Period Pain (Dysmenorrhoea)

period pain

Most women have some pain during periods. The pain is often mild but, in about 1 in 10 women, the pain is severe enough to affect day-to-day activities. The pain can be so severe that they are unable to go to school or work. Doctors may call period pain 'dysmenorrhoea'. Period pain is one type of pelvic pain.

  • Primary dysmenorrhoea is the most common type of painful periods. This is where there is no underlying problem of the womb (uterus) or pelvis. It often occurs in teenagers and women in their 20s.
  • Secondary dysmenorrhoea is pain caused by a problem of the womb or pelvis. This is less common, and is more likely to occur in women in their 30s and 40s.

Primary dysmenorrhoea

What causes the pain of primary dysmenorrhoea?

The cause is not clear. The womb is normal. It is thought that normal body chemicals (called prostaglandins) build up in the lining of the womb. Prostaglandins help the womb to contract and remove the lining of the womb during a period. In women with period pain there seems to be a build-up of too much prostaglandin, or the womb may be extra sensitive to the prostaglandins. This may cause the womb to contract too hard. This reduces the blood supply to the womb and leads to pain.

What are the symptoms of primary dysmenorrhoea?

The main symptom is crampy pain in your lower abdomen. Often, the first few periods that you have are painless. Period pains may only begin 6-12 months after you have started your periods. The pain:

May spread to your lower back, or to the top of your legs.

Usually starts as the bleeding starts, but it may start up to a day before.

Usually lasts 12-24 hours, but lasts 2-3 days in some cases.

Can vary with each period. Some periods are worse than others.

Tends to become less severe as you get older, or after having a baby.

In some women, other symptoms occur as well as pain. For example: headaches, tiredness, faintness, breast tenderness, feeling sick, bloating, diarrhoea and feeling emotional or tearful.

Note: the following are not symptoms of primary dysmenorrhoea: fever, vaginal discharge, sudden severe abdominal pain, pain when you have sex, vaginal bleeding between periods, vaginal bleeding after having sex. You should see your doctor if any of these symptoms develop.

What are the treatment options for primary dysmenorrhoea?

Most women with painful periods have mild pain that they can treat themselves at home. However, if your pain becomes more severe and is interfering with your usual activities, you should see your doctor.

There are a number of treatments that may help if you have primary dysmenorrhoea:

Warmth: you may find it soothing to hold a hot water bottle against your lower abdomen, or to have a hot bath. The pain often does not last long, and this may be all that you need. (Be careful not to burn yourself with a hot water bottle which is too hot.) A warm bath or shower may also help.

Non-steroidal anti-inflammatory painkillers

Paracetamol: this is an alternative painkiller that you can try if you cannot take non-steroidal anti-inflammatory painkillers. Also, paracetamol can be used in combination with a non-steroidal anti-inflammatory painkiller if the anti-inflammatory alone is not enough. Always read the details on the packet so that you do not exceed the maximum daily dose of either painkiller.

The combined oral contraceptive pill ('the pill'): this is an option if you also need contraception. Heavy periods are much less likely if you take 'the pill'. You can also take the pill, so that you have fewer periods in a year. This will reduce the number of times you have pain.

Secondary dysmenorrhoea - period pain due to an underlying cause

What causes secondary dysmenorrhoea?

A problem of the womb or pelvis sometimes causes painful periods. For example: endometriosis, fibroids, or infection of the womb and Fallopian tubes (pelvic inflammatory disease). Some types of intrauterine contraceptive device (IUCD - also known as the 'coil') also make painful periods worse in some women.

What are the symptoms of secondary dysmenorrhoea?

Again, the main symptom is crampy lower abdominal pain during your periods. With secondary dysmenorrhoea, your periods tend to become more painful after several years of 'normal' periods .

The following may indicate secondary dysmenorrhoea:

If you have a change in your usual pattern of pain. For example, if your periods become more painful than they used to be, or the pain lasts longer than it used to. In some women with secondary dysmenorrhoea the pain starts several days before the period begins, and lasts all the way through the period. (This is uncommon with primary dysmenorrhoea.)
If you have other symptoms. For example:

Irregular periods.
Bleeding between periods.
Pains between periods.
The bleeding becomes heavier than previously.
Vaginal discharge.
Pain during sex.

You should see your doctor if you develop any of these problems.

How is secondary dysmenorrhoea diagnosed?

Your doctor will usually examine you if they suspect that you have secondary dysmenorrhoea. This may involve an examination of your abdomen as well as an internal examination to check your womb and pelvis. The idea is to look for possible causes of your painful periods, such as fibroids in your uterus. Your doctor may also suggest that they take some swabs during the examination to look for any signs of infection.. The investigations that are carried out depend on the likely underlying problem. They may include an ultrasound scan of your uterus (womb) and pelvis, a hysteroscopy (an examination of the inside of your womb, using a telescope) or a laparoscopy (an examination of the internal organs of your pelvis, using a telescope).

What are the treatment options for secondary dysmenorrhoea?

The treatment of secondary dysmenorrhoea depends on the underlying cause. If you have an IUCD and have painful periods, the treatments for primary dysmenorrhoea (described above) often help. However, some women prefer to have their IUCD removed if symptoms do not improve.

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