If you menstruate, you know periods can be inconvenient and disruptive to your daily routine. They may even be painful sometimes. But if that pain is keeping you from living your life to the fullest, it’s important to speak up and let your doctor know.
As a gynecologist, I often help people with menstrual pain. And here's what I tell them: You don't have to put up with these discomforts, especially if they're interfering with work, school, or other daily activities, and you don’t have to have a period every month with treatments like hormonal birth control, which can be used to suppress the menstrual cycle. Using hormonal treatments to minimize periods can be life-changing for many patients.
What causes period pain?
When you have your period, your body makes chemicals, called prostaglandins, that make your uterus contract. These muscle contractions help the uterus expel blood and tissue from your body. However, they can be painful. Most people who menstruate have at least some pain during their period. You might feel cramps in your lower belly, back, or thighs. The pain can be mild to severe. Most of the time, period pain starts to subside one to three days after you start your period, as the body begins to make less prostaglandins.
You might have other symptoms related to painful periods, too, such as nausea, headaches, diarrhea, and fatigue. Mild to moderate pain can be normal, severe pain, or other associated symptoms like nausea and vomiting, that disrupt your life, is not normal.
This kind of period pain, known as primary dysmenorrhea, is quite common.
As I often tell my patients, while period pain is common, certain things can make you more likely to have it. For instance, your risk may be higher if you:
- Had your first period before age 11, known as early menarche
- Have long periods or heavy menstrual bleeding
- Smoke
- Have a lot of stress
- Have a family history of painful periods
But we don't always know why some people have period pain while others do not.
Secondary dysmenorrhea: Period pain may signal a health problem
Sometimes pain isn't part of a normal menstrual period. Instead, it's caused by a health problem or an infection in your reproductive organs. The name for this is secondary dysmenorrhea.
The two types of menstrual pain can be hard to tell apart. But one clue is that secondary dysmenorrhea tends to start earlier and last longer during your menstrual cycle. And it may become worse as you get older. Ultimately, I strongly urge everyone to let their doctor know if they have menstrual pain that:
- Is severe or long-lasting
- Isn’t relieved by over-the-counter medicines
- Feels different from what they’re used to
- Occurs with heavy bleeding
- Happens during or after sex
- Starts before your period or continues after it
Secondary dysmenorrhea can have many underlying causes, including:
Endometriosis. This condition occurs when uterine-like tissue grows outside the uterus. Endometriosis can cause severe pain and bleeding between periods.
Ovarian cysts. These fluid-filled sacs grow on the ovaries. Some can be painful.
Fibroids. Fibroids are non-cancerous growths that occur in or on the uterus.
Pelvic inflammatory disease. This infection can damage reproductive organs and cause pelvic and belly pain and pain when you urinate and have sex.
Adenomyosis. With this condition, uterine-like tissue grows inside the wall of the uterus.
Left untreated, these and other conditions that can cause period pain can cause other problems, too, such as infertility. That's another reason to tell your doctor about pain or other menstrual problems, like heavy bleeding. Menstrual bleeding is considered heavy if you:
- Have to wear a pad and tampon together
- Change menstrual products every two hours or less or throughout the night
- Pass clots larger than a quarter
To find out why my patients are having painful periods, I review their medical history and ask about their symptoms. The answers sometimes point to other potential causes of pain.
I may also recommend:
A pelvic exam. A pelvic exam can be helpful in checking the health of the reproductive organs, including the vagina, cervix, and uterus.
Imaging or other tests. Tests, such as ultrasound exams, help me look for conditions such as fibroids, endometriosis, or ovarian cysts.
Finding relief from painful periods
If your menstrual pain is caused by an underlying condition, treating that condition can help — and improve your quality of life. But treatment and lifestyle changes can help ease primary dysmenorrhea symptoms too. Some of the options I might suggest are:
Over-the-counter pain relief. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help with period cramps. I suggest taking them just before the period starts and for the first two to three days into it, which is when they may work best.
Hormonal birth control. Birth control pills, patches, vaginal rings, injections, and intrauterine devices (IUDs) thin the lining of the uterus and/or block ovulation to suppress the menstrual cycle, thereby reducing the prostaglandins that cause cramping pain. This may be a good option, unless you are trying to get pregnant.
Self-care. A number of lifestyle changes can also help relieve menstrual cramps, including:
- Heat therapy. Taking warm showers or putting a heating pad or hot water bottle on your belly may help relax cramping muscles and relieve pain.
- Exercising. Walking or other forms of activity increase endorphins, your body's natural feel-good chemicals. Endorphins can help ease pain, decrease stress, and lift your spirits.
- Prioritizing sleep. Getting more sleep around the time of your period may help you feel less bothered.
Hydration. Drinking plenty of water helps prevent dehydration, which can worsen cramps.
What about supplements for bad periods?
My patients sometimes ask about supplements and herbal remedies. We don't have a lot of good evidence that any of these work, so I typically don't recommend them for period pain.
Sometimes a procedure is needed
If medicines don't help ease your pain — or if your medical history and test results suggest an underlying medical condition from the start — your provider may recommend a laparoscopy.
During this procedure, we insert a laparoscope (a thin tube with an attached camera) through a small incision in the belly. This lets us
see inside the pelvis for problems — such as endometriosis — that might be causing your pain. Laparoscopy is a minimally invasive procedure, and most patients go home the same day.
If a medical condition is found to be the cause of painful periods, we might consider other treatments. These may include other types of medications or surgeries. These other treatments may relieve period pain by addressing the underlying cause.
Get expert help for menstrual pain
At Temple, you'll be cared for by experts who take the time to listen and understand how your menstrual health is affecting your daily life. And when it comes to your overall obstetrics and gynecology care, you can count on Temple's team throughout every stage of your life, from puberty through childbirth, menopause, and beyond.
Schedule an appointment online or call 800-TEMPLE-MED (800-836-7536).
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