What Causes Period Cramps?
Cramps are caused by prostaglandins. Prostaglandins are naturally occurring chemicals and can be found in tissues throughout the body, including in the uterus. They also trigger the uterine muscles to contract, which helps expel the uterine lining during menstruation. Prostaglandins are also involved in inducing labor contractions and childbirth. If your levels of prostaglandins are too high, it can trigger uterine contractions that are more intense. When the uterine contractions are especially strong, oxygen is temporarily cut off to parts of the muscle, which can lead to painful period cramps. Teens can experience worse period cramps because they naturally have higher levels of prostaglandins. As they get older and these levels decrease, the intensity of their cramps can also lessen. Some people also have easier, less painful periods after they give birth. Period cramps that are caused by the normal activity of prostaglandins are called primary dysmenorrhea. This type of painful period should not negatively impact your fertility. Period cramps that are caused or worsened by other diseases or abnormalities of the reproductive system are called secondary dysmenorrhea. It’s this type of painful period that can be associated with trouble getting pregnant.
Bad Menstrual Cramps and Your Fertility
Within the context of secondary dysmenorrhea, menstrual cramps can be caused by diseases that impact fertility. Some of these diseases develop over time, meaning you might not have symptoms right away or you might develop worsening symptoms as time goes on. There are several reproductive health conditions that can affect your periods and fertility.
Endometriosis
Endometriosis is notorious for causing painful periods and possible infertility. With this condition, a type of tissue that is similar to the endometrium (the tissue that usually lines the uterus) grows in places outside of the uterus where it shouldn’t. This tissue responds to monthly hormone variation and bleeds often leading to scar tissue and pain. It is estimated that up to 50% of people who struggle to conceive might have endometriosis. The condition often goes undiagnosed and untreated for years, if not decades.
Adenomyosis
Adenomyosis is when the endometrium grows within and into the muscle of the uterus. This is different from endometriosis, where endometrium-like tissue grows outside of the uterus. It’s also not the same as fibroids, which are a mass of tissue. Adenomyosis can cause painful and heavy periods. It’s unclear whether or not it affects fertility, but some studies have shown that it might.
Fibroids
Fibroids are muscular growths that can occur in or on the uterus, cervix, and even pelvic ligaments. They are typically benign and tend to grow during the reproductive years. Many people never know they have fibroids. However, the growths occasionally can cause pain, reduced fertility, and possibly increase the risk of miscarriage.
Pelvic Inflammatory Disease (PID)
Another possible cause of bad menstrual cramps that can also impact your fertility is pelvic inflammatory disease (PID). PID is caused by an infection in the reproductive organs, often an untreated or under-treated sexually transmitted infection. PID leads to the formation of scar tissue, which often looks like webbing between the ovaries, fallopian tubes, and uterus. PID is the most common cause of blocked fallopian tubes.
Pelvic Pain and Fertility
Pelvic pain can also occur when you are not expecting your period. For example, some people experience ovulation pain. Ovulation pain is common: Up to 50% of people report they’ve had it at least once in their lives, and 20% say they get it every month. Pain during ovulation is not normal if it interferes with your daily life and causes painful sexual intercourse, or if it is sudden and severe. Ovulation pain can be so severe in some people that it prevents them from having sex when they are most likely to conceive. If you’re trying to get pregnant, and pain is preventing you from having sex, that can certainly lower your odds of conception. However, some people experience painful intercourse no matter what time of the month it is. Sex should not hurt. If you have recurrent, persistent, or severe pain with sexual intercourse or during ovulation, talk to your doctor.
Can Treatments for Painful Periods Cause Infertility?
If you’re experiencing painful periods or pelvic pain, it’s important you talk to your doctor. They can figure out what is causing your pain and recommend treatment.
Medication
Sometimes, hormonal birth control is recommended for managing menstrual pain-related symptoms. However, this won’t be an option if you are trying to get pregnant, and likely isn’t going to treat the underlying cause of the pain. The most common treatment for painful periods is over-the-counter (OTC) pain medications like ibuprofen (like Advil), acetaminophen (like Tylenol), or naproxen (like Aleve.) It’s best to take OTC pain reliever when your painful period symptoms are just starting (as opposed to waiting until they have already begun). There has been some controversy that common OTC pain medications (specifically, nonsteroidal anti-inflammatory drugs or NSAIDs) could interfere with ovulation and cause issues with fertility. While some early research found a possible negative effect of taking ibuprofen during the early stages of the menstrual cycle, further studies have not reached the same conclusion. In fact, there is some evidence that pain relief might slightly improve certain fertility factors. In a study of just over 1,000 women, naproxen was found to possibly increase the time to conception in people trying to get pregnant. The effect seemed to increase with higher dosages of naproxen. Overall, the impact was small but statistically significant.
Surgery
Surgery is another possible treatment option if the pain is caused by endometriosis, fibroids, or adhesions. However, you might want to consult with a reproductive endocrinologist before considering surgery. They can help ensure that your fertility remains intact. In some cases, it is also beneficial to time fertility treatments soon after corrective surgery. In severe cases, removing the uterus (and possibly the ovaries and fallopian tubes as well) is recommended if someone has severe period pain that has not responded to treatment. If you are still trying to conceive, this might not be an option you want to consider.
A Word From Verywell
If you’re experiencing pelvic pain, talk to a healthcare provider about the treatment options that are available. You might want to start with relatively simple treatment like OTC pain relievers. If you are worried about the possible effect of these medications on your fertility, know that while some studies found a possible negative fertility effect to ibuprofen use, further studies did not come up with the same findings. Naproxen may have a slightly negative effect on fertility, but the relationship remains unclear. While painful periods themselves are not linked to fertility issues, some of the causes behind the pain are associated with infertility. Some of these conditions can get worse over time, which is why getting diagnosed and treated early is important. Finding the right treatment can help reduce your pain and might help protect your fertility or even increase your odds of fertility treatment success in the future.
