Period Pain: Why It Happens and How to Take Control of It, According to Ob-Gyns
Periods and discomfort pretty much go hand-in-hand. After all, most people who menstruate experience some level of pain during that time of the month. The pain is usually perfectly normal—and you can blame it on what's happening with your uterus.
"It's 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, tells 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, according to the American College of Obstetricians and Gynecologists (ACOG). So we reluctantly accept the fact that we might experience the pain, but why exactly does it happen? Here's how experts explain period pain—and what you can do to manage it.
Why do people get period pain?
Primary dysmenorrhea, the cramping pain that comes before and during a period, is caused by a change in natural chemicals in your body, per ACOG. These chemicals—called prostaglandins—are made in the lining of the uterus and have hormone-like effects, causing the muscles and blood vessels of the uterus to contract. On day one of a period, prostaglandins are in large supply. But as the uterine lining is shed (and bleeding continues), the prostaglandin level drops, which is why pain tends to become less intense after the first few days of menstruation.
Secondary dysmenorrhea is caused by a disorder in the reproductive organs, such as fibroids; tumors; endometriosis, pelvic inflammatory disease; or growths on your uterus, ovaries, or other organs, Yen Hope Tran, DO, ob-gyn at MemorialCare Orange Coast Medical Center in Fountain Valley, California, tells Health. In this case, period pain typically gets worse over the course of your period and often lasts longer into your period than regular menstrual cramps.
What does period pain feel like?
Everybody experiences cramps differently, but they're typically felt in the lower back or belly. Some people might feel cramps in other areas too, like their bowel and rectum. The cramps also tend to be more intense during the first day or two of a period, Dr. Ross says.
If you have heavy periods with large blood clots, you'll probably experience more intense cramping. But even if you only bleed lightly, you may still have severe cramps. "Blood flow and volume doesn't always determine how significant the cramping will be," Dr. Ross says.
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Mild to moderate period pain—and where yours falls on the scale is very much a personal call, as we all react to and tolerate pain differently—is a monthly nuisance that sometimes accompanies other symptoms of menstruation, like irritability, bloating, headache, fatigue, and nausea.
When the pain becomes severe and affects your quality of life, it's a different story altogether. Up to 20% of women suffer from menstrual cramping severe enough to interfere with daily activities, according to the American Academy of Family Physicians.
And that pain is often something that menstruating people suffer with in silence. An online survey of nearly 43,000 Dutch girls and women carried out in 2017 found that more than a third of the respondents experienced menstrual symptoms (including painful cramping) that stopped them from doing their normal daily activities. But less than half of them told their family members that the side effects of their period was the reason they had to cut back on daily tasks.
How can you manage period pain?
Dr. Ross agrees that persistent period pain just isn't talked about enough. If your menstrual cramps keep you from going to school or work, or simply getting out of bed, she recommends trying over-the-counter treatments such as NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen (Advil) or acetaminophen (Tylenol). If your period pain doesn't respond to these treatments, it's time to make an appointment with your health care provider. They'll ask about your medical history and might do a pelvic exam or imaging test to determine what's causing the pain and which treatment might help relieve your pain.
In extreme cases of period pain, your doctor might recommend hormonal birth control pills, which stop ovulation and decrease the severity of menstrual cramps, per the Mayo Clinic. Hormones that can ease period pain can also be given through an injection, skin patch, implant (placed under the skin on your arm), vaginal ring, or IUD.
For some people, home remedies are enough to manage period pain. Dr. Ross suggests trying heat in any form, such as soaking in a warm bath or applying a towel soaked in hot water, a hot water bottle, or an electric heating pad to the area where you feel cramping. "These all help to relieve cramps by increasing blood flow and relaxing the muscles," she explains. "Heat also has an analgesic (feel-good) effect."
Massage, rest, and relaxation techniques such as deep breathing, meditation, and yoga are other things to try to ease period pain, says Dr. Tran. Or your doctor may suggest trying acupuncture or a TENS (transcutaneous electrical nerve stimulation) device, which uses electrical currents to help lessen pain.
Some people use cannabidiol, widely known as CBD, to help relieve period pain. "This 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," Dr. Ross explains. "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." Don't worry, these products won't make you high—it's tetrahydrocannabinol (THC), another compound found in the hemp plant, that's known for its psychoactive effects.
The experts also recommend considering a diet overhaul. If you consume lots of caffeine, alcohol, and foods with high levels of salt, which all can cause dehydration and restrict blood flow, you might want to replace them with foods high in vitamins E, B1, and B6; magnesium; zinc; and omega-3 fatty acids (think along the lines of a plant-based Mediterranean diet, and you won't go far wrong).
Dr. Ross suggests adding plenty water-based foods that help with hydration, including strawberries, blueberries, celery, cucumber, lettuce, and watermelon. "Adding ginger to hot water is another useful remedy," she notes.
If your period pain is accompanied by nausea or vomiting, or the intensity of the pain gets worse with each cycle, don't delay getting medical help. "This calls for an ultrasound as soon as possible to rule out an enlarged ovarian cyst, fibroids, or endometriosis," warns Dr. Tran.