Most individuals with a uterus and ovaries experience discomfort or pain related to their menstrual cycle at some point in their lives. While many people think of cramping as a minimal to moderate inconvenience, for others, the severity of pain can cause serious interference with daily activities and lead to missed days of work or school. Many people delay inquiring about these symptoms at their annual exams, believing their level of pain to be normal or preferring not to focus on their reproductive organs. It’s important to remember that painful periods may be experienced by any person with a uterus who gets a period—not just women!
So, what causes this pain?
The medical term for painful periods is “dysmenorrhea,” which is most commonly described as recurring lower abdominal cramping, sometimes noted as sharp and intense and other times noted as dull and achy. It is not uncommon to feel lower back pain or radiating pain into the thighs. It is experienced primarily by those under the age of 30. Symptoms can often occur as a result of an underlying disorder but may also arise in the absence of any medical pathology.
Physiologically speaking, during a person’s period, the uterine walls are mildly contracting and tightening, which is what allows the temporary lining to shed—this is the visible bleeding known as a period. The uterus contains an extensive network of blood vessels, and during the compression of these contractions, the blood and oxygen supply decreases temporarily and stimulates the release of pain-causing hormones and chemicals. One theory about painful periods is that some individuals release more of these hormones and chemicals than others, resulting in worsened cramping.
Factors that may cause an increase in dysmenorrhea include getting your first period prior to age 12, irregular or heavy periods, having a low BMI, and smoking. Giving birth, particularly at a younger age, may decrease the likelihood of dysmenorrhea.
One common disorder that may be the culprit is a condition called endometriosis, which is more likely to be the cause if cramping is accompanied by particularly heavy bleeding, nausea or vomiting, worsening of symptoms with age, pain during penetrative sex, and generalized abdominal pain that occurs other times than during a period. Because officially identifying endometriosis requires an exploratory surgical procedure, many people experience a delay in diagnosis, particularly if their symptoms are vague.
Other potential causes may include uterine fibroids, pelvic inflammatory disease and adenomyosis, though each of these has a distinct set of symptoms and characteristics. Your healthcare provider may order testing such an internal pelvic sonogram to rule out these possibilities.
Possible treatment of dysmenorrhea may include a variety of medications (often hormonal) or lifestyle modifications like getting more active, changing your diet, or opting for loose-fitting clothes and affordable period underwear. Once you’ve seen your healthcare provider and ruled out any underlying causes of dysmenorrhea, there are a number of low-intervention strategies for menstrual pain that you can try at home:
Heat has been shown to be as effective as over-the-counter pain medications and may help improve other treatments
TENS (transcutaneous electrical nerve stimulation) units, which are often purchased inexpensively online and applied directly to the abdomen
Anything that increases circulation (which helps improve the blood and oxygen supply to the uterus), such as exercise and sexual activity/orgasm
Massage, both full body and focused abdominal work, can also be helpful with increasing circulation
Magnesium and ginger are two commonly used supplements that have the potential to decrease cramping
This includes the use of epsom salt baths, which are made up of magnesium salts and can calm irritated uterine muscle contractions
Acupuncture may significantly reduce the amount of cramping experienced, though it may take several cycles to see the full effects
Use of ibuprofen is common, though individuals should discuss the use of any medication, even over-the-counter ones, with their healthcare provider. Katie DePalma, a Certified Nurse-Midwife in Baltimore notes, “If a person is using ibuprofen during their period, it can be helpful to begin taking it 24-48 hours prior to the onset of bleeding, before the pain even starts. Ibuprofen should always be taken with food because it may upset the stomach. While many people think of ibuprofen solely as a pain reliever, it is also considered an “anti-prostaglandin” agent. Prostaglandins are the hormones in the body responsible for causing uterine cramping and gastrointestinal side effects that may occur during your period. By starting the ibuprofen before the cramping begins, it can actually reduce the total amount of prostaglandins your body releases, thereby preventing much of the cramping a person experiences through their period in the first place. Of course, a person should check with their healthcare provider first to ensure ibuprofen is a safe treatment for them.”
While some degree of cramping may be normal for many folks, pain that interferes significantly with your lifestyle and activities should always be evaluated by a medical professional. You know your body better than any health provider ever could and if symptoms are concerning to you, be sure to bring it up at your next visit.
The information in this article is not intended to be a substitute for professional medical advice. Each person has unique healthcare needs and should consult their own healthcare provider to determine what treatment options are best suited for them.
Signey Olson is a DC-based nurse practitioner and nurse-midwife whose work focuses on providing inclusive care to her queer community. She works primarily in GYN, fertility, and trans-affirming care at Columbia Fertility Associates in Washington, DC.