Painful periods: Are They Normal or not?
Dr. Kate Dudek • February 25, 2019 • 5 min read
Dysmenorrhoea is the term used to describe painful periods. Dysmenorrhoea is the most common gynaecological problem, affecting many women at some point during their menstruating years. Exact prevalence is difficult to ascertain, but it is thought that up to 80% of women suffer from painful cramps and related symptoms during their period.
Dysmenorrhoea is broadly categorized as being either primary or secondary. Primary dysmenorrhoea means that there is no underlying pathology; secondary dysmenorrhoea is always accompanied by a specific pelvic pathology. The most common form of secondary dysmenorrhoea is endometriosis; however, to put it into perspective, only about 10% of women who experience painful periods will be diagnosed with secondary dysmenorrhoea. Thus, the vast majority have primary dysmenorrhoea.
Primary dysmenorrhoea
Normal painful periods, primary dysmenorrhoea, usually occur for the first time 6-12 months after a girl gets her first period. The most common symptom is a cramping pain in the lower abdomen. Other symptoms include backache, headaches, diarrhoea, nausea and vomiting. The cramps normally last for between eight and 72 hours, coinciding with the start of menstrual flow. Stress and an unhealthy lifestyle (poor diet, smoking and obesity) are thought to exacerbate the condition and it is generally worse in those who have heavy periods. Some women notice an improvement in symptoms over time, particularly post-childbirth.
Secondary dysmenorrhoea
Endometriosis is not the only cause of secondary dysmenorrhoea; other conditions that affect the pelvis, such as fibroids, pelvic inflammatory disease (PID), polyps and adenomyosis, are also frequently associated with painful periods.
The major differences between primary and secondary dysmenorrhoea are that the latter can start at any time, often not affecting women until they reach their 30s or 40s; in addition, the timing and duration of pain can be different, as can the accompanying symptoms. With secondary dysmenorrhoea, the pain may be longer-lasting, or constant. Women often report heavy or irregular periods, dyspareunia and bleeding between periods. Ultrasound investigation can be used to identify any pelvic abnormality, aiding diagnosis.
Sometimes secondary dysmenorrhoea is accompanied by infertility. Secondary dysmenorrhoea also has a familial link, so is more likely in women who have a close female relative with the condition.
What causes dysmenorrhoea?
Dysmenorrhoea is usually triggered by an excess of prostaglandins. These specialised compounds have hormone-like properties and are released by the cells of the endometrium just prior to the start of menstruation. They stimulate the uterus to contract, which encourages the endometrial lining to shed. These contractions are responsible for the painful cramps characteristic of dysmenorrhoea. Furthermore, the localised blood vessels are compressed, reducing oxygen flow and triggering the activation of nearby pain receptors. The evidence for an involvement of prostaglandins comes from the discovery that women who experience severe period pain have higher levels of prostaglandins in their menstrual flow. Conditions such as endometriosis have also been shown to induce an inflammatory response, resulting in the release of additional prostaglandins.
In conclusion, painful periods affect many women, but endometriosis will probably be diagnosed in fewer than 10% of cases. If dysmenorrhoea is negatively impacting your quality of life, or you are experiencing any of the other symptoms associated with the secondary form of the condition, it is recommended that you speak with a healthcare professional. At the very least, they will be able to offer advice on how to alleviate the painful cramps.
Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and menopause.
Get in touch if you have any questions about this article or any aspect of women’s health. We’re here for you.
Sources:
- Osayande, A S, and S Mehulic. “Diagnosis and Initial Management of Dysmenorrhea.” American Family Physician, vol. 89, no. 5, 1 Mar. 2014, pp. 341–346.
- Proctor, M, and C Farquhar. “Diagnosis and Management of Dysmenorrhoea.” BMJ, vol. 332, no. 7550, 13 May 2006, pp. 1134–1138., doi:10.1136/bmj.332.7550.1134.
- Period Pain. NHS, www.nhs.uk/conditions/period-pain/. Page last reviewed: 28/07/2016.
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What are Sanitary Pads?
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What Type of Sanitary Products is Right for me?
From the time that a female starts her periods when she enters [](https://nabtahealth.com/what-is-puberty/)[puberty](https://nabtahealth.com/glossary/puberty/) until she reaches [](https://nabtahealth.com/about-the-three-stages-of-menopause/)[menopause](https://nabtahealth.com/glossary/menopause/) and stops having periods, menstrual hygiene will become something that she has to carefully consider. Most women menstruate for about 40 years and regular periods are a good indicator that a female is reproductively healthy. Although, unfortunately there are exceptions to this, for example women with [](https://nabtahealth.com/what-is-endometriosis/)[endometriosis](https://nabtahealth.com/glossary/endometriosis/) often have periods that appear normal. As menstruation is such a fundamental part of being a woman of reproductive age, taking the time to explore and sample the available sanitary products can help make periods more manageable. Deciding on which sanitary products to use can be influenced by a range of factors, including: * Cost * Environmental impact * How often the product will need changing throughout the day * Local availability * Heaviness of flow * Personal preference and/or recommendations by friends and family. The range of sanitary products available today means that the majority of women are able to manage their periods safely, comfortably and with dignity; in contrast to days gone by when old rags and sheep wool were commonly used to soak up menstrual blood. **Sanitary pads** ------------------- A common choice for girls who have only just started their periods. [Sanitary pads](https://nabtahealth.com/what-are-sanitary-pads/) are also known as sanitary napkins and sanitary towels. They are narrow pieces of absorbent material that fit directly into the underwear. Easy to use and change, they are available in different absorbencies to suit differing flow rates and times of the day. 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They are made from pure cotton, as it is the best material for absorbing and also the most comfortable to wear. **Tampons** ----------- Often preferred over sanitary pads by dancers, athletes and swimmers, [tampons](https://nabtahealth.com/what-are-tampons/) are worn internally. A simple concept, they are devised of a wad of cotton attached to a string. Some come with a plastic applicator for ease of insertion. Once inserted into the [vagina](https://nabtahealth.com/glossary/vagina/), they expand slightly to absorb menstrual blood. They will typically need changing every 4 to 6 hours and, as such, are not ideal for wearing overnight. In the 1980s, an association between tampon use and Toxic Shock Syndrome (TSS) was reported. Whilst the overall risk of developing TSS remained very low, the link between it and tampon use was enough to put some women off using them for prolonged periods of time. Like disposable pads, tampons incur significant plastic waste and many women today strive for alternatives that are more environmentally friendly. **Menstrual cups and disks** ------------------------------ A [menstrual cup](https://nabtahealth.com/what-are-menstrual-cups-and-why-are-they-growing-in-popularity/) is a reusable hygiene product. The cup is made from medical-grade rubber or silicone, it is small and funnel-shaped and is inserted into the [vagina](https://nabtahealth.com/glossary/vagina/), where it forms a seal and collects menstrual blood. There are disposable menstrual cups, but it is the reusable ones that have really been growing in popularity in recent years. The menstrual cup holds up to 38 ml fluid, meaning it requires changing less often than a sanitary pad or tampon; it also has fewer of the negative associations with TSS that tampons have. Whilst it can take a few attempts to master the [art](https://nabtahealth.com/glossary/art/) of insertion, leakage rates are low once the cup is in position. Reusable menstrual cups should be washed and wiped clean before each use and sterilised at the end of your period. Modern menstrual cups are very durable and can last for up to 10 years with proper care. Menstrual disks and cups are similar as both are inserted into the [vagina](https://nabtahealth.com/glossary/vagina/) and both collect blood rather than absorbing it. Disks typically sit higher up, where the [vagina](https://nabtahealth.com/glossary/vagina/) meets the [cervix](https://nabtahealth.com/glossary/cervix/) (the [vagina](https://nabtahealth.com/glossary/vagina/) fornix). Unlike cups, disks are usually not reusable and will need to be discarded after use. They can also be slightly messier to remove than cups. ### **_Advantages of menstrual cups and disks_** * They are affordable. * Potentially safer than tampons * Hold more blood than other sanitary products, meaning you can go longer without changing them or emptying them. * The reusable varieties are more eco-friendly than disposable pads or tampons. ### **_Disadvantages of menstrual cups and disks_** * Emptying them can be messy. * In very rare cases, may cause an allergic reaction. However, most modern varieties are made from hypoallergenic materials. * Vaginal irritation, particularly if not accurately inserted. * Hard to remove or insert. **Period pants** ---------------- Period underwear ([period pants](https://nabtahealth.com/what-are-period-pants/)) are a relatively new addition to the portfolio of sanitary products. These are more like normal underwear, except that they have additional layers of material built in to absorb any period blood. There are different types of pants available for light, medium, and heavy flow days. They can be worn alone, or as a back-up alongside tampons or menstrual cups. Fully reusable, they are another of the more environmentally-friendly options and, because there is no need for any internal insertion, they are a good option for those who are hesitant to use tampons, cups or disks. These special pants can also provide welcome relief for those who experience urinary incontinence. In conclusion, there are now a large selection of products that allow you to go about your normal life whilst on your period each month. Selecting the right product will minimise the risk of leaking, discomfort, embarrassment and inconvenience. Consider a women health test to learn more on your health. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#146d75787875547a757660757c717578607c3a777b79) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Eijk, Anna Maria Van, et al. “Menstrual Cup Use, Leakage, Acceptability, Safety, and Availability: a Systematic Review and Meta-Analysis.” _The Lancet Public Health_, vol. 4, no. 8, 1 Aug. 2019, pp. E376–E393., doi:10.1016/s2468-2667(19)30111-2. * Hajjeh, Rana A., et al. “Toxic Shock Syndrome in the United States: Surveillance Update, 1979–19961.” _Emerging Infectious Diseases_, vol. 5, no. 6, 1999, pp. 807–810., doi:10.3201/eid0506.990611. * “How Tampons and Pads Became so Unsustainable.” _National Geographic_, 18 Oct. 2019, [www.nationalgeographic.com/environment/2019/09/how-tampons-pads-became-unsustainable-story-of-plastic/](http://www.nationalgeographic.com/environment/2019/09/how-tampons-pads-became-unsustainable-story-of-plastic/). * “Menstrual Cups vs. Tampons: Things You Might Not Know.” _Mayo Clinic_, Mayo Foundation for Medical Education and Research, [newsnetwork.mayoclinic.org/discussion/menstrual-cups-vs-tampons-things-you-might-not-know-about-the-cup/](https://newsnetwork.mayoclinic.org/discussion/menstrual-cups-vs-tampons-things-you-might-not-know-about-the-cup/). * “Tired of Tampons? Here Are Pros and Cons of Menstrual Cups.” _Health Essentials from Cleveland Clinic_, Health Essentials from Cleveland Clinic, 15 Nov. 2019, [health.clevelandclinic.org/tired-of-tampons-here-are-pros-and-cons-of-menstrual-cups/](https://health.clevelandclinic.org/tired-of-tampons-here-are-pros-and-cons-of-menstrual-cups/).