Period pain: what’s normal, what helps and when to worry

Period pain is so common that many people grow up believing they just have to grit their teeth and get through it. More than half of people who menstruate have some pain for a day or two each month. It’s usually manageable, but pain that stops you from living your life is not something you have to accept. Here’s what causes period pain, what actually helps, and the signs that it’s time to get checked.

What causes period pain?

During your period, the lining of your uterus releases chemicals called prostaglandins. They make the muscles of the uterus contract to help shed the lining. The higher your prostaglandin levels, the stronger the contractions and the more it can hurt. Strong contractions can also briefly reduce blood flow to the uterine muscle, adding to the pain. Prostaglandins can cause nausea, loose stools, headaches or lightheadedness too. The pain is usually a cramping or aching feeling in the lower belly that can spread to the lower back and thighs.

Primary vs secondary dysmenorrhea

The medical term for painful periods is dysmenorrhea, and doctors distinguish two types:

• Primary dysmenorrhea is common period pain that isn’t caused by another condition. It usually appears within a year or two of your first period, starts just before or as bleeding begins, and lasts about 1 to 3 days. It often improves with age.
• Secondary dysmenorrhea is caused by a condition affecting the reproductive organs, such as endometriosis, adenomyosis or fibroids. The pain may start earlier in your cycle, last longer than your bleeding, get worse over time, or appear later in life after years of milder periods.

What helps relieve period pain

Common period pain usually responds well to simple measures, and combining a few often works best.

• Heat: a heat pad or hot water bottle on your lower belly or back, or a warm bath, helps relax the muscles. Some research suggests heat can work about as well as over-the-counter painkillers.
• Gentle movement: walking, swimming, stretching or yoga may ease cramps, and regular exercise throughout the month may reduce pain over time.
• Anti-inflammatory painkillers: non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen reduce prostaglandin production and tend to work best taken at the first sign of pain. Always follow the leaflet, and ask a pharmacist whether they’re suitable for you, especially if you have asthma, stomach or kidney problems, are pregnant or take other medicines. If they’re not suitable, a pharmacist can suggest alternatives such as paracetamol (acetaminophen).
• TENS: a small device that sends mild electrical pulses through pads on your skin can help some people.
• Rest and comfort: gentle massage of your lower belly, relaxation techniques and enough sleep can all help.

Hormonal and medical options

If self-care and over-the-counter painkillers aren’t enough, talk to a doctor. Hormonal contraception, such as the combined pill, patch or ring, a hormonal IUD, the implant or the injection, can make periods lighter and less painful, and some options can stop periods altogether. A doctor can help you weigh up the benefits and side effects and find something that suits you. If another condition is causing your pain, treatment will depend on the cause.

When period pain is not normal

Period pain is common, but some signs suggest it may have another cause and deserves a proper assessment:

• Pain that isn’t relieved by your usual painkillers
• Pain that makes you miss school, work or activities
• Pain during or after sex
• Pain when you have a bowel movement or pee, especially during your period
• Pain that’s getting worse over time
• Very heavy periods, bleeding between periods, or pelvic pain outside your period
• Difficulty getting pregnant

Conditions that can cause painful periods

Several conditions can cause secondary dysmenorrhea. The most common include:

• Endometriosis: tissue similar to the lining of the uterus grows outside it, for example on the ovaries or the lining of the pelvis. It affects about 1 in 10 women and girls of reproductive age and can take years to diagnose, so speaking up about your pain matters.
• Adenomyosis: tissue like the uterine lining grows into the muscular wall of the uterus, which can cause heavy, painful periods.
• Fibroids: non-cancerous growths in or around the uterus. Many cause no symptoms, but some lead to heavy or painful periods or a feeling of pressure.