Managing period pain

What does period pain feel like?

Period pain, also called dysmenorrhoea, is common. It can prevent some people from doing their normal activities.

People experience period pain differently. It can range from mild to severe. You might feel cramping, aching or heaviness. You might feel it in the lower part of your abdomen, your lower back or your legs.

What causes period pain?

There are 2 types of period pain — primary dysmenorrhoea and secondary dysmenorrhoea.

Primary dysmenorrhoea

This type of period pain can be a normal but uncomfortable part of your menstrual cycle. It is caused by chemicals called prostaglandins, which are naturally made in the lining of your uterus (womb). They trigger contractions of the muscles of your uterus during your period.

If you have this type of pain, you may have higher levels of prostaglandins. This can make your contractions stronger and more painful. This is the most common type of period pain and usually develops within a few years of your first period.

Secondary dysmenorrhoea

This type of period pain is caused by an underlying health condition, such as:

• endometriosis
• fibroids
• pelvic inflammatory disease
• adenomyosis
• a side effect of the copper intrauterine device (IUD)

How is period pain treated?

If you have secondary dysmenorrhoea, it’s best to treat the underlying cause.

There is a range of treatments you can try to help with period pain.

Pain relieving medicines

Anti-inflammatory medicines such as ibuprofen, mefenamic acid and naproxen stop your body from producing prostaglandins. They work best if you start taking them as soon as the pain starts, or 48 hours before you expect to get your period. They are available over the counter from a pharmacy. They may not be suitable for everyone, so speak to your pharmacist first to check whether they are safe for you. Remember to take anti-inflammatories with food.

Paracetamol can also help for mild cramps.

Stronger pain relieving medicines containing codeine are only available with a prescription from a doctor.

Hormone treatments

To help you manage period pain in the longer term, your doctor might prescribe the combined oral contraceptive pill or the contraceptive vaginal ring. They may make your periods less painful. Check with your doctor about using them continuously for a few months at a time, so that you get periods less often.

Long acting contraceptives, such as the progestogen implant or hormonal intrauterine device (IUD), can also reduce period pain. Many people who use these find that their periods become lighter or stop.

You can use a hormonal treatment together with pain relieving medicines.

Other pain relief options

Some people find relief from:

• heat packs
• gentle exercise
• transcutaneous electrical nerve stimulation (TENS)
• acupuncture
• relaxation or meditation to reduce stress
• supplements such as magnesium, fish oil, vitamin B1, vitamin B6 and vitamin E – discuss these first with your doctor or pharmacist

Is period pain different after having a baby?

When you’ve had a baby, it’s normal to experience period-like bleeding as your uterus contracts back to normal size. However, if you start to experience sweating, dizziness, weakness or trouble breathing, along with very heavy bleeding, contact your doctor or midwife immediately as you may be having a postpartum haemorrhage.

Your periods can return as soon as 4 to 6 weeks after having a baby. If you are breastfeeding, it can take longer for your periods to return. There is no way to know if your periods will return the same way they were before you were pregnant.

Taking period pain medication containing naproxen is not recommended if you are breastfeeding. Speak to your doctor or pharmacist if you have any concerns.

When should I see a doctor?

If your pain lasts just for the first 1 or 2 days of your period, goes away with pain relieving medicines and doesn’t stop you doing your usual activities, it is probably normal.

See your doctor if:

• your pain lasts longer than 2 days
• your pain doesn’t go away when you take a hormonal contraceptive or pain relieving medicines
• your pain stops you from doing your normal daily activities
• it hurts when you pass a bowel motion or have sex
• you get pain in your pelvic area when you don’t have your period
• you have pain with an intrauterine device (IUD)
• you start getting pain when you haven’t had it before, or your usual pain gets worse

It can help to keep a diary of your pain, bleeding and any other symptoms. It can help you tell your doctor about your symptoms. Try this symptom diary.