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Painful periods

Published by BUPA's Health Information Team
June 2003

Period pains are cramping abdominal pains experienced during, and sometimes just before, a woman's monthly period. They affect 80% of women at some time in their lives. Usually they are not a sign of a serious underlying problem and can be treated with self-help methods.

Painful periods

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

Primary dysmenorrhoea

This term is used to describe normal period pain experienced by many women around the time of their period. There is no underlying medical problem. It most commonly affects teenagers and young women. This is the type of period pain discussed in this factsheet.

Secondary dysmenorrhoea

This term is used to describe pain around the time of the period that’s caused by an underlying problem. It is less common than primary dysmenorrhoea, and tends to affect women later in their reproductive lives.

What causes period pain?

Pains may start with the first-ever period. However, they are more likely to begin 6-12 months later, once cycles where an egg is released are established. It's these cycles that appear to cause more pain.

The cause of period pain is not certain. Once an egg has been released from one of the ovaries, natural chemicals produced by the body called prostaglandins are made in the lining of the uterus (womb). Some prostaglandins cause the walls of the uterus to contract. Some women produce higher levels of prostaglandins, which may cause increased contractions of the uterus. These cramps may be more painful because there is reduced blood (and therefore oxygen) supply to the myometrium (muscle wall of the uterus) during the contractions.

Female pelvic organs

Symptoms of painful periods

Cramping lower abdominal pains are the most common symptom. Pain can also spread to the lower back and the thighs. When severe, the pain can be accompanied by nausea or vomiting, diarrhoea, constipation or feeling faint. Some women may also get headaches.

Pain usually lasts two to three days and tends to happen in the first few days of the period, coinciding with the time of heaviest blood flow. Period pains do not cause any damage to the uterus and a pelvic examination or "internal" would show that the uterus and ovaries are normal.

Up to 15% of women have period pains severe enough to interfere with their daily activities. This can lead to missing days at school or work or decreased participation in social or sporting activities.

Period pains are often worse in adolescence and tend to improve as women get older. Many women notice that their periods are less painful after they have had a baby.

Treatment

Self-help

Over the counter painkillers such as ibuprofen and paracetamol often help. There are also painkilling tablets available that contain the drug, hyoscine (eg Feminax), that may help prevent the muscle contractions.

Moderate physical exercise can also be helpful for relieving pain, and may help prevent period pain. Many women find a hot water bottle held to the abdomen or back is comforting. Self-heating patches or heat packs that can be warmed in a microwave are a convenient alternative.

Prescribed medicines

If these measures do not provide enough relief, or if period pains are interfering with daily life, then it’s best to see a doctor. A doctor can usually diagnose period pains easily and several treatment options may be discussed.

Anti-inflammatory drugs

These work by decreasing the levels of prostaglandins. Examples include ibuprofen, naproxen and mefenamic acid. They relieve pain and can also decrease the amount of bleeding. They work best when taken regularly from the time when either pain or bleeding starts or the day before a period is due.

These drugs are not suitable for everyone – for example, people with asthma or indigestion problems may not be able to take them.

Oral contraceptive pill

The combined oral contraceptive pill, which is the most widely used type of pill, prevents ovulation (the release of an egg). This may help to decrease period pains because the lining of the uterus remains thin and fewer prostaglandins build up. It is particularly useful if a woman also wants contraception.

Mirena intra-uterine system

Mirena is the brand name of a new type of intra-uterine contraceptive device (IUCD), or coil. It differs from other coils because it releases a form of the hormone progesterone (called levonorgestrel) into the uterus. This prevents the thickening of the lining of the uterus. In addition to providing contraception, some women find that their periods become much lighter within three to six months of having the coil fitted. In a few cases the periods stop altogether. As a result of this, many women find that they also experience less period pain.

Sometimes the non-hormone releasing coils can cause or increase period pains.

Other treatments

There is some evidence that taking thiamine (vitamin B1) or magnesium supplements can help reduce period pains.

Transcutaneous electrical nerve stimulation (TENS) is another alternative. This involves a small electrical device, which is taped to the lower back. It releases tiny electrical pulses that aim to "distract" the brain from experiencing pain from the nerves supplying the uterus. It’s most commonly used for labour pains. TENS machines are usually supplied by physiotherapists, but it’s also possible to buy or hire them from local health centres, high street chemists, hospital pain clinics or branches of the National Childbirth Trust (NCT).

Some people find that acupuncture relieves certain kinds of pain, including period pain, but there is little definite scientific evidence to prove this.

Could there be another problem?

As mentioned, period pains can sometimes be the result of an underlying gynaecological condition (secondary dysmenorrhoea). A doctor should be consulted if period pains are particularly severe, or new, or are associated with any of the following symptoms:

• bleeding between periods
• bleeding after intercourse
• pain during or after intercourse
• unusually heavy periods.

A doctor will carry out a pelvic examination and may then arrange further investigations or a referral to a gynaecologist. Tests might include, for example, an ultrasound scan of the pelvis to look at the uterus and ovaries. Other tests may take place in a hospital.

• Hysteroscopy – a thin telescope is passed through the neck of the womb (cervix) to enable the inside of the uterus to be viewed.
• Laparoscopy – where a small telescope is passed through a small cut in the wall of the abdomen allowing the pelvic organs to be viewed. Problems such as endometriosis can be diagnosed in this way (see the separate BUPA factsheet Endometriosis). Further treatment depends on the specific diagnosis.

Further information

Women’s Health Concern
http://www.womens-health-concern.org

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