Normal NOT Normal

Period Cramps: How To Know If Your Pain Is Normal

Period cramps, or dysmenorrhea, are a really common experience during menstruation (more common than we think!), but their intensity can vary from person to person. The bigger question that often arises is, how do you know if your cramps are just part of a healthy cycle, or if they signal something more serious?

Understanding how to measure the severity of menstrual cramps can help you determine when to manage the pain at home and when to seek help. In this guide, we’ll break down the different scales used to measure period pain, what’s considered “normal,” and when it’s time to be concerned.

If your cramps feel more intense than usual, last longer, or come with unusual symptoms, don’t hesitate to check in with a healthcare professional. Your comfort and wellbeing matter, and getting the right support can make all the difference.

What’s normal and what’s not?

Period cramps can feel different for everyone. Some women experience just a bit of discomfort, while others face intense pain that can mess with their day-to-day routine.

Here’s a quick rule of thumb about what's 'normal' and what's not:

Normal

Mild to moderate cramps that don’t stop you from going about your daily activities can usually be managed with simple remedies, such as heat packs or over-the-counter pain relievers. These sort of cramps are generally considered “normal”.

Not Normal

However, if the pain is extremely severe and persistent, preventing you from working, studying, or just going about your day (and nothing seems to help), it may be time to consult a doctor.

The scales to measure period cramps

There are several tools and scales that healthcare professionals use to assess the severity of period cramps. These methods help to categorize the pain, so patients and doctors can determine the appropriate course of action.

Here are the most commonly used scales:

1. VISUAL ANALOG SCALE (VAS)

The Visual Analog Scale is one of the simplest tools used to measure pain. It consists of a 10-cm line where one end represents "no pain at all" and the other end represents "unbearable pain."

• Mild Dysmenorrhea: A rating between 1 and 3.

• Moderate Dysmenorrhea: A rating between 4 and 7.

• Severe Dysmenorrhea: A rating between 8 and 10.

This scale helps you visually assess how much pain you’re in, based on a straightforward line, making it easier to communicate the severity of your cramps to a healthcare provider.

Fig 1: Linear Visual Analogue Scale (VAS) (www.​researchgate.​net/​publication/​259499877)

2. NUMERICAL RATING SCALE (NRS)

Another common method is the Numerical Rating Scale, which uses a 10-point scale to gauge pain intensity. You simply rate your pain from 1 (no pain) to 10 (the worst pain imaginable).

• Mild Dysmenorrhea: A score of 1 to 3.

• Moderate Dysmenorrhea: A score of 4 to 7.

• Severe Dysmenorrhea: A score of 8 to 10.

This scale is similar to the VAS, but it offers a clearer numerical representation, which can be particularly helpful for tracking pain over several months. However, both scales are considered extremely useful for assessing menstrual pain.¹

Fig 2: Figure available from https://www.physio-pedia.com/Numeric_Pain_Rating_Scale

3. VERBAL RATING SCALE (VRS)

The Verbal Rating Scale is commonly used in clinical settings, and one of the most well-known versions is the McGill Pain Questionnaire. This scale includes a list of descriptive terms such as "mild," "moderate," and "severe" pain, accompanied by visual representations that show different levels of intensity. The McGill Pain Questionnaire helps provide a more nuanced understanding of pain, beyond just numbers or lines.²

^{Fig 3: Figure available from Clinical Oral Investigations}

4. WaLIDD SCORE

The WaLIDD Score is a more comprehensive approach to measuring period cramps. It takes into account a combination of factors to offer the best analysis³, including:

• Working ability: How well you can perform daily activities.

• Location: Where the pain is located, such as your lower abdomen, back, legs, etc.

• Intensity: The severity of the pain.

• Days of pain: How many days the cramps last.

Fig 4: WaLIDD score variable (https://www.researchgate.net/profile/Anibal-Teheran)

References

1. Latthe PM, Latthe M, Say L, et al. Comparing visual-analog and numeric scales for assessing menstrual pain. Women's Health Issues. 2002;12(3):129–34. doi:10.1080/08964280209596043.

2. Kahl C, Cleland JA. Visual analogue scale, numeric pain rating scale and the McGill pain Questionnaire: an overview of psychometric properties. Physical therapy reviews. 2005 Jun 1;10(2):123-8.

3. Sahebazzamani Z, Rashidi Fakari F, Zeynivand F, et al. Efficacy of working ability, location, intensity, days of pain, and severity of dysmenorrhea. J Obstet Gynecol Cancer Res. 2021;6(4):227–33. Available from: https://www.jogcr.com/article_697237.html:contentReference[oaicite:2]{index=2}

Image References:

1. Ghaderi F, Banakar S, Rostami S. Effect of pre-cooling injection site on pain perception in pediatric dentistry:“A randomized clinical trial”. Dental research journal. 2013 Nov;10(6):790.

2. Jensen MP, McFarland CA. Increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain. 1993 Nov 1;55(2):195-203.

3. Relvas JB, Bastos MM, Marques AA, Garrido AD, Sponchiado EC. Assessment of postoperative pain after reciprocating or rotary NiTi instrumentation of root canals: a randomized, controlled clinical trial. Clinical oral investigations. 2016 Nov;20:1987-93.

4. Teherán AA, Piñeros LG, Pulido F, Mejía Guatibonza MC. WaLIDD score, a new tool to diagnose dysmenorrhea and predict medical leave in university students. International journal of women's health. 2018 Jan 17:35-45.