Painful periods (dysmenorrhoea)

About painful periods

Painful periods are thought to affect around three quarters of all women.

Types of painful periods

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 between the ages of 30 and 45.

Symptoms of painful periods

The most common symptom of painful periods is cramps or pain in your abdomen that may spread to your lower back and 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
  • mood changes

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

  • heavy periods
  • irregular periods
  • bleeding in between periods
  • pain during sex or bleeding after sex
  • a vaginal discharge

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

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 womb (uterus) to contract. Strong muscle contractions can temporarily stop the blood supply to your womb, which can be painful.

Secondary dysmenorrhoea, can be caused by a number of different conditions, including:

  • endometriosis (where cells that normally line your womb grow outside your womb 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 (the coil) – this is different to an intrauterine system (IUS) that can help the symptoms of painful periods

You're more likely to have painful periods if:

  • your periods started at a young age (before 12)
  • you smoke
  • you haven’t ever given birth

Diagnosis of painful periods

Your GP will ask about your symptoms and examine you. 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. He or she may also examine you internally. This will involve your GP inserting gloved, lubricated fingers into your vagina to feel for any abnormalities in your womb or ovaries. Your GP may take a swab from your vagina to rule out a sexually transmitted infection (STI).

Your GP may refer you for further tests. These may include:

  • blood tests – for example to check if you have an infection
  • a pelvic ultrasound which uses sound waves to produce an image of the inside of your body

If your GP thinks that there may be an underlying cause for your symptoms, he or she may refer you to see a gynaecologist (a doctor who specialises in women’s reproductive health) for further tests.

Treatment of painful periods

If you have secondary dysmenorrhoea, your doctor will treat the underlying condition that is causing your painful periods. 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, or to have a warm bath to reduce your pain.

A transcutaneous electrical nerve stimulation (TENS) machine may help relieve your symptoms. A TENS machine uses two electrodes, which are placed on your back. Electrical impulses are sent through the electrodes. These stimulate your nerve fibres and block the pain signals 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 – the Department of Health recommends that men drink no more than three or four units a day and women drink no more than two or three units a day

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 chemicals are involved in regulating pain signals to your brain. Taking NSAIDs will help to reduce the amount of pain you have during your period. If you're not able to take NSAIDs, for example if you have ever had a stomach or duodenal ulcer, your GP may suggest you try paracetamol instead.

If NSAIDs and paracetamol don't help to reduce your pain, your GP may prescribe codeine for you to take as well. Codeine is a stronger painkiller. 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 also help to reduce some of your symptoms.

Complementary therapies

There are a number of complementary therapies that claim to help ease the symptoms of painful periods, including acupressure, acupuncture, relaxation techniques, magnets, vitamin E, fish oil and magnesium supplements. However, more evidence is needed to show if these help. Spinal manipulation has been shown not to help.

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

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. This is because exercise encourages your body to produce endorphins. Endorphins are chemicals produced in your brain, which can relieve pain and can make you feel happier.

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.

It’s important that you include at least two weekly activities to build up muscle strength, such as exercising with weights. Try to spend as little time as possible being inactive.

Will having painful periods affect my ability to have children?

Answer

Whether painful periods affect your fertility will depend on what is causing them.

Explanation

If you have primary dysmenorrhoea, it's unlikely to affect your ability to conceive. This is because 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, the condition that causes it may affect your ability to have children. For example, pelvic inflammatory disease can cause infertility, particularly if you have had it more than once. It's important to 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 contraceptive pill or an intrauterine system (IUS).

Explanation

Taking the contraceptive pill can make your periods shorter and lighter. As a result, you may find you have less pain during your periods.

The IUS is a small T-shaped plastic frame that is fitted inside your womb. The stem of the ‘T’ has a small reservoir that 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 very slowly into your 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 an embryo to implant in your womb. It can also thicken the mucus that your cervix produces and this can help prevent sperm from entering your womb.

Not everyone can have an IUS fitted; it will depend on what is 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.