Every month women who are not pregnant will have a period, this is where the lining of the womb is shed as menstrual blood in preparation for the next cycle.
While the vaginal bleeding often comes with cramps as well as a lethargic feeling and other mild symptoms, significant pain is not normal.
Why do my periods hurt?
If your periods have been painful from close to when they first started, you may have a condition called primary dysmenorrhoea, which is not dangerous and does generally improve over time. This condition is caused by high levels of a substance called prostaglandins in the lining of the womb and is helped with anti-inflammatories and the contraceptive pill in most cases.
More concerning is secondary dysmenorrhoea, where periods that weren't previously particularly painful become painful as this suggests new problems have developed. If you also have pain deep inside with intercourse, or pain that starts before the period, heavy periods and/or pain with bladder and bowel function when you have your period, this can suggest endometriosis as the cause. A detailed pelvic ultrasound (called a COGU scan) can help diagnose this condition and plan treatment, but if it is normal does not completely exclude milder cases.
In mild cases, if medical treatments help and you are not planning pregnancy, operation is not essential but most women with significant symptoms or an abnormal ultrasound will be recommended minimally invasive (keyhole) surgery to remove as much of the endometriosis as possible and sometimes more than one operation is necessary to achieve this if the endometriosis is in a challenging location.
It is important to know that surgery will not cure endometriosis permanently in most women, and neither does pregnancy (although it is a common belief) although both bring about improvements. For this reason follow up hormonal therapy is recommended to keep the endometriosis suppressed and reduce the risk of symptoms returning and reoperation.
Although it is topical and many women are requesting screening for endometriosis, it is also important to remember that there are other causes of painful periods apart from endometriosis and these are treated differently depending on the cause. Additionally up to 1 in 10 otherwise healthy women having surgery for unrelated reasons have been identified as having mild endometriosis which has not caused problems.
How can painful periods be treated?
Some women feel that because their pain is invisible, they are not allowed to seek treatment- it is important to know that treatment is available and you should seek help if your periods are affecting your quality of life.
Leaving the specifics for each possible cause aside, in general your treatment options are:
conservative, also the same as 'expectant' which means continuing on as you are. This is acceptable if your symptoms are very mild or getting better or known due to a self-resolving cause but otherwise this is generally not a helpful option.
non-hormonal medical treatment: this includes pain relievers such as paracetamol, anti inflammatories, medications to decrease menstrual blood loss and other drugs.
hormonal medical treatment: this includes tablets, injections, implants and intrauterine devices, all of which change the way your menstrual cycle works to help the pain and also provide contraception.
an operation: this varies depending on the suspected cause for pain from keyhole, intrauterine (hysteroscopic), an open operation with a cut on the tummy.