What Causes Period Pain?

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To be blunt: periods suck. You are bleeding, you are bloated, and you are in pain. Friends, media, and even doctors tell you that it’s no big deal—that it’s natural. And yes, it is natural, but so is all other kinds of pain and we feel it for a reason.

Not all period pains are cause for alarm. This type of pain—called dysmenorrhea—falls into two different categories. Primary dysmenorrhea, the most common type of period pain, is caused by your period alone. The muscles of your uterus contract to expel its lining. The lipids that triggers these contractions, prostaglandins, are also involved with pain and inflammation. There are certain factors which can put you at a higher risk for bad cramps, like current age and menarche. Being below the age of thirty puts you at higher risk, as does an early puberty. 

Secondary dysmenorrhea is caused by a reproductive disorder. The symptoms of secondary dysmenorrhea tend to work in the inverse of primary dysmenorrhea, with symptoms getting worse as time goes on.

The most common cause behind secondary dysmenorrhea is a disorder called endometriosis. With endometriosis, the uterine lining that is shed every month is also growing outside the uterus. This disorder causes severe menstrual cramping, along with pain during or after sex, fatigue and infertility. Factors that can put you at higher risk includes shorter menstrual cycles, alcohol consumption, and low body mass index. This condition tends to begin years after the first period.

A different possible cause, especially for sexually active women, is pelvic inflammatory disease. Symptoms of this include putrid vaginal discharge, trouble urinating, nausea, and fever. However, pelvic inflammatory disease does not commonly cause symptoms; this is dangerous because without noticeable symptoms, women may not know that they need to be treated. The two largest causes behind pelvic inflammatory disease are gonorrhea and chlamydia, both of which are common sexually transmitted infections. Such diseases can be prevented through protected sex; be sure that on top of using contraceptives, both you and your partner get tested.

Another possible reason for secondary dysmenorrhea is uterine fibroids, which are non-cancerous growths within the uterus. These are fairly common, and a large number of women who have uterine fibroids have no symptoms. However, of those that do, common symptoms include difficulty emptying the bladder, spotting between periods, chronic pelvic pain, and intense menstrual cramps.

Adenomyosis is another possible culprit behind intense period pain. This occurs when the uterine lining grows into the muscles that surround the uterus. Adenomyosis tends to terminate with the onset of menopause. There is no known cause for this disease, but the information regarding treatment suggests that hormonal treatment can help. The only known “complete” cure at present would be hysterectomy.

The pain of secondary dysmenorrhea is different than the pain of primary dysmenorrhea. Secondary dysmenorrhea pain tends to last longer than regular menstrual cramps; it may start a few days prior, intensifying as you menstruate. If you have concerns, the best course of action is to go to a doctor. When you go, they will perform a pelvic exam to help diagnose you; they may also perform an ultrasound.

When going to a physician for period pain, it is important to make sure that they listen to you. Stories such as that of Melanie Greeke show how easily dysmenorrhea can be dismissed by the medical community, despite the possibility of a cause beyond menstruation itself; her extreme pain was dismissed by multiple medical professionals before she finally received a proper diagnosis. In fact, this is so common that the majority of women with endometriosis are only diagnosed after several years of pain.

No matter the cause, there are ways to alleviate the pain. The classic cure is warmth: hot water bottles, heating pads, hot baths. The heat helps relax cramped muscles. As tempting as it is to curl up in bed and pull the blankets over your head for a week, being active is a fantastic way to mitigate period pain. Yoga can help sore muscles, but any type of physical activity will help. Exercise creates endorphins, which are your body’s form of painkillers. If you don’t have time to or are in too much pain to exercise, bottled painkillers (think aspirin, not that bottle of wine waiting at home) may be a good place to start. While over-the-counter pain medication may not always help, both primary and secondary dysmenorrhea can be treated with birth control pills.

Regardless of the severity of your pain, periods are awful enough as it is. Take note of your symptoms and be sure to bring them to the attention of a physician if these pains are seriously impeding with your daily life. You already have more than enough to do as it is.