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Menstrual cramps can range from nonexistent to several days of intense pain. In women, they are one of the most common causes of pelvic pain, but are severe menstrual cramps a sign of more harmful underlying condition?

What are severe menstrual cramps?

Typically, menstrual cramps will begin a couple days before or the day your period starts. Under normal circumstances, this may feel like a throbbing, aching, or cramping pain in your lower abdomen, though the pain may also spread to your lower back or inner thighs.

While normal menstrual cramps can peak at a high level of pain, they can usually be controlled with over-the-counter (OTC) medications like ibuprofen or acetaminophen.

A person with severe cramps, however, will experience cramping that begins earlier in their menstrual cycle and will last longer than the typical 2 to 3 days. Additionally, people with severe cramps may find that their cramps heavily interfere with daily activities, are accompanied by heavy bleeding or clotting, and do not improve with OTC pain medication.

What Might Severe Cramps Mean for my Health?

While some people experience severe cramps without an underlying cause, extreme pain during your period may be a sign of one of the following conditions:


Endometriosis is a chronic, but noncancerous, medical condition in which cells like those in the uterine lining grow outside the uterus. This extra growth leads to painful periods, but also heavy periods, gastrointestinal pain, bleeding between periods, painful intercourse, and infertility.

Although endometriosis can’t be cured, patients should discuss pain management options with their OBGYN to determine which interventions may be best for them.

Polycystic Ovary Syndrome (PCOS)

PCOS is a hormone disorder which affects about 1 in 10 adult women. This disorder is caused by higher levels of androgens, a type of male hormone, in the body, which contributes to irregular, heavy, or prolonged periods, excessive facial or body hair, weight gain, acne, hair loss, skin tags, or dark patches of skin.

If you are diagnosed with PCOS, your doctor may prescribe you hormones like birth control to regularize periods, and may also suggest other ways to manage symptoms, including diet changes, creams to deal with acne or hair loss, and specific vitamins.


Painful periods may also be a sign of fibroids, which affect about half of all women before age 50. Fibroids are noncancerous growths inside or outside the uterus, some of which may be asymptomatic. Others, however, may cause severe menstrual cramps, lower back pain, pelvic pressure, constipation, and frequent urination.

The treatment for fibroids will depend on their severity. Some people may be able to live comfortably with fibroids and may not even realize they have them, while others may require invasive surgery for relief. Ultimately, patients with fibroids should discuss all options, including medications, birth control and possible surgery with their provider to decide which treatment best fits their needs.


While severe menstrual cramps are not always a sign of an underlying condition, if you find that your life is often disrupted by painful periods, talk to your healthcare provider to get to the bottom of what’s causing your severe cramps and develop a plan to manage your pain.