You might get the impression that very painful periods are the norm. Discomfort during menstruation isn’t uncommon, especially in younger people. About half of all people who menstruate experience pelvic achiness during their periods. But even if menstrual pain is common that doesn’t mean you need to suffer, so seek out advice and care options from your OB/GYN to find relief. With that said, really bad menstrual cramps are not normal. Severe period cramps can signal a problem—a problem that may impact your fertility. Here are six ways to know that your cramps might not be normal. As always, if you have any questions or concerns about your health, talk to your doctor. Some countries offer a couple days off every month for menstruation. Don’t misconstrue this for saying that menstruation should be so painful that you can’t go about your regular life. The issue is more complex than that. It’s not even clear whether these laws are good or bad. In 2013, Russian lawmaker Mikhail Degtyaryov proposed that Russia should offer days off for menstruation. He argued that sometimes the “pain for the fair sex is often so intense that it is necessary to call an ambulance.” Not exactly a realistic portrayal (or understanding) of menstruation. If your pain is bad enough to call an ambulance, please call one. Those aren’t period cramps. Something much more serious is going on. In a more likely scenario, if your pain is bad enough to regularly miss work or school, make an appointment to speak to your doctor. There may be something else going on that needs treatment and/or treatment options that can soothe your discomfort. Very important side note: Some people will take more than the recommended dosage of over-the-counter pain relievers thinking that since they are over-the-counter, they are therefore harmless. Over-the-counter is not a code word for dosage-doesn’t-really-matter. Don’t do this. It can be extremely dangerous and even deadly. Another possible sign your cramps aren’t normal is if you experience pain during sex. Some causes of painful sex are also responsible for abnormally bad period cramps. Cramps may start the day of or day just before the bleeding starts, but they should not continue all the way until the end of your period. They certainly shouldn’t still be there after your period ends. If you have a fever, your doc can confirm that by taking your temperature. If you’re experiencing pain, your doctor has to take your word for it. This keeps a lot of people from seeking help. Additionally, complaints about pain (especially coming from women and other historically marginalized groups) are sadly sometimes dismissed. If you brought up your pain to a doctor in the past, and they brushed it off as not serious, you may be reluctant to bring it up again. But you should bring it up again. Especially if you’re concerned about it. Some of the possible causes for painful cramps—like endometriosis—are diseases that take years to get properly diagnosed. Keep asking for help until someone hears you.
Cramps accompanied by nausea or diarrhea Difficulty getting pregnant Heavy bleeding Irregular cycles Pain during sex Pelvic pain at times beside your period Spotting between cycles
Bottom line: If you’re worried, talk to your doctor. To evaluate what may be wrong, your healthcare provider may suggest:
Adhesions Cervical stenosis Endometriosis Fibroids IUD birth control devices Ovarian cysts Pelvic inflammatory disease (PID)
Blood work Exploratory laparoscopy (in especially severe cases) Pelvic exam with sexually transmitted infection (STD/STI) testing Pelvic ultrasound
It’s important to know that endometriosis can only be diagnosed with exploratory laparoscopy. It can’t be ruled with ultrasound or a pelvic exam. However, laparoscopy is an invasive, surgical procedure, so your doctor may not recommend having it unless your symptoms are especially bad. Severe abdominal or pelvic pain may indicate something more serious than your period, like an ectopic pregnancy, toxic shock syndrome, acute PID, or appendicitis.
Treatment Options
Occasionally, it happens that you see your doctor and are told everything is fine, particularly if underlying causes have been ruled out. If your cramps aren’t interfering with your daily life, this may be a reassuring and acceptable answer. However, if your cramps are making it difficult to work and live, don’t accept “You’re fine” as an answer. Seek out another doctor. Medications, heating pads, resting, exercise, breath work, and other treatments may help you find relief. Sometimes, going on birth control pills can help regulate your cycle and reduce your period pain. Some types of birth control medications allow you to skip having your period for multiple months in a row, which is called menstrual suppression and means you will get your period—and any discomfort—much less often. However, the right treatment for you will depend on your personal situation and medical history, so consult with your doctor to create a plan that will reduce your monthly discomfort.
