Period pain — you know, those cramping, aching, and stabbing sensations down below. One moment you’re feeling great then suddenly you’re curled up in bed, clutching a hot water bottle and thinking how great it is to be a menstruating person. Seriously, lucky us.

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Even though most of us have experienced period pain, many people don’t know why period pain happens, or more importantly, that menstruating individuals don’t actually have to suffer month after month.

Period pain, also known as dysmenorrhoea, is incredibly common. Affecting up to 90% of us, it’s a serious issue that society has, unfortunately, come to accept as a painful and inescapable part of being a menstruating individual. In addition to affecting us physically, research shows that period pain causes a reduction in our daily functioning, negatively impacting our academic, professional, and social lives.

Seeing as we will experience around 450 periods in our lifetimes, it’s worth taking the time to understand why period pains happen, what’s really going on in our bodies when period pain strikes, and how we can all better manage period pain.

There’s no reason why our lives should be put on hold every four weeks just because we were born with a uterus. After all, “common” shouldn’t mean acceptable. Let’s learn more about what is period pain, really, and what we can do about it. 

What is Period Pain (Dysmenorrhea)?

Period pain (AKA dysmenorrhea) refers to pain experienced by some individuals during menstruation. It’s commonly characterised by cramps or discomfort felt in the lower abdomen or pelvic region and can happen either before your period begins or during active bleeding. 

There are two primary types of period pain, these are known as primary dysmenorrhea and secondary dysmenorrhea.

• Primary dysmenorrhea: This is your typical no-frills period pain that occurs simply because your uterus is cramping to expel menstrual blood, not because of an underlying medical condition.
  
  While extremely common primary dysmenorrhea is disregarded, underdiagnosed, and inadequately treated — probably because it only affects women and AFAB individuals (of course). This kind of period pain typically follows a cyclic pattern, whereby pain is severe during the first day of your period, and continuing for the next three days.
  

• Secondary dysmenorrhea: This type of period pain is caused by underlying medical conditions, such as endometriosis, uterine fibroids, pelvic inflammatory disease (PID), adenomyosis, or ovarian cysts.
  
  Secondary dysmenorrhea often develops later in life and tends to be more severe than primary dysmenorrhea. The pain experienced with secondary dysmenorrhea is usually not limited to the time of menstruation but may occur throughout the menstrual cycle.

What are Common Period Pain Symptoms?

Period pain is often more than just pain and can come in a variety of subtypes (lucky us!). Common period pain symptoms can vary from person to person, but typical symptoms include:

• Cramps: Menstrual cramps are the primary symptom of period pain. They are usually felt in the lower abdomen or pelvic region and can range from mild to severe. The intensity and duration of cramps can vary from person to person.
  
• Pelvic discomfort: Did someone lodge a football inside your vagina while you slept or is it your period? Some individuals experience a general sense of discomfort or heaviness in the pelvic area during their period.
  
• Lower back pain: Pain in the lower back is another common symptom of period pain. It can range from a dull ache to more severe pain.‍
• Abdominal pain: In addition to cramps, some individuals may experience generalised abdominal pain or aching during their period.
• ‍Headaches: During your period, it might not just be your pelvis that hurts, research suggests that most women will experience increased headaches during their periods. Additionally, around 8% of women will experience migraines alongside their periods. ‍
• Thigh and leg pain: While the primary location of period pain is typically the lower abdomen or pelvic region, the pain can radiate or be referred to other areas of the body, including the thighs and legs.

Additionally, some other PMS symptoms can amplify our period pain. These symptoms include.  

• Nausea and vomiting: In more severe cases, period pain can be accompanied by nausea and/or vomiting.
• ‍Diarrhoea or constipation: Some individuals may experience changes in bowel movements, including diarrhoea or constipation, during their period.‍
• Fatigue and lethargy: Feeling tired, fatigued, or experiencing a lack of energy is a common symptom associated with period pain.‍
• Mood swings: Fluctuations in hormone levels, particularly oestrogen and progesterone, can impact neurotransmitters in the brain and contribute to mood swings. ‍
• Anxiety: Some individuals may experience an increase in anxiety symptoms during their menstrual cycle. Hormonal fluctuations can potentially lead to increased feelings of worry or unease.‍
• Depression: Some individuals may experience a temporary worsening of depressive symptoms during their menstrual cycle. This could be due to hormonal changes, but it's important to differentiate between menstrual-related changes in mood and ongoing clinical depression.

Though pain is a common symptom many experience when they get their period, consistent and severely painful periods could be an indicator of something more serious, such as endometriosis. 

What are the causes of primary dysmenorrhea?

When it comes to primary dysmenorrhea, we can point the finger (middle or otherwise) at a hormone-like substance called prostaglandins. These lipid molecules act as messengers in our bodies causing inflammation, regulating pain, and making muscles contract.

During our periods, prostaglandins are produced by the uterine lining to make muscles in the uterus contract. These intense contractions are no joke — they are similar to the ones we experience during childbirth. These cramps help the uterus to shed the built-up endometrium (lining of the uterus) and expel it as menstrual blood.

While there are different types of prostaglandins floating around in our bodies, prostaglandin F2X are responsible for period pain. That being said, science isn’t sure why some people have higher levels of this prostaglandin, leading to more intense contractions and pain during their periods.

Because period pain isn’t the same for everyone, the exact causes of primary dysmenorrhea is unknown. A combination of lifestyle factors, stress, and genetics may all play a role in why some people have more prostaglandins shocking their cycles.

How is primary dysmenorrhoea treated?

Just because period pain is common, doesn’t mean that you have to live with it. Primary dysmenorrhea (period pain without an underlying condition like endometriosis) can vary in intensity and impact different individuals in different ways.

If you’ve been knocked around with period pain each month, it’s important to not take it lying down (or maybe a little laying down but also effective treatments). Take the time to learn about your treatment options and find something that provides relief and improves your overall well-being.

Some common period pain treatments include:

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs, i.e. ibuprofen and aspirin)
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  Pros: NSAIDs can effectively reduce period pain and provide relief.- NSAIDs help to decrease inflammation in the pelvic area and inhibit the production of prostaglandins.
  
  Cons: NSAIDs aren’t a great long-term solution: excessive use of NSAIDs can sometimes lead to side effects such as stomach upset, gastrointestinal bleeding, and ulcers. NSAIDs aren’t always safe to mix with other medications or they can mask symptoms of underlying conditions, like endometriosis.
• Paracetamol (acetaminophen)
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  Pros: Paracetamol can alleviate mild to moderate period pain by inhibiting chemicals involved in pain signalling and perception — though the exact mechanism of action is unknown.
  
  Cons: Paracetamol has a limited anti-inflammatory effect, only provides temporary relief, may interact with other medications, and has the potential to cause liver toxicity if taken in excess.
• Hormonal Contraceptives
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  Pros: Hormonal contraceptives can provide relief from menstrual pain by decreasing the amount of prostaglandins in your body.
  
  Cons: Hormonal contraceptives, like the pill, may come with side effects, including nausea, breast tenderness, weight changes, irregular bleeding, or mood changes. Individual response to hormone contraceptives can vary — it can take a lot of trial and error.
• Heat Therapy
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  Pros: Heat therapy, such as applying a hot water bottle to the lower abdomen, can offer a simple and inexpensive pain relief method that relieves pain by increasing blood flow and promoting muscle relaxation.
  
  Cons: Heat Therapy may not provide complete relief for severe period pain, and it doesn’t work for everyone. Applying excessive or prolonged heat also may cause burns or skin damage (in worst case scenarios)
• Lifestyle Modifications
  
  Pros: Lifestyle modifications, like increasing regular physical activity, getting enough sleep, and reducing stress, can contribute to overall well-being and potentially help manage symptoms.
  
  Cons: Making healthy changes to your life is great (like moving more or eating healthy) but it won’t provide immediate relief of period pain. They also may not directly address the underlying cause of primary/secondary dysmenorrhea. Results may vary depending on individual circumstances.
• Medical Cannabis
  
  Pros: Medicinal cannabis, which is most commonly administered orally (e.g. capsules), sublingually (e.g. oils or wafers) or via inhalation (vaporiser) has been shown to provide pain relief by modulating pain signalling and reducing pain sensation, reducing inflammation, and promoting muscle relaxation. One less common delivery format that is known to have higher efficacy is medicinal cannabis suppositories. CBD or THC suppositories (similar to tampons) offer increased bioavailability (more active treatment where it’s needed) compared to other administration methods.
  
  Cons: Medicinal cannabis is not available to buy over the counter. There can be potential side effects and not everyone will have the same response. There are also limitations when it comes to driving as a medicinal cannabis patient. It’s important to consult with a healthcare professional that specialises in alternative medicines, like a Hazel doctor.‍
• Cramp bark (Viburnum opulus)
  
  Pros: Cramp bark (Viburnum opulus) may help relieve period pain relief. The exact mechanism of action is not fully understood, but it may act as an antispasmodic.
  
  Cons: Scientific evidence supporting Cramp bark is limited and individual responses may vary. Additionally, the quality and purity of herbal remedies can vary significantly.
• Vitex Agnus Castus (Chasteberry)
  
  Pros: Vitex Agnus Castus (Chasteberry) may help regulate hormones and relieve symptoms in some individuals.
  
  Cons: Scientific evidence supporting Chasteberry is limited, effectiveness can vary, and it may take time to feel results. Potential side effects and interactions with other medications can also happen.
• Acupuncture
  
  Pros: Acupuncture is thought to reduce menstrual pain by stimulating endorphin release, enhancing blood circulation, and balancing energy flow,
  
  Cons: The effects of acupuncture may be short-lived, and multiple sessions may be needed to maintain the benefits. Although it’s not likely, rare, acupuncture can potentially lead to side effects such as mild bruising, bleeding, or pain at the needle insertion sites. 
• Transcutaneous Electrical Nerve Stimulation (TENS)
  
  Pros: TENS is a non-invasive method that is thought to provide pain relief by blocking or overriding the transmission of pain signals, reducing their perception.
  
  Cons: Prolonged use of TENS electrodes may potentially cause skin irritation, redness, or allergic reactions in some individuals. It may not be suitable for people with pacemakers or other implanted electronic devices and individual responses may vary.
• Dietary Supplements (e.g., Magnesium, Omega-3 fatty acids)
  
  Pros: Certain dietary supplements, such as magnesium and omega-3 fatty acids, may offer potential benefits for reducing inflammation and pain.
  
  Cons: Supplements won’t provide immediate relief and efficacy may vary. They can interact with other medications, and the quality and purity of supplements can differ significantly.
• Mind-Body Techniques (e.g., relaxation exercises, mindfulness)
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  Pros: Mind-body techniques, such as relaxation exercises and mindfulness, can help individuals relax and manage pain sensations.
  
  Cons: A little bit of Zen is great but individual responses can vary. Mind-body techniques may not provide complete relief and consistent practice and may be required to see significant benefits. 

This list might seem a bit OTT, but period pain is no joke. Different treatments will offer different effects for each patient — there is no one size fits all solution for period pain. To find the right period of pain relief for you, speak with a doctor who understands your pain (on a medical and personal level!).

What are the causes of secondary dysmenorrhoea?

Have you ever wondered why some people experience more intense period pain than others? It’s not their fault — it’s likely due to secondary dysmenorrhoea, also known as period pain caused by an underlying condition. Secondary dysmenorrhoea can have several causes, all of which deserve a lot of understanding (and probably a hug too).

• Endometriosis: This condition can make periods feel as painful as a heart attack. It involves the growth of uterine cells outside the uterus, which can lead to severe pain during periods.
  
• Fibroids: These are non-cancerous tumours made of muscle and tissue that can develop inside the uterus. Although they may cause pain during periods, the majority of people with fibroids do not experience symptoms.‍
• Adenomyosis: This condition occurs when endometrial cells grow within the muscular layers of the uterus, causing painful period cramps‍
• Polycystic Ovary Syndrome (PCOS): PCOS is a reproductive health condition where there is a hormonal imbalance. PCOS looks different on everyone but some of the most common symptoms are weight gain due to insulin resistance, thick hair on face arms and chest, acne, irregular cycles and infertility. If you’re having period pain with PCOS, it could also be a symptom of another condition like Endometriosis.
• Ovarian cysts: These are fluid-filled sacs that can develop on the ovaries. While many cysts are harmless and resolve on their own, larger or persistent cysts can cause pain and discomfort during menstruation and can require surgery to remove.‍
• Intrauterine device (IUD): Oh (no) baby — these can hurt! In some cases, the presence of an IUD, a form of birth control, can lead to secondary dysmenorrhea. Some individuals may experience increased cramping and discomfort after the insertion of an IUD due to the uterus cramping around the device. This pain shouldn’t last for more than a few weeks - and if it does, make sure to see a doctor to figure out what’s going on.

How is secondary dysmenorrhea treated?

When it comes to treating secondary dysmenorrhea, the appropriate treatment options can vary depending on the root cause of the period pain. While some of the treatments mentioned may provide relief for some people, it's important to remember that finding the right solution for your body and unique needs usually requires a little professional help (It’s not on you — secondary dysmenorrhea can be pretty complicated!)

If you're experiencing intense period pain or suspect that your pain is linked to another underlying condition, like endometriosis or PCOS,  we recommend consulting with a trustworthy healthcare professional. At Hazel, our team of experienced doctors can work closely with you to assess your individual situation, identify the root cause of your pain, and recommend personalised treatment options.

By taking into account the specific factors related to your condition, the severity of your symptoms, and your overall health, your doctor can create a tailored treatment plan that prioritises alleviating your period pain and enhancing your overall quality of life.

What if I experience period pain, but no period?

Lots of women experience pelvic pain and cramping at different stages of their menstrual cycle – but your period isn’t always to blame. What might feel like the pain or cramping you experience when you get your period could actually be attributed to things like cysts, constipation, pregnancy, UTI, IBS or even ovulation if your period is absent.

If you experience chronic pelvic pain that feels like period pain, with or without your period present, and it's impacting your daily life, it might be worth exploring your symptoms with a doctor who specialises in female pain and gynaecological conditions

Medicinal cannabis and period pain

There has been a lot of media attention around the potential benefits of medicinal cannabis for period pain, but how effective is it for period pain and who can try it?

We know that for a lot of women with chronic pelvic, including period pain and pain during sex cannabis has been shown to be a safe and effective option. Medical cannabis for period pain can help provide relief with few adverse side effects and  can assist with chronic period pain, as well as other common premenstrual symptoms  including sleep issues, nausea and vomiting, gastrointestinal issues, mood disturbances and more.

For individuals who’ve struggled with side effects that many standard pharmaceutical or period pain medications can bring, cannabis has been shown has the potential to reduce the need for those medications by at least half.

It’s important to note that more research is needed around cannabis and period pain specifically, even though cannabis has been shown to be effective in providing relief to women with endometriosis pain and people with chronic pain in general. If you’re interested in trying a natural therapy, like medicinal cannabis for  period pain, then it’s important to talk to a specialising doctor that can help you weigh the risks and benefits and see if medicinal cannabis could work for you.

To learn more about managing period pain with natural therapies like medicinal cannabis, book a consultation with Hazel.

The Wrap Up 

Period pain is so common, yet it's brushed off as something we have to endure or that suffering through it is the norm. Fortunately, it doesn't have to be that way.

If your period pain consistently interferes with your daily life, making it hard to work, study, socialise, or take care of yourself, that is not OK. The good news? There are doctors out there who can help. Don’t let period pain take over your life. Reach out to a doctor who listens without judgement and has the knowledge to help you understand if there's an underlying issue or explore potential treatments or interventions.

The sad truth is that we still have a long way to go in normalising conversations around period pain. So we’re creating an environment where menstruating individuals feel comfortable sharing their experiences, asking for support, and taking time off work if needed. 

Remember, period pain shouldn't hold you back. Just because it’s common doesn’t mean it’s normal. Period. 

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