Dysmenorrhea (Cramps)

Causes of Menstrual Pain

The uterus is a muscle, and like all muscles, it contracts and relaxes. This happens throughout the menstrual cycle. During your period, the uterus contracts more strongly. These contractions are caused by prostaglandins – a substance made by the endometrium. Sometimes, when the uterus contracts, it produces a cramping pain.

Before your period, the level of prostaglandins in your body increases. Prostaglandin is released when your period starts. As you menstruate, prostaglandin levels drop. This is why pain tends to lessen after the first few days of your period.

Types of Dysmenorrhea

There are two types of dysmenorrhea. Pain during your period can be classified as either primary or secondary dysmenorrhea.

Primary Dysmenorrhea

Primary dysmenorrhea is pelvic pain that is the result of having your period. Women with primary dysmenorrhea may have any of the following symptoms:

  • Cramps or pain in the lower abdomen or lower back
  • Pulling feeling in the inner thighs
  • Diarrhea
  • Nausea
  • Vomiting
  • Headache
  • Dizziness

Primary dysmenorrhea often begins soon after a girl begins having menstrual periods. As a woman gets older, her periods may become less painful. The pain may lessen after a woman gives birth. Not every woman is the same, however, and some do continue to have pain during their periods. Some cycles may be more painful than others.

Secondary Dysmenorrhea

Secondary dysmenorrhea is menstrual pain that has another cause in addition to menstruation. With secondary dysmenorrhea, pain often begins earlier in the menstrual cycle. It usually lasts longer than normal cramps. For example, it may begin long before your period starts, it may get worse with your period, or it may not go away after your period ends.

Some of the most common causes of secondary dysmenorrhea are:


A condition in which endometrial tissue is found in other areas in the body, such as the ovaries and fallopian tubes. This tissue acts like tissue in the uterus. Endometrial tissue outside the uterus responds to monthly changes in hormones the same way it does inside the uterus. It also breaks down and bleeds. This bleeding can cause pain, especially during your period


Tumors or growths that form on the outside, inside, or in the wall of the uterus. They are not cancerous, but they can cause more pain and heavier bleeding with periods.

Pelvic Inflammatory Disease

An infection of the uterus, fallopian tubes, or ovaries. Most cases develop from sexually transmitted diseases (STDs).

Intrauterine Device (IUD)

A device placed in the uterus to prevent pregnancy. It can cause pelvic pain and cramping and may make normal menstrual cramps worse.

Diagnosing Dysmenorrhea

Dysmenorrhea is diagnosed by exams and tests. For your doctor to diagnose a cause for dysmenorrhea, you will be asked to describe your history, symptoms, and menstrual cycles. Your doctor will then do a pelvic exam to check for anything abnormal in the reproductive organs. An ultrasound exam of the pelvic organs may also be done to further check for anything abnormal.

In some cases, the doctor can learn more by looking directly inside your body with laparoscopy. Laparoscopy is done with general anesthesia. This requires admission to an outpatient surgery unit. During laparoscopy, the doctor makes a small cut near your navel. A thin lighted scope – a laparoscope – is then inserted into your abdomen. The laparoscope allows the doctor to view the pelvic organs.

Sometimes, the doctor is able to find a cause for the dysmenorrhea. But, often there is no known cause. Based on the results of the tests, you and your doctor will decide which treatment is best for you.


There are effective ways to treat menstrual pain. Your doctor can prescribe or suggest medications that can help relieve your discomfort.

NSAIDS (nonsteroidal anti-inflammatory drugs)

Drugs that block the production of the prostaglandins that cause menstrual cramps. These drugs also can prevent the other symptoms caused by prostaglandins, such as nausea, diarrhea, and pain. You can buy most NSAIDs, such as ibuprofen(Motrin) or naproxen(Aleve), over the counter. If these do not relieve your pain, talk to your doctor. He or she may prescribe some stronger medications.

NSAIDs work best when they are taken at the first sign of your period or pain. You usually need to take them only for 1 or 2 days. Do not take more pills than the package recommends. You should avoid taking NSAIDs while driking alcohol. Women with bleeding disorders, liver damage, stomach disorders, or ulcers should not take NSAIDs.

Oral Contraceptives

Taking oral contraceptives (birth control pills) also reduces menstrual pain. The birth control pill causes less growth of the endometrium. Less prostaglandin is produced, and there are fewer strong contractions, less flow, and less pain. Birth control pills can be used along with NSAIDs if necessary.


Pain during the menstrual period is a common problem for women. Most of the pain is mild and can be treated with over-the-counter medications. Sometimes, however, menstrual pain is severe and requires medical treatment.

If you have severe menstrual cramps or cramps that last more than 2 or 3 days, call your doctor. He or she can examine you and help find a way to relieve the pain.