Severe menstrual pain, also known as dysmenorrhea, can significantly affect a woman's quality of life. The causes of this pain vary, and while period pains are sometimes normal, other times they can indicate a serious medical problem. In this article, we take a look at five of the most common causes of painful periods to help you understand when pain is a natural part of your cycle and when it's time to see a doctor for professional help.

1. Primary dysmenorrhea

Primary dysmenorrhea is pain caused directly by menstruation and related biological processes. With the onset of menstruation, the level of the hormone prostaglandin in the uterus increases. Prostaglandin causes the muscles of the uterus to contract, which helps the lining of the uterus to shed and leave the body. Strong contractions can cause pain, cramps, and even nausea.

The higher the prostaglandin level, the worse the pain. This type of pain usually begins the day before or the first day of your period and can last one to three days. Although dysmenorrhea symptoms can be severe, it is usually not a sign of disease and disappears with age or after childbirth.

2. Endometriosis

Endometriosis is a condition in which tissue similar to the endometrium (the inner layer of the uterus) begins to grow outside the uterus, often on the ovaries, fallopian tubes, or pelvis. This tissue acts like a normal endometrium: it thickens, breaks down, and bleeds every month in response to hormonal changes, which can cause significant pain.

The pain associated with endometriosis is usually worse than regular dysmenorrhea and can start a few days before your period and continue throughout and even after it ends. It is important to see a doctor if the pain becomes unbearable or is accompanied by other symptoms, such as pain during intercourse and defecation.

3. Uterine fibroids

Uterine fibroids are benign tumors that can develop in different parts of the uterus. Although fibroids don’t always cause symptoms, some women may experience severe menstrual cramps, heavy bleeding, pressure, and discomfort in the lower abdomen.

Depending on the location and size of the fibroid, this can increase menstrual pain as the tumor causes an expansion in the amount of tissue to be shed during the cycle. Sometimes fibroids need treatment, especially if they cause anemia from blood loss or increase the risk of pregnancy complications.

4. Cervical stenosis

Cervical stenosis is a narrowing of the passage in the cervix that can make it difficult for menstrual blood to pass through. This leads to increased pressure in the uterus, causing intense pain and cramping. Cervical stenosis can be congenital or develop after surgery or infection.

In women with this condition, menstruation may be accompanied by painful cramps and a feeling of heaviness in the lower abdomen. Cervical narrowing sometimes requires medical intervention to facilitate blood circulation. In some cases, the condition can be corrected by dilating the cervix.

5. Polycystic ovary syndrome (PCOS)

PCOS is a hormonal disorder characterized by irregular periods, elevated androgen levels, and the presence of multiple small cysts on the ovaries. Women with PCOS often experience pain during their periods caused by hormonal imbalances.

The pain may be associated with irregular menstruation and an increase in the volume of the endometrium. PCOS may be accompanied by cramping and discomfort, as well as other symptoms such as acne, weight gain, and excessive hair growth. Hormone therapy and lifestyle changes may be necessary to manage PCOS symptoms.

When should you consult a doctor?

Severe pain during menstruation is not always a sign of serious conditions. However, if the pain interferes with daily life or is accompanied by other symptoms such as heavy bleeding, pain during intercourse, weight loss, weakness, and fever, it is important to consult a gynecologist. Early detection and treatment of many diseases not only help to reduce the intensity of pain but also prevent possible complications such as infertility or chronic pelvic pain.