Painful menstrual periods (dysmenorrhea)

During your periods, your body produces chemicals (prostaglandins) that cause the womb to contract. This can be painful.

Menstruation is normal and happens when the womb sheds its lining once a month. You will normally have some pain in the lower belly and back, cramping, and discomfort during menstrual periods. Serious pain that interferes with your daily activities, such as making you unable to work or attend school, is not normal.

For most girls and women, the pain has been from their first menstruation, while some people may experience severe pain that is related to another illness.

You may experience severe lower abdominal pain. This pain may start before the onset of your menses and may continue for up to three days. Some women and girls may experience severe pain in their thighs and back, making walking difficult.

Others may feel like vomiting or actually vomit, have diarrhoea, feel tired, have headaches or feel that their belly is full.

Painful cramps during your menstrual flow may be due to many causes, including pain in the muscles that pushes out the blood and lining of the womb.  In some women, this may also be due to underlying medical conditions, like hormonal changes (premenstrual syndrome), endometriosis, uterine fibroids, infections in the uterus or fallopian tubes (pelvic inflammatory disease) or other conditions.

• Having early first menstruation (before 11 years old).
• Having a family history of painful periods.
• Smoking increases the risk of painful menses.
• Having heavy bleeding with periods.
• Having irregular periods.
• Never having been pregnant.

• When your pain is getting worse, despite using home remedies.
• Over-the-counter pain killers (e.g. paracetamol) do not give you any relief.
• If your menstrual pain does not go away after the menses.

You can reduce how much pain and discomfort you experience through self-care and over-the-counter medicines. Using pain relievers at the start of your period and stopping them as soon as symptoms resolve can reduce discomfort and improve function. Using herbal teas, exercise (especially yoga and stretching), a hot water bottle and eating a healthy diet (with fruits and vegetables) can help reduce how much pain you experience before and during your period.

If an underlying condition causes your pain, your healthcare provider can recommend appropriate treatment to resolve the problem.

Self-care:

• Using a hot water bottle on your lower belly or back. It is best to wrap the bottle in a towel to avoid burns.
• Massaging your belly where you feel the pain.
• Taking a warm bath can help you relax and may reduce pain. You can also practice breathing exercises for relaxation.
• Regular moderate exercise can make the pain more bearable.
• You can take over-the-counter pain killers like paracetamol, piroxicam or ibuprofen 3 days before you expect your period. This can help reduce the severity of the pain you feel.

Medical treatment:

• Your healthcare provider may try to identify an underlying cause of the pain. They will treat this as well as offer very active pain relievers too.
• Your healthcare provider may recommend that you use a hormonal contraceptive to see if that helps to reduce the pain.
• In some cases, where you may have had all the children you want, your healthcare provider may recommend surgery to remove your womb.
• Depression may sometimes make the menstrual pain more intense. Your healthcare provider may recommend that you use an antidepressant medicine.

Menstrual pains usually happen after a girl first gets their period. With age, they usually become less painful and may stop entirely after you have your first baby.

Using an over-the-counter pain killer can ensure you are able to function in spite of the menstrual cramps. Ensure you use the pain killers with a meal and use the lowest dose possible. You should not use two or more pain killers at the same time without speaking to your healthcare provider first.