Period pain that isn't normal, and how to tell the difference

Almost everyone with periods has had cramps. That universality is exactly the problem: it makes severe pain very easy to dismiss, both by other people and by yourself. "Everyone gets period pain" is true, and it has cost an enormous number of people a decade of their lives.

What ordinary period pain is

At the start of a period, the uterine lining releases prostaglandins, which make the uterine muscle contract to expel it. Those contractions temporarily reduce blood flow to the muscle, and that is what the cramping sensation is. Higher prostaglandin levels mean stronger contractions and more pain — and because prostaglandins also act on the gut, it is why nausea and loose stools often arrive on day one.

Ordinary primary dysmenorrhoea:

• Starts shortly before or with the bleeding
• Peaks in the first day or two and settles
• Is centred low in the abdomen, sometimes radiating to the lower back or thighs
• Responds meaningfully to NSAIDs like ibuprofen or naproxen, especially started before the pain peaks
• Does not stop you doing what you would otherwise do

That last point is the one to hold on to. Pain that is uncomfortable is normal. Pain that removes days from your life is not, regardless of how common it is.

The signs that point elsewhere

Secondary dysmenorrhoea means the pain has an underlying cause. The pattern usually looks different:

• Pain that starts days before bleeding rather than with it
• Pain that outlasts the bleeding
• Pain that NSAIDs barely touch
• Pain during or after sex, particularly deep pain — see why sex hurts
• Pain with bowel movements or urination, especially around your period
• Pain that has got worse over years rather than staying stable
• Pain plus heavy bleeding — see how heavy is too heavy
• Vomiting, fainting, or being unable to stand up straight
• Missing work, school or training regularly

Any of these shifts the question from "how do I manage this" to "what is causing this".

The three most common causes

Endometriosis. Tissue similar to the uterine lining growing outside the uterus, where it responds to hormonal cycling, bleeds, and provokes inflammation and adhesions. It affects roughly one in ten people of reproductive age. The pain is often cyclical at first and becomes more constant over time. Crucially, the amount of disease seen at surgery correlates poorly with how much pain someone is in — small amounts of tissue in the wrong place can be agonising, which is part of why patients get disbelieved. Endometriosis and the diagnostic delay covers what to do about the years it typically takes.

Adenomyosis. Endometrial-type tissue inside the muscular wall of the uterus. Classically heavy, painful periods with a dragging, bearing-down quality and a bulky tender uterus. Often diagnosed later than it should be, and it commonly coexists with endometriosis.

Fibroids. More often a cause of heaviness and pressure than sharp pain, but large or degenerating fibroids hurt.

Less commonly: pelvic inflammatory disease, ovarian cysts, a coil that has moved, and obstructive anomalies of the reproductive tract in younger patients.

What actually helps in the meantime

Even while you are working out the cause, treatment is available and worth taking seriously.

NSAIDs work better taken early. They inhibit prostaglandin production rather than blocking the pain after the fact, so starting them a day before you expect the pain — if your cycle is predictable enough — is meaningfully more effective than starting once it hurts. Take them with food, and not at all if you have a contraindication.

Heat is genuinely effective. Trials of continuous low-level heat have found effects comparable to NSAIDs. It is not a consolation prize.

Hormonal options — combined pills used continuously, progestogen-only methods, the hormonal coil — work by reducing or eliminating the lining that produces the prostaglandins. Suppressing periods is a legitimate treatment, not an avoidance of the problem.

Pelvic floor physiotherapy matters more than most people are told, because chronic pelvic pain drives protective muscle guarding that becomes its own pain source. The pelvic floor is a muscle group covers it.

The record is what shortens the delay

The single most useful thing for getting taken seriously is a specific, dated account: which days you hurt relative to bleeding, what the pain score was, what you took, whether it worked, what you could not do. Three months of that is a document. "It's really bad" is not.

That is a large part of why Naked exists — logging pain alongside your cycle, sleep, mood and activity, so what you bring to an appointment is a pattern rather than an impression. People who track often find the pain starts consistently three or four days before bleeding, which is itself diagnostically interesting and completely invisible without a record.

You do not have to earn treatment by proving your pain is bad enough. But in a ten-minute appointment, evidence moves things faster than adjectives.