There is a reason many women dread getting their period or give it disparaging nicknames like "the curse". If your periods are painful (i.e. you get menstrual or period cramps), it’s natural to want to be tucked up in bed with a hot water bottle for a day or two. If this sounds like you, read on to learn more about what period cramps are, why they happen and some tips to help you manage period cramps when they strike.
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What are period cramps and what do they feel like?
Period cramps go by several names, including period cramps or menstrual cramps, and are referred to as dysmenorrhea by medical professionals.
Period cramps typically strike just before and during your period, and you may feel most of the pain in your abdominal area. However, you may also experience lower back pain or even discomfort radiating down to the thighs.
Period cramps can present as either a dull and continuous ache, or as cramping, intense pain.
Before talking about the causes of period cramps, it’s important to go into a bit more detail about the different types of dysmenorrhea:
- Primary dysmenorrhea. This is essentially a medical name for the typical period cramps that occur just before or during your period and which are unrelated to any other health issues. Primary dysmenorrhea is more likely to affect younger girls (those who are just starting their periods), and for many, it gets less painful as they get older. Some women also notice they suffer less with period cramps after giving birth.
- Secondary dysmenorrhea. This is when period cramps are caused by a disorder in the reproductive organs (for example, a condition like endometriosis, where tissues from the womb lining grow outside the womb). Secondary dysmenorrhea is usually much worse than typical period cramps, and often lasts longer. It may even begin a few days before your period starts, with the pain getting worse over the course of the period. In some cases, it may not go away even after the period ends. Menstrual pain linked to an underlying condition tends to affect women aged 30 to 45.
What causes period cramps?
Primary and secondary period cramps have different causes, so we’ll cover them separately here:
Causes of primary dysmenorrhea (typical period cramps)
This type of period cramps occurs when the muscular wall of the womb tightens during menstruation. Although contractions of the womb happen all the time, they’re usually so mild that you don’t feel them.
However, during your period, the womb contracts more intensely to help the womb lining shed. You may think it’s this contraction that causes the pain, but it’s a little more complex than that.
When your womb contracts, the blood vessels in the womb lining get compressed. This causes the blood supply to get temporarily cut off, which also cuts off the oxygen supply to the tissues of the womb. This lack of oxygen is what causes these tissues to release pain- triggering chemicals called prostaglandins.
Prostaglandins cause the muscles and blood vessels of the womb to contract even more, with prostaglandin levels often at their highest on the first day of your period. As the uterus lining sheds, the level of prostaglandins decreases and the pain eases.
It’s unclear why some women experience more pain than others. One possible reason is that some women experience unbearable period cramps due to a greater build-up of prostaglandins, which cause more intense pain.
Causes of secondary dysmenorrhea
This type of period cramps is due to an underlying medical condition, such as:
- Endometriosis. When the cells or tissue that you’d normally find in the lining of the womb grows elsewhere, such as in the fallopian tubes or ovaries. When these cells shed, it can lead to intense and even unbearable period cramps.
- Fibroids. These are non-cancerous tumors that can grow in or around the womb, making periods heavier and more painful.
- Pelvic inflammatory disease. This is a condition caused by a bacterial infection in the womb, fallopian tubes and ovaries, causing severe inflammation.
- Adenomyosis. This condition is similar to endometriosis except, with adenomyosis, the tissue grows within the muscular wall of the womb, making periods particularly painful.
The above does not constitute medical advice; check with your doctor if you believe you may suffer from any of the above.
How do you know if you have severe period cramps?
Everyone’s perception of pain is different, and what you consider severe period cramps may differ from someone else’s perception of pain. Any period cramps you consider severe, whether or not you find the pain so debilitating it’s hard to get out of bed, are worth talking to your doctor about. Chances are you won’t need to ask yourself whether or not you are in severe pain, but if you’re struggling with intense pain, you may be wondering if it’s due to your period or if it could be something else.
Period cramps can include symptoms such as:
- Cramping or throbbing, sometimes combined with intense pain in your lower abdomen
- Pain that begins one to three days before your period starts (some women get cramps a week before their period starts), often getting worse one day after your period begins and then going away in about two to three days
- A dull and continuous ache
- Pain that can sometimes radiate into your lower back and thighs
- Feeling of pressure in the abdomen.
You may get some accompanying period symptoms along with the pain, such as:
- loose stools or even diarrhea (as excessive prostaglandins can cause the muscles of your bowels to contract)
How to treat and relieve period cramps
Most of the time, period cramp relief is within easy reach at home. For example, you may find any of the following can help with period cramps:
- Gentle exercise, like swimming, walking or cycling
- Using a heat pad or a hot water bottle wrapped in a tea towel on your tummy
- Taking a warm bath or shower to help relax the muscles
- Trying a relaxation technique, like yoga (there is even yoga for period cramps), to distract you from the feelings of pain
- Gentle massage, like light and circular massage around your lower abdomen
If these techniques don’t help with bad period cramps, and you think you may need medication to help with the pain, seek medical advice from your doctor or pharmacist.
Why you might get period cramps but no period
Sometimes you may get what feels like period cramps but it’s either not the right time for your period, or maybe it is but your period hasn’t actually started. There are a few reasons why you may have period cramps without an actual period, such as:
- Your period is on the way, it just hasn’t started yet. Some women have period cramps several days before their period starts, so the cramping could just be a sign your period is going to start soon.
- Ovulation pain. You might be experiencing something called ovulation pain, a pain in the lower abdomen—often to one side—midway through your cycle that happens when you ovulate. Ovulation pain can feel like a dull cramp, so it’s easy to mistake it for a menstrual cramp.
- Early pregnancy. You may feel abdominal cramping similar to period cramps in early pregnancy, usually caused by your womb expanding, or resulting from the side effects of hormonal changes, such as constipation. If you suspect you may be pregnant, take a pregnancy test. If you have severe pain, see your doctor straight away as it may indicate an ectopic pregnancy.
- Pelvic inflammatory disease. As mentioned above, this condition can make period cramps worse, but it can also cause abdominal cramping or pelvic pain at other times of the month.
- Endometriosis. Although endometriosis can make your period cramps worse, it can also cause cramping at other times of your cycle.
- Fibroids. These non-cancerous tumors in or around the womb can cause cramping or pain even when you don’t have your period.
- Irritable bowel syndrome (IBS). This is a condition that affects the digestive system and can cause cramps in the stomach or bowels, which may feel similar to period cramps.
There is also the rare chance that cramps that aren’t associated with your period could point to a more serious health condition, such as cancer, so if the pain persists, talk to your doctor. Even if you suspect the underlying cause is pregnancy or conditions like PID, endometriosis or fibroids, it’s always safest to get medical attention so that you can get the care or treatment you need.
Period cramps vs. early pregnancy cramps
You may feel some cramping during early pregnancy that feels similar to period cramps, but there is a subtle difference in the feeling. Early pregnancy cramps may be associated with:
- Implantation bleeding. This is when the fertilized egg implants in the lining of the uterus. It’s often described as feeling like a pricking, pulling or tingling sensation, and typically won’t be as strong as the cramps you may feel during your period.
- Ligament pain. As the ligaments stretch to accommodate your growing bump, you may feel a sharp cramp on one side of your lower tummy.
- Constipation. This is a common early pregnancy symptom, and it may lead you to feel pain in the stomach or bowel area.
- Trapped gas. You are more likely to feel this around the stomach, and it’s often accompanied by bloating.
- Ectopic pregnancy. An ectopic pregnancy is where a fertilized egg implants somewhere outside of the womb. This is a serious condition, which can cause intense pain/cramping and you should speak to your doctor immediately.
FAQs about period cramps
Can period cramps affect fertility?
Most of the time, period cramps are a normal part of the menstrual cycle and won’t affect your fertility. However, if your pain is caused by an underlying condition such as endometriosis or pelvic inflammatory disease, the associated scar tissue can make it harder for the sperm to reach the egg in the fallopian tube. This can have an effect on your fertility. See your doctor if you are concerned.
Why do I have cramps but no period?
It’s not uncommon to get cramps in the days leading up to your period, so it’s possible your period just hasn’t come yet. Or you may be pregnant, so take a pregnancy test, or see a doctor, if you think this could be possible. If you feel some cramping in the middle of your cycle, it could be ovulation pain—also known as mittelschmerz.
Do period cramps improve with age?
Yes, primary dysmenorrhea (period cramps that have no underlying medical cause) often improves as you get older.
Does having children reduce period cramps?
Some women report their period cramps lessen after having children.
How painful are period cramps?
Period cramps vary from woman to woman (and perhaps even from cycle to cycle). Some women have more intense pain than others, even if the pain doesn’t have an underlying medical cause. It’s possible that women with more intense period cramps have higher prostaglandin levels in their body.
Does chocolate help with period cramps?
There is little scientific evidence that chocolate can help with period cramps. Some women find chocolate acts as a comfort food, so it might help to have a piece of chocolate.
The bottom line
Period cramps can make you dread your period’s arrival but, luckily, when it comes to how to get rid of your period cramps, over-the-counter painkillers and a few healthy lifestyle changes can really help! Plus, it might make it more bearable to know that they will likely go away within a day of two.
If you do find yourself suffering more than you can bear, talk to your doctor. It’s possible unbearable period cramps have an underlying medical cause requiring specific tests and treatment, or that your doctor can prescribe you a stronger painkiller to make your life easier at this time of the month.
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