More than half of women who menstruate have pelvic pain for 1-2 days out of the month. Sometimes the pain is severe and keeps them from normal activities. Pain that is this severe is called dysmenorrhea and can be classified into two types- primary or secondary.

Primary Dysmenorrhea- Pelvic pain that comes from having your period and begins soon after a preteen/teen starts having a mentrual cycle. In many women the pelvic pain becomes less painful as they age. Childbirth can also lessen sypmtoms. However, this is not always the case.

Secondary Dysmenorrhea- This type of pelvic pain may begin later in life than primary dysmenorrhea and lasts longer than normal cramps. It could begin before your period starts. The pain may worsen with your period and not stop after your period ends. Some common causes of secondary dysmenorrhea are endometriosis and fibroids.

Symptoms- Some symptoms of dysmenorrhea are cramps, pain in the pelvis or low back, "pulling" feeling in the inner thigh area, diarrhea, nausea and/or vomiting, headache and dizziness.

Diagnosis- A doctor may diagnosis dysmenorrhea based on your medical history and pelvic exam. They may also suggest some additional testing such as lab tests, ultrasounds, and/or pap test. In some cases, your doctor may recommend a surgical procedure called laparoscopy. This is an outpatient surgery and is done with general anesthesia at a hospital or surgical center. With this surgery, the doctor makes a small cut near your naval. A small laparoscope (a thin lighted surgical device) is inserted into your abdomen enabling the doctor to view the pelvic organs. The doctor may find a specific cause for dysmenorrhea with this procedure, but often it cannot be defined. Based on the results of the laparoscopy and other test results, your doctor will choose what treatment is best.

Treatment- Treatments can include medications and techniques to relieve pain. If a cause for dysmenorrhea is found, the treatment will be based on removing or reducing the cause. Suggestions may include hormones, medications or surgery.

Medications: Medications called NSAIDs(ibuprofen or naproxen) help cramps from being so severe and can help relieve other symptoms, such as nausea and diarrhea. NSAIDs can be bought over-the-counter and work best if taken at the first sign of your period or pain.

Hormones: Hormonal contraception(birthcontrol pills, iud, vaginal ring) can also relieve menstrual pain. The hormones help control the growth of the uterine lining, resulting in less blood flow and less pain and cramping. They may also stop the growth of fibroids and endometriosis. However, after the treatment is stopped, they are likely to continuing growing. Sometimes, contraception is used in combination with other medications. This can decrease estrogen levels and even stop the menstrual cycle all together. Doing this can prevent pain from ever starting.

Surgery: Your doctor may suggest uterine artery embolization as a surgical method where the fibroid or the entire uterus may be removed. Laparoscopy could also be used. This surgery would treat endometriosis, a tissue growing outside the uterus. This tissue could return after the surgery, but removing it may reduce pelvic pain. In severe cases, a hysterectomy is required. This surgery would remove the uterus and possibly the tubes and ovaries, depending on doctor recommendations. This surgery would be a last resort.

Other treatments: Other options may be to take vitamin B1 or magnesium supplements, massage, or acupuncture. These treatments can help relieve pain but do not prevent it.