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Painful Menstrual Periods

The uterus is a muscle and contracts normally during the menstrual cycle. The contraction pushes out the build-up of tissue that occurs each month inside the uterus. If the contraction is very strong, it can cause pain because the muscle is not getting enough oxygen for the amount of work it is doing. Pain with menstruation is called “dysmenorrhea”. The pain may feel like a dull ache or throbbing in the lower abdomen. It may spread to your lower back or inner thighs. In severe cases there may also be nausea, vomiting, loose stools, sweating or dizziness.

There are two types of dysmenorrhea:

Primary Dysmenorrhea (common menstrual cramps) usually appears within one or two years after you start your periods. It usually gets better or goes away as you get older or when you have a baby. The menstrual cramps usually start just before, or on the day of your period, and last 1-3 days. Treatment is with comfort measures and anti-inflammatory drugs as described below (see Home Care). If your pain is not controlled with these measures, your doctor may prescribe birth control pills. This will reduce the pain of each period.

Secondary Dysmenorrhea starts later in life. The pain begins earlier in the menstrual cycle and lasts longer than common menstrual cramps. It is caused by a specific problem with the pelvic organs, such as:

  • PID (pelvic inflammatory disease) -- an infection in the fallopian tubes

  • Fibroids – benign tumors within the wall of the uterus (not cancer)

  • Endometriosis – the tissue that lines the uterus spreads outside the uterus and grows there. This tissue swells and bleeds each month, just like the tissue in your uterus, and causes pain.

  • IUD use -- especially in the first few months after placement

Once the cause of secondary dysmenorrhea is found, it can be treated.

Home Care:

  1. Most women with common menstrual cramping (primary dysmenorrhea) can remain active throughout their period. Many women find that regular exercise each werek reduces menstrual pain.

  2. If cramping is severe, rest in bed with a heating pad on the lower abdomen or lower back. A hot bath or massage to the lower back and abdomen may also give relief.

  3. Smoking can make symptoms worse. If you smoke, ask your doctor for help with a stop-smoking plan.

  4. Avoid caffeine and alcohol around the time of your period since these can make symptoms worse.

  5. Anti-inflammatory medicine such as aspirin, ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) can be very helpful, especially if taken at the very first signs of bleeding or cramping . Acetaminophen (Tylenol) is not as effective for this problem. [NOTE: If you have chronic liver or kidney disease or ever had a stomach ulcer or GI bleeding, talk with your doctor before using these medicines.]

  6. If your pain is not controlled by the above measures, a prescription pain medicine may be required for a short time. Discuss this with your doctor.

Follow Up

with your doctor as advised. If you have just started menstruating in the past 1-2 years, and your pain is mild to moderate, your symptoms are most likely not a cause for concern. However, if menstrual cramps are severe enough to interfere with your daily activities, last longer than a few days, or if you are older and just started having menstrual pain, it is important to see your doctor for further evaluation.

Get Prompt Medical Attention

if any of the following occur:

  • Fever over 100.4ºF (38.0ºC) with pelvic pain

  • Uncontrolled menstrual pain or pain that lasts longer than usual or occurs between periods

  • Unusual vaginal discharge between periods

  • Heavy vaginal bleeding (soaking more than one pad an hour for three hours)

  • Passage of pink or gray tissue from the vagina

If you use tampons, watch for the following signs of Toxic Shock Syndrome and return at once:

  • Fever over 102.0ºF (38.9ºC), with or without pelvic pain

  • Vomiting, diarrhea

  • Dizziness, weakness or fainting

  • Rash that looks like a bad sunburn


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