Painful Periods? Here's What Causes Dysmenorrhea

Let’s be real: periods are a pain.

Every month, 1.8 billion people worldwide menstruate, and more than half of those people have at least some pain for 1 to 2 days each month. Still, “dysmenorrhea”, the scientific term for painful periods or severe menstrual cramps, is not a phrase many women are familiar with or taught about in Sex Ed.

What causes dysmenorrhea?

If you’ve ever experienced abdominal cramps or aches during your period, you’ve likely dealt with dysmenorrhea — the medical term for those pesky, that-time-of-the-month cramps. These cramps are caused by uterine contractions, which help your uterus shed its lining each cycle. During your period, the uterine muscles and blood vessels contract as the lining is shed. Generally, outside of underlying causes, you can thank these uterine muscle contractions for those lovely monthly period cramps.

But dysmenorrhea can look different for everyone. For some, period pain is relatively mild. For others, including many women living with endometriosis, it can be downright debilitating — making it hard to work, study, or even get out of bed.

Wherever you fall on the spectrum, it’s important to know that certain red flags can signal that your pain might be linked to an underlying condition that needs attention.

Primary dysmenorrhea: When your period is the culprit

Primary dysmenorrhea is the type of period pain caused purely by your menstrual cycle. It happens because of prostaglandins, natural chemicals your body produces that trigger the muscles of your uterus to contract.

In a typical menstrual cycle, prostaglandin levels are highest on the first day of your period. Those uterine contractions help your body shed the lining of the uterus (a.k.a. your period). As bleeding continues, prostaglandin levels naturally drop, and the pain usually eases after the first few days.

While still uncomfortable, primary dysmenorrhea is often manageable. Many find relief with over-the-counter pain relievers like nonsteroidal anti-inflammatory drugs (NSAIDs) — such as ibuprofen — or acetaminophen (Tylenol), though research suggests NSAIDs may be more effective. Other helpful remedies include birth control pills, gentle exercise, heating pads, or abdominal massage.

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Did you know that getting an official diagnosis of endometriosis takes an average of 7 to 10 years from when symptoms first start? That’s nearly a decade of living with pain and uncertainty, often because many providers still mistakenly normalize pelvic pain and unexplained infertility and don’t immediately refer to specialists. But here’s the hopeful part: new non-invasive testing options, like the MyReceptiva test, are changing the game. This test looks for a protein marker linked to endometriosis inflammation and can offer critical clues without surgery, helping women advocate for themselves and get personalized care faster. It’s a reminder that menstrual and other pelvic pain is *never* just something to “suck up.” Your pain is real, and you deserve to be heard and supported every step of the way.

What is secondary dysmenorrhea?

Unlike primary dysmenorrhea, which is caused solely by your period, secondary dysmenorrhea occurs when menstrual pain is linked to an underlying condition. The symptoms also tend to be more severe and wide-ranging. In addition to intense cramping in the lower abdomen, you might experience:

• Lower back pain
• Pain radiating down the legs
• Nausea, vomiting, or diarrhea
• Fatigue or weakness
• Headaches or fainting

For some, the pain can be so intense that it becomes difficult to stand, walk, or carry on with daily life.

Endometriosis: A leading cause of secondary dysmenorrhea

One of the most common causes of secondary dysmenorrhea is endometriosis, a chronic condition affecting at least 7-15% of women worldwide. Endometriosis occurs when tissue similar, but not identical, to the lining of the uterus grows outside the uterus, leading to inflammation, scarring, and pain.

Endometriosis is often associated with severe, life-disrupting period pain, but its symptoms can extend far beyond menstruation. You may have endometriosis if you also experience:

• Pain during sex
• Pain with bowel movements and/or urination
• Chronic pelvic pain
• Bloating, nausea, or fatigue
• Difficulty conceiving (infertility)

If this sounds familiar, you’re not imagining it, and you’re not alone. Unfortunately, endometriosis is often missed, misdiagnosed, or dismissed entirely, leaving many to suffer without answers for years.

For those seeking clarity, non-invasive testing options like the MyReceptiva test can help start the conversation. This test detects a protein linked to inflammation associated with endometriosis, providing valuable insight without requiring surgery. You deserve to be heard, and MyReceptiva can be a powerful tool if you’re simply looking to better understand the root cause of your pain.

Other potential causes of dysmenorrhea

While endometriosis is the leading cause of secondary dysmenorrhea, several other conditions can contribute to severe menstrual pain:

• Pelvic Inflammatory Disease (PID): A serious infection of the uterus, fallopian tubes, and/or ovaries. Additional warning signs include painful urination, bleeding between periods or after sex, and unusual vaginal discharge — especially if it’s yellow, green, or has a foul odor.
• Polycystic Ovary Syndrome (PCOS): A common hormonal condition affecting 8–13% of women of reproductive age (though up to 70% of cases go undiagnosed). While PCOS varies from person to person, women may experience heavy bleeding, blood clots, and severe pain. Other symptoms include irregular or absent periods, infertility, acne or oily skin, and excess facial or body hair.
• Uterine fibroids: Benign growths on the uterus that can lead to severe cramps, irregular bleeding, frequent urination, pain during sex, and an enlarged uterus.
• Adenomyosis: A rarer condition where the uterine lining grows into the muscle of the uterus, sometimes causing it to double or triple in size. Symptoms can include heavy or abnormal bleeding, chronic pelvic pain, pain during sex, severe bloating, and infertility.

Though these conditions differ, the common thread is often persistent discomfort, and that’s always worth asking your doctor about.

Advocating for your health

The truth is, your monthly period should not be extreme or life-altering. Yet, the misconception that debilitating pain is “normal” persists, leaving countless people suffering in silence. Add to that the overlapping symptoms of many reproductive health conditions and a healthcare system that often minimizes women’s pain, and it’s no wonder so many struggle to get answers.

But your pain is real, and you deserve better. You have every right to seek help, and to keep seeking it until someone truly listens. If one doctor dismisses you, find another. Advocate for yourself, even if you shouldn’t have to. When something feels off in your body, you deserve answers — and to feel empowered in taking next steps.

If you suspect you may have endometriosis, or simply want to better understand what’s behind your pain, non-invasive tools like the MyReceptiva test can be a valuable starting point. It’s not a full diagnosis, but it can provide insight that opens doors to further evaluation and care.

Trust what you feel. And if you're curious, learn more about MyReceptiva here and use code RESCRIPTED for $85 off a testing kit.

Tassia O'Callaghan is an experienced women's health content writer and SEO content strategist, having written for brands like Peanut App Ltd, Scary Mommy, Fertility Mapper, Tally Workspace, and Office Christmas. She's an advocate for realistic sustainable living, supporting small businesses (author of A-Z of Marketing for Small Businesses), and equity across all walks of life. Follow her on LinkedIn or TikTok, or see more of her work on Authory or her website.