What are period pains?
Many women experience pain and discomfort during their period. For most, the pain and discomfort are not so intense as to significantly interfere with their daily life. In the majority of cases, no special medical attention or prescription of strong painkillers is required to relieve menstrual symptoms. However, when women experience such severe pain that they struggle to carry out basic functions (walking, working, sleeping), seeking medical advice and intervention becomes necessary.
How common are period pains?
Eight out of ten women report having experienced period pains at some point in their lives. The pain is usually mild and manageable, and it typically subsides within a few hours.
However, for a significant percentage of women, menstruation can be troublesome and unbearable due to the intense pain and persistent discomfort they feel, both in the days leading up to their period and during it. They may need to take time off work or school and stay home for one or two days. Many women report experiencing monthly period pain that they cannot manage even with strong painkillers.
The pain usually begins shortly before menstruation starts and subsides two to three days later. The first day of bleeding marks the first day of a normal menstrual cycle.
Although often painful, a period rarely indicates the presence of disease. If period pains become more than occasional or steady discomfort in the abdominal area, it is advisable to consult your doctor or gynecologist for advice. A specialist can identify the exact causes and recommend the most suitable treatment to help relieve symptoms.
What causes these pains? What are the underlying factors?
Natural period pains are caused by contractions of the uterine muscles. These contractions occur due to the release of prostaglandins, which are hormones located on the lining of the uterus.
Although the exact causes of severe period pain are still being investigated, heredity appears to be one of the strongest predisposing factors. Conditions such as endometriosis and uterine fibroids (especially when they are larger in size) seem to cause more intense menstrual pain for many women. At the same time, certain contraceptive methods, such as the intrauterine device (IUD), may also worsen symptoms.
How can you prevent the pain?
The best thing you can do, apart from reminding yourself that the discomfort is temporary, is to maintain good physical health. This can be achieved through a healthy lifestyle, daily exercise, adequate sleep, and proper rest. Reducing stress levels also helps significantly in limiting pain.
Most over-the-counter painkillers available at pharmacies, particularly those containing ibuprofen (such as Advil and Nurofen), may provide relief. After assessing your symptoms and needs, your pharmacist can advise you on the best option.
At the end of the day, a warm bath or shower can help reduce the muscle contractions associated with period pain. Combined with gentle abdominal massage, the results can be immediate. Before bedtime, a woman may use a hot water bottle or a heating pad that applies even pressure to the abdomen. Finally, it is important to stay well hydrated to avoid further weakening the body.
Period pain is manageable for the majority of women, although not all relief methods work for everyone. It is important to find the approach that works best for your own body.
What can your doctor do?
After taking a detailed medical history, performing a comprehensive clinical examination, and conducting an ultrasound evaluation, your gynecologist will assess all available treatment options, including hormone therapy and strong pain relievers (which, in most cases, require a prescription).
If your period pain does not stop or improve with the use of specific painkillers, your doctor may proceed with a detailed pelvic examination to identify the exact cause of the dysmenorrhea.
Based on this examination, they may recommend further diagnostic tests, such as a pelvic ultrasound or laparoscopy. Medical treatment may include non-steroidal anti-inflammatory drugs (NSAIDs) as well as contraceptive pills. In cases where contraceptives cannot be prescribed for medical reasons (e.g., thrombophilia), your doctor may suggest an alternative form of treatment.
By preventing ovulation, the contraceptive pill reduces the production of prostaglandins and therefore the pain. If the pain is caused by a condition such as pelvic inflammatory disease, endometriosis, or fibroids, the treatment plan will be designed accordingly.
Contact your doctor if your menstrual period is accompanied by severe symptoms, as developing an appropriate treatment plan can offer significant relief and greatly improve your quality of life.
What helps with period pain
- Heat. A heating pad or a warm bath relaxes the uterine muscle. In studies, local heat works almost as well as a simple painkiller.
- Painkillers at the right time. Anti-inflammatories work best when taken at the first sign, not when the pain has peaked. Ask your doctor or pharmacist whether you can take them.
- Movement. Walking, stretching, yoga. Regular exercise throughout the month reduces the intensity of cramps.
- Diet. Less salt, caffeine and alcohol in the days before your period. Magnesium and omega-3s seem to help some women.
- Sleep and relaxation. Fatigue and stress lower your pain threshold.
- Abdominal massage with circular movements, for a few minutes.
When period pain is not “just” period pain
Book an appointment if the pain keeps you in bed, does not go away with painkillers, started or got worse after age 25, or comes with very heavy periods, pain during sex or fever. In these cases we check for conditions such as endometriosis or fibroids. The medical side of the topic, with diagnosis and treatment, is covered in the article on dysmenorrhea.
The pain is often accompanied by other period symptoms, such as bloating, breast tenderness and irritability, which start a few days earlier.
A day-by-day relief plan for period pain
Most women deal with the pain once it has already flared up. A simple plan that starts before your period usually makes a bigger difference than any single remedy.
Two days before
- Cut down on salt and caffeine, and drink more water.
- Take a 20 to 30 minute walk or do some gentle exercise.
- If your doctor has approved it, keep your anti-inflammatory ready in your bag.
Day one
- Take the painkiller at the first sign of cramping, with a little food, and keep taking it at regular intervals as directed for the first 24 hours, instead of waiting for the pain to come back.
- A heating pad or a stick-on heat patch on your lower abdomen.
- Loose clothing, with no tight waistband.
Days two and three
- Gradually reduce the painkiller as the pain eases.
- Get moving again: stretching, yoga, swimming.
- Eat iron-rich foods to replace the blood you have lost.
Using painkillers correctly: common mistakes
Many women say that “painkillers don't work”, when in fact they are taking them the wrong way. The most common mistakes are:
- Too late: once prostaglandins have already been produced, the medication is less effective. Timing matters more than the dose.
- Only one dose: the pain comes back as soon as the effect wears off. Taking it regularly in the first 24 hours keeps levels steady.
- Combining two anti-inflammatories: for example ibuprofen with naproxen. It does not increase relief, it increases the risk to your stomach.
- Empty stomach: causes heartburn and discomfort. Take it with food or milk.
- Exceeding the maximum daily dose: it brings no extra relief, only more side effects.
If you have asthma, an ulcer or a kidney problem, or take anticoagulants, ask your doctor first which painkiller is right for you.
Exercises and positions that ease cramps
You do not need a gym. A few minutes on the floor at home is enough to relax the muscles of the abdomen and lower back:
- Child's pose: kneel, sit back on your heels and lean forward with your arms stretched out. Stay there for one to two minutes, breathing slowly.
- Cat-cow: on all fours, alternately round and arch your back in time with your breathing. Ten repetitions.
- Knees to chest: lying on your back, bring your knees toward your chest and make small circular movements.
- Supported pelvis: a pillow under your buttocks and your legs up against the wall for a few minutes.
In studies, regular aerobic exercise three times a week throughout the month reduced the intensity of period pain within a few cycles.
Lower back and thigh pain during your period
The uterus and the lower part of the spine share nerve pathways. That is why pain from contractions often “travels” to the lower back and inner thighs. It does not mean you have a back problem.
- A heating pad on the lower back often helps more than one on the abdomen.
- Sleep on your side with a pillow between your knees.
- Avoid standing for long periods and lifting heavy objects in the first days.
If the lower back pain is also present outside your period, or comes with numbness in the legs, it needs a different assessment.
TENS and heat patches: drug-free aids
Transcutaneous electrical nerve stimulation (TENS) devices send mild electrical impulses through stick-on electrodes on the skin. They “compete” with the pain signal traveling to the brain. Small studies show a benefit for period pain, especially at high frequencies. They are safe for most women, but not if you have a pacemaker.
Stick-on heat patches keep a steady temperature for several hours and can be worn discreetly under clothes at work or school. Never put them directly on bare skin overnight, to avoid low-temperature burns.
Mid-cycle pain or period pain?
Some women feel pain on one side of the abdomen about two weeks before their period. It is usually the pain of ovulation, which lasts from a few hours to two days and switches sides from month to month. It is harmless and eases with heat or a simple painkiller.
Normal period pain is symmetrical, in the center of the abdomen, and linked in time to the bleeding. Pain that is always on the same side every cycle, or lasts many days, may be related to ovarian cysts or endometriosis and needs an ultrasound.
Period pain that needs urgent medical help
Period pain is rarely an emergency. However, see a doctor right away if:
- the pain is sudden, very severe and different from your usual pain
- you have a positive pregnancy test or a late period along with pain and spotting, which may indicate an ectopic pregnancy
- there is fever, chills or foul-smelling vaginal discharge
- you faint, feel very dizzy or have a racing heart
- you have pain with vomiting that does not stop
- you use tampons and develop a high fever with a rash
For a personalized assessment of your case, book an appointment with Dr. Panagiotis Polyzos at his office in Athens or Volos.
Frequently Asked Questions
How many days of pain are normal?
Usually one to three days, peaking in the first 24 hours of the period. Pain that lasts the whole period or continues afterward should be checked.
Which painkiller is best for period pain?
Non-steroidal anti-inflammatory drugs are usually more effective than paracetamol (acetaminophen), because they target prostaglandins. They are not suitable for everyone, though, so ask a doctor or pharmacist.
Does a heating pad help?
Yes. Heat on the lower abdomen or lower back relaxes the muscles and reduces cramps, with no side effects.
Why do I hurt more than other women?
How intense the pain is depends on the amount of prostaglandins, heredity, stress and whether there is an underlying condition. If the pain seems out of proportion, it is worth getting checked.
Does period pain decrease after childbirth?
For many women yes, especially when there is no other cause. It is not true for everyone, though.
When should I take a painkiller for period pain?
At the first sign of cramping or when the bleeding starts, not when the pain has peaked. If your pain is predictable, your doctor may suggest starting one day earlier.
Does sex help with period pain?
For some women, yes. Orgasm causes contractions followed by relaxation of the uterus, and it releases endorphins. But if sex is painful, that is a symptom you should mention to your doctor.
Is it normal to vomit from period pain?
Nausea is common, because prostaglandins also affect the bowel. Occasional vomiting at the start of your period is not a cause for concern. But if vomiting happens every month or keeps you from holding down fluids, you need a medical assessment.
Can an IUD make period pain worse?
A copper IUD can make periods heavier and more painful, especially in the first months. A hormonal IUD, on the other hand, usually reduces both pain and flow. If the pain suddenly increases after some time, ask to have its position checked.
When is period pain considered dysmenorrhea?
The medical term dysmenorrhea describes painful periods in general. Medical investigation is needed when the pain keeps you from functioning, is not controlled with painkillers or gets worse over the years.
