WOMEN’S HEALTH
Period Pain — When to Seek Medical Advice
Why severe period pain should not be normalised, what it may indicate, and when assessment is worth arranging.
Period pain (dysmenorrhoea) is extremely common — most women experience it at some point. But severe pain that regularly disrupts work, sleep, education, exercise, or normal routine deserves proper assessment, particularly if it is worsening or associated with heavy bleeding, pain during sex, bowel symptoms, or pelvic pain outside the period itself.
For some women, painful periods have been present since adolescence. For others, the change is new. Both patterns can be clinically relevant. The key question is not whether period pain exists, but whether it is within a manageable range or whether it is starting to point towards a condition that needs review.
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Common causes of painful periods
Primary dysmenorrhoea — period pain without an identified structural cause — is the most common type, particularly in younger women. It is caused by prostaglandin-mediated uterine contractions and usually responds to NSAIDs and hormonal management. Endometriosis should be considered when pain is severe, progressive, associated with deep pain during sex, pain on opening the bowels during periods, chronic pelvic pain between cycles, or difficulty conceiving. Endometriosis affects an estimated 1 in 10 women but is often diagnosed late. Adenomyosis causes heavy, painful periods and a tender, enlarged uterus. Fibroids and ovarian cysts can also contribute to pelvic pain around menstruation. The treatment approach differs significantly depending on the likely cause.
Assessment
When to seek review
Review is sensible if pain is severe, if it is getting worse over time, if usual pain relief is no longer helping, or if it is associated with heavy bleeding, pain during sex, difficulty opening the bowels during periods, or fertility concerns. A consultation allows the doctor to look at timing, severity, associated symptoms, and whether referral or further investigation may be needed.
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Treatment
Treatment that fits the cause
Women should not have to repeatedly self-manage symptoms that are having a major effect on function without knowing what the longer-term plan is. Treatment options include optimised pain relief taken early in the cycle, hormonal management including the combined pill, progestogen-only methods, or the hormonal IUS, and where endometriosis or structural causes are suspected, onward referral for specialist assessment. Period pain may be common, but disabling pain should not be normalised.
Common questions
When does period pain warrant medical review?
Pain that interferes with work, sleep or daily activities, pain that does not respond to standard over-the-counter analgesia, pain that is getting worse over time, or pain accompanied by other symptoms (bleeding between periods, pain outside of menstruation, pain during intercourse) is worth reviewing — rather than assuming it is normal.
Could period pain point to something other than primary dysmenorrhoea?
Yes. Endometriosis, adenomyosis, fibroids, pelvic inflammatory disease and structural causes can all present as significant period pain, and these are worth considering if the pain is severe, progressive, or accompanied by other features. A clinical review helps decide whether investigation is warranted.
What treatments might be considered?
Options reviewed may include non-steroidal anti-inflammatories taken at the right time in the cycle, hormonal treatment that reduces or suppresses periods, and referral for imaging or gynaecology input where a secondary cause is suspected. Treatment is matched to the likely cause, not applied generically.
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