Severe Period Pain: Causes, Relief and When to See a Doctor

Many girls and women in Pakistan grow up hearing that period pain is just something to bear quietly. A little cramping is common. But pain that sends you to bed, makes you miss college or work, or leaves you vomiting is not something you simply have to accept. There are clear causes, safe ways to ease it, and signs that tell you it is time to see a doctor.

Why do periods hurt?

Before and during a period, the lining of the womb produces chemicals called prostaglandins. They make the womb muscle squeeze to shed the lining. The higher the prostaglandin level, the stronger the cramps. This is called primary dysmenorrhoea. It is not caused by any disease, usually begins within a year or two of a girl’s first period, and tends to improve with age and after childbirth.

Typical features of ordinary period pain:

• Cramping in the lower belly that can spread to the back and thighs
• Starts a day or so before bleeding, or when it begins
• Eases after 2 to 3 days
• May come with headache, nausea, loose stools or tiredness

When severe pain points to another cause

Pain that is new, getting worse, or starting after the age of 25 can be a sign of an underlying problem, known as secondary dysmenorrhoea. Common causes include:

• Endometriosis: tissue similar to the womb lining grows outside the womb. Pain is often severe and may also occur during sex, bowel movements or between periods.
• Fibroids: non-cancerous growths in the womb that can cause pain and heavy bleeding.
• Adenomyosis: the womb lining grows into the womb wall, causing heavy, painful periods.
• Pelvic inflammatory disease: an infection of the womb and tubes, sometimes with fever or unusual discharge.
• Copper intrauterine device (coil): can make periods heavier and more painful, especially in the first months.

PCOS mostly causes irregular periods, but some women with PCOS also have painful periods.

Safe ways to ease period pain

1. Start early. Take a painkiller at the first sign of cramps or when bleeding begins, rather than waiting for the pain to peak.
2. Choose the right medicine. Anti-inflammatory painkillers such as ibuprofen, naproxen or mefenamic acid block prostaglandins and are usually the most effective. Take them with food, for 2 to 3 days. Paracetamol is a gentler option if you cannot take these.
3. Try an antispasmodic. Medicines such as hyoscine or drotaverine relax the womb muscle and can be used alongside a painkiller.
4. Use heat. A hot water bottle or heating pad on the lower belly for 15 to 20 minutes relaxes the muscle as well as many tablets for some women.
5. Keep moving. Gentle walking and stretching release natural pain-relieving chemicals.
6. Rest and hydrate. Warm drinks, light meals and enough sleep help more than they seem to.

People with stomach ulcers, kidney problems, or asthma that worsens with painkillers should not take anti-inflammatory tablets without asking a doctor first.

Some women find that a daily magnesium or vitamin B1 supplement, or cutting down on caffeine and salty food in the week before a period, makes a small difference. Evidence is limited, so treat these as extras and not replacements for proper treatment.

Medical treatment when basic measures are not enough

If painkillers and heat do not control the pain, a doctor may recommend hormonal treatment such as the combined contraceptive pill or a progestin-only option. These reduce prostaglandin production and make periods lighter and less painful. Note that these are prescription medicines and are not right for everyone, for example women with a history of blood clots or migraine with aura. If a condition like endometriosis or fibroids is suspected, an ultrasound or other tests will be arranged.

Warning signs: see a doctor

• Pain so severe that you miss school or work every month
• Pain that does not improve after two or three cycles of proper painkillers
• Pain that is getting worse over time
• Soaking a pad or tampon every hour for several hours, or passing large clots
• Pain during sex or between periods
• Fever, foul-smelling discharge or sudden, severe pelvic pain
• Periods that suddenly become painful after being pain-free for years
• Trying to get pregnant without success

Heavy periods also drain iron. If you often feel dizzy and exhausted around your period, read our guide to iron deficiency anaemia in women.

Key takeaways

• Ordinary period pain is caused by prostaglandins and usually settles within 2 to 3 days.
• Take an anti-inflammatory painkiller early, with food, and use heat.
• Pain that is severe, worsening or new after 25 deserves a medical check for endometriosis, fibroids or infection.
• You never need to suffer in silence; effective treatment exists.

Related medicines on Medimart

These are the medicines most often used for period pain and heavy periods:

• Mefenamic Acid: an anti-inflammatory painkiller made for period pain
• Ibuprofen: an anti-inflammatory painkiller, taken with food
• Naproxen: a longer-acting anti-inflammatory painkiller
• Paracetamol: a gentler option if anti-inflammatories are unsuitable
• Drotaverine: relaxes the womb muscle to ease cramps
• Hyoscine Butylbromide: an antispasmodic for cramping pain
• Tranexamic Acid: used for heavy period bleeding, on a doctor's advice

Prescription medicines are supplied only against a valid prescription. Please take them only as advised by your doctor.

Explore period pain relief products on Medimart with delivery across Pakistan. Prescription medicines are supplied only against a valid prescription.

This guide is for general information and does not replace advice from a doctor. If your pain is severe or worrying, please see a doctor.