Menstrual cramps are caused by painful contractions of the uterus. These contractions result in the release of the uterine lining once a month (a period). The uterus knows when it's time to start contracting when it gets a signal from prostaglandins.

Prostaglandins are compounds that function like hormones in the body. Studies show that higher prostaglandin levels can lead to more uterine cramps, higher uterine pressure, and more pain, while lower prostaglandin levels can lead to fewer uterine cramps, lower uterine pressure, and less pain.

Pharmacological approaches to period pain relief tend to focus on lowering prostaglandin levels. For example, prescription nonsteroidal anti-inflammatory drugs (NSAIDs) can bind to enzymes involved in prostaglandin synthesis. By inhibiting this enzyme activity, these drugs can reduce pain levels.

When pelvic pain is caused solely by a menstrual cycle, it's called primary dysmenorrhea (painful menstruation). When pelvic pain has another underlying cause, like endometriosis or uterine fibroids, it's called secondary dysmenorrhea.

Primary dysmenorrhea

1. Pain cycles may begin 6 to 12 months after getting your first menstrual period

2. Pain may start 2 to 3 days before you get your period or when you start bleeding

3. Pain may last 8 to 72 hours

4. Pain may decrease as you get older

Secondary dysmenorrhea

1. Pain may be unusually severe and worse with time

2. Pain may last longer than 2 to 3 days

3. Pain may start later in life (like after age 25)

Clinicians usually recommend seeing a healthcare provider in person, likely for a pelvic exam, if you haven't experienced period pain relief after 3 to 6 months of NSAID or hormonal contraceptive treatment. They also recommend seeing a doctor if you have other symptoms of secondary dysmenorrhea, like pain during sex, pelvic pain that isn't related to your menstrual cycle, or abnormal bleeding.

For menstrual pain relief, your clinician may prescribe a specialized NSAID or a hormonal contraceptive.

Specialized NSAIDs like mefanamic acid and diclofenac can help relieve period pain by blocking prostaglandin action. They can be more effective for treating menstrual cramps than over-the-counter NSAIDs like ibuprofen, which are derived from phenylpropionic acid.

Your clinician may also prescribe hormonal contraceptives, which can lower prostaglandin levels. Forms of birth control your clinician may prescribe include pills, a vaginal ring, a subcutaneous injection (Depo-Provera), or a patch.

Please note: This information is for general reference only. Your online doctor or nurse practitioner will review your symptoms and health history to determine which (if any) dysmenorrhea treatments are medically appropriate.

Symptoms of endometriosis, a chronic condition that affects 1 in 10 women of reproductive age, can be treated with many of the same therapies that treat period cramps. If you've already been diagnosed with endometriosis, you can seek relief from your symptoms through Amazon Clinic.

Endometriosis is caused by endometrium cells growing and forming lesions outside the uterus (ectopically). The condition can cause inflammation, intense pain, and sometimes infertility. If you have signs of secondary dysmenorrhea (see "Should I be worried about pelvic pain?"), then make an appointment with a trusted healthcare provider like an obstretrician-gynecologist (OB-GYN) to rule out endometriosis.

Endometriosis can be diagnosed with medical imaging (ultrasound or MRI) or a surgical biopsy, yet it often takes years (10 on average) for women to be diagnosed.

Research has shown some benefits of exercise, applied heat (heating pads or hot water bottles), acupuncture, acupressure, and transcutaneous electrical nerve stimulation (TENS) on period pain.

Video visits are available in all 50 states and D.C. Message-only visits are available in 34 states. To see your visit options, first choose your state.

Amazon Clinic protects your health information by strictly following the requirements of the Health Insurance Portability and Accountability Act (HIPAA). HIPAA governs what Amazon Clinic and your healthcare providers can do with your medical information, as well as your contact and payment information. Amazon Clinic doesn’t and will never sell your personal information. Learn more on our privacy page.