Period Pain

Period pain – also called primary dysmenorrhoea – affects most women at some point during their lives.

As the name suggests, period pain is a pain suffered by women during their monthly periods. It usually presents as a discomforting cramping sensation in the lower muscles of the stomach, which can sometimes spread to the lower back and thighs.

The sensation of period pain can vary. For some women, the pain will come in intense spasms, whilst others experience a dull aching sensation instead. Period pain usually occurs at the same time as menstruation, and will normally last between 48-72 hours.

Period pain is caused by muscular contractions of the womb’s wall. During menstruation, these contractions become more intense, in order to encourage the wall to shed its lining.

These stronger contractions cause the wall of the womb to press against the surrounding blood vessels, briefly cutting off the womb’s blood supply. Without blood, the womb becomes temporarily deprived of oxygen, which causes the affected tissues to release a pain-triggering chemical. This, in turn, causes the body to produce another chemical called prostaglandins. Prostaglandins will cause the muscles in the womb to contract further, which will increase the intensity of the period pain even more.

In rare instances, period pain can be caused by an underlying medical condition. This kind of period pain is called secondary dysmenorrhoea. Some of the conditions that can cause secondary dysmenorrhoea include:

• Endometriosis: Where the cells that line the womb begin to develop elsewhere in the body, usually the ovaries and fallopian tubes. As these cells start to shed, they can cause intense pain.
• Pelvic inflammatory disease: A bacterial infection that affects the womb, causing it to become inflamed and irritated.
• Intrauterine devices: Also known as IUDs, these contraceptive devices are made from plastic and copper. Fitting inside the womb, they can sometimes cause period pain.
• Fibroids: is a condition caused by non-cancerous growths inside the womb. These benign tumours can make periods heavier and more painful.

Some women experience more period pain than others. The reason for this is still not entirely clear. However, it is suspected to be due to a build-up of prostaglandins, where some women appear to suffer a larger build-up than others. The higher the concentration of prostaglandins, the stronger the pain-inducing contractions will be.

Period pain is a very common infliction. It is thought to affect up to 90% of menstruating women. The majority of cases will present as:

• Painful muscle cramps in the lower stomach
• Painful muscle cramps in the lower back and thighs

Period pain can be experienced as intense spasms, whilst for others, the pain will be more constant and dull. Other associated symptoms of period pain can include:

• Feeling nauseous
• Vomiting
• Backache
• Bloating
• Diarrhoea
• Headache or migraine
• Emotional symptoms, such as mood swings

If you are suffering from secondary dysmenorrhoea, you may also experience the following symptoms:

• Irregular periods
• Thick and unpleasant smelling vaginal discharge
• Bleeding in between periods
• Pain during sexual intercourse

Secondary dysmenorrhoea is more likely to develop as you get older. The majority of women affected are aged between 30-45 years old.

If your period patterns change significantly, it is advised to discuss your symptoms with your doctor.

To make an informed diagnosis, your doctor will ask about your symptoms and review your medical history. They will likely inquire as to how period pain is affecting your daily life. The next step is usually an examination of the abdomen. If unsatisfied, your doctor may arrange for a vaginal exam, where lubricated, gloved fingers are inserted into the vagina to check for abnormalities.

In some cases, a vaginal swab may be taken to rule out any sexually transmitted infections (STIs). If your doctor is still unable to make a diagnosis then further testing may be required. This could involve a pelvic ultrasound exam (using sound waves to produce an image of the inside of the abdomen), or a referral to a gynaecologist. If during any of the physical examination processes you experience any pain, it is important to relay this to your examiner.

If suffering from secondary dysmenorrhoea, it will be important to identify the condition causing your symptoms before a suitable line of treatment can be discussed. However, if you suffer from primary dysmenorrhoea, there are several over-the-counter and prescription painkillers available to you.

For the majority of sufferers, period pain can be successfully treated at home using Non-Steroidal Anti-Inflammatory Drugs (NSAIDs):

Feminax Ultra 250mg: 9 tablets

• Provides period pain relief for up to 8 hours
• Suitable for women aged 15-50
• No prescription required

Feminax Express 342mg: 16 tablets

• Provides period pain relief after just 30 minutes
• Suitable for women and children aged 12+
• No prescription required

Mefenamic Acid 500mg: 9 tablets

• Fast-acting relief from period pain
• Suitable for women and children aged 14+
• Prescription is required

Taking tablets for period pain can help ease the discomfort caused by the muscular wall of your womb contracting. There are some things you need to keep in mind when taking this medication, though:

• Prolonged use of period pain tablets can lead to kidney and liver damage
• You shouldn’t take this medication if you have (or have had) a stomach ulcer
• Period pain tablets shouldn’t be taken while pregnant
• You should only take tablets at the recommended levels

If your period pain persists after taking painkillers for three months, speak to your doctor. They may refer you to a specialist for further tests to establish if you have an underlying medical condition. Along with a blood or urine test, these checks can include:

• A pelvic ultrasound: this checks for abnormalities in your reproductive organs.
• A laparoscopy: this checks your internal organs and takes tissue samples.
• A hysteroscopy: this uses a fiber-optic telescope to look for abnormalities.

In addition to period pain tablets, other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen, naproxen or cuprofen have proven effective at relieving period pain.

NSAIDs inhibit the production of prostaglandins, which is a chemical that causes the muscles in the womb to contract more severely during bouts of period pain. If NSAIDs are unsuitable, your doctor may recommend paracetamol instead.

A non-medicinal option for relieving period pain is transcutaneous electrical nerve stimulation (TENS). A TENS machine uses electrodes, which are placed on the skin at the site of pain. Electrical impulses are delivered through the electrodes, which is believed to interrupt the pain signals being sent to the brain.

Using heat patches and hot water bottles are effective ways of relieving period pain for many people. These are usually applied to the abdomen or the lower back. It is important not to apply heat directly to the skin, as it may damage it. Hot water bottles should only be used through clothes, and heat patches should only be applied as instructed by the manufacturer.

Period pain isn’t always possible to prevent. However, there are some self-help techniques and lifestyle changes that can help reduce the symptoms from developing. These include:

• Exercise: aim to achieve 150 minutes + of moderate-intensity exercise each week. Any type of aerobic exercise will cause the body to pump more blood; which will result in the release of endorphins to counteract the prostaglandins. This will help ease the painful cramps.
• Stop smoking
• Reduce alcohol consumption: current guidelines recommend not exceeding 2-3 units of alcohol per day, with at least two alcohol-free days per week.
• Improve your sleep and relax more often

If these preventative measures don’t work, you can use medicinal treatments (such as period pain relief tablets) or natural remedies (like taking a warm bath) to ease the symptoms of your menstrual cramps.