Dysmennorhea
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ACOG dysmenorrhea painful periods guidance NSAIDs hormonal treatment red flags
Dysmenorrhea means painful menstrual cramps or painful periods.
- Primary dysmenorrhea: Common cramping pain before or during periods, without an underlying pelvic disease. It is caused largely by prostaglandins, chemicals that increase uterine contractions.
- Secondary dysmenorrhea: Period pain due to another condition, such as endometriosis, adenomyosis, fibroids, pelvic inflammatory disease, or an ovarian cyst.
Usual first measures
- Heat pad or warm bath, gentle activity, adequate rest.
- Anti-inflammatory pain medicines such as ibuprofen or naproxen can help when started at the beginning of pain or just before a predictable period. Do not use them without medical advice if you have a stomach ulcer, kidney disease, are on blood thinners, have an NSAID allergy, or might be pregnant.
- If pain remains disruptive, a clinician may discuss hormonal options such as combined contraceptive pills, progestin-only methods, or a hormonal IUD. The ACOG patient guidance describes these options.
Seek medical assessment if pain starts later in life, progressively worsens, begins well before bleeding and continues after the period, does not improve with usual treatment, or occurs with very heavy bleeding, pain during sex, infertility, fever, unusual discharge, or a possible pregnancy.
Urgent care: sudden severe one-sided pelvic pain, fainting/dizziness, fever, vomiting, or pain with a positive pregnancy test.
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