Hot water bottle at the ready, painkillers on hand – period pain can be a common and regular part of a woman's monthly cycle.
We talk to Jean Hailes gynaecologist Dr Pav Nanayakkara about the different types of period pain, important questions to ask your doctor, and what the pain might mean.
Period pain is very common. Some research suggests that 70–90% of women experience it. In the younger age group (16–25 years) it has been reported to be as high as 88%.
Other Australian research found that one in five young women reported missing school or university because of period pain. Two in five young women said it affected their concentration or performance in class.
Doctors divide period pain into two different types. The more common is known as 'primary dysmenorrhoea'.
This type of period pain usually starts from the time you have your first period, or in the years shortly afterwards.
The pain is often felt in the lower abdomen (belly), but it’s sometimes felt in the lower back and thighs. It can feel like a constant ache, a heaviness, or a cramping, gripping pain.
For women with primary dysmenorrhoea, the pain often occurs in a regular pattern. The pain begins in the days leading up to the period, usually about once a month. It continues throughout the period then stops, or eases after the first few days of the period.
This type of period pain has no underlying condition. It can be managed well with over-the-counter painkillers such as Mefenamic acid (Ponstan), paracetamol, ibuprofen or the oral contraceptive pill, or through other means such as a hot water bottle or heat pack, physical activity or relaxation techniques.
The pain is generally not severe, and women can continue their daily activities with these management options.
However, if the pain is starting to impact work, study or life in general, and these management options are not helping, seek advice from your doctor.
Prostaglandins are natural chemicals produced in the body. They are responsible for period pain that is linked to primary dysmenorrhoea.
These chemicals play a variety of roles in the body, including opening or closing airways, and causing redness, swelling and pain. They are also responsible for the contractions (tensing and relaxing) of the muscles of the uterus (womb).
These muscle contractions help to shed the lining of the uterus, and this in turn becomes the menstrual fluid. However, in cases of period pain, the contractions are strong and painful, and blood flow to the area is reduced.
Women with primary dysmenorrhoea tend to have increased levels of prostaglandins, which make the contractions stronger.
The reason why some women have higher or lower levels of prostaglandins is still a mystery.
The other type of period pain that doctors talk about is called 'secondary dysmenorrhoea'.
People with secondary dysmenorrhoea may not have had painful periods during their younger years, but over time they may notice that their periods become heavier and more painful.
This type of period pain is caused by an underlying condition like endometriosis, adenomyosis, pelvic inflammatory disease or fibroids.
“In secondary dysmenorrhoea, the period pain is a symptom of a larger issue. Treatment may involve treating the underlying condition”, says Dr Nanayakkara.
Primary dysmenorrhoea is much more common than secondary dysmenorrhoea. But because secondary dysmenorrhoea is often linked to severe pain and serious health conditions, it’s important to know what is ‘normal’ and what is not when it comes to period pain.
It’s also important to know when it’s okay to manage the pain by yourself, and when to ask for help from a health professional.
To find out if you need extra help, ask yourself these five questions:
If you answered ‘Yes’ to 1 or more of these questions, it is important to talk to a trusted doctor about your painful periods.
There is no need to suffer silently with pain, heavy bleeding or other period issues. If you’re finding your period difficult to manage, you don’t need to go it alone. Help and effective treatment are available.
Even though period pain varies a lot between people, it’s important to learn what’s normal for you so you can be on the lookout for any changes.
If you experience a sudden increase to your ‘usual’ levels of period pain, or if you start to get period pain when previously you had none, it’s a good idea to speak to your doctor to rule out anything serious.
For more information on pelvic pain – including pain that occurs at times outside of your period – read our article, Pelvic pain: know the different causes and when to seek help