Menstrual pain, also known as dysmenorrhea, is a common experience for many
menstruating individuals. It is typically felt as cramping or discomfort in the lower
abdomen and lower back during menstruation. While some level of menstrual
discomfort is considered normal, there are certain characteristics of menstrual pain that
may indicate an underlying health concern. Understanding these red flags is crucial for
identifying potential issues and seeking timely medical attention.

Normal Menstrual Pain vs. Abnormal Menstrual Pain

Normal menstrual pain, also known as primary dysmenorrhea, is caused by the release of prostaglandins, which trigger uterine contractions to shed the uterine lining. This type of pain is typically manageable with over-the counter pain relievers, heating pads, and other self-care measures.

However, there are instances when menstrual pain may be abnormal, indicating an underlying medical condition. This is known as secondary dysmenorrhea, and it is important to recognize the characteristics that distinguish it from normal menstrual pain.

Characteristics of Abnormal Menstrual Pain

• Severe Pain: While mild to moderate cramps are common during menstruation, severe and incapacitating pain that interferes with daily activities is a red flag. Experiencing pain that is so intense it requires strong pain medication or disrupts daily life may indicate an underlying issue.

• Prolonged Pain: Menstrual pain typically lasts for a few days during menstruation. If the pain continues beyond the menstrual period or occurs at unexpected times in the cycle, it may be a cause for concern.

• Sudden Onset: If menstrual pain suddenly becomes severe or starts abruptly after years of pain-free periods, it should be evaluated by a healthcare professional.

• Irregular Menstrual Cycles: Menstrual pain that occurs along with irregular or absent periods may indicate hormonal imbalances or conditions affecting the reproductive system.

• Pain Not Relieved by Standard Treatments: If menstrual pain does not respond to over-the-counter pain relievers or other self-care measures, it is important to seek medical evaluation.

• Pain Accompanied by Other Symptoms: Menstrual pain that is accompanied by symptoms such as heavy bleeding, dizziness, nausea, vomiting, fever, or painful intercourse may require medical attention.

• Family History of Reproductive Disorders: If there is a family history of conditions such as endometriosis, uterine fibroids, or polycystic ovary syndrome (PCOS), menstrual pain should be closely monitored and evaluated.

• Painful Bowel Movements or Urination: Painful bowel movements or urination during menstruation may indicate conditions affecting the pelvic area, such as endometriosis or pelvic inflammatory disease (PID).

• Pain After Childbirth or Pelvic Surgery: Menstrual pain that occurs or worsens after childbirth or pelvic surgery should be evaluated by a healthcare provider.

Seeking Medical Attention

If any of the above characteristics are present, it is essential to seek medical attention. A healthcare provider can perform a thorough evaluation, which may include a pelvic exam, ultrasound, or other imaging tests, to identify any underlying conditions contributing to the abnormal menstrual pain.

Conditions That May Cause Abnormal Menstrual Pain

Several medical conditions can cause abnormal menstrual pain. Some of these conditions include:

• Endometriosis: A condition where tissue similar to the uterine lining grows outside the uterus, causing inflammation and pain.

• Uterine Fibroids: Non-cancerous growths in the uterus that can cause pain and heavy menstrual bleeding.

• Adenomyosis: A condition where the tissue lining the uterus grows into the uterine wall, leading to painful periods.

• Pelvic Inflammatory Disease (PID): An infection of the reproductive organs, often caused by sexually transmitted infections (STIs), which can cause pelvic pain and other symptoms.

• Ovarian Cysts: Fluid-filled sacs that can form on the ovaries, leading to pain and discomfort.

• Polycystic Ovary Syndrome (PCOS): A hormonal disorder that can cause irregular periods and pelvic pain.

While some level of menstrual pain is considered normal, certain characteristics may indicate abnormal menstrual pain that requires medical evaluation. Severe, prolonged, or sudden-onset pain, along with other accompanying symptoms, should be closely monitored and evaluated by a healthcare provider. Early detection and treatment of underlying conditions can help manage menstrual pain and improve reproductive health.

References:

• Proctor, M., Farquhar, C., & Stones, W. (2006). Dysmenorrhoea. BMJ clinical evidence, 0705.
• Marjoribanks, J., Ayeleke, R. O., Farquhar, C., & Proctor, M. (2015). Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database of Systematic Reviews, (7).
• American College of Obstetricians and Gynecologists. (2018). Dysmenorrhea: Painful Periods. ACOG Patient FAQ.
• Mayo Clinic. (2022). Menstrual cramps: Causes, treatment and self-care tips. https://www.mayoclinic.org/diseases-conditions/menstrual-cramps/symptoms-causes/syc-20374938
• The American Congress of Obstetricians and Gynecologists. (2020). Endometriosis. ACOG Patient FAQ.