Period Pain: What Is Normal?



There are several types of period pain:


1. Uterine Cramps

These are essentially muscle cramps. The womb is made up of a thick wall of smooth muscle called the myometrium. The muscle runs vertically, horizontally, and diagonally. The muscle contractions enable removal of old endometrial cells (endometrial shedding), and uterine contractions for childbirth.


Cramping typically lasts for a few seconds to minutes (no more than 10 minutes), and are described as an intense, sharp pain. Anything more severe or prolonged is not normal and should be investigated, especially if it is affecting your daily activities.



2. Associated/Referred Pain

Typical pain associated with menstrual periods includes lower back pain, abdominal heaviness, and vulva pain. This is usually described as aching pain. It is typically associated due to inflammation, water retention, constipation, diarrhea, and gas.


3. Endometriosis Pain

Endometriosis is a condition where endometrial tissue grows outside the womb. The endometrial cells form lesions typically around the ovaries, fallopian tubes, around the uterus, and bowels. These cells bleed, usually around menstruation, but do not have anywhere to go, and cause inflammation. This pain is usually described as constant (throughout the entire cycle), severe, and stabbing.


4. Fibroid Pain

Uterine fibroids are sometimes reported as severe menstrual cramping. Fibroids are benign abnormal collections of cells within the uterus. The size of the fibroid usually determines the severity of pain because of the inflammation and pain caused by pressing on other organs. Heavy menstrual bleeding is usually associated with uterine fibroids as well.


What to do if you experience moderate-severe menstrual pain:

  • Track your menstrual cycle along with associated symptoms. A phone app is very helpful --> I recommend the CLUE app.

  • Have your primary care physician or gynecologist complete a pelvic exam. A transvaginal ultrasound may be recommended as well.

  • Seek a consultation with a naturopathic doctor. Hormone, nutrient, and gut immunity testing may be recommended.