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Overview: Period pain

Last Update: May 12, 2023; Next update: 2026.

Introduction

Many girls and women have problems like abdominal cramps and pain during their menstrual period. The medical term for painful periods is “dysmenorrhea.”

Severe menstrual symptoms can usually be treated effectively. If you have very painful periods or the pain keeps getting worse over time, it can be a good idea to speak to your gynecologist. The abdominal pain is sometimes caused by a treatable condition such as endometriosis.

At a glance

  • Lots of women experience abdominal cramps and pain during their period, and sometimes nausea and headaches, too.
  • The symptoms can be so severe that normal daily activities are no longer possible.
  • Painkillers like ibuprofen can relieve the symptoms. Many women also try using heat, relaxation techniques or exercise for relief.
  • Hormonal contraceptives like the pill can help as well.
  • It is important to see a doctor to find the cause of very severe pain.

Symptoms

Period pain might only affect the lower abdomen, or it might be felt in the back or legs, too. It can cause nausea, vomiting or diarrhea in some women, as well as headaches or general discomfort. Women who have heavier periods often have more intense pain too.

Causes and risk factors

The lining of the womb gets thicker during every menstrual cycle to be able to receive a fertilized egg cell. If no fertilized egg cell settles there, the top layer of the lining is shed during menstruation.

Figure: Menstrual cycle

Menstrual cycle

To shed the lining during the monthly period, the muscles of the womb tighten (contract) and relax at irregular intervals. This helps the top layer of tissue lining the womb to detach and flow out of the body, together with blood, through the neck of the womb (cervix) and the vagina. Some women don’t notice anything at all, or just a mild pulling sensation, but others have painful cramps.

Doctors distinguish between two types of period pain, called primary and secondary dysmenorrhea. Primary dysmenorrhea is where the period pain is caused by the womb muscle contractions alone. Hormone-like substances called prostaglandins play an important role here. They cause the muscles in the womb to tighten, helping to shed the lining of the womb. Women who have primary dysmenorrhea probably make too many prostaglandins or might be particularly sensitive to them. Primary dysmenorrhea is more common in women under the age of 30 and women with heavy periods. It can run in families, and stress can play a role too.

Period pain that is caused by something other than the muscle contractions is called secondary dysmenorrhea. Benign (non-cancerous) growths in the womb, such as fibroids or polyps, are often responsible for secondary dysmenorrhea. Severe period pain can also be a symptom of endometriosis. The tissue lining the womb then also grows in the abdomen outside of the womb. Sometimes contraceptive coils (IUDs: intrauterine devices) used for birth control can also cause secondary dysmenorrhea.

Prevalence and outlook

Period pain is very common: most girls and women have pain of varying intensity at some point during their period. In 1 out of 10 women the pain is so bad that they're unable to carry out their usual daily activities on one to three days every month.

The pain is usually worse in women under the age of 20. It usually gets better or even goes away completely within a few years of their first period. In many women period pain becomes milder after the birth of their first child.

Secondary dysmenorrhea often first arises after a young woman has already been menstruating for several years. Here, women may also have pain at times of the month other than during menstruation.

Treatment

Women and girls get a lot of (sometimes contradictory) advice from doctors and other women. Painkillers such as ibuprofen and naproxen are effective. These belong to a group of medications known as non-steroidal anti-inflammatory drugs (NSAIDs). They can relieve period pain by reducing the production of prostaglandins. Although NSAIDs are usually well tolerated, side effects can occur, especially stomach problems.

Many contraceptives, such as the pill or contraceptive coils, can relieve period pain. The lining of the womb then doesn’t thicken as normal, and bleeding is usually less heavy and shorter than natural menstruation, or there is no bleeding at all. But hormonal contraceptives can cause side effects like headache and nausea, and some may also increase the risk of thrombosis. Your gynecologist can advise you about which hormonal contraceptives are an option.

Studies suggest that heating pads, patches or belts can relieve period pain. Some studies have also suggested that physical activity such as jogging, yoga and exercises can help. Other treatments – like acupuncture, dietary supplements or herbal products – haven't been proven to help. Although these approaches have been tested in a number of studies, the study results were contradictory or the studies weren't done properly.

Sometimes the pain is so bad that psychological treatment is considered. This may include things like talks with a psychotherapist and learning techniques that can reduce pain such as relaxation and mindfulness exercises.

If the pain is caused by fibroids or endometriosis, other treatment options can be considered – perhaps surgery, too.

Everyday life

Menstrual symptoms are not always taken seriously, sometimes not even by doctors. Lots of women also think that they just have to put up with the pain because it is “part of life as a woman,” and try to hide it as much as possible. But severe pain that affects your everyday activities on several days a month, maybe even preventing you from working, isn't something that you just have to live with because it's “natural.” Talking to people close to you about your symptoms, getting medical advice and looking for suitable treatment can all be important steps towards being able to cope with the symptoms better.

For example, many women try to take things a bit easier during their period. It may be helpful to avoid having demanding appointments and activities during that time. Some find that relaxation techniques, breathing exercises, yoga or tai chi help them feel more relaxed and reduce stress. Some women find that going for a walk or doing light exercise can help. Warm baths, hot water bottles and saunas can be soothing too.

Women who are often unable to go to work because of bad pain and cramps may face problems at work, as well as feeling guilty and ashamed. Having a partner, relatives or friends who are understanding and supportive can make an important difference.

Further information

Your gynecologist is the first person to contact if you have severe period pain. In our topic “Health care in Germany” you can read about how to find the right doctor – and our list of questions can help you to prepare for your appointment.

Sources

© IQWiG (Institute for Quality and Efficiency in Health Care)
Bookshelf ID: NBK279324

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