Painful periods (dysmenorrhoea)

What are painful periods (dysmenorrhoea)?

Period pain shouldn't stop you from doing the things you usually do. If your pain and symptoms feel extreme or unmanageable, you might have a condition called dysmenorrhoea.

How much pain is too much?

It's common to feel slight pain or discomfort before and during your period.

Symptoms that can come with your period include:

• cramping pains in your tummy and lower back
• bloating
• feeling tired
• mood changes.

It's normal to feel some of these symptoms if they're mild and get better after a couple of days or with pain killers. Read more about healthy period cycles.

Extreme or unmanageable period pain

Extreme or unmanageable period pain means needing to take time off work or school and stopping some or all of your daily activities.

You might have dysmenorrhoea if you get extreme symptoms every month that don't get better with pain relief.

You might find that along with normal period symptoms you also get:

• pain and tightness in your thighs
• nausea and vomiting
• diarrhoea
• a swollen tummy (bloating)
• feeling full or heavy in your tummy or pelvis
• extreme fatigue.

Causes

There are 2 types of dysmenorrhoea:

• primary – pain caused by prostaglandins (chemicals made in the lining of your uterus that cause it to contract)
• secondary – caused by another condition.

Primary dysmenorrhoea is more common in younger women when you get your first period and often improves on its own.

Secondary dysmenorrhoea is more common in your 30s and 40s. It can develop after years of not having any problems. It's often caused by things like:

• endometriosis
• adenomyosis
• polycystic ovary syndrome (PCOS)
• fibroids.

In children, pain can sometimes be caused by blockages or problems with the structure of the womb. They're serious issues that need to be assessed by a specialist paediatric and adolescent gynaecologist.

When to get help

Severe period pain isn't normal.

Talk to your GP if your symptoms:

• are affecting your daily life
• are getting or have recently got worse
• change suddenly.

It's important to tell them how much the pain is impacting your life, and if:

• you've had to miss school or work
• it's stopping you from doing things you enjoy
• it's affecting your mental health.

It's useful to also tell them about all the pain relief methods you've tried.

In the first 2 or 3 years after periods start, some young people can get pain between cycles. If this happens you should see your GP, particularly if:

• it gets worse with each cycle
• you have constant pain between cycles.

Diagnosis

Your GP will ask you about your symptoms and also:

• how often you have your period, how long it lasts and how much you bleed
• how intense the pain is each time – give it a score out of 10
• your general health and sexual health.

To help find out what's happening, they might:

• feel around your tummy and pelvis
• look for anything abnormal in your vagina and cervix
• take swabs of your vagina and cervix to test for infections
• refer you to a specialist for more tests.

In some cases, a specialist might use a small camera to look inside you, either:

• through your vagina (colposcopy)
• inside your pelvis with keyhole surgery (laparoscopy).

Sometimes there's no direct cause for your pain, which can be frustrating. Your GP will help you find ways to manage your pain and reduce the impact it has on your life.

Treatment

If your GP or specialist have been able to find what's causing your pain, they'll be able to treat it. If there's no obvious cause, there are still some treatments that can help.

• Hormones that stop ovulation, like the combined pill or hormonal IUD
• Anti-inflammatory painkillers like mefenamic acid or naproxen
• TENS machines that block pain receptors with electrical pulses

In children, progesterone is often used to reduce or stop the amount of bleeding. It's usually the most effective way to treat pain and has fewer side effects than contraceptive hormones.

Managing painful periods

Things that might help ease period pain include:

• heat packs and warm baths
• supplements like thiamine, magnesium and vitamin E
• acupuncture
• relaxation and meditation
• staying hydrated
• cutting down on caffeine and alcohol.

You can combine different methods of pain relief to see what works for you.

Read more about painful periods and managing period pain on the healthdirect website.

Talking to your child about painful periods

Talk to your child about normal period symptoms. They shouldn't be missing out on things they enjoy because of pain. If they're getting pain every month, help them talk to their GP about their symptoms.

In the first 2 to 3 years after periods start, some children might get pain between their cycles. If this happens, and particularly if the pain is constant or gets worse each cycle, see your GP. It can be serious and needs to be looked at by a paediatric and adolescent gynaecologist.

Read more about painful periods for pre-teens and teens on the Raising Children Australia website.