Dysmenorrhea, also known as dysmenorrhoea, painful periods, or menstrual cramps, is pain during menstruation. It usually begins around the time that menstruation begins. Symptoms typically last less than three days. The pain is usually in the pelvis or lower abdomen. Other symptoms may include back pain, diarrhea, or nausea.
In young women painful periods often occur without an underlying problem. In older women it is more often due to an underlying issues such as uterine fibroids, adenomyosis, or endometriosis. It is more common among those with heavy periods, irregular periods, whose periods started before twelve years of age, or who have a low body weight. A pelvic exam in those who are sexually active and ultrasound may be useful to help in diagnosis. Conditions that should be ruled out include ectopic pregnancy, pelvic inflammatory disease, interstitial cystitis, and chronic pelvic pain.
Dysmenorrhea occurs less often in those who exercise regularly and those who have children early in life. Treatment may include the use of a heating pad. Medications that may help include NSAIDs such as ibuprofen, hormonal birth control, and the IUD with progestogen. Taking vitamin B or magnesium may help. Evidence for yoga, acupuncture, and massage is insufficient. Surgery may be useful if certain underlying problems are present.
Dysmenorrhea is estimated to occur in 20% to 90% of women of reproductive age. It is the most common menstrual disorder. Typically it starts within a year of the first menstrual period. When there is no underlying cause often the pain improves with age or following having a child.
Dysmenorrhea can be classified as either primary or secondary based on the absence or presence of an underlying cause. Secondary dysmenorrhea is dysmenorrhea which is associated with an existing condition.
The most common cause of secondary dysmenorrhea is endometriosis, which can be visually confirmed by laparoscopy in approximately 70% of adolescents with dysmenorrhea.
Other causes of secondary dysmenorrhea include leiomyoma, adenomyosis, ovarian cysts, and pelvic congestion.
Unequal leg length might hypothetically be one of the contributors, as it may contribute to a tilted pelvis, which may cause lower back pain, which in turn may be mistaken for menstrual pain, as women with lower back pain experience increased pain during their periods.
Other skeletal abnormalities, such as scoliosis (sometimes caused by spina bifida) might be possible contributors as well.
You may be at greater risk of menstrual cramps if:
- You’re younger than age 30
- You started puberty early, at age 11 or younger
- You have heavy bleeding during periods (menorrhagia)
- You have irregular menstrual bleeding (metrorrhagia)
- You’ve never given birth
- You have a family history of dysmenorrhea
- You’re a smoker
Symptoms of menstrual cramps include:
- Throbbing or cramping pain in your lower abdomen that may be intense
- Dull, constant ache
- Pain that radiates to your lower back and thighs
Some women also experience:
- Loose stools
When to see a doctor
If you’ve started menstruating within the past few years and have menstrual cramps, chances are your menstrual pain isn’t a cause for concern. However, if menstrual cramps disrupt your life every month, if your symptoms progressively worsen, or if you’re older than 25 and just started having severe menstrual cramps, see your doctor
Your doctor will review your medical history and perform a physical exam, including a pelvic exam. During the pelvic exam, your doctor will check for any abnormalities in your reproductive organs and look for signs of infection.
If your doctor suspects that your menstrual cramps are being caused by an underlying disorder, he or she may recommend other tests, such as:
- Ultrasound. This test uses sound waves to create an image of your uterus, cervix, fallopian tubes and ovaries.
- Other imaging tests. A CT scan or magnetic resonance imaging (MRI) provides more detail than an ultrasound and can help your doctor diagnose underlying conditions. A CT scan combines X-ray images taken from many angles to produce cross-sectional images of bones, organs and other soft tissues inside your body.
MRI uses radio waves and a powerful magnetic field to produce detailed images of internal structures. Both tests are noninvasive and painless.
- Laparoscopy. Laparoscopy usually isn’t necessary for the diagnosis of menstrual cramps, but it can help detect an underlying condition, such as endometriosis, adhesions, fibroids, ovarian cysts and ectopic pregnancy. During this outpatient surgery, your doctor views your abdominal cavity and reproductive organs by making tiny incisions in your abdomen and inserting a fiber-optic tube with a small camera lens.
Menstrual cramps are treatable. Your doctor may recommend:
- Pain relievers. Your doctor may suggest taking over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), at regular doses starting the day before you expect your period to begin. Prescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as mefenamic acid (Ponstel), also are available. If you can’t take NSAIDs, acetaminophen (Tylenol, others) may lessen your pain.
Start taking the pain reliever at the beginning of your period, or as soon as you feel symptoms, and continue taking the medicine as directed for two to three days, or until your symptoms have gone away.
- Hormonal birth control. Oral birth control pills contain hormones that prevent ovulation and reduce the severity of menstrual cramps. These hormones can also be delivered in several other forms: an injection, a patch you wear on your skin, 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 menstrual cramps are caused by an underlying disorder, such as endometriosis or fibroids, surgery to correct the problem may help reduce your symptoms. Surgical removal of the uterus also may be an option if you’re not planning to have children.
The key to preventing dysmenorrhea is adapting a healthy lifestyle. This entails a proper diet consisting of food rich in fiber, nutrients, essential fatty acids, and low-fat protein, as well as avoiding fatty and sugary food and caffeine. Limiting—better yet, avoiding activities such as smoking and drinking alcoholic beverages will also prevent menstrual pain. Overweight women are more likely to suffer from dysmenorrhea, so regular exercise, at least three or four times a week, and stress-relieving activities are also encouraged to reduce tension and relax the body.
Doctors advise women to have regular checkups in order for them to properly assess the specific needs of women based on the patient’s menstrual cycle and individual response to various treatments.
Things you may want to try at home include:
- Exercise. Studies have found that physical activity may ease the pain of menstrual cramps.
- Heat. Soaking in a hot bath or using a heating pad, hot water bottle or heat patch on your lower abdomen may ease menstrual cramps. Applying heat may be just as effective as over-the-counter pain medication for relieving menstrual cramps.
- Dietary supplements. A number of studies have indicated that vitamin E, omega-3 fatty acids, vitamin B-1 (thiamine), vitamin B-6 and magnesium supplements may effectively reduce menstrual cramps.
- Avoiding alcohol and tobacco. These substances can make menstrual cramps worse.
- Reducing stress. Psychological stress may increase your risk of menstrual cramps and their severity.
With the use of NSAIDs, the prognosis for primary dysmenorrhea is excellent. The prognosis for secondary dysmenorrhea varies, depending on the underlying disease process. If a diagnosis of secondary dysmenorrhea is missed, the underlying pathology may lead to increased morbidity, including difficulty conceiving. 
Although dysmenorrhea itself is not life-threatening, it can have a profound negative impact on a woman’s day-to-day life. Besides missing work or school, she may be unable to participate in sports or other activities and thus experience additional emotional distress. Some 10% of dysmenorrheal women have severe pain that can be incapacitating. Dysmenorrhea is a public health problem associated with substantial economic loss related to work absences (an estimated 600 million work hours and 2 billion dollars in the United States).
Menstrual cramps don’t cause any other medical complications, but they can interfere with school, work and social activities.
Certain conditions associated with menstrual cramps may have complications, though. For example, endometriosis can cause fertility problems. Pelvic inflammatory disease can scar your fallopian tubes, increasing the risk of a fertilized egg implanting outside of your uterus (ectopic pregnancy).