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Period pain – symptoms and causes
While some women have hardly any pain at all, others suffer from severe abdominal cramps that are barely bearable without painkillers. Period pain during menstrual bleeding, known in medical terminology as dysmenorrhoea, can be very unpleasant and bring with it a whole range of symptoms.
From a medical point of view it is not a cause for concern in most cases. However, the pain can also be a sign of a condition affecting the lower abdomen. A distinction is made between primary and secondary period pain. The former is present from the very first monthly bleed onwards and usually does not indicate an illness. Secondary period pain, also called acquired dysmenorrhoea, appears at a later stage of life and is often caused by a gynaecological condition.1
What symptoms occur with period pain?
It is safe to say that many women feel anything but well at the start of their menstrual bleeding. Women who are spared the unpleasant symptoms that can come with a period can count themselves truly lucky.
Typical symptoms of primary period pain are abdominal cramps, but symptoms such as back pain, malaise, diarrhoea, tiredness, tender nipples, irritability and headaches or migraine can occur as well.2 Similar complaints occur with PMS, although those symptoms usually appear at an earlier point in the cycle.
The characteristic pain in the lower abdomen is cramp-like. It is often described as dull or dragging, and it usually grows stronger and weaker in waves. Some women are tormented by abdominal cramps so severe that these symptoms leave them signed off sick during their period.3 Alongside the pain, most also have heavy menstrual bleeding.
Secondary dysmenorrhoea can be caused by gynaecological conditions.1 The symptoms of secondary period pain are similar to those of the primary form. Depending on whether the abdominal cramps are triggered by an illness and on which organic causes are involved, further individual symptoms can appear.
When do you get period pain?
The cramps begin shortly before or on the first day of menstrual bleeding, with day 1 or 2 usually being the worst. By day 3 the period pain has normally eased off, and it disappears on the last day of bleeding, staying away until the start of the next cycle.4 It is best to keep a period calendar so that you know when your period, and with it the pain, is due.
Every now and then, no ovulation takes place in the female cycle. As a result no progesterone is formed and the uterine lining does not build up as much. Menstrual cycles without ovulation therefore mean that both the monthly bleed and the accompanying symptoms are weaker than usual.5 Menstrual complaints can also vary according to your lifestyle and diet or your mental state. Further down you will find tips on preventing period pain.
What causes period pain?
Period pain is triggered by so-called prostaglandins, the body’s own pain messengers. When your period starts or shortly afterwards, the prostaglandins produced in greater quantities during this phase are released by the uterus. At the same time the uterine lining is shed as the oestrogen and progesterone levels fall after ovulation, provided that no fertilisation has taken place.6
Prostaglandins cause the muscles of the uterus to contract, which reduces the blood flow to it and can give rise to period pain. These pain messengers can act not only in the uterus but also in other parts of the body and so lead to nausea, vomiting or diarrhoea.4
Psychological factors can also play a part in whether period pain occurs and how severe it is, for example when a woman subconsciously does not accept becoming or being a woman.6
If you want to get to know and better understand your natural cycle and the menstrual symptoms that come with it, the cycle computer cyclotest myWay can help you do exactly that. The clever device works out your fertile days on the basis of your body temperature and thus offers an alternative in the form of hormone-free contraception.
Secondary period pain, once it has been ‘acquired’ later in life, is often triggered by gynaecological conditions such as endometriosis, uterine polyps or an intrauterine device (a coil) that is in place. In such cases the diagnosis is most often endometriosis. With this, or with ‘acquired’ period pain, the pinching and dragging at first occurs only during the monthly bleed, but over time the pain becomes constant.
Psychosomatic factors can be a trigger for abdominal cramps too, for example if the woman affected has been subjected to sexual violence. An unfulfilled wish to have a child can also be the cause. The bleeding then comes as a disappointment for the woman, which can cause her emotional and physical suffering.1
Who suffers from period pain?
Period pain is one of the most common gynaecological complaints. Primary period pain occurs in around 30–40 % of all women, with the intensity of the pain varying. Young women in particular are affected. After a first pregnancy it often improves, and in some cases it also improves with increasing age.7
If you are under constant stress or overexert yourself physically, this can lead to period pain as well. Sometimes the pain can mean a loss of quality of life. It is also the reason for many days missed at school, in training and at work. In 10 out of 100 women the complaints are so severe that every month they are unable to cope with their usual daily routine for 1 to 3 days.8
Secondary period pain only appears with increasing age, as it usually has underlying causes related to illness.9
What can you do about period pain?
Unfortunately there is no one-size-fits-all treatment for tackling period pain. Even so, you do not simply have to put up with the unpleasant symptoms that come with your period. To ease the pain during those days you can take various measures in advance. For acute abdominal cramps there are also a great many remedies and options that can bring quick relief.
In exceptional cases you can of course also postpone your period. Unfortunately this is not an option as a permanent solution, as you should only use it for genuinely important occasions.
How can I prevent period pain?
It is not only various medicines and other remedies that can reduce the intensity of the pain in many women as a preventive measure, but your own lifestyle as well. What matters here is to apply the different measures for preventing period pain not just temporarily but permanently.2
Diet and lifestyle for period pain
Exercise
Endurance sports such as jogging, cycling or swimming help to prevent painful cramps in the abdomen and back. Anyone who exercises regularly also raises their own pain threshold and does something good for their health into the bargain.10
Diet
In general it is helpful in preventing period pain to make sure you eat a balanced diet and get all the important nutrients. An alkaline diet, which reduces acidity in the body, is also said to restore the hormone balance and so stop the cramping.11
Tackling stress
If you are often stressed, this can make your period pain worse on top of everything else. If that is the case for you, you should look for ways to reduce your stress level, for example through relaxation exercises, meditation or attending a stress-management course.
Nutrients for period pain
Various herbs and food supplements can help with pain in the lower abdomen in the long term, preventing or easing it. Chasteberry and black cohosh in capsule form, for instance, can bring relief because they regulate the hormone balance. Magnesium and vitamin B6 relieve cramping as well, and both are available as food supplements.3
Herbal teas can help as a preventive measure too, so it is best to start drinking them a few days before your period is due. Herbs that, according to traditional herbal medicine, are particularly good for prevention are yarrow, lady’s mantle, marjoram, marigold, silverweed, mugwort, lemon balm, chamomile, willow bark and oregano. Eating parsley is also said to have a positive effect on period pain, as it promotes blood circulation.2
Schuessler salts for cramps
Schuessler salts are mineral salts prepared homeopathically; taking them causes no side effects and they are said to help with numerous conditions. The Schuessler salt Magnesium phosphoricum is suitable for period pain. It is generally used for cramps and pain.12 Ferrum phosphoricum, Kalium chloratum, Natrium sulfuricum, Silicea and Calcium sulfuricum are also recommended.13
The pill for period pain
The contraceptive pill or other hormonal contraceptives are often prescribed to treat severe pain in the lower abdomen as well. Taking the hormones prevents the uterine lining from building up. This stops period pain or at least eases it.14 However, you should consider the possible side effects of the pill on your health.
Acute cramps: what helps with period pain?
The menstrual cycle is very complex. Which treatment helps best with acute pain and has an antispasmodic effect differs from woman to woman. You will probably have to try a few things out to find which measures and remedies work best against the pain.
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Which exercises help with acute period pain?
Exercises have also proved their worth in easing pain in the lower abdomen and back complaints. What matters here is that they are gentle exercises that do not overtax you, for example yoga, progressive muscle relaxation according to Jacobson or autogenic training. Period pain can be minimised and back pain improved through such exercises. As a general rule: anyone who exercises and goes through life in a relaxed way is less likely to suffer from abdominal cramps.15
Home remedies, heat and more for menstrual complaints
It is best to try things out and see what does you good. Rest, relaxing baths and enough sleep are also recommended for severe pain in the lower abdomen and have a cramp-relieving effect.
There are no scientific studies to prove it, but some women report that the pain improved after they used a menstrual cup instead of pads or tampons. A menstrual cup may take some getting used to if you have never tried one – but pain takes far more getting used to. So this method is well worth a try.
Tablets for period pain
If the tips above do not help, tablets containing the active ingredients ibuprofen, paracetamol, acetylsalicylic acid or naproxen can ease the abdominal cramps of acute period pain. There are also combination preparations that contain antispasmodic ingredients alongside paracetamol. If you are suffering from nausea on top of that, you should use suppositories instead of tablets.17
Severe period pain: when should you see a doctor?
If you have very severe period pain that is becoming increasingly intense and is affecting your normal daily routine, you should arrange a visit to the doctor in order to rule out any underlying illness. Another reason for severe complaints can be a copper coil.
The hormonal coil can cause severe pain as well. A doctor should then check whether the cramps can be traced back to the coil and remove it if necessary.18
If period pain has come on suddenly and you have largely been spared it until now, it is advisable to see your gynaecologist. The same applies if you have abdominal cramps outside your period. In both cases it is possible that the pain is being caused by gynaecological or other illnesses that need to be treated. A diagnosis by your gynaecologist is important in order to rule out possible illnesses.3
This should involve a detailed medical history as well as a thorough gynaecological examination. Depending on what the abdominal complaints point to, an ultrasound scan, a hysteroscopy or a laparoscopy can be carried out. Psychological factors should not be overlooked either.19
Lower abdominal pain without a period
Pain in the lower abdomen can also have causes unrelated to menstruation and therefore not be period pain at all. In the early stages of a pregnancy, abdominal cramps can occur which in some cases point to a threatened miscarriage or an ectopic pregnancy. In some women pain in the lower abdomen also occurs when the fertilised egg implants, which can then be taken as an early sign of pregnancy. So if abdominal cramps are troubling you at a time other than your usual period, you should consider whether the pain might be a sign that you are expecting a child.
Abdominal cramps can occur after giving birth as well, and these may be due to inflammation of the uterine lining or a thrombosis of the ovarian veins. Fibroids or ovarian tumours can be triggers too, as can conditions such as appendicitis, a bladder infection or kidney stones.20 If you have painful cramps in the lower abdomen without a monthly bleed, it is best to consult a specialist.
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