs work best if taken at the first sign of your period or pain. You usually take them for only 1 or 2 days and should avoid alcohol during this time. Women with bleeding disorders, liver or kidney damage, stomach disorders, or ulcers should not take NSAIDs.
Hormonal contraception, such as birth control pills, patches, implants and vaginal rings, also reduce menstrual pain. In some cases the hormonal intrauterine device (IUD) may be recommended. The hormones in these types of contraception help control the growth of the lining of the uterus so less prostaglandin is made—meaning fewer cramps, less blood flow, and less pain.
Surgery, in cases of severe dysmenorrhea, may be recommended. This may consist of laparoscopy for removal of endometriosis, or a hysterectomy to remove the uterus. Other surgical options may be discussed with your provider.