What Causes Cramps During Periods? When To Talk To Your Doctor About It?

Sometimes cramps and pain is just a natural downside of normal menstruation. Other times, it is a sign of an underlying health problem. Find out what causes cramps and pain during periods, what factors make women more at risk for painful periods, and when you should seek medical care for your symptoms.

Types of Period-Related Pain

There are many possible causes of pain just before and during your period, including:

Premenstrual Syndrome (PMS)

This condition includes a variety of physical and mood-related symptoms that start up to two weeks before a woman’s period begins.2 The symptoms usually resolve within 24 hours of the start of flow.3 The mild form of PMS may affect up to 3 out of 4 women, while its more severe form—premenstrual dysphoric disorder or PMDD—affects only about 3 to 8 out of 100 women.2

PMS and PMDD are believed to be caused by fluctuating hormones that impact mood and the body’s muscles and tissue. Common physical symptoms include fatigue, bloating, breast tenderness, headaches, weight gain, changes in appetite (including cravings), and joint or muscle pain. Common mood-related symptoms include irritability, anxiety or depression, feeling tense, and feeling moody or tearful.2

Primary Dysmenorrhoea
This is the scientific term for the kind of cramping pain many women have during periods and may not be associated with any medical conditions. Pain usually begins up to one or two days before periods, and slowly resolves over the first two to four days of bleeding.3 In many cases, it causes cramping in the lower abdomen. Some women may have pain in the back, thighs, or head, as well as nausea, dizziness, diarrhoea, fatigue, or flu-like symptoms.4

What causes cramps and pain during your period?

  • It is mainly due to an increase in production of a hormone called prostaglandin. Prostaglandins are found throughout your body, and do many things, including helping muscles tighten and relax. Just before and during your period, prostaglandins help your uterus contract and shed its lining. Normally, the levels peak in the first two days of periods. However, some women during menstruation produce excessive (higher than normal) prostaglandins causing them to experience period pains. The severity of pain is related to more excessive levels of prostaglandins.1
  • Due to the higher (than normal) prostaglandin levels, the uterus contracts more than it needs to causing restriction of blood and oxygen flow, leading to painful cramps. It can also lead to nausea and an upset stomach which are experienced by some women during their period.4 This results in the kind of pain and distress that can slow you down and keep you from doing the things you want and need to do.5

Risk Factors for Primary Dysmenorrhoea

Scientific studies point to several things related to your body and health history that can increase your risk of pain during your period. Risk factors include:

  • Younger age6

Period pain usually begins once your periods become established, meaning that most women are aged 20 or younger when they begin having painful periods. The good news is that many women find their periods less painful as they get older.

  • Never having given birth6

Multiple studies show that period pain eases for many women after they have had a child.

  • Having heavy bleeding during your periods5

Women with a heavier flow are more likely to report pain.

  • Having family members who also have/had painful periods6

Some studies suggest that period pain might be linked to genetic susceptibility; others point to sharing similar lifestyles and family living patterns.

  • Smoking

Some studies show that women who smoke have a higher risk for pain during their periods,5 and pain may be worse for women who smoke more cigarettes each day.6

  • Having less social support7

A study by researchers at the University of Wisconsin found that women with less stable social networks experience more pain during their periods compared to women in the study who reported stronger social support.

  • Feeling emotional or psychological stress or distress7

Women who report feeling anxious or depressed, or stressed due to work or general life events, may experience more pain during their periods.

Secondary Dysmenorrhoea

This is more common in women over 20 years old;6 and 1 in 10 women experience it.8 Its treatment may vary according to the condition, so seeing a doctor to find the exact cause of the period pain is important.

It is caused by underlying health problems, the most common of which are endometriosis and adenomyosis.9 Other conditions that may cause painful periods include pelvic inflammatory disease, leiomyomata, ectopic pregnancy, interstitial cystitis, or a condition called chronic pelvic pain.8

Endometriosis

Endometriosis is the growth of endometrial tissue—which normally lines the uterus—in other places. It may grow in the ovaries, fallopian tubes, on the outside of the uterus, or other areas in the pelvis.10 Its cause is not known, but risk factors for the condition include early age of onset of painful periods, having used oral contraceptives for a long time to treat painful periods, a positive family history, and missing school due to painful periods.8

Symptoms of endometriosis often include pain during or just before periods, pain between periods, pain during or after sex, and pain when urinating or having a bowel movement. Women with endometriosis may also have difficulty getting pregnant or may have ovarian cysts found during pelvic or ultrasound exams.10

When to See a Doctor for Your Period Pain

Many women and adolescents think that period pain is normal and not worth speaking to their doctor about.8 Even women with moderate to severe period pain do not tell their doctor about their symptoms. In one study, only about 1 in every 3 women with period pain spoke about it with their healthcare provider.11

What can happen if I don’t seek treatment?

Studies indicate that women with period pains may be more sensitive to pain in general—both during their periods and at other times of their cycles.1 Experiencing repeated pain every month may further increase sensitivity to pain, so treating period pains and reporting it to the doctor is important.8

Without treatment, painful periods can lead to difficulties attending school or work, poorer school performance, trouble doing daily activities, and disrupted relationships with both family and friends.12 If underlying health problems are the cause of the pain, they may lead to long-term concerns, such as worsening pain over time, the spread or worsening of the disease, difficulty becoming pregnant, and other health issues.10

Symptoms requiring medical attention

Very mild pain that does not bother you or disrupt your routine may not require a diagnosis from a medical professional, especially if over-the-counter medicine or holistic methods, such as heating pads or yoga, control your pain well. However, there are many reasons why you may wish or need to see a doctor for your period-related pain. These include:

  • Your pain doesn’t respond to pain medications. Some underlying health conditions, such as endometriosis, are more common among young women who still have period pain even after trying treatments to relieve period pain, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or oral contraceptives.8
  • Your pain is severe enough to affect your sleep or mood, or it keeps you from school, work, or your daily activities. As many as 1 in 3 women may have period pain that incapacitates them in this way, which may result in the restriction of daily activities.8
  • Your pain has recently changed or gotten worse, or is not limited to just a few days during or before your period. This may indicate some other underlying cause for the pain.5
  • You have unusual vaginal discharge or signs of an infection (such as a fever), especially if you are sexually active. These may indicate that you have an infection, inflammatory disease, or a sexually transmitted disease.5
  • You have any of the following:9
    • very heavy bleeding
    • unexpected bleeding
    • pain that gets worse over the course of a few periods
    • pain that does not get better with attempts to treat yourself at home
    • a history of skipped periods
    • severe and sharp pain in the lower abdomen
    • pain during sex
    • pain that radiates to the rectum
    • pain that is relieved by passing stool
    • difficulty passing stool
    • a change in urinary symptoms (having to urinate more often or waking at night more than usual to urinate)
    • pain that gets worse when you are anxious
    • any other symptom that you find very painful, bothersome, or worrisome

Treatment Options for Period Pains

There are many treatment options for women and adolescents experiencing period pain. Read about many effective holistic options in our How To Reduce Period Pain – 9 Proven Ways article. You can also learn more about over-the-counter and prescription pain relief options through our series of treatment-focused articles:


Discuss your pain with your doctor to learn about prescription pain relief options, diagnosis of your pain, and additional treatments.

References

1. Iacovides S, et al. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update. 2015;21(6):762-778.

2. Casper RF. Patient education: Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) (Beyond the Basics). UpToDate.com, reviewed Jun 2019; Updated 12 Feb 2019. Accessed online 10 June 2019.

3. Booton DA, Seideman RY. Relationship between premenstrual syndrome and dysmenorrhea. AAOHN J. 1989;37(8):308-15. 

4. Smith RP, Kaunitz AM. Patient education: Painful menstrual periods (dysmenorrhea) (Beyond the Basics). UpToDate.com, reviewed Apr 2019; updated 30 Mar 2018. Accessed online 07 May 2019. 

5. French L. Dysmenorrhea. American Family Physician. 2005;71(2):285-291.

6. Ju H, Jones M, Mishra G. The prevalence and risk factors of dysmenorrhea. Epidemiol Rev. 2014;36:104-13.

7. Alonso C, Coe CL. Disruptions of social relationships accentuate the association between emotional distress and menstrual pain in young women. Health Psychology. 2001;20(6):411-416. 

8. Osayande AS, Mehulic S. Diagnosis and initial management of dysmenorrhea. American Academy of Family Physicians. 2013;89(5):341-346

9. Bernardi M, Lazzeri L, Perelli F, Reis FM, Petraglia F. Dysmenorrhea and related disorders. F1000 Research. 2017;6(F1000 Faculty Rev):1645 Last updated 05 Sep 2017.

10. Levy BS. Patient education: Endometriosis (Beyond the Basics). UpToDate.com, reviewed Jun 2019; updated 30 Mar 2018. Accessed online 10 June 2019.

11. Subasinghe AK, et al. Prevalence and severity of dysmenorrhea, and management options reported by young Australian women. AFP. 2016;45(11):829-834.

12. Chauhan GD, Kodnani AH. A study of prevalence and impact of dysmenorrhea and its associated symptoms among adolescent girls residing in slum areas of Vadodara city, Gujarat. International Journal of Medical Science and Public Health. 2016;5(3):510-515.

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