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You may have painful menstrual cramps (dysmenorrhea) from time to time. Menstrual cramps can occur during or just before your period. The pain from these cramps can range from mild to severe. It can involve the lower belly, back, or thighs. You may also have headaches, nausea, dizziness, fainting, diarrhea, or constipation with your cramps.
During the menstrual cycle, the lining of the uterus produces a hormone called prostaglandin. This hormone causes the uterus to contract, often with pain. If you have severe cramps, you may be producing higher-than-normal amounts of prostaglandin. Or you may be more sensitive to its effects.
Primary dysmenorrhea is a term used to describe painful menstrual cramping that isn't caused by a medical problem. It often starts during the teen years, when periods first start. But the pain often improves as you get older.
Secondary dysmenorrhea is a term used to describe painful menstrual cramping that's caused by a physical problem other than menstruation. Problems that can cause this type of cramping include:
- A condition in which cells that look and act like the cells of the lining of the uterus (endometrium) are found in other parts of the belly cavity (endometriosis) or grow into the muscular tissue of the uterine wall (adenomyosis). Pain usually occurs 1 to 2 days before menstrual bleeding starts. It continues through the period.
- Growths in the pelvis that aren't cancer (benign growths). This includes ovarian cysts, cervical or uterine polyps, and fibroids.
- Pelvic infections. They can cause worse pain and cramping in your belly during your period.
- Using an intrauterine device (IUD). An IUD may cause worse cramping during your period for the first few months you use it. If menstrual cramps persist or get worse, talk to your doctor.
- Structural problems that were present at birth (congenital). This includes narrowing of the lower part of the uterus that opens into the vagina (cervix).
Menstrual-type cramps may occur after a medical procedure. Examples are cautery, cryotherapy, conization, radiation, endometrial biopsy, and IUD insertion.
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Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Pain in adults and older children
- Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
- Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
- Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
It's common to have painful cramps from your period now and then. But you can usually ease cramps with home treatment. Here are some things you can try.
- Apply heat to your belly.
Use a heating pad (set on low) or a hot water bottle on your belly, or take a warm bath. You might find that heat relieves the pain as well as medicine does.
Don't go to sleep with a heating pad on your skin. Put a thin cloth between the heating pad and your skin.
- Relieve pressure on your back.
Lie down and put a pillow under your knees. Or lie on your side, and bring your knees up to your chest.
- Get regular exercise.
It helps blood flow and may reduce cramping.
Using medicines for pain
It's common to have painful cramps from your period now and then. The good news is that you can usually ease cramps with over-the-counter (OTC) medicine.
Here are some medicines you can try and ways to help get the most benefit out of the medicine you use.
- Take over-the-counter medicines to reduce pain.
- Try nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) or naproxen (Aleve).
- Try acetaminophen (such as Tylenol) if NSAIDs don't relieve the pain.
Be safe with medicines. Read and follow all instructions on the label. If you are trying to become pregnant, talk to your doctor before you use any medicine.
- Stay ahead of the pain.
Pain medicine works better if you take it before the pain gets bad.
- Start taking the recommended dose of the pain medicine as soon as you start to feel cramping, or on the day before your period starts.
- Keep taking the medicine for as long as you have cramps.
When to call for help during self-care
Call a doctor if any of the following occur during self-care at home:
- New cramps in someone who could be pregnant.
- Pain that gets worse.
- Menstrual cramps that last longer than a period.
- New fever.
- Symptoms occur more often or are more severe.
Preparing For Your Appointment
You can help your doctor diagnose and treat your condition by being prepared for your appointment.
Current as of: November 22, 2021
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine