What causes painful menstruation?

Menstruation is a monthly occurrence for women in which the body sheds the lining of the uterus (womb), which is then passed through a small opening in the cervix and out through the vaginal canal.

Some pain, cramping, and discomfort during menstrual periods is normal. However, excessive pain that causes you to regularly miss work or school is not.

The medical term for painful menstruation is dysmenorrhea. Primary dysmenorrhea occurs in women who experience pain just before and during menstruation, but who are otherwise healthy. Women who have had normal periods that later become painful may have secondary dysmenorrhea. This condition is usually accompanied by a problem affecting the uterus or other pelvic organs.

painful menstruation

What Are the Causes?

There may not be an identifiable cause of your painful menstrual periods. Certain women are at a higher risk for having painful menstrual periods. Risk factors include:

  • being under age 20
  • having a family history of painful periods
  • smoking
  • having heavy bleeding with periods
  • having irregular periods
  • never having had a baby
  • having experienced early puberty, which is puberty before the age of 11

Hormone-like substances called prostaglandins trigger muscle contractions to help your uterus expel its lining each month. These contractions can cause pain and inflammation. Women with higher levels of prostaglandins may experience more severe menstrual cramping and pain.

In some cases, such as with secondary dysmenorrhea, painful menstrual periods can be the result of an underlying medical condition, such as:

  • premenstrual syndrome (PMS)
  • endometriosis (a painful medical condition in which cells from the lining of the uterus grow in other parts of the body)
  • fibroids in the uterus (noncancerous tumors)
  • pelvic inflammatory disease, an infection of the uterus, fallopian tubes, or ovaries often caused by sexually transmitted infections
  • sexually transmitted infections (STIs)
  • adenomyosis, a rare condition in which the uterine lining grows into the muscular wall of the uterus
  • cervical stenosis, a rare condition in which the cervix is so small it slows menstrual flow (NLM)

Certain types of birth control, specifically intrauterine devices (IUDs) made of copper, are associated with increased pain during menstruation.

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