Painful periods (dysmenorrhea) are cramps in the lower abdomen or back before or during menstruation. Most are caused by natural chemicals called prostaglandins and respond to anti-inflammatory painkillers, heat and hormonal contraception. Pain that is severe, getting worse, or starts later in life can be caused by endometriosis, adenomyosis or fibroids and should be checked.
- Primary
- No underlying disease
- Secondary
- Endometriosis, adenomyosis, fibroids
- First-line
- NSAIDs, heat, hormonal options
- Tests
- Pelvic exam and ultrasound
- When to check
- Pain disrupts daily life
- Seen by
- Dr. Sun-Ok Lee, OB-GYN specialist
Primary vs. secondary dysmenorrhea
| Primary dysmenorrhea | Secondary dysmenorrhea | |
|---|---|---|
| Cause | Prostaglandins make the uterus contract | An underlying condition in the pelvis |
| Typical start | Within a few years of the first period | Often later, or pain that changes over time |
| Timing | Starts with bleeding, lasts 1–3 days | May start days before and last throughout or beyond the period |
| Other symptoms | Nausea, loose stools, headache | Heavy bleeding, pain during sex, pain with bowel movements, fertility problems |
| Usual response to painkillers | Good | Often incomplete |
Ongoing pain outside your period is covered in our pelvic pain guide.
What conditions can cause severe period pain?
- Endometriosis — tissue similar to the uterine lining grows outside the uterus, causing inflammation and pain.
- Adenomyosis — lining tissue grows into the muscle wall of the uterus, often with heavy periods and an enlarged, tender uterus.
- Fibroids — especially those inside the cavity, which can cause cramping and heavy bleeding.
- Pelvic inflammatory disease — infection of the reproductive organs, often after an STI.
- Copper IUD — can increase cramps in some users, particularly in the first months.
How is the cause found?
- Pain history in English When the pain starts, how long it lasts, what helps, and related symptoms such as heavy bleeding or pain with sex. A pain diary over two cycles is useful.
- Pelvic exam Gently checks for tenderness, nodules or an enlarged uterus.
- Transvaginal ultrasound A same-day pelvic ultrasound looks for endometriomas (ovarian cysts), adenomyosis and fibroids.
- Infection tests if relevant Swabs for chlamydia and gonorrhea when pelvic infection is possible.
- Laparoscopy in selected cases Superficial endometriosis may not show on ultrasound; keyhole surgery can confirm and treat it when symptoms persist despite treatment.
Endometriosis-like tissue outside the uterus can cause inflammation and severe pain with each period.
Once the cause is identified and treated with medication or surgery, pain often becomes more manageable.
What treatments help?
- Anti-inflammatory painkillers (NSAIDs) such as ibuprofen or naproxen work best when started at the first sign of the period or pain, taken regularly for the first 1–3 days.
- Heat and exercise — a heat pad, warm bath and regular physical activity can reduce cramps.
- Hormonal contraception — the combined pill, continuous pill use, the hormonal IUD, implant or progestin-only methods often reduce or stop period pain. See IUD insertion or birth control pills in Korea.
- Treating the underlying cause — medication for endometriosis, removal of fibroids or polyps, or antibiotics for infection.
NSAIDs are not suitable for everyone, for example with stomach ulcers, certain kidney problems or some types of asthma; ask your doctor if you are unsure.
When to see a gynecologist
Book a check-up if painkillers do not control your pain, you miss work or school, pain is getting worse each cycle, or it comes with heavy bleeding, pain during sex or difficulty getting pregnant. At Yoonho Women’s Hospital in Apgujeong, Seoul, period pain is taken seriously and assessed with an exam and ultrasound on the same visit.
Cost and documents
As a general guide, consultations are about ₩50,000–100,000, with ultrasound and tests charged separately; a written estimate is given after consultation. NHI-enrolled residents are usually covered for medically necessary care; travelers can request English receipts and a diagnosis for insurance claims.
Why international patients choose Yoonho
Frequently asked questions
Is it normal to have very painful periods?
Mild to moderate cramps are common, but pain that stops you from daily activities is not something you need to accept. It is worth a check to look for treatable causes.
Does painful period pain mean I have endometriosis?
Not necessarily. Most period pain is primary dysmenorrhea. Endometriosis is more likely when pain is severe, worsens over time, or comes with pain during sex or bowel movements.
Can I buy period pain medication at Korean pharmacies?
Yes. Common painkillers such as ibuprofen and naproxen are available at pharmacies without a prescription. Ask the pharmacist about dosing and whether they are suitable for you.
Will birth control pills help period pain?
For many women, yes. Hormonal contraception thins the lining and reduces prostaglandins. Some combined pills are sold at Korean pharmacies, while others need a prescription.
Will painful periods affect my fertility?
Primary dysmenorrhea does not. Some causes of secondary dysmenorrhea, such as endometriosis, can affect fertility, which is another reason to get checked.
OB-GYN Specialist · Director of OB-GYN
M.D., Ewha Womans University College of Medicine · Former Clinical Instructor, Ewha Womans University Mokdong Hospital · Member, Korean Society of Menopause
Last reviewed: . This page is for general information and does not replace an in-person consultation.
Talk to an English-speaking gynecologist
Yoonho Hospital · 304 Apgujeong-ro, Gangnam-gu, Seoul · Mon–Fri 9:00–18:00, Sat 9:00–13:00 · Walk-ins welcome.