First period in 4 months and very heavy with lower back pain and severe cramping should I go to the er?

Menstrual period and. When you menstruate the organs and tissues inside your pelvis become engorged with blood and fluid. This additional pressure and engormenent is sense by the nerves which then send pain to the brain. This is usually manage with antiinflamm meds. If the bleeding persist of greater than 3 tampoons per hour then an er visit is warranted.
Not unless... .....You have a positive pregnancy test or pain unrelieved by Ibuprofen and/ or bleeding is too heavy. Likely your period is such because you have not shed your uterine lining for several months..

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