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You’re probably familiar with pain around the time of your period—cramps and a sore lower back. You might also experience pain in the middle of your cycle during ovulation.
For some people, menstrual cramps can be extremely painful.
Female pain is often overlooked or under-treated in comparison to male pain presentation (1). And reproductive and menstrual health are immensely under-researched—often, menstrual pain and reproductive illnesses (such as endometriosis) are not well-understood. It’s important to be an advocate for yourself and communicate pain levels to your healthcare provider.
Getting familiar with the basics of menstrual cycle-related pain can help you understand if your pain might be something to talk to your healthcare provider about.
So what exactly causes, and relieves, cramps?
What causes menstrual cramps?
Research shows that menstrual cycle-related pain is caused by prostaglandins—hormone-like substances that help the uterus contract to shed the uterine lining, also known as the endometrium (2, 3).
If you experience premenstrual cramps, the timing of when cramps occur will usually stay about the same, but they may vary in intensity from cycle to cycle (4).
It's still unclear what causes ovulation pain. It may be from the rupture of the ovarian follicle (5).
When do people usually get cramps?
Some people experience pain symptoms at specific times in their cycle.
Cramps in the uterus and pelvis are common symptoms in the days before and during menstruation. Pain associated with the period is also known as dysmenorrhea (6). Dysmenorrhea can also be felt in the lower back and thighs.
Pain can also occur in the middle of your cycle. Ovulation pain, also known as mittelschmerz, is usually felt in the lower abdomen.
Ovulation pain is felt as a sharp pelvic pain around the time of ovulation—it’s usually mild and may last from a few hours to even a couple of days (7). This pain signals that ovulation (the release of an egg from the ovary) has occurred, and is typically felt on one side of the lower abdomen—the side of the ovary that releases the egg (7).
How to relieve menstrual cramps
NSAIDs (non-steroidal anti-inflammatory drugs), like ibuprofen, block prostaglandin production and have been shown to be effective pain relief for cramping (8).
There’s also evidence for non-pharmaceutical pain relief methods. Heat (such as a heat pad or hot water bottle) has been shown to be as effective as NSAIDs and aspirin for pain relief in people without blood coagulation problems (9-11).
Herbal remedies, exercise, dietary changes, and acupuncture have also been studied—although results were promising, more research is needed here (2, 12-14).
Some people may choose to use hormonal contraceptives to relieve and prevent menstrual cramps altogether.
What kind of menstrual pain is “normal”?
Getting familiar with pain symptoms in your cycle is a helpful baseline for when you suspect something might be wrong. Tracking your cycle can be helpful in determining what “normal” menstrual pain is for you.
You also may be able to identify whether something in your life is triggering increased pain or symptoms—like stress or sleep—and/or identify helpful coping mechanisms, such as using ibuprofen and heating pads (4, 15).
You should see your healthcare provider if your pain symptoms are severe enough to disrupt your daily functioning, and/or significantly change in intensity during any given cycle, and if cramping is unusually severe or lasts more a few days.
Severe cramps or chronic pelvic pain could be a symptom of endometriosis. The pain experienced by people with endometriosis is different from normal menstrual cramping, and involves endometrial-like tissue which grows outside of the uterus. This tissue is responsive to the hormonal fluctuations within the body just like the endometrium, which can grow, bleed, and irritate surrounding tissue. This can create an inflammatory environment and tissue breakdown, which can cause adhesions (scar tissue) growths, and produce chronic and cyclic pelvic pain (16).
Tracking pain with Clue throughout the cycle for several cycles will help you determine which symptoms, if any, recur at specific times.
What causes menstrual cramps? Most women ask this question at some time in their life. It seems that when it comes to that time of the month, mild cramps, bloating, and irritability — although nuisances — are all to be expected. However, crippling period pain, heavy bleeding, serious fatigue, and other symptoms that affect your quality of life are not.
With menstrual cramps, mild to intense abdominal cramping begins within 24 hours of the start of your period and continues for days. Symptoms of period pain include:
Dull, constant ache
Menstrual cramps that radiate to your lower back and thighs
Throbbing or cramping pain in your uterus during the period
Some women also experience:
But what causes cramps during your period? Menstrual cramps are generally categorized as “primary dysmenorrhea,” which is caused by the elevated production of prostaglandins, hormones produced by the uterus that cause it to contract. When you have strong uterine contractions, the blood supply to the uterus is momentarily shut down, depriving the uterus muscle of oxygen and setting up the cycle of menstrual cramps and pain. Some studies show that women with severe menstrual cramps have stronger uterine contractions than others do when giving birth.
According to Mayo Clinic, certain conditions such as endometriosis and pelvic inflammatory disease are associated with menstrual cramps. Endometriosis can cause fertility problems. Pelvic inflammatory disease can scar your fallopian tubes, which increases the risk of an ectopic pregnancy, in which the fertilized egg implants outside your uterus. Other risk factors include use of an intrauterine device (IUD), uterine fibroid tumor, and sexually transmitted diseases.
If you have period pain, here are some home-care treatments to consider:
Dietary supplements Some findings report that natural dietary supplements containing omega-3 fatty acids and magnesium may reduce period pain.
Relaxation While emotional stress may increase your period pain, meditation and relaxation exercises can reduce their severity.
Exercise Physical activity, particularly yoga, may ease the pain of menstrual cramps.
Heat Try using a heating pad or microwaveable warm cozy on your abdomen during your period. Some find great period pain relief with a soak in a hot bath or shower.
Stop smoking and avoid alcohol. Both substances have been found to make menstrual cramps much worse.
A study published in October 2017 in the Journal of Bodywork and Movement Therapies concluded that women who practiced yoga 30 minutes per day, two days a week, for 12 weeks at home had a significant improvement in menstrual pain and physical fitness over the control group. Another study, published in January 2017 in the Journal of Alternative and Complementary Medicine, found that Hatha yoga practice was associated with a reduction in levels of chronic pelvic pain in women with endometriosis.
If your periods are causing you significant pain, consult your doctor, because menstrual pain can be a sign of a serious problem. Here are seven conditions known to cause painful menstrual cramps.
Endometriosis: A Common Cause of Severe Period Pain
2 / 8 Endometriosis: A Common Cause of Severe Period Pain
Endometriosis is a gynecological condition in which the tissue that forms the lining of the uterus — the endometrium — is found outside the uterus on other structures throughout the pelvis, including the ovaries, fallopian tubes, bladder, pelvic floor, and in more severe cases, the bowel, diaphragm, liver, lungs, and even the brain.
According to Ken R. Sinervo, MD, the medical director of the Center for Endometriosis Care in Atlanta, “We don’t really know why endometriosis causes menstrual pain … [The pain] may have to do with where [the endometriosis] is located and how it presents.”
Displaced endometrium can cause adhesions, chronic inflammation, chocolate cysts (cysts filled with blood), and internal bleeding — all of which can prompt excruciating pelvic pain. Endometriosis pain isn’t limited to period pain that goes on 24/7,” says Dr. Sinvero. “Many women also experience backache and other bowel symptoms, not to be confused with IBS,” he added.
Adenomyosis: Painful Cramps and Sex
3 / 8 Adenomyosis: Painful Cramps and Sex
Adenomyosis is like endometriosis, except instead of the endometrium implanting itself outside of the uterus, it is found embedded deep within the uterine muscle. In women with adenomyosis, “the uterus acts like a bruised muscle,” said Sinervo. Symptoms of adenomyosis include “painful central cramps and painful intercourse, which can hurt up until a day or two after.” Adenomyosis is usually seen in women over age 30 who have already had children. “However,” Sinervo added, “it has been seen in teenagers as well.”
Uterine Fibroids: A Monthly Period Nightmare for Some
4 / 8 Uterine Fibroids: A Monthly Period Nightmare for Some
As many as three out of four women will develop uterine fibroids, but most will not experience any symptoms. Fibroids range in size from microscopic to large enough to distort the shape of the uterus.
“Uterine fibroids can turn monthly menses into a monthly nightmare by increasing not only the amount of bleeding, but the severity of period pain,” says Lauren Streicher, MD, an associate professor of obstetrics and gynecology at the Feinberg School of Medicine at Northwestern University in Chicago, and the author of Love Sex Again. “The reason behind the pain is that the uterus during the period must contract (cramp) to expel the large blood clots that often result from heavy bleeding," says Dr. Streicher. Fortunately, fibroids do not put women at increased risk of uterine cancer and very rarely become cancerous.
Copper IUD: Period Pain After Insertion vs. Cramps Later On
5 / 8 Copper IUD: Period Pain After Insertion vs. Cramps Later On
A copper IUD is a nonpermanent, nonhormonal form of birth control that can prevent pregnancy for up to 10 years. The device, which is placed in the uterus by a licensed healthcare provider, works by continuously releasing copper, which immobilizes sperm and prevents egg implantation.
“A copper IUD, as opposed to a progestin IUD, can make menses heavier and more painful, particularly in the first few cycles after insertion,” says Streicher. “But be aware — if you have had your copper IUD for years and suddenly develop severe period pain, look for another reason. Your IUD is unlikely to be the culprit.”
Can Pelvic Inflammatory Disease (PID) Cause Menstrual Cramps?
6 / 8 Can Pelvic Inflammatory Disease (PID) Cause Menstrual Cramps?
Pelvic inflammatory disease is an infection of the female reproductive tract that is most commonly caused by untreated sexually transmitted infections. Left untreated, PID can cause inflammation, scarring, painful menstrual cramps, and infertility.
“[PID] most often occurs because sexually transmitted infections that cause PID can create scar tissue and adhesions in the pelvic region. During menstruation, hormones influence the uterus and surrounding structures — including the scar tissue and adhesions — which can increase inflammation, bleeding, and pain," says Shilpi Agarwal, MD, a board-certified family medicine and integrative physician in Washington, DC, and a columnist for Everyday Health. If caught early, PID can be treated with antibiotics, but antibiotics won’t undo any structural damage caused by the infection. “Practice safe sex, and get tested frequently for any sexually transmitted infections, especially if you have severe period pain,” Dr. Agarwal advises.
Uterine Defects: Structural Oddities That Can Lead to Menstrual Cramps and Infertility Too
7 / 8 Uterine Defects: Structural Oddities That Can Lead to Menstrual Cramps and Infertility Too
While a female fetus is still in its mother's uterus, its own uterus develops from two structures known as Müllerian ducts. In some cases, the uterus does not form correctly, which can cause infertility, period pain, and painful intercourse. For women with structural anomalies — such as a bicornuate uterus (two uteri that lead to one cervix), septate uterus (normal uterus with a fibrous band of tissue bisecting it), unicornuate uterus (a uterus that develops from only one Müllerian duct), uterus didelphys (two uteri, two cervices, and a septum, or membrane, dividing the vaginal canal) — menstrual cramps stem from blockages and membranes dividing the uterus and vagina.
Period Pain Affects Half of All Women
8 / 8 Period Pain Affects Half of All Women
Menstrual cramps that can’t be explained by structural defect or a reproductive condition, also known as primary dysmenorrhea, occurs at some point in almost half of all menstruating women. According to the American Congress of Obstetricians and Gynecologists, these cramps are caused by increased or imbalanced levels of prostaglandins — hormone-like fatty acids that stimulate the uterus to contract during the period. Changes in prostaglandin levels can cause more intense and frequent uterine contractions, compressing nearby blood vessels and cutting off oxygen to the uterus, thus causing painful cramps and discomfort.
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