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Period Pain Period pain – also known as menstrual pain or menstrual cramps, affects many women before, during and after their period. Some women find them uncomfortable but carry on as usual (often with the help of over the counter painkillers) but other women can find that the pain of menstrual cramps severely affects their ability to carry out normal activities. Here, we take a closer look at what causes period pain and how you can relieve it. What causes period pain? When you are having your period, your uterus (womb) sheds the lining it has prepared ready for conception. Substances called prostaglandins trigger contractions in the uterus to help it expel the lining. Severe period pains are usually caused by higher levels of prostaglandins. One in five women suffers from dysmenorrhea, or painful periods, to the point where they can interfere with her life, according to the American Academy of Family Physicians. In 2016, Professor John Guillebaud, an expert from the University College London, said that in some women, menstrual cramping can feel “as bad as having a heart attack." Period pain can be: • A cramping or throbbing in your lower abdomen. • Intense painful spasms. • A dull ache. • Pain in your back and thighs. Some women can also feel sick, suffer from diarrhoea and/or headaches. The symptoms may also vary from cycle to cycle. Conditions that may make period pain worse Although for many women some period pain is normal, there are some medical conditions which may cause severe pain. These include: • Endometriosis: where the lining of the uterus starts to implant in places other than your uterus, usually your ovaries, fallopian tubes or pelvic lining. • Uterine fibroids: these are non-cancerous growths in the wall of the uterus. • Adenomyosis: a condition in which the lining of the uterus starts to grow into the muscles of the uterus wall. • Pelvic inflammatory disease (PID): a sexually transmitted infection. • Cervical stenosis: A condition where the cervical opening is too small to allow menstrual flow to escape properly, causing a painful build-up of pressure in the uterus. How long should period pain last? In most women, period pain usually starts at the same time as their bleeding, but it can start several days beforehand. It should only last for up to 72 hours, although in some cases severe period pain can last for longer. The pain is usually at its worst when the bleeding is at its heaviest. The good news is that period pains tend to lessen as women get older, and some women also say that their period pain improves after they have had children. Which painkillers are good for period pain? Depending on how severe your period pain is, there are various ways that you can treat/relieve the symptoms. Doctors will often recommend over the counter painkillers containing ibuprofen or aspirin, but if these haven’t worked for you, your doctor may be able to prescribe an alternative like naproxen or mefenamic acid. If NSAID drugs aren’t suitable for you because of asthma, stomach, kidney or liver problems, ask a pharmacist or doctor for advice for an alternative. You should also avoid NSAIDs if you are breastfeeding. Paracetamol is another option but studies have shown that it may not be as effective as ibuprofen and other NSAIDs in relieving period pain. You could also ask your doctor for painkillers containing codeine if you can’t get relief from over the counter medicines. The Pill and period pain Some women find that their period pain gets better or disappears while they are taking the combined contraceptive pill. This is because the hormones in the Pill thin the lining of the uterus, so your period is lighter, fewer prostaglandins are released and your uterus doesn’t have to contract so much to shed its lining. Contraceptive implants or injections are another option if the Pill doesn’t suit you. Self-help for period pain For mild period pain, and to avoid taking painkillers, there are things you can do to help relieve the cramping. • Exercise – although this is probably the last thing you want to do, swapping lying on the sofa with a hot water bottle and a bar of chocolate for a gentle walk or swim can actually help to relieve mild period pain. • Heat – a hot water bottle or a heat pad can be very soothing for period pain. You can buy self-heating pads designed for menstrual cramps in most chemists. • Taking a warm bath or shower – a relaxing bath can help soothe the cramps and backaches as can a warm shower. • Giving up smoking – smoking has been shown to make period pain worse, so if you’re a smoker, it makes sense to try and give up. When should you see a doctor? If you have only recently started menstruating (having periods) in the last few years, your body is probably still getting used to your cycles and all the hormonal changes involved, so it’s unlikely that period pains are anything to be concerned about. You should make an appointment to see your doctor if your period pain begins to disrupt your day to day activities, if the pain is getting worse over time or if you’re over the age of 25 and have only just started to suffer from severe period pain.