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What's Up, Down There

What’s Up Down There: Why Do I Get Period Cramps?

Let’s be honest — period cramps are one of those things that women have been told to just “push through” for way too long. Pop some ibuprofen, put a heating pad on your stomach, and get on with your day. Sound familiar?

But not all cramps are created equal. Some are a normal part of your cycle. Others are a signal that something else is going on — something that deserves real attention and real treatment.

In this edition of What’s Up, Down There, we’re breaking down everything you need to know about period cramps: why they happen, how to tell if yours are normal, and what you can actually do about them.

So Cramps Happen in the First Place?

Every month, your uterus contracts to shed its lining — that’s what your period is. To trigger those contractions, your body releases hormone-like chemicals called prostaglandins. The more prostaglandins your body produces, the stronger the contractions, and the more intense the cramping.

This type of cramping — the kind that’s directly caused by your menstrual cycle and not linked to any underlying condition — is called primary dysmenorrhea. It’s the most common kind, and it’s what most of us experience, especially in our teens and twenties.

Primary dysmenorrhea usually:

Starts a day or two before your period begins

Peaks in the first 1–2 days of bleeding

Feels like dull, crampy aching in your lower abdomen

Sometimes radiates to your lower back or thighs

Eases up as your period progresses

The good news? For many women, primary dysmenorrhea actually improves with age, and often after giving birth.

Okay, But How Much Pain Is Actually Normal?

This is the question we get a lot — and honestly, it’s one of the most important ones to ask.

Some discomfort and mild cramping is a normal part of having a period. But “normal” does not mean debilitating. If your cramps are:

Stopping you from going to work, school, or your regular activities

Not responding to over-the-counter pain relievers like ibuprofen

Getting progressively worse over time (not better)

Accompanied by very heavy bleeding, painful sex, or pain outside of your period

Showing up later in life after years of manageable periods

When Cramps Are a Sign of Something More

When cramps are caused by an underlying condition rather than just your cycle itself, it’s called secondary dysmenorrhea. It often comes with more intense pain, pain that shows up outside your period, or pain that gets worse over time. Here are the most common culprits:

Endometriosis

Endometriosis is a condition where tissue similar to your uterine lining grows outside the uterus — on the ovaries, fallopian tubes, or elsewhere in the pelvis. Like the lining inside your uterus, this tissue responds to your hormones, builds up, and tries to shed each month. But because it has nowhere to go, it causes inflammation, scarring, and significant pain.

Endometriosis affects roughly 1 in 10 women of reproductive age, but it takes an average of 7–10 years to get a diagnosis — largely because women are so often told their pain is “normal.” It is not.

Signs to watch for:

Cramps that are severe and start before your period

Pain during or after sex

Pain with bowel movements or urination during your period

Heavy periods or spotting between periods

Difficulty getting pregnant

Adenomyosis

Think of adenomyosis as endometriosis’s close cousin. Instead of growing outside the uterus, the uterine lining grows into the muscular wall of the uterus itself. This causes the uterus to enlarge and leads to heavy, painful periods. It’s more common in women who’ve had children or are in their 30s and 40s, but it can affect anyone.

Signs to watch for:

Heavy or prolonged periods

Severe cramping, especially in the lower abdomen

A feeling of pressure or bloating in the pelvis

Pain that tends to get worse as you get older

Uterine Fibroids

Fibroids are non-cancerous growths that form in or on the walls of the uterus. Small ones often cause no symptoms at all. But larger fibroids — or those located in certain spots — can make periods heavier, longer, and significantly more painful.

Signs to watch for:

Heavy menstrual bleeding (soaking through a pad or tampon in under 2 hours)

Periods lasting longer than 7 days

Pelvic pressure or a feeling of fullness

Frequent urination or difficulty emptying your bladder

Pelvic Inflammatory Disease (PID)

PID is an infection of the reproductive organs, usually caused by an untreated STI like chlamydia or gonorrhea. It can cause pelvic pain that gets worse during your period, along with unusual discharge, fever, and pain during sex. PID needs prompt treatment — if left untreated, it can affect fertility.

Treatment Options

The good news is there’s a whole spectrum of options depending on how severe your cramps are. You don’t have to just suffer through it.

For Mild to Moderate Cramps

NSAIDs (such as Ibuprofen, Midol, Aleve): Over-the-counter anti-inflammatory medications are often the first line of relief. They work best when you start taking them a day or two before your period begins rather than waiting until the pain is already bad.

Heat Therapy: A heating pad on your lower abdomen or lower back can help relax the uterine muscles. It sounds simple because it is — and the research actually backs it up.

Exercise: We know, we know — the last thing you want to do when you’re cramping is move. But gentle movement like walking or yoga can reduce prostaglandin levels and boost natural pain-relieving endorphins

Diet: What you eat can play a role in how you feel. Some studies suggest that a low-fat, primarily vegetarian diet that includes adequate dairy may help reduce cramping. Certain supplements — like vitamin E, B1, B6, fish oil, and ginger — may also provide relief. Talk to your provider before adding any new supplements to your routine.

For Moderate to Severe Cramps

Hormonal birth control: The pill, patch, ring, hormonal IUD, implant, and injection can all help by thinning the uterine lining — which means less tissue to shed and fewer prostaglandins released. Many women find significant relief within a few months of starting hormonal contraception.

Prescription-strength NSAIDs: If OTC options aren’t cutting it, your provider can prescribe stronger doses.

GnRH agonists: These medications temporarily reduce estrogen levels to relieve pain, particularly for conditions like endometriosis. They’re usually prescribed short-term due to side effects like hot flashes and bone density changes.

When Surgery May Be Recommended

Laparoscopy for endometriosis: If endometriosis is suspected, a minimally invasive laparoscopic procedure allows your provider to diagnose and surgically remove endometrial tissue. This is currently the gold standard treatment for endo-related pain.

Myomectomy or fibroid treatment: If fibroids are contributing to your symptoms, your provider may recommend treatment options ranging from minimally invasive procedures that reduce blood flow to the fibroid to surgical removal, depending on size, location, and severity of symptoms.

Endometrial ablation: For women with heavy periods who don’t plan to get pregnant, this procedure destroys the uterine lining to significantly reduce or stop menstrual bleeding and the pain that comes with it.

When to Make That Appointment

If any of the following sound like you, it’s time to talk to your Axia provider — not next cycle, not “when it gets worse.” Now.