Period pain is the commonest type of pelvic pain, but what’s normal? None of us know what another woman’s pain is like.
You may have wondered if your bad period pain is really normal and you are weak in some way.
What is normal period pain?
Period pain should be considered normal if:
- The pain is only there on the first 1 or 2 days of your period, and,
- It goes away if you use the Pill or take period pain medications
- If not, it is not normal.
Severe period pain in young women is a bigger problem now than it was in the past. Our grandmothers often had their first baby before they were 20 years old. After that came years spent pregnant or breast-feeding until menopause arrived. Even if their periods were painful, at least they didn’t have many of them.
Girls start their periods earlier now and become pregnant later. They may have 300 to 400 periods ahead of them before menopause.
I don’t think my pain is normal. What could it be?
Painful periods can be due to:
- Pain in the uterus (womb), especially if pain is on the first 1-2 days of a period, or,
- Pain from endometriosis, especially if pain is there for more than 1-2 days, comes before a period or doesn’t get better with the pill
Many women with bad period pain have both these problems, and we know that women with endometriosis often have a painful uterus as well, even if it looks normal.
Teens often worry about being different from other girls. In fact, a study of 1000 girls aged 16-18 years in Canberra, Australia found that 21% of the girls had severe pain with periods and 26% had missed school because of period symptoms.
It’s really important that teenage girls get good care so they can live normally.
There is more information on endometriosis in the Endometriosis Information Sheet.
How can I manage my period pain? – Simple things first
Period pain medications work best when they are taken before the pain gets bad, so keep some with you all the time and take them regularly during periods.
The commonly used medications include ibuprofen 200mg, naproxen 275mg, or diclofenac 25mg.
Take two straight away then one, three times a day with food. All these medications can cause stomach irritation, which is why it is recommended that they are taken with food.
The Contraceptive Pill is often helpful. Ask your doctor for a pill with more progestogen than estrogen for the best effect. Many women skip periods on the pill because fewer periods means less pain. To do this, you need to be on a pill where all the hormone tablets are the same colour. Plan a period only every 2-3 months or preferably not at all. Ask your doctor or pharmacist how to do this.
A Mirena® intrauterine device (IUCD) is currently the most effective treatment for pain from the uterus and lasts up to 5 years. It slowly releases a progestogen medication to the uterus that makes periods lighter, less painful and it is also a contraceptive. Remember that it is common to have irregular bleeding and crampy pains for the first few months, but these problems usually settle.
If you have not had children, or have a tender pelvis you may be able to have it inserted under an anaesthetic if you wish. The best time is just after a period, sometimes at the same time as a laparoscopy.
Complementary therapies that can help include acupuncture, Vitex Agnus Castus 1000mg daily (if you are off the contraceptive pill) and magnesium 100-200mg every 2 hours at period time for no more than 2 days.
If these treatments for period pain don’t help, you may have endometriosis. This is where tissue like the lining of the uterus grows in places outside the uterus around the pelvis. Most endometriosis can’t be seen on an ultrasound.
When simple things don’t help – A laparoscopy
A laparoscopy is an operation where a doctor puts a telescope through a small cut in your umbilicus (belly button) to look inside your pelvis. He or she can then:
- Diagnose if any endometriosis is present, and
- Remove the endometriosis as completely as possible
There are different types of surgery available to treat endometriosis. Sometimes the endometriosis is excised which means cut out and sometimes it is cauterised (diathermied) which means burnt.
Some laparoscopies for endometriosis are fairly short and straight forward, while others take much longer and are more difficult. It depends on where the endometriosis is and how severe it is.
Endometriosis in teens often looks different to endometriosis in older women, and can easily be missed. In older women it is often a dark brown colour. In young women it may look like tiny clear bubbles that can be hard to see.
We know that the amount of endometriosis found at a laparoscopy doesn’t fit with the amount of pain. So, you may have a little bit of endometriosis and a lot of pain, or a lot of endometriosis and very little pain.
We also know that women with endometriosis often have other pain problems as well. This might include a painful bladder, an irritable bowel, bad headaches, pelvic muscle pain, a painful vulva and pain on most days (chronic pain).
A laparoscopy Remember that even if you have endometriosis, that a lot of your period pain may also be from the uterus, even if the uterus looks normal.
This is why a good combination of treatments to consider is:
- A laparoscopy to remove any endometriosis in the pelvis, and
- An hormonal treatment to manage the pain from the uterus. This could mean staying on the pill and skipping periods, having a Mirena IUCD inserted at the same time as the laparoscopy or using both these treatments together.
The Mirena can easily be removed later by your doctor without an anaesthetic if it doesn’t suit you. After a laparoscopy try to minimise bleeding and periods.
It is also true that even if you do have endometriosis, a lot of your pain may be due to other things such as a painful bladder, painful nerves or painful pelvic muscles.
Endometriosis medications such as the Pill, Dienogest, Norethisterone or GNRH analogues do not remove endometriosis and do not improve fertility, but can be helpful for pain relief.
Am I too young to have endometriosis?
Endometriosis used to be thought of as an uncommon problem of women in their 30s and 40s. We now know that it is a common problem that usually starts in the teens or twenties.
Period pain doesn’t have to be ‘just part of being a woman’.
There is much more that can be done now.