Dysmenorrhea

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Dysmenorrhea (painful period cramps) is the most common symptom reported by teens during their periods. Learn about the types of dysmenorrhea, symptoms and how it can be treated.

Key points

  • Dysmenorrhea is painful menstrual cramps that aren’t controlled by over-the-counter pain medication and impact daily activities.
  • There are two types of dysmenorrhea: primary and secondary.
  • The main symptoms of dysmenorrhea are cramping and pain in the lower abdomen, pain in the low back and pain that spreads down the legs.
  • Treatment for dysmenorrhea depends on the cause of the pain.

What is dysmenorrhea?

Dysmenorrhea, or painful menstrual (period) cramps, is the most common symptom reported by adolescents during their periods. Having cramps and experiencing some pain during your period is normal. Dysmenorrhea is when the pain is not controlled by over-the-counter pain medication or it impacts your daily activities (e.g., you miss school, don’t see your friends).

There are two types of dysmenorrhea.

  • Primary dysmenorrhea is the most common type and usually begins within one year of starting your period. Cramping pain in the lower abdomen typically begins 1-2 days before a period starts and lasts for a total of 2-4 days.
  • Secondary dysmenorrhea is caused by a medical condition. Endometriosis is the most common cause of secondary dysmenorrhea. Other causes include infections, fibroids or growths.

What are menstrual cramps?

Menstrual cramps are caused by contractions (tightening and relaxing) of the muscles of the uterus, which allows blood to leave the uterus. Contractions are controlled by the hormone prostaglandin, released from the lining of the uterus. Prostaglandin levels are higher during the first few days of the menstrual cycle, so cramps are more painful during this time.

What are the symptoms of dysmenorrhea?

The main symptoms of dysmenorrhea are:

  • cramping and pain in the lower abdomen
  • pain in the lower back
  • pain that spreads down the legs

Other symptoms of dysmenorrhea can include:

  • nausea
  • vomiting
  • diarrhea
  • headaches
  • muscle cramps
  • trouble sleeping

If you have menstrual cramps that cannot be controlled by over-the-counter pain medication, pain that interferes with your daily activities or any of the above symptoms, make an appointment to speak with your health-care provider.

How is dysmenorrhea diagnosed?

Your health-care provider will ask you about your symptoms, your medical history and possibly your family medical history. You will also have a physical exam, which may include a pelvic exam.

Your health-care provider may also recommend an ultrasound to check on the uterus and other internal reproductive organs if they suspect you have secondary dysmenorrhea.

If relevant, some people may be tested for sexually transmitted infections (STIs).

How is dysmenorrhea treated?

Treatment will depend on your symptoms, age and how severe your pain is. Your health-care provider may recommend taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, starting 1-2 days before your period begins and continuing for the first few days of bleeding.

In some cases, your health-care provider may recommend hormonal birth control, such as combined oral contraceptive pills, intrauterine contraception, vaginal ring, contraceptive patch, contraceptive implant, or injectable contraception. Medications used for birth control are often used to treat dysmenorrhea even in people who are not having sex and don’t need contraception.

Using a heating pad or hot water bottle can also help to improve blood flow and relieve pain. Exercise can help to reduce cramps.

For secondary dysmenorrhea, you may be referred to a gynaecologist, a doctor who specializes in female reproductive health.

Last updated: January 26th 2023