The different types of period pain – and what the pain might mean

The most common type of period pain

Doctors divide period pain into 2 types. The more common is known as ‘primary dysmenorrhoea’. It usually begins from the time of your first period or in the years shortly afterwards.

The pain can be felt in the lower abdomen (belly), but sometimes it’s felt in the lower back and thighs. It can feel like a dull ache or heaviness, or a cramping, gripping pain.

The pain usually begins in the days leading up to a period. It eases after the first few days of a period or continues until the period stops.

Gynaecologist Dr Pav Nanayakkara from the Jean Hailes Clinics explains that there’s no underlying health condition or disease causing this type of period pain. “It's just how your body reacts during your period,” she says.

What causes this type of period pain?

Natural chemicals known as ‘prostaglandins’ are produced in the body. They are responsible for period pain linked to primary dysmenorrhoea.

These chemicals do several jobs and are responsible for the contractions (tensing and relaxing) of the muscles of the uterus (womb).

These contractions help to shed the lining of the uterus, and this in turn becomes menstrual fluid. However, in cases of period pain, the contractions are strong and painful, and the blood flow to the area is reduced.

Women with primary dysmenorrhoea tend to have increased levels of prostaglandins, causing the contractions to be stronger and more painful. Doctors still don’t know why this happens to some people and not others.

How can you feel better?

Most of the time, this kind of period pain can be managed by:

• taking over-the-counter pain relief medicines such as mefenamic acid, ibuprofen or paracetamol
• using a heat pack or hot water bottle on your belly or back
• doing gentle exercise, like walking or stretching
• practicing relaxation or breathing techniques
• taking the Pill or other hormone medicines, which a doctor can prescribe.

“If these things help and the pain doesn’t get in the way of your daily life, there’s usually no need to worry,” says Dr Nanayakkara.

The second type of period pain

Sometimes, period pain isn’t just from prostaglandins and can be a sign that something else is going on in your body.

This is called ‘secondary dysmenorrhoea’ and it’s 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 period and pelvic pain.
• Adenomyosis is a condition with symptoms like heavy periods, painful periods (often after years without pain) and painful sex.
• Pelvic inflammatory disease occurs when an infection spreads from the vagina to the upper reproductive organs. It is usually caused by a sexually transmitted infection (STI), such as chlamydia or gonorrhoea, that has been left untreated.
• Fibroids are common non-cancerous growths of muscle that form within the muscular wall of the uterus (womb). They can cause heavy bleeding.

These conditions often need treatment from a doctor or specialist, and the pain usually won’t go away with basic pain relief medicine alone.

“In secondary dysmenorrhoea, the period pain is a symptom of a larger issue,” explains Dr Nanayakkara.

When to seek help

It’s important to know what is ‘normal’ with period pain. It’s also important to know when it’s okay to manage the pain yourself, and when to seek medical help. Answering the following questions will help:

• Does your period pain stop you from going to school or work, or going about your daily life?
• When you have your period, do you experience pain when you wee or poo?
• Is the period pain so bad that it can’t be eased by over-the-counter pain medicines?
• 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?
• Is sex painful? This is a common symptom of health conditions such as endometriosis and adenomyosis.

If you answered yes to one or more of these questions, it’s important to talk to a trusted doctor.

Dr Nanayakkara recommends reaching out for help as early as possible. “Recent research has shown that severe period pain can lead to other long-term pain issues, especially if it’s not treated early,” she explains.

“Many people don’t get proper treatment for their pain, even though low-cost and helpful options are available. You don’t need to wait until it gets ‘really bad’. It’s OK to ask for help early.”

The key takeaway

Period pain is common, but that doesn’t mean it should be ignored. Knowing more about period pain and understanding your body can help you feel more in control.

If period pain is making life hard, talk to your doctor. Effective treatments are available and you deserve to feel better.