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Different types of period pain and what they might mean

Health tips 11 Jun 2019
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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 Janine Manwaring about what causes period pain, the different types, important questions to ask and what the pain might mean.

How common is period pain?

The medical term for period pain is dysmenorrhoea – and it's a condition that many women are familiar with.

The research on just how many women have painful periods varies but, in a 2012 study from Italy, 84% of young women experienced period pain.

In an Australian study of female high school students, it affected 93%.

The different types of period pain

Doctors divide period pain into two different types. The more common type is called primary dysmenorrhoea. This type of period pain typically starts from your first period, or in the years shortly after.

With this type there is no underlying condition causing the period pain, says Dr Manwaring.

"The levels of pain can vary in primary dysmenorrhoea," she says. "Typically, the pain has a regular pattern, beginning just before or as the period begins. It usually lasts for 1-3 days, but is most severe during the first or second day of the period."

The pain is usually located in the lower abdomen (belly), but can also affect the lower back and thighs. It's often described as a constant ache or a cramping, gripping pain.

Dr Manwaring says the period pain from primary dysmenorrhoea can usually be well controlled with over-the-counter painkillers (such as ibuprofen), the oral contraceptive pill, or through other means; for example, a hot water bottle or heat pack, physical activity or relaxation techniques.

"However, if these techniques are not managing the pain, seek advice from a health practitioner," says Dr Manwaring.

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What causes period pain?

The reason why periods are painful in primary dysmenorrhoea comes down to natural compounds, known as prostaglandins, produced in the body.

Prostaglandins are involved in many bodily processes, including inflammation and digestion. 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, which in turn becomes your 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 makes the contractions stronger.

However, exactly why some women have higher or lower levels of prostaglandins, and what causes the higher levels, is not known.

The other type of period pain that doctors refer to is secondary dysmenorrhoea.

This type of period pain is caused by an underlying reproductive disorder, such as endometriosis, adenomyosis, pelvic inflammatory disease or fibroids.

  • Endometriosis is a condition that affects a woman's reproductive organs. It occurs when cells similar to those that line the uterus are found in other parts of the body.
  • Adenomyosis is a condition of the uterus in which the cells that normally form a lining on the inside of the uterus also grow in the muscle wall of the uterus.
  • Pelvic inflammatory disease occurs when an infection spreads from the vagina to the upper reproductive organs. It is usually caused by the sexually transmissible infections (STIs) chlamydia or gonorrhoea.
  • Fibroids are non-cancerous growths or lumps of muscle tissue that form within the walls of the uterus.

"In secondary dysmenorrhoea, the period pain is a symptom of a larger issue, and treatment may involve treating the underlying condition," says Dr Manwaring.

How do you know which type you have?

Primary dysmenorrhoea is much more common than secondary dysmenorrhoea. However, because the period pain of secondary dysmenorrhoea can be severe and linked with serious health conditions, it's important to be aware of what's 'normal' and what's not when it comes to period pain.

It's also important to know when it's okay to manage the pain on your own, and when it's better to reach out for extra help.

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Important questions to ask yourself

To find out if you need extra help, Dr Manwaring recommends you 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 go to the toilet?
  3. Does your period pain get so bad that even over-the-counter painkillers don't help?
  4. Do you commonly experience pain in your pelvic area outside of the times of your period? For example, for a few days every week or every second week?
  5. Do you experience painful sex?

If you answered 'yes' to one or more of these questions, talk to a trusted doctor about your painful periods.

Pain, heavy bleeding or other factors regarding your period that get in the way of you going about your life shouldn't be suffered in silence.

If you're finding your period hard to manage, you don't need to go it alone. Help and effective treatments are available.

On the lookout for changes

Even though there are a wide array of experiences of period pain, it's also important to learn what's normal for you, so you can be on the lookout for any changes.

If you experience a sudden increase in 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 recent article, Pelvic pain: know the different causes and when to seek help.