Period pain is extremely common and a normal part of the menstrual cycle. It is experienced by most people who menstruate at some time in their lives.
It is usually felt as painful cramps in the abdominal area, pelvic pain, or pain in the back and thighs. This can be dull or can come in intense spasms.
Sometimes menstrual pain can become so severe that it prevents you from performing everyday tasks. There are a number of reasons that might explain this severe pain, some of which require medical attention.
Read more: Woman suffering crippling period pain discovers life-changing answer on internet.
What causes period pain?
Period pain happens when the muscular wall of the uterus contracts. During your period the wall of uterus contracts vigorously to help the endometrium (lining of the uterus) shed as part of your period. When the wall of the uterus contracts it compresses the blood vessels. This temporarily cuts off the blood supply – and oxygen supply – to your uterus. Without oxygen the tissues in your uterus release chemicals that trigger pain.
While your body is releasing these pain-triggering chemicals it's also producing other chemicals called prostaglandins. These encourage the uterus to contract more, further increasing the level of pain.
What is normal?
Period pain usually starts when your bleeding begins although some women have pain several days before the start of their period. The pain usually lasts 48 to 72 hours although it can last longer. The pain can range from very mild to severe and this could be normal if it is what you usually experience. The pain should go away or be significantly reduced by taking painkillers.
Causes of severe pain
Endometriosis
This is where cells that normally line the uterus grow in other places such as in the fallopian tubes and ovaries. These cells can cause intense pain when they shed.
Endometriosis is notoriously hard to diagnose and there is currently no cure. The main symptoms of endometriosis are: pain in your uterus, back and pelvis; pain during sex; pain when using the toilet; feeling sick; constipation; diarrhoea; heavy periods; and difficulty getting pregnant.
If you think you have endometriosis you should contact your GP. They will explain diagnosis and treatment options.
Fibroids
Fibroids are non-cancerous growths that develop in or around the uterus. They are made up of muscle and fibrous tissue and vary in size.
Only one in three people with fibroids experience symptoms. These include heavy periods, abdominal pain, frequent urination, constipation, and pain during sex. You should contact your GP if you have these symptoms to rule out other conditions.
Pelvic inflammatory disease
Pelvic inflammatory disease is an infection of the reproductive system which includes the uterus, fallopian tubes, and ovaries. It is a common condition although it's not clear how many people in the UK are affected.
Most symptoms are mild but can include abdominal pain, painful and heavy periods, and unusual discharge. You should contact your GP if you think you have pelvic inflammatory disease.
Adenomyosis
Adenomyosis is a condition in which the inner lining of the uterus breaks through the muscle wall of the uterus. It can cause menstrual cramps, abdominal pressure, and bloating before periods and can result in heavy periods.
Adenomyosis is a common condition. It is most often diagnosed in middle-aged people who have had children.
IUD contraceptives
An IUD is a small T-shaped plastic or copper device that's put into your uterus by a doctor or nurse. It can sometimes cause period pain, particularly during the first few months after it's inserted.
You could also experience irregular periods, bleeding between periods, abnormal discharge, or pain during sex. You should see a GP if you experience all of these symptoms.
Other factors
There are a number of factors which can increase period pain that are not linked to a medical condition. Lack of exercise, excess caffeine, and smoking can all affect the intensity of menstrual cramps. Stress and lack of sleep could also make cramps worse.
How to treat yourself at home
Most period pain is mild enough to be treated at home. Painkillers such as ibuprofen, aspirin, or paracetamol can help to ease the pain.
You can also try:
When to see a GP
You should see a GP if you notice any changes in your period, including severe pain. You should also make an appointment if you think you have any of the medical conditions listed above.
Your GP can prescribed stronger painkillers such as codeine or naproxen. They will also examine you to diagnose any medical conditions which may be causing the pain. If the period pain has not been resolved within three months you could be referred to a specialist.