Oh, menstrual cramps. If you’ve never complained about the aches and pains of your period to a friend, you’re a rare individual. It’s a frequent topic of conversation. And yet, with all that talking, you probably still don’t know what’s considered normal and what’s not.
You might get the impression that very painful periods are the norm. Discomfort during menstruation isn’t uncommon, especially in young individuals. About half of all menstruators experience pelvic achiness during their periods.
With that said, really bad menstrual cramps are not normal. Severe period cramps can signal a problem—a problem that may impact your fertility.
Here are six ways to know if your cramps aren’t the regular sort. As always, if you have any questions or concerns about your health, talk to your doctor.
Your Period Cramps Keep You From Going About Your Normal Life
If your period pain is so bad that you need to call off work on a regular basis, you should speak to your doctor.
Depending on the study, between five and 20 percent of women experience painful periods that interfere with their daily life. It’s not rare. But it’s not normal, either.
Some countries offer a couple days off every month for menstruation. Don’t misconstrue this for saying that menstruation should be so painful that you can’t come to work. The issue is more complex than that. It’s not even clear whether these laws are good or bad.
In 2013, Russian lawmaker Mikhail Degtyaryov proposed that Russia should offer days off for menstruation. This was his argument: “During that period (of menstruation), most women experience psychological and physiological discomfort. The pain for the fair sex is often so intense that it is necessary to call an ambulance.” Not exactly a realistic portrayal (or understanding) of menstruation.
If your pain is bad enough to call an ambulance, please call one. Those aren’t period cramps. Something much more serious is going on.
In a more likely scenario, if your pain is bad enough to regularly miss work or school, make an appointment to speak to your doctor.
For those 20 percent who experience monthly discomfort, most can get relief with over-the-counter pain medications, like ibuprofen or acetaminophen.
If over-the-counter medication is not enough to help you get on with your day, then your period cramps aren’t normal.
Very important side note: Some people will take more than the recommended dosage of over-the-counter pain relievers thinking that since they are over-the-counter, they are therefore harmless. Over-the-counter is not a code word for dosage-doesn’t-really-matter. Don’t do this. It can be extremely dangerous and even deadly.
If the recommended dosages aren’t enough, go to your doctor.
Pelvic discomfort just before your period and during the first few days of your period can be normal. You may also experience some sensitivity around ovulation. But if you have pelvic pain at other times during your cycle, that may signal a problem.
Another possible sign your cramps aren’t normal is if you experience pain during sex. Some causes of painful sex are also responsible for abnormally bad period cramps.
It’s normal for the bleeding during menstruation to last anywhere from two to seven days. It’s not normal, however, to have bad period cramps during that entire time.
Two or three days of menstrual discomfort is considered to be normal.
Cramps may start the day of or day just before the bleeding starts, but they should not continue all the way until the end of your period. They certainly shouldn’t still be there after your period ends.
You’re Worried Your Period Cramps Aren’t Normal
If you’re worried your period cramps aren’t normal, then you should take that concern seriously. Worrying isn’t a sign that something is wrong, but it could suggest things might be wrong. Many people are afraid to talk to their doctors about symptoms that can’t easily be quantified.
If you have a fever, your doc can confirm that by taking your temperature. If you’re experiencing pain, your doctor has to take your word for it. This keeps a lot of people from seeking help.
Also—sadly—complaints about pain (especially coming from a woman) are sometimes dismissed by those in the medical profession.
If you brought up your pain to a doctor in the past, and they brushed it off as not serious, you may be remiss to bring it up again. But you should bring it up again. Especially if you’re concerned about it.
Some of the possible causes for painful cramps—like endometriosis—are diseases that take years to get properly diagnosed. Keep asking for help until someone hears you
Maybe you’re really not sure whether your cramps are normal or not, but you also experience other worrisome (related) symptoms.
Other worrisome symptoms may include:
Bottom line: if you’re worried, talk to your doctor.
What Could Be Wrong?
Let’s say your cramps are worse than average. What could be wrong? There are a few possibilities.
Really bad menstrual cramps may be caused by:
To evaluate what may be wrong, you may have:
- Blood work
- A pelvic exam with sexually transited infection (STD/STI) testing
- A pelvic ultrasound
- Exploratory laparoscopy (in especially severe cases)
It’s important to know that endometriosis can only be diagnosed with exploratory laparoscopy. It can’t be ruled with ultrasound or a pelvic exam. However, laparoscopy is an invasive, surgical procedure, so your doctor may not recommend having it unless your symptoms are especially bad.
Sometimes it happens that you see your doctor and are told everything is fine. If your cramps aren’t interfering with your daily life, this may be reassuring and an acceptable answer.
However, if your cramps are making it difficult to work and live, don’t accept “You’re fine” as an answer. Seek out another doctor.
Warning: If severe cramping is accompanied by fever, vomiting, dizziness, or unusual vaginal bleeding or discharge, call your doctor immediately. Also, if the pain is especially severe, call your doctor right away.