Notes on Women's Health
Notes on Women's Health

When Painful Menstrual Cramps Aren’t Normal

This is the fifth in a series of five blogs about conditions that can be related to abnormal uterine bleeding.

painful menstrual cramps

Mild vs. serious menstrual cramp pain

Most women experience mild to moderate menstrual cramping on occasion. When it occurs, the medical term for it is usually “primary dysmenorrhea,” which means painful menstrual cramps caused only by normal menstruation and not by an underlying condition or disease. Symptoms of normal primary dysmenorrhea can include pain that:

  • feels like mild to moderate cramps in your lower pelvis or back
  • occurs a day or two before your period or during the first few days of your period
  • is accompanied by mild nausea or diarrhea
  • doesn’t interfere with your daily activities
  • improves with one or two doses of ibuprofen

Primary dysmenorrhea is caused by the release of chemical compounds called prostaglandins in your uterus, and it often improves as you get older. Primary dysmenorrhea often responds well to prostaglandin-lowering treatments such as ibuprofen, magnesium and certain dietary changes.

When menstrual cramping is caused by an underlying disease or condition, it can be more serious and more painful. It’s called “secondary dysmenorrhea,” and it can sometimes accompany abnormal uterine bleeding. In some cases, it can go undiagnosed for years.

What counts as “severe” menstrual cramp pain

If you’re experiencing unusually painful menstrual cramps, it may be difficult for you to know whether the pain is “normal” or not. Here are a few guidelines to help you know.

You may be experiencing secondary dysmennorhea if you experience pain that:

  • you might describe as throbbing, burning or stabbing
  • causes severe nausea
  • lasts for three or more days
  • occurs many days before your period or after your period ends
  • doesn’t lessen after you take one or two doses of ibuprofen
  • makes you miss work, school or other obligations
  • gets worse as you get older

How to treat painful menstrual cramps

If you are experiencing any dysmenorrhea symptoms, your healthcare provider may be able to help. He or she may do a physical exam and perhaps order blood tests or conduct an imaging study called a pelvic ultrasound. It may also be necessary to conduct laparoscopy — a type of surgery that lets your healthcare provider see inside the pelvic region. The purpose of these tests is to look for the underlying condition that is causing the pain. In many cases, the pain’s underlying cause may be endometriosis, adenomyosis, uterine fibroids or an infection, including pelvic inflammatory disease.

These conditions all have different treatments, but the typical order of treatment is to first try medication such as pain relievers or hormonal approaches. Lifestyle changes such as exercise and relaxation techniques may also be suggested. If these approaches do not relieve pain, treatment typically shifts to finding and removing the cause of the pain. In some cases, a mix of treatments works best.

If your symptoms or a laparoscopy indicate that endometriosis is the cause of (as is often the case with secondary dysmenorrhea), your treatments could include hormonal pills, implants, injections, or a hormonal intrauterine device. Gonadotropin-releasing hormone agonists may also relieve pain. These drugs are typically given for a limited amount of time. Surgery to remove the endometriosis can relieve pain, usually for about three years, although this can be extended for up to five or six years through the use of hormone therapy. For the most severe cases, surgical removal of the uterus and all adjacent endometriosis will permanently relieve pain in nearly all patients.

Whatever is causing your painful menstrual cramps, remember that there are many treatments available, and one or more of them may provide the relief that you need. So speak up, and don’t be afraid to contact your healthcare provider or to get a second opinion.

Additional information

If you have any questions about abnormal uterine bleeding or dysmenorrhea, feel free to contact us for more information and to discuss your particular situation. More information can be found below.

Dr. John M. Garofalo, M.D.: dysmenorrhea

American Congress of Obstetricians and Gynecologists: frequently asked questions on dysmenorrhea

About the practice

Dr. John Garofalo, M.D., is an Connecticut obgyn located in Fairfield County. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.

Laury Berkwitt, APRN, is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Laury has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for more than 10 years, caring for women of all ages.

For more information, go to www.garofaloobgyn.com. John Garofalo, MD, and Laury Berkwitt, APRN, can be reached for personal consultations by calling 203.803.1098