Factors that may contribute to severe menstrual cramps (dysmenorrhea) include:

• Early onset of puberty (age 11 or younger).
  
  
• Family history of painful menstrual periods.
  
  
• Prolonged menstrual periods (lasting five days or longer).
  
  
• Use of an intrauterine device (IUD). If the menstrual cramps continue after three months or become worse, a woman may need to consider having the IUD removed and choosing another birth control method.
  
  

  

• Excessive weight or obesity.
  
  
• Use of alcohol.
  
  
• Cigarette smoking.
  
  
• Stress and anxiety.
  
  
• History of sexual or physical abuse.
  
  
• No history of pregnancy.

Prostaglandins are hormone-like substances produced by the tissue that lines a woman’s uterus (endometrium). These chemicals cause many of the symptoms associated with menstrual discomfort.

Prostaglandins trigger the uterine muscle to contract, which helps the uterus expel its lining during the menstrual cycle. The hormones also reduce the blood supply to the uterus and increase the sensitivity of nerve endings to pain. Researchers believe that elevated levels of these substances cause dysmenorrhea.

Menstrual cramps are classified into primary and secondary dysmenorrhea. Primary dysmenorrhea is menstrual pain occurring in the absence of any physical or medical condition. Secondary dysmenorrhea is menstrual cramps caused by an underlying pelvic condition or abnormality.

A number of conditions can cause secondary dysmenorrhea. They include:

• Endometriosis. A condition in which the type of tissue that lines a woman’s uterus becomes implanted outside the uterus, most commonly in the fallopian tubes, ovaries or the tissue lining the pelvis. This outside tissue becomes stimulated each month by the hormones and can spread resulting in adhesions and scarring. Though noncancerous, endometriosis can cause chronic pelvic pain and problems with fertility.

• Pelvic inflammatory disease (PID). An infection of the female reproductive organs that is sometimes caused by sexually transmitted bacteria. Left untreated or treated too late, PID can damage the reproductive organs, which may make it difficult or impossible for a woman to conceive.  PID can also increase the risk of pregnancy complications.
  
  
• Uterine fibroids. Noncancerous tumors or growths within the lining of the uterus. They range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus.
  
  
• Adenomyosis. In this condition, glands that are normally found in the endometrium penetrate the muscular wall of the uterus. Pain results when displaced glandular tissue develops during a woman’s menstrual cycle and then attempts to slough off during menstruation.
  
  
• Ovarian cysts. Fluid-filled sacs or pockets within or on the surface of an ovary. They typically occur as the result of ovulation (the release of an egg from the ovary) and are common in women of childbearing age. Most cysts are normal and shrink over time, usually within one to three months.
  
  
• Abnormal pregnancy, such as an ectopic pregnancy (when a fertilized egg becomes implanted outside the uterus, usually in the fallopian tubes).
  
  
• Narrow cervix (cervical stenosis). This abnormality may be present at birth or result from the removal of polyps or treatment of a precancerous condition (cervical dysplasia) or cancer of the cervix (cervical cancer).

Most women experience menstrual cramps at some time in their lives. The pelvic pain usually starts within three years of menarche. It may persist until a woman’s 20s or until she delivers a child and, for unknown reasons, may then decrease in intensity.

If the pelvic pain is severe, it may be caused by an underlying condition or abnormality and a woman will continue experiencing painful periods until the cause is treated. A physician, typically a gynecologist, should be consulted to diagnose the cause of the pain and determine appropriate treatment.