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During the first few days of their periods, most women experience mild to moderate menstrual cramps. However, some women experience severe, debilitating pain during their periods. This condition of severely painful monthly periods is called dysmenorrhea. Women who have this condition oftentimes have many questions about their condition. This page can help answer frequently asked questions about dysmenorrhea and how to manage the symptoms.


Every month, your reproductive system goes through a series of changes that allow it to prepare for a potential pregnancy. These changes are monitored and controlled by important hormones called estrogen and progesterone.  These hormones send signals to the reproductive organs to prepare for pregnancy on a 28-day schedule called the menstrual cycle. During day one of your cycles, you will be in the process of menstruation- where the uterine lining is shed through the vagina if an egg is not fertilized. By day five of your cycle, your estrogen and progesterone levels increase, signaling the uterine lining to re-grow, which prepares for a potentially fertilized egg. On day fourteen, your ovaries release an egg, which travels into the fallopian tubes to have the chance of being fertilized. If by day 28 the egg is still not fertilized, the progesterone and estrogen levels will drop, signaling menstruation to begin, and the cycle to restart.

During menstruation, your uterus muscle contracts in order to shed the unneeded endometrial lining. These contractions, although minimal compared to those during labor, can still cause pain in women during the first day or two of their period.


Women who experience severe, debilitating pain during their periods are said to have dysmenorrhea, which is the condition of intense cramping pain when menstruating. There are two types of dysmenorrhea:

  • Primary Dysmenorrhea: Primary dysmenorrhea is caused by the natural hormone prostaglandin causing your uterine muscles to contract during menses, therefore resulting in cramping pain. Although sometimes very painful, primary dysmenorrhea is not life-threatening or the symptom of a greater illness.
  • Secondary Dysmenorrhea: Secondary dysmenorrhea is oftentimes caused by not only prostaglandins and uterine cramping but also because of another illness. Sometimes, the pain may be very mild for the rest of the month but increases greatly during menstruation. There are several conditions that can cause intense pain while menstruating:
    • Fibroids- muscle growths or tumors that grow inside or outside the uterine wall. They are not cancerous but they can create a severe amount of pain.
    • Endometriosis- a condition in which the endometrial lining tissue begins to grow outside the uterus as on the ovaries, bowels, bladder, or fallopian tubes. Even though this new tissue is not in the uterus, it still reacts to the hormone changes of the menstrual cycle and begins to break down and bleed just like the normal tissue inside the uterus. Endometriosis may cause very severe pain before, during, and after your period.


  • Severe cramps
  • Pain in the abdomen or lower back
  • Nausea
  • Vomiting
  • Dizziness
  • Headache
  • Pulling feeling in the inner thighs



If you suspect that you may have dysmenorrhea, schedule an appointment with your doctor. There, he or she will ask you questions about your medical history, symptoms, and the nature of your pain. Then your doctor will perform a pelvic exam. Based on the results of your pelvic exam, your doctor may what to order more tests.

If your doctor suspects secondary dysmenorrhea, he or she may perform a pap test, an ultrasound exam, or certain lab tests, to determine the secondary cause of your dysmenorrhea. If this is still inconclusive, he or she may recommend a laparoscopy. This is an outpatient procedure during which the doctor makes an incision near your navel and inserts a thin, telescope-like device into your abdomen to look for other causes of dysmenorrhea like endometriosis or fibroids.


If you have primary dysmenorrhea, your doctor may prescribe certain medications to manage the pain. He or she may also suggest certain exercises or positions to use when you are menstruating to make the process less painful. There are certain medications that are used to relax the uterus, which will lessen the pain.  Also, birth control pills are very helpful in relieving menstrual cramps and pain.

If you have secondary dysmenorrhea, you may need certain other treatments or sometimes surgery. Your doctor may perform surgery to remove endometriosis tissue or fibroids.


Menstrual pain is very common among women. However, extreme cramps and pelvic pain can often be debilitating and may need treatment. If you experience symptoms of dysmenorrhea, make sure to talk to your doctor about what can be done.