Period pain

What is period pain?

Period pain, otherwise known as dysmenorrhoea, is the absolutely natural pain experienced around the time of your monthly menstrual bleed. It usually starts just before the bleed or on the first bleed day, and lasts 2–3 days. The pain is mainly cramping, but may vary from intermittent spasms to a continuous dull ache, and fluctuate in severity. The pain is experienced in the lower abdomen, sometimes spreading into the back and down the thighs.

Facts about period pain

Period pain is common, with approximately 80% of women experiencing it at some time in their life. It commonly occurs at the start of menstrual life in girls and young women and may continue until menopause, although it usually improves with age. Period pain is more likely to affect women whose mother experienced period pain. For most women, painful periods are a mild discomfort, but they can affect overall quality of life and interfere with normal daily activities for up to 10% of women. Painful periods may be more likely in women who started periods at a young age, have long periods or heavy bleeding, smoke, or are overweight.

Types of period pain

There are two types of period pain.

• Primary dysmenorrhoea is period pain that is not caused by any specific condition. It is a normal and natural condition for women, occurring when first starting your periods.

• Secondary dysmenorrhoea is the pain resulting from an underlying medical condition, e.g., endometriosis, inflammation, fibroids, or adenomyosis. It usually starts some years after your first period, usually in your 30s or 40s, and occurs at any time during your monthly cycle. Pain may be more intense, and bleeds may be irregular, prolonged and heavier.

Causes of period pain

In primary dysmenorrhoea, the muscles in your uterus (womb) contract to enable shedding of the womb lining forming part of your monthly period. When the womb contracts the blood supply (and therefore oxygen) to the womb is reduced. This results in the womb releasing natural chemicals that cause pain; simultaneously, hormones called prostaglandins are also released, causing further contractions of the womb and therefore increasing the severity of pain. The reason for some women experiencing greater period pain than others is not known but it may be because they accumulate more prostaglandins, and thus have stronger contractions.

Secondary dysmenorrhoea may be caused by other medical conditions affecting the uterus, including endometriosis (when cells of the uterus lining grow outside of the uterus, causing great pain when they shed), pelvic inflammatory disease (an uterine infection, also involving the fallopian tubes and ovaries), fibroids (uterine growths, causing heavy, painful periods), or adenomyosis (when the uterus lining grows into the uterine muscle wall).

Symptoms of period pain

Symptoms tend to differ between women.

With primary dysmenorrhoea, the major symptom is cramping pain in the lower abdomen, which sometimes radiates into your back and thighs. You may also experience other symptoms at the time of your period, including tiredness, bloating, tender breasts, backache, mood changes, lack of concentration, and stomach upset (nausea, vomiting, and diarrhoea).

With secondary dysmenorrhoea, there is also a cramping pain, with a heavy feeling in the lower abdomen, and back pain. You may also experience headaches, bleeding between periods, a thick smelly vaginal discharge, pain during sexual intercourse, and nausea, vomiting, and diarrhoea.

Diagnosis of period pain

For a diagnosis, you will be asked about your periods, your symptoms, and how they affect your daily life. If primary dysmenorrhoea is suspected, then your doctor may examine your abdomen only, particularly if you are young and do not have sex. If secondary dysmenorrhoea may be the problem, and/or you are sexually active, your doctor may examine your vagina. An instrument called a speculum is used to open the vagina so that the cervix can be examined and a swab taken. Some women are referred to a specialist (gynaecologist) for tests to determine the cause of the symptoms.

Treatment of period pain

Treatment of painful periods will depend on the cause and severity of pain and symptoms. It is important to know that period pain during the natural menstrual cycle does not affect your fertility, but that secondary dysmenorrhoea conditions may do so and should be treated if necessary.

Managing your symptoms

Many women are able to manage their symptoms themselves at home. Heat on your lower abdomen or back can be a great help, such as a warm bath, a hot water bottle, or heat patch, as can abdominal and back massage. A transcutaneous electrical nerve stimulation (TENS) machine may help, as it sends electrical impulses to modify the pain signals that travel to your brain.

Other ways to ease discomfort include wearing loose fitting clothing, relaxation techniques, and physical exercise, which improve blood flow to the pelvic area. Lifestyle changes have also helped some women; these include not smoking (smoking reduces the oxygen supply to the pelvic area), limiting alcohol consumption, a healthy diet, low salt intake (to avoid water retention) and taking vitamin supplements (e.g. vitamin E, primrose oil or starflower oil help maintain hormonal balance).

Medicines

Painkillers bought from the pharmacy, such as paracetamol, aspirin, or ibuprofen may ease symptoms; some products specifically target period pain. Your doctor may also prescribe other non-steroidal anti-inflammatory drugs (NSAID) such as mefenamic acid. NSAIDs ease pain by blocking the production of hormones called prostaglandins that cause the uterus (womb) muscles to contract, which causes pain by reducing blood flow to the pelvic area. Talk to the doctor or pharmacist about your other medical conditions and medicines before taking painkillers. Hormonal contraception, such as the combined contraceptive pill, progesterone-only pill, hormone implants, or an intrauterine system may also be used to reduce symptoms, but only if you are not planning a pregnancy.

Treatment options specifically for secondary dysmenorrhoea will depend on the cause of your condition. You may require keyhole surgery (laproscopy), where a tube with a camera at the end is inserted into your abdomen to visualise any abnormalities. Pelvic inflammatory disease caused by infection can be treated with antibiotics, and fibroids can be surgically removed.