Painful periods can affect women at all ages during their reproductive life. Periods tend to become less painful as one gets older and often after childbirth.

Dysmenorrhoea

Dysmenorrhoea is the medical term for painful periods. This may be further classified as Primary or Secondary Dysmenorrhoea.

Primary Dysmenorrhoea

Is used to describe painful periods that usually do not have an underlying cause. It occurs in three quarters of young girls and women at some point in their life, often making them miss school or work. It is characterised by the pain starting the day before or during the first day of bleeding and usually settles by 2-3 days into the period.

Cause of Pain

During the periods, the uterus (womb) releases chemicals known as Prostaglandins, which in turn cause spasms of the muscle wall of the womb, reducing blood flow and oxygen to the uterus and thereby causing pain. These chemicals can also cause nausea, vomiting and diarrhoea in some women during their periods. This is why taking anti-prostaglandins such as Ibuprofen and Neurofen taken regularly during the period can often help ease the pain compared to Paracetamol.

Secondary Dysmenorrhoea

Is used to describe period pain that usually occurs a few days before the blood flow starts and may actually become slightly better once the bleed starts. Women may not have had any significant pain with their periods previously. Women with periods that have become painful over time may have underlying causes such as Endometriosis (see separate leaflet), Pelvic Congestion, Pelvic Inflammatory Disease (PID), Adenomyosis (where the lining of the womb pushes into the muscle layer of the womb, also known as uterine or internal endometriosis) and Fibroids (see separate leaflet). Many of these women may have heavy periods (see separate leaflet) as well as painful periods.

Management of Painful Periods

Medical Management

NSAIDS: If not allergic to them, anti prostaglandins medications (Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) like Ibuprofen or Neurofen, taken two - three times a day after food (to avoid gastritis) in the appropriate dose, started the day before the period starts or as soon as bleeding starts are very effective in most cases with primary and some cases with secondary dysmenorrhoea. The mistake often made by women is waiting to take the medicines once pain has already started. In this situation, the drugs take longer to counteract the prostaglandins already released by the womb.

Hormones: If a woman is not trying for a pregnancy, using birth control pills or hormonal implants including the progesterone releasing intrauterine system (Mirena IUS) may be a very effective way in reducing both heavy and painful periods by thinning the lining of the womb. The oral contraceptive pill can be safely taken back to back with breaks every few cycles in many women.

Surgical options: are not really helpful in primary dysmenorrhoea. In women with endometriosis, options such as laparoscopic treatment (key hole surgery) may be beneficial in helping with period pains.

Alternate measures:

Being active: It has been shown that doing exercise before and during periods reduces the intensity of period pains. Walking, running, swimming, yoga, pilates, team sports or gym are all equally helpful. It is advised to avoid handstands or headstands during periods to try and avoid retrograde (blood flowing backwards) menstruation.

Heat: Using a heat pad or a hot water bottle often helps easing the pain, especially when used in combination with NSAIDs. Care must be taken to ensure that the heat applied is not too high to avoid burns to the skin.

Complementary Therapies: Acupuncture and yoga also have shown to be helpful in reducing painful periods.

Diet: A healthy balanced diet rich in fresh fruit, vegetables, beans and grains will help with reducing period pains, by increasing the fibre and reducing the fat in the diet (i.e. eating a naturally occurring Low Fat High Fibre diet)

Nitu Bajekal Nov 2013