7 Reasons Your Period Cramps are Truly Terrible

Feel like your uterus is mad at you every month? You're not alone. Severe period cramps, also known as dysmenorrhea, affect millions of women worldwide. While some discomfort during menstruation is normal, intense pain that disrupts your daily life isn't something you should just grin and bear. Kristen Larter, ARNP, WHNP, UnityPoint Health, dives into what causes these next-level cramps and ways to find relief.

What Causes Severe Period Cramps?

Period cramps happen when the uterus, and blood vessels inside the uterus, contract to shed the uterine lining. These contractions can be painful and create pressure in the lower abdomen and pelvic area. When period cramps are particularly intense, there are several potential reasons:

• Adenomyosis is when the uterine lining grows into the uterine muscle and causes intense cramps.
• Cervical stenosis happens when the cervix is narrowed and obstructs period flow, causing pressure and pain.
• Endometriosis happens when endometrial tissue grows outside the uterus and causes painful cramps during menstruation.
• Fibroids are common, non-cancerous growths in the uterus that make cramps feel worse.
• High levels of prostaglandins cause inflammation and lead to more intense, painful cramps.
• Pelvic Inflammatory Disease (PID) is a painful infection in the uterus, fallopian tubes or ovaries.
• A weak uterine muscle may result in stronger contractions to shed the lining and cause cramping.

Many of these underlying conditions can also cause irregular periods or abnormal bleeding. If your notice a change in the severity of your period cramps, with or without irregular bleeding, it's always a good idea to talk to your doctor. 

What Should Normal Period Cramps Feel Like?

Period cramps occur in the pelvis. For some, pain is felt in the lower back and radiates to the upper thighs or abdomen. Period cramps feel like:

• Tightening of the pelvic muscles
• Bloating
• Aching
• Nausea
• Sharp, dull or intermittent

Period cramps can last for several days, starting before your period arrives and 1-3 days into menstruation. Many times, the cramps ease up toward the end of your period. However, severe cramps may last your entire menstrual cycle.

Why Are Some Period Cramps So Bad?

Menstrual cramps that are severe are caused by high levels of prostaglandins, which trigger uterine contractions and create inflammation that leads to really bad period cramps.

“If you’re having horrible period cramps, so bad you can’t move, see a provider,” Larter says. “You could have an underlying condition that causes severe period cramps. These can include, but aren’t limited to, endometriosis, fibroids, polyps, infections, pelvic inflammatory disease or ovarian cysts.”

Why Am I Having Cramps but No Period?

If you have period cramps but no period, it’s possible your period is coming but just running late. If you have pelvic cramping without a period, it could be caused by another condition such as a pelvic infection, cysts, constipation or pregnancy.

“It’s hard to tell the difference between period and pregnancy cramps,” Larter says. “Period cramps typically feel stronger than pregnancy cramps. If you think you’re pregnant or missed your period, it’s a good idea to take a pregnancy test to confirm.”

How to Relieve Severe Period Cramps at Home

What helps with period cramps typically depends on the person, but Larter says there are some remedies and lifestyle choices known to provide consistent period cramp relief.

• Ibuprofen, naproxen and Midol are over-the-counter medicines that work well for easing period cramps. For severe period cramps, take up to 800 mg of ibuprofen every 8 hours with food. This dose is higher than what’s recommended on the bottle. It’s OK to take an 800 mg dose for up to five days. Don’t take ibuprofen if you have stomach or digestive problems. For naproxen, take one or two tabs every 12 hours.
• A heating pad for period cramps can be applied to the lower abdomen or back.
• Warm baths
• Exercise
• Good teas for period cramps include ginger, chamomile or peppermint.
• Dark chocolate to relieve period cramps is supported in a few small studies. It contains a higher level of magnesium than milk chocolate. Magnesium relaxes muscles, which can help with period cramps.
• Foods with anti-inflammatory properties may help with period cramps. These include fruits and vegetables such as bananas, lemons, oranges, watermelon, berries, broccoli and kale. Whole grains, seeds and nuts can help, too.

When to See a Doctor for Period Cramps

If your period cramps are severe, talk to your provider to discuss options, like starting a birth control method to help with your cramps and assessing for any underlying conditions. Additionally, let your doctor know if you experience any of the following:

• Severe cramps with every period
• Pain between periods
• Heavy periods with bad cramps
• Cramps that cause nausea or other symptoms
• Missing work or school due to period cramps