Period pain


If period pain is so bad that it interferes with your daily living, or stops you from going to school or work, please see your doctor to discuss it. Period pain, what causes period pain, what is 'normal' and some possible ways to get relief from period pain are discussed.

Period pain (dysmenorrhoea)

hot water bottleSome women experience minimal or mild discomfort during menstruation, but others suffer from severe, debilitating pain that prevents them from doing their day-to-day activities. None of us knows what another woman's pain is like, so it is useful to understand what periods should feel like and then decide if all is normal. Some women might have always experienced painful periods; others might develop pain. Period pain is more common in adolescents and women in their 20s, but can also occur in older women.

Period pain happens when the muscles in the uterus contract or tighten. Pain can include cramping and heaviness in the pelvic area, as well as pain in the lower back, stomach or even legs. Some women also experience nausea, vomiting, paleness, diarrhoea or loose bowels. Women who experience painful periods can have higher levels of prostaglandins – a natural body chemical that causes contractions of the uterus, bowel and blood vessels.[1]

Period pain is the most common cause of pelvic pain.

What is normal period pain?

Period pain is only considered 'normal' if:

  • the pain is there only on the first one or two days of your period
  • the pain goes away if you take period pain medications or use the contraceptive pill
  • your ability to do your normal activities is not impaired.

If the pain is not like this, it is not normal.

What causes period pain?

Painful periods can be due to:

  • pain in the uterine (womb) muscle (myometrium), especially if the pain is on the first one or two days of a period
  • pain from endometriosis and/or adenomyosis, especially if the pain is present for more than one to two days before the period starts.

Many women with strong period pain have both these problems, and women with adenomyosis have a more painful uterus than other women, even if it looks normal.

Adenomyosis is a condition in which the cells that normally form a lining in the uterus also grow in the muscle wall of the uterus.

Endometriosis is a condition in which cells similiar to those found in the lining of the uterus (endometrium), grow outside the uterus. It used to be thought of as an uncommon problem of women in their 30s and 40s. We now know it is a common problem that usually starts in the teens (see our webpages on endometriosis).

Symptom relief for painful periods

Apply heat on the belly or lower back Helps relax muscles
Exercise

Releases endorphins (natural feel-good hormones)

Relax with rest, warm baths or meditating Relieves stress

Complementary therapies

Acupuncture, or discuss taking fish oils and magnesium with a qualified naturopath
Pain relief: ibuprofen, naproxen or diclofenac [2] Take period pain medications at the onset of pain, and take regularly during the days you normally have pain. All these medications can cause stomach irritation, so they are best taken with food. Discuss the pros and cons of using them with your doctor.

The oral contraceptive pill (OCP) [3]

Ask your doctor about:

  • a pill with more progestogen than oestrogen for the best effect
  • planning a period only every 2-3 months, or not at all.
Mirena® intrauterine device (IUD) [4]

Currently the most effective treatment for pain from the uterus; lasts up to five years.

It slowly releases a progestogen medication to the uterus that makes periods lighter and less painful. It is also a contraceptive.

It is common to have irregular bleeding and cramp pains during the first few months of use, but these problems usually settle.

It can be inserted in the doctor's surgery or under a general anaesthetic.

If simple treatments for period pain don't help, see your doctor to discuss the possible causes and what might be best to do in your individual case.

References

  1. Willman EA, Collins WP, Clayton SG. Studies in the involvement of prostaglandins in uterine symptomatology and pathology. Br J Obstet Gynaecol. 1976;33:337.

  2. Marjoribanks J, Proctor M, Farquhar C, Derks RS. Non-steroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev. 2010;CD001751.

  3. Wong CL, Farquhar C, Roberts H, Proctor M. Oral contraceptive pill for primary dysmenorrhoea. Cochrane Database Syst Rev. 2009;CD002120.

  4. Bahamondes L, Petta CA, Fernandes A, Monteiro I. Use of the levonorgestrel-releasing intrauterine system in women with endometriosis, chronic pelvic pain and dysmenorrhoea. Contraception. 2007 Jun;75:S134-9.

Last updated 20 July 2018 — Last reviewed 10 July 2018

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at July 2018.

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