Many people who get a period are used to cramps coming along with it, but not all cramps are created equal. The medical term for cramping is “dysmenorrhea,” and there is both "primary" and “secondary” dysmenorrhea.
Primary and secondary dysmenorrhea
Primary dysmenorrhea is the name for common menstrual cramps. Typically, this cramping begins one or a few days before a period starts, peaks about 24 hours after your period starts, and can last another couple of days. These kind of cramps are usually in the lower abdomen, back, or inner thighs, and can range from mild to severe. They can also come with symptoms like fatigue, diarrhea, nausea, vomiting, headaches, or dizziness. Cramps that are particularly bad are more common if you have heavy periods, irregular bleeding, a family history of cramps, or smoke (and smoking isn’t good for your health for countless other reasons too, so you should really talk to your healthcare provider about quitting if this describes you).
With primary dysmenorrhea - or common, normal cramping - some people experience cramps with their first period, but for others, cramping might not really begin until a year or two later when their cycle is more regular. Primary dysmenorrhea cramping can often improve as a person ages and even after giving birth.
Secondary dysmenorrhea is the kind of cramping that’s caused by a disorder in the reproductive organs. This sort of pain exists at different times in the cycle compared to common period cramping, and usually happens earlier in the menstrual cycle and lasts longer. This sort of pain also typically starts later in life than primary dysmenorrhea and tends to get worse over time. The pain that comes with secondary dysmenorrhea is not usually accompanied by things fatigue, diarrhea, nausea, vomiting, headaches, or dizziness. Secondary dysmenorrhea can be caused by conditions like endometriosis, adenomyosis, uterine fibroids, cervical stenosis, or pelvic inflammatory disease.
So what’s normal?
Some people never experience cramps, other people experience severe period cramping that is still considered normal. Really, there’s a range of what's normal. Over time, people often begin to understand what feels normal for them during their cycle, and what sort of cramping is typical for them. Paying attention to when in your cycle the cramping occurs and what other symptoms accompany it can help you distinguish between primary and secondary dysmenorrhea, or normal cramping and something that could be more serious. That’s one reason why it can be so helpful to track your cycle and take note of the symptoms, like cramping, that you experience during your period and at other times during the month.
When should you call your healthcare provider?
If you think you might be experiencing cramping related to secondary dysmenorrhea, reach out to your healthcare provider since the cramping could be part of a medical problem with your reproductive organs. And if you have cramps that feel especially painful or strong, that seem different from what’s normal for you, that last for more than two or three days, or that are really impacting your day to day life - or, really, if you have any questions about if what you’re experiencing is normal or not - get in touch with your healthcare provider and tell them what’s going on. They will be able to help figure out if what’s happening is normal. If what you’re experiencing is normal, a healthcare provider can make suggestions for how to get relief and lessen the pain. If something else might be going on, like secondary dysmenorrhea, a healthcare provider may be able to diagnose and treat the underlying issue.
Even if your cramping is related to a healthy cycle, you shouldn’t suffer from severe pain. If you’re experiencing extreme period symptoms, reach out to your provider so that you can work together to find a way to manage your discomfort and feel like you best self.
Mayo Clinic Staff. “Menstrual cramps.” Mayo Clinic. Mayo Foundation for Medical Education and Research, April 14 2018. Retrieved February 25 2019. https://www.mayoclinic.org/diseases-conditions/menstrual-cramps/symptoms-causes/syc-20374938.
“Dysmenorrhea.” Cleveland Clinic. Cleveland Clinic. Retrieved February 25 2019. https://my.clevelandclinic.org/health/diseases/4148-dysmenorrhea.
“Dysmenorrhea: Painful Periods.” The American College of Obstetricians and Gynecologists. The American College of Obstetricians and Gynecologists. January 2015. Retrieved February 25 2019. https://www.acog.org/Patients/FAQs/Dysmenorrhea-Painful-Periods.
“What can I do about cramps and PMS?” Planned Parenthood. Planned Parenthood Federation of America. Retrieved February 25 2019. https://www.plannedparenthood.org/learn/health-and-wellness/menstruation/what-can-i-do-about-cramps-and-pms.