Dysmenorrhea (period pain)

Period Pain

Period pain, also known as dysmenorrhoea, occurs when the muscles of the womb contract or tighten as it sheds the lining of the uterus. The pain often feels like cramping or heaviness in the pelvic area, lower back, or stomach – enter the term “menstrual cramps”.

Affecting up to 90% of us, period pain is a regular visitor for many menstruators…yet it has only been examined in Australian women in a small number of studies. 

We have the research gap to thank for that. 

Symptoms of period pain

Period pain typically starts when your period begins or even earlier, with the first 24 hours usually being the most painful. How painful? Well, research shows that for some people dysmenorrhea can be as painful as a heart attack, meaning women and people who menstruate experience excruciating pain every month. 

On top of the period pain and menstrual bleeding itself, you may also experience the following symptoms during your period: 

• Severe menstrual aches and menstrual pain 
• Mood changes 
• Headaches 
• Heavy menstrual bleeding
• Nausea and vomiting 
• Periodic pain in the thigh and leg 
• Fainting 
• Digestive issues (including constipation and diarrhoea) 
• PMS symptoms like sore breasts and bloating
  
  

It’s worth noting that while period pain is a common companion to the menstrual cycle, unbearable period pain should not be “just another part of being a woman”.

Period pain and other menstrual symptoms can seriously affect your quality of life. In fact, one study showed that 1 in 3 women quit daily activities because of menstrual symptoms. If your periods are so painful that they interrupt your daily activities and seriously disrupt your everyday life, we recommend speaking to a doctor with experience in painful periods, dysmenorrhoea, and period pain relief.

What is normal period pain?

Everyone’s experience with period pain is unique, but it shouldn’t be so severe it stops you in your tracks. While it’s totally common to experience some discomfort during your period, that doesn't mean you should be doubled over in agony.

Typical period pain might include some discomfort in the lower abdomen or back, but if you’re experiencing symptoms like severe cramps, heavy bleeding, nausea, headaches, or fainting, that’s no longer just “normal.” It's a red flag for something more serious—like secondary dysmenorrhoea, which could point to conditions such as endometriosis or fibroids.

When to see your doctor about period pain

If your period pain is interfering with your daily activities or if it’s severe enough to leave you feeling dizzy or faint, it's time to talk to your doctor or make an appointment with one of our Hazel specialists. While some discomfort is normal, persistent or intense pain that disrupts your routine may signal an underlying issue. Here are some signs that it’s time to seek medical attention:

• Pain that's unusually intense: If your period pain is severe enough to require you to miss work, school, or social events, or if it causes nausea, vomiting, or fainting, it may be more than just regular cramps.
• Pain that lasts longer than usual: Period pain usually lasts for 1–2 days, but if it’s lasting longer or getting worse, it might indicate a condition like endometriosis, fibroids, or adenomyosis.
• Pain that doesn’t improve with typical treatments: Over-the-counter pain relievers like ibuprofen or heat therapy usually help relieve period pain. If they don’t, this could suggest a more serious issue requiring professional evaluation.
• Heavy bleeding: If you’re experiencing bleeding so heavy that you need to change your pad or tampon every hour, or if you pass large blood clots, you may have conditions like fibroids or endometrial polyps that need medical intervention.
• New or unexpected symptoms: Pain accompanied by unusual symptoms like digestive issues, extreme fatigue, or unexplained weight gain may suggest a medical condition that requires treatment.
• Pain that affects your ability to function: If the pain leaves you unable to go about your daily life—such as causing problems with work, relationships, or self-care—it’s time to seek medical advice.

When to seek immediate medical attention

‍Period pain might be a regular visitor, but some symptoms are red flags you shouldn’t ignore. Knowing the difference between “ugh, cramps” and “get to a doctor, STAT” can be a lifesaver. Seek immediate medical attention if you experience:

• Heavy menstrual bleeding that soaks through one or more pads or tampons every hour for several hours.
• Severe dizziness or fainting during your period.
• Sudden, intense pelvic pain unrelated to your usual cycle.
• Fever or chills accompanying pelvic pain.
• Blood clots larger than a 50-cent piece (or other concerning clots).

These symptoms may indicate serious conditions like haemorrhage, infection, or other complications requiring urgent care. Trust your gut and make sure you visit a doctor or emergency room if you’re concerned.

What is primary dysmenorrhoea?

Severe period pain, or dysmenorrhoea, is divided into two categories: primary and secondary.

Primary dysmenorrhoea refers to recurrent menstrual pain that isn’t tied to an underlying medical condition. It’s mainly due to prostaglandins, hormone-like substances that trigger uterine contractions to shed the lining.

These pesky prostaglandins can cause intense cramping, nausea, and other symptoms. The silver lining? For many, this type of pain can improve with age or after having children.

What is secondary dysmenorrhoea?

Secondary dysmenorrhoea isn’t just your standard period pain—it’s got additional causes. This type of pain happens thanks to underlying medical conditions, such as:

• Infections (including pelvic inflammatory disease) 
• Endometriosis
• large cesarean scar niche, 
• Fibroids
• Adenomyosis
• Endometrial polyps
• Intrauterine contraceptive system (IUDs)
  

While primary and secondary dysmenorrhoea may share similar symptoms, the symptoms of secondary dysmenorrhoea, such as extreme period pain and heavy menstrual bleeding, are more persistent and severe.

Unlike primary dysmenorrhoea, secondary dysmenorrhoea does not improve with age or after childbirth. Long-term approaches to treatment (including pain relief and hormonal therapy) can help to manage the symptoms of the underlying condition and reduce associated period pain. ‍

Diagnosis and tests for dysmenorrhoea

Diagnosing dysmenorrhoea involves more than just identifying period pain—it’s also about ruling out other potential causes to get to the heart (or uterus) of the issue.

This diagnostic journey typically starts with a thorough evaluation to distinguish between primary dysmenorrhoea, where pain is linked to menstrual cramps, and secondary dysmenorrhoea, which is associated with underlying conditions like endometriosis or fibroids.

The process often includes:

• A detailed medical history
• Pelvic exam: A pelvic exam enables your doctor to check your reproductive organs for any abnormalities and rule out any potential conditions. 
• Pap smear: A pap smear checks for infections, bacteria, STIs, and other issues that could be contributing to your period pain.
• Blood tests: Blood tests can help to identify thyroid issues, and other infections that a pelvic exam and pap smear may have missed.
• Laparoscopy: If your doctor suspects endometriosis, they may refer you for laparoscopic surgery. Laparoscopic surgery allows for a closer examination of your reproductive organs and is commonly used for the diagnosis of endometriosis and other invisible conditions. 
• Imaging Studies which could include:
  ‍
  • Ultrasounds: Uses sound waves to create images of the reproductive organs to detect abnormalities like fibroids or ovarian cysts.
  • CT Scans: Offers detailed imaging to assess pelvic structures, which might not be as visible on an ultrasound.
  • MRI: Provides a highly detailed view of the pelvic organs, especially useful for diagnosing conditions like endometriosis or adenomyosis that may be challenging to detect otherwise.

By assessing these factors, healthcare providers can pinpoint whether the pain stems from an identifiable condition and tailor treatment strategies accordingly.

Why do some people experience more painful periods?

Why do some people seem to have more painful periods, even if they don’t have a specific condition? It turns out that menstrual pain isn't one-size-fits-all.

Individual experiences can vary widely due to factors like pain threshold, hormonal differences, and even genetic influences. Some women may have higher levels of prostaglandins—hormones that trigger uterine contractions—making their periods more painful.

Additionally, lifestyle factors and overall reproductive health can play a role. Understanding these differences helps in crafting a more personalised approach to managing period pain, ensuring that treatment strategies can be as unique as each person’s experience.

Period pain treatment

These days, managing period pain goes beyond paracetamol and warm baths (though if that’s your go-to, we’re all for it). Whether you’re dealing with primary or secondary dysmenorrhoea, there are a variety of treatments that might help ease your symptoms. Here’s a quick rundown:

Pain Relievers: If you’re after quick relief, NSAIDs are a popular choice. Nonsteroidal anti-inflammatory drugs (NSAIDs) work by reducing inflammation and pain, targeting the pesky prostaglandins that cause those contractions. But keep in mind, long-term use or misuse of NSAIDs can come with side effects like:

• Nausea
• Heartburn
• Stomach pain
• Gastrointestinal bleeding
• Kidney damage

Hormonal Treatments: Hormone treatments like birth control pills, IUDs, and patches can help by regulating or suppressing the menstrual cycle. They work by stabilising hormone levels, reducing prostaglandin production, and easing uterine contractions. However, they may also come with potential side effects such as:

• Weight gain
• Mood swings
• Breakthrough bleeding
• Breast tenderness

Natural Medicine: Some natural remedies can help reduce inflammation and muscle tension. A 2022 Australian study noted improvements in period pain with these treatments.

• Supplements: Omega-3 fatty acids, vitamin B1, and magnesium have been shown to help manage period pain.
  
• Heat Therapy: Applying heat to the abdomen or back can be soothing. Hot water bottles, heat packs, and heating pads are great options. In fact, research has shown that combining heat therapy with ibuprofen is more effective than pain medication alone.
  
• Acupuncture: This Traditional Chinese Medicine technique might help by boosting endorphins, improving blood flow, and balancing energy.
  
• Medicinal cannabis vaginal suppositories: These may offer targeted relief by delivering cannabinoids directly to the area, potentially reducing inflammation and muscle tension. They can act faster than oral options, but it's crucial to consult with a healthcare provider to ensure they're right for you.

Remember: period pain is common, but it’s not normal to suffer intensely. If your pain significantly impacts your daily life, don’t hesitate to reach out to a trusted medical practitioner. 

Dysmenorrhoea (Period Pain) in a Nutshell

Period pain, or dysmenorrhoea, is a reality for nearly 90% of people who menstruate, ranging from manageable cramps to pain so severe it disrupts daily life. Primary dysmenorrhoea stems from menstrual cramps without an underlying condition, while secondary dysmenorrhoea is linked to medical issues like endometriosis or fibroids.

Symptoms often include pelvic pain, heavy bleeding, nausea, and even fainting. While common, excruciating pain is not normal and deserves medical attention. Treatment options span from NSAIDs and hormonal therapies to natural remedies like heat therapy, acupuncture, and medicinal cannabis. For secondary dysmenorrhoea, addressing the underlying cause is key.

If period pain is controlling your life, don’t ignore it—book an appointment with a Hazel specialist today. Relief starts with understanding, and we’re here to help.

Dysmenorrhoea (Period Pain) FAQs

Can stress affect period pain?

Absolutely. Stress doesn’t just make you anxious—it can spike your period pain. When you're stressed, your body pumps out cortisol, which increases inflammation and can make those cramps feel that much worse. But good news: managing stress can help reduce the intensity of your cramps. Relaxation techniques, breathing exercises, and a bit of yoga might not only calm your mind but help make those cramps bearable too. [Subhead] Is it normal to have intense period pain?

Here's the thing: No, not really. Mild cramps? Sure. They're common. But if you're doubling over in pain, missing work or school, or thinking about taking a day off to lie in bed with a heating pad and Netflix, something might be up. Intense pain can signal underlying issues like endometriosis, fibroids, or even pelvic inflammatory disease.

Can exercise help reduce period pain?

You might not feel like moving when you’re cramping up, but trust me, exercise can be your best friend during that time of the month. It’s all about those endorphins—your body's natural painkillers. Even light exercise, like stretching, yoga, or a casual walk, can increase blood flow and reduce muscle tension in the abdomen, easing cramps. No need to hit the gym with full force—just a little movement can make a world of difference.

What are the long-term treatment options for period pain?

If you’re tired of popping painkillers every month, there are plenty of long-term options to consider. Hormonal treatments like birth control pills, IUDs, or patches can be game-changers. They can help regulate your cycle, reduce hormone fluctuations, and keep those cramp-causing prostaglandins in check. And if you’ve tried all the pills and potions and still can’t catch a break, surgery might be necessary for conditions like endometriosis or fibroids. Yes, it’s a big step, but for some, it’s the only thing that works.