Period pain, dysmenorrhoea

Some women experience minimal or mild discomfort during menstruation, but others suffer from severe, debilitating pain that prevents them from doing their day-to-day activities.

None of us knows what another woman’s pain is like, so it is useful to understand what periods should feel like and then decide if all is normal. Some women might have always experienced painful periods; others might develop pain. Period pain is more common in adolescents and women in their 20s, but can also occur in older women.

Period pain happens when the muscles in the uterus contract or tighten. Pain can include cramping and heaviness in the pelvic area, as well as pain in the lower back, stomach or even legs. Some women also experience nausea, vomiting, paleness, diarrhoea or loose bowels. Women who experience painful periods can have higher levels of prostaglandins – a natural body chemical that causes contractions of the uterus, bowel and blood vessels.

Period pain is the most common cause of pelvic pain.

What is normal period pain?

Period pain is only considered ‘normal’ if:

  • the pain is there only on the first one or two days of your period
  • the pain goes away if you take period pain medications or use the contraceptive pill
  • your ability to do your normal activities is not impaired.

If the pain is not like this, it is not normal.

What causes period pain?

Painful periods can be due to:

  • pain in the uterine (womb) muscle (myometrium), especially if the pain is on the first one or two days of a period
  • pain from endometriosis and/or adenomyosis, especially if the pain is present for more than one to two days before the period starts.

Many women with strong period pain have both these problems, and women with adenomyosis have a more painful uterus than other women, even if it looks normal.

Adenomyosis is a condition in which the cells that normally form a lining in the uterus also grow in the muscle wall of the uterus.

Endometriosis is a condition in which cells similiar to those found in the lining of the uterus (endometrium), grow outside the uterus. It used to be thought of as an uncommon problem of women in their 30s and 40s. We now know it is a common problem that usually starts in the teens (see our webpages on endometriosis).

Symptom relief for painful periods
Apply heat on the belly or lower back Helps relax muscles
Exercise Releases endorphins (natural feel-good hormones)
Relax with rest, warm baths or meditating Relieves stress
Complementary therapies Acupuncture, or discuss taking fish oils and magnesium with a qualified naturopath
Pain relief: ibuprofen, naproxen or diclofenac Take period pain medications at the onset of pain, and take regularly during the days you normally have pain. All these medications can cause stomach irritation, so they are best taken with food. Discuss the pros and cons of using them with your doctor.
The oral contraceptive pill (OCP) Ask your doctor about:

  • a pill with more progestogen than oestrogen for the best effect
  • planning a period only every 2-3 months, or not at all.
Mirena® intrauterine device (IUD) 4 Currently the most effective treatment for pain from the uterus; lasts up to five years.

It slowly releases a progestogen medication to the uterus that makes periods lighter and less painful. It is also a contraceptive.

It is common to have irregular bleeding and cramp pains during the first few months of use, but these problems usually settle.

It can be inserted in the doctor’s surgery or under a general anaesthetic.

If simple treatments for period pain don’t help, see your doctor to discuss the possible causes and what might be best to do in your individual case.
Breast pain

The menstrual cycle can lead to breasts being temporarily tender, engorged and lumpier.

Studies show around two out of three women experience some breast pain during their cycle, which is usually normal.

“Most often, symptoms peak just before the period and improve with the onset of bleeding,” says Jane O’Brien, specialist breast surgeon at the Epworth Breast Service, Richmond. “Symptoms appear to peak in adolescent girls and again in perimenopausal women, possibly because of fluctuating hormone levels. Normally pain is mild, and women simply require reassurance that there’s no cause for concern.”

Treating tender breasts

If pain and tenderness are more severe, evening primrose oil might be recommended – around 4g or four capsules per day. “There is some limited scientific evidence of the benefit of evening primrose oil, and it is virtually side-effect free,” says Jane O’Brien. “It’s believed to act by increasing the level of one of the essential fatty acids in the breast tissue and has a cumulative (increasing) effect, so you need to take it daily over several months to see maximal benefit.

“Around 60% of women may obtain some relief from evening primrose oil.”

See your doctor to discuss what you can do if breast pain is troubling you and you think it is related to your menstrual cycle.

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