Why is menstruation painful?

Menstruation is a natural physiological process of the female body, yet for many women, it can be accompanied by unpleasant or even severe pain. But at what point is menstrual pain considered "normal," and when is a medical examination warranted?

Why is menstruation painful if there is no underlying disease?

Many people equate menstruation with the shedding of the uterine lining, but the process is much more complex than that. Primary menstrual pain (primary dysmenorrhea) is a condition in which there is no detectable anatomical abnormality or disease, yet it can still cause significant pain.

It is important to emphasize, however, that if menstrual pain is extreme, leaves you bedridden, causes feelings of fainting or nausea, or is accompanied by bowel or urinary issues, then you should see a gynecologist. In such cases, endometriosis—a chronic gynecological condition that often causes similar symptoms—may be suspected. With endometriosis, pain can begin days before menstruation, radiate to the back and legs, and does not always respond to traditional painkillers.

Main causes of menstrual pain

1. Prostaglandins and inflammatory processes: During menstruation, when the uterine lining sheds, prostaglandins are released, playing a key role in inflammatory processes. These substances irritate nerve endings, increasing pain. The intensity of the pain also depends on individual nervous system sensitivity.
2. Uterine contractions and oxygen deficiency: The uterine muscle contracts during menstruation to help expel the lining. However, these intense contractions can compress the small blood vessels supplying the uterus, potentially leading to oxygen deficiency. This can cause pain similar to muscle cramps.

How can menstrual pain be relieved?

There are many effective ways to reduce menstrual pain:

• NSAID painkillers: Non-steroidal anti-inflammatory drugs (e.g., ibuprofen, naproxen) inhibit prostaglandin production, thereby reducing pain and the inflammatory response.
• Magnesium and Vitamin B6: These can reduce the strength of contractions by relaxing the smooth muscles of the uterus.
• Regular exercise: Sports improve blood circulation, thereby increasing oxygen supply and reducing pain.
• Omega-3 fatty acids: Due to their anti-inflammatory effects, they can contribute to alleviating menstrual pain.

Primary painful menstruation often appears in the teenage years, but over time—especially after childbirth—it may improve for many women. Until then, lifestyle changes and appropriate support can help ensure that your period is not the most difficult time of every month.