Table of ContentsView AllTable of ContentsOverviewSymptomsCausesWhen to See a Healthcare ProviderWhat to Tell a Healthcare ProviderDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Overview
Symptoms
Causes
When to See a Healthcare Provider
What to Tell a Healthcare Provider
Diagnosis
Treatment
If you have painful periods, you are not alone. Estimates vary, but up to 90% of women may experience some discomfort during their menstruation, known as dysmenorrhea.But sometimes, that pain can be very intense.
If you are in your teens or early 20s and you are having very painful periods, you likely have a condition known as primary dysmenorrhea.
Painful periods are the leading cause of missed school days all over the world,as seen in some West African countries.
martin-dm / Getty Images
Primary dysmenorrhea is used to describe the cramping pain that happens during your period when there is no other pelvic condition that could cause the pain.Typically primary dysmenorrhea starts within the first year or so after you start getting your periods regularly.
The pain of primary dysmenorrhea is pretty typical. It usually starts within 12 hours before or about 6 hours after you start your period.The pain is usually the worst on your heaviest flow day. But in some young women, the pain can last for up to 3 days.
The pain of primary dysmenorrhea is usually the same and predictable from period to period. It is most often described as a cramping pain that starts in the middle of your lower abdomen. The pain will often spread to your lower back and even to your upper thighs as a dull and constant or throbbing discomfort.
You may have some other unpleasant symptoms that go along with the pain of primary dysmenorrhea. These symptoms may include:
The lining of your uterus produces natural chemicals called prostaglandins.
Some of theseprostaglandinscause the muscle and the blood vessels in your uterus to contract. When the muscle and the blood vessels contract it temporarily decreases the blood flow to the uterus.This decreased blood flow is calledischemia. In the uterus, the ischemia is short-lived and comes in waves as the uterus contracts.But these changes are similar to what happens during a heart attack. The decreased blood flow to the uterus is a part of what causes the pain of primary dysmenorrhea.
First of all, you should not suffer from painful periods. Remember you are not alone. Studies suggest a high percentage of teenage girls report intensely painful periods and conclude primary dysmenorrhea is the leading cause of absenteeism among adolescent women worldwide.
There is no reason for you to miss out on school, work or other activities because of painful periods. It is a good idea to discuss your periods with your healthcare provider if they are interfering with your regular activities either because of pain, heavy bleeding or both.
Before you talk to your healthcare provider about your painful periods it is a good idea to think about how you will describe your symptoms.
Most healthcare providers will ask you questions to help them figure out what is causing your pain so they can make the right diagnosis. Think about how you would answer the following questions.
Maybe even consider writing down your answers to these questions and bring them with you to your healthcare provider’s appointment. Being prepared and working with your provider will help you to get the correct diagnosis and help you feel better faster.
Depending on the information you provided to your healthcare provider, you may not need to have a pelvic exam for your provider to make the diagnosis of primary dysmenorrhea.
In fact, it is unlikely that you will need a pelvic exam if you are a teen, have never been sexually active, and your symptoms are typical of primary dysmenorrhea.
If your pain does not go away after a few months of medical treatment or if the answers to your questions suggest an underlying problem, your healthcare provider will likely suggest a pelvic exam even if you have not started having sex yet.
No additional testing or pelvic imaging is needed to make a diagnosis of primary dysmenorrhea. However, if your healthcare provider thinks that your painful periods may be due to an underlying pelvic condition meaning that you have secondary dysmenorrhea, your provider will likely suggest additional testing.
When thinking about treatment options, it is important to remember that the natural chemicals called prostaglandins that are produced in the lining of the uterus are responsible for the symptoms of primary dysmenorrhea.
The goal of medical management is to decrease the production of prostaglandins in the lining of your uterus. There are two types of medications that do this,non-steroidal anti-inflammatory drugs (NSAIDs)andhormonal contraceptive medications.
Keep in mind that NSAIDs can cause inflammation of the stomach lining (gastritis) and other gastrointestinal problems, though Celebrex causes fewer problems than ibuprofen and naproxen.You should never take NSAIDs on an empty stomach.
In addition to medications, there are some lifestyle changes that can help reduce menstrual pain.
Getting adequate aerobic exercise on a regular basis has been shown to reduce painful periods.
Though research is limited, dietary changes may help. Some research suggests that omega-3 fatty acids can help relieve dysmenorrhea.While you can get omega-3s from supplements, many foods are rich in omega-3 fatty acids, including walnuts, chia seeds, and fatty fish such as salmon.
A Word From Verywell
Remember you don’t have to settle for painful periods. Don’t be embarrassed to discuss your periods with your healthcare provider. By making simple lifestyle changes and trying the right medications, you can live very well with a diagnosis of primary dysmenorrhea.
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ferries-Rowe E, Corey E, Archer JS.Primary dysmenorrhea: diagnosis and therapy.Obstet Gynecol. 2020;136(5):1047-1058. doi:10.1097/aog.0000000000004096American College of Obstetricians and Gynecologists Committee on Adolescent Health Care.ACOG committee opinion No. 760: dysmenorrhea and endometriosis in the adolescent.Obstet Gynecol. 2018;132(6):e249-e258. doi:10.1097/AOG.0000000000002978Hennegan J, OlaOlorun FM, Oumarou S, et al.School and work absenteeism due to menstruation in three West African countries: findings from PMA2020 surveys.Sex Reprod Health Matters. 2021;29(1):409-424. doi:10.1080/26410397.2021.1915940American College of Obstetricians and Gynecologists.Dysmenorrhea: painful periods.Kural M, Noor N, Pandit D, Joshi T, Patil A.Menstrual characteristics and prevalence of dysmenorrhea in college going girls.J Family Med Prim Care. 2015;4(3):426. doi:10.4103/2249-4863.161345Barcikowska Z, Rajkowska-Labon E, Grzybowska ME, Hansdorfer-Korzon R, Zorena K.Inflammatory markers in dysmenorrhea and therapeutic options.Int J Environ Res Public Health. 2020;17(4):1191. doi:10.3390/ijerph17041191Sen E, Ozdemir O, Ozdemir S, Atalay CR.The relationship between serum ischemia-modified albumin levels and uterine artery Doppler parameters in patients with primary dysmenorrhea.Rev Bras Ginecol Obstet. 2020;42(10):630-633. doi:10.1055/s-0040-1715141Osayande AS, Mehulic S.Diagnosis and initial management of dysmenorrhea.Am Fam Physician. 2014;89(5):341-346.Sohail R, Mathew M, Patel KK, et al.Effects of non-steroidal anti-inflammatory drugs (NSAIDs) and gastroprotective NSAIDs on the gastrointestinal tract: a narrative review.Cureus. 2023;15(4):e37080. doi:10.7759/cureus.37080UpToDate.Patient education: hormonal methods of birth control (Beyond the Basics).Dehnavi ZM, Jafarnejad F, Kamali Z.The effect of aerobic exercise on primary dysmenorrhea: a clinical trial study.J Educ Health Promot. 2018;7:3. doi:10.4103/jehp.jehp_79_17Snipe RMJ, Brelis B, Kappas C, et al.Omega-3 long chain polyunsaturated fatty acids as a potential treatment for reducing dysmenorrhoea pain: systematic literature review and meta-analysis.Nutr Diet. 2024;81(1):94-106. doi:10.1111/1747-0080.12835National Institutes of Health Office of Dietary Supplements.Omega-3 fatty acids: fact sheet for health professionals.
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ferries-Rowe E, Corey E, Archer JS.Primary dysmenorrhea: diagnosis and therapy.Obstet Gynecol. 2020;136(5):1047-1058. doi:10.1097/aog.0000000000004096American College of Obstetricians and Gynecologists Committee on Adolescent Health Care.ACOG committee opinion No. 760: dysmenorrhea and endometriosis in the adolescent.Obstet Gynecol. 2018;132(6):e249-e258. doi:10.1097/AOG.0000000000002978Hennegan J, OlaOlorun FM, Oumarou S, et al.School and work absenteeism due to menstruation in three West African countries: findings from PMA2020 surveys.Sex Reprod Health Matters. 2021;29(1):409-424. doi:10.1080/26410397.2021.1915940American College of Obstetricians and Gynecologists.Dysmenorrhea: painful periods.Kural M, Noor N, Pandit D, Joshi T, Patil A.Menstrual characteristics and prevalence of dysmenorrhea in college going girls.J Family Med Prim Care. 2015;4(3):426. doi:10.4103/2249-4863.161345Barcikowska Z, Rajkowska-Labon E, Grzybowska ME, Hansdorfer-Korzon R, Zorena K.Inflammatory markers in dysmenorrhea and therapeutic options.Int J Environ Res Public Health. 2020;17(4):1191. doi:10.3390/ijerph17041191Sen E, Ozdemir O, Ozdemir S, Atalay CR.The relationship between serum ischemia-modified albumin levels and uterine artery Doppler parameters in patients with primary dysmenorrhea.Rev Bras Ginecol Obstet. 2020;42(10):630-633. doi:10.1055/s-0040-1715141Osayande AS, Mehulic S.Diagnosis and initial management of dysmenorrhea.Am Fam Physician. 2014;89(5):341-346.Sohail R, Mathew M, Patel KK, et al.Effects of non-steroidal anti-inflammatory drugs (NSAIDs) and gastroprotective NSAIDs on the gastrointestinal tract: a narrative review.Cureus. 2023;15(4):e37080. doi:10.7759/cureus.37080UpToDate.Patient education: hormonal methods of birth control (Beyond the Basics).Dehnavi ZM, Jafarnejad F, Kamali Z.The effect of aerobic exercise on primary dysmenorrhea: a clinical trial study.J Educ Health Promot. 2018;7:3. doi:10.4103/jehp.jehp_79_17Snipe RMJ, Brelis B, Kappas C, et al.Omega-3 long chain polyunsaturated fatty acids as a potential treatment for reducing dysmenorrhoea pain: systematic literature review and meta-analysis.Nutr Diet. 2024;81(1):94-106. doi:10.1111/1747-0080.12835National Institutes of Health Office of Dietary Supplements.Omega-3 fatty acids: fact sheet for health professionals.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Ferries-Rowe E, Corey E, Archer JS.Primary dysmenorrhea: diagnosis and therapy.Obstet Gynecol. 2020;136(5):1047-1058. doi:10.1097/aog.0000000000004096American College of Obstetricians and Gynecologists Committee on Adolescent Health Care.ACOG committee opinion No. 760: dysmenorrhea and endometriosis in the adolescent.Obstet Gynecol. 2018;132(6):e249-e258. doi:10.1097/AOG.0000000000002978Hennegan J, OlaOlorun FM, Oumarou S, et al.School and work absenteeism due to menstruation in three West African countries: findings from PMA2020 surveys.Sex Reprod Health Matters. 2021;29(1):409-424. doi:10.1080/26410397.2021.1915940American College of Obstetricians and Gynecologists.Dysmenorrhea: painful periods.Kural M, Noor N, Pandit D, Joshi T, Patil A.Menstrual characteristics and prevalence of dysmenorrhea in college going girls.J Family Med Prim Care. 2015;4(3):426. doi:10.4103/2249-4863.161345Barcikowska Z, Rajkowska-Labon E, Grzybowska ME, Hansdorfer-Korzon R, Zorena K.Inflammatory markers in dysmenorrhea and therapeutic options.Int J Environ Res Public Health. 2020;17(4):1191. doi:10.3390/ijerph17041191Sen E, Ozdemir O, Ozdemir S, Atalay CR.The relationship between serum ischemia-modified albumin levels and uterine artery Doppler parameters in patients with primary dysmenorrhea.Rev Bras Ginecol Obstet. 2020;42(10):630-633. doi:10.1055/s-0040-1715141Osayande AS, Mehulic S.Diagnosis and initial management of dysmenorrhea.Am Fam Physician. 2014;89(5):341-346.Sohail R, Mathew M, Patel KK, et al.Effects of non-steroidal anti-inflammatory drugs (NSAIDs) and gastroprotective NSAIDs on the gastrointestinal tract: a narrative review.Cureus. 2023;15(4):e37080. doi:10.7759/cureus.37080UpToDate.Patient education: hormonal methods of birth control (Beyond the Basics).Dehnavi ZM, Jafarnejad F, Kamali Z.The effect of aerobic exercise on primary dysmenorrhea: a clinical trial study.J Educ Health Promot. 2018;7:3. doi:10.4103/jehp.jehp_79_17Snipe RMJ, Brelis B, Kappas C, et al.Omega-3 long chain polyunsaturated fatty acids as a potential treatment for reducing dysmenorrhoea pain: systematic literature review and meta-analysis.Nutr Diet. 2024;81(1):94-106. doi:10.1111/1747-0080.12835National Institutes of Health Office of Dietary Supplements.Omega-3 fatty acids: fact sheet for health professionals.
Ferries-Rowe E, Corey E, Archer JS.Primary dysmenorrhea: diagnosis and therapy.Obstet Gynecol. 2020;136(5):1047-1058. doi:10.1097/aog.0000000000004096
American College of Obstetricians and Gynecologists Committee on Adolescent Health Care.ACOG committee opinion No. 760: dysmenorrhea and endometriosis in the adolescent.Obstet Gynecol. 2018;132(6):e249-e258. doi:10.1097/AOG.0000000000002978
Hennegan J, OlaOlorun FM, Oumarou S, et al.School and work absenteeism due to menstruation in three West African countries: findings from PMA2020 surveys.Sex Reprod Health Matters. 2021;29(1):409-424. doi:10.1080/26410397.2021.1915940
American College of Obstetricians and Gynecologists.Dysmenorrhea: painful periods.
Kural M, Noor N, Pandit D, Joshi T, Patil A.Menstrual characteristics and prevalence of dysmenorrhea in college going girls.J Family Med Prim Care. 2015;4(3):426. doi:10.4103/2249-4863.161345
Barcikowska Z, Rajkowska-Labon E, Grzybowska ME, Hansdorfer-Korzon R, Zorena K.Inflammatory markers in dysmenorrhea and therapeutic options.Int J Environ Res Public Health. 2020;17(4):1191. doi:10.3390/ijerph17041191
Sen E, Ozdemir O, Ozdemir S, Atalay CR.The relationship between serum ischemia-modified albumin levels and uterine artery Doppler parameters in patients with primary dysmenorrhea.Rev Bras Ginecol Obstet. 2020;42(10):630-633. doi:10.1055/s-0040-1715141
Osayande AS, Mehulic S.Diagnosis and initial management of dysmenorrhea.Am Fam Physician. 2014;89(5):341-346.
Sohail R, Mathew M, Patel KK, et al.Effects of non-steroidal anti-inflammatory drugs (NSAIDs) and gastroprotective NSAIDs on the gastrointestinal tract: a narrative review.Cureus. 2023;15(4):e37080. doi:10.7759/cureus.37080
UpToDate.Patient education: hormonal methods of birth control (Beyond the Basics).
Dehnavi ZM, Jafarnejad F, Kamali Z.The effect of aerobic exercise on primary dysmenorrhea: a clinical trial study.J Educ Health Promot. 2018;7:3. doi:10.4103/jehp.jehp_79_17
Snipe RMJ, Brelis B, Kappas C, et al.Omega-3 long chain polyunsaturated fatty acids as a potential treatment for reducing dysmenorrhoea pain: systematic literature review and meta-analysis.Nutr Diet. 2024;81(1):94-106. doi:10.1111/1747-0080.12835
National Institutes of Health Office of Dietary Supplements.Omega-3 fatty acids: fact sheet for health professionals.
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