What is a painful period?

Painful periods are menstrual periods with severe and frequent cramps and pain. They may start with your first period and continue through your life. Or they may happen later in life because of fibroids or endometriosis.

What causes painful periods?

A painful period is often caused when the uterus contracts abnormally. This is because of a chemical problem in the body. For example, the natural chemical prostaglandin controls the contractions of the uterus.

When an underlying condition causes painful periods, it’s often endometriosis. This is a condition where tissue from the lining of the uterus grows outside the uterus. Endometriosis often causes infertility and pelvic pain.

Other causes of painful periods include:

• Pelvic inflammatory disease (PID)

• Uterine fibroids

• Abnormal pregnancy, such as a miscarriage or ectopic pregnancy

• Infection, tumors, or polyps in the pelvic cavity

Who is at risk for painful periods?

Any woman can have painful periods. But these women may be at an increased risk for the condition:

• Women who smoke

• Women who drink alcohol during their period. Alcohol tends to make menstrual pain continue.

• Women who are overweight

• Women who started their periods before age 11

• Women who have never been pregnant

What are the symptoms of a painful period?

These are the most common symptoms of painful periods. But each woman may have slightly different symptoms. Symptoms may include:

• Cramping in the lower belly

• Pain in the lower belly

• Low back pain

• Pain spreading down the legs

• Nausea

• Vomiting

• Diarrhea

• Fatigue

• Weakness

• Fainting

• Headaches

The symptoms of a painful period may look like other health problems. Always talk with your healthcare provider for a diagnosis.

How are painful periods diagnosed?

To diagnose painful periods, your healthcare provider will ask about your health history. They will do a physical and pelvic exam. Other tests may include:

• Ultrasound. This test uses high-frequency sound waves to create an image of the internal organs.

• MRI. This test uses large magnets, radio waves, and a computer to make detailed images of organs and structures within the body.

• Laparoscopy. This minor procedure uses a laparoscope. This is a thin tube with a lens and a light. It’s put into a cut (incision) in the belly (abdominal) wall. The healthcare provider uses this tool to see into the pelvic and abdomen area. They may find abnormal growths.

• Hysteroscopy. This test looks at the canal of the cervix and the inside of the uterus. It uses a viewing tool (hysteroscope) put through the vagina.

How are painful periods treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is. Treatment to manage symptoms may include:

• Prostaglandin inhibitors. These include nonsteroidal anti-inflammatory medicines (NSAIDs), such as aspirin and ibuprofen. These medicines reduce pain.

• Acetaminophen

• Birth control pills (ovulation inhibitors)

• Hormone treatment (progesterone)

• Diet changes. These changes include eating more protein and less sugar and caffeine.

• Vitamin supplements

• Regular exercise

• Heating pad across the belly

• Hot bath or shower

• Belly massage

• Hysterectomy. This is the surgical removal of the uterus.

Key points about painful periods

• Painful periods are periods with severe and frequent menstrual cramps and pain.

• The condition may start with your first period and continue throughout your life. Or it may begin later in life because of an underlying condition, such as fibroids or endometriosis.

• Symptoms may include cramping or pain in the lower abdomen, low back pain, pain spreading down the legs, nausea, vomiting, diarrhea, fatigue, weakness, fainting, or headaches.

• Treatments may include NSAIDS, acetaminophen, birth control pills, hormone treatment, dietary changes, vitamins, exercise, heat, or massage.

• In extreme cases, you may need surgery.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions.