Painful periods (dysmenorrhea) can be very disruptive to a person’s physical and emotional wellbeing. Those who suffer from painful periods may miss work, school and family activities and also can feel unsupported during the experience.

Painful periods can begin with the onset of the menstrual cycles in puberty but may arise at any time during a person’s reproductive life. Either way, spending a week out of each month in great pain is not tolerable.

While abnormal menstrual bleeding and menstrual pain are fairly common, about 15% of people experience periods so painful they disrupt normal activities. There are a few treatments available to manage painful periods that you can discuss with your healthcare provider based on your specific causes and symptoms.

What causes painful periods?

You may have heard the terms primary and secondary dysmenorrhea—two types of menstrual pain with the key difference between them being their underlying causes:

Primary Dysmenorrhea is menstrual pain that occurs without any underlying medical condition. It is a normal part of the menstrual cycle and typically begins a day or two before menstruation and continues for 2-3 days into the period.

The pain is usually crampy and located in the lower abdomen. It may be accompanied by other common symptoms like headaches, nausea and fatigue. It often starts shortly after menarche (the first menstrual period) and may improve with age or after childbirth.

Secondary Dysmenorrhea is menstrual pain that is caused by an underlying medical condition or reproductive issue, such as uterine fibroids, infections, endometriosis, adenomyosis (a form of endometriosis of the uterus), ovarian cysts and other pelvic or lower abdominal conditions. The pain is often more severe and persistent than primary dysmenorrhea and is associated with the underlying condition. It may be accompanied by other symptoms related to the specific cause.

Secondary dysmenorrhea can start at any time during the reproductive years and may worsen over time. It typically develops later in life and may not improve with age or after childbirth.

When determining a treatment plan, your provider will ask about your history and may perform a physical exam or order a pelvic ultrasound to evaluate possible underlying conditions.

Treatments for painful periods

Over-the-counter pain relievers

The most common treatment option is the use of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, acetaminophen or naproxen.

These are usually taken as soon as your period starts and can greatly reduce the pain (like cramps) associated with menses. These are typically taken with food and for a limited time during the menstrual cycle, and they can be quite effective for the level of pain many people feel.

You may pair these with some home remedies like applying a heating pad to your lower abdomen, staying well-hydrated, engaging in physical activity or practicing relaxation methods.

Hormonal contraception for painful periods

Hormonal birth control can be used to help with painful periods or offer pain reduction as a secondary benefit. Most frequently, this means a birth control pill that contains both estrogen and progestin–but can also include the birth control patch or vaginal ring.

There are many different types of pills available and almost all are low-dose pills that contain both estrogen and progestin. The pill will typically decrease the amount of bleeding you encounter each month, too, which in turn decreases cramping and pain. It is important to remember that there are many OCPs available, so if you have a side effect with one, ask your provider to prescribe another.

For some, using the pill in a continuous fashion will be more effective. This is when the placebo pills in the pill pack (sugar pills that are a different color at the end of the pack) are omitted, under the direction of your healthcare provider, and you start a new package right away. This will typically result in the absence of periods.

Progestin-only treatments for painful periods

Hormonal IUDs, like Mirena, Kyleena, Liletta and Skyla; the hormonal implant Nexplanon; progestin-only pills; and Depo-Provera (injection) are other ways to treat painful periods, depending on your medical history and personal preference.

How these each work varies, but all decrease the amount of bleeding you have during your menstrual cycle which can affect pain levels.

Surgical methods for alleviating painful periods

Typically, most patients will respond to some form of medical management before the need to discuss surgical alternatives. These options can include endometrial ablation, surgery to remove fibroids or endometriosis tissue, or, as a last resort, hysterectomy.

If you have painful periods or other issues around menstruation, contact Women’s Healthcare Associates to make an appointment with a physician, nurse midwife or nurse practitioner.