What causes period cramps? Symptoms, causes & treatments

What causes period cramps?

Period cramps are caused by higher levels of a hormone-like substance called prostaglandins, which make the muscles and blood vessels in the uterus contract (think of it as similar to getting muscle cramps while training hard). The pain is usually the most intense on the first day of the period because that’s when the levels of prostaglandins are the highest. Although, some people may experience cramps in the days before and throughout the duration of their period.

How intense the pain is will be different for each person. Some might only feel very light discomfort, mild pain, or nothing at all, while others suffer from very painful period cramps. The pain can also vary from one menstrual cycle to the next. However, some people tend to have higher levels of prostaglandins, and they are also prone to more pain associated with period cramps.[1] 

These are some things that are related to a higher risk of painful period cramps:

• Period flow and length: having heavier periods and periods that last longer than seven days
• Cycle regularity: having irregular periods (if your periods are less than 21 days or more than 34 days apart)
• Age: being under the age of 30
• Early puberty: going through puberty at age 11 or younger
• Genetics: having a family history of painful period cramps
• Smoking: being a smoker is linked to more period cramps 

What are the symptoms of period cramps?

Since everyone is different, we’ll all experience symptoms in different ways and to varying degrees. Typical symptoms of period cramps are:

• Contractions in the lower abdomen
• Dull pain that feels more constant
• Pain radiating into the lower back, hips, and thighs

Some may also experience other symptoms like nausea, dizziness, headaches, or even an upset stomach — that’s right, period poop is actually a thing!

What is dysmenorrhea?

Dysmenorrhea is the medical name for painful menstrual periods. There are two types of dysmenorrhea, primary and secondary, and they differ slightly in terms of symptoms. Let’s walk through how to tell them apart.

Primary dysmenorrhea

Primary dysmenorrhea refers to “regular” period cramps — the kind we usually mean when talking about period pains — and it’s caused by the period itself and not by any other underlying condition. Research has shown that it affects between 45-95% of females of reproductive age at some point in their lives, and between 2-29% have severe period pains.[2] This kind of period cramps is likely to become less painful as we get older or after childbirth.

Secondary dysmenorrhea

Secondary dysmenorrhea is when period cramps or pains are caused by an underlying medical condition. Some studies suggest that this type of period pain affects around 10% of women, but more research is needed since it’s often underdiagnosed. [3] 

There are a few different conditions that can cause painful periods: 

• Endometriosis: a condition where tissue similar to the uterine lining forms outside of the uterus, for example, in the fallopian tubes, which can cause more chronic pain than regular period cramps.
• Uterine fibroids: non-cancerous growths on the uterus wall that can sometimes cause pain in the affected area.
• Adenomyosis: when the tissue lining of the uterus begins to grow into the uterine walls.
• Pelvic inflammatory disease (PID): an infection of the female reproductive system that’s usually caused by bacteria transmitted through sex.
• Cervical stenosis: when the opening of the cervix is smaller and restricts the flow of menstrual blood — this can cause a painful increase of pressure in the uterus.

Symptoms of primary dysmenorrhea vs. secondary dysmenorrhea 

Unfortunately, it’s not always easy to tell what’s causing your period pain. However, for primary dysmenorrhea, the pain is isolated to the time just before and during the period. Cramping may start one or two days before your period begins. It’s usually the most intense on the first day of the period because the levels of prostaglandins are highest at this point. The pain then decreases in the following couple of days before going away completely.

If you have secondary dysmenorrhea, the pain often lasts longer than regular period cramps. It might start a few days before the period bleeding starts and continue after the period ends, and the pain can also get worse as the period continues (compared to regular period cramps where the pain subsides). Treating or managing the root cause will help relieve the symptoms. Talk to your doctor to learn more about the type of period pain you’re experiencing.

How can I treat period pain?

Period cramps can range from feeling like a small nuisance to being really disruptive. If the pain gets in the way of your life, it’s important to get medical treatment to address the cause. Which treatment you get will depend on if you’re diagnosed with primary or secondary dysmenorrhea. We’ve listed some common treatments that you can consider, but it’s always best to discuss your options with your doctor to make sure you find the right fit for you. However, there are also a few things you can try to manage period cramps from home: 

1. Pain medication

Pain medication is often used a first step when treating painful periods. It can either be prescription or over-the-counter pain medication, like Advil (Ibuprofen) or Tylenol (acetaminophen), depending on your pain levels.

You’ll likely get the best results from pain relievers that also have anti-inflammatory properties (Advil is one example) since these both help reduce the pain and decrease the levels of prostaglandins that cause cramping. On the other hand, Tylenol is generally considered easier on the stomach, which may be something to keep in mind if you’re having an upset stomach during your period. [4] However, it’s always a good idea to check with your healthcare provider before taking medication. 

2. Hormonal birth control

In some cases, your healthcare provider might suggest starting hormonal birth control, like the pill, IUD, or the patch. It can be used as a treatment for both primary and secondary dysmenorrhea. Most hormonal birth control methods stop your menstrual cycle, which means that you don’t get periods (although you may experience withdrawal bleeding), so it can help reduce pain levels. However, the symptoms may return if you stop using hormonal birth control.

3. Surgery

Surgery can be used to treat the underlying cause of secondary dysmenorrhea. For example, if you have endometriosis, your doctor may recommend surgery to remove the endometriosis tissue, which should help relieve symptoms. 

4. Applying heat

Heat therapy has also been suggested to relieve painful cramps during your period. [5] For example, you can try placing a hot water bottle or heat pad on your belly to soothe symptoms or take a warm bath to help you relax.

5. Diet and habits

Different kinds of supplements like vitamins and minerals are commonly suggested to help reduce period pain. However, there isn’t a lot of research to support these claims. A review article that summarized studies on several kinds of vitamins and minerals did find some promising results, mainly for vitamin D, zinc, calcium, and magnesium, but more research is needed to understand things like dosage, how long the treatment should last, and if it should be combined with other lifestyle changes like exercise. [6] As always, when it comes to supplements, it’s good to check with your healthcare provider before starting any new regimen.

That said, eating a balanced and nutritious diet has general health benefits, even if you’re not taking any specific supplements — you can get a lot of the vitamins and minerals you need from eating well. Avoiding alcohol, caffeine, and tobacco in the days leading up to your period may also reduce the symptoms of menstrual cramps. 

6. TENS

TENS (transcutaneous electrical nerve stimulation) is another option you can consider for pain relief. When using a TENS device, you attach electrodes with sticky pads to the area you want to treat, and the device transmits an electrical current that stimulates the nerves. It feels like a tingling or prickling sensation in the skin and muscles around the electrodes. 

While more research is needed, studies suggest that TENS may relieve pain since it improves blood flow and possibly also lowers the prostaglandin levels that cause cramps. [7] Additionally, it’s thought to disrupt the pain signals to the brain since it provides another stimulus for the brain to focus on. 

TENS is generally a safe treatment option without side effects, but some people aren’t recommended to use it — this may be the case if you have a pacemaker, epilepsy, or a heart condition. It’s always best to speak with your doctor or a physical therapist before trying TENS to make sure it’s a good option for you.

7. Exercise

Some research has been done into whether exercise can be used to treat period pains, and there have actually been some promising results. This review article found that exercising regularly and over time (for at least 8-12 weeks) may help reduce pain levels caused by period cramps, specifically from primary dysmenorrhea. [8] However, more research is needed into what types of exercise are most effective. 

If you want to try it out, listen to your body and find a way of exercising that works for you, whether it’s yoga, running, or just taking a gentle walk. 

8. Masturbation

Masturbating is another option for helping to reduce period pain. There’s also research to support this — two studies on 20 women found that vaginal self-stimulation improved their pain tolerance, and the effect was bigger when the stimulation resulted in orgasm. [9] While we understand that it’s not for everyone, if you’re in the mood during your period, why not give it a try?

How is the cause of severe period pain diagnosed?

Severe period cramps can be the result of both primary and secondary dysmenorrhea, and getting the right diagnosis is an important step to finding the right treatment. Your doctor will usually start by doing a pelvic exam. You’ll also be asked about your medical history and your periods to get a full picture of your situation. 

If there’s no clear cause for the pain found during the initial exam and your doctor thinks that it could be caused by another condition, they may also do some imaging tests, like an ultrasound or MRI scan, to diagnose or rule out secondary dysmenorrhea. 

In rare cases (and after other examinations), they may need to do a laparoscopy, which is a surgery to look inside the stomach. This is done under general anesthesia, and the surgeon makes a small incision to insert a camera to have a look around. 

When should I see a doctor for my period pain?

Some pain during our period is expected and normal since period cramps are essentially a symptom of a natural process where the uterus contracts while shedding its lining. However, there are situations when you should reach out to your healthcare provider:

• The pain disrupts your life
• Your symptoms get worse over time
• You begin to get severe cramps after the age of 25 
• You have pain when you’re not on your period
• The pain is accompanied by a fever

There’s still a lot of stigma around periods, and as a result, symptoms like painful cramps are often underdiagnosed since many don’t seek treatment for their pain, thinking it’s something that’s part of the package with periods. [10] Historically, women’s health has been an under-researched area, and a lack of information combined with this pre-existing stigma has made it harder for individuals to access the treatment they need. However, it’s important to listen to your body and not ignore the pain — it may be a sign of something more, and you don’t have to suffer in silence. Talk to your doctor about your symptoms and find out what treatment and management options are available to you.

Keep track of your period symptoms with Natural Cycles

At Natural Cycles, we’re passionate about giving you the knowledge you need to take charge of your health, closing the knowledge gap in women’s health, and breaking stigmas around the menstrual cycle. 

The NC° app makes it easy to track period cramps and how intense the pain is each day, along with other cycle-related symptoms. Understanding your pain levels during your cycle can help you learn more about your body and support conversations with your healthcare provider. On top of learning about your cycle, the NC° algorithm will predict when your period will start and send you reminders so you can prepare accordingly. Why not see if Natural Cycles is right for you today?