Painful Periods — Dysmenorrhoea Explained
Current Guidance Update
NSAIDs First-Line
NSAIDs are the recommended first-line pharmacological treatment for dysmenorrhoea and should be started before the onset of menstrual bleeding for maximum effectiveness.
Evaluate for Endometriosis
Women with severe or worsening dysmenorrhoea, especially when accompanied by dyschezia or deep dyspareunia, should be evaluated for possible endometriosis.
Reduce Diagnostic Delay
Endometriosis diagnosis is delayed by an average of 7–10 years, highlighting the importance of early clinical suspicion and timely referral.
Early Assessment
Persistent menstrual pain that interferes with daily activities or fails to respond to first-line therapy requires further investigation and individualized management.
Introduction Introduction
Dysmenorrhoea: Causes, Assessment & Treatment
Primary vs Secondary Dysmenorrhoea
Primary dysmenorrhoea occurs without identifiable pelvic pathology and is caused by prostaglandin-mediated uterine contractions, usually beginning 1–2 years after menarche. Secondary dysmenorrhoea results from underlying pelvic disease and any new or worsening pain should always be investigated.
Secondary Dysmenorrhoea
- Endometriosis – most common cause
- Adenomyosis
- Uterine fibroids
- Ovarian cysts and endometriomas
- Pelvic inflammatory disease (PID)
Clinical Assessment
- Detailed menstrual history
- Pelvic examination
- Pelvic ultrasound
- Laparoscopy when endometriosis is suspected
Treatment of Primary Dysmenorrhoea
- NSAIDs started 24–48 hours before bleeding
- Combined oral contraceptive pill
- Levonorgestrel IUS for adenomyosis
- Heat therapy and TENS as supportive treatments
When Laparoscopy Is Indicated
- Severe dysmenorrhoea not responding to medical treatment
- Suspected secondary dysmenorrhoea, especially endometriosis
- Associated infertility
- When a definitive diagnosis is desired before long-term therapy
Frequently Asked Questions
Is it normal to miss school or work because of period pain?
No — this degree of dysmenorrhoea is NOT normal and should be investigated to exclude secondary causes.
Will having a baby cure my painful periods?
Some women experience improvement after childbirth, but this is not universal and does not address endometriosis if present.
Conclusion
Dysmenorrhoea is a clinical condition, not an inevitable aspect of womanhood. Effective treatment exists for both primary and secondary causes.
Sources & References
This article draws on guidance current at the time of writing from the following bodies and publications:
- ACOG (2022)
- RCOG (2023)
- ESHRE (2022 Endometriosis Guideline)
General reference bodies for women's health guidance:
RCOG
rcog.org.ukACOG
acog.orgFIGO
figo.orgWHO
who.intNICE
nice.org.uk⚠ IMPORTANT DISCLAIMER
This article is provided for general knowledge and reference purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. No medication, treatment, or change to your healthcare should be undertaken based on this content without first consulting a qualified doctor. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
