Severe period pain: when should you see a doctor?

With severe period pain, see a doctor if the pain regularly knocks you out of everyday life, standard painkillers barely help, the symptoms get worse from month to month or extra symptoms such as pain during sex, fever or circulatory problems come on top. Severe pain is not something you simply have to put up with.

Contents

• Is severe period pain normal?
• How do you know pain needs checking out?
• When is period pain an emergency?
• What can be behind severe period pain?
• How do you prepare for the appointment?
• What happens at the appointment?
• How do you raise it if you don't feel taken seriously?
• Common questions about severe period pain

Is severe period pain normal?

A mild dragging feeling in the lower abdomen during the first days of your period is common and usually harmless. Most people who menstruate know it, around 85 per cent have period pain at least occasionally. Severe pain is a different matter, and you don't have to accept it as normal.

But here is the important difference: pain that regularly puts you in bed is not normal. As a rule of thumb: if the pain keeps you from work, school or sport, makes you cancel plans or leaves you curled up with a hot water bottle and a tablet, that is no longer ordinary period pain.

This is exactly where a mistaken belief creeps in, one that many carry for years. Because period pain is so widespread, even severe pain often counts as something you just endure. That isn't true. Severe pain is a signal from your body that deserves an explanation.

How do you know pain needs checking out?

There are clear warning signs. If one or more of them apply to you, have your symptoms checked at a gynaecology practice:

• The pain is so bad that you regularly can't go to work, school or sport.
• Standard painkillers barely work any more, or not at all.
• The pain gets worse from month to month.
• You also have lower abdominal pain outside your period.
• Pain occurs during sex, when passing urine or during bowel movements.
• Your bleeding is unusually heavy, lasts longer than usual or is irregular.
• You have spotting between periods or unusual discharge.
• The pain has changed suddenly, even though your period used to be manageable.
• You are trying to conceive without success.

This list is not a diagnosis. A single sign does not automatically mean something serious is going on. But each one is a good reason to look more closely instead of carrying on enduring it.

When is period pain an emergency?

Most period pain is not an emergency, even when it feels awful. But there are situations where you shouldn't wait for the next regular appointment and should get medical help quickly, if in doubt via the out of hours medical service.

That mainly includes:

• Sudden, very severe lower abdominal pain
• Severe pain together with fever
• Circulatory problems, fainting or repeated vomiting
• Unusually heavy bleeding that you can't make sense of

Combinations like these can point to an acute condition of the reproductive organs that should be treated quickly. Better to get checked once too often than to miss a real warning sign.

What can be behind severe period pain?

When period pain has no identifiable physical cause, it is called primary dysmenorrhoea. The body simply reacts sensitively to the normal contractions of the uterus. Unpleasant, but not an illness in itself.

Secondary dysmenorrhoea is different. Here a physical cause lies behind the pain. It often develops later in life, after periods that were previously manageable. Possible causes include endometriosis, fibroids or overgrowth of the uterine lining.

Endometriosis in particular is a reason why getting checked pays off. Tissue similar to the uterine lining settles outside the uterus and can cause severe pain. It often takes several years to reach a diagnosis, partly because severe period pain gets dismissed as normal for so long. If you recognise yourself in the warning signs, a closer look is worth it. You can read more in our article on endometriosis, linked below.

How do you prepare for the appointment?

A well prepared appointment makes it easier to place your symptoms correctly. These points help:

• Keep a pain diary. Over one or two cycles, note when the pain occurs, how bad it is (for example on a scale of 1 to 10) and what helps.
• Write down all your symptoms. Including the ones that seem unrelated to your cycle, such as pain during bowel movements, exhaustion or discomfort during sex.
• Record the impact. How often did you have to cancel something or miss school or work? That is what makes the burden visible.
• Note what you've tried. Which painkillers or home remedies have you used and how well did they work?
• Bring your questions. Write down beforehand what you want to know.

If it helps, take someone you trust along. You are also allowed to take your time and ask follow up questions.

What happens at the appointment?

Before your first appointment you need nothing except honesty about how you are doing. The process is usually straightforward.

It starts with a conversation. The doctor asks about your cycle, how the pain behaves, your contraception and your medical history. The more precisely you can describe things, the better, which is why the pain diary counts for so much.

Then comes a gynaecological examination, often with an ultrasound. That allows many possible causes such as cysts or fibroids to be assessed. Depending on what is suspected, further steps follow. The examination is nothing to worry about, it is a route to clarity and to treatment that suits you.

How do you raise it if you don't feel taken seriously?

Unfortunately some women still hear sentences like "that's just part of it" in the consulting room. That is frustrating, and you don't have to accept it. Your pain is real, even if nobody has found a cause yet.

One clear sentence can get your point across: "This pain seriously restricts my daily life. I want us to investigate the cause." If you don't feel taken seriously, a second opinion is your right. You can change practice or ask for a referral to a specialist centre.

Being persistent here isn't making a fuss, it is looking after yourself. With conditions like endometriosis, persistence often decides how quickly you get answers.

This article is for general information and does not replace medical advice. If your symptoms are severe, unusual or persistent, please contact your gynaecologist.