You’re probably familiar with pain around the time of your period—cramps and a sore lower back. You might also experience pain in the middle of your cycle during ovulation.
For some people, menstrual cramps can be extremely painful.
Female pain is often overlooked or under-treated in comparison to male pain presentation (1). And reproductive and menstrual health are immensely under-researched—often, menstrual pain and reproductive illnesses (such as endometriosis) are not well-understood. It’s important to be an advocate for yourself and communicate pain levels to your healthcare provider.
Getting familiar with the basics of menstrual cycle-related pain can help you understand if your pain might be something to talk to your healthcare provider about.
So what exactly causes, and relieves, cramps?
What causes menstrual cramps?
Research shows that menstrual cycle-related pain is caused by prostaglandins—hormone-like substances that help the uterus contract to shed the uterine lining, also known as the endometrium (2, 3).
If you experience premenstrual cramps, the timing of when cramps occur will usually stay about the same, but they may vary in intensity from cycle to cycle (4).
It’s still unclear what causes ovulation pain. It may be from the rupture of the ovarian follicle (5).
When do people usually get cramps?
Some people experience pain symptoms at specific times in their cycle.
Cramps in the uterus and pelvis are common symptoms in the days before and during menstruation. Pain associated with the period is also known as dysmenorrhea (6). Dysmenorrhea can also be felt in the lower back and thighs.
Pain can also occur in the middle of your cycle. Ovulation pain, also known as mittelschmerz, is usually felt in the lower abdomen.
Ovulation pain is felt as a sharp pelvic pain around the time of ovulation—it’s usually mild and may last from a few hours to even a couple of days (7). This pain signals that ovulation (the release of an egg from the ovary) has occurred, and is typically felt on one side of the lower abdomen—the side of the ovary that releases the egg (7).
How to relieve menstrual cramps
NSAIDs (non-steroidal anti-inflammatory drugs), like ibuprofen, block prostaglandin production and have been shown to be effective pain relief for cramping (8).
There’s also evidence for non-pharmaceutical pain relief methods. Heat (such as a heat pad or hot water bottle) has been shown to be as effective as NSAIDs and aspirin for pain relief in people without blood coagulation problems (9-11).
Herbal remedies, exercise, dietary changes, and acupuncture have also been studied—although results were promising, more research is needed here (2, 12-14).
Some people may choose to use hormonal contraceptives to relieve and prevent menstrual cramps altogether.
What kind of menstrual pain is “normal”?
Getting familiar with pain symptoms in your cycle is a helpful baseline for when you suspect something might be wrong. Tracking your cycle can be helpful in determining what “normal” menstrual pain is for you.
You also may be able to identify whether something in your life is triggering increased pain or symptoms—like stress or sleep—and/or identify helpful coping mechanisms, such as using ibuprofen and heating pads (4, 15).
You should see your healthcare provider if your pain symptoms are severe enough to disrupt your daily functioning, and/or significantly change in intensity during any given cycle, and if cramping is unusually severe or lasts more a few days.
Severe cramps or chronic pelvic pain could be a symptom of endometriosis. The pain experienced by people with endometriosis is different from normal menstrual cramping, and involves endometrial-like tissue which grows outside of the uterus. This tissue is responsive to the hormonal fluctuations within the body just like the endometrium, which can grow, bleed, and irritate surrounding tissue. This can create an inflammatory environment and tissue breakdown, which can cause adhesions (scar tissue) growths, and produce chronic and cyclic pelvic pain (16).
Tracking pain with Clue throughout the cycle for several cycles will help you determine which symptoms, if any, recur at specific times.