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Painful periods (dysmenorrhoea)

Painful periods are defined as pain and cramps, often in the lower abdomen (tummy), that sometimes spread to the lower back and upper thighs. These can start just before or during a woman’s period.

Painful periods are a very common problem. More than half of all women are thought to be affected.

There are two types of painful periods.

  • Primary dysmenorrhoea. This is pain that isn't caused by a specific condition. It's most common in the first year after your periods start. For most women, the symptoms of primary dysmenorrhoea get better as they get older, or after they have children.
  • Secondary dysmenorrhoea. This is pain caused by a specific condition, such as endometriosis or fibroids. Secondary dysmenorrhoea usually affects women in their 20s and 30s.
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Details

  • Symptoms Symptoms of painful periods

    The most common symptom of painful periods is cramps or pain in your abdomen (tummy). This pain may also spread to your lower back and the top of your thighs. This can happen before and/or during the first few days of your period. Other symptoms of painful periods may include:

    • tiredness
    • feeling sick or vomiting
    • diarrhoea
    • backache
    • a headache or migraine
    • bloating
    • emotional symptoms and mood changes

    If you have secondary dysmenorrhoea, you may also have other symptoms, such as:

    • heavy periods 
    • irregular periods
    • bleeding in between periods
    • a vaginal discharge

    These symptoms may be caused by problems other than painful periods. If you have any of these symptoms, contact your GP for advice.

  • Diagnosis Diagnosis of painful periods

    Your GP will ask about your symptoms. He or she may also ask you about your medical history and how painful periods are affecting your day-to-day life.

    Your GP will then examine your abdomen (tummy). He or she may arrange for you to have a vaginal examination. This will involve your GP inserting gloved, lubricated fingers into your vagina. They will gently feel for any abnormalities in your womb or ovaries.

    Your GP may arrange a swab from your vagina to rule out a sexually transmitted infection (STI). They may refer you for further tests. For example, you may be advised to have a pelvic ultrasound, which uses sound waves to produce an image of the inside of your body.

    If you feel any pain during your vaginal examination or ultrasound scan, be sure to tell the person who is examining you.

    If your GP thinks there may be another cause for your symptoms, they may refer you to see a gynaecologist. This is a doctor who specialises in women’s reproductive health. He or she may advise you to have further tests.

  • Treatment Treatment of painful periods

    If you have secondary dysmenorrhoea, your doctor will try to identify the condition causing your symptoms and will discuss your treatment options with you. If you have primary dysmenorrhoea, you may be able to relieve your symptoms with over-the-counter painkillers or with self-help techniques. There are also treatments that your GP can prescribe you.

    Self-help

    You may find it helps to use a hot water bottle or a heat patch over your abdomen (tummy) to reduce your pain. Don’t apply heat directly to your skin though, as it can damage your skin. Always read the instructions that come with your heat patch. This will tell you how to use your heat patch correctly.

    A transcutaneous electrical nerve stimulation (TENS) machine may help relieve your symptoms. A TENS machine uses two electrodes, which are placed on your skin, near the place where you feel pain. Electrical impulses are sent through the electrodes. These are thought to affect the pain signals that travel to your brain.

    You may also find that making some lifestyle changes helps to relieve your symptoms. These include:

    • stopping smoking 
    • exercising – aim to do 150 minutes of moderate intensity exercise in bouts of 10 minutes or more each week 
    • drinking only in moderation – current guidelines recommend not regularly drinking more than two or three units a day with at least two alcohol-free days a week 
    • improving your sleep and relaxing

    Medicines

    Your GP may prescribe you a non-steroidal anti-inflammatory drug (NSAID), such as mefenamic acid, ibuprofen or naproxen. NSAIDs block the production of chemicals in the body known as prostaglandins. These are chemicals that cause the muscles of your uterus (womb) to contract. Strong muscle contractions can temporarily stop the blood supply to your uterus, which can be painful.

    Taking NSAIDs may help to reduce the amount of pain you have during your period. If you're not able to take NSAIDs, your GP may suggest you try paracetamol instead. Take these at regular intervals, as explained in the patient information leaflet.

    If NSAIDs or paracetamol don't help to reduce your pain, your GP may prescribe you a stronger painkiller such as codeine. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your doctor or pharmacist for advice.

    If you're not trying to get pregnant, hormonal contraception, such as the combined contraceptive pill, may help to reduce some of your symptoms. The combined contraceptive pill may be helpful in younger women and teenagers. If you have any questions about your treatment options, speak to your GP for more information.

    Complementary therapies

    At the moment, doctors aren’t sure if complementary therapies, such as acupressure or magnet therapy, can help ease the symptoms of painful periods. We also don’t know if taking vitamin E, fish oil and magnesium supplements can affect your symptoms. More proof is needed to show if these are helpful for women with painful periods or not.

    Ask your GP for advice if you want to try a complementary therapy.

  • Treatment for heavy periods on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including heavy period treatment.

  • Causes Causes of painful periods

    Primary dysmenorrhoea isn't caused by one specific condition. The main cause is thought to be an increase in the amount of prostaglandins in your body. These are chemicals that cause the muscles of your uterus (womb) to contract. Strong muscle contractions can temporarily stop the blood supply to your uterus, which can be painful.

    Secondary dysmenorrhoea, can be caused by a number of different conditions. These include:

    • endometriosis (where cells that normally line your uterus grow outside it in other parts of your body but go through the same monthly changes) 
    • fibroids or endometrial polyps (non-cancerous growths of your womb)
    • pelvic inflammatory disease (an infection in your reproductive organs)
    • adenomyosis (thickening of the walls of your uterus)

    Using an intrauterine device (IUD) as contraception can also cause secondary dysmenorrhoea. An IUD is made of copper and plastic and is sometimes known as the coil. This is different to an intrauterine system (IUS), which is a small device that releases hormones. An IUS can help the symptoms of painful periods.

    You're more likely to have painful periods if:

    • your periods started at a young age
    • you smoke
  • FAQs FAQs

    Should I exercise if I have painful periods?

    Answer

    Yes, exercise can help reduce your pain if you have painful periods.

    Explanation

    Gentle exercise, such as swimming or walking, may help to reduce the amount of pain you have during your period. Exercise is thought to encourage your body to produce natural chemicals called endorphins. Endorphins are a type of hormone that may help relieve pain.

    You can perform exercise at different intensities. Moderate means your breathing is faster, your heart rate is increased and you feel warmer. At this level of activity, your heart and lungs are being stimulated and this goes towards making you fitter. Vigorous intensity activity means that your breathing will be much stronger and your heart rate will increase rapidly. You will find it difficult to hold a conversation.

    You should aim to do some physical activity every day. The recommended healthy level of physical activity is 150 minutes (two and a half hours) of moderate exercise over a week in bouts of 10 minutes or more. You can do this by carrying out 30 minutes on at least five days each week. Alternatively, you can do 75 minutes of vigorous intensity activity. Try to spend as little time as possible being inactive.

    Will having painful periods affect my ability to have children?

    Answer

    If you have secondary dysmenorrhoea that’s caused by another health condition, it may affect your ability to have children. 

    Explanation

    Primary dysmenorrhoea isn't thought to be caused by a problem with your reproductive organs. Some women find that their symptoms actually improve after they have had a child.

    However, if you have secondary dysmenorrhoea that’s caused by another health condition, it may affect your ability to have children. For example, secondary dysmenorrhoea can be caused by pelvic inflammatory disease, which may cause infertility. If you’re unsure about how you could be affected, talk to your GP about your options and any concerns you have.

    Can I take contraceptives to help the symptoms of my painful periods?

    Answer

    Yes, some contraceptives can help to reduce your symptoms of painful periods, such as the intrauterine system (IUS).

    Explanation

    An intrauterine system (IUS) can help to reduce period pain. The IUS is a small T-shaped plastic frame that is fitted inside your womb. The stem of the ‘T’ contains a hormone called levonorgestrel. Levonorgestrel is similar to the natural hormone progesterone that is produced by your ovaries each month.

    The IUS releases levonorgestrel into your uterus (womb). This hormone stops the lining of your womb thickening each month, making your periods shorter and lighter. Some women find that their periods stop altogether.

    The IUS works as a contraceptive by making it difficult for a fertilised egg to implant in your womb. Not everyone can have an IUS fitted; it will depend on what's causing your painful periods. If you have painful periods and want to use a contraceptive to reduce your symptoms, talk to your GP about your options.

  • Resources Resources

    Further information

    Sources

    • Dysmenorrhea. The Merck Manuals. www.merckmanuals.com, published October 2013
    • Dysmenorrhoea. NICE Clinical Knowledge Summaries. cks.nice.og.uk, published May 2014
    • Contraception – IUS/IUD. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published June 2012
    • Dysmenorrhoea. Map of Medicine. www.mapofmedicine.com. International View. London: Map of Medicine; 2013 (Issue 1)
    • Marjoribanks J, Proctor M, Farquhar C, et al. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database of Systematic Reviews 2010, Issue 1. doi: 10.1002/14651858.CD001751.pub2
    • Brown J, Brown S. Exercise for dysmenorrhoea. Cochrane Database of Systematic Reviews 2010, Issue 2. doi: 10.1002/14651858.CD004142.pub2
    • Start active, stay active: a report on physical activity for health from the four home countries’ chief medical officers. Department of Health. www.dh.gov.uk, published 11 July 2011
    • The initial management of chronic pain. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published May 2012
    • Wong CL, Farquhar C, Roberts H, et al. Oral contraceptive pill for primary dysmenorrhoea. The Cochrane Library 2009. Issue 4. doi: 10.1002/14651858.CD002120.pub3
    • Proctor M, Farquhar C, Stones W, et al. Transcutaneous electrical nerve stimulation for primary dysmenorrhoea. Cochrane Database of Systematic Reviews 2002, Issue 1. doi: 10.1002/14651858.CD002123
    • Dysmenorrhoea. Medscape. www.emedicine.medscape.com, published 22 July 2013
    • Dysmenorrhea. The American College of Obstretricians and Gynaecologists. www.acog.org, published July 2012
    • Pelvic inflammatory disease. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published March 2013
    • Alcohol and women. Drinkaware. www.drinkaware.co.uk, published June 2014
    • IUD. Family Planning Agency. www.fpa.org.uk, accessed 12 November 2014
    • Intrauterine system. PatientPlus. www.patient.co.uk/patientplus.asp, published 18 August 2014
    • Gyneacological history and examination. PatientPlus. www.patient.co.uk/patientplus.asp, published 18 March 2011
    • Transcutaneous electrical nerve stimulation. American Cancer Society. www.cancer.org, published 14 April 2011
    • Transcutaneous electrical nerve stimulation. Medscape. www.emedicine.medscape.com, published 26 June 2013
    • Sherwood, L. Human physiology: from cells to systems. 8th ed. USA: Brooks/Cole; 2013
    • Contraception – general overview. PatientPlus. www.patient.co.uk/patientplus.asp, published 5 November 2012
    • Contraception and young people. PatientPlus. www.patient.co.uk/patientplus.asp, published 21 July 2014
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    Reviewed by Hemali Bedi, Bupa Health Content Team, January 2015.

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