Painful periods are a common experience for girls and women around the world – however, that doesn’t mean that we just have to ‘put up with it’.
Mild period pain that lasts for 2-3 days and settles with simple measures such as ibuprofen, paracetamol and a hot pack on your tummy is normal…
..Annoying, but normal.
Primary Dysmenorrhoea – Painful Periods
This kind of period pain is called ‘primary dysmenorrhoea’. ‘Primary’, because there is no underlying, more serious cause other than chemicals called prostaglandins causing uterine cramping in order to expel the endometrial lining (your period) that builds up over the course of the month.
More severe period pain can be managed with the above measures plus the oral contraceptive pill. ‘Tricycling’ the pill, or skipping the sugar or placebo pills, can be useful as this will allow you to miss a period.
Some women aren’t able to take the pill for medical reasons (for example: a history of migraines, clots in the legs or the lungs). An Implanon or a Mirena IUD may then be a useful option to consider.
Other common causes of Painful Periods
More severe period pain, or ‘secondary dysmenorrhoea’ can be caused by a number of conditions, with endometriosis being the most common.
Other causes of secondary dysmenorrhoea include:
- Pelvic inflammatory disease
- Ovarian cysts and tumours
- Cervical stenosis or blockage
- Fibroids or
- Uterine polyps.
Girls and women with endometriosis often describe period pain that starts days before their period arrives. They can experience a range of symptoms, including: cramping pains that shoot down the front and backs of the legs; stabbing pains in the pelvis; back pain; bloating; pain with sex; vulval pain; nausea; vomiting; diarrhea or constipation; and urinary frequency. Some women suffer from headaches and mood changes too.
Endometriosis occurs when endometrial tissue grows outside of the uterine cavity. The lesions are usually in the pelvis, but can be found on the bowel wall, bladder, diaphragm and lining of the lungs.
The lesions trigger an inflammatory response and release of pain mediators (or chemical signals) resulting in increased activation of sensory nerve fibers. Oestrogen acts as a neuromodulator, influencing and intensifying the nerve sensitivity.
If these changes continue for a long time, the whole nervous system is ‘sensitised’ or ‘up-regulated’, potentially leading to chronic pain issues.
Our understanding of endometriosis is increasing and so there is much that can be done.
A correct diagnosis is important, and a detailed history, physical examination and detailed pelvic ultrasound is where your doctor should start.
While a pelvic ultrasound may not identify lesions of endometriosis, it can exclude other causes of pelvic pain.
The first aim of treatment to stop periods as much as possible.
A doctor experienced in managing endometriosis will also work with physiotherapists, psychologists, and dieticians to reduce any other causes of pelvic pain such as pelvic muscle spasm, painful bladder syndrome and irritable bowel symptoms from food intolerances.
If medical management doesn’t produce good results in three months or so, then a referral to a skilled surgeon for a laparoscopy is the next step.
It is important to remember however, that surgery will not fix all pelvic pains and ongoing medical and allied health management is necessary to prevent a relapse.
If your periods are a REAL pain – interfering with school, uni, sport or work, make an appointment to see Dr Mezzini today. Periods aren’t a punishment to be endured.
Dr Tonia Mezzini is known for offering the best possible advice and treatment options for a person’s sexual health care needs. In particular, she cares for patients with:
- Gender-affirming hormone therapy
- Complex contraceptive choices
- Sexually transmitted infections such as recurrent genital herpes
- Recurrent bacterial vaginosis
- Recurrent thrush
- Information about sexual health
- Menopause and hormonal concerns
- Breast cancer prevention strategies
- Chronic pelvic pain in men and women
- Painful periods and endometriosis
- Vulval pain syndromes and vulval skin conditions
- Low libido and pain with intercourse
- Polycystic Ovarian Syndrome
 Lee HJ. Park YM, Lee BC, et al. Various anatomic locations of surgically proven endometriosis: A single-center experience. Obstet Gynaecol Sci 2015;58:53.
 McKinnon BD, Bertschi D, Bersinger NA, Mueller MD. Inflammation and nerve fiber interaction in endometriotic pain. Trends Endocrinol Metab 2015;21:1.
 Liang Y, Yao S. Potential role of oestrogen in maintaining the imbalanced sympathetic and sensory innervation in endometriosis. Mol Cell Endocrinol 2016;424:42.
 As-Saine S, Harris RE, Napadow V, et al. Changes in regional gray matter volume in women with chronic pelvic pain: a voxel-based morphometry study. Pain 2012;153:1006.