Feeling that familiar twinge of pain in your gut is often the first sign that your period is starting. In these moments, some may reach for a heating pad or ibuprofen and know the cramps will be better soon. But if you have more severe menstrual cramps, common home remedies for period pain may not always be effective enough.

Severe cramps aren’t just painful – they can become obstacles to daily life. So at what point are painful menstrual cramps worth a trip to the doctor?

Keep reading to learn about types of menstrual cramps, when and what to tell a doctor about your cramps, what treatments are available and more.

How much pain is "normal” during your period?

According to The American College of Obstetricians and Genecologists, some cramping each month is extremely common. In fact, more than half of women who menstruate have some pain for a couple of days each month.

But menstrual cramps feel different for everyone, so there’s no true “normal.” Cramps may feel like a constant dull ache, occasional shooting pains or anything in between. Cramps can often be felt in the lower stomach, but they may also affect the groin, thighs or lower back. And the intensity of pain can vary too.

Understanding the different types of menstrual cramps (dysmenorrhea)

There are two different types of period cramps: primary dysmenorrhea and secondary dysmenorrhea. The main difference between the two is whether pain is associated with prostaglandin production or an underlying medical condition.

Primary dysmenorrhea

Primary dysmenorrhea refers to the “regular” menstrual cramps that can come with every period for many women who menstruate. These cramps are caused by changes in prostaglandin, a chemical produced in the uterine lining that makes the uterus contract to shed that lining each period.

Prostaglandin levels are higher at the start of each period and decrease as the uterine lining is shed. As a result, related cramps typically last for the first couple days of your period. Primary dysmenorrhea tends to become less painful with age and after giving birth.

But it’s important to note that excess prostaglandin production is possible, which can result in particularly painful cramps.

Secondary dysmenorrhea

Secondary dysmenorrhea is less common and caused by medical conditions related to the female reproductive system, such as infection, premenstrual dysphoric disorder (PMDD), endometriosis, uterine fibroids or ovarian cysts. The amount, type and timing of pain caused by secondary dysmenorrhea can vary based on the underlying cause. For people with secondary dysmenorrhea, pain and cramping tends to:

  • Last longer than two days, up to the entire duration of your period
  • Start before or after the actual start of your menstrual flow
  • Get worse over time

Since there isn’t one standard or “normal” experience to compare menstrual symptoms to, the best way to find out what’s normal for you is to talk to your primary care doctor, OB-GYN or another women’s health expert. You should talk to a doctor any time you have questions or concerns about your menstrual symptoms, but particularly if:

  • Period pain feels unbearable or interferes with your daily life
  • Cramps last longer than two days
  • You get little or no relief from over-the-counter pain medication
  • You have cramps outside of your period
  • You notice a change in how your cramps feel over time
  • You experience other severe symptoms alongside your cramps (such as heavy menstrual bleeding, vomiting or fever)

How are severe menstrual cramps diagnosed?

If you have severe menstrual cramps, a visit with your doctor is the only way to determine the exact cause of your pain. During your visit, your doctor will ask about your menstrual cycle in general, as well as about the features and severity of your pain, and any other symptoms you’re experiencing. The discussion will likely include:

  • The level of pain cramps cause you
  • How long your cramps last
  • The average length of your cycle
  • How much you bleed during your period
  • Other things you may have noticed, like spotting or pain outside your period

If your doctor needs additional information, a pelvic exam or ultrasound might be performed. If it seems like your pain may be the result of secondary dysmenorrhea, your doctor may also recommend a laparoscopy, which is a minor outpatient procedure that can help diagnose underlying conditions.

How are severe menstrual cramps treated?

When home remedies for relieving period cramps aren’t effective, treatments may include:

  • Hormonal birth control methods – If your menstrual cramps are caused by a hormone imbalance, your doctor might recommend hormonal birth control. In addition to preventing pregnancy, taking hormonal birth control can help correct the levels of estrogen and progesterone in your body, which affects the thickness of the uterine lining. Thinning the uterine lining can reduce prostaglandin and bring pain relief. In some cases, these birth control methods can even stop periods and cramps, altogether.
  • Prescription medication – If over-the-counter medicines don’t work, your doctor might recommend prescription-strength nonsteroidal anti-inflammatory drugs (NSAIDs). These medicines are much stronger than the ones you can get over-the-counter. They can significantly reduce prostaglandins in your uterus and lessen their effects.
  • Surgery – In some cases of secondary dysmenorrhea where other treatments don’t work, surgery may help relieve pain, especially if it’s related to endometriosis tissue or uterine fibroids.

Don’t ignore severe period cramps

Your menstrual cycle is part of your life, but it shouldn’t be an obstacle to living the way you want to. If you have any questions or concerns about your cramps or other menstrual symptoms, you don’t have to put up with them. A women’s health expert or primary care doctor can help you determine what’s normal for you, diagnose any underlying conditions that may contribute to pain and recommend treatments to improve your quality of life.