Period Pain (Dysmenorrhoea)


Many women experience an ache in the lower abdomen, back and tops of their legs, especially in the first few days of their period. The first couple of days are usually the worst and then it lessens. Sometimes conditions such as endometriosis can make period pains become worse.

 
What is Dysmenorrhoea?

Most women have some pain during periods. It is often mild but, in about 10% of women, the pain is severe enough to affect normal activities, it can even stop them from going to work or school. The pain can be so severe that they are unable to go to school or work.

Primary dysmenorrhoea is common. This occurs where there is pain but no underlying problem of the uterus or pelvis. It usually affects younger women.

Secondary dysmenorrhoea is pain caused by a problem of the uterus or pelvis. This is less common and is more likely to occur in women in their 30's and 40's.

What are the Symptoms of Dysmenorrhoea?

Cramping pain in your pelvis. Often, when you start your periods, they are painless. Pains may only begin 6-12 months after you start having periods. The pain:

  • May spread to your lower back, or to the top of your legs.
  • Usually starts the day before or as you start bleeding.
  • Usually lasts 12-24 hours but can last 2-3 days.
  • Is variable. Some periods are worse than others.
  • Often eases as you get older, or after having a baby.

In some women, other symptoms occur as well as pain - for example:

  • Headaches.
  • Tiredness.
  • Faintness.
  • Breast tenderness.
  • Feeling sick (nausea).
  • Bloating.
  • Diarrhoea.
  • Feeling emotional or tearful.

Note: the following are not symptoms of primary dysmenorrhoea:

  • High temperature (fever).
  • Vaginal discharge.
  • Sudden severe abdominal pain.
  • Pain when you have sex.
  • Vaginal bleeding between periods.
  • Vaginal bleeding after having sex.

You should see your doctor if any of these symptoms develop.

Secondary dysmenorrhoea

This also causes cramping pelvic pain during your periods. It usually comes on after years of ‘normal’ periods. Your pain may become more severe or last for longer than it used to.

What are the causes?

Primary dysmenorrhoea
There is no obvious cause. The uterus is normal. It is thought that chemicals called prostaglandins build up in the uterine lining. They help with uterine contraction and removal of the lining during a period. There may be a build-up of this chemical, or the uterus may be extra sensitive to the prostaglandins. This may cause it to contract too hard, reducing the blood supply and leading to pain.

Secondary dysmenorrhoea - A problem of the womb or pelvis sometimes causes painful periods. For example:
  • Endometriosis.
  • Fibroids.
  • Infections causing pelvic inflammatory disease.

What tests are needed for painful periods?

Usually in primary dysmenorrhoea the history and examination are enough to diagnose the problem. Tests and an internal examination are only needed if symptoms are unusual.
Secondary dysmenorrhoea - Your doctor will take a history and examine you, an internal examination may also be required. Swabs may be taken to rule out infection and an ultrasound scan will usually be ordered to look for fibroids. If needed, you will be referred to a gynaecologist to consider further tests including a hysteroscopy (telescope into the uterus) and biopsies or laparoscope. (Telescope into the pelvis.) 

What are the treatments for dysmenorrhoea?

Primary dysmenorrhoea
Most women with painful periods have mild pain that they can treat themselves. However, if your pain is getting worse and affecting your usual activities, you should see your doctor. There are a number of treatments that may help if you have primary dysmenorrhoea:

Keep active and try gentle massage and relaxation techniques.

Warmth. You may find a hot water bottle or wheat bag soothing. The pain is often brief, and this may be all that you need. (Make sure you wrap them in a towel and do not put them in direct contact with your skin)

Non-steroidal anti-inflammatories. Anti-inflammatories help in about 70% cases. They counteract the prostaglandin chemicals which may cause the pain and can reduce blood flow. Some tips when using an anti-inflammatory include the following:

  • Start them as soon as you feel pain or start to bleed. Some women even start them the day before if they know when their period is due.
  • Take the tablets regularly, for the first couple of days of each period, rather than waiting for the pain to build up.
  • Make sure you take the right dose for your age and weight.
  • Speak to your doctor or pharmacist if you think you can’t take anti-inflammatories. They can cause stomach problems or affect people with asthma.

Paracetamol. Paracetamol can be used instead of, or in combination with, a non-steroidal anti-inflammatory if your pain relief is not enough. Always read the details on the packet so that you do not exceed the maximum daily dose of either painkiller.

Combined oral contraceptive (COC) is the contraceptive pill. It can be used to regulate and lighten your periods. It can even be taken without breaks to reduce the number of periods you have each year. The contraceptive patch and ring can also help in this way.

The intrauterine system (IUS). An intrauterine contraceptive device called the IUS is a good choice if you also want long-term contraception. It slowly releases a hormone which 'thins' the uterine lining. It can reduce period pain and bleeding.

Other progestogen contraceptives. These can be administered as tablets, injections or a rod inserted into your arm. They can reduce bleeding but are more unpredictable than the combined contraceptive options.

A transcutaneous electrical nerve stimulation (TENS) machine. A TENS machine is an option for women who prefer not to use medication. They seem to work by affecting the pain signal pathways to the brain.

Secondary dysmenorrhoea
The treatment of secondary dysmenorrhoea depends on the underlying cause. Please see blogs to learn more about Fibroids, Endometriosis and Pelvic Inflammatory Disease, which describe in more detail some of the problems that can cause secondary dysmenorrhoea. If you have an intrauterine contraceptive device (IUD - also known as 'the copper coil') and have painful periods, the treatments for primary dysmenorrhoea (described above) often help. However, some women prefer to have their IUD removed if symptoms do not improve.

We appreciate there is a lot of information to process and encourage you to discuss this with an Integriti GP to ensure the treatment option is best for you.


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