What Could Be the Cause of Painful Menstruation?

As Vulva Specialists explain: “Menstrual cramps (dysmenorrhea) are throbbing or cramping pains in the lower abdomen. Many women have them just before and during their menstrual periods. For some women, the discomfort is merely annoying. For others, menstrual cramps can be severe enough to interfere with everyday activities several days each month” [1]. So if the latter applies to you, book an online or in-person appointment with a Vulva Doctor ASAP

Did You Know?

Menstrual cramps can be caused by certain conditions such as uterine fibroids or endometriosis.

So What Symptoms Should I Look Out For?

• Cramping or throbbing pain in the lower abdomen (this can be on a variable pain scale form mild to intense)
• Pain which begins 1 to 3 days prior to having a period; peaks 24 hours after the period started; and subsides within 2 to 3 days
• A dull, non-stop ache
• Pain which radiates to the thighs and lower back [1]

Of note: it is a good idea to keep a ‘Pain Diary,’ that way, you can show it to your Vulva Consultant on both your initial and follow-up appointments. This will be very helpful, and that way, you will be giving your Vulva Doctor accurate information that was recorded at the time it occurred. (The Pain Dairy should have daily entry spaces; and you should list: the symptoms, how the long the pain lasted, and how intense the pain felt).

In addition to the aforementioned, some women also experience:
• Dizziness
• Headache
• Loose stools
• Nausea [1]

A Detailed Overview on What Causes Painful Menstruation

When a woman has a menstrual period, their uterus contracts in order to help discharge its lining. When this happens, prostaglandins (hormone-like substances that are associated with inflammation and pain), trigger the contraction of the uterine muscle. Of note: higher levels of prostaglandins are linked to more severe menstrual cramps [1].

The root causes of menstrual cramps comprise:

• Endometriosis: this condition is similar to the uterus lining growing outside the uterus. It mainly affects the fallopian tubes, the ovaries, and the tissue lining the pelvis.
• Uterine fibroids: these are non-cancerous growths which are found in the uterus wall. In some instances, they can be painful
• Adenomyosis: this refers to the tissue that lines the uterus beginning to grow into the uterus’ muscular walls
• Pelvic inflammatory disease: this describes an infection in the female reproductive organs. In the majority of cases, it comes about from sexually transmitted bacteria
• Cervical stenosis: this refers to a condition in which the opening of the cervix is small enough to obstruct menstrual flow. When this happens, the pressure within the uterus increases; and this is painful [1]

So What Are the Risk Factors For Getting Menstrual Cramps?

Women may be at risk of contracting menstrual cramps, if:
• They are under 30 years of age
• They had early puberty (age 11 or younger)
• They experience heavily bleeding (menorrhagia) when they have a period
• They experience metrorrhagia (irregular menstrual bleeding)
• They have a family history of dysmenorrhea (menstrual cramps)
• They smoke [1]

Are There Any Complications Connected to Menstrual Cramps?

The short answer to this is “no;” however, menstrual cramps can interfere with various activities.
Moreover, as Vulva Doctors regularly see, some of the conditions linked to menstrual cramps do have complications. Examples of this include: endometriosis, which can cause fertility issues; and pelvic inflammatory disease, which can scar the fallopian tubes, thus escalating the risk of an ectopic pregnancy (a fertilized egg implanting outside of the uterus) [1].

When to See a Vulva Doctor

Do this if your:
• Menstrual cramps are disrupting your life every month
• Your symptoms get progressively worse
• You’ve just begun experiencing severe menstrual cramps after age 25 [1]


[1]. Mayo Clinic (2022). “Menstrual Cramps.”