Painful Periods

Benign growths

Abnormal growths within, or on the inner (such as fibroids) or outer surface of, the muscular walls of the uterus may lead to pain. These can even make the normal contracting of the uterus to expel the lining very painful.

• Benign growths: These can occur on the inner, outer, or middle muscle walls of the uterus, again making normal contractions very painful. However, it is also possible to have benign growths that are otherwise painless.
• Overgrown tissue: Discussed prior, the menstrual tissue that normally lines the uterus may grow into the muscle walls of the uterus (called adenomyosis), making the normal contractions very painful.

Rare and unusual causes

It is possible for tumors of the pelvic organs to cause severe menstrual cramping and bleeding. Your doctor can diagnose these and begin a plan of treatment.

We've listed some specific conditions that can cause painful periods, along with how to identify each of them:

This list does not constitute medical advice and may not accurately represent what you have.

Menstrual cramps

Menstrual cramps, also called dysmenorrhea, are actually contractions of the uterus as it expels its lining during a woman's monthly period.

A certain amount of mild cramping is normal, triggered by hormone-like substances called prostaglandins. However, painful cramps may be caused by underlying conditions such as endometriosis, uterine fibroids, high prostaglandin levels, or pelvic inflammatory disease (PID.)

Severe cramping may be present, as well as nausea, headache, and dull pain that radiates to the low back and thighs. It is most common in women under age 30 who smoke, have heavy and irregular periods, and have never given birth.

An obstetrician/gynecologist (women's specialist) can do tests for underlying conditions such as those mentioned above. Women over age 25 who suddenly begin having severe cramps should see a doctor to rule out the sudden onset of a more serious concern.

Treatment of mild cramping can be done with heating pads to the abdomen and with over-the-counter pain relievers such as ibuprofen. Birth control pills, which regulate the menstrual cycle, are often effective in lessening cramps.

Rarity: Common

Top Symptoms: abdominal pain (stomach ache), abdominal cramps (stomach cramps), painful periods, lower back pain, abdominal pain that shoots to the back

Symptoms that always occur with menstrual cramps: abdominal pain (stomach ache)

Symptoms that never occur with menstrual cramps: being severely ill, disapearance of periods for over a year

Urgency: Self-treatment

Uterine fibroids

Uterine fibroids are benign growths in the wall of the uterus and most often appear during childbearing years. Fibroids are almost never associated with cancer.

Those at higher risk include black women and women who started their periods at a young age. Other risk factors are vitamin D deficiency, poor diet, obesity, drinking alcohol, and family history of fibroids.

Fibroids can cause pelvic pressure and pain, severe menstrual cramping, and heavy menstrual bleeding that leads to anemia. Quality of life is diminished due to the chronic pain and discomfort. Though fibroids don't always make it impossible to become pregnant, infertility and pregnancy loss may occur as well as pre-term delivery.

Fibroids can be diagnosed through a routine pelvic exam or ultrasound in a doctor's office.

A gynecologist can prescribe various medications to ease the symptoms and regulate the menstrual cycle. There are also a number of surgical techniques, some minimally invasive, to shrink or remove the fibroids while leaving the uterus in place. Hysterectomy, or removal of the uterus, is an option in some cases.

Rarity: Common

Top Symptoms: vaginal bleeding, pelvis pain, abdominal cramps (stomach cramps), painful periods, irregular period

Urgency: Primary care doctor

Premenstrual syndrome

Premenstrual syndrome, or PMS, refers to a set of symptoms experienced by some women just before the start of a menstrual period.

The exact cause of PMS is uncertain, but changing hormone levels are always involved. Ongoing depression will make the symptoms worse and may be connected to low levels of the brain chemical serotonin, which influences mood, food cravings, and sleep patterns.

Symptoms include irritability, mood swings, insomnia, difficulty concentrating, weight gain, fluid retention, bloating, abdominal discomfort, food cravings, and breast tenderness.

PMS normally fades within a day or two of start of the menstrual period. If the symptoms are interfering with activities of daily living, a medical provider may be able to help. Some symptoms can be treated for improved quality of life.

Diagnosis is made through patient history.

Treatment primarily involves making lifestyle improvements in diet, exercise, and stress management. Nonsteroidal anti-inflammatory drugs can address the physical discomfort, and diuretics will help with fluid retention. Hormone-based contraceptives can regulate the cycle and ease symptoms. In some cases, antidepressants are helpful.

Normal variation of constipation

Constipation means bowel movements which have become infrequent and/or hardened and difficult to pass.

There is wide variation in what is thought "normal" when it comes to frequency of bowel movements. Anywhere from three times a day to three times a week is considered normal.

As long as stools are easy to pass, laxatives should not be used in an effort to force the body to a more frequent schedule.

Constipation is usually caused by lack of fiber in the diet; not drinking enough water; insufficient exercise; and often suppressing the urge to have a bowel movement.

A number of medications and remedies, especially narcotic pain relievers, can cause constipation.

Women are often affected, due to pregnancy and other hormonal changes. Young children who demand low-fiber or "junk food" diets are also susceptible.

Constipation is a condition, not a disease, and most of the time is easily corrected. If simple adjustments in diet, exercise, and bowel habits don't help, a doctor can be consulted to rule out a more serious cause.

Mature cystic teratoma of the ovary

The ovary is an important part of the female reproductive system. An ovarian cyst is a fluid-filled sac in the ovarian tissue. It is not a cancerous growth but because it is in such a small organ it can cause pressure and pain.

You should schedule an appointment with your doctor, who may recommend a minimally invasive procedure to remove the cyst.

Rarity: Ultra rare

Top Symptoms: abdominal pain (stomach ache), pelvis pain, painful periods, painful sex, spontaneous back pain

Urgency: Primary care doctor

Endometriosis

Endometriosis is a condition where the tissue that normally forms the lining of the uterus – the endometrium – also begins growing on the outside of the ovaries and fallopian tubes. This out-of-place endometrium still thickens and bleeds each month, causing pain, scar tissue, and adhesions.

Risk factors include short menstrual cycles that begin at a young age, with menopause at an older age; never giving birth; uterine abnormalities; family history; and alcohol use.

Symptoms include severe pelvic pain, cramping, and excessive bleeding during menstruation. There may be pain during sexual intercourse and sometimes during bowel movements and urination. Diarrhea, constipation, nausea, and bloating are also common, as is difficulty becoming pregnant.

Endometriosis can be confused with other conditions, such as pelvic inflammatory disease or irritable bowel syndrome. Permanent infertility can occur with untreated endometriosis.

Diagnosis is made by pelvic examination, ultrasound, and sometimes laparoscopy.

Treatment involves over-the-counter pain relievers and hormone therapy, including contraceptives. Surgery may be done to remove endometriosis tissue. As a last resort, removal of the ovaries and the uterus may be recommended.

Rarity: Uncommon

Top Symptoms: vaginal discharge, abdominal pain (stomach ache), vaginal bleeding, pelvis pain, painful periods

Urgency: Primary care doctor

Dyspepsia or gastritis

Indigestion, also called upset stomach, dyspepsia, or functional dyspepsia, is not a disease but a collection of very common symptoms. Note: Heartburn is a separate condition.

Common causes are eating too much or too rapidly; greasy or spicy foods; overdoing caffeine, alcohol, or carbonated beverages; smoking; and anxiety. Some antibiotics, pain relievers, and vitamin/mineral supplements can cause indigestion.

The most common symptoms are pain, discomfort, and bloating in the upper abdomen soon after eating.

Indigestion that lasts longer than two weeks, and does not respond to simple treatment, may indicate a more serious condition. Upper abdominal pain that radiates to the jaw, neck, or arm is a medical emergency.

Diagnosis is made through patient history and physical examination. If the symptoms began suddenly, laboratory tests on blood, breath, and stool may be ordered. Upper endoscopy or abdominal x-ray may be done.

For functional dyspepsia – "ordinary" indigestion – treatment and prevention are the same. Eating five or six smaller meals per day with lighter, simpler food; managing stress; and finding alternatives for some medications will provide relief.

Do birth control pills help menstrual cramps?

Yes, unless there is also some other disorder of the reproductive tract such as fibroids or any sort of tumor. Birth control pills prevent ovulation and therefore lower the production of prostaglandins. It is the prostaglandins, created in the built-up lining of the uterus, which cause the cramping each month.

Are severe menstrual cramps a sign of cancer?

Only in very rare cases. Severe menstrual cramps are not uncommon and have many other possible causes. If there is also abnormal bleeding, there may be more cause for concern. A gynecologist can perform tests and get a definitive answer one way or the other.

Is abnormal vaginal discharge part of having menstrual cramps?

No. If the discharge becomes irritating and/or foul-smelling, that is a symptom of some other condition such as a yeast infection or a sexually transmitted disease. This kind of discharge should always be investigated by a gynecologist, who can order tests to determine the cause and then begin the appropriate treatment.

Do severe menstrual cramps cause pain in the digestive tract?

Some women report mild nausea with severe cramps, but otherwise, menstrual cramps do not affect the stomach, intestines, or rectum. If there is pain, cramping, or an abnormal discharge that seems to involve any of these parts of the body, it should be investigated separately by a physician who can arrange for the proper tests and treatment.

Does fibromyalgia make menstrual cramps worse?

In many cases, yes. Some women report that their menstrual pain is worse with fibromyalgia, and their fibromyalgia is worse during their menstrual periods. Fibromyalgia is believed to be an autoimmune disease that causes increased sensitivity of the nerves. When both fibromyalgia and menstrual pain are present, both a fibromyalgia specialist and a gynecologist should be seen.

Questions your doctor may ask about painful periods

• Are you sexually active?
• Have you given birth to any children?
• Do your symptoms occur or worsen before or during your period?
• Have you ever had any surgeries?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.