Debilitatingly painful periods are not normal. In fact, they're often a sign that there might be a physiological or emotional reason underlying the pain. While some cramping, discomfort, or mild pain is normal and to be expected, excessive pain that inhibits your movement or activity is not.

We understand that getting to the root of the problem can feel confusing and frustrating, especially if your healthcare provider dismisses your pain as a “normal” symptom of having a period. To help guide you, we've outlined some of the potential underlying causes.

Painful menstruation is also called dysmenorrhea, and it's important to differentiate between the two different types of dysmenorrhea: primary and secondary.

Primary dysmenorrhea

This term refers to cramps that occur before or during menstruation. This pain is caused by natural chemicals called prostaglandins that are made in the lining of the uterus. They cause the muscles and blood vessels of the uterus to contract. On the first day of your period, the level of prostaglandins in your body is high. As bleeding continues and the lining of the uterus is shed, this level goes down. This is why pain tends to lessen after the first few days of a period. This condition is common, and it most often occurs in females who start having periods before the age of 11 years.  

Secondary dysmenorrhea

This term refers to a condition caused by a disorder in the reproductive organs. Pain, in this case, tends to get worse over time and it often lasts longer than normal menstrual cramps. 

Medical Conditions That Could Cause Secondary Dysmenorrhea 

• Premenstrual dysphoric disorder (PMDD) is a much more severe form of premenstrual syndrome (PMS). Many women experience it without realizing it’s a condition that can be treated medically. Symptoms include: severe cramps, irritability and anger, extreme mood swings, depression, vomiting, backache, dizziness, and paranoia. The exact cause of PMDD is not known, but researchers believe that it may be an abnormal reaction to normal hormone changes that happen with each menstrual cycle. 
• Endometriosis is a condition where the cells from the lining of the uterus grow outside the uterus and in other parts of the body, such as the fallopian tubes, ovaries, or tissue lining the pelvis. In more severe cases, the cells can grow on the bladder, bowl, diaphragm, liver, lungs, and even brain. During menstruation, the shedding of these cells can cause intense pain.
• Polycystic ovary syndrome (PCOS) is a hormonal disorder that can cause small cysts, or fluid-filled sacs, to develop in the ovaries, causing irregular and painful periods.
• Fibroids in the uterus are noncancerous tumors that can grow in or around the womb and can make your periods heavy and painful, though they often don’t cause symptoms.
• Pelvic inflammatory disease (PID) is an infection of the uterus, fallopian tubes, or ovaries often caused by sexually transmitted bacteria that lead to inflammation of the reproductive organs and pain.
• Adenomyosis is a very rare condition where the tissue that normally lines the uterus or womb starts to grow within the muscular uterine wall, causing inflammation and pressure. This can lead to heavier, longer, and more painful periods. 
• Cervical stenosis is a rare condition in which the cervix is so small or narrow that it slows menstrual flow, causing an increase of pressure inside the uterus that causes pain.
• Certain abnormalities in the uterus, fallopian tubes, and other reproductive organs, which a woman would be born with, can result in pain during menstruation.
• Some medical conditions, such as Crohn’s disease and urinary disorders, can flare up during a period and cause pain.

Diagnosing the Cause of Painful Periods

To diagnose the cause of painful periods, your doctor may perform one or more of these tests: 

• Pelvic floor examination: A physical examination of the pelvic floor organs – this includes the uterus, cervix, vagina, ovaries, and fallopian tubes. 
• Blood tests: These will be done to look for signs of iron deficiency, thyroid disorders, or blood-clotting abnormalities.
• Ultrasound: This diagnostic tool uses sound waves to produce images of the uterus, cervix, fallopian tubes, and ovaries.
• Pap smear: A sample of cells from the cervix are examined under a microscope for infection or changes that can lead to cancer or already are cancerous.
• Endometrial biopsy: This test samples a small amount of endometrial tissue for examination under a microscope.
• Magnetic resonance imaging (MRI) scans: This non-invasive and painless test will produce detailed images of pelvic organs.

A final note

Don't ignore your symptoms if you feel something is not right. You know your body better than anyone else does. Trust its ability to tell you when something is wrong.

Find a healthcare professional that you can trust. Ask questions and receive the support you’re looking for.

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