Painful Periods: What Is Normal and When to Seek Help

Types of Period Pain

Period pain (dysmenorrhea) is broadly categorised into two types:

• Primary dysmenorrhea — Pain caused by the natural process of menstruation, without an underlying condition.
• Secondary dysmenorrhea — Pain caused by an underlying reproductive health condition.

Primary Dysmenorrhea

This is the most common type of period pain.

• Usually begins within 1–2 years of menarche (first period).
• Caused by prostaglandins — chemicals that cause the uterus to contract to shed its lining.
• Pain is typically cramping in the lower abdomen, sometimes radiating to the lower back or thighs.
• Usually starts just before or at the beginning of a period and lasts 1–3 days.
• Tends to improve with age and sometimes after pregnancy.

Secondary Dysmenorrhea

This type of pain is caused by a condition affecting the reproductive organs. It may:

• Start later in life (though it can also begin in adolescence).
• Worsen over time rather than improving.
• Last longer than typical period cramps.
• Be accompanied by other symptoms such as heavy bleeding, pain during sex, or pain between periods.

Possible Causes of Severe Pain

Endometriosis

Tissue similar to the uterine lining grows outside the uterus. It can cause severe pain, heavy periods, pain during sex, and fertility issues. It is estimated to affect approximately 1 in 10 women and people with uteruses of reproductive age.

Fibroids

Non-cancerous growths in or around the uterus. They can cause heavy bleeding, pelvic pressure, and pain.

Adenomyosis

The uterine lining grows into the muscular wall of the uterus. Can cause heavy, painful periods and a feeling of pelvic heaviness.

Pelvic Inflammatory Disease (PID)

An infection of the reproductive organs, often caused by untreated STIs. Can cause pelvic pain, abnormal discharge, and fever.

Ovarian Cysts

Fluid-filled sacs on the ovaries. Most are harmless and resolve on their own, but some can cause pain.

Managing Period Pain

For mild to moderate pain:

• Over-the-counter pain relief — Ibuprofen or naproxen (NSAIDs) are often most effective when taken at the first sign of pain. Paracetamol/acetaminophen is an alternative.
• Heat — A hot water bottle or heating pad on the lower abdomen or back can help relax muscles.
• Gentle exercise — Light physical activity can help relieve cramps.
• Rest — Listen to your body.
• Hormonal contraception — The pill, hormonal IUS, or other hormonal methods may reduce period pain for some people. Discuss with a healthcare provider.

Warning Signs

The following signs suggest your period pain may need medical evaluation:

• Pain that does not improve with over-the-counter pain relief
• Pain that gets worse over time
• Pain that prevents you from attending school, work, or daily activities
• Heavy bleeding (soaking through a pad or tampon every 1–2 hours)
• Pain during sex
• Pain when urinating or having a bowel movement during your period
• Bleeding between periods
• Pain that starts before your period and continues after it ends

When to Seek Professional Help

See a healthcare provider if:

• Your period pain is severe or worsening
• Over-the-counter pain medication is not helping
• You are missing school or work because of period pain
• You have any of the warning signs listed above
• Period pain is affecting your quality of life

You deserve to have your pain taken seriously. If a healthcare provider dismisses your concerns, it is appropriate to seek a second opinion.