Learn about dysmenorrhoea, when period pain needs assessment, possible causes, treatment options and when to talk to a doctor about severe symptoms.
Dysmenorrhoea is the medical term for cramping lower abdominal pain during or before a period, commonly called period pain or menstrual cramps. Many people have no underlying disease, and treatment can ease the pain. However, pain that disrupts daily life, school or work, or changes over time, needs assessment. The information below offers a general overview and does not replace an individual diagnosis or treatment advice.
What is dysmenorrhoea?
Dysmenorrhoea is considered in two main groups. The distinction depends on whether a structural problem or disease underlies the pain.
Primary dysmenorrhoea
In primary dysmenorrhoea, there is no disease in the pelvic organs to explain the pain. The pain is usually related to the start of menstrual bleeding and may begin during adolescence. Most period pain in adolescents falls into this group. The condition is usually considered on the basis of the history and examination.
Secondary dysmenorrhoea
Secondary dysmenorrhoea is period pain caused by an underlying pelvic condition such as endometriosis. Endometriosis is reported to be one of the main causes of secondary dysmenorrhoea in adolescents. This possibility is also assessed if significant pain persists despite first-line treatment. Pain alone is not proof of disease; assessment is made by a doctor.
What are the symptoms of dysmenorrhoea, and how does it differ from usual period pain?
The typical symptom is cramping lower abdominal pain, which may spread to the lower back and legs. Some people also have nausea, headaches, weakness or diarrhoea. Mood and physical symptoms in the days before a period are a separate topic and are considered separately.
Mild to moderate pain occurs in many people. The following features may require assessment:
- Pain that significantly disrupts daily activities, school or work
- An inadequate response to painkillers
- Pain that gradually increases over the years or feels different from the familiar pain
- Pain on days outside the period, or pain accompanied by pain during sex or very heavy bleeding
Symptoms involving the amount and regularity of menstrual bleeding need a separate assessment. It helps to tell your doctor if heavy bleeding accompanies the pain.
What may cause dysmenorrhoea?
In primary dysmenorrhoea, pain is thought to be related to contractions of the uterine muscle during menstruation and certain chemicals released in this process. This is why some pain-relieving medicines may be effective. The reasons for differences in severity between individuals are not fully explained.
In secondary dysmenorrhoea, conditions involving the womb and ovaries, endometriosis and other pelvic diseases are considered. These diseases should not be assumed to be the only causes of pain; not every episode of period pain signals a disease.
When is assessment by a gynaecologist needed?
It is appropriate to consult an obstetrician and gynaecologist in the following situations:
- Pain significantly affects your life despite painkillers and supportive measures
- Pain first started in adulthood or is increasing over time
- There is also pain outside periods, pain during sex, or very heavy or irregular bleeding
- Pregnancy is possible
- Symptoms have not improved sufficiently with first-line treatment over several months
If you are the parent or guardian of an adolescent, pain that prevents school attendance is sufficient reason to seek care.
How is dysmenorrhoea assessed?
Assessment begins with a detailed history covering when the pain started, its relationship to periods, its severity and accompanying symptoms. If the history suggests primary dysmenorrhoea and symptoms are typical, treatment may begin without further tests and the response is monitored. If the response is inadequate or the history suggests another cause, examination and imaging such as ultrasound are used. The doctor chooses abdominal or vaginal ultrasound according to the person's circumstances. The scope of the examination is agreed with the doctor according to age and symptoms.
How is dysmenorrhoea treated?
Treatment depends on the type of pain and the person's circumstances. The following is a general overview; the choice of medicine, dose and duration are medical decisions.
Painkillers (NSAIDs)
Non-steroidal anti-inflammatory drugs (NSAIDs) form the basis of treatment for primary dysmenorrhoea. When and for how long they are taken is determined according to a doctor's or pharmacist's advice. These medicines may be unsuitable in situations such as stomach or bowel problems, kidney problems, a history of asthma or allergies, bleeding disorders and pregnancy. Consult a doctor or pharmacist before using them.
Hormonal methods
Hormonal methods such as combined oral contraceptives, a levonorgestrel-releasing intrauterine system and implants are among the effective options for period pain. They are generally considered when painkillers are insufficient or the person also wants contraception. Conditions such as a risk of blood clots or migraine with aura may restrict the use of some hormonal methods. The choice is made following medical assessment.
Supportive and non-drug approaches
Many people find applying warmth to the abdomen, regular movement and rest soothing. The effects of herbal products and supplements have not been sufficiently demonstrated; consult your doctor before using them.
Treating a secondary cause
If an underlying cause is identified, treatment is directed at it. Medication or, if needed, surgical options are discussed with the doctor according to the findings.
Can period pain affect my fertility?
Some diseases that cause secondary dysmenorrhoea may affect fertility. Assessment is therefore important for people who are planning a pregnancy and have significant pain. You can discuss hormonal methods and pregnancy plans with your doctor.
Frequently Asked Questions
Does every woman have period pain, and is it always normal?
Period pain is common. However, severe pain that limits your ability to function should not be dismissed as something everyone puts up with. Pain that affects your life should be assessed.
How do primary and secondary dysmenorrhoea differ?
In primary dysmenorrhoea, no pelvic disease explains the pain, which usually begins during adolescence. Secondary dysmenorrhoea is caused by an underlying pelvic condition such as endometriosis. Your doctor distinguishes them through your history and further investigations if needed.
Can the contraceptive pill help with period pain?
Combined oral contraceptives are among the options that may be effective for period pain. They may not suit everyone; use is determined following medical assessment.
Are hormonal methods used only to prevent pregnancy?
No. Combined oral contraceptives, an intrauterine system and implants are also effective options for reducing period pain, particularly when painkillers are insufficient or contraception is also wanted.
When might hormonal methods be unsuitable?
Some may be unsuitable if you have a clotting risk or migraine with aura; your doctor selects a method with you.
Does period pain mean endometriosis?
No. Most period pain in adolescents occurs without an underlying disease. However, if pain is severe, does not respond to treatment or increases over time, causes such as endometriosis are considered and assessed.
Which tests are requested for period pain?
The history and examination are often sufficient. Ultrasound is performed if needed; the doctor decides whether further tests are necessary.
What should I do if painkillers are not enough?
Consult an obstetrician and gynaecologist if pain disrupts daily life, school or work despite taking painkillers, you need medication with every period, or the pain increases over time. NSAIDs may be unsuitable in situations such as stomach or kidney problems, asthma, bleeding disorders or pregnancy. Medicines should be used with advice from a doctor or pharmacist.
Can heat or rest help period pain?
Yes. Many people find relief from abdominal heat, regular movement and rest. Herbal products and supplements do not have adequately proven effects; consult your doctor before using them.
What should I do about unusually severe period pain if pregnancy is possible?
If pregnancy is possible and pain is unusually severe, seek advice from a gynaecologist without delay.
What should I do if my adolescent child's period pain prevents school attendance?
Pain preventing school attendance is sufficient reason to seek advice for your adolescent child; there is no need to wait for it to improve with time.
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