Menstrual Period: Painful Periods (Dysmenorrhea)

It’s common for many girls to have mild pain with their periods a couple of days each month. However, if your pain is not relieved with over-the-counter pain medicine, and you miss school or doing things with your friends because of it, you may have “dysmenorrhea” (pronounced: dis–men–o–ree–a).

What is dysmenorrhea?

Dysmenorrhea is a medical term that means “difficult or painful periods”. There are two types of dysmenorrhea; primary and secondary.

• Primary dysmenorrhea is the most common kind of dysmenorrhea. Cramping pain in the lower abdomen (belly) can start from 1–2 days before your period begins and can last 2–4 days. The pain is typically similar from one period to the next.
• Secondary dysmenorrhea is when cramps are a result of a medical problem such as endometriosis. Endometriosis is a condition that occurs when tissue similar to the lining of the uterus is found outside its normal location. This usually causes pain before and/or during a young woman’s menstrual period.

What causes dysmenorrhea?

The cramps you feel as a result of dysmenorrhea are caused by uterine contractions (when your uterus tightens and relaxes, allowing blood to leave your uterus). The lining of your uterus releases special chemicals called “prostaglandins” (pronounced: pross–ta–glan–dins). These chemicals are released from the lining of the uterus and increase the strength of the contractions, especially during the first couple of days of a woman’s menstrual cycle (when levels are high). High levels of prostaglandins may also cause nausea, diarrhea, and lightheadedness.

What are the symptoms of dysmenorrhea?

Most young women who have dysmenorrhea experience lower back pain and cramping in the lower area of the abdomen during their periods. This pain can range from dull to throbbing. Some girls may have other symptoms during their period such as nausea, vomiting, loose bowel movements/diarrhea, constipation, bloating in the belly area, headaches, and/or lightheadedness, all of which can be mild to severe.

Is it normal to have cramps during your period?

Yes, it’s normal to have mild cramps during your period, because of uterine contractions. The uterus is a muscle that tightens and relaxes. This can cause jabbing, or cramp–like pain. However, if the discomfort is not relieved with over-the-counter medications (such as ibuprofen) or causes you to miss school or other daily activities, it could mean that there is another reason for your symptoms.

Some or all of these problems may start a day or two before your menstrual period and can last for part or all of your menstrual period. These signs could be caused by other medical conditions and therefore it’s important to tell your health care provider about all of your symptoms. If your pain interferes with your daily life activities, you should see a health care provider to evaluate further.

Is it okay to exercise when I have my period?

It is safe to exercise when you have your period, and it’s a great way to stay healthy. Exercise can be very beneficial in managing period symptoms, especially cramps. Some girls enjoy high intensity exercise such as running, cycling, or kick boxing. While others enjoy low intensity work outs such as yoga, walking, or weight training. Whether it’s high or low intensity, exercise is may be beneficial in managing period symptoms, give it a try!

Are menstrual cramps the same as PMS (Pre–Menstrual Syndrome)?

Menstrual cramps are not the same as PMS. Symptoms of PMS such as mood swings, breast soreness, and bloating happen before a woman’s period begins and get better when it starts. On the other hand, with dysmenorrhea, cramps are usually worse the first few days of a woman’s period and have a different cause and treatment.

How is dysmenorrhea treated?

• Anti-inflammatory medication– If your menstrual cramps are painful, you may want to take an over–the–counter nonsteroidal ant-inflammatory (NSAID) medication for 1–2 days of your period. If your pain is severe, you may want to begin taking an NSAID 1-2 days before your period starts. These medications are “anti–prostaglandins” (pronounced: an–tee–pross–ta–glan–dins), meaning that they work to stop the cramping effects of prostaglandins. They help to relieve discomfort, make your flow lighter, and cause your uterus to cramp less. Try over–the–counter medicine with ibuprofen (Motrin) or naproxen sodium (Aleve) in it. Make sure you read the label so you know how much and how often to take it. You should not take these medications if you are allergic to aspirin–like medications or if you have stomach problems (such as ulcers). Remember to always take these medications with food.
• Additional pain reliever medication- If your menstrual cramps are still painful or you cannot take over-the-counter NSAID medications, you may want to take Acetaminophen (Tylenol). You can take acetaminophen 1-2 days of your period. If your pain is severe, you may want to begin taking an NSAID 1-2 days before your period starts. Make sure you read the label, so you know how much and how often to take it. It is OK to take acetaminophen with NSAID medication together at the same time. You may also alternate when you take each medication to help relieve your pain. However, you should not take acetaminophen if you have kidney or liver disease.
• Hormonal treatment – Oral contraceptive pills (OCPs), also called birth control pills, as well as other hormonal treatments (patch, vaginal hormonal ring, Depo-provera, IUD and hormonal implants) are often prescribed because the hormones thin out the lining of the uterus which lessens the blood flow and cramping. These medications are sometimes prescribed continuously so you don’t get a period.

Is there anything else I can do to help my dysmenorrhea?

• Heat – Natural remedies such as a microwavable heating pack or a heating pad placed on your lower abdomen may help. Be sure to check that the heating pad is not too hot, as it can burn your skin.
• TENS Unit are very helpful in relieving the pain caused by menstrual cramps. The pads can be place on the lower abdomen, lower back, or anywhere there is pain. The unit sends soothing pulse via the pads to relax the skin, muscles, and nerve endings.
• Soaking in a warm bath may also help to relieve cramps.
• Acupuncture is a complementary therapy that may be recommended to treat dysmenorrhea.
• Yoga is a type of exercise that has shown to help lessen menstrual cramps for some girls/women.
• Regular exercise has been known to lower pain.
• Pelvic Floor Physical Therapy is known to help relax the muscles of the pelvic floor to help lower pain.
• Track your menstrual cycle with our period and pain tracker to see if there is a pattern to your pain–when it begins and ends.

What is a Period and Pain Tracker?

This is a tool to help you keep track of your menstrual cycle and any pain you may have; when it comes, where it hurts, how long it lasts, and what relieves it. It’s a good idea to keep track of your pain for about 3 cycles. Be sure to bring your completed Period and Pain Tracker with you when you have appointments with your health care provider or gynecologist.

Do I need to have any tests?

If comfort measures such as using a heating pad, TENS unit, exercising, and taking over-the-counter medicine and/or hormonal treatment are not helpful, or the pain gets worse, make an appointment to see your health care provider (HCP) or gynecologist. Your HCP will decide if you need to have any tests such as a pelvic ultrasound. If you are sexually active, your HCP may test you for sexually transmitted infections (STIs). If you still have pain after 2-3 months of taking OCPs and mild pain medication, your HCP may talk to you about seeing a gynecologist. Your gynecologist may discuss another procedure called laparoscopy to find out the cause of your pain.

Our health guides are developed through a systematic, rigorous process to ensure accuracy, reliability, and trustworthiness. Written and reviewed by experienced healthcare clinicians from Boston Children's Hospital, a Harvard Medical School teaching hospital and consistently ranked as a top hospital by Newsweek and U.S. News & World Report, these guides combine clinical expertise, specialized knowledge, and evidence-based medicine. We also incorporate research and best practices from authoritative sources such as the CDC, NIH, PubMed, top medical journals, and UpToDate.com. Clinical specialists and subject matter experts review and edit each guide, reinforcing our commitment to high-quality, factual, scientifically accurate health information for young people.