Period Pain - How to manage?

Simply put, a period occurs as a result of the lining of the womb (uterus) breaking down – every month it prepares the womb for a potential pregnancy, making the lining thicker and increasing blood supply. It’s thought that this constant tissue generation, breakdown and renewal process keeps the womb environment free from any build-up of bacteria, making it a sterile environment to keep you and any future babies healthy.

You will experience contractions as the womb starts to shed the thick lining, cutting off the blood supply so the tissue comes away. The contractions are what we call period pains and the shedding is menstrual bleeding. Prostaglandins help this shedding process – these are hormones that have a hand in inflammation and bleeding, helping tissue to repair.

But too many prostaglandins are thought to increase period pain. It’s not known why some women produce more prostaglandins than others, but it’s thought to have a genetic component (ask your mother or grandmother).

Other female hormones help to control the menstrual cycle, and these can also give you uncomfortable sensations alongside period cramps, like bloating, appetite changes, breast tenderness, headaches and feeling a bit low, irritable or tearful.

Understanding the science behind the problem helps us pick the right treatment. Ibuprofen and others in the family of non-steroidal anti-inflammatory drugs (NSAIDs like aspirin can be an excellent choice, as they specifically target and block prostaglandins. Taken orally as tablets or liquid, they can transform your period pain to allow you to get on with your day.

What about a gel?

Ibuprofen gel is less likely to work, as the problem lies with the lining of the womb (uterus), so topical treatment to the skin may not reach this deep into the tissue.

When should I start an NSAID?

Prostaglandins can accumulate in the days leading up to menstrual bleeding, so it’s a good preventative measure to start ibuprofen a couple of days before you expect your period, and block this build-up. A diary or app can help you keep track of your next period so you can pre-empt symptoms.

Who should avoid NSAIDs?

You should avoid NSAIDs if you’ve had stomach ulcers or an allergy, you have NSAID-sensitive asthma, or if you have long-term kidney disease. You should avoid aspirin if you are under 16.

In this case, or if your period pain is very mild, paracetamol may be the best option for you. It’s a mild painkiller, it’s considered safe and tolerated well, and if that does the trick, then that’s all you need.

If period pain is all-consuming, you’ll want to have a few remedies to hand, and these tried and tested techniques can work alone or alongside medication.

Heating pads

Heat can help to ease the pelvic muscles causing contractions. A good place to start is applying heat packs over the lower abdomen – a hot water bottle wrapped in a towel, for example, or try a warm bath. If you need to get to work or school, a heat patch or heating pad under your clothes can be a convenient and effective method to soothe, or you can try specific creams or balms that act to warm the area.

TENS machine

A TENS machine (transcutaneous electronic nerve stimulation) may help to reduce pain. It works by delivering a mild electric current to your tummy and can also be effective for any associated back pain. It’s most associated with relieving the pain of contractions in childbirth, which suggests how effective it can be.

Exercises techniques

Simple movements to gently move the pelvis around can be very soothing and help reduce inflammation. One suggested move is to lie on your back with knees bent and feet on the floor, and gently create a bridge by lifting your pelvis up and down in slow movements. Another exercise is to lie on your back, bend your knees to your chest, and move 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

Finally, don’t underestimate the power of the mind when it comes to pain relief. Relaxation techniques such as mindfulness, meditation or gentle yoga may help to distract from the discomfort, calm the mind, and prevent stress and anxiety building up in relation to period pain.

Give up smoking

If you need any other reason to take this step to look after your health, there’s evidence that smokers may suffer worse period pain than non-smokers, and one Australian study suggested that the severity of period pain correlated with the number of cigarettes smoked per day. Check our helpful guide on how to quit smoking.

Ginger tea

Ginger tea has good anecdotal evidence that it eases pain and inflammation for all sorts of ailments, including period pain, and it can feel comforting to hold a warm cup when you’re not feeling your best.

Vitamin and mineral supplements

A comprehensive review of trials of so-called micronutrients (vitamins K, D, B1, and E, and calcium, magnesium, zinc sulfate and boron), found that vitamins D and E significantly reduced dysmenorrhoea, compared to placebo, but the Journal of Caring Sciences concluded that more research was needed to confirm safety and effectiveness. Anecdotally, many women believe magnesium taken daily helps reduce the severity of their period pain.

Antioxidant-rich diet

Adding lots of antioxidant foods to your diet may help to reduce inflammation and hence crampy pain – this includes lots of fresh and raw fruits and vegetables, whole grains, nuts and seeds. To date, the direct effect on alleviating dysmenorrhoea remains a theory and there’s no evidence to support this, but here at Healthwords, a plant-based diet with lots of varied and colourful foodstuffs would always get our vote to keep you healthy.

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. Another type of NSAID, mefanamic acid, is often used to good effect for mild to moderate pain, although it is less good at reducing any associated inflammation. Your doctor will advise on the dose and frequency, and they suggest increasing this on review.

Hormonal contraceptive methods may also help, such as the contraceptive pill, implant or injection, or a contraceptive coil that delivers progestogen. All of these can help reduce the build-up of prostaglandins and thereby reduce 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, pelvic inflammatory disease 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, as 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 a reason to book an appointment with your doctor.