Period pain. All that you need to know. 

Period pain, also known as dysmenorrhea, is one of the most common problems to affect women¹. It begins for most women during adolescence, usually within four to five years of the first menstruation¹. Period pain can significantly impact your life, resulting in a restriction of daily activities, poor quality of sleep, and negative effects on mood, causing anxiety and depression².

Normal Menstrual Cycle

Your menstrual cycle is the period between two menstruation phases; or from the first day of the last menstruation to the first day of the next menstruation³. The menstrual cycle can vary in cycle length from 26 to 35 days⁴. 

Menstruation is one part of your cycle when the lining of the uterus (known as the endometrium) is shed³. With each monthly cycle, the endometrium prepares itself to nourish a fetus³. In 80% of ovulatory women, menstrual bleeding occurs over 3 to 6 days (but it can vary between 2 and 12 days), with the heaviest flow on Day 2. The amount of blood loss averages 33.2 ml (10–84 ml)⁴.

Is it usual to have period pain?

Period pain is a global problem, and it is experienced by 45-93% of women of reproductive age². For some women, the discomfort is merely annoying⁵. For others, period pain can be severe enough to interfere with everyday activities for a few days every month⁵.

The characteristics of period pain include⁵:

• Intense throbbing or cramping pain in your lower abdomen ⁵
• Pain usually starts 1 to 3 days before your period, peaks 24 hours after the onset of your period and subsides in 2 to 3 days⁵
• Dull, continuous ache⁵
• Pain can radiate to lower back and thighs⁵

Other symptoms accompanying period pain include nausea, loose stools, headache and dizziness⁵.

What are the causes of period pain?

Period pain can be classified as^2,5:

• primary – menstrual pain without organic disease^2,5
• secondary – menstrual pain associated with pelvic pathology^2,5

Primary period pain is associated with a high level of prostaglandins^2,5. During your period, the uterus contracts to help expel its lining⁵. Prostaglandins, which are involved in pain and inflammation, trigger uterine muscle contractions⁵. Higher levels of prostaglandins are connected with more severe period pain⁵.

Secondary period pain can occur due to:^2,5

• Endometriosis. The presence of tissue similar to the lining of the womb being present outside the uterus, most commonly on ovaries, fallopian tubes or the tissue lining your pelvis^2,5.
• Uterine fibroids. These are noncancerous growths in the wall of the uterus that can cause pain⁵.
• Adenomyosis. The tissue that lines your uterus begins to grow into the myometrium which are the muscular walls of the uterus^2,5.
• Pelvic inflammatory disease. This infection of the female reproductive organs is usually caused by sexually transmitted bacteria⁵.

How to relieve period pain?

For management of primary period pain, your physician could prescribe you²:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) which block prostaglandin production². Common NSAIDs are very effective in relieving period pain²
• Oral contraceptives that suppress ovulation and cause no endometrial proliferation². These may be helpful against heavy and painful periods and irregular bleeding²
• Intrauterine device (IUD). The intrauterine device can reduce dysmenorrhea by as much as 50 percent¹.

Self-care approaches to pain relief include^1,6:

• Getting enough sleep and rest⁶
• Exercise regularly. Medical studies show that exercise reduces menstrual symptoms, including pain^1,6
• Use heat. Applying heat to the lower abdomen with a heating pad, hot water bottle, or self-heating patch can significantly reduce pain, often as effectively as treatment with an NSAID^1,6
• You can try dietary supplements, such as vitamin E, omega-3 fatty acids, vitamin B-1 (thiamin), vitamin B-6 and magnesium⁶
• Reduce stress⁶

When should you see your physician?

We recommend you to see your physician when⁵:

• Menstrual pain disrupts your life every month⁵
• Your symptoms progressively worsen⁵
• You just started having severe menstrual pain after age 25⁵