Dysmenorrhea, also known as painful periods or menstrual cramps, is pain during menstruation. Its usual onset occurs when menstruation begins. Symptoms usually last less than three days. The pain is usually in the pelvis or lower abdomen. Other symptoms may include back pain, diarrhea or nausea.

Dysmenorrhea can occur without an underlying problem. The underlying problems that can cause dysmenorrhea include uterine fibroids, adenomyosis and, most commonly, endometriosis. It is more common in those with heavy periods, irregular periods, those whose periods started before the age of twelve, and those with low body weight. A pelvic exam and ultrasound in sexually active people may be helpful for the diagnosis. Conditions to be excluded include ectopic pregnancy, pelvic inflammatory disease, interstitial cystitis, and chronic pelvic pain.

Dysmenorrhea occurs less often in those who exercise regularly and in those who have children early in life. Treatment may include the use of a heating pad. Medications that can help include NSAIDs such as ibuprofen, hormonal birth control, and the progestin-only IUD. Taking vitamin B1 or magnesium can help. There is insufficient evidence for yoga, acupuncture, and massage. Surgery can be helpful if certain underlying problems are present.

Estimates of the percentage of women of reproductive age affected range from 20% to 90%. It is the most common menstrual disorder. As a rule, this begins within a year of the first menstrual period. When there is no underlying cause, pain often improves with age or after having a child.


Symptoms of dysmenorrhea can include:

Pain in the abdomen, which can spread to the lower back and legs
Pain that is gripping or perceived as constant pain, or a combination of both.

The pain starts when the period starts or earlier
The first 24 hours can be the most painful
Clots can be carried over in menstrual blood.
Dysmenorrhea can be associated with:

a headache
Nausea and vomiting
Digestive problems such as diarrhea or constipation
premenstrual symptoms such as tender breasts and a swollen abdomen that can persist throughout the period
The pain persists after the first 24 hours (this tends to subside after two or three days).


During your menstrual period, your uterus contracts to help push out its lining. Hormonal substances (prostaglandins) involved in pain and inflammation trigger uterine muscle contractions. Higher levels of prostaglandins are associated with more severe menstrual cramps.

Menstrual cramps can be caused by:

Endometriosis. The tissue that lines your uterus is implanted outside your uterus, most often on your fallopian tubes, ovaries, or the tissue lining your pelvis.
Uterine fibroids. These non-cancerous growths in the lining of the uterus can cause pain.
Adenomyosis. The tissue that lines your uterus begins to grow in the muscle walls of the uterus.
Pelvic inflammatory disease. This infection of the female reproductive organs is usually caused by sexually transmitted bacteria.
Cervical stenosis. In some women, the opening of the cervix is ​​small enough to interfere with menstrual flow, causing the pressure in the uterus to increase painfully.


Dysmenorrhea is usually divided into two categories based on pathophysiology (table). Primary dysmenorrhea is menstrual pain with no organic disease, and secondary dysmenorrhea is menstrual pain associated with an identifiable disease. Common in secondary dysmenorrhea are endometriosis, fibroids (fibroids), adenomyosis, endometrial polyps, pelvic inflammatory disease, and the use of an intrauterine contraceptive.


To relieve your period cramps, your doctor may recommend:

Pain relief. Over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), in regular doses starting the day before your period starts can help control the pain of cramps. Prescription nonsteroidal anti-inflammatory drugs are also available.

Start taking the pain reliever at the start of your period, or as soon as you experience symptoms, and continue taking the medicine as directed for two to three days or until your symptoms subside.

Hormonal birth control. Oral contraceptive pills contain hormones that prevent ovulation and reduce the severity of period cramps. These hormones can also be delivered in several other forms: an injection, a skin patch, an implant placed under the skin of your arm, a flexible ring that you insert into your vagina, or an intrauterine device (IUD).
Surgery. If your period cramps are caused by a disorder such as endometriosis or fibroids, surgery to correct the problem may help your symptoms. Surgical removal of the uterus may also be an option if other approaches fail to relieve your symptoms and if you are not planning on having children.


Your doctor will review your medical history and perform a physical exam, including a pelvic exam. During the pelvic exam, your doctor will examine your reproductive organs for abnormalities and look for signs of infection.

If your doctor suspects that a disorder is causing your menstrual cramps, they may recommend other tests, such as:

Ultrasonic. This test uses sound waves to create a picture of your uterus, cervix, fallopian tubes, and ovaries.
Other imaging tests. A CT or MRI scan provides more detail than an ultrasound and can help your doctor diagnose underlying conditions. CT combines x-rays from many angles to create cross-sectional images of bones, organs, and other soft tissues in your body.

MRI uses radio waves and a strong magnetic field to create detailed images of internal structures. Both tests are non-invasive and painless.

Laparoscopy. Although laparoscopy is not usually required to diagnose menstrual cramps, it can help identify an underlying condition such as endometriosis, adhesions, fibroids, ovarian cysts, and ectopic pregnancy. During this outpatient surgery, your doctor will view your abdominal cavity and reproductive organs by making tiny incisions in your abdomen and inserting fiberglass tubing with a small camera lens.

Risk factor

You may be at risk for menstrual cramps if:

Are you under 30
You started puberty early, at age 11 or younger
You bleed heavily during your period (menorrhagia)
You have irregular menstrual bleeding (metrorrhagia)
You have a family history of menstrual cramps (dysmenorrhea)
You smoke
Menstrual cramps don’t cause other medical complications, but they can interfere with school, work, and social activities.

Some conditions associated with menstrual cramps, however, can lead to complications. For example, endometriosis can cause fertility problems. Pelvic inflammatory disease can scar your fallopian tubes, increasing the risk of a fertilized egg implanting outside your uterus (ectopic pregnancy).

Health condition

Women with primary dysmenorrhea have abnormal contractions of the uterus due to a chemical imbalance in the body. For example, the chemical prostaglandin controls the contractions of the uterus. Secondary dysmenorrhea is caused by other conditions, most often endometriosis.

When to see docter

See your doctor if:

Menstrual cramps disrupt your life every month
Your symptoms gradually get worse
You have just started to have severe menstrual cramps after 25 years


You may experience mild to severe pain in your lower abdomen, back, or thighs. Pain can usually last 12 to 72 hours, and you may have other symptoms such as nausea and vomiting, tiredness, and even diarrhea.