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When does menstrual cramp pain indicate that something more serious is wrong?

Violet Bauske, for Saint Joseph Mercy Health System
If menstrual cramps consistently prevent a woman from her regular activities, there is reason to suspect that something else is going on.

Cramps are a well-known symptom of being female. But what is known about how much discomfort is normal?

A high percentage of women experience painful periods that interfere with their daily life. This condition is called dysmenorrhea. While debilitating cramps are not rare, they shouldn’t be considered normal.

If menstrual cramps consistently prevent a woman from engaging in regular activities such as going to work, there is reason to suspect that something else is going on. Severe cramps should be brought to a doctor’s attention in case an underlying medical issue exists.

Here are cramps that may be abnormal:

Cramps that interfere with daily life

If the cramps are so bad a woman calls off work on a regular basis, something is not normal. Fun fact — some countries actually give women a few days paid time off at “that time of the month.” Unfortunately American women are still on the hook for work.

However, some women call in sick on a regular basis due to intolerable cramps. Not only does this suck up their hard-earned vacation time, it may indicate a serious medical condition.

Cramps that don’t respond to over-the-counter painkillers

Run-of-the-mill menstrual cramps should respond well to OTC pain medications, like ibuprofen or acetaminophen.

If these medications don’t dull the pain, a different issue such as ovarian cysts or endometriosis could be the cause.

Cramps occurring at off times of the month

Pelvic discomfort should really only occur for a few days around the start of a menstrual period. It is also considered normal to have slight discomfort around ovulation, which takes place midcycle. Cramps should not happen right after a period ends or consistently throughout the month.

Cramps or pain during sex

Pain during sex can indicate underlying pelvic problems. Sometimes the cause of pain during sex is the same root cause of abnormally painful menstrual cramps. Many common and treatable conditions can cause cramps during sex.

Cramps that worsen

Cramps that suddenly worsen or steadily worsen over time can indicate a problem. Normal menstrual cramps are more likely to improve with age, especially among women who have given birth.

Identifying symptoms can be helpful but it’s always good to talk to a doctor to define a course of action if there needs to be one. More than likely, however, there are a few usual suspects that are causing the symptoms:


Endometriosis occurs when the tissue that lines the uterus spreads to other pelvic organs such as the ovaries, fallopian tubes and pelvic lining. Treatments include hormone therapy and laparoscopic surgery.

Uterine fibroids

Uterine fibroids are noncancerous growths in the wall of the uterus. Treatments include medications, myomectomy, hysterectomy or uterine artery embolization.

Pelvic inflammatory disease

Pelvic inflammatory disease is an infection of the reproductive organs often caused by a sexually transmitted disease. The treatment is usually antibiotics.

Cervical stenosis

This is a condition in which the opening of the cervix is too small and impedes menstrual flow, causing painful pressure in the uterus. Treatment is a gradual widening of the cervix using surgical tools.

Ovarian cysts

When a cyst grows on the ovary it can cause pelvic bloating, cramping and pain that doesn’t respond well to OTC pain medication. The treatment is laparoscopic surgery to remove the cyst, or sometimes to remove the whole ovary depending on the size and placement of the cyst.

Talking with a doctor about menstrual cramps isn’t always easy. Coming prepared with a clear description of the cramps, such as exactly when they occur and what they feel like, can be helpful. A doctor may recommend medication first but be sure to tell them which medications have already been tried. Tests and imaging will likely be ordered to reach a diagnosis.

While most women experience some level of discomfort before and during their periods, the pain should not be consistently severe. Most of the time the underlying causes are treatable or curable so make an appointment to see a doctor if concerns exist.

Saint Joseph Mercy Health System offers preventative care and treatment options for women. Visit us online at to check out locations and services, or to talk to a doctor about identifying and treating menstrual pain.

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