Period Problems

Warning
Warning:

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.

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:

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:

Further information and advice

When to see your doctor

Immediately:

As soon as possible:

simplechangesMake Some Simple Changes


simplechangesTreatment Options:


simplechanges Applying Heat for primary period pain

OverviewWarm water bottles, baths or showers probably help by increasing blood flow to the womb and relaxing your muscles. If your pain is short-lived, this may be enough to get you through the first few hours.
EvidenceTwo studies have suggested that heat might help with painful periods. In one study, it seemed to work better than paracetamol.
SafetyThere are unlikely to be any safety problems as long as you use warm (rather than hot) water bottles. If you use a heat pack of any sort, make sure you wrap it in a towel to protect your skin from burning.
Cost
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simplechanges Cutting down on alcohol and stopping smoking

OverviewSmoking seems to be linked to painful periods but we don't know whether stopping smoking reduces symptoms. There doesn't seem to be a link between drinking alcohol and getting period pain.
EvidenceMore research needs to be done to find out whether cutting down on alcohol and smoking are likely to ease painful periods.
SafetyCutting down on smoking and alcohol is safe, but if you are cutting down from heavy use, there can be side-effects, including loss of appetite and difficulty sleeping. There are unlikely to be side-effects if you are cutting down from a moderate alcohol intake. If you are a very heavy drinker, it is a good idea to see your GP and ask for some help while you're cutting down
CostThere are no costs. In fact you will save money
Find out moreNote: Moderate drinking means men should not regularly drink more than 3–4 units a day and women should not regularly drink more than 2-3 units a day.

A unit is:
- half a pint of ordinary-strength beer, lager or cider
or
- a small pub measure (25 ml) of spirits
or
- a standard pub measure (50 ml) of fortified wine such as sherry or port (20% alcohol by volume)

A small (125 ml) glass of basic wine is 1 and a half units.

See the information on NHS Choices on sensible drinking.

Giving up or cutting down on smoking? You can order a Quit Kit from the NHS.
You can also phone the NHS Free Smoking Helpline on 0800 022 4332
Evidence:
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simplechanges Cutting down on caffeine for PMS

OverviewWhen you feel tired it's tempting to reach for stimulating drinks such as tea, coffee, colas or so-called 'energy drinks'. They can give you a quick lift, but if you rely on them they will only keep you going until your energy stores run down further. Reducing caffeine might help with PMS.
Evidence[1] Cutting down on caffeine is likely to help reduce stress and anxiety, so may help with some symptoms of PMS.
Safety

If you are cutting down on large amounts of caffeine, headaches might be a problem for two or three days. It is better to reduce the amount of caffeine slowly, over a few days.
CostThere are no costs. In fact you will save money.
Evidence:
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simplechanges Exercise for primary period pain and PMS

OverviewScience tells us that our relatively lazy modern lifestyle is bad for our health. Being more active can keep you fit by making your heart and lungs work better, toning your muscles and strengthening your bones and joints. It also stimulates blood circulation to your brain and internal organs, boosts your immune system, and helps protect against osteoporosis. Importantly for people feeling low or depressed, it triggers brain chemicals that lift your mood and can generate a real sense of well-being. It can also be a very good way of meeting people, and it definitely makes a difference to all sorts of health problems. Regular exercise seems to change the way people experience pain, and it definitely lift mood. So in theory at least it ought to help primary period pain and PMS.

Exercise can include aerobics such as stepping and walking; strengthening exercises such as lifting weights or using resistance machines; and stretching for flexibility. Other types of exercise are Tai Chi, Qigong and yoga.
EvidenceThere is little evidence to show that exercise can help painful periods. But just getting more active even a half hour's walk every day may help.
SafetySupervised exercise programmes are safe for most people. But at first you might feel more tired. If you're not used to being active, start off slowly and build up gradually, doing a bit more every other day. If you feel worse, cut back, and increase your activity more slowly. If you think it isn't helping or that you're getting worse in any way, check with your doctor. Anyone with severe osteoporosis, joint problems, acute back pain or recent injuries should first get advice about exercise from a doctor or physiotherapist
CostYou can exercise at home for nothing - walking and gardening is all exercise - although you should get advice on the best exercises to do from a trainer first. There will probably be a small cost (usually £5-£8 a class), if you join an organised programme
Evidence:
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simplechanges Relaxation techniques for primary period pain

OverviewRelaxation training can make you more aware of how your body reacts to certain situations or pressures. It can help you control the stress response and improve your mood. Stress raises your blood pressure, speeds up your heart, makes your muscles tense and increases your sensitivity to pain. It also affects the way your stomach and intestines work. Relaxation methods include slow breathing and muscle relaxation, self-hypnosis and imagery techniques, or a combination of two or more
EvidenceThree research trials reported varied results for relaxation techniques when used for period pain. Only one of them suggested that it might be worth trying.
SafetyThese techniques are generally safe unless you have a severe or enduring mental health problem (see our leaflet on Stress and Anxiety).
CostsProgressive muscular relaxation can be learned from a book, CD, DVD or during exercise classes such as yoga classes. No costs are involved, although you may need to buy a CD, DVD or book. If you have access to the Internet, you can visit www.bhma.org for podcasts and leaflets.
Evidence:
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simplechanges Special diets for PMS

OverviewSome women say their PMS is worse if they eat the wrong foods. Food cravings can be part of PMS. If you crave chocolate and sweets, and eat lots of them, this could be making your symptoms worse.
Evidence[?] Low-carbohydrate diets (in which you exclude foods like bread, rice and potatoes) are worth trying. But they don't work for everyone.
Safety

It can be quite difficult to exclude certain foods and still have a balanced diet. If you want to make big changes to what you eat, it is a good idea to see a dietician. They can help you make sure you are still eating a healthy diet and getting all the nutrients you need.
Cost

Eating a healthy diet and excluding some foods need not cost you anything. But if you consult a dietician there will be a charge, unless this is a service provided by your GP's practice.
Evidence:
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buysomethingBuy Something


buysomethingTreatment Options:


buysomething Before You Buy

OverviewFor safe use of over-the-counter medicines, herbal remedies and supplements:

Consult a qualified person (such as a pharmacist) before buying or taking any medicine, remedy or supplement:
- if you have a serious medical condition
- if you are breast-feeding, pregnant or planning to become pregnant
- if you are already taking other medicines, herbal remedies or supplements
- if you suffer from allergies

Always read the package insert before taking any product.
Avoid taking the product if you think you may be allergic to any of the ingredients.
Do not combine any over-the-counter medicines, remedies or supplements with other medicines, remedies or supplements unless you have first checked with a qualified person (such as the pharmacist in your local chemist).

Seek advice from your doctor or pharmacist:
- If your symptoms do not get better
- if your symptoms get worse
- if you get new symptoms or have a side effect

The information here, including dosages, only applies to adults (over 16 years). Keep all medicines out of the reach of children.
Evidence:
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buysomething Calcium and magnesium for PMS

OverviewSome women find using a combination of magnesium and calcium supplements effective for relieving symptoms of PMS.
EvidenceResearch suggests that taking 1000-1200 mg of calcium a day may ease PMS symptoms. Research suggests that taking 200-400 mg a day of magnesium for the two weeks before a period may help reduce PMS symptoms.
SafetyIf these supplements have not helped after three cycles they should be stopped. Magnesium supplements give some people diarrhoea. Using a lower dose should stop this happening
CostThese supplements are generally inexpensive and can be bought from most high street pharmacies.
Evidence:
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buysomething Chasteberry (Vitex Agnus castus) for PMS

OverviewThis shrub from southern Europe produces small, fragrant white flowers and dark fruits about the size of peppercorns. This herb seems to help some women has been used traditionally to help relieve PMS symptoms.
EvidenceSome studies suggest that chasteberry extracts help in PMS but more research is needed before we can be sure.
SafetySide-effects are not common, and they are mild and reversible. The most frequent problems are digestive upsets and headaches. Allergic skin reactions are rare. There are no known problems caused by taking chasteberry as well as ordinary medicines.
CostThis preparation is generally inexpensive and can be bought from most high street pharmacies or health food shops.
Evidence:
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buysomething Evening primrose oil (EPO) for PMS

OverviewEvening primrose is a yellow, flowering plant that blooms in the evening. It contains gamma-linolenic acid (GLA), an omega-6 essential fatty acid required by the body for growth and development. The body can't make GLA so we need to get it from our food.
EvidenceAlthough EPO has a reputation for easing PMS symptoms, the research results have been quite inconclusive.
SafetyEPO is generally safe in recommended doses. Reported side-effects are rare and mild. If you experience stomach pain and loose stools, this may mean you are taking too much. If you get seizures (such as epileptic fits), be careful with omega-6 supplements like EPO. They may make seizures more likely. EPO should be taken cautiously if you have bleeding problems or a blood disorder.
CostThese supplements are generally inexpensive and can be bought from most high street pharmacies.
Evidence:
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buysomething Herbal remedies and food supplements

OverviewHerbal and dietary supplements seem to help some women with period problems and most pharmacies sell various herbs and nutritional supplements for PMS and painful periods. But there is not enough evidence to be certain and more research is needed. We have supplied a summary of the available evidence in case you want to consider these options.
Evidence:
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buysomething Magnesium for primary period pain

OverviewSome women find that using magnesium supplements help with painful periods (see below for using magnesium for PMS).
EvidenceThere is evidence to show that some types of magnesium supplements may help ease painful periods.
SafetyThe research has not shown what the effective dose of magnesium would be. There should be no safety problem in taking 100 mg three times daily. But some people get diarrhoea when they take magnesium.
CostThis supplement can be bought from most high street pharmacies for low cost.
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buysomething NSAIDs and painkillers for primary period pain

OverviewNon-steroidal anti-inflammatory drugs (NSAIDs) stop prostaglandins from cramping the womb and may also reduce bleeding. NSAIDs are safe for most people in short courses. Read the package information for cautions.

Start the tablets as soon as your period begins or even the day before. Try taking them every 6 hours for two or three days and check with a pharmacist that you are taking a large enough dose. If you still have problems with period pain, despite a full course at the full dosage, get your GP's advice.

Paracetamol is good to try if NSAIDs don't suit you. Tablets containing a mixture of paracetamol and codeine may be even better. Ibuprofen can also ease period pain. You can also combine these sorts of painkiller with an NSAID. Do not take more than the maximum recommended daily dose of any painkiller.
EvidenceThere is good evidence that ibuprofen helps with painful periods. Paracetamol may be helpful if the pain is mild.
SafetyNSAIDs can cause indigestion. Do not use them if you have had stomach or duodenal ulcers. If you think you are allergic to aspirin then you should avoid NSAIDs. Ask your pharmacist about this.
CostNSAIDS and painkillers are generally inexpensive and can be bought from most high street pharmacies.
Evidence:
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buysomething St John's Wort (Hypericum)

OverviewPMS mood shifts occur around periods, whereas depressive mood changes can happen at any time. Research has shown this herb can treat depression but there isn't any research suggesting that it helps PMS.
EvidenceThere is not enough research to prove whether or not St John's Wort is helpful for PMS.
SafetyYou should always get medical advice before taking St John's Wort while on other medicines. This is especially important if you are taking warfarin (an anti-coagulant or blood-thinning medication), digoxin (for heart failure), oral contraceptives, protease inhibitors for HIV infection, chemotherapy or transplant drugs, or anti-schizophrenia drugs.
CostThese supplements are generally inexpensive and can be bought from most high street pharmacies.
Evidence:
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buysomething TENS for primary period pain

OverviewTranscutaneous electrical nerve stimulation (TENS) is a way of delivering a small, pulsating current to your muscles and nerve endings. Small electrical currents are sent through pads on the skin near the site of pain. Several small studies have suggested that using TENS machines may help some people with period pains.
EvidenceSome small studies of TENS have shown that it may help in painful periods. Some people did have mild side-effects.
SafetySee the information sheet on TENS machines from Arthritis Care for information on how to use TENS machines safely.
CostTENS machines are available from many pharmacies and some Internet retailers. They usually cost between £20 and £40 but this is a one-off cost.
Evidence:
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buysomething Vitamin B1 for primary period pain

OverviewVitamin B1 is used by some women to help relieve painful periods (see below for using B vitamins for PMS).
EvidenceIn one large research study, vitamin B1 supplements were found to help with painful periods.
SafetyVitamin B1 was effective when taken at 100 mg daily. There should not be any safety issues with this dose.
CostThese supplements are generally inexpensive and can be bought from most high street pharmacies.
Evidence:
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buysomething Vitamin B6 for PMS

OverviewVitamin B6 is used by some women to help relieve symptoms of PMS.
EvidenceVitamin B6 seems to help with PMS symptoms, according to the available research.
SafetyThe safe maximum dose of vitamin B6 is 100 mg a day. So start off with 50mg a day and take no more than 100. Larger doses may cause pain and numbness.
CostThese supplements are generally inexpensive and can be bought from most high street pharmacies.
Evidence:
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attendvisitAttend Classes / Visit Practitioner


attendvisitTreatment Options:


attendvisit Acupuncture and acupressure for primary period pain

OverviewAcupuncture is a traditional treatment that was first used in China thousands of years ago. Thin needles are inserted into the skin at certain points on the body, which practitioners believe will help restore health. The treatment sometimes also involves heat, pressure, electrical currents or soft-laser light. In the UK, acupuncture is most commonly used for pain relief.

Acupressure involves pressing deeply into particular places on the body that are said to reduce pain elsewhere. One traditional pain relief point can be found by pinching the web of your hand between your thumb and first finger. You have to hold the pressure firmly for half a minute, while breathing slowly and relaxing. This method is safe, free and worth trying.
Evidence[?] A recent review of research into acupuncture for period pain suggest that in can help There is some evidence to support acupressure too. But there is not enough good evidence showing that it can help PMS.
Safety

Acupuncture is generally considered to be safe if practised by a trained acupuncturist. The most common problems are slight discomfort (common) and bruising (occasionally).
Cost

A session may cost £35-£50. Frequency of treatment will depend on you and your practitioner.
Find out moreThe following professional organisations can help you find a qualified practitioner:
Acupuncture Association of Chartered Physiotherapists
British Academy of Western Medical Acupuncture
British Acupuncture Council
British Medical Acupuncture Society
Evidence:
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attendvisit Psychological therapies for PMS

OverviewWhen people think of 'talking therapies' they usually mean either counselling or psychotherapy. Counselling and psychotherapy aim to help people change thoughts, feelings and attitudes. Counsellors help you talk about difficult feelings and understand conflict. It can be helpful just to have time alone with a counsellor to talk in confidence about how you feel. Spending time reflecting on problems often brings insight and puts things into perspective. Psychotherapy helps people learn better ways of thinking or behaving that can reduce their symptoms, disability and distress. Some psychotherapists are trained to help you explore possible causes of distress or symptoms in your past. Cognitive behavioural therapy (CBT) is the type of psychotherapy that is currently most widely available in the NHS.

Instead of exploring causes of distress or symptoms in the past (like many other types of therapy), CBT looks for ways to improve your state of mind right now. The therapist does this by helping you spot unhelpful thought processes and change them. The Royal College of Psychiatrists says "CBT can help you to change how you think ('cognitive') and what you do ('behavioural')". For instance, CBT can help you make sense of what seem like overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you.
EvidenceSome studies suggest that psychological therapies may be helpful in PMS. Better, larger studies are needed.
SafetyThese techniques are generally safe if carried out by or under the guidance of a qualified counsellor or psychologist.
CostIn most areas your GP can refer you for CBT or a psychological therapist in the NHS. There are often long waiting lists. A session of CBT or psychological therapy may cost between £20-£50. Frequency will depend on you and your therapist. A typical course of CBT lasts between 6-12 weekly sessions.
Find out moreIt is important to find a qualified counsellor or psychologist. Contact The British Psychological Society
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attendvisit Yoga for PMS

OverviewYoga, as taught in the UK, generally includes physical postures or stretches, breathing techniques, meditation and relaxation. There are several different types of yoga. Some of them are mainly based on the physical exercises (some types are much more strenuous than others). Others focus more on meditation.
Evidence[1] There is some evidence from research that yoga can help ease PMS symptoms.
Safety

Yoga is generally safe when practiced appropriately and at the right level. Classes are run for different ability levels so look for one that is right for you. Yoga stretches should be increased slowly. If in doubt, check with your doctor, osteopath or physiotherapist. Avoid with severe osteoporosis or acute joint or back pain, or recent injuries.
Cost

Once you have learned the techniques you can do this at home, at no cost.
Find out moreClasses are run in most areas by both private tutors and by adult education services.

To find a qualified teacher near you see also the The British Council for Yoga Therapy
and the The British Wheel of Yoga
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