Introduction

Photo of a young woman holding her tummy in pain (PantherMedia / Alexander Raths) Many girls and women have problems like abdominal cramps and pain during their menstrual period. The medical term for painful periods is “dysmenorrhea.”

Although menstruation is a normal part of a woman's life, severe period pain need not be. Women don't have to simply put up with it – menstrual pain can usually be treated effectively. If you have very painful periods or the pain keeps getting worse over time, it can be a good idea to see a doctor.

Symptoms

Every month the lining of a woman’s womb builds up and is then shed again at the end of the menstrual cycle, when she has her period – unless she is pregnant. To shed the lining during the monthly period, the muscles of the womb tighten (contract) and relax in an irregular rhythm. This helps the tissue lining the womb to detach and flow out of the body, together with blood, through the neck of the womb (cervix) and the vagina.

The muscle contractions are sometimes not noticeable or only cause mild discomfort, but they're also sometimes felt as painful cramps. Period pain might only affect the lower abdomen, or it might be felt in the back or legs too. It can cause nausea, vomiting or diarrhea in some women, as well as headaches or general discomfort. Women who have heavier periods often have more intense pain too.Illustration: Menstrual cycleMenstrual cycle

Causes and risk factors

Doctors distinguish between two types of period pain, called primary and secondary dysmenorrhea. Primary dysmenorrhea is where the period pain is caused by the womb muscle contractions alone. Hormone-like substances called prostaglandins play an important role here. They influence the perception of pain and cause the muscles in the womb to tighten, helping to shed the lining of the womb. Primary dysmenorrhea is more common in women under the age of 30 and women with heavy periods. It can run in families, and stress can play a role too.

Period pain that is caused by something other than the muscle contractions is called secondary dysmenorrhea. Benign (non-cancerous) growths in the womb, such as fibroids or polyps, are often responsible for secondary dysmenorrhea. Severe period pain may also be caused by endometriosis. In endometriosis, the kind of tissue that lines the womb (endometrium) grows elsewhere in the abdomen too. Sometimes contraceptive coils (IUDs: intrauterine devices) used for birth control can also cause secondary dysmenorrhea.

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Prevalence and outlook

Period pain is very common: most girls and women have pain of varying intensity at some point during their period. In 10 out of 100 women the pain is so bad that they're unable to carry out their usual daily activities on one to three days every month.

The pain is usually worse in women under the age of 20. It usually gets better or even goes away completely within a few years of their first period. In many women period pain becomes milder after the birth of their first child.

Secondary dysmenorrhea often first arises after a young woman has already been menstruating for several years. Here, women may also have pain at times of the month other than during menstruation.

Treatment

Women and girls get a lot of (sometimes contradictory) advice from doctors and other women. Painkillers such as ibuprofen and naproxen are effective. These belong to a group of medications known as non-steroidal anti-inflammatory drugs (NSAIDs). They can relieve period pain by reducing the production of prostaglandins. Although NSAIDs are usually well tolerated, they sometimes have side effects, especially stomach-related problems.

The birth control pill can relieve period pain too because it prevents ovulation. This reduces the production of prostaglandins. It also means that the lining of the woman's womb doesn’t become as thick as usual, and she has a lighter period. The birth control pill can have side effects too, such as headaches and nausea. It also increases the risk of thrombosis.

Some evidence suggests that applying warmth, for instance with heat packs, can relieve period pain. A few studies have also suggested that physical activity such as jogging, yoga and exercises can help.

Other treatments – like acupuncture, dietary supplements or herbal products – haven't been proven to help. Although these approaches have been tested in a number of studies, the study results were contradictory or the studies weren't done properly.

Sometimes the pain is so bad that psychological treatment is considered. This may include things like talks with a psychotherapist and learning techniques that can reduce pain (such as relaxation and mindfulness exercises).

If the pain is caused by fibroids or endometriosis, other treatment options can be considered – perhaps surgery, too.

Research summaries

Everyday life

Sometimes friends, relatives, colleagues and even doctors don't take period pain seriously. And some women think they just have to put up with the pain because it's a normal part of being a woman. But severe pain that affects your everyday activities on several days a month, maybe even preventing you from working, isn't something that you just have to live with because it's “natural.” Advice like this can make it difficult to feel comfortable about withdrawing from activities to get some rest, and might stop women from seeking professional help or treatment.

It may be possible to find ways to deal with the “painful” days so they are less of a problem. For example, many women try to take things a bit easier on those days. It may be helpful to avoid having demanding appointments and activities during that time of month. Some find that relaxation techniques, breathing exercises, yoga or tai chi help them feel more relaxed and reduce stress. Getting a lot of exercise also helps relieve period pain in some women. Warm baths and saunas can be soothing too.

Women who are often unable to go to work because of bad pain and cramps may face problems at work, as well as feeling guilty and ashamed. Having a partner, relatives or friends who are understanding and supportive can make an important difference.

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.