For a few days every month, does the pain leave you curled up in bed, in a cold sweat, or even nauseous and dizzy? Period pain is very common, but "common" does not mean you have to put up with it in silence, nor that all period pain is the same. Some period pain comes from the body's normal processes; some may be linked to gynaecological problems that need a doctor's examination.
This article explains how primary and secondary period pain differ, warning signs to look out for, everyday relief and precautions, how Chinese medicine understands period pain, and when to see a doctor. It is health education and cannot replace an in-person consultation or diagnosis by a registered clinician.
What Is Period Pain?
Period pain (dysmenorrhoea) is lower abdominal pain before or during a period. It may come with lower back ache, pain in the inner thighs, nausea, diarrhoea or headache. Medically it is usually divided into two types:
- Primary period pain: there is no other gynaecological condition; it is mainly linked to prostaglandins released by the womb during a period, which make it contract. It usually starts within a year or two of the first period, and the pain is usually worst on days one to three.
- Secondary period pain: caused by another gynaecological problem, such as endometriosis, adenomyosis, fibroids or pelvic inflammatory disease. It more often starts later in life, or the pattern of pain changes.
Common Symptoms
- Cramping or bloating pain in the lower abdomen: it can come in waves of cramps or be a constant dull ache.
- Lower back ache and inner-thigh pain: the pain can spread to the back and thighs.
- Stomach upset: some people have nausea, diarrhoea or a poor appetite.
- Headache and tiredness: lower energy during a period.
Keep a record of your periods and pain
Use a calendar or your phone to record the dates of each period, how heavy the bleeding is, how bad the pain is (for example on a scale of 0–10) and any other symptoms. If the pattern of pain changes, these records help a doctor understand the situation more quickly.
*Note: the above is not a self-diagnosis tool.
When to Be Extra Careful
The following may suggest secondary period pain or another problem; see a doctor promptly (such as a family doctor or gynaecologist):
- Period pain that starts after age 25, or a clear change in the pattern, getting worse every year.
- Very heavy bleeding (for example, needing to change a pad every hour or two), large clots, or unusually long periods.
- Pain outside your period, bleeding between periods, or pain during sex.
- Period pain with fever or unusual discharge.
- Pain that painkillers and rest do not relieve at all, affecting school or work.
When to seek help immediately
If you might be pregnant and have sudden severe lower abdominal pain, vaginal bleeding, dizziness or fainting, or extremely severe abdominal pain with a high fever, go to A&E immediately.
Everyday Relief and Precautions
1. Heat and rest
A hot-water bottle or heat pack on the lower abdomen or back helps many people. Make sure it is not too hot, and do not leave it directly on the skin for too long, to avoid burns.
2. Moderate activity
Regular exercise, and gentle walking and stretching during your period, help some people. There is no need to force yourself into strenuous exercise.
3. Use painkillers as directed
Some over-the-counter painkillers (such as NSAIDs) are commonly used for period pain, but they do not suit everyone. If you have stomach problems, asthma or kidney disease, take other medicines or might be pregnant, ask a doctor or pharmacist first, follow the label or your doctor's instructions, and do not increase the dose yourself.
4. Look at your lifestyle
- Keep a regular routine and avoid smoking.
- Keep warm around your period, and have fewer very cold foods and drinks.
- For some people, period pain is worse at times of stress or an irregular routine.
How Chinese Medicine Understands Period Pain
Chinese medicine generally links period pain to "blockage causes pain" or "lack of nourishment causes pain". Common patterns include cold congealing with blood stasis, qi stagnation with blood stasis, and qi and blood deficiency. Each pattern looks different and is managed differently; for example, not all period pain is a "cold womb", and ginger tea alone may not be suitable.
If you are considering Chinese medicine, have your pattern assessed in person by a registered Chinese medicine practitioner rather than buying proprietary Chinese medicines to take long term. Chinese medicine care should not replace gynaecological tests: if you have any of the warning signs above, a doctor should first rule out gynaecological disease.
When to See a Doctor
If period pain is severe enough to affect daily life, you often need time off, or you have any of the warning signs above, see a doctor. The doctor will ask about your history, examine you as needed, or arrange tests such as an ultrasound to find out whether there is a gynaecological problem that needs treatment.
Remember: you don't have to grit your teeth through period pain, but it matters more to find out which type it is and follow your doctor's advice.
Frequently Asked Questions
Does period pain go away after having a baby?
Not necessarily. Some people have less period pain after giving birth, but not everyone, and secondary period pain is not directly related to whether you have had children. If the pain is severe or changes, see a doctor.
Are painkillers addictive or harmful?
The non-steroidal anti-inflammatory painkillers (NSAIDs) commonly used for period pain are generally not addictive, but they may not suit people with stomach problems, asthma, kidney disease or who take other medicines. Ask a doctor or pharmacist first and use them as directed.
Is period pain always caused by a "cold womb"?
No. Chinese medicine divides period pain into several types, and cold congealing is only one of them. Modern medicine also needs to rule out gynaecological problems such as endometriosis. Judging it yourself can delay the right tests.
When should I go to A&E?
If you might be pregnant and have sudden severe lower abdominal pain, bleeding, dizziness or fainting, or extremely severe abdominal pain with a high fever, go to A&E immediately.
If your period pain changes, get checked early
This article is health education and does not constitute a diagnosis or treatment advice. If period pain is severe, its pattern changes or you have warning signs, please consult a family doctor, gynaecologist or other registered clinician promptly.