Dysmenorrhoea: Understanding and Managing Painful Periods

What is dysmenorrhoea?

Dysmenorrhoea is the medical word for period pain. Most period pain is mild and settles with simple care at home. When pain is severe enough to stop your day, keeps you from school, college or work, or is not helped by painkillers, it needs a doctor.

Many girls and women are told that bad pain is just part of being a woman, and that they should bear it quietly. That is not true. Severe pain can be treated. Sometimes it is a sign of a condition that needs care. Talking about it openly is the first step.

Why periods hurt

During your period, the womb (uterus) tightens to help shed its lining. The lining releases chemicals called prostaglandins. These make the muscle of the womb contract more strongly, and they briefly reduce the blood flow to it. This causes cramping pain.

People who make more prostaglandins, or whose womb is more sensitive to them, tend to have more pain. Doctors describe two kinds of dysmenorrhoea: primary and secondary.

Primary dysmenorrhoea

Primary dysmenorrhoea is period pain with no other condition behind it. It is very common after puberty. It usually starts within a year or two of the first period, once the ovaries begin releasing an egg regularly. It often eases with age.

The pain usually starts just before or when bleeding begins. It lasts one to three days and is often worst on the first day or two.

Where you may feel it

• Lower tummy
• Lower back
• Thighs and legs

Other symptoms that can come with it

• Tiredness or weakness
• Feeling dizzy
• Nausea or vomiting
• Loose stools
• Headache

Secondary dysmenorrhoea

Secondary dysmenorrhoea is period pain caused by a condition in the womb or pelvis. It often starts later in life, after years of easier periods. The pain may begin several days before bleeding, last longer than the period, or get worse over time. Common causes include:

• Endometriosis. Tissue similar to the lining of the womb grows outside it, for example on the ovaries, the fallopian tubes, the ligaments around the womb or the bowel. It can cause severe period pain, pain during sex and pain when passing stools. It can also make it harder to get pregnant. Treatment may include pain relief, hormone medicines or surgery.
• Adenomyosis. The lining of the womb grows into its muscle wall. The womb may become larger and tender, and periods can be heavy and painful. Treatment ranges from medicines to surgery.
• Fibroids. These are non-cancerous growths in or on the womb. They are very common in women of reproductive age. Many cause no symptoms. Some cause heavy periods, pain, pressure or constipation, and these can be treated with medicines or surgery.
• Pelvic inflammatory disease (PID). This is an infection of the womb, fallopian tubes or ovaries, often passed on through sex. It can cause pain in the lower tummy, fever, unusual discharge and pain during sex. PID needs prompt antibiotic treatment from a doctor. Severe cases may need hospital care. Without treatment it can affect fertility later.
• Differences in the shape of the womb that are present from birth. Some of these may need surgery. A doctor will advise.

How doctors treat painful periods

If your periods are very painful, see a doctor. They will ask about your pain and your cycle. They may examine your tummy, and they may suggest an ultrasound scan to look for a cause. You can ask for a female doctor if you prefer.

For primary dysmenorrhoea, doctors often suggest anti-inflammatory painkillers. These work best when taken as the pain begins, or just before your period is due. Ask a doctor or pharmacist which medicine and dose is right for you, especially if you have asthma or stomach or kidney problems. Hormone medicines can also ease period pain; these need a doctor's prescription.

For secondary dysmenorrhoea, treatment depends on the cause. That is why finding the cause matters.

Things that can help at home

• Put a hot water bottle or heating pad on your tummy or lower back. Wrap it in a cloth so it does not burn your skin.
• Take a warm bath or shower.
• Try gentle movement such as walking, stretching or yoga. Regular exercise through the month may help too.
• Rub your lower tummy gently in slow circles.
• Rest when you need to, and sip warm drinks.
• Eat a balanced diet and drink enough water. Ask your doctor before starting any supplement.
• If you smoke, try to stop. Smoking is linked to worse period pain.

Some people find acupressure helps, though the evidence is limited. Comfort measures help with everyday cramps. They are not a replacement for seeing a doctor when pain is severe.

How to support someone with painful periods

If a friend, sister, classmate or colleague often has painful periods, believe her. Do not tell her it is normal and she must bear it. Help her find a doctor, and go with her if she wants company.

In India, 1 in 4 girls stay home from school during their periods (BMJ Open review of Indian studies, 2016). Pain that is never treated can keep girls away from class, month after month. Teachers and parents can help by letting a girl rest when she needs to, and by taking her pain seriously.

When to see a doctor

• Your period pain stops you going to school, college or work.
• Painkillers from a pharmacist do not help.
• Your pain is getting worse over time, or has started after years of easy periods.
• You have pain between periods, during sex or when passing stools.
• Your periods are very heavy: you soak a pad every hour or two, or pass large clots.
• You bleed between periods or after sex.
• You have fever, unusual discharge and pain in your lower tummy. See a doctor the same day.
• You have sudden, severe pain, or severe pain and you could be pregnant. Get medical help at once.

Have a question about period pain or your periods? Call our menstrual helpline on 85888 70999. It answers at any hour.

FAQs

What is dysmenorrhoea?

It is the medical word for period pain. Most of it is mild. When it is severe enough to stop your day, it needs a doctor.

What is the difference between primary and secondary dysmenorrhoea?

Primary dysmenorrhoea is period pain with no other cause. Secondary dysmenorrhoea is caused by a condition such as endometriosis, adenomyosis, fibroids or an infection.

How long does normal period pain last?

Usually one to three days, starting just before or when bleeding begins. Pain that lasts longer or keeps getting worse should be checked by a doctor.

What can I do at home to ease cramps?

Try a hot water bottle, a warm bath, gentle movement, rest and warm drinks. For painkillers, ask a doctor or pharmacist what is right for you.

Is severe period pain normal?

Some pain is common, but pain that keeps you from school, college or work is not something to put up with. A doctor can find the cause and help.

In short

Period pain is common, and most of it can be eased at home. Severe pain is not something girls and women have to bear in silence. If pain stops your day, see a doctor.

About Pinkishe Foundation

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Learn more

• Period and ovulation calculator
• Menstrual myths and facts
• Test your knowledge: take our menstrual quiz