Why Menstrual Pain Persists for Some—and Improves for Others: New Insights from a 2-Year Study

Menstrual pain is often dismissed as something people should simply “push through.” But for many, it’s far more than a monthly inconvenience—it’s a chronic condition that affects daily life, mental health, and long-term well-being.

In a new study published in the Journal of Obstetrics and Gynaecology Canada, our research team followed over 150 young women for two years to better understand how menstrual pain changes over time—and why it improves for some but persists for others.

Four patterns of menstrual pain over two years.

Most participants experienced persistently high pain over time, while smaller groups showed improvement or worsening symptoms. Understanding why some people improve—and others don’t—is a major focus of our ongoing research.

Four distinct pain trajectories

Using advanced statistical modeling, we identified four distinct patterns of menstrual pain over two years:

• High-stable pain (63%) – consistently severe pain over time

• Low-stable pain (15%) – consistently mild or minimal pain

• Improving pain (11%) – pain decreased over time

• Worsening pain (11%) – pain increased over time

The most striking finding? The majority of participants with moderate-to-severe dysmenorrhea remained in a high-pain state across two years, challenging the common belief that menstrual pain naturally improves with age.

Pain isn’t just about the uterus

What separated these groups wasn’t just menstrual cramps themselves—it was the broader pain and sensory profile.

Participants with persistently high pain had:

• More non-menstrual pelvic pain

• Greater somatic sensitivity (heightened bodily symptom awareness)

• More sleep disturbance

These features resemble patterns seen in chronic pain conditions, suggesting that for many individuals, menstrual pain is part of a broader pain-processing vulnerability rather than an isolated gynecologic issue.

Interestingly, anxiety and depression—often assumed to drive pain—did not distinguish pain trajectories in this study.

Hormones may matter—but they’re not the whole story

Participants whose pain improved over time were more likely to use hormonal contraception during follow-up. While this doesn’t prove causation, it suggests that effective hormonal suppression may help some individuals, particularly when paired with other supportive strategies.

At the same time, hormonal treatment alone did not explain why most participants remained in persistent pain—highlighting the need for more comprehensive, personalized care.

Why this matters

Menstrual pain is often the first pain condition people experience—and for many, it becomes a gateway to chronic pelvic pain later in life. Our findings suggest that:

• Persistent menstrual pain is common, not exceptional

• Early indicators—such as sleep disruption and multisite pain—may help identify individuals at risk

• Addressing menstrual pain early, and holistically, could help prevent long-term pain trajectories

This work supports a shift away from a “just cramps” mindset toward a biopsychosocial, systems-based understanding of menstrual pain.

What’s next?

Building on these findings, our lab has two new NIH-funded studies designed to move beyond describing menstrual pain—and toward understanding why it happens and how we can prevent it from becoming chronic.

NSAID-HEAL: Targeting Individual Responses to Common Pain Relievers

(NSAID-HEAL: Interindividual Variability in NSAID Responses to Mitigate Chronic Pelvic Pain Risk)

Many people rely on over-the-counter medications like naproxen (Aleve) to manage menstrual pain—but not everyone responds the same way. This study asks a critical question:

Can NSAIDs do more than reduce pain in the moment—can they actually change long-term pain trajectories?

Using detailed symptom tracking, biological sampling, and clinical assessments, NSAID-HEAL examines why some individuals experience meaningful pain relief while others do not. Our goal is to identify biological and physiological markers that predict treatment response and long-term risk for chronic pelvic pain.

Who can participate:• Individuals assigned female at birth• Ages 18–35• Regular menstrual cycles• Experiencing painful periods

Where: Evanston Hospital

Compensation: Up to $750

To sign up go to nsaidheal.com

CRAMPP²: Cross-Organ Mechanisms in Chronic Pelvic Pain

Menstrual pain does not occur in isolation. Many people with dysmenorrhea also experience bladder, bowel, or pelvic floor symptoms—suggesting shared biological pathways.

The cRAMPP² study uses advanced imaging (including MRI) and symptom profiling to understand how pain signals move between pelvic organs and how this contributes to persistent pain conditions. This work aims to identify early markers of chronic pelvic pain and uncover new targets for prevention and treatment.

Who can participate:• Individuals assigned female at birth, ages 18–45• Regular menstrual cycles• With or without painful periods• Including individuals with endometriosis or uterine fibroids• Pain-free volunteers also welcome• No IUD use

Where: Virtual participation with optional in-person visits at Evanston Hospital

Compensation: Up to $395

to sign up go to evanstonperiodstudy.com

Read the full paper here: https://authors.elsevier.com/c/1mKNo62pzAlEkl

Psychosocial Predictors of Dysmenorrhea Stability and Change: A Two-Year Longitudinal Study

Journal of Obstetrics and Gynaecology Canada (2026)