Periods are annoying. I’ve felt this way since I was first struck by the crimson tide at age 12 — and so has pretty much every woman I know. Not only is menstruating a monthly inconvenience (changing tampons, buying pads, et al.), but it can also be physically trying. Cramps, anyone?
Regardless of their bodily discomfort, most ladies manage to haul themselves out of bed during those five days. But, what if, suddenly, you can’t? What if your period grievances start going beyond bloating and mood swings into deeper, scarier territory?
First, don’t panic — give yourself a minute to see if your cycle re-regulates. As Dr. Vanessa Cullins, vice president for external medical affairs at Planned Parenthood Federation of America, explains, “If there is a big change in your periods over two or three cycles, where the pain is not being relieved by an over-the-counter medication such as Aleve or ibuprofen, then it’s time to be evaluated by a healthcare provider.”
Because, according to Dr. Tamer Seckin, a gynecological surgeon in New York, advocating for yourself is crucial when it comes to reproductive ailments. “Women should know their bodies,” he says. Not just “the difference between cramps and other pain,” but a basic knowledge of your repro system, including where your vagina, cervix, and uterus are exactly. Serkin also advises women to clearly explain their complaints to their doctor because “if the patient does not ask the right questions, she won't get the right answers.”
If you’re not sure where your period pains fall, keep reading. We’ve rounded up some of the more common causes of menstrual pain, as well as tips and treatment info, to help you get informed.
Most women get cramps — if not with every period, then now and again. Menstrual cramps tend to start shortly before or at the start of a woman’s period, generally lasting one to three days. Cramping is the natural result of contractions in the uterus, which help slough off and force out the uterus’ lining. If the uterus contracts too intensely, it can push against blood vessels, killing the supply of oxygen to the muscle tissue of the uterus and causing abdominal cramping.
“Young women who have just started to have periods may be more sensitive to cramps,” Dr. Cullins explains, partially because their uteruses are smaller than older women who may have been pregnant before.
Dr. Cullins suggests warm baths, heating pads, and rest to help soothe your cramps. Exercise can help some women, as can having an orgasm (yay!). If the pain gets much worse, your doctor can prescribe higher doses of over-the-counter drugs like ibuprofen.
Endometriosis is the main culprit when it comes to painful periods, according to Dr. Cullins, and more than five million American women suffer from it. The condition occurs when the endometrium, the tissue that lines the uterus or womb, starts to grow outside the uterus (usually on other parts of the reproductive system).
The most common sign is intense pain, generally coinciding with your periods. “Anna,” 25, is a newly diagnosed endometriosis sufferer who has endured unexplained, prolonged pain for 10 years. She has experienced vomiting, fainting, and cramping so bad she “couldn’t stand up straight.” After seeing doctor after doctor dismiss her concerns — some even flatly accused her of lying — Anna’s endometriosis was finally diagnosed in January, and she’ll be getting surgery soon. Dr. Tamer Seckin, a New York City-based endometriosis surgeon, validates Anna’s claim of being mistreated by doctors, saying, “It’s always a blame-the-victim thing.”
Some people with endometriosis can be unaware they have the condition until the pain is so bad, they need to have a diagnostic laparoscopy (the most common procedure to identify endometriosis), or if they’ve been unsuccessfully trying to become pregnant. Other symptoms include pain after sex, painful bowel movements, nausea, and chronic lower-back pain. But, endometriosis doesn’t affect every woman the same way. “Some people have pain and some people don’t have pain,” Dr. Cullins notes. “Some people end up with infertility, and some people don’t.”
When it comes to treatment, doctors will usually start off prescribing OTC anti-inflammatory agents and painkillers like Aleve. They may also suggest a hormone treatment, like starting birth control pills. Surgery is necessary in severe cases, and, Dr. Cullins says, “Some women who have severe chronic pain or infertility may end up needing to have a hysterectomy.”
Fibroids are benign tumors on the walls of the uterus, and they’re quite common, affecting about 30% of women aged 30 to 45. Their cause is unclear.
Abnormal uterine bleeding is the most common symptom. If the tumors are close to the uterine lining, or get in the way of blood flow to the lining, they can spark painful periods, prolonged periods, and spotting. Fibroids can cause other problems, too, depending on size and location.
Fibroids aren’t always serious, but some studies suggest that they can impact fertility and potentially cause miscarriages. If you’re experiencing period pain or unexplained bleeding, call your ob-gyn — fibroids can be diagnosed by pelvic exam and ultrasound. Treatments for fibroids are wide-ranging and can include anything from low-dose contraceptive pills to surgeries such as a hysterectomy or myomectomy (removal of the fibroid-affected part of the uterus).
Cysts, on the other hand, are fluid-filled sacs that can occur anywhere on your body, according to Dr. Cullins. Ones in the reproductive region most commonly appear on the ovaries. An ovarian cyst can spark pain anytime — not just during your period — as well as a range of other symptoms like pain during sex, weight gain, vomiting or nausea, and breast tenderness.
Doctors often spot ovarian cysts during routine pelvic exams. Once a cyst is found, tests (such as ultrasounds, blood tests, and hormone tests) are conducted to determine treatment. The good news? Most cysts aren’t cancerous, and many can go away on their own.
PID is a broad term for infection of a woman’s reproductive organs that’s generally prompted by untreated sexually transmitted diseases. It can also be caused by unrelated, non-sexually-transmitted infections. Women don’t always know they have PID — symptoms can be mild, but the infection can be serious if left alone too long. Plus, one in eight women with PID will eventually have difficulty getting pregnant.
The trickiest aspect of PID is that there aren’t any specific tests for it — a diagnosis is usually reached via physical exam, medical history, and other results. The infection isn’t always associated with painful periods, though it can certainly play a part in them. As Dr. Cullins says, “When a woman comes in and complains about pain during her period, we don’t automatically think ‘PID,’ but we will check for PID.” Treatment usually includes antibiotics, though surgery might be needed in more developed cases.
Adenomyosis is a common, non-life-threatening condition in which the uterus’ inner lining (known as the endometrium) busts through the uterine muscle wall (the myometrium). This condition can be found throughout the entire uterus or in one particular spot. Adenomyosis can cause lower abdominal pain, cramps, and bloating before a woman’s period, and can also bring on heavy periods. “You’ve got bleeding that’s going on inside the muscle, and that causes pain,” Dr. Cullins says. “The ultimate treatment is hysterectomy, but before you get to a hysterectomy, you’ll try pain medications.”
The cause of adenomyosis isn't known, though research has indicated that multiple hormones — including estrogen, progesterone, prolactin, and follicle-stimulating hormone — might play a part in triggering the ailment. Adenomyosis can be detected with a pelvic exam; treatment, depending on the symptoms’ severity, can include OTC pain meds, anti-inflammatory drugs (NSAIDs), and a heating pad to soothe cramps. Surgery is reserved for the most difficult cases.
The copper IUD is a reliable (99% effective!) long-term birth control method that stops sperm from fertilizing an egg. It also affects the egg’s transport in the fallopian tubes and alters the lining of the womb, making it less pregnancy friendly.
Unfortunately, some women also find that the IUD makes their periods heavier and more painful, though the cramps can usually be sufficiently treated with trusty OTC meds like Aleve and ibuprofen. It’s also believed that higher levels of IUD-triggered period pain often begin to lessen within a few months, once the body becomes accustomed to it. If excessive pain persists, you can always have the IUD removed — that’s the beauty of non-permanent birth control!
OHSS is a medical condition that can affect women receiving injectable hCG hormones during in vitro fertilization (IVF) to stimulate ovulation. Dr. Cullins notes, “If you overstimulate the ovaries, it can cause [serious] problems — it could potentially be life-threatening.” Fortunately, the condition is rare, and severe OHSS only occurs in about 1.4% of all hCG cycles.
When an excess of hormones bring on OHSS, the woman’s ovaries can become painfully swollen. Symptoms of mild or moderate OHSS usually begin within 10 days after using the injectables and can include abdominal pain, bloating, nausea, vomiting, and tenderness in your ovary area.
Severe OHSS can cause more intense abdominal pain, rapid weight gain (think five pounds in one day), vomiting, dizziness, and shortness of breath. If you’re getting IVF treatments and notice any of these signs, seek medical help immediately. We don’t want to freak you out, but left untreated, severe OHSS can cause blood clots, kidney problems, and even death.