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Painful periods (dysmenorrhoea)

Painful periods are very common; in fact, as many as nine out of ten women have them. The pain sometimes starts a few days before your period and can last for several days. When your period ends, the pain usually does too. Period pain is usually in the lower part of your abdomen (tummy) and is a cramping kind of pain.

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Details

  • Types Types of painful periods

    There are two types of painful periods.

    • Primary dysmenorrhoea. This is period pain that isn't caused by a specific condition. It usually starts within six to 12 months of your periods first starting when you’re a teenager. The pain usually lasts between eight hours and three days.
    • Secondary dysmenorrhoea. This is pain caused by a specific condition, such as endometriosis or fibroids. This type of period pain can start years after your periods have started, often when you’re in your 30s and 40s. The pain may come on at other times during your monthly cycle, as well as when you have your period. It can also get worse, rather than better, as your period goes on.

    Painful periods can have a big impact on your quality of life, and lead to time off school or work. They can be physically and mentally hard to manage if your symptoms are severe, and can affect your normal day-to-day life.

  • Symptoms Symptoms associated with painful periods

    You may experience other symptoms at the same time as painful periods. The main symptom associated with primary dysmenorrhoea is cramping pain in your lower abdomen (tummy). The pain can also spread to your lower back and your thighs. As well as pain, you might have some other symptoms before or during your period, such as:

    • tiredness
    • feeling sick or being sick
    • diarrhoea
    • backache
    • a headache
    • bloating
    • emotional symptoms

    If you have secondary dysmenorrhoea, the pain can be cramping but you might also have a feeling of heaviness in your lower abdomen and back pain. You may also have other symptoms, such as:

    • heavy or irregular periods
    • bleeding in-between periods
    • unusual discharge from your vagina
    • sex is painful and you may bleed afterwards

    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. They may also ask you about your medical history and how your periods are affecting your day-to-day life.

    If you’re young and not sexually active, and your GP thinks you may have primary dysmenorrhoea, they may just examine your abdomen. If you’re sexually active, or your GP thinks you may have secondary dysmenorrhoea, then they’re likely to suggest you have a vaginal examination too. To do this, your GP will put gloved, lubricated fingers into your vagina to gently feel for anything different in your womb or cervix. They will use a tool called a speculum to gently hold your vagina open while they check your cervix. At the same time as the vaginal examination, they will use their other hand to press on the lower part of your abdomen.

    Your GP may also suggest the following tests:

    • Using a swab to take a sample from inside your vagina, to check for infection
    • Blood tests to check for anaemia and other conditions
    • A transvaginal ultrasound. This is a scan that looks at your womb from the outside, through your lower abdomen, and from the inside using a device that goes into your vagina. The scan may feel uncomfortable but it shouldn’t be painful.

    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. Sometimes your GP may refer you directly to a gynaecologist for the initial tests mentioned above. In some cases, your GP or gynaecologist might recommend that you have other tests such as a laparoscopy.

  • Treatment Treatment of painful periods

    The treatment you need will depend on what’s causing your painful periods and how severe the pain and symptoms are. Many women never see their doctor about painful periods and manage the symptoms themselves at home.

    If you have primary dysmenorrhoea, you may be able to ease your symptoms with over-the-counter painkillers or with self-help techniques. There are also treatments that your GP can prescribe for you.

    If you have secondary dysmenorrhoea, your doctor will try and find out what condition is causing your symptoms and will discuss your treatment options with you.

    Self-help

    Using heat can help to make you feel more comfortable. You can try putting a hot-water bottle or heat patch on your back or lower abdomen. Don’t put a hot-water bottle or patch directly onto your skin though, as it can damage it. Always follow the instructions that come with your heat patch. Some doctors also recommend a warm bath to help with cramps.

    A transcutaneous electrical nerve stimulation (TENS) machine may also help to ease symptoms. A TENS machine uses electrodes to send electrical signals. You put these on your skin, near the place where you feel pain. You control how strong the electrical impulses are, and how often the machine sends them. The electrical impulses are thought to affect the pain signals that travel to your brain.

    If you’re a smoker, there is some evidence that it can affect period pains. So, if you smoke, stopping may help to ease your symptoms. Being physically active may also help to reduce the likelihood of having period pain.

    Medicines

    If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and, if you have any questions, ask your pharmacist for advice.

    Your GP may also prescribe a non-steroidal anti-inflammatory drug (NSAID) called mefenamic acid. NSAIDs can ease pain and cramping by blocking the production of chemicals called prostaglandins. These are chemicals that cause the muscles of your uterus (womb) to tighten, affecting the blood flow and causing the pain.

    If you're not trying to get pregnant, hormonal contraception may help to reduce some of your symptoms. Your GP may suggest the combined contraceptive pill, hormone implant, progesterone-only pill or an intrauterine system (IUS). Talk to your GP about the best option for you.

    Surgery

    If you have had severe period pain for a long time, your GP or gynaecologist may suggest a laparoscopy This is a type of ‘keyhole’ surgery. A small telescope with a camera attached (a laparoscope) is put through a small cut in your belly button. This may be done to check whether you have endometriosis.

    As a last resort and in rare cases, if other treatments haven’t worked and you don’t want to have children in the future, your gynaecologist may suggest a hysterectomy. This is an operation to remove your womb (uterus). Talk to your gynaecologist for more information.

    Complementary therapies

    Some women use complementary therapies and medicines to ease the symptoms of painful periods.

    There is currently no clear evidence that herbal medicines or dietary supplements have any effect on painful periods. Researchers have also looked at the use of acupuncture and acupressure, and neither of these therapies has any clear effect. 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 a specific condition. Doctors think that the main cause is an increase in the amount of prostaglandin in your body around the time of your period. These are chemicals that cause the muscles of your uterus (womb) to tighten. This tightening of the muscles can temporarily stop the blood supply to your uterus, which causes your pain. When the amount of prostaglandin goes down in your body, the pain naturally stops.

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

    • Endometriosis. This is when cells that normally line your uterus grow outside it in other parts of your body, but go through the same monthly changes. 
    • Fibroids (non-cancerous growths of your womb).
    • Pelvic inflammatory disease (an infection in your uterus and fallopian tubes, and sometimes your ovaries).
    • Adenomyosis. This is when the glands that are usually in the lining of your uterus grow inside the walls of the uterus as well. Your uterus grows much larger than it should do. This can cause heavy periods with cramps. If you are not trying to get pregnant, using a contraceptive intrauterine system (IUS) may help reduce the pain and bleeding caused by adenomyosis.

    While an IUS may help with painful periods, using a contraceptive intrauterine device (IUD) that contains copper can sometimes cause secondary dysmenorrhoea. You may develop painful periods around three to six months after the device is fitted. If this continues to be a problem, your GP or gynaecologist may suggest having the IUD removed and using a different type of contraception.

    You're more likely to have painful periods if:

    • your periods started at a young age
    • you have heavy bleeding or long periods
    • you smoke
    • you’re overweight
  • FAQ: Exercise Should I exercise if I have painful periods?

    Being physically active may help reduce your pain if you have painful periods, though the evidence about how well it works isn’t very clear.

    If you’re overweight or depressed, then you’re more likely to have period pain. However, being active can help to boost your mood and help you lose weight or maintain a healthy weight, both of which may help to reduce your symptoms.

    You should aim to do some activity every day. The recommended healthy level of physical activity is 150 minutes (two and a half hours) of moderate activity, spread over a week in sessions of 10 minutes or more. This means doing an activity that leaves you warm and out of breath, but still able to talk. This could include brisk walking, cycling and vigorous housework or gardening.

    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.

  • FAQ: Having a baby Could painful periods affect my ability to have children?

    Primary dysmenorrhoea won’t affect your ability to have children. However, if there is an underlying cause for your pain (secondary dysmenorrhoea) then that condition may affect your fertility. Secondary dysmenorrhoea can be caused by conditions such as pelvic inflammatory disease, fibroids and endometriosis, all of which can make it more difficult to get pregnant. If you’re unsure about how you could be affected, talk to your GP about your options and any concerns you have.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Dysmenorrhoea. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised May 2014
    • Assessment of dysmenorrhoea. BMJ Best Practice. bestpractice.bmj.com, last updated October 2015
    • Dysmenorrhoea. Medscape. emedicine.medscape.com, updated October 2016
    • Dysmenorrhoea. PatientPlus. www.patient.info, last checked December 2014
    • Pelvic examination technique. Medscape. emedicine.medscape.com, updated November 2016
    • Uterine fibroids. BMJ Best Practice. bestpractice.bmj.com, last updated February 2017
    • Ultrasound scan. Target Ovarian Cancer. www.targetovariancancer.org.uk, last reviewed January 2015
    • Emmanuel A, Achema G, Gimba SM, et al. Dysmenorrhoea: pain relief strategies among a cohort of undergraduates in Nigeria. Int J Med Biomed Res 2013; 2(2):142–46. www.ijmbr.com
    • Proctor M, Farquhar C, Stones W, et al. Transcutaneous electrical nerve stimulation for primary dysmenorrhoea. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD002123. DOI: 10.1002/14651858.CD002123
    • Transcutaneous Electrical Nerve Stimulation. Medscape. http://emedicine.medscape.com/article/325107-overview, updated December 2015
    • Dorn LD1, Negriff S, Huang B, et al. Menstrual symptoms in adolescent girls: association with smoking, depressive symptoms, and anxiety. J Adolesc Health 2009; 44(3):237–43. doi: 10.1016/j.jadohealth.2008.07.018
    • Latthe P, Mignini L, Gray R, et al. Factors predisposing women to chronic pelvic pain: systematic review. BMJ 2006; 332(7544):749–55. doi: 10.1136/bmj.38748.697465.55
    • Pattanittum P, Kunyanone N, Brown J, et al. Dietary supplements for dysmenorrhoea. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD002124. DOI: 10.1002/14651858.CD002124.pub2
    • Smith CA, Armour M, Zhu X, et al. Acupuncture for dysmenorrhoea. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD007854. DOI: 10.1002/14651858.CD007854.pub3
    • Endometriosis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised May 2014
    • Uterine Adenomyosis. The MSD Manual. www.msdmanuals.com, last full review July 2014
    • Uterine artery embolisation for treating adenomyosis. NICE interventional procedures guidance IPG473. nice.org.uk, published December 2013
    • 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
    • Infertility in women. BMJ Best Practice. bestpractice.bmj.com, last updated August 2016
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  • Author information Author information

    Reviewed by Graham Pembrey, Lead Editor, July 2017
    Expert reviewer, Miss Shirin Irani, Consultant Gynaecologist
    Next review due July 2020

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