Period pains are experienced by up to two thirds of women. The degree of the pain varies from woman to woman and can often be very mild, but around 10% of women will experience period pains which are severe enough to interrupt their normal daily lives.
Primary dysmenorrhoea is the most common type of period pain and tends to occur most often in teenagers and young women. No underlying disease processes are present in the pelvis or uterus (womb) and the pains will usually be helped by one of the treatments described below.
In primary dysmenorrhoea colicky period (menstrual) cramps usually come on with the beginning of bleeding but may occur up to a day beforehand. The pains can be felt in the lower abdomen (belly), groins and lower back. The underlying cause of the pain is not fully understood but chemicals called prostaglandins probably play a significant role.
The pain only tends to occur in ovulatory cycles (cycles where an egg is released), because the rise in certain hormone levels associated with producing an egg leads to higher levels of prostaglandins in the menstrual loss. The prostaglandins accumulate in the womb lining and assist in shedding this during a period by helping the muscles of the womb to contract. In primary dysmenorrhoea there may be a build up of too much prostaglandin or it may be that the womb is slightly more sensitive to it. This causes excessive contractions in the womb muscles which can lead to cramp like pains.
The pain experienced may sometimes last for just the first few hours of the period but can persist for several days before resolving. Period pain does not necessarily last for a similar length of time with each cycle and sometimes may be more prolonged than others.
Other symptoms which may occur along with the pain include nausea, diarrhoea, flushing, headaches, breast tenderness, tiredness and faintness. Usually primary dysmenorrhoea becomes less of a problem as women get older and certainly childbirth seems to help a lot, with many women noticing a significant reduction in the amount of pain they experience with their periods after they have had a baby.
Painkillers and local heat are the most effective basic measures you can take to try and alleviate period pains. Holding a hot water bottle (make sure it's not too hot!) against either the abdomen or the back can help to ease cramps, as can a warm bath. Simple painkilling tablets such as Paracetamol or Aspirin are often sufficient to reduce the pain if it is not too severe. If the pain is more severe then some people find anti-inflammatory painkillers such as Ibuprofen more helpful. There are also some stronger anti-inflammatory tablets which can be prescribed by your doctor which can be very effective in alleviating period pains and also reducing the amount of blood flow during the period.
Anti-inflammatory painkillers help to block the effects of the prostaglandins which contribute to the cramp like pains in the womb. If you do take an anti-inflammatory medication for period pains, it is advisable to start taking it, if possible, the day before your period is due and then to continue taking it regularly over the next few days until the pain has eased off. As with all medicines, care has to be taken when taking anti-inflammatory tablets, particularly in those who have had problems with indigestion and also in people with asthma. They can, however, be extremely effective.
Another possible treatment for painful periods is the combined oral contraceptive pill. This is particularly useful if contraception is also required. The combined pill tends to reduce the pain and heaviness of periods because it thins the lining of the womb and prevents ovulation (egg release), thereby reducing the amounts of prostaglandin which are produced.
Occasionally referral to a hospital specialist is required if period pains continue to be particularly severe, for example affecting school, work or other daily activities, despite using the above treatments.
Secondary dysmenorrhoea tends to occur in older ladies and is less common than the primary type. Sometimes, as in primary dysmenorrhoea, no underlying disease process is found and it is thought that the symptoms may be associated with 'pelvic congestion'. Often, however, with secondary dysmenorrhoea there is an identifiable underlying problem within the pelvis, such as endometriosis, fibroids or infection and further investigations and specific treatments may be required.
In secondary dysmenorrhoea the pain often starts several days before a period is due and tends to be constant rather than colicky in nature. Women with secondary dysmenorrhoea may also complain of other symptoms such as irregular periods, bleeding in between periods, pain between periods, very heavy periods, pain during intercourse or a discharge from the vagina.
It is worth seeking medical advice if there is a change from your usual pattern of period pain, for example if you notice a significant increase in period pain or the pains you experience become more prolonged. You should also attend your surgery if the pain is accompanied by any of the symptoms mentioned above. Very often no underlying disease is found, but it is important to be checked over properly in order to make sure there is nothing going on which requires specific treatment.
Disclaimer: This page is for informational purposes only and should not be considered as medical advice or substituted for professional advice. Always consult your doctor with your questions and concerns.
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