Diane W. Shannon, MD, MPH
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 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:
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:
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:
Call your doctor if you have:
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:
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
Birth control pills
may be prescribed in some cases.
Other ways to ease discomfort include:
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:
American Congress of Obstetricians and Gynecologists
Family Doctor—American Academy of Family Physicians
Society of Obstetricians and Gynaecologists of Canada
Women's Health Matters
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Last reviewed September 2016 by Michael Woods, MD
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