People with periods are badasses for each month putting up with what's at least an annoyance, at most a stopover in Hell. If you're one of the unlucky ones, you may be dealing with bleeding reminiscent of The Shining's elevator scene, frustrating bloating, and of course, atrocious cramping. There's nothing like an achy midsection to make you want to rip out your uterus with your own two hands. But aside from just being painful, severe cramps can be scary for another reason: Sometimes it’s your reproductive tract's way of waving a flag and saying, "Yoo-hoo, something's wrong down here!" That's especially nerve-racking if you want to have kids or are concerned about your fertility.
A lot of people get menstrual cramps. It's normal—unless yours are debilitating to the point where they regularly interrupt your life. If they're that severe, it could in fact be a sign something's up with your body. "Just having bad periods all by themselves usually doesn't happen," Jacques Moritz, M.D., an ob/gyn at NewYork-Presbyterian and Weill Cornell Medicine, tells SELF. Kristyn Brandi, M.D., an ob/gyn with expertise in heavy vaginal bleeding management from Boston University/Boston Medical Center, agrees. "[If you're having painful periods], typically something is going on, but these things are hard to diagnose," she tells SELF.
Endometriosis, which affects one in 10 women, happens when tissue that makes up the lining of the uterus grows elsewhere in the body. "We suspect it goes through the fallopian tubes and out on top of different organs," Brandi says. "It functions same way the rest of your endometrial tissue does, so you can have cramping and bleeding. That tissue floating around causes a lot of pain for some women." It may also lead to scar tissue forming in the affected areas, creating additional pain and problems conceiving or carrying a pregnancy to term.
Although endometriosis is often in the gynecologic spotlight, it has a lesser known relative that can cause similar issues. "There's a subcategory of endometriosis called adenomyosis that most people don't know about," Moritz says. "It's basically when the lining of uterus starts growing into the muscle portion of the uterus instead of staying where it should." Like endometriosis, this can cause intensely painful periods, and it can also affect fertility because of how it impacts uterine function.
Symptoms of endometriosis and adenomyosis are often treated with pain relievers or hormonal birth control, although surgery to remove the wayward tissue can be in order when fertility is impaired.
The most common noncancerous tumors in women of childbearing age, fibroids are growths in the walls of the uterus. As many as 80 percent of women will deal with them at some point in their lives, the U.S. Department of Health and Human Services' Office on Women's Health estimates. But their symptoms vary wildly: Some people have fibroids without noticeable side effects, while others deal with intense periods, pain, or abdominal swelling. And if the fibroids get big enough or are positioned in a certain way, they can make the uterus an inhospitable home for a growing fetus, leading to problems with having a baby.
Luckily, there are treatments for fibroids, including hormonal birth control to manage terrible periods or, in the instance of fibroid-related infertility, a procedure known as a myomectomy to remove the tumor.
It's less likely, but it's possible. When it happens, it may come down to your body releasing higher than usual levels of prostaglandins, or the chemicals that cause your uterus to contract, or an unusual amount of cytokines, which are proteins that can have an inflammatory response on your cells, Moritz explains. You might even have a different way of processing pain that makes you feel it more intensely than other people, he says. And if you fall into one of those camps, there's good news: "If you know it’s not endometriosis or any other thing and you're just having painful periods, that’s a sensitivity issue, and it shouldn't increase your chance of not getting pregnant," Moritz says.
But if you're nervous about your period pain, definitely bring it up with a medical professional. "It's always important to talk to your doctor about it, which at times can be difficult," Brandi says. "But doctors want to have a conversation, find out why you're having pain, and fix it."
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