Different types of period pain and what they might mean

How common is period pain?

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.

The more common type of period pain

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.

What causes this type of period pain?

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

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.

• Endometriosis is a condition that affects the female reproductive organs, and is often linked to pelvic pain and period pain.
• Adenomyosis is a condition with symptoms such as abnormal or heavy periods, painful periods (often after years without pain) and painful sex.
• Pelvic inflammatory disease occurs when an infection spreads from the upper part of the vagina to the upper reproductive organs. Pelvic inflammatory disease can be caused by a sexually transmitted infections (STI), such as chlamydia or gonorrhoea, that is left untreated. It can also be caused by an overgrowth of the normal bacteria in the vagina and rectum (back passage).
• Fibroids are common non-cancerous growths of muscle that form within the muscular wall of the uterus (womb). Fibroids can often cause heavier bleeding as well.

“In secondary dysmenorrhoea, the period pain is a symptom of a larger issue. Treatment may involve treating the underlying condition”, says Dr Nanayakkara.

How do you know which type you have?

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.

Important questions to ask yourself

To find out if you need extra help, ask yourself these five questions:

1. Does your period pain get so bad it stops you from going to school or work, or generally going about your day?
2. When you have your period, do you get pain when you pass poo or wee?
3. Does your period pain get so bad that even over-the-counter painkillers don’t help?
4. Do you often experience pain in your pelvic area in the times outside of your period? For example, for a few days every week or every second week?
5. Do you experience painful sex? (Painful sex is a common symptom of health conditions such as endometriosis and adenomyosis.)

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.

On the lookout for changes

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.