Period cramps: almost everyone gets them, and everyone hates them. But most people take them as a given — an annoying part of life that you just have to deal with, like your commute or your in-laws.

“While most women don’t hope for cramps, realistically, many women experience some cramping either just prior to their menstrual cycle or the first few days of their flow,” says Alyssa Dweck, M.D., gynecologist, and author of The Complete A to Z for Your V.

While it’s hard to say what normal cramps should feel like, and “every woman’s pain tolerance is different,” according to Dr. Dweck, cramps shouldn’t interfere with your daily life. Generally, cramps that start a day or two before your flow and gradually decrease over the first few days of your period are considered normal. Cramps that prevent you from making plans with friends, going to work, or aren’t soothable with a heating pad or OTC meds could be a sign that something’s up.

Another sign Dr. Dweck advises to watch out for: sudden changes. Ideally, your period should be consistent, so if you’ve only ever had mild cramps and suddenly find yourself doubled over in pain every time your period starts, or if you notice they’re progressively getting worse each month, discuss it with your doctor, because changes to your cramps could be a sign of an underlying condition. Here are five potential culprits:

Endometriosis: Endometriosis is a condition in which tissue that normally lines your uterus instead grows outside of it in places like the fallopian tubes, bladder, or pelvic floor. It is estimated to affect around 11 percent of women. Telltale signs of endometriosis? Painful, heavy periods and severe cramps that are often accompanied by severe nausea, vomiting, constipation, back pain, and pain during sex. Experts still aren’t sure why, exactly, some women get endo and others don’t, but there may be a genetic component to it. Unfortunately, there’s no cure for endometriosis and left untreated it can cause serious problems, including infertility. But it is manageable (treatment options include birth control and hormone therapy, and in severe cases, surgery), so you definitely don’t have to live with the pain forever.

Uterine fibroids: Uterine fibroids are common, with as many as 75 percent of women developing them at some point in their lives. Most of the time, fibroids are painless and don’t cause any real trouble (they’re very rarely cancerous); however, for some women, uterine fibroids “can turn monthly menses into a monthly nightmare by increasing not only the amount of bleeding, but the severity of menstrual pain,” Lauren Streicher, MD, associate professor of obstetrics and gynecology at Feinberg School of Medicine at Northwestern University, told Everyday Health. Depending on how bad the pain is, some women choose to take a wait-and-see approach, but if you really can’t live with the pain, talk to your doctor about switching up your birth control, which may shrink the fibroids.

Pelvic inflammatory disease:
Also known as PID, Pelvic Inflammatory Disease is often caused by an underlying STI. That said, you can still get PID when bacteria spreads from your vagina to your uterus, fallopian tubes, or ovaries. Often, PID is asymptomatic, but some symptoms can include pain in your abdomen and pelvis, pain during sex, and constant heavy bleeding, especially after sex or between periods.

Adenomyosis: Adenomyosis is similar to endometriosis, except that in this case, your uterine lining burrows itself way down deep in the uterine muscle. Like PID, adenomyosis can be asymptomatic, but symptoms can also include heavy bleeding during your period, menstrual cramps that last throughout the entirety of your period and get worse as you get older, blood clots during your period, and pain during sex. According to the Mayo Clinic, most cases are found in postmenopausal women; however, recent research suggests that it may be much more common than previously believed in younger women and is going undiagnosed. Treatment often depends on age (adenomyosis often goes away after menopause), but some options include anti-inflammatory drugs and treatment with hormonal birth control.

Primary or secondary dysmenorrhea: Both primary and secondary dysmenorrhea refer to painful period cramps, but the first one generally refers to severe cramps that have no known cause, while the second is an umbrella term for period pain that is caused by some kind of disorder (the most common cause of secondary dysmenorrhea is endometriosis). A 2013 study suggests that a little over one-third of women may suffer from primary dysmenorrhea, which is often accompanied by nausea, headaches, and vomiting. Unfortunately, because doctors know so little about what causes primary dysmenorrhea, there’s no real way to treat it. Your best bet? Following a healthy lifestyle – getting enough sleep, eating a healthy diet, exercising regularly, trying not to stress (much easier said than done, we know) – and popping a couple of Advil when your period rolls around will all help to mitigate painful periods. If after a few months, you’re not feeling any relief, talk to your doc.

You might be stuck with cramps every month, but they shouldn’t rule your life. You’re the best judge of what feels normal for you — so if it feels as though something isn’t right, don’t be afraid to speak up.

Alanna is a freelance writer and editor living in Brooklyn. She's written for Shape, Fitness, Cosmopolitan, Reader's Digest, Vivala.com, and more, and mostly spends her time now searching for the perfect coffee shop, writing about all things health and wellness, taking photos of her dog, and trying (and failing) to become a dedicated runner. Follow her on Twitter or Instagram.