Patient information from BMJ

Painful periods

Last published:Sep 29, 2022

Painful periods can make you feel miserable and stop you fully enjoying life. But there are treatments that can help you feel better, including things you can do besides taking medicines.

You can use our information to talk to your doctor or pharmacist and decide which treatments are right for you.

What causes painful periods?

Many women get pain in their lower abdomen (pelvis) during their period.

Research suggests that the pain is usually caused by the body making large quantities of chemicals called prostaglandins.

Prostaglandins help the womb to squeeze (contract) to shed its lining each month, resulting in the flow of blood during a woman's period.

Women who have higher amounts of prostaglandins tend to have worse period pain.

Although period pain is not usually a sign of an underlying problem, it can sometimes be caused by a medical condition. For example, period pain can be caused by:

• endometriosis (when bits of womb lining grow in your lower abdomen), and by

• pelvic inflammatory disease, or PID for short (when an infection in your reproductive organs has caused inflammation).

Your doctor may do tests to check for these and other conditions. If your period pain starts when you're in your 30s or 40s, it's more likely to be caused by a medical condition.

Here, however, we focus on period pain that is not caused by a medical condition.

What are the symptoms?

The most common symptom is sharp spasms (cramps), usually in the middle of the lower abdomen. You may also get:

• pain in your lower back and down the backs of your legs

• nausea and vomiting

• headaches and light-headedness.

For most women, period pain comes on when their bleeding starts, or a few hours before. It is usually worst during the heaviest days of their period.

This type of period pain is most common in younger women. It often starts 6 to 12 months after a young woman has had her first period.

You should talk to your doctor if you get any of the following symptoms, as it may suggest you have an underlying medical condition causing your pain:

• Pain at other times (not just in the first few days of your period)

• Pain during sex

• Bleeding after sex

• A discharge from your vagina that is different from normal.

What treatments work?

Medicines

Painkillers can help with painful periods. Medicines called non-steroidal anti-inflammatory drugs (NSAIDs) seem to work best for period pain.

Ibuprofen is an NSAID that you can buy over the counter from a pharmacy. But for some NSAIDs (such as mefenamic acid and naproxen), you’ll need a prescription from your doctor.

NSAIDs can sometimes cause side effects such as a headache and an upset stomach. You shouldn't take an NSAID called diclofenac if you have heart problems.

Other painkillers you can try for painful periods include paracetamol and aspirin. These might not work as well as NSAIDs, and aspirin can cause an upset stomach.

If you take paracetamol, you need to be careful to take only the recommended dose, as taking too much can damage your liver.

Another treatment that can prevent or lessen period pain is the contraceptive pill.

If you also need long-term contraception, your doctor may suggest using a type of IUD (intra-uterine device) that contains a hormone called levonorgestrel. This might also help your period pain.

Things you can do for yourself

Some women find applying heat to their abdomen works as well as taking ibuprofen and better than taking paracetamol. And if you combine heat and ibuprofen, your pain might go away faster.

You can try a safety-approved heating pad, or a warm bath or shower.

You can also use self-heating patches, or packs you heat in the microwave. You can buy these in pharmacies or on the Internet.

Other treatments

Some studies have suggested that taking certain nutritional supplements may help reduce period pain.

There has also been interest in whether acupuncture, acupressure, a transcutaneous electrical nerve stimulation (TENS) machine, relaxation, or exercise might help as well. But we don't know for certain if any of these works well.

It's a good idea to check with your doctor before making any changes to your lifestyle. For example, you might want to discuss what kind of exercise might be right for you.

What will happen to me?

If you get painful periods when you're young, your period pain may get better as you get older. Also, many women find their periods are less painful after they have had a baby.

If you have bad period pain, you don't need to suffer. Your doctor can help you find a treatment that is right for you.