Menstrual Disorders

Menstrual Cramps and Dysmenorrhea

Menstrual Cramps

As any woman who has been through labor can tell you, the uterus is a strong muscle capable of very intense contractions. While the normal changes that cause you to bleed each month also cause the uterus to contract, fortunately, theses contractions—menstrual cramps—are only a fraction as strong as they are during labor. That said, the level of discomfort some women experience can still be hard to cope with.

What Exactly Are Menstrual Cramps?

Menstrual cramps are the result of hormone-induced muscular contractions of the uterus. 

Your uterus is made up of two main layers. The outer muscular layer, the myometrium, is composed of smooth muscle cells. The inner layer, the endometrium, responds to changes in your hormone levels. The endometrium builds up in the first half of your menstrual cycle, preparing for pregnancy.

When pregnancy doesn't happen, hormone changes cause substances known as prostaglandins to be released from the endometrium. These cause the muscle of your uterus, or the myometrium, to contract, resulting in the shedding of the endometrial lining. This shed lining is a big part of your menstrual flow. 

This is a normal body function, and most women will have some mild discomfort every month during the beginning of their period because of it.

Three Things to Know About Menstrual Cramps

Normal Can Still Be a Problem

Yes, menstrual cramps are a normal part of your menstrual cycle. But that doesn't mean they are not a problem for you.

Sometimes these contractions are intense enough to interfere with the usual blood flow to your uterus. This decreased blood flow triggers a pain response. This pain associated with your period is called dysmenorrhea. It is often significant enough to interrupt your usual activities, including school or work. 

Dysmenorrhea can be mild and easily treated with lifestyle changes or over-the-counter pain medication. Dysmenorrhea can also be severe, requiring multiple medications or even surgery.

Not All Menstrual Cramps Are the Same

There are two types of dysmenorrhea. In general, the different types are based on when the cramps started and what is causing them.

  • Primary Dysmenorrhea: For some women, their periods have been painful from the very start. If you have always had painful periods, it is likely that your menstrual cramps are caused by an exaggerated response to your body's normal changes. Specifically, it is thought that women with primary dysmenorrhea have increased amounts of prostaglandins, the substances that causes the uterus to contract.
  • Secondary Dysmenorrhea:  If you have developed painful periods over time, you may have developed an underlying condition that is aggravated by the normal changes causing uterine contractions. Common issues that may cause secondary dysmenorrhea include fibroids, adenomyosis, infection, and the use of a copper T IUD.

Don't Suffer in Silence: Talking With Your Doctor

Painful periods are not something that you have to live with. If you have menstrual cramps, you should discuss them with your doctor.

Be Prepared To Discuss Your Symptoms

You will likely be asked to describe your pain. Think about descriptive words like sharp, stabbing, or burning. Be able to explain where the pain is located and if the pain goes anywhere else, like your lower back or upper thighs. This information will help your doctor understand if there is an underlying cause of your painful periods.

Have Answers to Common Questions

It's also useful to review the following list of questions that you might be asked and write down your answers to them before your visit:

  • How old were you when you got your first period?
  • Are your menstrual cycles regular? How long do they last? How much do you bleed?
  • When was the first day of your last two periods? Were they different than usual?
  • Has your period always been painful? If not, when did it start being painful?
  • Does the pain keep you out of school or work?
  • Do you have pelvic pain that is not related to your period?
  • Are you sexually active?
  • Do you use any form of birth control? If yes, what method do you use?
  • Does anyone in your family have a history of painful periods?
  • Have you used any medication to relieve the pain? If yes, what did you use? Did it help?

Other Testing May or May Not Be Needed

Your answers to the questions your doctor asks you and the other details you provide about your painful periods will begin to help your doctor determine the cause of your pain. Your doctor may or may not do a pelvic exam.

You may need additional testing depending on the other symptoms you report and the findings on exam.

Other tests that your doctor might suggest ( in no particular order) include:

  • Ultrasound
  • MRI
  • CT scan
  • Cervical cultures
  • Urine cultures
  • Laparoscopy

Don't be surprised if your doctor does not order any testing, especially if you are a teenager and you are not yet sexually active. 

Discussing Treatment Options

There any several options for treating dysmenorrhea. They range from lifestyle changes to surgery. Sometimes multiple treatments are combined. If your doctor suspects that you have primary dysmenorrhea, it is likely that your doctor will suggest a three-month trial of NSAIDs or a hormonal contraceptive before doing any additional testing. It is important to understand all of your treatment options for painful periods.

A Word From Verywell

If you are missing out on school, work, sports, or any other activities for even one day every month because of painful periods, you need to talk to your doctor. Even though menstrual cramps are a normal part of your body's function, it is not normal if they are significant enough to cause disruption of your usual daily activities. There are many safe and effective treatment options for you to live well with menstrual cramps.


Society of Obstetricians & Gynecologists of Canada. (2005) SOGC guideline no.169: Primary Dysmenorrhea Consensus Guideline. J Obstet Gynecol Can. 27(12)1117-30.

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