Table of ContentsView All
View All
Table of Contents
What Qualifies as Severe Period Cramps?
‘Normal’ vs. Unbearable Period Pain
Causes of Horrible Period Cramps
How Long Should Period Cramps Last?
How Are Bad Period Cramps Diagnosed?
Medical Treatment for Bad Period Cramps
How to Prepare for Painful Menstrual Cycles
You’re not alone if you experience intense, debilitating cramps before, during, or after yourmenstrual cycle(period). More than half of those who menstruate have mild to moderate pain for a couple of days.
Though it’s typical to have somediscomfort with your period, it should be a low-level annoyance instead of excruciating pain. Underlying medical conditions, like fibroids or pelvic inflammatory disease (PID), can cause period cramps so bad you can’t move.
Severe period cramps might:
This article reviews the characteristics of severe period cramps, their causes, how long cramps should last, diagnosis, relief, and treatment.
Severe period crampingis intense lower abdominal (belly) pain. It’s typically constant and may feel like a dull ache or a throbbing pain (like muscle contractions).
It’s challenging to find relief from severe cramps, which can be debilitating. They can make it hard to get out of bed or do anything other than focus on the pain.
If period cramps are severe and hinder your ability to go about daily life, there may be an underlying issue that needs attention. A few causes of severe period cramps include:
Cramping After Sex: Is It Normal, Causes in Men and Women
Some mild to moderate cramps for a couple of days with your period are typical. You can find relief with “normal” period pain through natural remedies or over-the-counter pain medications.
Normal period cramps should be an annoyance but not excruciating. Unbearable period pain is so intense it affects your ability to move around or participate in regular activities.
Experiencing intense, debilitating cramps is not “normal” and involves:
You may also have the following symptoms:
Cramps But No Period: Getting to the Cause
Primary and secondary dysmenorrhea (period pain) are the leading causes of horrible cramps. However, several underlying medical conditions can contribute to secondary dysmenorrhea.
Period Cramps: Relief When Pain Feels Unbearable
Primary Dysmenorrhea
Primary dysmenorrhea (PD) occurs without any underlying medical condition, typically due to high levels of the hormoneprostaglandin, which causes the uterus to contract.
Primary Dysmenorrhea CrampsPrimary dysmenorrhea cramps begin before or at the beginning of menses (period bleeding) when prostaglandin levels are at their highest. Symptoms typically begin during adolescence and are one of the leading causes of school or work absenteeism. PD causes:14–51% of those with PD to miss schoolA 29–50% decrease in school attendanceA loss of 600 million work and school hours a year
Primary Dysmenorrhea Cramps
Primary dysmenorrhea cramps begin before or at the beginning of menses (period bleeding) when prostaglandin levels are at their highest. Symptoms typically begin during adolescence and are one of the leading causes of school or work absenteeism. PD causes:14–51% of those with PD to miss schoolA 29–50% decrease in school attendanceA loss of 600 million work and school hours a year
Primary dysmenorrhea cramps begin before or at the beginning of menses (period bleeding) when prostaglandin levels are at their highest. Symptoms typically begin during adolescence and are one of the leading causes of school or work absenteeism. PD causes:
Secondary Dysmenorrhea
Secondary dysmenorrhea (SD) is due to an underlying medical condition ofreproductive organs, including those listed in this section.
Secondary dysmenorrhea pain characteristics involve:
Endometriosis
Endometriosisaffects 5–10 million reproductive-aged women in the United States.It occurs when tissue similar to the endometrium (uterine lining) grows outside the uterus, usually in thepelvis(between the hips) orreproductive organs. Endometrial-like tissue or lesions bleed but don’t have a way to leave the body, causing pain.
Endometriosis Pain Doesn’t Always Correlate With the Extent Of DiseaseThose with minimal endometriosis may have painful periods, while others with more intense endometriosis may not. It depends on hormones, nerve involvement, depth of lesions, and lifestyle factors.Many women don’t realize they have endometriosis until they have another problem, such as infertility.
Endometriosis Pain Doesn’t Always Correlate With the Extent Of Disease
Those with minimal endometriosis may have painful periods, while others with more intense endometriosis may not. It depends on hormones, nerve involvement, depth of lesions, and lifestyle factors.Many women don’t realize they have endometriosis until they have another problem, such as infertility.
Endometriosis Cramps Explained: Location and Frequency
Fibroids
Uterine fibroidsare non-cancerous growths that develop in the uterine wall and may also involve:
Pelvic Inflammatory Disease (PID)
Pelvic inflammatory disease (PID), an infection of the reproductive organs, occurs in over 1 million women annually in the United States.
Sexually transmitted infections (STIs)such aschlamydiaandgonorrheaare the most common cause. But other non-STI vaginal infections, such asbacterial vaginosis(unbalanced vaginal flora), can also cause PID. Left untreated, PID can lead to infertility and may involve:
Adenomyosis
Adenomyosisis similar to endometriosis, but the endometrial-like tissue doesn’t leave the uterus. It spreads to themyometrium(uterus muscles) and causes pain in your abdomen, hips, or lower back.
Intrauterine Device (IUD)
A healthcare provider inserts anintrauterine device (IUD)into the uterus for pregnancy prevention. Many women note that hormonal IUDs help relieve cramping.However, hormonal and copper IUDs can also cause irregular periods and worsen cramping.
Cramping Without Heavy BleedingPainful cramps may occur without heavy bleeding in conditions such as:Ovarian cystsPolycystic ovarian syndrome (PCOS)(may cause missed periods)PID (cramping can occur between menstrual cycles)Non-gynecological conditions that can also contribute to painful periods include:Crohn’s diseaseIrritable bowel syndrome (IBS)Cystitis(bladder inflammation)
Cramping Without Heavy Bleeding
Painful cramps may occur without heavy bleeding in conditions such as:Ovarian cystsPolycystic ovarian syndrome (PCOS)(may cause missed periods)PID (cramping can occur between menstrual cycles)Non-gynecological conditions that can also contribute to painful periods include:Crohn’s diseaseIrritable bowel syndrome (IBS)Cystitis(bladder inflammation)
Painful cramps may occur without heavy bleeding in conditions such as:
Non-gynecological conditions that can also contribute to painful periods include:
Cramps typically begin before or when bleeding starts and last for around two to three days.Signs your cramping is going on for longer than “normal” include:
What Is Heavy Bleeding?The following signs indicateheavy periodbleeding:Passing blood clots larger than a quarterUsing a pad and tampon together to control bleedingBleeding that soaks through a pad or tampon every two hours or lessHaving to frequently change your tampon or pad throughout the night
What Is Heavy Bleeding?
The following signs indicateheavy periodbleeding:Passing blood clots larger than a quarterUsing a pad and tampon together to control bleedingBleeding that soaks through a pad or tampon every two hours or lessHaving to frequently change your tampon or pad throughout the night
The following signs indicateheavy periodbleeding:
How Long Does a Period Last?
Your healthcare provider will diagnose dysmenorrhea with a medical history, abdominal and pelvic exam, and diagnostic tests, including:
Providers May Bypass Vaginal Exams for Young Women
Stop Period Pain Immediately: How to Take Care of Yourself
You can try the following remedies for bad cramps.Ask your provider before taking a new medication, homeopathic treatment, orheat (or cold) therapy.
If the pain persists, seek emergency care.
Comparing Different Medicines for Period Cramps: What’s Strongest?
Unbearable cramps are not a “normal” part of menstruation, and it’s best to talk to a healthcare provider about relief options. If they disregard your symptoms, consider talking to them again or seeking another opinion.
In addition to the treatments mentioned above, medical treatment may involve:
Medication for Painful PeriodsPonstel (mefenamic acid) is a non-opioid anti-inflammatory medication that providers frequently prescribe for menstrual pain.
Medication for Painful Periods
Ponstel (mefenamic acid) is a non-opioid anti-inflammatory medication that providers frequently prescribe for menstrual pain.
Lifestyle Changes
Lifestyle changes that minimize cramping include:
Exercise and Your Menstrual Cycle
The following are a few things that can help you prevent and manage painful periods.
Keep Supplies Handy
Schedule Pain Medicine
Scheduling pain medicine can help prevent severe pain. Try taking NSAIDs (OTC or prescription) the day before your period is due or as soon as you start cramping or bleeding. If your healthcare provider OKs it, try taking them on a schedule during your period, regardless of your pain level.
Massage
Amassagecan help relax your muscles andreduce stress. The stress hormone cortisol causes inflammation and muscle tension. Some find it helpful to give themselves a gentle tummy massage before and during their period.
Pamper Yourself
Pamper yourself with a warm bath or a soft blanket and heating pad.Add your favorite bath salts,aromatherapy, book, or movie. This helps release muscle tension and stress. Remember to drink plenty of water (plain or infused) or non-caffeinated herbal or arnica tea.
Summary
Mild to moderate period cramps that last a couple of days are typical. You should find relief with natural remedies or over-the-counter pain medications. Excruciating period pain affects your ability to move around or participate in regular activities and is not “normal.” If you have severe period pain, speak with your healthcare provider about treatment options or schedule an exam or tests to check for underlying health conditions.
14 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.American College of Obstetricians and Gynecologists (ACOG).Dysmenorrhea: painful periods.Itani R, Soubra L, Karout S, et al.Primary dysmenorrhea: pathophysiology, diagnosis, and treatment updates.Korean J Fam Med. 2022;43(2):101-108. doi:10.4082/kjfm.21.0103Centers for Disease Control and Prevention.Heavy menstrual bleeding.Nezhat C, Vang N, Tanaka P.Optimal management of endometriosis and pain.Obstetrics & Gynecology. 2019:134(4):834-839. doi: 10.1097/AOG.0000000000003461Awad E, Ahmed HAH, Yousef A, Abbas R.Efficacy of exercise on pelvic pain and posture associated with endometriosis: Within subject design.J Phys Ther Sci. 2017;29(12):2112-2115. doi:10.1589/jpts.29.2112American College of Obstetricians and Gynecologists (ACOG).Pelvic inflammatory disease (PID).Vermeulen N, Abrao M, Einarsson J et al.Endometriosis classification, staging and reporting systems: a review on the road to a universally accepted endometriosis classification.J Minim Invasive Gynecol. 2021;28(11):1822-1848. doi:10.1016/j.jmig.2021.07.023Planned Parenthood.What are the side effects of IUDs?UpToDate.Patient education: painful menstrual periods (dysmenorrhea) (Beyond the Basics).American College of Obstetricians and Gynecologists (ACOG).Heavy menstrual bleeding.Derry S, Wiffen PJ, Kalso EA, et al.Topical analgesics for acute and chronic pain in adults - an overview of Cochrane Reviews.Cochrane Database Syst Rev. 2017;5(5):CD008609. doi: 10.1002/14651858.CD008609.pub2Smith AG, Miles VN, Holmes DT, et al.Clinical trials, potential mechanisms, and adverse effects of arnica as an adjunct medication for pain management.Medicines (Basel). 2021;8(10):58. doi: 10.3390/medicines8100058MedlinePlus.Mefenamic acid.American Society for Reproductive Medicine.Endometriosis - a patient education video.Additional ReadingAmerican College of Gynecology (ACOG).Dysmenorrhea: Painful periods.Itani R, Soubra L, Karout S, Rahme D, Karout L, Khojah HMJ.Primary dysmenorrhea: Pathophysiology, diagnosis, and treatment updates.Korean J Fam Med. 2022;43(2):101-108. doi:10.4082/kjfm.21.0103Up-to-date.Patient education: Painful menstrual periods (dysmenorrhea) - Beyond the basics.
14 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.American College of Obstetricians and Gynecologists (ACOG).Dysmenorrhea: painful periods.Itani R, Soubra L, Karout S, et al.Primary dysmenorrhea: pathophysiology, diagnosis, and treatment updates.Korean J Fam Med. 2022;43(2):101-108. doi:10.4082/kjfm.21.0103Centers for Disease Control and Prevention.Heavy menstrual bleeding.Nezhat C, Vang N, Tanaka P.Optimal management of endometriosis and pain.Obstetrics & Gynecology. 2019:134(4):834-839. doi: 10.1097/AOG.0000000000003461Awad E, Ahmed HAH, Yousef A, Abbas R.Efficacy of exercise on pelvic pain and posture associated with endometriosis: Within subject design.J Phys Ther Sci. 2017;29(12):2112-2115. doi:10.1589/jpts.29.2112American College of Obstetricians and Gynecologists (ACOG).Pelvic inflammatory disease (PID).Vermeulen N, Abrao M, Einarsson J et al.Endometriosis classification, staging and reporting systems: a review on the road to a universally accepted endometriosis classification.J Minim Invasive Gynecol. 2021;28(11):1822-1848. doi:10.1016/j.jmig.2021.07.023Planned Parenthood.What are the side effects of IUDs?UpToDate.Patient education: painful menstrual periods (dysmenorrhea) (Beyond the Basics).American College of Obstetricians and Gynecologists (ACOG).Heavy menstrual bleeding.Derry S, Wiffen PJ, Kalso EA, et al.Topical analgesics for acute and chronic pain in adults - an overview of Cochrane Reviews.Cochrane Database Syst Rev. 2017;5(5):CD008609. doi: 10.1002/14651858.CD008609.pub2Smith AG, Miles VN, Holmes DT, et al.Clinical trials, potential mechanisms, and adverse effects of arnica as an adjunct medication for pain management.Medicines (Basel). 2021;8(10):58. doi: 10.3390/medicines8100058MedlinePlus.Mefenamic acid.American Society for Reproductive Medicine.Endometriosis - a patient education video.Additional ReadingAmerican College of Gynecology (ACOG).Dysmenorrhea: Painful periods.Itani R, Soubra L, Karout S, Rahme D, Karout L, Khojah HMJ.Primary dysmenorrhea: Pathophysiology, diagnosis, and treatment updates.Korean J Fam Med. 2022;43(2):101-108. doi:10.4082/kjfm.21.0103Up-to-date.Patient education: Painful menstrual periods (dysmenorrhea) - Beyond the basics.
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.
American College of Obstetricians and Gynecologists (ACOG).Dysmenorrhea: painful periods.Itani R, Soubra L, Karout S, et al.Primary dysmenorrhea: pathophysiology, diagnosis, and treatment updates.Korean J Fam Med. 2022;43(2):101-108. doi:10.4082/kjfm.21.0103Centers for Disease Control and Prevention.Heavy menstrual bleeding.Nezhat C, Vang N, Tanaka P.Optimal management of endometriosis and pain.Obstetrics & Gynecology. 2019:134(4):834-839. doi: 10.1097/AOG.0000000000003461Awad E, Ahmed HAH, Yousef A, Abbas R.Efficacy of exercise on pelvic pain and posture associated with endometriosis: Within subject design.J Phys Ther Sci. 2017;29(12):2112-2115. doi:10.1589/jpts.29.2112American College of Obstetricians and Gynecologists (ACOG).Pelvic inflammatory disease (PID).Vermeulen N, Abrao M, Einarsson J et al.Endometriosis classification, staging and reporting systems: a review on the road to a universally accepted endometriosis classification.J Minim Invasive Gynecol. 2021;28(11):1822-1848. doi:10.1016/j.jmig.2021.07.023Planned Parenthood.What are the side effects of IUDs?UpToDate.Patient education: painful menstrual periods (dysmenorrhea) (Beyond the Basics).American College of Obstetricians and Gynecologists (ACOG).Heavy menstrual bleeding.Derry S, Wiffen PJ, Kalso EA, et al.Topical analgesics for acute and chronic pain in adults - an overview of Cochrane Reviews.Cochrane Database Syst Rev. 2017;5(5):CD008609. doi: 10.1002/14651858.CD008609.pub2Smith AG, Miles VN, Holmes DT, et al.Clinical trials, potential mechanisms, and adverse effects of arnica as an adjunct medication for pain management.Medicines (Basel). 2021;8(10):58. doi: 10.3390/medicines8100058MedlinePlus.Mefenamic acid.American Society for Reproductive Medicine.Endometriosis - a patient education video.
American College of Obstetricians and Gynecologists (ACOG).Dysmenorrhea: painful periods.
Itani R, Soubra L, Karout S, et al.Primary dysmenorrhea: pathophysiology, diagnosis, and treatment updates.Korean J Fam Med. 2022;43(2):101-108. doi:10.4082/kjfm.21.0103
Centers for Disease Control and Prevention.Heavy menstrual bleeding.
Nezhat C, Vang N, Tanaka P.Optimal management of endometriosis and pain.Obstetrics & Gynecology. 2019:134(4):834-839. doi: 10.1097/AOG.0000000000003461
Awad E, Ahmed HAH, Yousef A, Abbas R.Efficacy of exercise on pelvic pain and posture associated with endometriosis: Within subject design.J Phys Ther Sci. 2017;29(12):2112-2115. doi:10.1589/jpts.29.2112
American College of Obstetricians and Gynecologists (ACOG).Pelvic inflammatory disease (PID).
Vermeulen N, Abrao M, Einarsson J et al.Endometriosis classification, staging and reporting systems: a review on the road to a universally accepted endometriosis classification.J Minim Invasive Gynecol. 2021;28(11):1822-1848. doi:10.1016/j.jmig.2021.07.023
Planned Parenthood.What are the side effects of IUDs?
UpToDate.Patient education: painful menstrual periods (dysmenorrhea) (Beyond the Basics).
American College of Obstetricians and Gynecologists (ACOG).Heavy menstrual bleeding.
Derry S, Wiffen PJ, Kalso EA, et al.Topical analgesics for acute and chronic pain in adults - an overview of Cochrane Reviews.Cochrane Database Syst Rev. 2017;5(5):CD008609. doi: 10.1002/14651858.CD008609.pub2
Smith AG, Miles VN, Holmes DT, et al.Clinical trials, potential mechanisms, and adverse effects of arnica as an adjunct medication for pain management.Medicines (Basel). 2021;8(10):58. doi: 10.3390/medicines8100058
MedlinePlus.Mefenamic acid.
American Society for Reproductive Medicine.Endometriosis - a patient education video.
American College of Gynecology (ACOG).Dysmenorrhea: Painful periods.Itani R, Soubra L, Karout S, Rahme D, Karout L, Khojah HMJ.Primary dysmenorrhea: Pathophysiology, diagnosis, and treatment updates.Korean J Fam Med. 2022;43(2):101-108. doi:10.4082/kjfm.21.0103Up-to-date.Patient education: Painful menstrual periods (dysmenorrhea) - Beyond the basics.
American College of Gynecology (ACOG).Dysmenorrhea: Painful periods.
Itani R, Soubra L, Karout S, Rahme D, Karout L, Khojah HMJ.Primary dysmenorrhea: Pathophysiology, diagnosis, and treatment updates.Korean J Fam Med. 2022;43(2):101-108. doi:10.4082/kjfm.21.0103
Up-to-date.Patient education: Painful menstrual periods (dysmenorrhea) - Beyond the basics.
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
