Period pain: what actually helps, and when it is not normal

Period pain is so common that it often goes unmentioned, and many people assume that whatever they experience is simply what periods are. Some discomfort is indeed normal. Pain that stops you working, studying or sleeping is not, and it deserves looking at rather than enduring month after month.

Why it hurts

During a period the womb contracts to shed its lining, and it does so under the influence of natural chemicals called prostaglandins. Those contractions briefly reduce the blood supply to the muscle, which is what produces the cramping sensation. People who make more prostaglandins tend to have stronger cramps, and they also tend to get the nausea, loose stools and headaches that often come alongside.

Understanding that explains why one family of painkillers works noticeably better than another here.

What works, roughly in order

Anti-inflammatory painkillers such as ibuprofen work by reducing prostaglandin production, so they address the cause rather than only the sensation. They are usually more effective for period pain than paracetamol. Start them as soon as the pain begins, or even the day before if your cycle is predictable, rather than waiting until it is severe. Take them with food.

Heat genuinely helps and is not merely comforting; a hot water bottle or a heat patch on the lower abdomen relaxes the muscle and has been shown to work about as well as a painkiller for mild to moderate cramps. The two together are better than either alone.

Gentle movement — walking, stretching, light exercise — helps many people, although it is the last thing you feel like doing. Staying hydrated and reducing caffeine in the days beforehand helps some. Lying still for three days usually makes everything worse.

Hormonal options

If pain is bad every month, hormonal contraception is often very effective, and it is used for this reason as much as for contraception. The combined pill usually makes periods lighter and less painful; the hormonal coil frequently makes them very light or stops them altogether. Neither is a drastic step, and both are reversible.

This is worth raising even if you are not currently sexually active, because the benefit is to the pain rather than to contraception. Many people spend years not knowing it is an option.

When it is not ordinary period pain

• Pain that has become steadily worse over months or years.
• Pain that lasts beyond your period, or occurs at other times in the month.
• Pain during sex, or when passing urine or stool during your period.
• Bleeding so heavy you are changing protection every hour, or passing large clots.
• Bleeding between periods or after sex.
• Difficulty becoming pregnant alongside painful periods.

Any of these deserves proper assessment. Conditions such as endometriosis and fibroids are common, treatable, and routinely dismissed as ordinary period pain for years before anybody investigates. If you recognise yourself in that list, please do not wait.

Keeping a simple record

Before any appointment, a few months of notes are worth more than a long description from memory. Record the first and last day of bleeding, how heavy it was, how bad the pain was out of ten, what you took and whether it helped. A phone app or the back page of a notebook both work.

That record turns a vague conversation into a specific one, and it often reveals a pattern that neither you nor anyone else had noticed.

Worth noting before an appointment

• The first and last day of bleeding each month.
• How heavy it was, and whether you passed large clots.
• How bad the pain was, out of ten.
• What you took and whether it helped.
• Any pain outside your period, or during sex.

Questions we are asked about this

When should I take the painkiller?

As soon as the pain begins, or even the day before if your cycle is predictable. Anti-inflammatory painkillers work by reducing the chemicals that cause the cramping, so getting ahead of them works far better than catching up once the pain is severe.

Is it normal to feel sick or have loose stools with my period?

It is common, and it comes from the same chemicals that cause the cramps acting on the gut. It usually improves with the same anti-inflammatory treatment. If it is severe every month, it is worth mentioning.

Can contraception be used for pain rather than contraception?

Yes, and it often is. The combined pill and the hormonal coil both commonly make periods much lighter and less painful, and that is a legitimate reason to use them whether or not you need contraception.

How heavy is too heavy?

Changing protection every hour or two, flooding through clothing, passing clots larger than a coin, or needing to plan your life around your period all count as heavy and are worth assessing. Heavy periods are also the commonest cause of iron deficiency in women.

This article is general information from the Dantrio Pharmacy team. It cannot take the place of advice from a pharmacist or doctor who knows your medical history. If you feel seriously unwell, seek medical help straight away.