What is period pain?

Period pain, also known as dysmenorrhoea, is usually felt in your lower abdomen (tummy).

Many people will have some form of pain during their period. Some people experience mild discomfort while others have severe pain.

Your period pain is normal if:

• it happens just before or during the first 2 days of your period
• it doesn't affect your daily life
• it improves with self-care measures, such as pain-relief medicines

What symptoms are related to period pain?

Period pain can feel different for everyone, depending on how severe it is. Many people have pain in their abdomen that may feel like:

• cramps
• heaviness or pressure
• a constant, dull ache

You may also have:

• nausea or vomiting
• diarrhoea
• pain in your stomach, back and thighs
• fatigue or insomnia
• dizziness
• bloating
• premenstrual syndrome (PMS)

It's estimated that, at some time in their life, period pain affects about 8 out of 10 people who have periods.

What causes period pain?

There are 2 types of period pain:

• Primary dysmenorrhoea — this is pain caused by muscle contractions as your uterus sheds its lining
• Secondary dysmenorrhoea — this is pain caused by an underlying health condition.

Primary dysmenorrhoea

Primary dysmenorrhoea is caused by contractions (tightening) of the muscle in your uterus. These contractions help your uterus shed its lining during a period.

Primary dysmenorrhoea usually:

• feels like cramps in your lower abdomen
• happens just before or during your period
• lasts for 8 to 72 hours
• starts 6 to 12 months after first getting your period

You are more likely to have primary dysmenorrhoea if you:

• started your periods before 12 years of age
• are less than 30 years of age
• have a body mass index (BMI) of less than 20 or more than 30
• haven't given birth before
• smoke or vape
• have had pelvic inflammatory disease (PID)

You have a higher chance of having primary dysmenorrhoea if other people in your family have painful periods.

Primary dysmenorrhoea is the most common type of period pain. About 9 in 10 people with period pain have primary dysmenorrhoea.

Secondary dysmenorrhoea

Secondary dysmenorrhoea is caused by an underlying medical condition that affects your uterus. Conditions that can cause painful periods include:

• endometriosis — when tissue from the lining of your uterus also grows in other parts of your body
• adenomyosis — when the cells that normally line the inside of your uterus also grow in the layer of muscle in the wall of the uterus
• fibroids — when you have non-cancerous growths in the muscle layer of your uterus
• pelvic inflammatory disease — inflammation or infection of the pelvic area, which is often caused by sexually transmitted infections

Secondary dysmenorrhoea often occurs several years after your periods start, most often between 30 and 40 years of age.

This type of period pain is less common. About 1 in 10 people with painful periods have secondary dysmenorrhoea.

When should I see my doctor?

See your doctor if your period pain stops you going to work or school.

You should also see your doctor if you have:

• period pain when you haven't had it in the past
• period pain that gets worse during your period
• period pain that lasts longer than it used to
• pain between periods
• pain during sex
• bleeding between periods or irregular periods
• pain when you pass urine (wee) or stool (poo)

It's helpful to make a record of things your doctor may ask you, such as:

• when you get your period
• how long your period lasts
• how heavy your period is
• how your period pain affects you

Your doctor should do their best to listen to you and take your concerns seriously. If this doesn't happen, do not be afraid to find a new doctor.

How is the cause of period pain diagnosed?

To diagnose dysmenorrhoea, your doctor may ask about:

• the age your periods started
• your symptoms
• what helps with pain
• your sexual history
• your medical history

Your doctor may perform a physical examination.

In some cases your doctor may recommend further testing, such as:

• a blood test
• a urine test
• an ultrasound scan of your pelvis
• a magnetic resonance imaging (MRI) scan
• a sexually transmitted infection (STI) test

In rare cases, your doctor may recommend a procedure to look inside your uterus, such as a:

• hysteroscopy
• laparoscopy

How is period pain treated?

There are many ways to treat period pain.

Self-care at home

You can help reduce the symptoms of period pain by:

• using a heat pack or hot water bottle
• having a warm bath or shower
• regular, gentle exercise — 45 to 60 minutes, 3 or more times a week
• relaxation techniques to lower stress

Medicines for period pain

Non-steroidal anti-inflammatory drugs (NSAIDs) can help improve the symptoms of period pain. These medicines should be taken:

• 1 to 2 days before your period starts
• regularly for the first 2 to 3 days of bleeding

Some examples of NSAIDs include:

• ibuprofen
• naproxen
• mefenamic acid

These medicines are not right for everyone. Ask your doctor or pharmacist if they are safe for you.

Other treatment options

Sometimes, painful periods can be treated with combined hormonal contraception such as:

• the oral contraceptive pill, also known as 'the pill'
• a contraceptive vaginal ring

Long-acting reversible contraception can also help treat painful periods. Options include:

• a hormonal intrauterine device (IUD)
• contraceptive implants
• contraceptive injections

Some alternative therapies have been shown to help painful periods, such as:

• transcutaneous electrical nerve stimulation (TENS)
• ginger — this helps reduce nausea and vomiting

Always check with your doctor before starting any alternative treatments.

Surgery may be needed to treat primary dysmenorrhoea. Surgery is only considered if self-care and medicines have not helped with your symptoms.

What are the complications of period pain?

If you have severe period pain you may be more likely to get other chronic (ongoing) pain conditions, such as:

• irritable bowel syndrome (IBS)
• low back pain
• fibromyalgia
• chronic headaches
• painful bladder syndrome
• persistent pelvic pain
• chronic fatigue syndrome

Period pain can also affect your daily life and may lead to complications such as:

• missing school or work
• less participation in daily social or sporting activities
• difficulty concentrating
• poor mental health

If period pain is affecting your life, see your doctor for advice and treatment.

Resources and support

The Jean Hailes for Women's Health website offers information on:

• periods
• premenstrual syndrome (PMS)
• heavy periods
• different types of period pain

The Australian Institute of Health and Welfare page has information on menstrual disorders including painful periods.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.