Are Painful Periods a Sign of Good Fertility?

By Dr. Kenosha Gleaton, OBGYN

Dysmenorrhea: What Are Painful Periods?

Mild to moderate menstrual cramps are normal and experienced in over half of menstruating people, however; some will experience severe pain during their period that interferes with day-to-day life and activities. [1-2] Painful periods, medically known as dysmenorrhea, are thought to occur in around 15% of people assigned female at birth (AFAB). [2] Dysmenorrhea is characterized by painful cramps and can also cause symptoms like nausea, fatigue, dizziness, headache, and diarrhea. [1-2] Symptoms can occur the day before menstruation begins or the day of menstruation and may last for two to three days. Read my overview of the menstrual cycle phases >

Primary vs Secondary Dysmenorrhea

The two types of dysmenorrhea, primary and secondary, are distinguished by their cause. Primary dysmenorrhea is cyclical pain that isn’t tied to an underlying medical condition. [1] Pain may begin around the start of menstruation and can range from mild to severe in the stomach, back, and thighs. Primary dysmenorrhea is more common than secondary dysmenorrhea, which is related to an underlying medical condition. [2] Those with secondary dysmenorrhea may be experiencing period pain due to an infection, endometriosis, fibroids, or another condition or infection impacting the reproductive organs. [1-2] Pain associated with secondary dysmenorrhea can begin earlier in the menstrual cycle and may last longer than typical menstrual cramps. 

Causes of Painful Periods

Menstrual cramps are a normal symptom associated with the body shedding the uterine lining. In order for the lining to shed, there is an increase in the level of prostaglandins in the body. [2] Prostaglandins are chemicals that cause the uterus to contract, which causes the feeling of a menstrual cramp. Researchers are still learning more about why some people have more cramps or pain than others, but some data suggests that higher levels of prostaglandins could be to blame. [3] Other causes of painful periods include [1-2]:

• Endometriosis: A condition in which uterine tissue grows in other areas of the body, such as the ovaries, fallopian tubes, and bladder.
• Adenomyosis: A condition in which uterine tissue grows in the muscle wall of the uterus
• Fibroids: Noncancerous tumors found in and around the uterus
• Pelvic inflammatory disease (PID): An infection caused by the spread of bacteria from the uterus to other organs
• Irregularly shaped uterus 
• Cervical stenosis: A condition in which the cervix narrows

Other conditions can also lead to painful or abnormal periods. You should speak with a healthcare provider if you have questions about your health. 

Are Painful Periods a Sign of Good Fertility?

Painful periods don’t give you much insight into your fertility without understanding the cause of the pain. If you have been diagnosed with primary dysmenorrhea, meaning there is no known condition or infection causing the pain, then you will likely need to take a women’s fertility test, speak to a healthcare provider, and track ovulation to gain more insight into your fertility. 

Those with secondary dysmenorrhea may have a better understanding of their fertility, depending on the condition or infection causing the period pain. While not impossible, some conditions such as endometriosis can make it more difficult to conceive.  If you are hoping to conceive soon, you should speak with a provider to gain more insight. Some treatment options may be available that can help you manage and treat your period pain while supporting your family planning goals. Learn the odds of getting pregnant on your period. 

What Are Signs of Good Fertility?

As many of us know already, fertility is not black and white. Some people can conceive without much effort, while others may spend years trying to conceive with no real understanding as to why they aren’t getting pregnant. While some factors, including age, underlying conditions, family history, medical history, and more, can give us an idea of someone’s fertility, many other factors can also influence reproductive health. [4] There are many unique factors to take into consideration, which is why it’s best to speak with a provider directly. All of this being said, some factors or symptoms that someone is fertile include [4-6]:

• Regular menstrual cycles (support cycle regularity with these menstrual cycle supplements and ovulation test kit) 
• Positive ovulation tests 
• Changes in cervical mucus
• Healthy hormone levels- including estrogen, progesterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and others.
• High antral follicle count

Learn more about signs of high fertility → 

How to Manage Painful Period Pain

Fortunately, there are ways to manage painful periods. Let’s review some common methods. 

Hormonal Birth Control

Hormonal birth control methods, including the pill, patch, vaginal ring, and others, tend to lessen menstrual cramps. [2] This may not be the ideal treatment for you if you are hoping to conceive soon, but this is an option to consider if you are experiencing dysmenorrhea. Speak with your provider about whether or not hormonal medications would work for you. 

NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first treatment for dysmenorrhea. [1-2] NSAIDs include medications like ibuprofen that can be purchased over-the-counter at most local drugstores. NSAIDs help reduce the amount of prostaglandins in the body, providing some relief for painful menstrual cramps as well as other aches and pains. [2] 

Prescription Medications

If over-the-counter medications aren’t bringing you relief or if you have an underlying condition causing your pain, a prescription medication may be helpful.  Your provider may be able to prescribe a higher dose of a pain reliever or another type of medication to improve your dysmenorrhea. [1-2] 

Home Remedies

Many home remedies can also lessen pain and improve comfort during menstruation. These include massaging the lower back and abdomen, avoiding caffeine, getting extra rest, using a heating pad, exercising regularly, and avoiding cigarettes and alcohol. [1-2] 

Surgical Interventions

Depending on the cause of your period pain, some surgical or medical interventions may be helpful. For example, those with endometriosis or fibroids may opt for surgical removal of growths and tissues. [1-2] This can relieve many symptoms associated with these conditions, including period pain. 

Keep in mind that some period pain is normal and is experienced by the majority of people who menstruate. Pain can vary from person to person but shouldn’t interfere with your daily life. If you are having difficulty managing your pain from home, you should speak with a healthcare provider. Always consult a provider before trying any new medications or supplements. 

How Natalist Can Help

Painful periods can be difficult to navigate, especially if you’re hoping to conceive soon. If you are experiencing dysmenorrhea, know that you aren’t alone. Painful periods are not necessarily a sign of good fertility, but they don’t always indicate poor fertility either. There are some underlying conditions associated with painful periods that may make it more difficult to conceive. It’s best to speak with a provider about your symptoms so you can get a better understanding of your reproductive health. Get prenatal vitamins for women, postnatal vitamins, and other fertility products on the Natalist website, or continue reading on the Natalist blog. 

References:

1. Dysmenorrhea: Painful Periods. American College of Obstetricians and Gynecologists. FAQ 046. January 2022. https://www.acog.org/womens-health/faqs/dysmenorrhea-painful-periods
2. Dysmenorrhea. Cleveland Clinic. May 2023. https://my.clevelandclinic.org/health/diseases/4148-dysmenorrhea
3. Barcikowska Z, Rajkowska-Labon E, Grzybowska ME, Hansdorfer-Korzon R, Zorena K. Inflammatory Markers in Dysmenorrhea and Therapeutic Options. Int J Environ Res Public Health. 2020;17(4):1191. Published 2020 Feb 13. doi:10.3390/ijerph17041191
4. Evaluating Infertility. American College of Obstetricians and Gynecologists. FAQ 136. August 2022. https://www.acog.org/womens-health/faqs/evaluating-infertility
5. G.J. Scheffer and others, The number of antral follicles in normal women with proven fertility is the best reflection of reproductive age, Human Reproduction, Volume 18, Issue 4, April 2003, Pages 700–706, https://doi.org/10.1093/humrep/deg135
6. Anti-Mullerian Hormone Test. Cleveland Clinic. April 2022. URL. 

Dr. Kenosha Gleaton is board-certified in gynecology and obstetrics and is the Medical Advisor of Natalist. She received her MD from MUSC and completed her residency at Carolinas Medical Center in Charlotte, NC.

Dr. Gleaton is passionate about women, health equity, and mentoring. She is the CEO of The EpiCentre, an OBGYN spa-like practice, and is a Clinical faculty member of Charleston Southern University. She is also a member of the American College of Obstetrics & Gynecology, the American Association of Gynecologic Laparoscopists, and the American Association of Professional Women