Period pain, also known as dysmenorrhea, is a common symptom of menstruation that many women experience. For some women, period pain can be mild and just a nuisance. But for others, it can be so severe that it interferes with daily activities. So why do some women suffer from intense menstrual cramps while others breeze through their periods pain-free? Here are some key factors that explain why period pain happens and why some women get it worse than others.
What causes period pain?
Period pain is caused by contractions in the uterus triggered by prostaglandins, chemicals that are produced in the lining of the uterus leading up to menstruation. When the uterus contracts, it constricts blood vessels in the lining causing a temporary lack of oxygen. This lack of oxygen is what causes the cramps and pain.
More specifically, here’s what’s happening inside the body:
- Just before your period, levels of prostaglandins rise in the uterus lining.
- When your period starts, the uterus lining begins to shed.
- The prostaglandins cause the uterus muscles to contract tightly and constrict blood vessels.
- The contractions block oxygen supply to the uterus lining, causing painful cramps.
So in summary, it’s the prostaglandin-triggered contractions and lack of oxygen that lead to the sensation of painful menstrual cramps.
Why do some women get worse period pain?
While most women experience some degree of period pain, there are several factors that cause some women to have more severe dysmenorrhea than others:
- Prostaglandin levels – Women with heavy, painful periods tend to have higher levels of prostaglandins. The more prostaglandins, the more severe the uterine contractions.
- Genetics – Research shows that period pain can run in families. If your mother or sisters had bad cramps, you’re statistically more likely to as well.
- Stress – Mental and physical stress can make cramps worse. Stress causes muscles throughout the body to contract, adding to cramping in the uterus.
- Young age – Most women find their cramps tend to improve with age as their bodies get used to menstruation. Cramps are typically worse through the late teens and 20s.
- Smoke – Smoking is linked with more painful periods. Toxins in cigarettes may increase prostaglandin production.
- Miscarriage – Prior miscarriages or abortion can scar the uterus lining and lead to more painful cramps.
In addition, certain medical conditions are associated with more painful menstruation, including:
- Endometriosis
- Fibroids
- Pelvic inflammatory disease
- Adenomyosis
- Cervical stenosis
Women with one of these conditions may produce higher levels of prostaglandins or have more sensitivity to normal prostaglandin levels, resulting in worse menstrual cramps.
What’s happening inside the body during period pain?
Now that we know some of the main causes behind painful periods, let’s take a more detailed look at the specific physiological processes occurring inside the body that create that all-too-familiar period pain:
1. Your uterus lining thickens
In the first half of your menstrual cycle, estrogen causes the lining of your uterus (womb) to thicken to prepare for a potential pregnancy. This thick, blood vessel-rich lining will provide nourishment to an embryo if pregnancy occurs. If no embryo implants, you enter the next phase.
2. Hormone levels drop
Approaching your period, your estrogen and progesterone levels decline. This signals your body to begin the shedding process. The previously thickened uterus lining is no longer needed and will be shed as your menstrual flow.
3. Prostaglandins are released
As estrogen and progesterone levels decline, your uterus starts producing prostaglandins. Prostaglandins are hormone-like compounds that trigger smooth muscle contractions throughout the body, including the uterus. Higher levels of prostaglandins are linked to more severe menstrual cramps.
4. The uterus contracts
The prostaglandins cause your uterine muscles to contract. These involuntary contractions are what you feel as painful cramping. The contractions become stronger and more painful as more of the uterus lining breaks down and sheds.
5. Blood vessels are constricted
The powerful uterine contractions also constrict the blood vessels that nourish the shedding uterus lining. This temporarily cuts off oxygen to the uterine tissues, intensifying the cramping sensation.
6. Your period starts flowing
Finally, the constricted uterus muscles force out the shed bloody lining through your cervix and vagina. This is the start of your menstrual bleeding. The contractions continue throughout your period, causing varying levels of pain.
When period pain becomes a problem
It’s normal to have some mild discomfort or cramps during your period. But if you regularly have severe dysmenorrhea that interrupts your day-to-day activities, it’s time to see your doctor. You may be experiencing above-normal prostaglandin levels or have an underlying gynecological condition contributing to painful periods.
See your doctor right away if you have period pain along with:
- Fever and chills
- Severe pain that isn’t relieved by over-the-counter medication
- Fainting or severe weakness
- Vomiting or diarrhea
These can be signs of a more serious medical issue requiring prompt treatment.
Treatments for painful periods
If you’re struggling with difficult menstrual cramps, there are both medication and lifestyle approaches that can help provide relief:
Medications
- NSAIDs – Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen sodium work by blocking prostaglandin production. They are very effective at easing period cramps.
- Birth control pills – Birth control regulates progesterone and estrogen levels which helps reduce cramps. The pill also lightens periods overall.
- Prescription NSAIDs – For severe pain not relieved by OTC NSAIDs, your doctor may prescribe a stronger NSAID.
Lifestyle remedies
- Heat – Applying a heating pad or hot water bottle to your lower abdomen can relax cramping muscles.
- Massage – Massaging your lower abdomen can reduce tension in the muscles causing cramping.
- Exercise – Light exercise like yoga helps increase blood flow and releases endorphins to ease pain.
- Stay hydrated – Drinking plenty of water prevents cramps worsened by dehydration.
For temporary pain relief, take an OTC painkiller as soon as cramps begin. This helps stop prostaglandin production and relaxes the uterus muscles to curb contractions.
When to see your doctor about period pain
You should make an appointment with your doctor if:
- OTC medications don’t provide relief for your cramps
- Your periods are so heavy and painful that you regularly miss work or school
- Period pain has become progressively worse over the last few cycles
- You suffer pain throughout your cycle, not just during your period
- You have symptoms like fainting, fever, or vomiting with your period
- You’re over 25 and have never given birth but suffer severe cramps
Your doctor can check for any underlying causes and may prescribe stronger medication if OTC options are ineffective. They may also recommend hormonal birth control to regulate your cycles and lighten your flow.
When to consider seeing a gynecologist
If your regular doctor suspects a gynecological condition may be causing severe dysmenorrhea, they will likely refer you to a gynecologist. A gynecologist specializes in the female reproductive system and can investigate potential causes such as:
- Endometriosis
- Uterine fibroids
- Adenomyosis
- Pelvic inflammatory disease
- Cervical stenosis
They may order ultrasound or laparoscopy to check for issues in your reproductive organs. Based on their findings, they can suggest medication, hormonal therapy, or minor surgeries to treat the underlying problem.
Preventing painful periods
While you can’t always prevent period cramps completely, here are some tips that may help reduce your monthly pain:
- Exercise regularly – This improves blood flow and releases endorphins.
- Take OTC painkillers at the first twinge of pain – Don’t wait until cramps become severe.
- Try magnesium and vitamin B supplements – Some studies suggest they may lessen cramps.
- Limit caffeine, alcohol, sugar, and salty foods – These can all make cramps and bloating worse.
- Stay warm – Cramps can worsen when you get cold, so layer up and keep your feet warm.
- Manage stress – Anxiety and tension makes pain worse, so practice relaxation techniques.
- Apply heat – Heating pads and hot water bottles provide fast cramp relief.
While you probably can’t banish period cramps forever, these lifestyle measures can help make your monthly symptoms more tolerable.
When period pain means something more serious
Most of the time, painful periods indicate fairly routine causes like high prostaglandin levels or common conditions like endometriosis. But in rare cases, severe cramping or pelvic pain can signal a serious underlying medical problem requiring prompt treatment, such as:
Miscarriage
Severe pain accompanied by heavy bleeding may indicate you are having a miscarriage, especially if the pain comes outside your usual period. Seek emergency care if you have reason to think you may be pregnant.
Ectopic pregnancy
A developing embryo implanting somewhere outside the uterus (like the fallopian tube) is an ectopic pregnancy. The pain tends to be very severe and one-sided. An ectopic pregnancy is an urgent medical emergency.
Pelvic inflammatory disease
An infection of the female reproductive system, PID causes bleeding between periods along with fever, vomiting, and sharp pelvic pain. It requires prompt antibiotic treatment.
Cysts or tumors
Ovarian cysts can sometimes twist or rupture, causing severe pain. Ovarian or uterine tumors are less common but can also lead to abnormal pelvic pain.
Endometriosis complications
Endometriosis causes tissue normally lining the uterus to grow in other areas. In rare cases, it can spread to other pelvic organs like the bladder or rectum leading to severe pain.
If your cramps seem abnormally severe or you have other troubling symptoms, seek medical advice promptly. Don’t assume painful periods are “normal” or something you just have to put up with.
Conclusion
Period pain is caused by a variety of hormonal, genetic, and lifestyle factors that all ultimately lead to uncomfortable uterine muscle contractions. While painful periods are common, severe dysmenorrhea can signal certain medical conditions that may require treatment.
If you regularly experience disruptive period cramps, see your doctor to discuss potential causes and solutions. With the right medications, lifestyle changes, or gynecological treatments if needed, you can hopefully find some relief and make your periods less painful.