The different types of period pain… And what the pain might mean

The most common type of period pain

Doctors divide period pain into two 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 constant ache, a heaviness, or a cramping, gripping pain.

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

There’s no underlying condition with this type of period pain. It can be managed with over-the-counter painkillers like Mefenamic acid (Ponstan), paracetamol or the contraceptive pill. A hot water bottle, heat pack, physical activity or relaxation techniques are also helpful.

The pain is usually not severe and, if treated with any of these options, it doesn’t get in the way of your work, studies, social life or sport. If, however, the pain starts to impact your daily activities, it’s important to talk to your doctor.

What causes this type of period pain?

Natural chemicals – called 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. No one knows why some women have higher or lower levels of the chemicals.

The second type of period pain

The other type of period pain is known medically as ‘secondary dysmenorrhoea’. It is period pain 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.

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

Where 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, 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 painkillers?
• 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.

Remember, you’re not alone and effective treatments are available.