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Painful periods (dysmenorrhoea)


Expert reviewer, Miss Shirin Irani, Consultant Gynaecologist
Next review due August 2022

Painful periods are very common. Many women have some pain in their lower abdomen (tummy) during their periods, and you may feel this is a normal part of life. But you may have pain that’s so severe it affects your day-to-day activities and leads to time off work or school.

You may find that using self-help tips and over-the-counter painkillers can help to stop period pain. If these aren’t working or the pain is severe and affecting your quality of life, contact your GP for more help.

 Woman sitting on the bed embracing her legs

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 starts 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 may start 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, as well as when you have your period. It can also get worse, rather than better, as your period goes on.

Symptoms associated with 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:


If you have secondary dysmenorrhoea, besides cramping pain 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 may be 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 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, they’ll probably suggest you have a vaginal examination too.

For a vaginal examination, your GP will put gloved, lubricated fingers into your vagina to gently feel for anything different in your womb or cervix. They’ll 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’ll use their other hand to press on the lower part of your abdomen. You can ask to have someone with you while you’re being examined.

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.
  • An ultrasound scan. An abdominal scan looks at your womb from the outside, through your lower abdomen. A transvaginal scan is carried out 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 specific cause for your symptoms or your symptoms are severe, they may refer you to a gynaecologist. This is a doctor who specialises in women’s reproductive health. In some cases, your gynaecologist might recommend that you have other tests such as a laparoscopy, an MRI scan or a hysteroscopy.

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Self-help for painful periods

Most women never see their doctor about period pain and manage the symptoms themselves at home. There’s a lot you can do to help yourself.

Tips on how to stop period pain include the following.

  • Use a hot water bottle or heat patch to apply heat to your abdomen or back. For safety, don’t put these directly against your skin.
  • A warm bath or shower may be worth trying and may help you relax.
  • Gently massaging your abdomen 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. If there are reasons you can’t take ibuprofen, paracetamol may help instead. Your pharmacist will be able to give you help and advice.
  • A transcutaneous electrical nerve stimulation (TENS) machine may also 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. TENS machines can be bought from your local pharmacy and are safe to use.

If you’re a smoker, this may affect period pains. Stopping smoking may help to ease your symptoms in future.

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.

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

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

The painkillers most usually used for painful periods are the non-steroidal anti-inflammatory drugs (NSAIDs). 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 by blocking the production of chemicals called prostaglandins. See our section on causes of painful periods for more information about these chemicals.

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.

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 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). This would only be suggested if no other specific cause or successful treatment for your painful periods has been found. 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 research is needed to show if these are helpful for women with painful periods or not.

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 uterus (womb) around the time of your period. These are chemicals that cause the muscles of your uterus to tighten. This tightening of the muscles can temporarily stop the blood supply to your uterus, which causes your pain. So, treatments that reduce the amount of prostaglandins produced, such as NSAID medicines, reduce your symptoms.

Secondary dysmenorrhoea can be caused by a number of different conditions. These 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 (non-cancerous growths of your womb).
  • Pelvic inflammatory disease (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 uterus grow inside the walls of your uterus as well. Your uterus grows much larger than it should do, and you may have heavy periods with cramps.

An intrauterine system that releases hormones (also known as an IUS or coil) may help with painful periods. But a contraceptive intrauterine device (IUD), especially one that contains copper, can sometimes cause secondary dysmenorrhoea. You may develop painful periods in the first few 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
  • other women in your family have painful periods
  • you've never been pregnant
  • you smoke
  • you’re overweight
  • you have depression

Frequently asked questions

  • No one knows for sure whether exercise specifically eases period pains, but it may well help.

    Doctors know that you’re more likely to have period pain if you’re overweight or depressed. Being active can help to boost your mood and 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.

    You may find gentle exercise such as yoga may help to ease your symptoms during a period.

  • Primary dysmenorrhoea won’t affect your ability to have children. However, if there is an underlying cause for your pain (secondary dysmenorrhoea), 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.


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Related information

    • Dysmenorrhoea. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised November 2018
    • Endometriosis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised May 2014
    • Pelvic inflammatory disease. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised June 2019
    • Assessment of dysmenorrhoea. BMJ Best practice. bestpractice.bmj.com, last reviewed July 2019
    • Painful periods. Patient information from the BMJ. bestpractice.bmj.com, last published February 2019
    • Infertility in women. BMJ Best practice. bestpractice.bmj.com, last reviewed July 2019
    • . Medscape. emedicine.medscape.com, updated October 2018
    • Pelvic examination. Medscape. emedicine.medscape.com, updated September 2018
    • electrical nerve stimulation. Medscape. emedicine.medscape.com, updated December 2015
    • . Patient. patient.info/doctor, last edited December 2014
    • Uterine adenomyosis. The MSD Manuals. www.msdmanuals.com, last full review/revision May 2019
    • Non-steroidal anti-inflammatory drugs. NICE British National Formulary. bnf.nice.org.uk, accessed August 2019
    • P, Kunyanone N, Brown J, et al. Dietary supplements for dysmenorrhoea. Cochrane Database of Systematic Reviews 2016, Issue 3. doi:10.1002/14651858.CD002124.pub2
    • Smith C, Armour M, Zhu X, et al. Acupuncture for dysmenorrhoea. Cochrane Database of Systematic Reviews 2016, Issue 4. doi:10.1002/14651858.CD007854.pub3.
    • ultrasound. Inside Radiology. Insideradiology.com.au, last modified August 2017
    • Period pain. Women’s Health Concern. womens-health-concern.org, reviewed November 2017
    • Armour M, Smith C, Steel K, et al. The effectiveness of self-care and lifestyle interventions in primary dysmenorrhea: a systematic review and meta-analysis. BMC Complement Altern Med 2019; 19(22). doi: 10.1186/s12906-019-2433-8
    • Physical activity guidelines for adults (19–64). Chief Medical Office (CMO) 2011. www.gov.uk
    • Electronic pain relief (TENS). Versus Arthritis. versusarthritis.org, published 2015
    • Personal communication, Miss Shirin Irani, Consultant Gynaecologist, August 2019
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, August 2019
    Expert reviewer, Miss Shirin Irani, Consultant Gynaecologist
    Next review due August 2022



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