Primary dysmenorrhea is caused by high levels of a hormone called prostaglandins.

Secondary dysmenorrhea is caused by a health issue such as:

  • Endometriosis
  • Ovarian cysts
  • Pelvic inflammatory disease or other infection
  • Noncancerous growths in the uterus—uterine fibroids
  • Intrauterine device (IUD)
  • Scars from a past surgery
  • Tumors
  • Inflammatory bowel disease

Risk Factors

Painful menstrual periods are more common in people under 30 years of age. They may also be more common in people who:

  • Have low body weight, especially as a teen
  • Smoke
  • Started their menstrual periods before 12 years of age
  • Have longer menstrual cycles or heavy bleeding during periods
  • Have not delivered a baby
  • Have depression, anxiety, or other mental health issues



The pain may be sharp and throbbing, or dull and aching. It often starts in the lower belly and may spread to the low back or thighs. A person may also have:

  • Nausea
  • Vomiting
  • Diarrhea
  • Headache
  • Irritability


The doctor will ask about symptoms and past health. A pelvic exam will be done. Other tests may be done to look for causes. Tests may be:

  • Pelvic ultrasound
  • Hysteroscopy
  • Hysterosalpingogram
  • Pelvic laparoscopy



Medicine and home care can help manage primary dysmenorrhea. Treatment for secondary dysmenorrhea will focus on the health issue causing the problem.

Over the counter medicines such as ibuprofen and naproxen can help.

The doctor may advise birth control pills for some. They may help balance hormones.

Other ways to ease discomfort include:

  • Heat therapy—such as heating pads, warm baths, or low-level heat patches
  • Regular exercise
  • Alternative treatments—such as herbs, supplements, acupuncture, and yoga


Things that may reduce the risk of some painful menstrual periods are:

  • Exercising regularly
  • Not smoking.
  • Limiting caffeine and alcohol

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.