Crampy pain in the lower tummy in the days before and during your period is something most women suffer, especially in your teens and 20s. For most, this is mild, but for some it can be debilitating, causing them to miss school, college or work, and becoming a feared monthly event in their calendar. When causing significant distress or impact on your life, doctors call this dysmenorrhoea. It’s not something you need to put up with, just as part of being a woman. There are things to help. You should also take comfort that you’re not alone: this is common, and shouldn’t be ruling your life. Let’s go through what might help you.
There are tried and tested methods that can help, either with or without medication. Try heat packs over the lower tummy – a hot water bottle wrapped in a towel, for example, or a warm bath. Also try simple exercises to gently move the pelvis around, as this can help. One is lying on your back with knees bent and feet on the floor and gently creating a bridge by lifting you pelvis up and down slowly. Another is lying on your back, bend your knees and moves them gently in circles with your hands. This will also help if pain has spread from the tummy to the lower back and thighs. Relaxation techniques such as mindfulness or gentle yoga may help to distract from the discomfort and prevent stress and anxiety building up in relation to period pain. Smoking may make period pains worse, so it’s a good reason to quit. It’s always best to start with the safest and mildest pain relief – if that does the trick, then that’s all you need. Paracetamol is first on the list, it’s safe for all ages, and may just be enough to make your muscle cramps more tolerable.
Ibuprofen is the next step up in pain relief, and it belongs to a class of drugs called non-steroidal anti-inflammatories (NSAIDs). These specifically target and block prostaglandins, a hormone released in inflammation and a key player in period pain. This can transform period pain, and you can buy ibuprofen over-the-counter. Ibuprofen gels are less likely to work, as the problem lies with the lining of the womb (uterus), to it may not reach them sufficiently. A TENS machine (transcutaneous electronic nerve stimulation) may help to reduce pain. It works by delivering a mild electric current to your tummy, and is also used in labour.
If pain is more severe, it may be that you need a stronger NSAID, and your doctor will need to prescribe this. Naproxen is a good choice, as a stronger version of ibuprofen, and mefanamic acid is frequently used to good effect, although it is less good at reducing any associated inflammation. Your doctor will advise on the dose and frequency, and may need to increase this on review. Contraceptive methods may also help, such as the contraceptive pill, implant or injection, or the Mirena coil, which delivers progestogen directly from a device inserted in your womb. Any of these reduce the build-up of prostaglandins to ease period pain. If your period pain is bad enough for you to miss school, college or work repeatedly, or you have the same crampy spasms when you are not having your period, you should see your doctor as there may be other causes such as endometriosis or fibroids. These are more likely to occur in your 30s and early 40s. If you are getting pelvic pain during sex, or bleeding after sex or between periods, or an unusual vaginal discharge, this is reason to see your doctor or go to a sexual health clinic near you. A sexually transmitted infection or pelvic inflammatory disease may be the cause. Painful periods often go hand-in-hand with heavy periods (menorrhagia), and if this is difficult to manage, this is also reason to book an appointment with your doctor.
Prostaglandins can accumulate, so it’s a good idea to keep tabs on when your period is due, and start NSAIDs – whether you’ve bought ibuprofen or you’ve been prescribed stronger medication – a couple of days before you expect your period. Pain can start before the period, but most women experience it Download an app, keep a diary, and try to pre-empt the period cramps. This will reduce the build-up of prostaglandins in the first place, and hopefully make the pain relief more effective.