Period pain

Period pain is also called dysmenorrhoea (painful menstrual bleeding). Period pain is a common problem, and when severe it can stop you from doing your usual activities. However, there are treatments available for painful periods.

Period pain can be classified into primary or secondary dysmenorrhoea.

Period pain symptoms

The main symptom of period pain is cramping pain in the lower abdomen (pelvis), which begins just before the start of menstrual bleeding and usually lasts about 2 or 3 days. The severity ranges from mild to severe and incapacitating.

Other symptoms associated with period pain include:

  • low back pain;
  • pain in the thighs;
  • diarrhoea;
  • nausea and vomiting;
  • tiredness;
  • headaches; and
  • dizziness or feeling faint.

Primary dysmenorrhoea

Primary dysmenorrhoea is pain associated with menstruation that has no other medical cause. Period pain that begins within 6 to 12 months of your first period is usually primary dysmenorrhoea.

Primary dysmenorrhoea often improves with age and may also improve after childbirth.

The cause of primary dysmenorrhoea is chemical substances known as prostaglandins, which are made in the lining of the uterus. Prostaglandins cause period pain by triggering muscle contractions in the uterus during your period, as well as constricting and compressing blood vessels in the uterus, briefly depriving tissues of their blood supply.

Prostaglandins can also contribute to the diarrhoea and nausea associated with period pain.

The higher the concentration of prostaglandins, the more severe the period pain.

Risk factors for developing primary dysmenorrhoea include:

  • periods beginning at age 11 or younger;
  • prolonged periods;
  • heavy menstrual bleeding;
  • a family history of primary dysmenorrhoea;
  • being obese;
  • drinking alcohol; and
  • being a smoker.

Women who have heavy periods (menorrhagia) tend to experience period pain more often than women who do not. Their pain may be made worse by the uterus trying to expel blood clots that have not fully dissolved.

Secondary dysmenorrhoea

Secondary dysmenorrhoea is period pain caused by an underlying medical condition. It often begins in your 30s or 40s.

In secondary dysmenorrhoea, the pain may continue for the duration of bleeding, and sometimes occurs between periods. The pain associated with secondary dysmenorrhoea tends to get worse over time.

Other factors suggesting secondary dysmenorrhoea include:

  • period pain that has recently changed;
  • heavy periods;
  • bleeding between periods or after sex;
  • pain during sex;
  • discharge from the vagina; and
  • irregular periods.

Causes of secondary dysmenorrhoea include:

  • endometriosis (when tissue similar to the lining of the uterus grows elsewhere in the body, causing pain);
  • fibroids (benign growths in the uterus);
  • pelvic inflammatory disease (infection and inflammation of the female reproductive organs);
  • adenomyosis (a condition where the lining of the uterus grows into the muscular wall of the uterus);
  • non-hormonal intrauterine devices (IUDs);
  • congenital conditions affecting the female reproductive organs, and
  • narrowing of the cervical canal (the entrance to the uterus), which restricts the flow of blood.

Diagnosis and tests

Your doctor will ask about your symptoms, about your menstrual cycle and may perform a physical examination of your pelvic area. The diagnosis of primary dysmenorrhoea can usually be made without any further investigations.

Tests may be recommended for some women, including those with severe period pain and/or features suggestive of secondary dysmenorrhoea.

Tests may include:

  • a pelvic ultrasound scan;
  • a laparoscopy (examination of your pelvic organs with a telescopic instrument inserted into a small hole below your navel, carried out under anaesthetic ); or
  • a hysteroscopy (a procedure where a narrow tube with a camera on the end is passed through the cervix to look at the inside of the uterus, carried out under anaesthetic).

Treatment for period pain

There are several treatment options available for primary dysmenorrhoea. Pain relievers can be used in combination with hormonal treatments and self-care measures.

The treatment of secondary dysmenorrhoea includes treatment of the cause, as well as pain-relieving medicines.

Pain relievers

Medicines known as non-steroidal anti-inflammatory drugs (NSAIDs) are effective for the treatment of period pain. These medicines stop the production of prostaglandins – the chemical that causes period pain.

To be properly effective, NSAIDs should be taken before the onset of pain (if possible) or at the start of pain. (Because they prevent prostaglandins being formed, they can prevent period pain developing but don’t reverse period pain that is already present).

Your doctor may recommend that you start taking regular doses of NSAIDs a day or 2 before you expect your period to begin, and continue taking them for 2 to 3 days.

NSAIDs commonly recommended for period pain include:

  • ibuprofen (e.g. Advil, Nurofen, Rafen);
  • naproxen (brand names Naprogesic, Naprosyn, Inza); and
  • mefenamic acid (brand name Ponstan).

NSAIDs can cause stomach upsets, and should be avoided in people who have stomach ulcers or symptoms of indigestion, or who are allergic to aspirin. NSAIDs should be taken after eating.

NSAIDs should also be used with caution in people with asthma or those who have kidney problems. Talk to your doctor or pharmacist about the best treatment for you.

Other pain relievers that can be used in the treatment of period pain include paracetamol and aspirin.

Hormonal treatments

Certain formulations of the combined oral contraceptive pill can be effective in treating period pain. Other hormonal forms of contraception (such as the vaginal ring) as well as long-term contraceptive options such as implants, injections and hormone-releasing intra-uterine devices (e.g. Mirena) can also help.

These hormonal treatments work by thinning the lining of the uterus. This helps reduce the amount of prostaglandins released during your period, and reduces the force of the contractions of the uterus. Your periods will also become lighter, and with some hormonal treatments, less frequent.

Other treatments

Some women find that taking nutritional supplements such as magnesium, vitamin B1 (thiamine), vitamin E, pyridoxine or fish oil helps relieve their pain.

Acupuncture and acupressure may also help relieve period pain in some women.

TENS — transcutaneous (through the skin) electrical nerve stimulation is a treatment that uses low voltage electrical currents to relieve pain.

Self-care

Applying heat to your abdomen using a hot water bottle or a heat pack may offer some relief from period pain.

Gentle exercise may also help. Some women find that doing gentle stretching exercises or going for a walk helps relieve the pain. Try to also exercise regularly between periods.

Smoking and alcohol can make period pain worse, so quitting smoking and avoiding alcohol can help improve period pain.

When to seek medical advice

Period pain is common but treatable. You should see your doctor for advice on the best ways to manage period pain, especially if your period pain is stopping you participating in your usual activities.

If your period pain has started after a history of trouble-free periods or is getting worse, visit your doctor to make sure that there is no underlying disorder causing your period pain.

You should seek medical advice if:

  • the pain is getting worse with each period;
  • the pain lasts longer than the first 2 days of your period;
  • over-the-counter medicines that you have used in the past can no longer control the pain;
  • menstrual bleeding has become increasingly heavy;
  • the pain is accompanied by fever;
  • there is abnormal discharge or bleeding;
  • the pain occurs at times unrelated to menstruation;
  • there is a recent change in the nature of your period pain; or
  • you use an intrauterine device (IUD) as a method of contraception. 
Last Reviewed: 30 July 2016
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References

1. Dysmenorrhoea (published March 2014). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2016 Mar. http://online.tg.org.au/complete/ (accessed Jul 2016).
2. American College of Obstetricians and Gynaecologists. Dysmenorrhea: Painful periods (Jan 2015). http://www.acog.org/Patients/FAQs/Dysmenorrhea-Painful-Periods (accessed Jul 2016).
3. Patient information from the BMJ Group. Painful periods (published 6 Jul 2016). http://bestpractice.bmj.com/best-practice/pdf/patient-summaries/532625.pdf (accessed Jul 2016)
4. Mayo Clinic. Menstrual cramps (updated 8 May 2014). http://www.mayoclinic.org/diseases-conditions/menstrual-cramps/basics/definition/con-20025447 (accessed Jul 2016).
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