What are painful periods?

While some manageable pain during periods is normal, painful periods (dysmenorrhoea) can be a serious problem for many women and have a big impact on their life.

“In some cases, period pain can be so debilitating that it stops you from going about your day-to-day activities, or means you need to take time off work,” says Dr Samantha Wild, women’s health clinical lead at Bupa Health Clinics.

There are two types of period pain, she explains: “Primary dysmenorrhoea. This is period pain that isn’t caused by a specific condition. It usually happens within six to 12 months of your periods first starting, and the pain usually begins when your period arrives and lasts for between one and three days.

“And secondary dysmenorrhoea – pain caused by an underlying medical condition, such as endometriosis or fibroids. This type of period pain gets worse with age and may happen years after your periods have started, often when you’re in your 30s or 40s. The pain may come on at other times during your monthly cycle, especially in the few days before your period starts, as well as when you have your period. It can also get worse, rather than better, as your period goes on.”

Here’s a closer look at some conditions that cause painful periods…


Endometriosis is a disease where tissue similar to the lining of the womb grows in other places. This can result in chronic inflammation of affected areas, plus scar tissue and adhesions.

“It can cause severe pain in your lower tummy, pelvis or back, which is usually worse during your period but can be present throughout the month. The pain is often so bad, it can stop people from doing their normal day-to-day activities,” says Wild. “It is likely to also cause pain after sex and can cause pain when peeing or pooing during your period or leave you feeling sick, and cause constipation or diarrhoea.”

Dr. Vivek Nama, a consultant gynaecologist at The Door W4, adds: “The classical symptoms of endometriosis are the five Ds, which are dyspareunia – pain during sex, which is often very deep; dysmenorrhoea – painful periods; dyschezia – pain while passing bowel movements, especially during menstruation; dysuria – pain while passing urine, again, especially during menstruation, and a dull aching pain in the lower part of the stomach, especially between periods.” Severe bloating is also common for people living with endometriosis, especially as the condition progresses.


“Adenomyosis and endometriosis are very closely related,” says Nama. “Adenomyosis is a condition where the lining of the womb starts to grow into the muscle in the wall of the womb. This often causes bleeding into the muscle, which causes severe, painful periods.”

Wild adds this can often be “severe sharp, stabbing pain”. Another tell-tale characteristic is the uterus appearing ‘bulky’ and possibly enlarged during scans.


Non-cancerous growths that develop in and around the uterus, and fibroids vary in size and severity. Wild explains: “Heavy and painful periods are common for people who have fibroids, along with tummy and lower back pain. You may experience increased pelvic pressure, heavier blood flow, often with clots and severe cramps.”

Nama adds: “Fibroids are especially associated with heavy bleeding because they alter the contractility of the muscles in the womb, causing severe dysmenorrhea. If a fibroid is very large, it will develop its own blood supply. Sometimes, when a fibroid dies, it can also cause acute pain.”

Ovarian cysts

Ovarian cysts are very common and don’t always cause problems, but they can also be a medical concern.

“Ovarian cysts can be associated with painful periods, particularly if they are larger cysts,” says Wild. “Although, ovarian cysts can be present, and the person may have no idea until one bursts. When one bursts, it can cause severe pain and swelling of the abdomen.”

Pelvic inflammatory disease (PID)

“PID is another reason for painful periods, and is an infection of the female reproductive tract that is most commonly caused by untreated sexually transmitted infections,” says Wild. “PID causes heavy and painful periods, and in some cases can lead to severe pain in the stomach.”

What should you do if period pain is a problem?

Nama says: “I would advise patients who are requiring a lot of painkillers, having to take time off work, or having limited mobility during their cycle to seek advice.”

Wild adds: “When period pain is so debilitating that it impacts your day-to-day life, it’s important to see a medical professional, who will be able to look into why you are experiencing it and suggest a treatment plan. Many women put up with it, but they don’t need to, it’s not normal to experience painful periods every month.”

Treatments include pain management strategies and medication, as well as hormonal therapies and contraceptive methods which may help. For some conditions, surgery may be an option.