For Health Practitioners

Period Pain

Period Pain

Period Pain

Period pain is the most common type of pelvic pain, but what’s normal? None of us know what pain another person is experiencing.

You may have wondered if your period pain is bad,  or if it’s normal and you somehow can’t handle normal pain.

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; and
  • if not, it is not normal.

Severe period pain in young women and people assigned female at birth is a bigger problem now than in the past. Our grandmothers often had their first baby before they were 20 years old. After that, many years were often spent pregnant or breastfeeding until menopause. Even if their periods were painful,  there were fewer 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 and people assigned female at birth with bad period pain have both these problems. We know that women and people assigned female at birth with endometriosis often have a painful uterus, even if it looks normal.

Teens often worry about being different from other girls. However, you should know that 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.
Common medications include ibuprofen 200mg, naproxen 275mg, or diclofenac 25mg.

Take two straight away, then one, three times a day with food. 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 mean less pain. To do this, you need to take an oral contraceptive 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 uterine pain and lasts up to 5 years. It slowly releases a progestogen medication to the uterus that makes periods lighter and 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 two 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. They 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; sometimes, it is cauterised (diathermied), which means burnt.

Some laparoscopies for endometriosis are relatively short and straightforward, while others take much longer and are more complex. It depends on where the endometriosis is and how severe it is.

Endometriosis in teens often looks different to endometriosis in those who are older and can easily be missed. In older people it is often a dark brown colour. In young people, 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 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. These problems might include a painful bladder, an irritable bowel, bad headaches, pelvic muscle pain, a painful vulva and pain on most days (chronic pain).

Remember that even if you have endometriosis, a lot of your period pain may also be from the uterus, even if the uterus looks normal.

With this in mind, a good combination of treatments to consider may be:

  • Laparoscopy to remove any endometriosis in the pelvis, and
  • A 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 have endometriosis, a lot of your pain may be due to other things such as a painful bladder, nerves or 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?

If you are old enough to have periods, you are old enough to have endometriosis.

Endometriosis used to be thought of as an uncommon problem for those 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 life’.

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