Pain during menstruation is a very common complaint. According to ACOG, more than half of women experience painful symptoms during their periods for 1–2 days. However, severe pain that interferes with work, studying, sleep, or everyday activities should not be considered something normal that simply needs to be endured.
In medicine, painful periods are called dysmenorrhea. It can be primary or secondary.
Why Does Your Abdomen Hurt During Your Period?
With primary dysmenorrhea, the pain is not associated with any disease of the pelvic organs. During menstruation, the activity of prostaglandins increases — substances that promote uterine contractions. The higher their levels, the more pronounced the cramps may be.
This type of pain usually begins immediately before menstruation or during the first hours after it starts, is most intense during the first day, and gradually decreases over 2–3 days.
Interestingly, primary dysmenorrhea usually does not become more severe with age. On the contrary, in many women, menstrual pain becomes less pronounced over time and may sometimes decrease after childbirth.
How Can You Assess the Intensity of Menstrual Pain?
The intensity of menstrual pain can be assessed using a visual analogue scale (VAS) or a numerical scale from 0 to 10, where:
- 0 points — no pain;
- 1–3 points — mild pain;
- 4–6 points — moderate pain;
- 7–10 points — severe pain.
The VAS helps to objectively quantify subjective pain intensity, assess changes over time, and evaluate the effectiveness of treatment.
Why Can Periods Become More Painful With Age?
If your periods were previously almost painless but pain later develops or gradually becomes more severe, it is important to rule out secondary dysmenorrhea — pain associated with a specific gynecological condition.
Possible causes include:
- Endometriosis — one of the most common causes of secondary dysmenorrhea; pain may become more severe over time, begin before menstruation, and persist for several days;
- Adenomyosis — may be associated with painful and heavy periods; symptoms often become more noticeable with age;
- Uterine fibroids — some fibroids may cause painful and/or heavier menstrual bleeding;
- Less commonly, the cause may be pelvic inflammatory disease or other gynecological conditions.
Therefore, the statement that “periods simply become more painful with age” is not entirely correct. Age itself is not a cause of increasing menstrual pain. Rather, over time, conditions that can cause secondary dysmenorrhea may develop or become clinically apparent.
When Is Painful Menstruation a Reason to See a Gynecologist?
It is worth discussing your symptoms with a gynecologist if the pain:
- develops recently, even though your periods were previously painless;
- gradually becomes more severe;
- interferes with your daily life and regularly requires you to miss work, classes, or other activities;
- continues beyond the first few days of menstruation;
- is accompanied by very heavy or irregular bleeding;
- occurs together with pain during sexual intercourse, bowel movements, or urination.
In such cases, the doctor’s task is not simply to prescribe a painkiller, but to determine whether there is an underlying cause of secondary dysmenorrhea.
What Is Important to Remember?
Moderate cramps during the first days of menstruation are common. However, severe or progressively worsening pain should not be considered an inevitable part of the menstrual cycle.
If your periods have become noticeably more painful, especially if this was not a problem before, it is worth seeing a gynecologist to determine the cause.