What Causes Painful Periods?

Painful periods are usually caused by womb contractions, but conditions such as endometriosis, adenomyosis, fibroids, ovarian endometrioma, or pelvic inflammatory disease can also cause them. The medical term is dysmenorrhoea. Cramping may begin shortly before bleeding or during the first days of a period, and the discomfort can spread to the lower back or thighs.

Primary period pain comes from chemical signals that make the womb tighten while it sheds its lining. Secondary period pain is linked to another pelvic condition and may appear for the first time later in life, become stronger over time, last beyond the early bleeding days, or occur with pain during sex, bowel movements, or urination. Endometriosis involves tissue similar to the womb lining outside the womb; adenomyosis involves similar tissue within the womb muscle. Fibroids and ovarian endometrioma can also contribute, while pelvic inflammatory disease may cause pelvic pain alongside infection symptoms. A painful period does not by itself identify the cause.

Record when the pain starts, where you feel it, how long it lasts, how heavy the bleeding is, and whether it affects work or sleep. Heat over the lower abdomen, gentle movement, rest, and an anti-inflammatory medicine may help some people; use medicines only as directed and check suitability with a pharmacist or clinician, especially if you have stomach, kidney, bleeding, or pregnancy concerns. A clinician can discuss anti-inflammatory therapy, hormonal options such as the combined pill, or evaluation for an underlying condition.

Arrange a medical assessment if pain is new, worsening, severe, or not controlled by self-care, or if periods are disrupting normal activities. Seek prompt care for severe pelvic pain with fever, unusual vaginal discharge, vomiting, faintness, or possible pregnancy. Contact a clinician if bleeding is unusually heavy, happens between periods, or occurs after sex. These features need assessment because infection, pregnancy-related problems, or a condition affecting the womb or ovaries may require specific treatment.

You could ask: What might be causing my pattern of pain? Do I need an examination or imaging? Which pain medicines are suitable for me, and when should I take them? Could hormonal treatment help? What symptoms should prompt urgent review?