Period pain: The Optum Store Guide

As your uterus sheds its lining once a month, it contracts to push out period blood and tissue. Those muscle contractions are likely caused by compounds called prostaglandins. Prostaglandins are also involved in controlling pain and inflammation. If you have a large concentration of prostaglandins in your body, you may have more severe cramping.

There is also a second type of pain that can happen during your period. It’s called secondary dysmenorrhea — and painful periods are not the only symptom. Women who suffer from this kind of period pain have a disease that also impacts the uterus or other reproductive organs.

Endometriosis is the most common cause. This is a painful condition in which the tissue that normally lines the uterus (the endometrium) develops outside the uterus. The tissue can end up on the fallopian tubes, pelvis and ovaries. Those rogue areas of tissue swell every month in preparation for a possible pregnancy, just like the tissue inside the uterus does. And that can cause severe pain during your period. Other conditions that can cause period pain include:

• Adenomyosis (the growth of tissue into the muscular wall of the uterus)
• Uterine fibroids (non-cancerous growths in the uterus)
• Pelvic inflammatory disease (an infection of the reproductive organs)
• Cervical stenosis (a condition in which the opening of the cervix is so small it affects menstrual flow)

The big symptom of period pain is cramping in your lower abdomen and lower back. It can be throbbing, aching and dull. Sometimes the cramps can be so painful that they cause nausea and vomiting.

“It tends to come right around the start, or maybe even a day before, your period,” says Sheryl A. Ross, MD. She is an obstetrician-gynecologist (OB-GYN) at Providence Saint John’s Health Center in Santa Monica, California. “You get this intense sharp pain in your lower back, or it could be in your belly area or your lower abdominal area. It tends to be worse the first day or two.”

You might also get headaches, dizziness, diarrhea and breast tenderness. Many of these symptoms are tied to having an overload of prostaglandins in your body during your period. For instance, “breast pain is a common side effect of the prostaglandin release during a cycle,” says Monique Brotman, DO. She is an OB-GYN in private practice in Oak Park, Illinois.

Make an appointment if the cramps interfere with your daily life or start to get worse, says Dr. Ross. Other reasons to seek medical care include:

• You have a fever with period pain
• You have pain without a period
• You have new symptoms
• You faint
• You can’t have sex because of the pain

Sometimes severe period pain can be the first clue that you have certain health conditions, such as endometriosis or a thyroid condition.

Use a period tracker app to note your symptoms over 2 or 3 months, if possible. These questions will help you collect important information to tell your OB-GYN:

• When does your period start?
• When does the cramping start?
• How long does the period cramping/pain last?
• What’s the pain intensity on a scale of 1 to 10 (with 10 being the most severe, 1 the least)?
• Do you have other symptoms?
• Is period pain affecting sleep?
• Is it affecting your ability to do your daily activities?
• Is it affecting your relationship?
• Do you have pain during exercise or sex?

If you have severe cramping that doesn’t get better, you may have secondary dysmenorrhea due to a health condition. Cramping can worsen as the months pass with this type of period pain.

“Symptoms of endometriosis can include pelvic pain not just during a woman’s period but also throughout the month,” says OB-GYN Iris Kerin Orbuch, MD. She’s the director of the Advanced Gynecologic Laparoscopy Center in Los Angeles.

In addition to severe cramping, endometriosis symptoms can include:

• Bloating
• Constipation
• Heavy periods
• Infertility
• Lower back pain
• Painful bowel movements
• Painful intercourse

You should also tell your doctor if you pass large blood clots, Dr. Ross says. Clots could possibly be caused by uterine polyps or fibroids.

Your OB-GYN will likely perform a pelvic exam to check your reproductive organs. He or she will use a speculum — a hinged instrument shaped like a duck’s bill — to spread open your vaginal walls and get a better view of your vagina and cervix. (If you’ve ever had a Pap smear, this process will be familiar.)

To examine your uterus and ovaries, the doctor will insert gloved fingers into your vagina while gently pressing on your lower abdomen with their other hand. That way, they can feel those organs and look for any irregularities.

Your OB-GYN might also recommend other screening tests, such as an ultrasound, according to the Mayo Clinic. These additional tests can help determine whether the pain is being caused by an infection or some other problem, such as:

• Ovarian cysts
• Uterine fibroids
• Endometriosis

Then further evaluation might be needed. If you have endometriosis, for instance, your doctor might order a laparoscopy. This is a minimally invasive surgical procedure that diagnoses and treats the condition.

No. PMS is short for premenstrual syndrome. According to the American College of Obstetricians and Gynecologists, it refers to the mood changes, irritability, fatigue and anxiety that some women get in the days leading up to their period. PMS does not involve menstrual pain, says Dr. Orbuch.

It depends. Your cramps can be worse if your period is heavy, but not always. “It’s different for every woman,” Dr. Ross says. “Some women can have these really heavy periods and pass clots and have horrible cramping. Other women have really light bleeding and they still have severe cramps.”

It’s possible, but every woman is different. If your cramps were bad in your 20s but they’ve gotten less painful in your 40s, they may have eased up. Or the pain might be the same, but you’ve just gotten used to it, says Dr. Brotman.

If your cramps are getting worse as you age, however, talk to your doctor. “Usually, it shouldn’t get worse when you’re older,” says Dr. Ross. “Sometimes when you’re older and you’re seeing different flows or different pain, that’s when we start looking for fibroids or polyps.”

You can treat cramps with over-the-counter (OTC) medications or prescription ones.

OTC medications. Your first line of defense is nonsteroidal anti-inflammatory drugs (NSAIDs), which you can buy at the drugstore. Options include:

• Advil^® (Ibuprofen)
• Aleve^® (Naproxen)

NSAIDs are prostaglandin inhibitors. That means they help block the release of the compounds that cause menstrual cramping.

Timing is key. Try using a period tracker app to follow your menstrual cycle, then start taking an NSAID on the first day of your period as a pretreatment. That way you get a jump-start on dealing with the pain. Continue to take it as needed, following the dosage directions on the bottle.

Prescription medications. Hormonal birth control can make periods lighter and reduce menstrual cramps each month, according to Planned Parenthood. Talk to your OB-GYN about what might be best for you. Options include:

• Birth control pills
• The patch
• The ring
• An intrauterine device, or IUD
• Hormonal shots

Yes. Doctors agree that there are effective home remedies you can try, including:

• Heat relief. Heat relaxes your muscles. You can place a heating pad on your abdomen (or lower back, depending on where you feel your cramps) or take a hot bath with Epsom salts.
   
• Stay hydrated. Drink lots of water. It helps reduce bloating, which could relieve some period pain. Eating hydrating foods such as watermelon and cucumber can also help. And if you have nausea, try drinking hot ginger tea.
   
• Take supplements. Cannabidiol, or CBD, products may help relieve period pain, says Dr. Ross. “Calcium works well too for cramps, and you can eat it as dairy or you can take supplements,” she says.
   
• Take a probiotic. There are lots of probiotics out there, including ones for gut health. Make sure you pick one that is formulated specifically for vaginal health, says Dr. Brotman.
   
• Work out. Go for a walk, play tennis or do yoga. Exercise releases feel-good hormones called endorphins.

These lifestyle changes could help ease period pain. But ultimately, finding the root of why you’re having bad cramps is the key to stopping them. Even if it’s frustrating, don’t give up. Work with your doctor to find a solution that works for you.

Monique Brotman, DO
Obstetrician-gynecologist in private practice in Oak Park, Illinois. She is also affiliated with West Suburban Medical Center and AMITA Health Adventist Medical Center Hinsdale.

Iris Kerin Orbuch, MD
Director of the Advanced Gynecologic Laparoscopy Center in Los Angeles and New York City. She co-authored Beating Endo: How to Reclaim Your Life from Endometriosis.

Sheryl A. Ross, MD
Obstetrician-gynecologist, woman’s health expert at Providence Saint John’s Health Center in Santa Monica, California, and author of She-ology: The Definitive Guide to Women’s Intimate Health.

Ultrasound screening: Mayo Clinic (n.d.). “Menstrual Cramps”
Endometriosis overview: Johns Hopkins Medicine (n.d.). “Endometriosis”
PMS facts: American College of Obstetricians and Gynecologists (2021). “Premenstrual Syndrome”
Birth control for period pain: Planned Parenthood (2020). “Can Birth Control Help with Period Pain?”