Skip to main content

The question

I am 42, and experiencing severe cramps at the onset of every menstrual period. I have always had some degree of pain, but I have noticed that it has increased with the past few periods. I am having to take over-the-counter painkillers at least 2-3 times a day, before it stops.

Could there be any underlying condition? Do you recommend consulting a specialist?

The answer

Painful menstrual periods or dysmenorrhea is very common and is one of the leading causes of sick days off work for women.

The intensity of pain can vary between individuals and can also be different within each person from cycle to cycle, but generally felt as a dull, cramping ache in the lower abdomen and can be accompanied by symptoms of low energy, headache, nausea, and vomiting.

Painful menstrual periods fall into two groups depending on the cause:

Primary dysmenorrhea is the most common form of painful periods and can affect women of any age but often improves after childbirth. Primary dysmenorrhea is not due to any abnormality in the reproductive system, but is thought to be due to the production of hormones called prostaglandins which cause contractions of the muscular wall of the uterus. Pain starts a day or two before menstruation and is worse on the first 2 days of the cycle.

Excessive prostaglandin production can cause strong uterine contractions which can be very painful. Antinflammatories such as ibuprofen (Advil/Motrin) work by inhibiting prostaglandin production which is why they work well for this type of dysmenorrhea. Oral contraceptive pills are also used for painful periods as they too decrease prostaglandin production.

Secondary dysmenorrhea is less common and is due to underlying conditions that affect the uterus and reproductive organs. As in your situation, secondary dysmenorrhea can occur for women who may have had normal periods in the past, but start to develop more severe pain later in life. Because they are thought to be due to an underlying condition, a visit to your doctor would be important to rule out the following potential causes:

Pelvic inflammatory disease (PID): A complication of sexually transmitted infection which causes inflammation in the uterus and fallopian tubes and can lead to painful periods.

Endometriosis: Occurs with the growth of endometrial tissue (tissue lining the uterus) outside of the uterus. During menstruation, this tissue breaks down and bleed causing severe abdominal pain

Fibroids: Benign, noncancerous growths in the uterus that can cause pain and heavy menstrual blood loss.

Cervical stenosis: narrowing of the opening to the uterus, which can cause painful cramping as the utuers needs to work harder/contract stronger to expel blood.

IUD: intrauterine device made of copper is used as contraception but can trigger heavier and more painful periods.

In your situation, I would recommend a visit to your family doctor to rule out one of these underlying causes for your painful periods, especially since they are getting worse.

By identifying the potential causes, treatment can be started by your family doctor, but in some cases such as with fibroids or endometriosis - surgery may be needed and your family doctor can refer you to a gynecologist for further care.

Send family doctor Sheila Wijayasinghe your questions at She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

Read more Q&As from Dr. Wijayasinghe.

Click here to see Q&As from all of our health experts.

The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.