Understanding the Science Behind Menstrual Cramps
If you experience menstruation, there is a high chance you have dealt with menstrual cramps.
The medical term for period pain is dysmenorrhea, and it is very common, affecting an estimated 45 to 95 percent of people who menstruate. Despite its prevalence, medical professionals often overlook concerns about period pain. This leads to the condition being undertreated and allows underlying causes of painful periods to go unrecognized or undiagnosed.
What is considered normal period pain?
The first category of dysmenorrhea is primary dysmenorrhea. This refers to pain caused by the natural process of menstruation. It usually involves cramping in the abdominal or pelvic area and can also include nausea, vomiting, headaches, back pain, mood changes and sleep disturbances.
Research has not fully uncovered why primary dysmenorrhea occurs, but one major factor is prostaglandins. Prostaglandins are naturally produced substances involved in many body functions. At the end of the luteal phase, progesterone levels drop. This allows menstruation to begin and triggers the uterus to produce and release prostaglandins.
Prostaglandins cause the muscles and blood vessels in the uterus to contract so the endometrium, which is the uterine lining, can shed. When the uterus releases higher levels of prostaglandins, contractions and inflammation increase. This sensitizes pain receptors in the pelvic region, which leads to stronger cramping. These contractions also reduce blood flow and oxygen to the uterus, which contributes to pain. People who experience dysmenorrhea usually have higher prostaglandin levels than those who do not, and higher levels are associated with more severe pain.
Even though primary dysmenorrhea occurs due to a natural process, high levels of pain are not something you should ignore. Your pain is real and valid.
Treating menstrual cramps
There are many options available to help manage period pain. Medical treatments include non-steroidal anti-inflammatory drugs such as Ibuprofen and Naproxen, which reduce prostaglandin production. Hormone based treatments such as the pill, patch or IUD can also help reduce prostaglandins and relieve pain.
Holistic and supportive approaches include:
Using heating pads
TENS machines
Regular exercise
Diet and nutrition management
Relaxation and stress reduction techniques
If these strategies do not help, it may indicate a larger underlying issue.
When cramps point to another condition
The second classification of dysmenorrhea is secondary dysmenorrhea. This occurs when menstrual pain is caused by an underlying conditions. Common causes include endometriosis, adenomyosis, uterine fibroids, uterine polyps and pelvic inflammatory disease. In some cases, non-gynaecological disorders such as Crohn's disease or urinary conditions may also cause pain around menstruation.
Symptoms that may indicate secondary dysmenorrhea include:
Heavy or irregular bleeding
Cramps that get worse over time
Pain that lasts longer than a few days
Painful intercourse
If your pain is interfering with your daily life, or if these symptoms sound familiar, it is important to seek medical assessment. Diagnosis may involve pelvic exams, ultrasounds, MRI scans or laparoscopic surgery.
Your pain deserves attention
Too many people are told that painful periods are normal or that they will eventually grow out of them. Menstrual pain can significantly impact quality of life. Early intervention for conditions that cause secondary dysmenorrhea, especially endometriosis, can prevent worsening of the condition and improve long term outcomes by reducing pain and symptoms.
You deserve care that looks deeper. Your pain is real and it matters.
References
[1] Nagy, H., Carlson, K., & Khan, M. A. B. (2023, November 12). Dysmenorrhea. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK560834/
[2] Itani, R., Soubra, L., Karout, S., Rahme, D., Karout, L., & Khojah, H. M. (2022). Primary dysmenorrhea: Pathophysiology, diagnosis, and treatment updates. Korean Journal of Family Medicine, 43(2), 101–108. https://doi.org/10.4082/kjfm.21.0103
[3] Dysmenorrhea: Painful periods. ACOG. (n.d.). https://www.acog.org/womens-health/faqs/dysmenorrhea-painful-periods
[4] The zoom in: Prostaglandins and menstrual cycle. Hummingway. (n.d.). https://ourhummingway.com/article/the-zoom-in-prostaglandins
[5] Prostaglandins: What it is, Function & Side effects. Cleveland Clinic. (2025, March 19). https://my.clevelandclinic.org/health/articles/24411-prostaglandins
[6] U.S. National Library of Medicine. (n.d.). Period pain | menstrual cramps. MedlinePlus. https://medlineplus.gov/periodpain.html#:~:text=The%20cause%20is%20usually%20having,women%20it%20can%20last%20longer
[7] The importance of an early endometriosis diagnosis. Endometriosis Treatment Center of America. (2025, April 21). https://www.centerofendometriosis.com/blog/the-importance-of-an-early-endometriosis-diagnosis/