Painful Periods? Here's What Causes Dysmenorrhea

Let’s be real — periods are a pain. 

Every month, 1.8 billion people across the world menstruate. More than half of people who menstruate have at least some pain for 1 to 2 days each month. However, “dysmenorrhea”, the medical term for painful periods or severe menstrual cramps, is not a phrase many people are familiar with or taught about. 

What is Dysmenorrhea?

“Dysmenorrhea” is the medical term used for cramping, and aching pains in your abdomen experienced during your period. Primarily, the cramps you feel are likely caused by uterine contractions. During your menstrual period, the uterine muscles and blood vessels contract as the lining of the uterus is shed. Generally, outside of underlying causes, you can thank these uterine muscle contractions for those lovely monthly period cramps.

Dysmenorrhea can present differently across different bodies — for some, period pain can be relatively mild. For others, period pain can be debilitating, creating a hindrance to the ability to go about your everyday activities. Wherever you fall on the spectrum, there are certain red flags to look out for when it comes to period pain, as it may be caused by an underlying issue.

Primary Dysmenorrhea

Primary Dysmenorrhea is caused by natural chemicals made within the body called prostaglandins — i.e., the chemicals that trigger the muscles of your uterus to contract. In other words, primary dysmenorrhea is caused exclusively by your period.

In a medically normal menstrual cycle, prostaglandins are usually highest on the first day of your period. The uterus contracts, these contractions help your body to dispel and shed the uterine lining, and as bleeding continues your prostaglandin level decreases. In cases of primary dysmenorrhea, pain is usually only present for the first few days of your period & lessens as the cycle continues.

While still a pain, most cases of primary dysmenorrhea can find relief through nonsteroidal anti-inflammatory drugs (aka NSAIDs) such as ibuprofen, or acetaminophen (Tylenol), though research suggests NSAIDs may work better. Other options for relief include birth control pills, gentle exercise, heating pads, or massage. 

Secondary Dysmenorrhea

In contrast to primary dysmenorrhea, secondary dysmenorrhea occurs when your period pains are due to, or increased by a secondary cause — think an underlying disorder or medical condition. With secondary dysmenorrhea, symptoms also tend to be more severe. In addition to extreme bouts of cramping or pain in the lower abdomen, you might also experience lower back pain, pains that spread down your legs, nausea, vomiting, diarrhea, fatigue, weakness, fainting, or headaches. Secondary dysmenorrhea can cause pains so severe that it becomes difficult to stand or walk. 

The leading cause of secondary dysmenorrhea is endometriosis, which affects about 10% of people of reproductive age globally. Endometriosis is a chronic condition where tissue similar to the lining of the uterus grows outside of the uterus. 

Among other symptoms, endo is associated with severe and life-impacting pain during periods. Endometriosis should be considered in patients with persistent & significant dysmenorrhea, though unfortunately symptoms are often missed or misdiagnosed by medical providers. You may have endometriosis if your other symptoms include pain during sex, pain during bowel movements and/or urination, chronic pelvic pain, abdominal bloating, nausea, fatigue, and infertility.

Other potential causes of Dysmenorrhea 

• Pelvic inflammatory disease - a serious infection occurring in your uterus, fallopian tubes, and/or ovaries. Watch out for additional symptoms of pelvic inflammatory disease such as pain when peeing, bleeding between periods and after sex, or unusual vaginal discharge - especially if it's yellow, green, or has a foul odor.
• Polycystic ovary syndrome (aka PCOS) - PCOS is a common hormonal condition causing many small sacs of fluid (cysts) to develop along the outer edge of the ovaries. While PCOS impacts an estimated 8–13% of women of reproductive age, up to 70% of cases are undiagnosed. Symptoms of PCOS vary from person to person, but when menstruation occurs they often experience heavy bleeding, clots, and severe period pain. Other PCOS symptoms to look out for include unpredictable or absent periods, infertility, acne or oily skin, and excessive hair on the face or body.
• Uterine Fibroids - Fibroids are benign growths that form on uterine tissue. In addition to severe cramps, fibroids can cause irregular bleeding, an enlarged uterus, frequent urination, and pain during sex.
• Adenomyosis - similar to endometriosis but occurring in much rarer cases, adenomyosis is a disorder where the uterine lining grows into the actual muscle of your uterine wall. This can cause the uterus to double or triple in size. Alongside period pain, symptoms to watch out for include heavy or abnormal menstrual bleeding, chronic pelvic pain, pain during sex, severe abdominal bloating, and infertility.

Don’t be afraid to advocate for yourself — even though you shouldn’t have to

In short, period pain should not be extreme or life-altering. Unfortunately, the idea that severe pain should be an expected part of your period is a widely believed misconception. This belief is often exacerbated by the fact that many underlying causes of dysmenorrhea have overlapping symptoms and can be difficult to diagnose. 

It’s a shame that we live in a world where women’s pain is so often downplayed, questioned, or downright not believed. If you find that your experience during your period includes pain that impacts your everyday life, don’t be afraid to speak to your doctor. In fact, don’t be afraid to speak to multiple doctors. Know that it is not “normal” to have debilitating period pains: you are not alone, your pain is real, and you deserve answers.

Lindsey Williams is a library worker and writer who lives in Arizona with her daughter, husband, and their dog, Peaches.