Painful Periods

Causes

The pain of periods is caused by contractions of the uterus or womb, similar to those of another 'normal' pain women suffer - during labour.

Mild contractions constantly pass through the muscular wall of the womb, although most women are unaware of them. During menstruation, however, they are stronger than normal and during labour they're stronger still.

Each contraction causes the blood supply to the womb to be temporarily cut down as the blood vessels in the muscle wall are compressed. As the tissues are starved of oxygen, chemicals that trigger pain are released.

At the same time the body is also releasing chemicals called prostaglandins, which induce stronger contractions and which may directly cause pain in the womb. As the contractions get stronger, so the pain increases.

The aim of these contractions is to help the womb shed its delicate lining (as a period or bleed), so a new lining can be grown ready for a fertilised egg to implant itself. This is an essential part of female fertility, but pain is a side effect.

When is it not normal?

Severe period pains should always be investigated to check for a treatable cause. As a very rough guide, if you've had severe period pain (known as dysmenorrhoea) since around the time your periods first started, it's less likely that a particular cause will be found. However, even if this is the case, other factors - especially stress - can make the pain more difficult to cope with. Treating these factors can therefore help to reduce the pain.

However, there are exceptions to this guide. Conditions such as endometriosis can sometimes cause severe pain from an early age (although the pain typically gets worse as the disease does more damage with each monthly cycle). Other causes of severe period pain include fibroids, pelvic inflammatory disease and sometimes narrowing of the cervix.

The best guide to seeking help is when the pain begins to interfere with life, preventing you from working or coping with daily tasks. The first step is to find a simple treatment that works for you. If this doesn't control the pain, talk to your doctor.

Simple treatments

Exercise - you may not feel like it, but getting active is a good way to ease pain. Try gentle swimming, walking or cycling.

Painkillers - ibuprofen and aspirin can be particularly effective as they have anti-prostaglandin effects. Take them regularly throughout the day (following the packet instructions), not just when pain becomes difficult to cope with.

Complementary therapies - there are lots to try, including herbal treatments (evening primrose oil or raspberry leaf tea) or meditation. For more information, take a look at our Complementary medicine section.

Tens - transcutaneous electronic nerve stimulation, or Tens, is widely used for period pains, especially in Scandinavia. Small electrodes are placed on the abdomen to stimulate the nerve in the pelvic area in a way that reduces pain.

Top tips

Periods pains are rarely a sign of disease, especially in young women.

Try to find a simple remedy that suits you; you may find it's enough to control the pain.

If pain is unbearable, talk to your doctor - there are several possible treatment options and it may be necessary to rule out other conditions.

Beware abnormal or extra symptoms - these might be a clue to endometriosis.

If these measures fail to control the pain or your doctor suspects endometriosis or another condition, a more detailed investigation may be recommended. This will probably involve using an ultrasound scan or minor laparoscopy (where a doctor uses a telescopic instrument to look inside the abdomen).

In the US, more invasive surgery is quite common, but in the UK such operations are controversial except for proven endometriosis.

The final option, hysterectomy (removal of the womb), may seem drastic, especially if there's no underlying disease. However, the agony of period pains can be so great that a few women - who've perhaps completed their families and have tried other treatments without success - feel it's a rational option.

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