A guide to period pains
Aside from the bleeding of menstruation, the most well-known period symptom is cramping and pain. In this article, consultant GP Dr Claire Agathou explains why period pain happens, and when to know if there is cause for concern.
What is normal period pain?
Each individual experiences their period differently and their symptoms can vary. The duration of the menstrual cycle is between 22 and 45 days, and will start during adolescence and last until around 50 years of age.
Period pain, known as menstrual cramps or dysmenorrhea, is a normal, expected part of the menstrual cycle. It manifests as an aching or cramping pain that is focused in the lower abdomen and pelvis.
Period pain can start a couple of days before the actual menstruation, and end around three days after the bleeding has stopped for the cycle. The pain can range from mild discomfort to severe enough to inhibit individuals from participating in their regular activities for a few days each cycle.
The pain may have peaks in intensity but typically is a continuous and dull sensation. It may also be accompanied by nausea, headaches, and dizziness.
What causes period pain?
Period pain is caused by contractions in the muscle walls of the uterus, which happens to facilitate the expulsion of the uterine lining (that which is shed in menstruation) by depriving the tissues of oxygen and blood supply. Prostaglandins, which are lipids (fats) that function similarly to hormones, peak during this period and trigger the contractions by causing pain and inflammation.
When is period pain abnormal?
Period pain is normal – but it shouldn’t be debilitating. In severe cases of period pain, it is possible that there is an underlying condition that is exacerbating the pain, such as:
- Endometriosis, which is when the uterine lining tissue grows outside of the womb and onto other structures, such as the fallopian tubes and ovaries, but in some cases can even reach the lungs. This tissue is also subject to the menstrual cycle, and will shed and slough off the structures monthly, but do not have an avenue to exit the body like the uterine lining, which causes particular pain
- Uterine fibroids, which are benign growths along and inside the uterus. They cause extra pain because the surface area of the uterine tissue is increased, meaning that more tissue is inflamed and triggered by the prostaglandins.
- Pelvic infections, where the pelvic organs are inflamed due to bacterial infection.
- Cervical stenosis, which is a narrowed opening in the cervix that impedes normal blood flow, causing extra pain.
Patients with the copper coil (known as an intrauterine device (IUD)) can also experience heavy periods and intensified period pain, especially during the first few months after insertion. It is due to the release of copper from the IUD triggering the aforementioned contractions. It is important to note however that, intrauterine system (IUS) coils containing the hormone progesterone work differently and can make periods very light and even cause no bleeding at all. These are often used for women suffering from difficulty due to very heavy periods (menorrhagia).
Patients who experience excessive period pain, or pain during sexual intercourse and outside of the expected days around menstruation, irregular bleeding bloating, or abnormal vaginal discharge should seek medical advice. Severe or sharp pelvic pain, causing fever and body aches suggestive of infection, should be assessed immediately on the day.
Dr Claire Agathou
Dr Agathou is a co-founder of The A-Z General Practice at HCA Healthcare UK The Wellington Hospital in St John’s Wood. Dr Agathou works in close collaboration with Dr Michael Zemenides, offering patients and their families dedicated, personalised care across all ages. Together, they provide comprehensive access to on-site services, including blood tests, investigations, advanced imaging, and immediate referrals to world-class specialists.