Pain in and around the abdomen and pelvic area during your period can affect your ability to enjoy everyday activities.
Around four in every five women have period pain and nausea at some time in their life. For one in 10 women, it is severe enough to affect their daily activities, such as preventing them from going to school or work.
Everyone experiences pain differently but persistent discomfort each month could be a sign of something that can be treated.
Period pain is usually experienced as painful muscle cramps in your tummy area, which can spread to your back and thighs. Pain can vary from one period to the next, with some periods causing no or minimal discomfort and others causing severe pain. Some women may also experience pain in their pelvic area in between periods. Pain can be constant and dull, or intense and in spasms.
Period pain is also known as dysmenorrhoea or menstrual cramps.
The muscles of your womb (uterus) continually contract and relax in waves but you usually can't feel it. During your periods, these contractions are stronger to help the lining of your womb shed away, resulting in the blood loss seen during a period. The contractions are triggered by hormones called prostaglandins.
When your womb contracts, it compresses the blood vessels that line it and temporarily stops the flow of blood and oxygen to your womb. The tissues of your womb react by releasing chemicals that cause pain. These chemicals also cause prostaglandins to be released, which make your womb contract even more — this increases the pain you feel.
The exact cause of most period pain is unknown. It may be that some women have a greater build-up of prostaglandins than others, causing stronger and more painful contractions.
Period pain can be caused by a medical condition although this is less common and usually affects women aged 30–45. Medical conditions include:
Period pain can also be caused by contraceptive devices. An IUS (intrauterine system) can cause period pain, especially in the initial months after insertion. The period pain you experience may be different if it is caused by a contraceptive device eg more severe or lasting longer. You may also have:
There are two types of period pain — primary and secondary dysmenorrhoea.
This is the most common type of period pain and does not involve any underlying problems with your pelvis or womb. Symptoms include:
It's most common in your teens and early twenties.
This is a sign of an underlying medical condition, such as a problem with your pelvis or womb. Symptoms include:
It's more likely in your late twenties onwards.
Menstrual cramps differ from premenstrual syndrome (PMS) discomfort.
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The main symptom of primary dysmenorrhoea is cramps in your lower tummy during your periods. It is common not to experience any pain during your first few periods, with pain starting 6–12 months later. Your period pain:
In addition to pain, you may experience:
The following symptoms are not caused by primary dysmenorrhoea and if you experience them you should see your GP:
The main symptom of secondary dysmenorrhoea is cramps in your lower tummy during your periods. You may notice that your periods become more painful after several years of less painful or normal periods. If your pattern of period pain changes, eg becomes more severe or lasts longer, you may have secondary dysmenorrhoea. See your GP if you have the following symptoms:
Period pain usually starts when the bleeding starts. However, some women have pain up to several days before their period starts. Pain usually lasts 12–24 hours but can last 2–3 days or longer. It is usually most severe when your bleeding is heaviest.
In young girls, period pain usually starts when they start getting periods. If there is no underlying problem eg with the pelvis or womb, period pain usually improves as women get older and after having a baby.
You should also see your GP if period pain starts to suddenly worsen, or you have any of these symptoms:
They may perform an internal examination to check for underlying conditions.
If your period pain has no obvious cause, your GP may refer you to a gynaecologist who may carry out:
You should see your GP if your period pain starts to suddenly worsen or you have any of these symptoms:
Your GP may examine the front of your tummy — in primary dysmenorrhea, the front of your tummy will be normal. They may also check for underlying conditions by performing an internal pelvic examination. With your permission, your GP will insert a gloved, lubricated finger into your vagina and feel for any abnormalities in your ovaries or womb.
You can ask to have a female doctor perform your internal pelvic examination or have a practice nurse be present as a chaperone. You can also choose a friend or relative to be present during your examination.
If after three months of treatment with painkillers or a suitable hormonal contraceptive, your period pain has not improved, your GP may refer you to a gynaecologist who may carry out:
You can try aspirin and ibuprofen for period pain relief as paracetamol may not be as effective. You should not take aspirin if you are aged under 16.
Your doctor may prescribe a painkiller, such as naproxen or codeine, if over-the-counter medicines don't work.
If you are taking a non-steroidal anti-inflammatory (NSAID), such as aspirin, ibuprofen or naproxen, try to:
If you take NSAID painkillers for a few days in a row during each period, you're unlikely to have side effects. But make sure you’re aware of the possible side effects by reading the leaflet that comes with your tablets.
You should not take NSAID painkillers if you have asthma or kidney, liver or stomach problems.
You could also try:
Certain birth control options can also help with period pain:
If your period pain is due to an underlying medical condition, your treatment will depend on the condition; eg pelvic inflammatory disease can be treated with antibiotics and fibroids can be treated with an IUS, medications or surgery.
Period pain as part of your normal menstrual cycle, which doesn't include symptoms in between periods, will not affect your fertility. However, period pain caused by an underlying medical condition may affect your fertility. For example endometriosis and pelvic inflammatory disease, which both cause period pain, also cause scarring and a build-up of tissue in your fallopian tubes — this makes it more difficult for sperm to reach your eggs
How do you stop period pains?
Period pains can be reduced by taking over-the-counter painkillers, such as aspirin and ibuprofen, or by taking prescription painkillers, such as codeine and naproxen. However, you should not take aspirin, ibuprofen or naproxen if you have asthma or kidney, liver or stomach problems, and you should not take aspirin if you are aged under 16.
Some women find using a TENS (transcutaneous electrical stimulation) machine is helpful. You can also try exercise, lightly massaging your lower abdomen, relaxation techniques, and warm baths or showers. Stopping smoking can help too.
Certain birth control options are known to help — these include the combined contraceptive pill, contraceptive implants or injections, and the intrauterine system (IUS).
If your period pain does not improve with these techniques, see your GP.
Why is my period so painful?
Periods can be painful for a variety of reasons. The most common reason is the waves of contractions that your womb goes through to shed your womb lining. The contractions are triggered by hormones called prostaglandins.
When your womb contracts, it compresses the blood vessels that line it and temporarily stops the flow of blood and oxygen to your womb, which causes more prostaglandins to be released. This triggers further contractions and increases your pain.
Periods can also be painful due to an underlying medical condition, which is more common in women aged 30–45. Conditions include adenomyosis, endometriosis, fibroids and pelvic inflammatory disease.
If you’re concerned about your period pain or have noticed it has become more severe, see your GP.
Is it normal to have cramps while on your period?
Around four in every five women have period pain, which often includes cramps, at some time in their life. Muscle cramps are usually due to your womb contracting to shed your womb lining, which can be painful.
Do period pains get worse with age?
Period pains that are not caused by an underlying medical condition usually get better with age. However, period pains caused by an underlying medical condition, such as endometriosis, may get worse with age. If you’re concerned about your period pain or have noticed it has become more severe, see your GP.
Are painful periods a sign of good fertility?
Painful periods are not a sign of good fertility. Period pain that is not caused by an underlying medical condition doesn’t affect your fertility. In contrast, period pain that is caused by an underlying medical condition, such as endometriosis or pelvic inflammatory disease, can reduce your fertility by causing scarring and a build-up of tissue in your fallopian tubes — this makes it more difficult for sperm to reach your eggs.
Why do I only get period pain on one side?
You may only get period pain on one side of your body if it is caused by an underlying medical condition eg endometriosis. Endometriosis can cause lesions to develop in and around your womb; if they are located on one side, you may only experience period pain on this side. If you are concerned that your period pain is caused by an underlying medical condition, see your GP.