Why am I in so much pain during my period?

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This pain comes before or during your period and is caused by natural chemicals called prostaglandins that are made in the lining of the uterus.1 Prostaglandins cause the muscles and blood vessels of the uterus to contract, which is what helps the uterine lining to leave the body.

For many women, it’s the first sign that their period is coming—or has arrived. The unmistakable feeling of menstrual cramps. Ugh. Grab the blankets and hot tea. Here we go again.

More than half of women who menstruate have some pain for a day or two each month.1 Although the pain is usually mild, some women experience severe pain that keeps them from doing their normal daily activities for several days a month.1 That severe pain can bring along some unwelcome friends, including diarrhea, nausea, vomiting, headache, and dizziness.1

So, period pain can be…well, a major pain. Many of us have just come to accept it. But should we? And why are we in pain anyway? Let’s dig a little deeper.

There are two types of period pain
The technical term for period pain is dysmenorrhea (dis-men-uh-REE-uh). And there are two types: primary and secondary.

Primary dysmenorrhea is the name for common menstrual cramps that rear their ugly heads every month. This pain comes before or during your period and is caused by natural chemicals called prostaglandins that are made in the lining of the uterus.1 Prostaglandins cause the muscles and blood vessels of the uterus to contract, which is what helps the uterine lining to leave the body.

On the first day of a period, the level of prostaglandins is high. But as the lining of the uterus is shed during your period, the level goes down. This is why your pain tends to decrease as your period progresses.1

Pain may range from mild to severe and you may feel it most in your lower abdomen, back, or thighs.2 You might also have other symptoms, like nausea, vomiting, fatigue, and diarrhea.2 For most women, this type of period pain gets less painful as we get older.3

Secondary dysmenorrhea is pain caused by a disorder in the reproductive organs.1 Pain from secondary dysmenorrhea usually begins earlier in the menstrual cycle and lasts longer than common menstrual cramps.2 For example, the pain may begin a few days before your period starts, get worse as your period continues, and not go away after it ends. You usually don’t have nausea, vomiting, fatigue, or diarrhea.2

Some of the conditions that can cause secondary dysmenorrhea include:

  • Fibroids—Fibroids are growths that form on the outside, on the inside, or in the walls of the uterus. Small fibroids usually don’t cause pain, but fibroids located in the wall of the uterus can be very painful.1-3
  • Endometriosis—Tissue that lines the uterus (the endometrium) grows in areas outside of the uterus. This tissue breaks down and bleeds during your period and can cause pain.1-3
  • Adenomyosis—Tissue that normally lines the uterus grows into the muscle of the uterus, which can cause the uterus to increase in size and cause abnormal bleeding and pain.1,2
  • Ovarian cysts—Cysts are fluid-filled sacs on the ovary. Most ovarian cysts don’t cause any symptoms, but some can cause pain during your period or at ovulation.3

Secondary dysmenorrhea pain can also result from defects in the uterus, fallopian tubes, and other reproductive organs and from certain medical conditions that can flare up during a period, like Crohn’s disease and urinary disorders.1

How to relieve the pain
A good idea is to start simple. Although your urge may be to curl up into a ball in a dark room, getting out and moving around is a better plan. Even a walk may help improve how you feel.

Next, over-the-counter medications called nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen, ibuprofen, or aspirin can help relieve menstrual pain.

It’s also a good idea to track your periods, including symptoms and pain, in a diary or app. That way, if your pain worsens or your symptoms change, you have a history you can share with your doctor or nurse.

When to talk to a doctor
First, don’t ever think your pain isn’t worth mentioning to your doctor. Sure, menstrual pain is common, but your doctor can help determine if the pain you’re experiencing is typical or if it could be indicative of other issues.

Talk to your doctor or nurse if over-the-counter pain medicines aren’t helping or if the pain is getting in the way of your daily life. Your doctor will ask you questions and do some tests, including possibly a physical exam, to help determine if your pain could be caused by primary or secondary dysmenorrhea and if treatment is necessary. Take a look at our Doctor Discussion Guide to help you prepare for your next visit.

Treatment for the pain
Treatment depends on what is causing your pain. Your doctor may recommend hormonal medications in the form of a pill, intrauterine device, or injection to help with the pain. Another option could be medical procedures such as intrauterine tissue removal procedures and laparoscopic radiofrequency ablation, both of which require little to no incisions and are treatment options for women experiencing the disruptive symptoms of fibroids.

The bottom line is although period pain is common, it can also be a sign of underlying issues. Your doctor can help you determine the best way to move forward.

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