Painful menstrual periods, also called dysmenorrhea, may include pain in the pelvis, abdomen, back, or legs, abdominal cramps, headache, and fatigue. Most women have painful periods at some time in their lives. In some women, the pain is severe enough to interfere with normal activities.

There are 2 types of dysmenorrhea:

  • Primary—painful regular menstrual cycles caused by uterine muscle contractions
  • Secondary—painful periods due to an underlying condition, such as endometriosis
  • Menstrual Flow

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    Primary dysmenorrhea is caused by high levels of prostaglandins in the uterus. Prostaglandins are hormone-like substances normally found throughout the body.

    Secondary dysmenorrhea can be caused by:

  • Endometriosis
  • Ovarian cysts
  • Infection of the female reproductive organs—pelvic inflammatory disease
  • Noncancerous growths in the uterus—uterine fibroids
  • Intrauterine device (IUDs)
  • Scars inside the abdomen from previous surgery
  • Tumors
  • Inflammatory bowel disease
  • Risk Factors

    Painful menstrual periods are more common in women under age 30 years. Other factors that may increase your risk of having painful menstrual periods include:

  • Low body weight, especially during adolescence
  • Smoking
  • Early onset of menstruation—younger than 12 years old
  • Longer menstrual cycles
  • Heavy bleeding during periods
  • Never having delivered a baby
  • Psychological disorders, such as depression or anxiety
  • You are also at risk if you have a related condition, such as endometriosis or ovarian cysts.


    The pain associated with either primary or secondary dysmenorrhea may be sharp and throbbing, or dull and aching. It is most typically located in the lower abdomen and may spread to the low back or thighs. Other symptoms may include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Headache
  • Irritability
  • When Should I Call My Doctor?

    Call your doctor if you have:

  • Severe or unusual cramps
  • Cramps that last for more than a few days
  • Signs of infection, such as fever or chills
  • Cramps with heavy menstrual bleeding
  • Abdominal or pelvic tenderness
  • Vaginal discharge other than menstrual bleeding
  • Also, call you doctor if you are having vaginal bleeding or pain and are unsure if it is related to menstruation.


    You will be asked detailed questions about your symptoms and medical history. A pelvic exam will be done.

    Specific tests can evaluate your pelvic organs and surrounding structures. Tests may include:

  • Pelvic ultrasound
  • Hysteroscopy
  • Hysterosalpingogram
  • Pelvic laparoscopy
  • Treatment

    Primary dysmenorrhea is usually treated with medications and lifestyle changes.

    The treatment of secondary dysmenorrhea varies depending on the underlying condition.


    Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the first-line treatment for menstrual pain. Examples of these medications include ibuprofen and naproxen.

    Birth control pills may be prescribed in some cases.

    Other Treatments

    Other ways to ease discomfort include:

  • Heat therapy, which may include heating pads, warm baths, or continuous low-level heat patches
  • Regular exercise
  • Alternative treatments, such as:     
  • Herbs or supplements, such as vitamin B1, magnesium, and Chinese herbal medicine
  • Acupuncture or yoga
  • Talk to your doctor before taking any herbs and supplements. They may interact with your other medications and conditions.


    To help reduce your chance of painful menstrual periods:

  • Exercise regularly
  • If you smoke, talk to your doctor about how you can quit
  • Drink only moderate amounts of caffeine and alcohol