Are period cramps normal? What hurts, what helps, and when to see a doctor.

Myths about menstruation have existed for as long as people have menstruated.

The ancient Romans believed that menstrual fluid could kill crops. And today, the urban legend that swimming in the ocean with a tampon attracts sharks still scares beachgoers. It’s clear that menstruation can be a confusing and sometimes mysterious thing.

Menstrual cramps — one of the classic period symptoms — can be baffling, in part because of how varied the experience is. Some people breeze through their cycle experiencing mild to nonexistent discomfort. For others, the pain is blinding, and they can barely pry themselves out of bed or off the bathroom floor.

Are period cramps normal?

Painful menstrual cramps, known medically as dysmenorrhea, is a very common, occurring in 50 to 90 percent of girls and women of reproductive age. To understand why it happens, we have to go back to health class and go over the basics of menstruation: bleeding during your period — also known as shedding the uterine lining. This is caused by two things: 1) hormones causing the uterine lining to thicken in preparation for the possible implantation of a fertilized egg, or zygote, and 2) a fertilized egg not implanting in the uterus. When no fertilized egg implants, the body sheds the uterine lining as well as the unfertilized egg.

Kelli Burroughs, a board-certified OB/GYN in Texas, tells Inverse that typical period pain is caused by an increase in prostaglandins, which are compounds our bodies create that enable the muscles and blood vessels in the uterus to contract.

On the first day of a menstrual cycle, levels of prostaglandins are high, which is why so many people experience the worst cramping in those initial days. As the days continue, the lining of the uterus is shed, and prostaglandin levels decrease, resulting in less pain.

Not everyone experiences cramping, however. Aparna Sridhar, an OB/GYN and Associate Clinical Professor in Obstetrics and Gynecology at UCLA, tells Inverse that we don’t always know why some people get more severe cramps than others.

“In some who experience worse cramps during menstruation, there is an underlying cause...In some others, there is no demonstrable cause that we can pinpoint,” she says.

Burroughs says some researchers think women with more severe period cramps might simply produce more prostaglandins than others, though more research is needed to know for sure.

Prostaglandins aren’t always to blame. Some underlying conditions can also increase cramp severity. Gynecologists say these conditions can contribute to worse menstrual cramping:

Endometriosis: This is the most common cause of secondary cramping (cramps caused by an underlying condition). Burroughs explains, “Endometriosis happens when tissue similar to the lining of the uterus grows in other areas of the body, such as on the ovaries and fallopian tubes, behind the uterus, and on the bladder.”

Like the lining of the uterus, this tissue thickens, breaks down, and bleeds during the menstrual cycle. The bleeding associated with this abnormally located tissue causes pain and can result in adhesions or scar tissue, which Burroughs says can lead to chronic pain.

Uterine fibroids: Fibroids, Burroughs explains, are “typically benign growths that form on the outside, on the inside, or in the walls of the uterus. Fibroids located in the wall of the uterus are more likely to cause pain. Small fibroids usually do not cause pain.”

Adenomyosis: This condition develops when tissue associated with the lining of the uterus begins to grow in the muscle wall of the uterus, Greg Marchand, a gynecological surgeon tells Inverse.

Burroughs says that structural problems with the uterus, fallopian tubes, and other reproductive organs can also be a secondary source of cramps.

Do tampons cause worse cramps?

I don’t know where I first heard that tampons could make cramps worse or why I believed it so quickly, but Burroughs says there’s no evidence to support that claim.

Sridhar agrees. “[A] tampon is usually in the vaginal area, and cramps originate from the uterus.” This makes it unlikely one is affected by the other.

However, conditions like endometriosis or vaginismus — where the vaginal muscles contract involuntarily or persistently when penetration occurs — might make it feel like tampons are making cramps worse.

Other than over-the-counter pain medication, what helps cramps?

Burroughs says most menstrual cramps can be well-managed with over-the-counter options such as NSAIDs like ibuprofen, which decrease the production of prostaglandins, and heating pads. “Medication use is most effective when started 1–2 days before the onset of menses and continued through the first 2–3 days of bleeding,” she says.

Marchand notes that taking medications like Ibuprofen and Naproxen with food is important, as is never using them together.

Other medications that can help are birth control methods that contain estrogen and progestin, like “the pill, the patch, the vaginal ring, progesterone intrauterine device, and progesterone contraception injection,” Burroughs says.

Non-medication options include heating pads, acupuncture, acupressure, and physical exercise (as unappealing as that may sound while cramping). Even masturbation can temporarily relieve cramps.

Anna Cabeca, an OB/GYN in Georgia, tells Inverse, “Everything period related is connected to the fluctuations of our hormones, and what you put in your body will have a direct impact [on cramps].” She suggests minimizing coffee intake to 1 cup per day, saying “too much caffeine can constrict the blood vessels which can worsen your cramps.”

She also advises staying away from sugar and carbs during your period.

“Sugar is an inflammatory, which can make cramps worse. By increasing your sugar intake at that time, all you do is add fuel to the fire,” she says. “Also, avoid fatty and processed foods, and minimize chocolate intake, as chocolate can elevate prostaglandins, and we know that high levels of those will increase the severity of your cramps.”

When to see a doctor for period cramps

If your period pain worsens or is unresponsive to treatment, Burroughs says it’s time to consult with an OB/GYN. “Keeping a menstrual diary is also helpful in order to document the length of your menstrual cycle, number of days with severe cramping, and heaviness of bleeding. Discussing your menstrual diary with your physician will aid in proper diagnosis and treatment options,” she says.

Sridhar adds, “If the cramps are altering their daily life and interfering with the quality of life, it is a good time to make an appointment to see a doctor.”