Is My Period Pain Normal? How to Tell, and What Helps

The short answer: Period cramps that start just before or on the first day of your period, last up to about three days, and ease with heat, gentle movement or a simple painkiller are normal. Pain that keeps you in bed or away from school or work, isn't helped by painkillers, gets worse year after year, or comes with pain during sex, heavy bleeding or bleeding between periods is not something to put up with. See a doctor, because treatment can help.

Why periods hurt

Your womb is a muscle. During your period it tightens and relaxes to help shed its lining. These contractions are triggered by chemicals called prostaglandins, which your womb lining releases as it breaks down.

When the muscle squeezes hard, it briefly presses on the blood vessels that supply the womb. That short drop in oxygen to the muscle is what you feel as cramping. Women with higher levels of prostaglandins tend to have stronger cramps, and those same chemicals can also cause nausea, loose motions and headaches on the first day.

Primary and secondary period pain

Doctors use the word dysmenorrhoea for painful periods. There are two types:

• Primary dysmenorrhoea: ordinary period pain with no underlying condition. It often starts within a year or two of your first period and may ease with age or after having a baby.
• Secondary dysmenorrhoea: period pain caused by another condition, such as endometriosis, adenomyosis or fibroids. It often starts later, in your 20s, 30s or 40s, or gets steadily worse over time.

What normal period pain feels like

Normal period pain is real pain, and it can be strong. What makes it "normal" is its pattern and the fact that it responds to simple measures. Typically, it:

• Feels like cramps, a dull ache or occasional sharp twinges low in your tummy
• Sometimes spreads to your lower back and the tops of your thighs
• Starts a day or so before your period, or on the first day
• Is strongest in the first one or two days, then fades
• Lasts up to about three days
• Gets better with a hot water bottle, rest, gentle movement or a painkiller

You might also feel tired, a little sick, or have looser stools on day one. If this describes your experience most months, and you can get on with your day once you've taken a painkiller, it's very likely ordinary period pain.

Signs your period pain isn't normal

Many Indian girls grow up hearing that pain is just part of being a woman, and that you should quietly bear it. But severe pain is a symptom, not a test of strength. These are the signs that point to something worth checking:

Conditions that can cause severe period pain

Endometriosis

In endometriosis, cells similar to the womb lining grow in other places, such as on the ovaries, the fallopian tubes or the lining of the pelvis. They react to your monthly hormones and cause inflammation and pain. Symptoms can include severe period pain, pelvic pain at other times, pain during or after sex, pain when going to the toilet, heavy periods, extreme tiredness and difficulty getting pregnant.

Diagnosis can take a long time. A doctor may start with an examination and an ultrasound, but the condition often doesn't show clearly on scans. A laparoscopy, where a small camera is passed through a tiny cut in the tummy, can confirm it. There's no cure yet, but painkillers, hormonal treatment and sometimes surgery can manage symptoms well.

Adenomyosis

Here, tissue like the womb lining grows into the muscle wall of the womb itself. It can cause heavy, painful periods and a feeling of pressure in the pelvis. It's more often found in women in their 30s and 40s, especially those who have had children.

Fibroids

Fibroids are non-cancerous growths in or around the womb. Many cause no symptoms, but some lead to heavy periods, period pain, a swollen tummy or needing to pee often. An ultrasound usually finds them.

Pelvic inflammatory disease (PID)

PID is an infection of the womb, fallopian tubes and ovaries. It can cause pelvic pain, pain during sex, unusual discharge, bleeding between periods and a fever. It usually needs antibiotics, and treating it early protects your fertility.

An IUD

A copper IUD or a hormonal IUD (also called an IUS) can cause more cramping, especially in the first three to six months after it's fitted. If pain is severe or starts suddenly long after fitting, see your doctor.

What helps period pain at home

Heat

Heat relaxes the muscles of your womb. Place a hot water bottle wrapped in a towel or a heat pad on your lower tummy or back, or take a warm bath or shower. Never put a very hot bottle directly on your skin.

Gentle movement

It's tempting to curl up in bed, but gentle activity often helps. Try a slow walk, light stretching, yoga, swimming or cycling. Poses like child's pose or lying on your back with your knees hugged to your chest can ease cramps.

Massage

Gently rub your lower tummy and lower back in slow circles. A little warm coconut or sesame oil can make it more soothing.

Painkillers

Paracetamol or ibuprofen can help. Ibuprofen works on prostaglandins, so it tends to work well if you take it as soon as the pain starts, or even a little before if you know your pattern. Ibuprofen isn't suitable for everyone, for example people with stomach ulcers, some types of asthma, or kidney problems. Read the packet or ask a pharmacist what's right for you, and don't take more than the packet says.

Lifestyle habits that help

Cutting down on alcohol and not smoking may help period pain. Regular exercise across the month, eating regular balanced meals and getting enough sleep can all make your periods easier to manage. Warm drinks such as ginger tea or ajwain water are comforting for many women, though there is no strong evidence that they reduce cramps.

Staying comfortable on cramp days

When your tummy aches, tight jeans and elastic that digs in can make it worse. Loose clothes help, and so does not having to worry about leaks while you're lying curled up.

A soft high waist period panty gives gentle cover over your lower tummy, and its built-in absorbent layers and leak-resistant barrier mean you can rest, sleep or use a hot water bottle without checking your clothes every hour. For long nights on heavy days, our guide to period panties for sleep has practical tips.

Period pain in teenagers

Period pain is very common in teenage girls, and it's a common reason girls miss school. Usually it's primary dysmenorrhoea and improves with the steps above. Parents can help by keeping a hot water bottle and painkiller suitable for her age at home, letting the school know if needed, and not dismissing her pain.

A teen should see a doctor if pain regularly keeps her home from school, painkillers don't help, or she has very heavy bleeding. Our guide to periods at school has more ideas for getting through the day.

What a doctor can do

Start with your family doctor or a gynaecologist. They'll ask when the pain started, how long it lasts, how strong it is, how heavy your periods are, and whether you have pain at other times or during sex. A pain diary over two or three cycles helps a lot. Note the day of your cycle, the pain on a 0 to 10 scale, what you took and whether it helped.

Depending on what they find, your doctor may:

• Examine your tummy, and sometimes do an internal examination if you're sexually active
• Suggest a pelvic ultrasound scan to look for fibroids, ovarian cysts or adenomyosis
• Test for infection if PID is possible
• Recommend stronger anti-inflammatory painkillers, such as naproxen or mefenamic acid
• Suggest a TENS machine, a small device that uses mild electrical pulses to reduce pain
• Suggest hormonal contraception, such as the pill, the implant, the injection or a hormonal IUD, which thins the womb lining and often makes periods lighter and less painful
• Refer you to a gynaecologist for further tests, such as a laparoscopy, if endometriosis is suspected

If an underlying condition is found, treating it usually eases the pain. For example, fibroids may be treated with medicine or surgery, and PID with antibiotics.

See a doctor if

• Your periods become more painful, heavier or irregular
• Pain stops you doing your usual activities
• You have pain during sex, or when peeing or pooing
• You bleed between periods or after sex
• You notice a change in how often you pee or poo
• You have a swollen tummy, have lost your appetite or are losing weight without trying

Get urgent help if

Call 112 or 108, or go to the nearest hospital emergency department, if:

• Your pelvic or period pain is severe or much worse than usual, and painkillers haven't helped
• You have a high temperature, feel faint, or are vomiting with the pain
• You could be pregnant and have strong pain on one side of your tummy, shoulder-tip pain, or bleeding, as these can be signs of an ectopic pregnancy

Frequently asked questions

Is it normal to vomit or have loose motions with period pain? Some women feel sick or have loose motions on the first day, caused by the same prostaglandins that cause cramps. If it's severe or happens every month, see a doctor.

Why is my period pain worse than it used to be? Cramps can change with age, but pain that steadily gets worse can be a sign of endometriosis, adenomyosis or fibroids. It's worth getting checked.

Can period pain be a sign of infertility? Ordinary cramps aren't. Some conditions that cause severe pain, such as endometriosis and PID, can affect fertility, which is another reason to get severe pain looked at early.

Does exercise really help cramps? For many women, yes. Gentle activity such as walking, yoga or swimming can ease cramps and lift your mood.

Is it normal to have clots along with cramps? Small clots on heavy days are common. Large clots, or clots with very heavy bleeding, are worth checking. Our guide to blood clots in your period explains the coin test.

Will period pain go away after marriage or childbirth? Primary period pain sometimes eases after having a baby, but marriage itself doesn't change it. Don't wait for either if your pain is severe. See a doctor now.

Can I take a painkiller every month? Many women safely use paracetamol or ibuprofen for a day or two each period, following the packet. If you need painkillers for many days, or they don't work, see a doctor.

Related reading

• Heavy Periods: How Much Bleeding Is Too Much?
• PMS: Symptoms, Causes and What Actually Helps
• PCOS Explained: Symptoms, Diagnosis and Treatment
• How Periods Change in Your 30s and 40s

This article is for general information and doesn't replace advice from your doctor.

Sources: NHS: Period pain, NHS: Endometriosis