Period Pain: Why It Happens and How To Manage It, According to OB-GYNs

Most menstruating people experience some level of pain during that time of the month. Normally, you can blame that discomfort on what's going on with your uterus.

"[The uterus is] basically one big muscle, shaped like a pear, which contracts and sheds its lining once a month," Sherry Ross, MD, OB-GYN and women's health expert at Providence Saint John's Health Center in Santa Monica, California, told Health. "This shedding results in four to six days of uterine bleeding and is fondly known as your period."

More than half of people who menstruate experience one or two days of some period pain each month. Typically, that pain is manageable. But in some people, the discomfort can be so bad that it causes them to miss school or work. 

So, we reluctantly accept that we might experience the pain, but why does it happen? Here's how experts explained period pain and what you can do to manage it.

Why Do People Get Period Pain?

The clinical term for period pain is dysmenorrhea. Dysmenorrhea comes in two types: Primary and secondary.

Primary dysmenorrhea, the cramping pain that comes before and during a period, is caused by changes in your body's natural chemicals. Those chemicals, called prostaglandins, are made in the uterus lining. Prostaglandins cause the uterine muscles to contract, which helps the uterine lining shed through the vagina during menstrual bleeding.

On the first day of your period, prostaglandins are in large supply. But as the uterine lining sheds and bleeding continues, prostaglandin levels drop. So, pain tends to become less intense after the first few days after your period starts.

But in cases of primary dysmenorrhea, the body may produce more prostaglandins than normal. More prostaglandins cause more contractions and painful cramps.

Secondary dysmenorrhea is period pain caused by an underlying health condition, such as:

• Uterine fibroids
• Tumors
• Endometriosis
• Pelvic inflammatory disease
• Adenomyosis, which causes the tissue that normally lines the inside of the uterus to grow into the uterine muscles
• Uterine polyps

Scarring from previous surgeries or an intrauterine device (IUD), a type of birth control, may also cause secondary dysmenorrhea, Yen Hope Tran, DO, an OB-GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, Calif., told Health.

In the case of secondary dysmenorrhea, the pain typically gets worse over time. Additionally, the pain may last longer than regular period cramps.

What Does Period Pain Feel Like?

Everybody experiences period pain differently. Where your pain falls on the scale is a personal call, as we all react to and tolerate pain differently.

But usually, cramps are felt in the lower back or belly. Some people might also feel cramps in other areas, like their bowels and rectum. According to Dr. Ross, cramps also tend to be more intense during the first day or two of a period. 

If you have heavy periods with large blood clots, you might experience more intense cramping than normal. But even if you only bleed lightly, you may still have severe cramps. 

"Blood flow and volume don't always determine how significant the cramping will be," noted Dr. Ross.

Mild to moderate period pain sometimes accompanies other symptoms of menstrual bleeding, like:

• Irritability
• Bloating
• Headache
• Fatigue
• Nausea and vomiting
• Diarrhea
• Constipation
• Indigestion
• Lower back pain
• Butt cramps

When pain becomes severe and affects your quality of life, it's a different story altogether. Up to 20% of women suffer from cramps severe enough to interfere with daily activities.

And that pain is often something that people experience in silence. In 2017, an online survey of nearly 43,000 girls and women found that more than one-third of respondents experienced symptoms, like painful cramping, that stopped them from doing normal daily activities. 

However, less than half of the respondents reported telling their family members that the side effects of their periods were the reason they had to cut back on daily tasks. And Dr. Ross agreed that persistent period pain just isn't talked about enough.

How Can You Manage Period Pain?

If you experience secondary dysmenorrhea, consulting a healthcare provider about treating the underlying condition is essential. For example, surgery may be the best route to addressing painful symptoms in cases of endometriosis. With endometriosis, the tissue that normally lines the inside of the uterus grows outside the uterus.

But if you have primary dysmenorrhea, there are many methods that you can try for managing period pain.

Home Remedies

For some people, home remedies are enough to manage period pain.

Dr. Ross suggested soaking in a warm bath or applying a hot towel, hot water bottle, or an electric heating pad to the area where you feel pain. 

"These all help to relieve cramps by increasing blood flow and relaxing the muscles," explained Dr. Ross. "Heat also has an analgesic [feel-good] effect."

In addition to applying heat, sipping on a warm beverage may also provide some relief.

"Adding ginger to hot water is another useful remedy," added Dr. Ross.

Relaxation

Massage, rest, and relaxation techniques are other things that may help ease period pain. Relaxation techniques include the following:

• Deep breathing
• Meditation
• Yoga 

Or a healthcare provider may suggest acupuncture or a transcutaneous electrical nerve stimulation (TENS) device. A TENS device uses electrical currents to help lessen pain.

Cannabidiol (CBD)

Some people use cannabidiol, also known as CBD, to help relieve period pain.

"[CBD] is the active ingredient in marijuana that helps make your body feel good, relaxes muscles in the pelvis, and distracts your brain from feeling the pain associated with menstrual cramps," explained Dr. Ross. "There are many ways to use CBD products, including bath salts, tampons, suppositories, infused chocolates, body balms, and tinctures. And they all seem to be effective for mild and moderate cramps."

And don't worry. Those products won't make you high. Tetrahydrocannabinol (THC), another compound found in the hemp plant, is what's known for its psychoactive effects.

Medications

If your period pain keeps you from going to school or work or simply getting out of bed, Dr. Ross recommended over-the-counter (OTC) treatments. Nonsteroidal anti-inflammatory drugs (NSAIDs), like Advil (ibuprofen), or a pain reliever, like Tylenol (acetaminophen), may help reduce cramps.

How Can You Reduce Your Risk of Period Pain?

You can also take some steps to make it less likely that you'll experience that period pain caused by primary dysmenorrhea during your next menstrual cycle.

Diet

Caffeine, alcohol, and foods with a lot of salt can cause dehydration and restrict blood flow, which may worsen cramps. Instead, it may help to increase your intake of foods that have the following nutrients:

• Vitamins E, B1, and B6
• Magnesium
• Zinc
• Omega-3 fatty acids

For example, a plant-based Mediterranean diet incorporates foods high in those nutrients. Additionally, some evidence suggests that eating plenty of fruits, vegetables, fish, and dairy can reduce a person's risk of period pain.

Dr. Ross suggested adding plenty of water-based foods that help with hydration, including fruits (strawberries, blueberries, and watermelon) and vegetables (celery, cucumbers, and lettuce).

Lifestyle

Maintaining a healthy lifestyle can reduce your risk of period pain. 

"In general, try to stay active every day, get eight hours of sleep a night, don't smoke, and take steps to reduce stress in your life," advised Dr. Tran. 

Some people even experience relief from cramps when they exercise during their periods. If you can manage some light exercise during your period, try incorporating walking, swimming, or cycling to help reduce cramps.

Medical Interventions

If your period pain interferes with daily activities or doesn't respond to OTC medications, it may help to consult a healthcare provider. They'll ask about your medical history and might do a pelvic exam or imaging test to determine what's causing the pain. A healthcare provider can also determine what treatment might help relieve your pain.

You should also see a healthcare provider if you notice blood clots larger than the size of a quarter. If nausea or vomiting accompanies your period pain, or the intensity of your cramps worsens with each cycle, don't delay seeking medical attention. 

"This calls for an ultrasound as soon as possible to rule out an enlarged ovarian cyst, fibroids, or endometriosis," said Dr. Tran.

In cases of severe period pain, a healthcare provider might recommend a birth control pill to stop ovulation and decrease the intensity of menstrual cramps. Other methods that can ease period pain include:

• Injections 
• Skin patches
• Implants placed under the skin on your arm
• Vaginal rings
• IUDs 

A Quick Review

If you have periods, then there's a chance that you've also experienced period pain. Fortunately, you can usually manage period pain with home remedies, relaxation, and medication. Sometimes, you can even prevent it with diet and lifestyle changes.

If none of those strategies are effective at managing your period pain, or if your pain interferes with your life or is accompanied by other symptoms, it may help to consult a healthcare provider.