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This site gives you information NOT medical advice. You should consult your medical practitioner if you have any unexplained symptoms of illness or concerns about treatment. Do not stop a prescribed conventional treatment without consulting a doctor. Tell all the practitioners you're working with, conventional or complementary, about any medicines, remedies, herbs or supplements you are taking or considering using.

Period Problems

What do we mean by Period Problems?

Period Pains
Most women say their periods can sometimes be uncomfortable. One woman in ten gets pain that is bad enough for her to take time off school or work. Doctors call painful periods dysmenorrhoea (pronounced dis-men-or-ee-a), often shortened to dysmen (pronounced dis-men).

Primary period pain is the commonest kind. It causes crampy pains below the navel, usually affecting women during their teens and twenties. This is distressing and uncomfortable but it doesn’t indicate any basic problem with the womb or nearby in the pelvis.

Secondary period pain is more likely to be experienced by women in their thirties and forties. The pain is due to a problem in the uterus or nearby in the pelvis, so your doctor will want to find out why. Sometimes periods get heavier as well, depending on the cause of the pain (for example, pelvic infections, endometriosis or fibroids). Some intra-uterine contraceptive devices (IUDs) trigger more painful and/or heavier periods.

This leaflet is not about secondary period pain or heavy periods.

What causes primary period pain?

Every month, your womb (uterus) builds up its lining in preparation for pregnancy. If you don’t get pregnant, the lining dissolves. Chemicals called prostaglandins encourage the womb to contract to help squeezes the lining out. The contractions can be painful if the prostaglandins mount up. Even though there is nothing wrong with the womb, very strong contraction can reduce the blood supply enough to cause painful cramps.

When periods first start, they are often painless. But it’s quite common for crampy pains to start up to a year later. Period pains can cause aching in your lower back or even your upper thighs. Discomfort may begin the day before bleeding. It usually lasts less than a day, but can carry on for as long as three days. Some periods hurt more than others. Primary period pain usually eases off after having a baby, or as you get older.

Treatment options for primary period pain

Most women with mild dysmenorrhea treat themselves. If self-care and over-the-counter medicines have not helped enough, you should get your GP’s advice.

Your doctor might prescribe stronger non-steroidal anti-inflammatory drugs (NSAIDs). The combined oral contraceptive pill makes the lining of the womb thinner, so this can help reduce period pain. Progestogen-only contraceptive pills and injections can have the same effect. There is also an intra-uterine contraceptive device that slow-releases progestogen. Ask your GP or clinic for details of these options if you need contraception as well as pain relief.

What do we mean by PMS?

Some women get unpleasant symptoms before their periods. These symptoms may include increased nervous tension, so PMS is sometimes also called premenstrual tension (PMT). PMS symptoms include headaches, sore breasts, feeling sick or tired, a bloated abdomen, diarrhoea, and feeling irritable, moody or weepy.

If you get PMS you may find that you feel unusually impatient, angry, low, anxious, lacking in confidence, weepy, tense, nervy, irritable or tired. You might find you sleep more, or less than usual; that your sex-drive goes down, or up; or that you get more, or less hungry. These emotional changes can put an added strain on relationships or make your job or home-life more difficult.

Some symptoms of PMS are physical rather than emotional. These may include headaches, swelling and/or soreness in your abdomen, breasts, feet or hands, and fluid retention and/or weight gain. Other health problems, such as migraine, cold sores, epilepsy and asthma, might get worse too.

What causes PMS?

Each month, one of your ovaries lets go of an egg and starts making more of a hormone called progesterone. Progesterone triggers symptoms in women who are extra-sensitive to it. This sensitivity to progesterone probably affects the way the mood chemical known as serotonin works in the brain. Selective Serotonin Re-uptake Inhibitors (SSRIs) are medicines that help relieve severe PMS, probably by increasing the amount of serotonin in the brain.

Why do I get PMS?

PMS can be a problem whatever your age, but more often in your thirties and forties than in your twenties. Most women only get mild symptoms but 1 in 20 women have PMS that is bad enough to interfere with their everyday life, work, family and friendships.

There is an overlap between PMS symptoms and those of anxiety or depression. The difference is that PMS symptoms come and go with your period cycle. If you are not sure whether you have PMS or depression, keep a diary of your symptoms, and when they occur for three cycles. PMS symptoms may begin as soon as you have ovulated – usually about a fortnight before your period. But more commonly they start in the five days before your period, steadily increasing until your period begins and generally easing up within four days of your period starting.

Looking after yourself

Most women find that self-care is all they need: being aware that they have PMS, understanding what causes it, learning to forecast their symptoms and planning ahead to reduce the pressure they are under at these times. Exercise, diet and relaxation skills may help too (see below).

Here are some simple tips that may ease your PMS:

  • Learn to anticipate your PMS symptoms, so you can predict the difficult days in your monthly cycle. Use a diary or a chart to mark days when you are likely to get mood changes or physical symptoms. Note how soon before a period they begin, and when they fade away.
  • Adjust to your PMS cycle. Once you can predict the pattern, knowing when the most difficult days are likely to fall, you can prepare for them. Even if you can’t keep the worst PMS days free, you can at least be aware that these are times when your mood and sensitivity might cause problems.
  • Be open about your PMS. Your family and friends may have noticed your ups and downs already; your partner too. Tell them what’s going on. But choose a time to discuss it when you’re not having PMS!
  • Get active. Some women say their PMS is less bothersome if they exercise regularly. You might need to do this three or four times a week for it to help. Those who exercise regularly say they have fewer problems with PMS. Try doing some regular exercise several times a week.
  • Watch what you eat and drink. Some women get food cravings before their periods, often for sugary and fatty foods. But these foods can sometimes make their PMS symptoms worse. Try eating fewer carbohydrates before your period.
  • Cut down on caffeine and alcohol. Alcohol and caffeine (found in tea, coffee, cola and energy drinks) sometimes make PMS worse. See if reducing them works for you.

Other information

If you have tried our suggested self-care methods and still find your PMS is interfering a lot with your everyday life, your doctor might recommend one of the following medical treatments for severe PMS:

  • the combined oral contraceptive pill (COCP)
  • cognitive-behavioural therapy (CBT)
  • oestrogen patches or gels
  • if you feel sore in several places in your body as well, see the leaflet on Sore Muscles
  • if diarrhoea and constipation and bloating are persistent problems, see the leaflet on IBS
  • if you are exhausted most of the time, see the leaflet on Tiredness, Fatigue and Feeling Run-Down

Further information and advice