Causes and Risk Factors of Menstrual Cramps

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Menstrual cramps (also called dysmenorrhea, or menstrual pain) are throbbing, aching, or dull pains in the abdomen or lower back in the days leading up to and during the monthly menstrual period. Dysmenorrhea has several risk factors, both lifestyle factors that can be modified and those that can't.

Menstrual cramps are one of the most common complaints when it comes to dealing with periods. Research published in Epidemiologic Reviews found that in a series of 15 published studies there was a wide range of prevalence of dysmenorrhea between 16% and 91%, while 2% to 29% of people studied reported severe menstrual cramps.

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Common Causes

While a majority of people who menstruate will experience menstrual cramps as part of their period, there are two types of dysmenorrhea—primary and secondary.

Primary dysmenorrhea causes menstrual cramps to occur as a result of uterine muscle contractions. People who also have a higher level of prostaglandins, a group of lipids that have hormone-like effects and can cause contractions may also experience more discomfort with their menstrual cramps than people who have lower levels of prostaglandins.

Secondary dysmenorrhea causes menstrual cramps as a result of a preexisting health condition. These include:

Non-modifiable risk factors for dysmenorrhea include:

  • Age, with greater risk at younger age.
  • If you started your period before age 11.
  • You experience heavy menstrual blood flow with your period.
  • You have an irregular period, especially a period of longer duration.


Previous research has determined that family history and genetics seem to play a part in the role of how strong menstrual cramps are, but how they influence these period symptoms is not completely understood.

One study published in Pain found that severity of cramps seems to be a combined result of both genetics with specific nerve growth factor (NGF), along with active epigenetic marks (which tell your genes to turn off or on) in fat and ovary tissue, as well as the RNA present in the aorta tissue.

But epigenetic marks are also influenced by your environment, including your diet, lifestyle choices, and more. NGF has previously been linked to other chronic pain disorders, and so this link between NGF and menstrual cramp pain makes sense.

In addition to this genetic connection, the study also found that people who had extreme menstrual cramps were more likely to have endometriosis, polycystic ovarian syndrome (PCOS), depression, and other psychiatric disorders which all may have a genetic component to them as well.

Lifestyle Risk Factors

There are many lifestyle factors that come into play that can affect how painful menstrual cramps are. They include:

  • You’ve never had a baby.
  • You have too low or too high body weight. A study found that both underweight and obese women were more likely to have dysmenorrhea.
  • You smoke. A meta-analysis of 24 studies found that smokers were 1.45 times more likely to develop dysmenorrhea than non-smokers.
  • Your diet. Research published in The Journal of Obstetrics and Gynaecology Research found in a study of Iranian women, those who reported more severe menstrual cramps and pain had lower vegetable intake.
  • Stress. Women who felt stressed, anxious, or depressed in the two weeks leading up to their period experience stronger symptoms such as cramps, as researchers with the National Institutes of Health found.

A Word From Verywell

Whether your menstrual cramps are caused by primary or secondary dysmenorrhea its pretty much inevitable that all women will experience some form of cramping before and/or during their period. On average, the median duration of cramps is about two days, but some people may experience menstrual cramps for longer or shorter.

While there is no way to completely eliminate menstrual cramps, establishing healthy habits through your diet, stress management, and other self-care techniques can go a long way in easing period-related aches and pains.

If you’re worried about your menstrual cramps being too painful, make sure to bring it to the attention of your healthcare provider who can help rule out an underlying health condition or walk you through which over-the-counter medications may help make you more comfortable.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Colleen Travers
Colleen Travers writes about health, fitness, travel, parenting, and women’s lifestyle for various publications and brands.