Feeling slight strain or cramps in the lower abdomen and waist during menstruation is a natural biological process. When the muscles contract to expel the inner layer of the uterus, the hormone 'Prostaglandins' causes mild pain. But for years this conservative belief has persisted in the society that "There is pain during periods, learn to tolerate it." Due to this thinking, lakhs of women silently tolerate the unbearable and life-threatening pain every month, considering it normal or manage by taking painkillers without medical advice. Gynecologists clearly say that if the pain is so intense that it completely stops your normal daily work, office going or college routine, then ignoring it can be fatal. This severe pain, which is called 'Secondary Dysmenorrhea' in medical language, can be a clear alarm of some hidden serious disease developing in the uterus and reproductive organs. 1. Endometriosis: The most common but most delayed disease, the main cause of unbearable period pain is endometriosis, which affects 1 in 10 women worldwide. What happens when: The endometrium-like layer that forms inside the uterus grows on tissues outside the uterus—fallopian tubes, ovaries, intestines, or pelvic tissues. Symptoms: sharp pain in the abdomen, back and legs that extends to the bones during menstruation, prickling sensation while urinating or defecating, extreme pain during intercourse and difficulty in conceiving a child for a long time (risk of infertility). Challenge: It is not easily visible in sonography at the initial stage, due to which it takes an average of 7 to 8 years to be diagnosed. 2. Uterine Fibroids: Formation of lumps in the uterus. Fibroids are non-cancerous tumors or lumps of flesh that develop in the wall of the uterus. Pressure and cramps: As these fibroids increase in size, they put constant pressure on the uterine muscles, causing severe cramps and contractions in the uterus during periods. Heavy Bleeding: Due to fibroids, periods can drag on for more than 7 to 10 days, large blood clots fall and severe anemia (blood deficiency) occurs in women. Apart from this, there is heaviness in the pelvic area all the time. 3. Adenomyosis: Swelling of the walls of the uterus. This problem is often seen in women above 30 years of age. Internal proliferation in the walls: In this disease, the inner layer of the uterus (Endometrium) starts growing inside the outer muscular wall of the uterus (Myometrium). Identification: Due to this, the uterus swells to double or triple its normal size. During periods, there is not only intense pressure and cramps in the abdomen, but there is also a dull strain and pain in the pelvic area throughout the month. 4. Pelvic Inflammatory Disease (PID): Serious infection of the reproductive organs. PID is a serious bacterial infection that spreads to the female reproductive organs (uterus, fallopian tubes, and ovaries). Effect of infection: This inflammation is often caused by sexually transmitted infections (STIs) or the spread of normal vaginal bacteria. Symptoms: Pain during periods many times more than normal, unusual smelly vaginal discharge, spotting between periods, persistent pain in the waist and sometimes mild fever are its main signs. If not treated on time, it can block the fallopian tube. Normal pain vs pain from illness: how to recognize the difference? Symptoms Normal period pain (Primary) Indication of disease (Secondary) Onset a few hours before bleeding Starts several days before the period begins Periods are quiet for the first 24 to 48 hours Continues throughout the period or after it ends Effects can be relieved by heating pads or simple rest Pain even after taking painkillers Ineffective Pain extends only to the lower middle part of the abdomen to the lower back, thighs and legs Daily life Mildly uncomfortable, but continues from bed Impossible to get up, dizziness and vomiting, when should one immediately run to the doctor? If you notice the following 'red flag' symptoms in your menstrual cycle, you should immediately get a pelvic ultrasound and examination from a qualified gynecologist without any hesitation: Frequent dizziness, vomiting or fainting due to pain. Pad becoming completely wet and large clots (larger than the size of a coin) coming out every 1-2 hours. Persistent pain in the pelvic area, lower abdomen or waist even after periods are over. No relief even after taking over-the-counter painkillers (Mefenamic Acid etc.) regularly. After the age of 25, period pain suddenly increases manifold, whereas earlier the cycle was normal. Remember that accepting pain as just a matter of luck can be a major compromise with your fertility and long-term health. These diseases can be controlled by getting tests like sonography and MRI done at the right time.