Period pain is the commonest type of pelvic pain, but what’s normal? None of us know what another woman’s pain is like, and you may have wondered if your bad period pain is really normal and you are weak in some way.
What is normal period pain?
Well, period pain should only be considered ‘normal’ if:
The pain is only there on the first 1 or 2 days of your period, and
It goes away if you use the Pill or take period pain medications
If not, it is not normal!
Severe period pain in young women is a bigger problem now than it was in the past. Our grandmothers often had their first baby before they were 20 years old. After that came years spent pregnant or breast-feeding until menopause arrived. Even if their periods were painful, at least they didn’t have many of them. Girls start their periods earlier now and become pregnant later. They may have 300 to 400 periods ahead of them before menopause.
“Period pain doesn’t have to be ‘just part of being a woman”
I don’t think my pain is normal. What could it be?
Painful periods can be due to:
Pain in the uterus (womb), especially if pain is on the first 1-2 days of a period, or,
Pain from endometriosis, especially if pain is there for more than 1-2 days or doesn’t get better with the pill
Many women with bad period pain have both these problems, and we know that women with endometriosis have a more painful uterus than other women, even if it looks normal.
Am I too young to have endometriosis?
Endometriosis used to be thought of as an uncommon problem of women in their 30s and 40s. We now know that it is a common problem that usually starts in the teens.
Endometriosis in teens often looks different at a laparoscopy and can easily be missed. In older women it is often a dark brown color. In young women it may look like tiny clear bubbles that can be hard to see.
Teens often worry about being different from other girls. In fact, a study of 1000 girls aged 16-18 years in Canberra, Australia (MDOT study) found that 21% of the girls had severe pain with periods and 26% had missed school because of period symptoms. It’s really important that teenage girls get good care so they can live normally.
What can I do?
Simple things first:
Period pain medications work best when they are taken before the pain gets bad, so keep some with you all the time and take them regularly during periods. The commonly used medications include ibuprofen 200mg, naproxen 275mg, or diclofenac 25mg. Take two straight away then one, three times a day with food. All these medications can cause stomach irritation, so are best taken with food.
The Contraceptive Pill is often helpful. Ask your doctor for a pill with more progestogen than estrogen for the best effect. Many women skip periods on the pill because fewer periods means less pain. To do this, you need to be on a pill where all the hormone tablets are the same color. Plan a period only every 2-3 months or preferably not at all. Ask your doctor or pharmacist how to do this. If pills don’t suit your mood, try one called Qlaira.
A Mirena ® intrauterine device (IUCD) is currently the most effective treatment for pain from the uterus and lasts up to 5 years. It slowly releases a progestogen medication to the uterus that makes periods lighter, less painful and it is also a contraceptive. Remember that it is common to have irregular bleeding and crampy pains for the first few months, but these problems usually settle. If you have not had children, or have a tender pelvis you can ask to have it inserted under an anesthetic if you wish. The best time is just after a period, sometimes at the same time as a laparoscopy.
Complementary therapies that can help include acupuncture, Vitex Agnus Castus (1000mg daily) and magnesium (100-200mg every 2 hours at period time for 2 days only).
If simple treatments for period pain don’t help, you may have endometriosis. This is where tissue like the lining of the uterus grows in places outside the uterus around the pelvis. Most endometriosis can’t be seen on an ultrasound.
“You may have been told that your period pain is normal, just part of being a woman, or that you should have a baby. There is much more that can be done now”
When simple things don’t help
A laparoscopy is an operation where a doctor puts a telescope through a small cut in your umbilicus (belly button) to look inside your pelvis. He or she can then:
Diagnose if endometriosis is present
Remove the endometriosis if possible
There are different types of surgery available to treat endometriosis. Sometimes the endometriosis is excised which means cut out and sometimes it is cauterized (diathermied) which means burnt.
Some laparoscopies for endometriosis are fairly short and straight forward, while others take much longer and are more difficult. It depends on where the endometriosis is and how severe it is.
We know that the amount of endometriosis found at a laparoscopy doesn’t fit with the amount of pain. So, you may have a little bit of endometriosis and a lot of pain, or a lot of endometriosis and very little pain. Remember that even if you have endometriosis, that a lot of your period pain may also be from the uterus, even if the uterus looks normal.
This is why a good combination of treatments to consider is a laparoscopy to remove any endometriosis and a Mirena IUCD inserted at the same time. The Mirena can easily be removed later by your doctor without an anesthetic if it doesn’t suit you. After a laparoscopy aim for as few and as light periods as possible to reduce the chance of new endometriosis lesions developing.
Remember that even if you do have endometriosis, a lot of your pain may be due to other things such as a painful bladder, painful nerves or painful pelvic muscles.
Progestogen medications such as norethisterone or dienogest taken continuously are a good way to avoid periods and keep endometriosis quiet.
Content provided by Dr Susan Evans, Gynecologist, Laparoscopic Surgeon, & Specialist Pain Medicine Physician (https://www.drsusanevans.com.au/). Permission has been granted to publish this content on www.theendolifestyle.com.