Painful Menstrual Periods

(Dysmenorrhea; Menstrual Cramps)


Dysmenorrhea is a painful menstrual period. It may be pain in the pelvis, abdomen, back, or legs, abdominal cramps, headache, and fatigue. This pain is severe enough to make day to day habits hard to get through.

There are 2 types of dysmenorrhea:

  • Primary—caused by uterine muscle contractions
  • Secondary—caused an underlying condition, such as endometriosis

Menstrual Flow

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Primary dysmenorrhea is caused by high levels of a hormone called prostaglandins.

Secondary dysmenorrhea is caused by a health issue such as:

Risk Factors

Painful menstrual periods are more common in women under age 30 years. They may also be more common in women with:

  • Low body weight, especially during adolescence
  • Smoking habit
  • Early onset of menstruation—younger than 12 years old
  • Longer menstrual cycles
  • Heavy bleeding during periods
  • No history of delivering a baby
  • Psychological disorders, such as depression or anxiety


The pain may be sharp and throbbing, or dull and aching. It most often starts in the lower belly and may spread to the low back or thighs. Other symptoms may include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Headache
  • Irritability

When Should I Call My Doctor?

Call your doctor if you have:

  • Severe or unusual cramps
  • Cramps that last for more than a few days
  • Signs of infection, such as fever or chills
  • Cramps with heavy menstrual bleeding
  • Abdominal or pelvic tenderness
  • Vaginal discharge other than menstrual bleeding

Also, call you doctor if you are having vaginal bleeding or pain and are unsure if it is related to menstruation.


The doctor will ask about symptoms and past health. A pelvic exam will be done. Other tests may be done to look for possible causes. Tests may include:


Medicine and home care can help to manage primary dysmenorrhea. Treatment for secondary dysmenorrhea will focus on the health issue that is causing the problem.

Over the counter nonsteroidal anti-inflammatory drugs (NSAIDs) can help. Examples of these medicines include ibuprofen and naproxen.

Birth control pills may be recommended as well for some. It may help balance hormones.

Other ways to ease discomfort include:

  • Heat therapy—may include heating pads, warm baths, or low-level heat patches
  • Regular exercise
  • Alternative treatments—such as herbs, supplements, acupuncture, and yoga


Steps that may reduce risk of some painful menstrual periods are:

  • Exercise regularly.
  • Do not smoke.
  • Limit caffeine and alcohol.


American Congress of Obstetricians and Gynecologists
Family Doctor—American Academy of Family Physicians


Society of Obstetricians and Gynaecologists of Canada
Women's Health Matters


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Last reviewed September 2019 by EBSCO Medical Review Board Chelsea Skucek, MSN, BS, RNC-NIC