Menstrual Cramping: Diagnosis and Treatment

Menstrual Cramps

Is period pain common? Yes. Is it normalized? Yes. Is it normal? No!

The medical term for menstrual pain is dysmenorrhea. It’s the most common menstrual cycle complaint. Most of the time, it shows up as lower abdominal pain in the form of cramping, throbbing, and aching; it starts up a few days before your period or once flow has begun. It can also show up as lower back pain, upper-leg heaviness or numbness, nausea, heavy bleeding, headaches, and fatigue. Menstrual pain tends to be worse on the heaviest days of flow (usually the first and second days of a period), and it can show up for a few hours or even stick around for a few days.

lining of the uterus, the endometrium, is shed. This shedding occurs thanks to a coordinated hormonal and inflammatory response. The inflammatory process brings more blood cells and fluid to the endometrium and involves immune compounds called prostaglandins and leukotrienes. Menstruators with period pain tend to have more of these compounds in their flow, so we think that’s part of the story.

But, like most stories, there are plot twists. There doesn’t seem to be a singular cause for period pain, and contributing factors can include family history, age at menarche (first period ever), nutritional deficiencies, and heavy menstrual flow. Then, we have to account for the possibility of an underlying condition or structural issue. Dysmenorrhea can be categorized into “primary” and “secondary” types.

Primary dysmenorrhea is period pain that does not have an underlying pathology that’s causing the pain. This kind is more common if you’ve recently started menstruating, and it’s related more to an exaggerated inflammatory response.

Secondary dysmenorrhea is period pain caused by an underlying structural issue or medical condition like endometriosis, infections, fibroids, or cysts. These conditions can be present in the early menstruating years, but they are more likely to develop later.


Unfortunately, there aren’t a whole lot of tests to pinpoint the cause of an individual person’s period pain. Not just that, but the normalization of cramping is so deep-seated that many healthcare providers don’t even blink when menstruators share their experiences. So, the onus falls on the patient to really advocate for themselves and describe their pain effectively to their practitioners. Tracking your pain is extremely helpful here, so I’ve come up with some questions that you can answer and take to your healthcare provider:

» Where is the pain?

» When does it start and end? 

» What’s the severity (rate it on a scale from 0–10)? 

» Are there any other symptoms? 

» What do you do to manage it (painkillers, heating pad, tea, etc.)? 

» What makes it better/worse? 

» How does it impact your quality of life?

Imaging (ultrasound) and a manual exam are good places to start to identify if there are any growths or structural issues. Sometimes, these tests may yield no diagnosis. This could mean that it’s primary dysmenorrhea; however, it could also be indicative of endometriosis, especially if your pain is not responsive to painkillers, is associated with painful penetrative intercourse or bowel movements, or if you also have unexplained infertility.

Endometriosis is an inflammatory condition in which tissue that looks like your endometrium grows outside of the uterus—sometimes around the ovaries, bladder, and rectum. It’s a sneaky condition that can evade ultrasound technology. Laparoscopy (a minimally-invasive keyhole surgery) is the gold standard for diagnosis . . . but it’s a challenge to get that done in Ontario. Getting a referral to a gynecologist can be helpful here. Gynecologists are specialists in reproductive health that are more familiar with endometriosis (and other reproductive tract conditions). They can help expedite diagnosis and are more up-to-date with treatment options as well. 

“The birth control pill and intrauterine devices (IUDs) are also used for period pain and heavy flow, but they can come with a bunch of adverse side effects.”

There can be an element of pelvic floor dysfunction in period pain. The pelvic floor refers to the muscles in the pelvis to which the uterus, bladder, and rectum are tethered. When these muscles aren’t working together as they should, it can lead to pelvic pain. A pelvic physiotherapist is super helpful here.


Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, mefenamic acid, and naproxen, are the most conventional options for treating menstrual cramps. These drugs target those inflammatory mediators called prostaglandins, and they do a good job at it. The nice thing about these meds is that you can use them for a few days as needed, then put them aside. The downside? Long-term and frequent use can damage the gut and liver. 

The birth control pill and intrauterine devices (IUDs) are also used for period pain and heavy flow, but they can come with a bunch of adverse side effects. Then, there are more involved options like ablation and surgery, which might be best for excising endometriosis lesions, polyps, and/or fibroids.

There’s a lot that can be done outside of meds for menstrual cramping, although you can pair the following solutions with meds, if you’d like. There is no one correct approach—it just has to be right for you. 

Food & Nutrition

You can’t go wrong with eating more fruits and veggies. The daily recommended intake of fruits and veggies is six to eight servings per day. One serving looks like 1 cup of raw spinach, ½ cup of berries, or a medium-sized apple. Fruits and veggies offer fibre, vitamins, minerals, and antioxidants that support menstrual and overall health. 

Eating enough is another consideration. There’s an association between undereating or skipping meals and a higher degree of dysmenorrhea; low omega-3 consumption is also associated with higher period pain. So, make sure to eat adequately to fuel your body, get your omega-3s (through diet or supplementation), and include lots of plant foods while decreasing fried food and saturated fats found in red meat.

I know it’s cliché, but hydration is key to tackling period pain. As Canada’s Food Guide says: “Water should be the drink of choice.” Both alcohol and coffee have been implicated in dysmenorrhea, so limiting those can be beneficial. That’s not to say that you have to ditch your coffee entirely, however. Perhaps replacing your second coffee with decaf or green tea is a better way to go. 

Herbs & Supplements 

Ginger is, hands-down, the favourite herb for period pain. It’s anti-inflammatory and anti-spasmodic (i.e., it helps with muscle cramps), and it can be used in forms such as teas, tinctures, or capsules. In research studies, ginger was put toe-totoe with ibuprofen and mefenamic acid and was shown to be just as effective, which is cool. The dosage used in those studies was 1250–1500 mg in divided doses of a standardized ginger extract.1,2 Ginger has been used worldwide for pain and inflammatory conditions. 

In herbal medicine, ginger is often combined with other antiinflammatory herbs that help with cramps, like Boswellia serrata (Indian frankincense) and the aptly named crampbark.

If there’s one vitamin that’s important to discuss for menstrual conditions, it’s vitamin D. Deficiency in this vitamin is associated with dysmenorrhea of all types, so testing and supplementing appropriately is always a good idea. And if there’s one mineral to discuss, it’s magnesium. Approximately 200 mg per day can help relax smooth muscle, relieve tension, and support the nervous system as well. 

Many other vitamins and minerals (like zinc, vitamin E, calcium, and B vitamins) have been shown to help cramping too, but I wonder if this is because there’s an overall theme of inadequate nutrients; that is to say, maybe we need to do better at diversifying nutrition and eating plentiful plant foods. A multivitamin might be a good idea in the meantime, however.

Warm Up & Go with the Flow 

From a Traditional Chinese Medicine perspective, period pain is caused by stagnation of Blood and Qi. The way to promote smooth flow is through nourishment, movement, and warmth. Taking care of yourself, resting, filling your cup by eating nutritious food, doing the things you love, and sleeping well all have roles to play. Good ol’ heat, exercise, acupuncture, massage therapy, and transcutaneous electrical nerve stimulation (TENS) also offer period pain support.

I know cramping can be a pain in the butt (quite literally), so don’t shy away from seeking care. Painful periods rob so many menstruators of days and weeks every year. We want you to thrive and not let cramping get in the way of your life.