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Got Serious Cramps? Here Are 4 Causes of Painful Periods

In this video, learn common medical causes of primary and secondary dysmenorrhea, or pain during menstruation.

Lauren SmithPreeti Parikh, MD
Written by Lauren Smith | Reviewed by Preeti Parikh, MD
Updated on January 3, 2022

Everyone’s body works a little bit differently, so it’s no surprise that everyone experiences their period a little bit differently as well. If you ask someone how they feel about their period, the reactions you hear may range from “fine” to “absolutely debilitating.”

A big factor in how someone feels about their period is the pain factor. Some get through menstruation with little to no pain, while others may end up in fetal position on their bed for a couple days a month.

If the latter sounds like you, you’re not alone: More than half of menstruating women admit to suffering from some amount of period pain at least a couple days a month, according to the American College of Obstetricians and Gynecologists (ACOG). Pain associated with menstruation is called dysmenorrhea.

There are four common causes of dysmenorrhea:

1. Primary dysmenorrhea (a.k.a., “menstrual cramps”)

Primary dysmenorrhea is when the pain is caused by period-related hormones, and there is no other condition causing the pain. It’s essentially the medical name for cramps.

Throughout the menstrual cycle, the uterine lining produces prostaglandins. Almost every cell in the body makes these, but in the uterus, they’re responsible for contracting the uterine muscles to shed your endometrium. Prostaglandin levels are highest when your period starts in order to shed that lining. As the lining sheds, the prostaglandin levels drop, and pain decreases. Learn more about what causes menstrual cramps here.

But not all people experience the same level of prostaglandin production. People with higher prostaglandin levels experience more severe pain, resulting in painful and debilitating periods. (Here are tips to help soothe menstrual cramp pain.)

When period pain is the result of a disorder of the reproductive system, this is called secondary dysmenorrhea. There are three common types of secondary dysmenorrhea.

2. Endometriosis

Endometriosis is incredibly common, affecting one in 10 women of reproductive age, according to the ACOG. This painful condition causes uterine tissue (endometrium) to develop outside the uterus, such as on the ovaries, the bladder, or the intestines.

Endometriosis can be painful throughout the entire menstrual cycle. Since this rogue endometrium is very responsive to hormones, the pain typically worsens during menstruation. Periods may also be long and heavy. Learn more about the symptoms of endometriosis here.

3. Uterine fibroids

Uterine fibroids are non-cancerous growths that appear on the muscle tissue of the uterus. They vary widely in size and shape, as well as in the symptoms they cause.

Some uterine fibroids cause no symptoms at all and are only found in pelvic exams; others may cause longer, heavier, and more painful periods. Uterine fibroids can also cause pain during sex, constipation or difficulty urinating, bloated abdomen, and even miscarriages.

4. Adenomyosis

Adenomyosis is when tissue of the uterine lining grows on the muscle wall of the uterus, according to the ACOG. This condition can cause chronic pelvic pain that worsens during menstruation.

Like other types of secondary dysmenorrhea, adenomyosis is also associated with heavy and prolonged bleeding. (Here are other reasons your period is heavier than usual.)

The big takeaway here is that severe pain during periods is not “normal,” and dysmenorrhea can be treated. Menstruation is different for everyone, so comparing your experience to your mom’s or friends’ is just counterproductive.

If your period pain is affecting your quality of life and causing you to miss work or social engagements, talk to your doctor.


Dysmenorrhea. Washington, DC: American College of Obstetricians and Gynecologists, 2015. (Accessed on January 4, 2022 at https://www.acog.org/Patients/FAQs/Dysmenorrhea-Painful-Periods.)

Endometriosis. Washington, DC: American College of Obstetricians and Gynecologists, 2019. (Accessed on January 4, 2022 at https://www.acog.org/Patients/FAQs/Endometriosis.)

View All References (3)

Period pain. Washington, DC: MedlinePlus, U.S. National Library of Medicine. (Accessed on January 4, 2022 at https://medlineplus.gov/periodpain.html.)

Taran FA, Stewart EA, Brucker S. Adenomyosis: epidemiology, risk factors, clinical phenotype and surgical and interventional alternatives to hysterectomy. Geburtshilfe Frauenheilkd. 2013 Sep;73(9):924-31.

Uterine fibroids. Washington, DC: American College of Obstetricians and Gynecologists, 2018. (Accessed on January 4, 2022 at https://www.acog.org/Patients/FAQs/Uterine-Fibroids.)

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