Menstrual cramps

Periods are part of a woman's life, but severe menstrual cramps don't have to be. They can usually be effectively treated. Women experiencing severe or worsening pain should be examined by a doctor.

At a glance

  • For many girls and women, their period is associated with symptoms like lower abdominal cramps and pain.
  • There are two types of menstrual cramps: primary and secondary.
  • Menstrual cramps can be limited to the lower abdomen or can radiate to the back and legs. Nausea, vomiting, diarrhea, and headache can also occur.
  • For 10 in 100 women, the pain is so severe that they cannot function normally for 1 to 3 days each month.
  • Severe menstrual cramps can be effectively treated.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Period pain: woman lying on her back on a couch with her legs pulled up towards her chest holding her belly with both hands. Her lips are pressed together slightly.

What are menstrual cramps?

The term menstrual cramps refers to cramps and pain in the lower abdomen that occur during monthly menstruation. Many girls and women are experiencing menstrual cramps. The medical term is dysmenorrhea.

Periods are part of a woman's life, but severe menstrual cramps don't have to be since they can usually be effectively treated. In the case of severe pain or if the pain increases over time, a medical examination should be performed to determine the cause.

What are the symptoms of menstrual cramps?

The uterine lining builds up each month. If insemination does not occur, the uterine lining is shed and menstruation begins. During menstruation, the uterine muscles contract and relax with an irregular rhythm, causing the lining to detach from the uterine wall. The tissue and blood are then discharged via the cervix and the vagina.

Sometimes the contracting of the muscles goes unnoticed or only causes a slight pulling sensation, but it can also result in painful cramps.

Menstrual cramps originate in the lower abdomen but can radiate to the back and legs. In addition to cramps, some women experience nausea, vomiting, and diarrhea. Headache or a sense of feeling generally unwell also often accompany menstrual cramps. Women with heavy periods often experience greater pain.

What causes menstrual cramps?

There are two types of menstrual cramps: primary and secondary. 

Primary menstrual cramps are caused by contractions of the uterine muscles. Prostaglandins, hormone-like messengers that influence the perception of pain, play an important role. Prostaglandins cause the uterus to contract and shed its lining. Especially women under the age of 30 and women with heavy periods are more frequently affected by primary menstrual cramps. Factors like hereditary predisposition and stress can increase the risk of menstrual cramps.

Secondary menstrual cramps are often triggered by benign uterine tumors, including myomas and polyps. Endometriosis can also cause severe pain.­ In endometriosis the uterine lining grows outside the uterus, thereby causing problems. In some cases secondary menstrual cramps can also be caused by a contraceptive coil or IUD.

How common are menstrual cramps?

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Menstrual cramps are very common. Most girls and women experience varying degrees of pain during menstruation. For 10 in every 100 women, their symptoms are so severe that they cannot function normally for 1 to 3 days each month.

The pain is usually more significant in women under the age of 20 than in older women. It often decreases or even stops a few years after the first period. Many women also experience fewer symptoms after the birth of their first child.

Secondary menstrual cramps usually first occur when a young woman has already had her period for several years. They can also occur outside menstruation.

How are menstrual cramps treated?

There are many, at times contradictory, recommendations from both doctors and other women for dealing with menstrual cramps.

For example, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can be effective pain relievers. These drugs can reduce menstrual cramps because they inhibit prostaglandin production. Most women tolerate NSAIDs well. Gastric issues can be a possible side effect.

The birth control pill can also alleviate menstrual cramps since it prevents ovulation resulting in lower prostaglandin production. The uterine lining is also thinner. As a result, menstruation is lighter thereby typically reducing the associated symptoms. Side effects of the birth control pill include headache and nausea and an increased risk of thrombosis.

Heat plasters and heat wraps may help to alleviate pain. In addition, a small number of studies have shown that physical exercise like jogging, yoga, and aerobics might perhaps help alleviate pain.

The effectiveness of other treatments, like acupuncture, supplements, and herbal remedies, has not been proven. The relevant studies were not designed well or yielded contradictory results.

Important: Some women find the pain so stressful that psychological pain treatment can be helpful. Such treatment can include psychological counseling and techniques to manage pain, e.g., relaxation and awareness exercises.

When the pain is caused by myomas or endometriosis, additional treatment options are available. Surgery is also a possibility.

For detailed information, for instance about using medication to treat menstrual cramps, visit

How do women cope with severe menstrual cramps in everyday life?

Friends, family members, colleagues, as well as doctors may not take menstrual cramps seriously.

Some women also think they need to suffer through the pain because it is just part of menstruation. However, significant pain that affects life every month for multiple days and perhaps makes a woman unable to work does not have to be accepted as "natural". Downplaying or trivializing symptoms can make it difficult to seek medical advice or a suitable treatment.

Many women find a way to make accommodations for the days on which they experience pain, including taking it easy on those days. Demanding activities may be able to be postponed. Relaxation techniques, breathing exercises, yoga, and tai chi are often found to be helpful for finding peace and reducing stress. Some women find it helpful to be active. In addition, warm baths and sauna sessions are deemed beneficial.

Women who often have to miss work due to severe pain and cramps can have problems at their job and suffer from feelings of guilt and self-reproach. Understanding and support from partners, family, and friends are important and provide a sense of relief for many women.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG).

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