When period pain may need investigating
Period pain is common, but severe or disruptive pain shouldn’t always be something you simply learn to live with.
If you’ve ever said, “My periods are really painful, but I suppose that’s normal”, you’re certainly not alone.
Over the years, I’ve seen just how easily women can normalise significant period pain.
It might be because they’ve always had painful periods, because other women in their family experience the same thing, or because they were reassured that painful periods are simply something they have to put up with.
And while some period pain can be normal, there is a difference between having some discomfort with your period and having pain that regularly interferes with your life.
So, how do you know which is which?
Some period pain is normal
Period pain, or dysmenorrhoea, is very common. It usually happens around the beginning of your period and is caused by the uterus contracting as it sheds its lining.
You might experience some cramping or aching in your lower abdomen, perhaps with some backache or a general feeling of discomfort.
For many women, this is manageable with simple measures such as heat, rest and appropriate pain relief, and it settles within the first few days of the period.
But period pain shouldn’t have to take over your life.
If you regularly find yourself arranging your work, social life, exercise or family commitments around your period because you know you’ll be in too much pain to function normally, that’s something I’d want to hear about.
“But my periods have always been like this…”
This is one of the most common things I hear in clinic.
And I completely understand why women assume that long-standing symptoms must be normal.
You may have grown up hearing that periods are painful. Perhaps your mum had terrible periods too. Maybe you’ve always been told that it’s simply part of being a woman.
But just because something is common doesn’t mean you have to put up with it.
Pain that has been there for years can still have a cause, and sometimes women don’t realise how much their symptoms have affected their lives until they start talking about them properly.
What sort of period pain should you have checked?
I would encourage you to speak to a healthcare professional if your period pain:
- Is severe or regularly stops you from doing normal activities.
- Makes you miss work, school, exercise or social plans.
- Requires you to take regular or strong pain relief just to get through your period.
- Is getting worse over time.
- Lasts for several days or continues after your period has finished.
- Is associated with pain during or after sex.
- Causes pain when opening your bowels or passing urine, particularly around your period.
- Is accompanied by persistent pelvic pain between periods.
- Is affecting your fertility or you are having difficulty conceiving.
You don’t need to have all of these symptoms. If your pain is affecting your quality of life, it’s reasonable to ask whether there might be an underlying reason.
Could there be a reason for your pain?
There are several conditions that can cause painful periods or pelvic pain.
Endometriosis
Endometriosis is one of the conditions we think about when period pain is severe, particularly when there are other symptoms such as pain during sex, bowel or bladder symptoms, or difficulties with fertility.
Importantly, endometriosis doesn’t look the same in every woman.
Adenomyosis
Adenomyosis occurs when tissue similar to the lining of the womb grows into the muscle of the uterus.
It can cause painful periods, heavy bleeding and pelvic pain, and symptoms can sometimes become more noticeable as women get older.
Fibroids
Fibroids are non-cancerous growths that develop in or around the womb. Depending on their size and location, they can cause heavier periods, pelvic pressure or pain.
Other causes
There are other possible causes of pelvic or period pain too, including ovarian cysts, pelvic infections and other gynaecological conditions.
That’s why the symptoms you describe are just as important as what we see on a scan.
What if my ultrasound is normal?
This is another really important question.
A normal ultrasound scan can be reassuring, but it doesn’t necessarily mean that there is no explanation for your symptoms.
Some conditions can be difficult to identify, particularly if the scan isn’t performed with a specific clinical question in mind. This is why, when we’re investigating pelvic pain, we don’t just look at the scan in isolation.
Your symptoms, your menstrual cycle, your medical history, any previous surgery or pregnancies, your fertility plans and what you’re experiencing day to day all help us understand the bigger picture.
A good gynaecological assessment isn’t simply about looking at an ultrasound image and saying, “Everything looks normal.”
It’s about asking whether the findings make sense alongside your symptoms.
So, what should you do if your periods are really painful?
The first step is simply to talk to someone.
Try to be as specific as you can about what your pain is like and how it affects you. It can be helpful to keep a note of when the pain happens in relation to your period, how severe it is, how long it lasts and whether you notice other symptoms.
You don’t need to arrive at an appointment knowing whether you have endometriosis, adenomyosis or something else. You just need to be able to tell us what you’re experiencing.
From there, we can decide whether further assessment or investigation would be helpful.
You don’t have to put your life on hold for your periods
One of the things I would most like women to take away from this is that painful periods are common, but debilitating period pain isn’t something you should automatically accept as your normal.
You know your body better than anyone.
If your period regularly leaves you curled up in bed, unable to work, unable to exercise, unable to sleep, or planning your life around when your next period is due, it’s worth talking about.
There may be a straightforward explanation. There may be something that needs further investigation. And sometimes we may not find a single cause straight away.
But you deserve to be listened to.
If your periods are affecting your life, don’t be afraid to ask: “Is this really normal for me?”
It may be the first step towards getting the answers you’ve been looking for.