Painful periods

Painful periods (dysmenorrhoea) is cramping pain in the lower abdomen or pelvis that comes with menstruation, sometimes spreading to the lower back and thighs. Doctors divide it into two kinds. Primary dysmenorrhoea is period pain without any underlying disease: it is caused by natural chemicals called prostaglandins that make the womb contract to shed its lining, and it typically begins in the teenage years, comes with the first day or two of bleeding, and eases over time or after childbirth. It is very common and, while it can be distressing, is not a sign of anything wrong. Secondary dysmenorrhoea is period pain caused by an underlying condition, and it is suggested by a different pattern: pain that starts later in life, is worsening over time, lasts longer than the bleeding, or comes with other symptoms. The important underlying causes are endometriosis (where womb-like tissue grows outside the womb), adenomyosis, uterine fibroids, pelvic infection, and problems related to a coil (IUD). So the key to painful periods is the pattern: long-standing, cyclical pain that responds to simple measures is usually primary, whereas severe, changing, or new period pain — especially with pain outside periods, pain during sex, heavy bleeding or difficulty conceiving — points toward a cause worth investigating.

• Primary dysmenorrhoea — normal period pain from prostaglandins; no underlying disease.
• Endometriosis — womb-like tissue outside the womb; a key cause of severe, worsening pain.
• Adenomyosis — womb-lining tissue within the muscle wall.
• Uterine fibroids — benign growths, often with heavy periods.
• Pelvic inflammatory disease (infection).
• An intrauterine device (coil).
• Ovarian cysts.

Painful periods are assessed mainly from the history and examination, with pelvic ultrasound the key investigation when an underlying cause is suspected. Blood tests play a supporting role: a full blood count and ferritin check for anaemia if periods are also heavy, and inflammatory markers or swabs are used if pelvic infection is suspected. Endometriosis, an important cause, is not diagnosed by a blood test — it needs specialist assessment and sometimes laparoscopy. Mediora.AI can surface a low-haemoglobin, low-ferritin pattern pointing to blood loss, or inflammatory markers suggesting infection, but painful periods that are severe, worsening or new are assessed clinically, often with ultrasound, by your doctor or gynaecologist.