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Medically Reviewed April 2023, by Mr. Bryan Mayou (GMC: 1414396) - founder of the Cadogan Clinic and one of the world's leading plastic surgeons
Period pain, also often referred to as period cramps, are a normal and common part of a woman’s menstrual cycle. It happens when the muscles in the uterus contract to shed its lining, resulting in the monthly bleed.
Period cramping can be felt in the lower stomach, sometimes spreading to the lower back and thighs. The intensity and presentation of period pain not only varies from person to person, but a woman may find it can vary from month to month. Sometimes period pain can feel like a dull, constant ache or it may come in intense spasms. Period cramping may bring no more than mild discomfort to some women, while others experience particularly painful periods which can affect their physical and mental health and impact on their work and lifestyle. Sometimes painful periods are the result of an underlying medical problem, such as endometriosis or fibroids.
Often over-the-counter painkillers and lifestyle changes are enough to soothe period cramps, but if your period pain is severe or your normal pattern of bleeding changes, for example you start bleeding more heavily or it becomes irregular, then you should visit a doctor for further investigations.
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Period pain is caused by the uterus contracting in order to shed and expel the uterine lining.
When the uterine wall contracts, it compresses the surrounding blood vessels and temporarily cuts off the blood and oxygen supply to the uterus. This prompts the uterus to release pain-triggering chemicals and other chemicals called prostaglandins that encourage the muscles to contract more, thus causing more pain. It is not known why some women experience more period pain than others.
Period cramps usually start when the bleeding begins, although some women experience pain several days beforehand. Period pain usually lasts for two or three days but it can last longer.
Period pain can be felt in the lower abdomen, lower back and thighs and the presentation and intensity of the pain varies from person to person and from period to period.
Period cramps are common and, although they can be highly unpleasant, they are not normally anything to worry about and can be easily treated at home. However sometimes period pain can be caused by an underlying medical condition, which may require treatment. Women between the ages of 30 and 45 are more likely to be affected by period pain linked to an underlying medical condition. Common underlying causes of painful periods include:
Endometriosis is a condition where tissue similar to that found in the lining of the uterus is found growing outside of this space, such as on or in the fallopian tubes, ovaries, vagina or intestine. Uterine tissue that has grown on the ovaries or fallopian tubes can cause immense pain when shed. Endometriosis pain can be debilitating and the condition sometimes causes infertility.
Fibroids are noncancerous growths made up of muscle and fibrous tissue that develop in or around the uterus. They vary in size from the size of a pea up to the size of a melon. One in three women with fibroids will experience symptoms including heavy or painful periods. In rare cases, fibroids may cause infertility and problems in pregnancy.
With this condition, tissue that normally lines the uterus starts to grow within the muscular wall of the uterus, causing a great deal of pelvic pain and period pain. Heavy, painful or irregular periods are common with adenomyosis.
Pelvic Inflammatory Disease (PID)
Pelvic Inflammatory Disease (PID) is a common bacterial infection of the female reproductive system that encompasses the uterus, ovaries and fallopian tubes. Not all women with PID will experience symptoms, but others will have symptoms including painful or irregular periods. PID is usually caused by a bacterial infection that has worked its way up from the vagina or cervix.
Intrauterine device (IUD)
An IUD is a small T-shaped plastic and copper device that's put into the uterus to prevent a fertilised egg attaching to the uterine lining, preventing pregnancy. It can cause period pain, particularly within the first few months of it being put in place.
Period pain that does not have one of the above underlying causes tends to improve as a woman gets older, particularly if they have had children. Girls and teenagers who have just started to menstruate often experience period pain.
If your period pain is so severe that it stops you from carrying out day-to-day activities, which may include going to work, college or university or socialising, then you should go see a doctor.
You should also seek medical advice if you notice a change in the pattern of your period pain. For example, you may have noticed that your pain level has increased, or the period pain may be lasting for longer than before. If you are experiencing pain at other times during your cycle, i.e. when you are not bleeding, and if you notice a feeling of heaviness in your tummy and/or back pain, then this is also something that requires further investigation.
You should also seek medical advice if you are experiencing one or more of the following symptoms alongside your period pain:
These symptoms may indicate the presence of an underlying medical condition that requires swift treatment.
There are several treatments for heavy periods. The treatment will depend on whether there is an underlying medical condition present and how much of an impact painful periods are having on your day-to-day life.
Non-steroidal anti-inflammatory drugs (NSAIDs): If your symptoms are not severe, your doctor may recommend pain management with NSAIDs, such as ibuprofen and aspirin. However you should avoid aspirin and ibuprofen if you have asthma or stomach, liver or kidney problems. Aspirin should not be taken by anyone aged under 16.
If aspirin and ibuprofen do not help your period pain, then a doctor can prescribe a stronger painkiller, such as codeine or naproxen.
Hormone medicines and contraceptives: The female sex hormone oestrogen encourages endometrial tissue to grow and to shed. By limiting the amount of oestrogen using hormone therapy, this can reduce the amount of endometrial tissue in the body. Hormone treatments include the combined oral contraceptive pill, containing oestrogen and progestogen, which can stop ovulation, therefore making periods lighter and less painful.
The Mirena intrauterine system (IUS), the contraceptive injection, the implant or progestogen pills can also help with painful periods.
Keyhole surgery (laparoscopy): A small camera is inserted into the abdomen and a laser, electric current, or beam of special gas is used to destroy patches of endometrial tissue.
Myomectomy: Myomectomy is a surgery to remove fibroids from the uterine wall.
Antibiotics: If Pelvic Inflammatory Disease (PID) is diagnosed as the root cause of your painful periods, then the doctor will prescribe antibiotics to treat the infection.
Hysterectomy: A hysterectomy is a surgical procedure to remove the uterus. Once the uterus has been removed, your periods will stop and you will no longer be able to get pregnant.
A hysterectomy is carried out to treat a range of health conditions that affect the female reproductive system, including fibroids, pelvic pain, adenomyosis and heavy, painful periods that are impacting on a woman’s quality of life. Hysterectomy is a major surgery and is usually only considered if all other treatment options have not worked. Sometimes the ovaries, fallopian tubes, part of the vagina, lymph glands and fatty tissue are also removed.
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Why am I having period pain without my period?
Sometimes a woman may experience a feeling similar to period cramps, but without having a period. These feelings may be caused by ovulation, constipation, pregnancy, trapped wind, menopause, Irritable Bowel Syndrome (IBS) or even stress. However the presence of period pain without a period may be a sign of something more serious, such as Pelvic Inflammatory Disease, Polycystic Ovary Syndrome (PCOS), ovarian cysts, appendicitis or ovarian cancer. So it is important to get any unexplained checked out by a medical professional.
Is period pain normal?
Unfortunately period pain goes hand-in-hand with menstruation. It is normal to experience period cramps for two or three days or so each month, with pain ranging from a dull, continuous ache to sudden, sharp and intense episodes of pain. Often these can be treated at home with over-the-counter painkillers and self-care.
However if your period pain is so severe that it is affecting your day-to-day life, if the pattern of your period pain has changed or you are experiencing other symptoms alongside your period pain, then you should go to a doctor for further investigation.
What are the different types of period pain?
Period pain is known by the medical term dysmenorrhoea and the types of period pain are divided up into two categories.
Primary dysmenorrhoea is period pain that is not caused by any underlying health condition and this usually comes at the same time the bleeding starts. Secondary dysmenorrhea is period pain that is caused by an underlying health condition, such as endometriosis or fibroids. Sometimes a woman may have primary dysmenorrhoea for a number of years and go on to develop secondary dysmenorrhea (if she develops pelvic inflammatory disease, for example).
What can I do at home to soothe period pain?
Often period pain can be managed at home with ibuprofen or aspirin. Women with more mild period pain often find that a heat pad or a hot water bottle on the stomach or lower back helps to ease period cramps. Gentle exercise, such as swimming, walking or cycling, may help too. You may also wish to try an abdominal massage or a warm bath. If you are a smoker, it is a good idea to quit, as smoking is believed to increase the risk of period pain.
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