Period Pain

It is common for women to suffer pain associated with their normal menstrual cycle. One type of pain that you may experience is congestive pain. This occurs a few days before your period and usually improves when bleeding begins. Women describe this pain as a deep, dull ache.

Pain during your period is known as dysmenorrhoea. Dysmenorrhoea is usually classified into primary or secondary dysmenorrhoea.

Primary dysmenorrhoea

Primary dysmenorrhoea usually begins within a year or 2 of your first period. The pain is spasmodic and colic-like or cramping. This type of pain occurs when your period begins and lasts about 2 to 3 days. It is thought to be due to forceful contractions of your womb (uterus) brought about by prostaglandins.

Prostaglandins are normal hormones that are produced by the body. They stimulate contractions of your uterus during your period and are responsible for contractions in childbirth, during labour. The contractions are painful because they compress the blood vessels to the uterus, cutting off the blood supply and depriving the tissues of blood.

Secondary dysmenorrhoea

Secondary dysmenorrhoea is period pain caused by an underlying disorder. It usually begins later in life. Causes include endometriosis (when tissue from the lining of the womb grows elsewhere in the body and bleeds every month when you have your period), pelvic inflammatory disease, a benign tumour of the uterus called a submucous myoma, IUDs, a rare congenital condition called a blind uterine horn, and narrowing of the cervical canal (the entrance to the uterus), which restricts the flow of blood.

Women who have heavy periods (menorrhagia) have trouble with period pain more often than women who do not. Their pain may be caused by the uterus trying to expel blood clots that have not fully dissolved.
How do you treat period pain?

Visit your doctor
Visit your family doctor if the pain has started after a history of trouble-free periods or is getting worse. It is important to make sure that there is no underlying disorder causing the pain.

Your doctor may suggest an internal examination. For some women, in conjunction with a medical and symptom history, this will be sufficient for the doctor to make a diagnosis.

For other women with severe pain, a range of investigations may be offered. These may include a laparoscopy (examination of your pelvic organs with a telescopic instrument inserted into a small hole below your navel, carried out under anaesthetic) or a pelvic ultrasound (in which sound waves aimed through your pelvis or vagina bounce back and give a picture of your internal organs).

Self care
A warm pack, such as a hot water bottle or wheat bag, applied to the abdomen can give relief.

Keep a diary of your symptoms for a couple of months. It will force you to look closely at when the pain is at its worst and enable you to plan ahead. You will also be able to give your doctor accurate information about the nature of the pain, if required.

Exercise regularly between periods. When you have a period, resist the urge to walk hunched over (you may need to take some mild painkillers to do this). Some women find that doing gentle stretching exercises or going for a walk relieves their pain.

Some women find that a hot drink can help them feel better, especially ginger tea, which can help with cramps and nausea. Mint tea is useful to ease abdominal discomfort if caused by wind.

Various herbal and mineral remedies have been claimed to help with period pain. These include black cohosh, evening primrose oil, magnesium, dong quai and Vitex agnus castus. Acupuncture and TENS (transcutaneous electrical nerve stimulation) have also been used.
Medications

Mild painkillers, such as paracetamol or aspirin, can help relieve the pain for some women. However, because some period pain can be caused by an excess of prostaglandins in the uterus, medications which can stop the production of prostaglandins are often very effective in relieving period pain.

These types of medications include non-steroidal anti-inflammatory drugs (NSAIDs). Examples of NSAIDs used for period pain that are available from pharmacists are diclofenac (such as Voltaren), ibuprofen (e.g. Nurofen), mefenamic acid (Ponstan) and naproxen (e.g. Naprogesic). Although you can buy these products without a prescription, it's advisable to discuss with your doctor or pharmacist which medication would suit you best. Stronger painkillers are also available on prescription from your doctor.

One successful treatment is the contraceptive pill, which suppresses ovulation and so causes bleeding to be less painful in some women. This works because the pain of dysmenorrhoea only occurs in menstrual cycles in which ovulation (release of an egg) occurs.

For secondary dysmenorrhoea, treatments will vary depending on the nature of the underlying problem.