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Painful periods (dysmenorrhoea)

Expert reviewer, Dr Madhavi Vellayan, Consultant Gynaecologist
Next review due November 2024

Painful periods cause pain in your tummy when you have your period. Painful periods are common. This pain can be mild for some people. But it can be so severe that it affects your day-to-day activities and you may have to take time off work or school. There are some things you can do yourself to help relieve the pain, but if the pain is severe and affects your quality of life, contact a GP for help.

An image showing the female reproductive system

Types of painful periods

The medical name for painful periods is dysmenorrhoea. There are two types of painful periods.

  • Primary dysmenorrhoea. This is period pain that isn't caused by a specific condition. It usually happens within six to 12 months of your periods first starting when you’re a teenager. The pain usually begins when your period arrives each month and lasts for between one and three days.
  • Secondary dysmenorrhoea. This is pain caused by an underlying medical condition, such as endometriosis or fibroids. This type of period pain gets worse with age. It may happen years after your periods have started, often when you’re in your 30s or 40s. The pain may come on at other times during your monthly cycle, especially in the few days before your period starts, as well as when you have your period. It can also get worse, rather than better, as your period goes on.
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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 prostaglandins in your womb (uterus) around the time of your period. Prostaglandins are chemicals that cause the muscles of your womb to tighten. This tightening of the muscles can temporarily reduce the blood supply to your womb, which causes pain.

Causes of secondary dysmenorrhoea include the following.

  • 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. Endometriosis is the most common cause of secondary dysmenorrhoea.
  • Fibroids. These are non-cancerous growths of your womb.
  • Pelvic inflammatory disease. This is an infection in your uterus and fallopian tubes, and sometimes your ovaries.
  • Adenomyosis. This is a condition where the glands that are usually in the lining of your womb grow inside the walls of your womb as well. Your womb gets slightly larger than it should be, and you may have heavy periods with cramps.
  • A contraceptive intrauterine device (IUD) that contains copper can sometimes cause secondary dysmenorrhoea. You may develop painful periods in the three to six months after the device is fitted, which should then settle. If this continues to be a problem, a GP or gynaecologist may suggest that you have the IUD removed and use a different type of contraception. Or try an intrauterine system that releases hormones (also known as an IUS or coil) as this may help with painful periods.

You're more likely to have painful periods if:

  • your periods started at a young age
  • you have heavy bleeding or long periods
  • other women in your family have painful periods
  • you've never had children
  • you smoke
  • you’re overweight
  • you have depression

Symptoms associated with painful periods

The main symptom of primary dysmenorrhoea is cramping pain in your tummy (lower abdomen). The pain can also spread to your lower back and your thighs. You may feel this a few days before and/or during your period, and it usually gets better at the end of your period.

As well as pain, you might have some other symptoms before or during your period, such as:

  • tiredness
  • feeling sick or being sick
  • diarrhoea
  • a headache or feeling light-headed
  • bloating
  • emotional symptoms

If you have secondary dysmenorrhoea, besides cramping pain you might also have a feeling of heaviness in your tummy, and back pain. You may also have other secondary dysmenorrhoea symptoms, such as:

  • heavy or irregular periods
  • bleeding in-between periods
  • an unusual discharge from your vagina
  • pain during sex, and you may bleed afterwards

If you have any of these symptoms, contact your GP for advice.

Diagnosis of painful periods

The GP will ask about your symptoms and how your periods affect your day-to-day life, as well as about your medical history.

If you’re young and haven’t had sex, and your GP thinks you may have primary dysmenorrhoea, they may just examine your tummy. If you’re sexually active or your GP thinks you may have secondary dysmenorrhoea, they’ll probably examine inside your vagina too.

Your GP will put on some gloves and use some lubricant to put their fingers into your vagina to gently feel for anything different in your womb or cervix. At the same time as the vaginal examination, they’ll use their other hand to press on the lower part of your tummy. They’ll use a tool called a speculum to gently hold your vagina open while they check your cervix. You can ask to have someone with you during the examination if you want to.

Your GP may also suggest the following tests.

  • A swab to take a sample from inside your vagina, to check for infection.
  • Blood tests to check for anaemia and other conditions.
  • An ultrasound scan to look at your womb from the outside, through your tummy. You may also have a transvaginal scan, that scans 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 or your symptoms are severe, they may refer you to see a gynaecologist. This is a doctor who specialises in women’s reproductive health. Your gynaecologist might recommend that you have other tests such as a:

Self-help for painful periods

There’s a lot you can do to help yourself. So you might not need to see your doctor about period pain and can manage the symptoms yourself at home. Tips on how to stop period pain include the following.

  • Use a hot water bottle or heat patch to apply heat to your tummy or back. Don’t put these directly against your skin as you may burn yourself.
  • A warm bath or shower may help you relax.
  • Gently massaging your tummy or back may help.
  • Wear loose-fitting clothing just before and during your period.
  • If you need a painkiller, try an over-the-counter painkiller such as ibuprofen or paracetamol. Your pharmacist will be able to give you help and advice on which is best for you.
  • A transcutaneous electrical nerve stimulation (TENS) machine may help to ease symptoms. This sends mild electrical signals to your skin near the place you feel pain. These are thought to affect the pain signals that travel to your brain. You can buy a TENS machine from a pharmacy.

If you smoke, this may increase your chances of period pain. So it may help to ease your symptoms if you stop smoking.

Treatment of painful periods

Any treatment you need will depend on what’s causing your painful periods and how severe the pain and symptoms are.

There are treatments that your GP can prescribe for primary dysmenorrhoea. If you have secondary dysmenorrhoea, your doctor will try to find out what condition is causing your symptoms and will discuss your treatment options with you.

Medicines

Painkillers

Non-steroidal anti-inflammatory drugs (NSAIDs) are often used to treat painful periods. Ibuprofen, which you can buy over the counter, is one of these, and your GP might prescribe others such as mefenamic acid. NSAIDs can ease pain and cramping as they block the production of chemicals called prostaglandins. See our section on Causes of painful periods for more information about these chemicals. There are potential side-effects from these medicines. Ask your doctor or pharmacist to explain these to you.

Hormonal contraception

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, progesterone-only pill, contraceptive injection, hormone implant, or an intrauterine system (IUS). Talk to your GP about the best option for you. Always read the patient information leaflet that comes with your medicine carefully and, if you have any questions, ask your pharmacist.

Surgery

As a last resort, 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). They’ll only suggest this if they can’t find any specific cause for your painful periods, or a treatment that works for you. Talk to your gynaecologist for more information.

Complementary therapies

Some people use complementary therapies and medicines to ease the symptoms of painful periods. But there’s currently no clear evidence that herbal medicines or dietary supplements have any effect on painful periods. Researchers have looked at the use of acupuncture and acupressure, for example, and neither of these therapies has any clear effect. More research is needed to show if these are helpful for women with painful periods or not.

Frequently asked questions about painful periods

  • You may have an underlying medical condition, such as endometriosis or fibroids. But sometimes, they aren’t caused by a specific condition. Doctors think the main cause is an increase in the chemicals that cause the muscles of your womb to tighten. This can temporarily reduce the blood supply to your uterus, which causes pain.

    See our section: Causes of painful periods above for more information.

  • You may be able to ease the symptoms of painful periods with over-the-counter painkillers or with self-help techniques. There are also treatments that your GP can prescribe for you.

    See our section: Treatment of painful periods above for more information.

  • Primary dysmenorrhoea won’t affect your ability to have children as it’s not caused by any particular condition, but if you have secondary dysmenorrhoea, it might. Conditions that cause secondary dysmenorrhoea, such as pelvic inflammatory disease, fibroids and endometriosis, can all make it more difficult to get pregnant. If you’re unsure about how your painful periods might affect your fertility, talk to your GP.

  • No one knows for sure whether exercise specifically eases period pains, but it may well help. Aim to do some activity every day, and do something you enjoy so you’re more likely to keep it up. You may also find gentle exercise such as yoga may help to ease your symptoms during a period.



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Related information

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    • Assessment of dysmenorrhoea. BMJ Best Practice. bestpractice.bmj.com, last reviewed 18 Oct 2021
    • Personal communication, Dr Madhavi Vellayan, Consultant Gynaecologist, 19 December 2021
    • Endometriosis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised February 2020
    • Pelvic inflammatory disease. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised June 2019
    • Dysmenorrhoea. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised November 2018
    • Faculty of Sexual and Reproductive Healthcare clinical guidance. Contraceptive choices for young people. Royal College of Obstetricians and Gynaecologists. www.fsrh.org, amended May 2019
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    • Pelvic/gynaecology ultrasound (including transvaginal). British Medical Ultrasound Society. www.bmus.org, accessed 19 November 2021
    • Dysmenorrhea. Medscape. medicine.medscape.com, updated 15 November 2021
    • Period pain. Women's Health Concern. www.womens-health-concern.org, reviewed November 2019
    • Transcutaneous electrical nerve stimulation. Medscape. emedicine.medscape.com, updated 12 November 2019
    • Hysterectomy. Medscape. emedicine.medscape.com, updated 3 May 2021
    • Infertility in women. BMJ Best Practice. bestpractice.bmj.com, last reviewed 18 Oct 2021
    • Armour M, Ee CC, Naidoo D, et al. Exercise for dysmenorrhoea. Cochrane Database of Systematic Reviews 2019, Issue 9. doi: 10.1002/14651858.CD004142.pub4
    • UK Chief Medical Officers' physical activity guidelines. GOV.UK. gov.uk, published 7 September 2019
  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, December 2021
    Expert reviewer, Dr Madhavi Vellayan, Consultant Gynaecologist
    Next review due December 2024

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