Painful periods Dr Trisha Macnair There's hardly a woman on the planet who doesn't know the misery of period pains. Surveys show that 70 per cent of young women regularly use painkillers to cope with the pain and at least 50 per cent say it seriously disrupts their lives.

In this article

What is the cause? When is it not normal?

How is it treated? Further investigations

The pain that accompanies periods is caused by contractions of the uterus or womb, similar to those of another 'normal' pain women suffer - during labour.

Mild contractions constantly pass through the muscular wall of the womb, although most women are unaware of them. These are stronger than normal during menstruation and stronger still during labour.

Each contraction causes the blood supply to the womb to be cut down temporarily as the blood vessels in the muscle wall are compressed. As the tissues are starved of oxygen, chemicals that trigger pain are released.

At the same time the body is releasing chemicals called prostaglandins, which induce stronger contractions and which may directly cause pain in the womb. As the contractions get stronger, so the pain increases.

The aim of these contractions is to help the womb shed its delicate lining (as a period or bleed), so a new lining can be grown ready for a fertilised egg to implant itself. This is an essential part of female fertility, but pain is a side effect.

Severe period pains should always be investigated to check for a treatable cause

Severe period pains should always be investigated to check for a treatable cause.

As a rough guide, if you've had severe period pain (known as dysmenorrhoea) since around the time your periods first started, it's less likely a particular cause will be found. However, even if this is the case, other factors - especially stress - can make the pain more difficult to cope with. Treating these factors can therefore help reduce the pain.

There are exceptions to this. Conditions such as endometriosis can sometimes cause severe pain from an early age (although the pain typically gets worse as the disease does more damage with each monthly cycle). Other causes include fibroids, pelvic inflammatory disease and sometimes a narrowing of the cervix.

Bear in mind, though, that period pains are rarely a sign of disease, especially in younger women.

If the pain begins to interfere with your life, preventing you from working or coping with daily tasks, you should seek help.

The first step is to find a simple treatment that works for you. If this doesn't control the pain, talk to your doctor.

• Exercise - you may not feel like it, but getting active is a good way to ease pain. Try gentle swimming, walking or cycling.
• Painkillers - ibuprofen and aspirin can be particularly effective as they have anti-prostaglandin effects. Take them regularly throughout the day (following the packet instructions), not just when pain becomes difficult to cope with.
• TENS - transcutaneous electronic nerve stimulation, or TENS, is widely used for period pains. Small electrodes are placed on the abdomen to stimulate the nerve in the pelvic area in a way that may reduce pain.

If these measures fail to control the pain or your doctor suspects endometriosis or another condition, a more detailed investigation may be recommended.

This will probably involve using an ultrasound scan to check the organs in the pelvis or minor laparoscopy, using a telescopic instrument to look inside the abdomen and pelvis.

In the US, more invasive surgery is quite common. However, in the UK such operations are controversial, except for proven endometriosis.

The final option, hysterectomy (removal of the womb), may seem drastic, especially if there's no underlying disease. However, the agony of period pains can be so great that a few women - who've perhaps completed their families and have tried other treatments without success - feel it's a rational option.

This article was last medically reviewed by Dr Trisha Macnair in August 2007.