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(Painful Menstrual Cycles; Menstrual Cramps)

Pronounced: dis-men-oh-REE-ah

En Español (Spanish Version)


Dysmenorrhea is painful menstruation. It may include pain in the abdomen, back and legs, abdominal cramps, headache, and fatigue. Most women have painful periods at some time in their life. In some women, the pain is severe enough to interfere with normal activities.

There are two types of dysmenorrhea:

  • Primary dysmenorrhea—painful regular (ovulatory) menstrual cycles; the pain is caused by utrine muscle contractions caused by high levels of prostaglandins produced in the lining and body of the uterus after ovulation.
  • Secondary dysmenorrhea—painful periods due to an underlying condition, such as endometriosis (a condition involving the lining of the uterus or womb) or infection, that can begin at any age

Menstrual Flow

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Primary dysmenorrhea is caused by high levels of prostaglandins in the uterus. Prostaglandins are hormone-like substances normally found throughout the body.

Secondary dysmenorrhea can be caused by:

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors for primary dysmenorrhea include:

  • Ovulatory menstrual cycles ( a normal physiologic condition)
  • Age: less than 20 years old
  • Early onset of menstruation (less than 12 years old)
  • Depression or anxiety
  • Attempts to lose weight (in women 14-20 years old)
  • Heavy bleeding during periods
  • Nulliparity (never having delivered a baby)
  • Smoking

The presence of a known cause of secondary dysmenorrhea (see “Causes”) is a risk factor for developing the condition.


The pain associated with either primary or secondary dysmenorrhea may be sharp and throbbing or dull and aching, depending on the individual. It is most typically located in the lower abdomen and may radiate to the low back or thighs. Other symptoms may include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Headache
  • Irritability


Your doctor will ask detailed questions about your symptoms and medical history, and perform a pelvic examination.

Diagnostic tests may include:

  • Pelvic ultrasound —a test that uses sound waves to examine structures in the pelvis
  • Pelvic laparoscopy —a thin, lighted tube inserted through a small incision in the abdomen to view structures in the pelvis

These tests are usually performed to look for causes of secondary dysmenorrhea.


The treatment of secondary dysmenorrhea varies depending on the underlying condition (for example, antibiotics for an infection or surgery to remove fibroids).

Primary dysmenorrhea is usually treated with medications and lifestyle changes.


  • Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen or naproxen, to reduce levels of prostaglandins in the uterus and decrease pain
  • Oral contraceptives, which prevent ovulation and reduce menstrual blood flow—This is particularly useful in women interested in contraception.

Lifestyle Changes

  • Using a heating pad on your abdomen or taking a warm bath can reduce the discomfort of dysmenorrhea.
  • Talk with your doctor about taking herbs and supplements. Fish oil, magnesium, and vitamin E may help reduce menstrual pain. Other natural treatments, such as the herb boswellia, have been suggested to be helpful for this condition, but there is less evidence for their effectiveness.


To help reduce your chance of getting dysmenorrhea, take the following steps:

  • Exercise regularly.
  • Don’t smoke. If you smoke, quit.
  • Drink caffeine and alcohol moderately.


American Academy of Family Physicians

Women's Health.gov


The Society of Obstetricians and Gynaecologists of Canada

Women's Health Matters


Coco AS. Primary dysmenorrhea. Am Fam Physician . 1999;60:489-496.

Dysmenorrhea: painful menstrual periods. American Academy of Family Physicians website. Available at: http://www.familydoctor.org/829.xml?printxml . Accessed August 10, 2005.

French L. Dysmenorrhea. Am Fam Physician . 2005;71:285-291.

Menstrual cramps (dysmenorrhea). Mayo Clinic website. Available at: http://www.mayoclinic.com/invoke.cfm?id=DS00506 . Accessed August 12. 2005.

Speroff L. Clinical Gynecologic Endocrinology and Infertility. 6th ed. Baltimore, MD: Lippincott Williams & Wilkins; 1999.

Last reviewed January 2008 by Ganson Purcell Jr., MD, FACOG, FACPE

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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