Menstrual cramps painful: Normal vs. Severe Pain, Causes, Relief Tips

27.09.202329.06.2023 by alexxlab

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Normal vs. Severe Pain, Causes, Relief Tips

Severe Menstrual Cramps: Normal vs. Severe Pain, Causes, Relief Tips

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Medically reviewed by Deborah Weatherspoon, Ph. D., MSN — By Adrienne Santos-Longhurst — Updated on February 28, 2023

If you have severe menstrual cramps that disrupt your daily life, regular exercise, heating pads, and some supplements could make a difference. For severe pain, a healthcare professional may be able to recommend strategies for lasting relief.

Menstrual cramps can range from a mild nuisance lasting a day or two to several days of unbearable pain that interferes with everyday activities. They’re one of the most common causes of pelvic pain and many experience them just before and during their period.

The pain is caused by uterine contractions that happen just before or during the onset of your period. But what makes the pain more severe for some people?

Read on to learn more about the potential causes of severe cramps and how to manage the pain.

Menstrual cramps feel like a throbbing or cramping pain in your lower abdomen. You may also feel pressure or a continuous dull ache in the area. The pain may radiate to your lower back and inner thighs.

Cramps usually begin a day or two before your period, peaking around 24 hours after your period starts. They typically last for two to three days.

Menstrual cramps can be accompanied by other symptoms, including:

nausea
fatigue
loose stools
headache
dizziness

Typical menstrual cramps are painful, but they usually respond well to over-the-counter (OTC) pain relievers, including ibuprofen.

Severe cramps, however, tend to begin earlier in the menstrual cycle and last longer than typical cramps do.

signs of severe cramps
Not sure if your cramps are typical or severe? Generally, severe menstrual cramps:
don’t improve when you take OTC pain medication
interfere with your daily activities
are often accompanied by heavy bleeding or clotting

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

Endometriosis is a chronic, noncancerous condition where cells that resemble the uterus lining, called endometrial cells, grow outside the 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

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

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.

If you have very painful menstrual cramps or cramps that last longer than two or three days, make an appointment with your healthcare provider.

They’ll likely start by reviewing your medical history and performing a physical exam, including a pelvic exam. They may also give you a Pap test.

Depending on your other symptoms, they may recommend additional tests, including:

an ultrasound to check the size and thickness of your uterus as well as detect fibroids or cysts
a CT scan, which can provide a detailed view of your reproductive organs
gynecologic laparoscopy, a minimally invasive surgical procedure, to confirm a diagnosis of endometriosis

Severe menstrual cramps are typically hard to treat on your own, but these tips may help while you work with your healthcare provider to narrow down an underlying cause:

Get regular exercise. Results of a 2015 study showed that doing 30 minutes of aerobic exercise three times a week significantly reduced the severity of menstrual cramps over the course of 8 weeks.
Use a heating pad. There’s evidence that heat may be as effective as ibuprofen for relieving menstrual cramps. Place a heating pad on your lower abdomen for relief.
Manage your stress. Work and general life stress has been linked to menstrual cramps. Breathing exercises, yoga, and spending time doing things that you enjoy can help keep your stress down.
Soak in a hot bath. Soaking in a hot bath soothes your lower abdomen and back. It’s also relaxing and a great way to relieve stress.
Take supplements. Certain supplements may help reduce the severity of menstrual cramps. These include omega-3 fatty acids, magnesium, and vitamins B-1 and B-6.
OTC pain medication. OTC pain relievers, such as ibuprofen and acetaminophen, often aren’t enough to completely eliminate severe menstrual cramps. If you take them a day before you usually start to experience cramps, they may be more effective.

You don’t have to power through severe menstrual cramps. If your pain interferes with your ability to go on about your day or lasts longer than two or three days, talk to your healthcare provider. They can help you get to the bottom of what’s causing your severe cramps and recommend a plan to keep the pain under control.

Last medically reviewed on May 10, 2019

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Adenomyosis. (2017).
my.clevelandclinic.org/health/diseases/14167-adenomyosis
Dehnavi ZM, et al. (2018). The effect of aerobic exercise on primary dysmenorrhea: A clinical trial study. DOI:
10.4103/jehp.jehp_79_17
Dysmenorrhea. (2014).
my.clevelandclinic.org/health/diseases/4148-dysmenorrhea
Intrauterine device (IUD). (2017).
hhs.gov/opa/pregnancy-prevention/birth-control-methods/iud/index.html
Ju H, et al. (2014). The prevalence and risk factors of dysmenorrhea. DOI:
10.1093/epirev/mxt009
Mayo Clinic Staff. (2018). Uterine fibroids.
mayoclinic.org/diseases-conditions/uterine-fibroids/symptoms-causes/syc-20354288
Osayande AS, et al. (2014). Diagnosis and initial management of dysmenorrhea.
aafp.org/afp/2014/0301/p341.html
Parasar P, et al. (2017). Endometriosis: Epidemiology, diagnosis and clinical management.
ncbi.nlm.nih.gov/pmc/articles/PMC5737931/
Pelvic inflammatory disease (PID) – CDC fact sheet. (2015).
cdc.gov/std/pid/stdfact-pid.htm
Polycystic ovary syndrome. (2019).
womenshealth.gov/a-z-topics/polycystic-ovary-syndrome
Rigi N, et al. (2012). Comparing the analgesic effect of heat patch containing iron chip and ibuprofen for primary dysmenorrhea: a randomized controlled trial. DOI:
10.1186/1472-6874-12-25

Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.

Current Version

May 10, 2019

Written By

Adrienne Santos-Longhurst

Edited By

Phil Riches

Medically Reviewed By

Deborah Weatherspoon, Ph.D., MSN

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Medically reviewed by Deborah Weatherspoon, Ph.D., MSN — By Adrienne Santos-Longhurst — Updated on February 28, 2023

Period Pain: Could It Be Endometriosis?

Reviewed By:

No woman looks forward to “that time of the month.” Most of us deal with mood swings, bloating and cramps, which are never fun. But women with endometriosis often find getting a period particularly unbearable. For them, an average period is anything but average, with debilitating cramps.

During a typical menstrual cycle, the lining inside your uterus — the endometrium — builds up and is then shed. And, well, you know what happens then. In women with endometriosis, that lining grows outside the uterus, usually around the ovaries or beneath the uterus in an area called the posterior cul-de-sac. As it builds up and breaks down, it causes small amounts of bleeding inside the pelvis. This leads to pain, inflammation, swelling and scarring.

If you think you might have endometriosis, know that you aren’t alone. The condition affects hundreds of thousands of women every year. Even Lena Dunham, star of the television show Girls, brought widespread attention to this condition by talking about her own diagnosis and subsequent surgeries to correct it.

Watch Out for These Five Symptoms

Johns Hopkins gynecologist Mindy Christianson, M.D., says there are five common signs of endometriosis. Here’s what you should watch out for:

Painful periods. Most of us have cramps during our periods, but women with endometriosis often have debilitating pain.
Chronic pelvic pain. Sometimes women have chronic and severe pelvic pain even when they don’t have their periods, Christianson says. This can be due to prolonged disease and scarring.
Painful intercourse. This common symptom, also known as dyspareunia, is due to endometriosis beneath the uterus. During penetration, women might have intense, localized pain.
Ovarian cysts. These cysts, known as endometriomas, are another hallmark of endometriosis. They can become large and painful, and often need to be removed.
Infertility. Infertility is defined as not conceiving within one year despite regular sexual intercourse without contraception. About 10 percent of women living with infertility have endometriosis. “This is the leading cause of infertility because it can cause scar tissue as well as damage and inflammation to the fallopian tubes, which are needed to conceive naturally,” Christianson explains. “Research also shows that endometriosis can affect egg quality and reduce the number of eggs in the body.”

The symptoms above aren’t exclusive to endometriosis, Christianson says. Painful periods don’t always point to endometriosis; sometimes they’re a separate condition known as dysmenorrhea. Pelvic pain can also be caused by scar tissue, previous infections or a history of appendicitis. Irritable or inflammatory bowel syndromes can also cause pelvic pain.

Diagnosing and Treating Endometriosis

If you have any of the above symptoms, see your gynecologist. Women with infertility might be referred to a reproductive endocrinologist or a fertility specialist. Some doctors also specialize in pelvic pain and endometriosis.

To confirm a diagnosis, your doctor will likely perform a minimally invasive laparoscopy. During this procedure, a thin, lighted tube will be put into a tiny abdominal incision. This allows your doctor to see your pelvic organs and take a small amount of tissue for biopsy to make a diagnosis.

Often, symptoms can be controlled with medications like birth control pills or leuprolide acetate. Both suppress the pituitary from releasing hormones that make endometriosis grow.

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Painful menstruation – causes, diseases, diagnosis and treatment

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Painful menstruation – the causes of occurrence, in which diseases occur, diagnosis and methods of treatment.

Almost half of girls and women experience painful menstruation (dysmenorrhea). For many of them, pain and discomfort lead to disability within 1-3 days. Clinicians do not attribute this condition to an independent disease, but associate it with a menstrual cycle disorder, which is manifested by cramping or pulling pains in the lower abdomen and in the lumbar region during menstrual bleeding. Pain can be aggravated by other unpleasant symptoms: headache, nausea, fainting. The cause of pain is spastic uterine contractions, during which the endometrium is rejected.

Dysmenorrhea can be based on neurogenic, metabolic and psychological disorders, which must be taken into account in the diagnosis.

Varieties

Dysmenorrhea can be primary (not associated with pathology of the pelvic organs) or secondary (against the background of pathologies of the pelvic organs, due to urogenital diseases and inflammatory processes). Depending on the stage of the disease, there are compensated (the intensity of pain is constant for a long time) and decompensated (symptoms become more pronounced every year) forms.

What diseases cause dysmenorrhea

Adolescent girls are characterized by primary dysmenorrhea, the cause of which is difficult to identify. The basis of primary dysmenorrhea is the accumulation of prostaglandins – physiologically active substances – in the endometrium of the uterus, which cause its spastic contractions.

Excess production of prostaglandins is the result of hormonal changes during puberty.

The occurrence of menstrual pain can provoke the hormone vasopressin. An increase in its level in the blood leads to stagnation of blood in the tissues of the small pelvis.

Secondary dysmenorrhea is caused by various gynecological and infectious diseases.

Sometimes inflammatory processes and adhesions in the pelvic organs lead to dysmenorrhea.

Diagnostics and examination

When diagnosing dysmenorrhea, the woman’s age, concomitant or past diseases, data from a general examination, and ultrasound are taken into account. If the age of the patient does not exceed 25-30 years and the examination did not reveal other diseases, the diagnosis of primary dysmenorrhea is most likely. To confirm the diagnosis, the doctor prescribes a series of tests and tests. It is necessary to assess the hormonal background, first of all, the determination of estradiol levels

Estradiol (E2, Estradiol)

Synonyms: Blood test for estradiol. 17-beta-estradiol.
Brief description of the analyte Estradiol
Estradiol is a steroid hormone with maximum estrogen…

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and progesterone.

Progesterone

Synonyms: Progestin; Gestagen. P4; Pregn-4-ene-3,20-dione.

Brief description of the analyte Progesterone

Progesterone is produced in the ovaries and in a small. ..

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If pain during menstruation appeared in a woman 30 years of age or older, this may indicate the development of endometriosis or the growth of a myomatous node.

Endometriosis is the growth of endometrial cells (the inner layer of the uterine cavity) on its surface and / or in the tissues of nearby organs.

The disease can occur both in women who have given birth, who have undergone abortions or diagnostic curettage, and in nulliparous women suffering from infertility.

If the cause of dysmenorrhea is inflammatory diseases, then the pain is characterized by a different temporary appearance. They increase before the onset of menstruation, and after the first day their intensity decreases. In addition, pulling and aching pains also occur in the pelvic area. In this case, the study of the smear and the identification of the pathogen in the discharge of the cervical canal and vagina confirms the diagnosis.

Ultrasound of the pelvic organs is also prescribed to clarify the diagnosis,

Ultrasound of the soft tissues

Examination of soft tissues to detect pathological changes and diagnose neoplasms.

RUB 1,790

hysterosalpingography

Hysterosalpingography (Hysterosalpingography)

Hysterosalpingography (HSG) is a method of radiographic examination of the state of the uterine cavity and patency of the fallopian tubes using a contrast agent …

RUB 9,490

hysteroscopy.

When diagnosing the causes of dysmenorrhea, one should not exclude such a pathological process as genital tuberculosis, the prevalence of which has increased significantly in recent years. Sometimes the first sign of the disease is infertility. Accompanying symptoms may include lack of appetite, unreasonable weight loss, night sweats, constant body temperature in the range of 37.1-38.0 ° C.

Dysmenorrhea can be caused not only by hormonal imbalance and diseases of the pelvic organs. Intrauterine devices (IUD)

sometimes set without taking into account contraindications and additional examinations.

If the spiral is chosen incorrectly, this can lead to menstrual irregularities and dysmenorrhea.

Which doctors to contact

With the exception of dysmenorrhea caused by genital tuberculosis, women with complaints of painful menstruation are treated by a gynecologist. If a neurogenic and psychosomatic component of dysmenorrhea is detected, a psychotherapist can be involved in the treatment.

What to do

Many women think that painful periods are normal and limit themselves to taking painkillers for a long time. Without establishing a correct diagnosis, these measures often lead to a gradual increase in pain. Even if it is possible to stop pain with the help of anti-inflammatory drugs, it is necessary to find out its cause, which is especially important in secondary dysmenorrhea.

Treatment

In primary dysmenorrhea, treatment is aimed at restoring the hormonal background and stopping the pain syndrome.

The first task is solved by the use of hormonal drugs, the choice of which is determined by the severity of dysmenorrhea.

The doctor can individually select combined oral contraceptives (COCs). The results of studies show that after a year of using COCs, the menstrual cycle normalizes, and the effect persists even after stopping these drugs.

Physiotherapeutic procedures serve as an additional method of treatment: magnetotherapy, transcutaneous electrical nerve stimulation, ultrasonic waves, ultraviolet rays, laser radiation, acupuncture, gynecological massage, etc. Local impulse effect on the pelvic organs leads to an acceleration of recovery and compensatory processes in the body . Positive results are obtained by non-drug methods of treatment: physiotherapy exercises (exercise therapy), proper nutrition with the mandatory inclusion of products containing vitamins B1, B6 and E.

A number of studies have noted the importance of introducing magnesium preparations into the therapeutic course, since it is involved in the regulation of muscle contractions. If the analysis reveals a lack of magnesium in the blood,

Serum magnesium (Magnesium, Serum; Mg)

Synonyms: Blood test for magnesium; total magnesium; Magnesium ions. Serum Magnesium Test; Magnesium test; Magnesium, blood; serum magnesium.

Brief description of the analyzed analyte Magnesium
…

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Your doctor may recommend taking a combination of magnesium and vitamin B6 to normalize your menstrual cycle.

Pregnancy and childbirth in most cases lead to the weakening or disappearance of primary dysmenorrhea.

Treatment for secondary dysmenorrhea depends on the cause of the pain.

Endometriosis, as the most common cause of secondary dysmenorrhea, requires complex and long-term treatment. Removal of the endometrium does not eliminate the recurrence of the disease after a few years. Based on the results of clinical trials, doctors recommend long-term drug therapy after surgery. As a rule, in mild forms of endometriosis, combined oral contraceptives, progestogen preparations are prescribed. The clinical efficacy of dienogest in endometrioid lesions has been proven. This drug well relieves pain associated with endometriosis and pain in the pelvic organs.

Cervical stenosis (narrowing of the cervical canal) is treated by dilating the cervix. A stable result is given by pregnancy and vaginal delivery.

Treatment of adhesions, which may be due to diseases such as cervicitis (inflammation of the cervix) and pelvic inflammatory disease, includes a range of measures from symptomatic therapy (non-steroidal anti-inflammatory drugs) to surgical excision of adhesions. In some cases, antiprostaglandin drugs are effective.

Sources:

Clinical guidelines “Endometriosis”. Developed by: Russian Society of Obstetricians and Gynecologists. – 2020.
Clinical guidelines “Hyperplasia of the endometrium”. Developed by: Russian Society of Obstetricians and Gynecologists. – 2021. Tags: dysmenorrhea, endometriosis, infertility

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

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PAIN DURING MENSTRUCTION AND HORMONAL FAILURE: HOW IS IT RELATED? – Toast

Painful periods are sometimes considered normal. Statistics say that severe pain during menstruation (dysmenorrhea) is regularly experienced by 10-15%, periodically – up to 70% of women of childbearing age. In fact, this is not the norm, but a violation of the menstrual function, by correcting which, you can get rid of the pain.

For many of them, pain and discomfort lead to loss of working capacity within 1-3 days. Clinicians do not refer to this situation as an independent disease, but associate it with a menstrual cycle disorder, which is manifested by cramping or pulling pains in the lower abdomen and in the lower back during menstrual bleeding. Pain can be aggravated by other unpleasant symptoms: headache, nausea, fainting. The cause of the pain is spastic uterine contractions, during which the rejection of the endometrium occurs.

Dysmenorrhea may be based on neurogenic, metabolic and psychological disorders that must be taken into account in the diagnosis.

WHAT DISEASES CAUSE DYSMENORRHEA?

Adolescent girls are characterized by primary dysmenorrhea, the cause of which is difficult to identify. The basis of primary dysmenorrhea is the accumulation of prostaglandins – physiologically active substances – in the endometrium of the uterus, which cause its spastic contractions. Excess production of prostaglandins is the result of hormonal changes during puberty.

The occurrence of menstrual pain can be triggered by the hormone vasopressin. An increase in its level in the blood leads to stagnation of blood in the tissues of the small pelvis.

DIAGNOSTICS AND EXAMINATION

When diagnosing dysmenorrhea, Zdravitsa doctors take into account the woman’s age, concomitant or past diseases, general examination data, and ultrasound examination. If the patient’s age does not exceed 25-30 years and no other diseases are found during the examination, the diagnosis of primary dysmenorrhea is most likely. To confirm the diagnosis, the doctor prescribes a list of tests and samples. An assessment of the hormonal background is necessary, first of all, the determination of the level of estradiol. If pain during menstruation appeared in a woman 30 years of age or older, this may indicate the development of endometriosis or the growth of a myomatous node.

TREATMENT:

Many women think that painful periods are normal and limit themselves to taking painkillers for a long time. Without establishing a correct diagnosis, these measures often lead to a gradual increase in pain. Even if pain can be treated with anti-inflammatory drugs, it is necessary to find out its cause, which is especially important in secondary dysmenorrhea.

In primary dysmenorrhea, treatment is aimed at restoring hormonal levels and reducing pain. The first task is solved by the use of hormonal drugs, the choice of which is determined by the severity of dysmenorrhea.

Menstrual pain should not be ignored. If the cause that causes them is not eliminated, in addition to the unpleasant sensations and consequences of a possible gynecological disease, you can get a decrease in sexual desire and even infertility.

Menstrual cramps painful: Normal vs. Severe Pain, Causes, Relief Tips

Normal vs. Severe Pain, Causes, Relief Tips

Endometriosis

Polycystic ovary syndrome (PCOS)

Fibroids

Pelvic inflammatory disease (PID)

Cervical stenosis

Adenomyosis

Intrauterine device (IUD)

How we reviewed this article:

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Period Pain: Could It Be Endometriosis?

Watch Out for These Five Symptoms

Diagnosing and Treating Endometriosis

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PAIN DURING MENSTRUCTION AND HORMONAL FAILURE: HOW IS IT RELATED? – Toast

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