Pain With Your Menstrual Period

Painful cramping during your period is very common. Sometimes this pain and other symptoms are severe enough that you may have to miss school, work, sports or other important activities. If the pain is this bad, talk to your doctor. The medical term for pain with your period is dysmenorrhea (DIS-men-or-REE-a).

There are 2 types of dysmenorrhea: “primary dysmenorrhea” and “secondary dysmenorrhea.”

Primary dysmenorrhea means that periods are painful, but not because of an underlying abnormality or disease. It is not entirely understood, but we think it happens because your body produces high levels of natural chemicals (prostaglandins) during your period. These chemicals make your uterus cramp and shed its uterine lining. More prostaglandins can cause more cramping. Many people have primary dysmenorrhea. It can happen at any age.

Secondary dysmenorrhea is when something else is causing the pain. These causes include:

Endometriosis: This is when the cells lining your uterus (endometrium) are also outside your uterus. When this happens, these cells can be on your ovaries, on the ligaments holding your uterus, or even on your bowels (intestines) or bladder. Up to 1 in 4 people with a uterus have this condition.

Fibroids: These are non-cancerous tumors that may grow in your uterus. Fibroids are not common in adolescents.

Infections: Infections inside the uterus (pelvic inflammatory disease or PID) or outside the uterus (like appendicitis, an infection of the appendix) can be painful. Your period may make both of these worse. 

Ovarian cysts: Ovarian cysts (usually fluid-filled but sometimes solid) may also cause pain with your periods. Most ovarian cysts are not cancerous. To learn more, read our handout “Ovarian Cysts.”
seattlechildrens.org/pdf/PE2190.pdf

Obstructed uterus or vaginal septum: This happens when there is a blockage in your vagina, making it too narrow for the uterine lining to shed easily. Or it could be because your vagina or cervix (the bottom opening of the uterus) did not form properly. This may cause blood to build up inside your uterus or vagina which can be very painful. Your doctor can tell if you have this from a pelvic examination or with an ultrasound.

Stress: Stress, depression and anxiety can make coping with pain more difficult.

There are certain things that can make it more likely for you to have severe pain with your period. These include:

• You have never been pregnant before.
• You have a developmental difference of your uterus or vagina. To learn more, read our handout “Developmental Differences of the Female Reproductive Organs.”
  seattlechildrens.org/pdf/PE999.pdf
• Endometriosis. 
• Family history of endometriosis or severe pain with periods.
• Stress, depression or anxiety.

Heating pads, warm baths, and exercise including yoga can help. As in any condition associated with pain, limiting life stressors and getting counseling may help reduce your pain.

Roughly 9 out of 10 people find over-the-counter pain relievers to be helpful. Taking these pain relievers may decrease your pain and the amount of blood you pass during your period. These include:

• Ibuprofen (Advil, Motrin): 400 to 600 mg of ibuprofen by mouth every 6 hours. Some people cannot take ibuprofen because they have had stomach ulcers or kidney damage.
• Naproxen (Aleve): 220 mg every 12 hours. Some people cannot take naproxen, because they have had stomach ulcers or kidney damage. 
• Acetaminophen (Tylenol): 500 mg every 6 hours. 

Use these medicines only if recommended by your healthcare provider. Check with your healthcare provider first before taking any type of medicine. If you have pain that is not relieved by medicine and comfort measures, please call the clinic.

After trying over-the-counter pain relievers, your doctor may prescribe hormonal medicine to lessen or stop pain and bleeding. These include:

• Birth control pills, patch or vaginal ring
• Depo Provera shot
• Progestin intrauterine device (IUD)
• Progestin implant (Nexplanon)

If you continue to have pain despite pain relievers or hormonal medications, you may need a pelvic ultrasound. Depending on how severe your pain is and if it is ongoing, we may consider a laparoscopy to look for what is causing the pain.

A laparoscopy is a surgery where we make small surgical cuts into your belly, so we can insert a very small, thin camera (laparoscope). We use this camera to look for endometriosis or help us treat an ovarian cyst. Your doctor may recommend surgery if an ultrasound shows an ovarian cyst or blockage of your cervix or vagina.

Approved by Seattle Children’s Pharmacy and Therapeutics Committee, June, 2025.