Period pain (dysmenorrhoea)
Also called: painful periods, menstrual cramps, menstrual pain, dysmenorrhea, primary dysmenorrhoea, secondary dysmenorrhoea
Period pain (dysmenorrhoea) is cramping pain in the lower tummy before or during a period. It is common and usually eases with heat, exercise and anti-inflammatory painkillers. See a doctor if pain stops your daily life, gets worse over time or comes with other symptoms.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Period pain, called dysmenorrhoea by doctors, is pain or cramps in the lower tummy that comes with a monthly period. The pain can be sharp or a dull ache and may spread to the lower back and thighs. It often starts when bleeding begins, or a day or two before, and usually lasts up to about three days. Some pain with periods is normal, but very strong pain is not. Period pain is a leading reason why young women in their teens and twenties miss school, college or work.
There are two types. Primary dysmenorrhoea is the most common. It starts soon after periods first begin and is not caused by another illness. It happens because the womb makes chemicals called prostaglandins, which make the womb muscle tighten. This type often gets better with age and may ease after having a baby.
Secondary dysmenorrhoea is pain caused by a problem in the womb or nearby organs, such as endometriosis (tissue like the womb lining growing outside the womb), adenomyosis (the same tissue growing into the womb wall), fibroids or a pelvic infection. It usually starts later in life, in someone whose periods were not painful before, and often gets worse over time. Most period pain can be managed with self-care and simple painkillers, but a doctor should check pain that is severe, new or changing.
In Pakistan
In an online survey of 226 undergraduate students at Pakistani universities, about 85% reported period pain and around half of them were taking medicines for it. Talk to a pharmacist or doctor rather than relying on self-medication, especially if pain is severe or changing.
Symptoms
- Cramping or throbbing pain in the lower tummy, starting when the period begins or a few days before
- Pain that spreads to the lower back and thighs
- Pain that is sharp, or a dull constant ache
- Pain that usually lasts up to about three days
- Feeling sick (nausea)
- Loose stools (diarrhoea)
- Headaches
- Pain strong enough to stop you studying, working, sleeping or going out
Causes and risk factors
Causes
- Prostaglandins (natural chemicals made in the womb) that make the womb muscle tighten during a period; this causes primary dysmenorrhoea
- Endometriosis or adenomyosis, where tissue like the womb lining grows outside the womb or into its muscle wall
- Fibroids (non-cancerous growths in or around the womb)
- Pelvic inflammatory disease (an infection of the womb, fallopian tubes and ovaries) or other sexually transmitted infections
- A copper intrauterine device (coil), especially in the first few months after it is fitted
What makes it more likely
- Being in your teens or twenties, especially in the first years after periods start
- Not having had a baby, as primary period pain may ease after childbirth
- Having a copper coil fitted
- Smoking and drinking alcohol
- Stress and anxiety
- Having endometriosis, fibroids or a pelvic infection
Complications
Period pain itself does not damage the body, but severe pain can affect daily life a great deal. It can mean missing school, college or work, poor sleep and trouble concentrating every month. When pain is caused by another condition, such as endometriosis, fibroids or a pelvic infection, that condition can get worse if it is not found and treated. Pelvic infections usually need antibiotics. Painkillers called NSAIDs work well, but they can cause side effects in some people, and they are not suitable for people with stomach ulcers, bleeding problems, liver disease or an allergy to aspirin.
When to see a doctor
- Sudden or severe pelvic pain, especially if your period is more than a week late and you have been sexually active: get medical help straight away
- Fever together with pelvic pain, or vaginal discharge that is heavier than usual or smells bad: see a doctor urgently
- Period or pelvic pain that is much worse than usual and not helped by painkillers: get an urgent appointment
- Pain during sex, or when passing urine or stools
- Bleeding between periods, or periods that become heavier, irregular or more painful than before
- Pain outside your period, pain that starts more than five days before a period or carries on after it ends
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Diagnosis
Period pain is usually diagnosed from your story. The doctor asks when the pain started, how long it lasts each month, how strong it is and how much it affects school, work and sleep. Keeping a simple diary of your periods and symptoms before the visit can help. Pain that started soon after your first periods and lasts the first one to three days of bleeding is usually primary dysmenorrhoea, but the doctor first checks for signs of another cause.
If another cause is suspected, the doctor may examine your tummy and, depending on your age and whether you are sexually active and with your permission, do an internal pelvic examination. Swabs can check for infection, and a blood count may be done. A pelvic ultrasound scan can look for fibroids and other problems in the womb and ovaries. Sometimes a specialist does a laparoscopy (a small keyhole operation with a camera) to look for endometriosis.
Treatment
- Start with self-care: put a wrapped hot water bottle or heat pad on your tummy, take a warm bath or shower, gently massage your tummy and back, and keep active with walking, swimming, cycling or yoga.
- Take an anti-inflammatory painkiller (NSAID) such as ibuprofen, which is usually the first choice. A pharmacist can advise whether it is safe for you. Your doctor or pharmacist decides the dose.
- If you cannot take NSAIDs, or they do not help enough, paracetamol can be used instead, or added to an NSAID.
- For pain that is still bad, a doctor may suggest a stronger prescription NSAID or a TENS machine (a small device that sends mild electrical pulses through the skin).
- If you do not want to get pregnant, the doctor may suggest trying hormonal contraception for three to six months, such as the combined pill, a progestogen-only pill, injection, implant or hormonal coil. These make the womb lining thinner and periods lighter and less painful. It can be used together with a painkiller.
- If pain is not controlled, or another cause such as endometriosis, fibroids or infection is suspected, the doctor will arrange tests or refer you to a gynaecologist. Treatment then depends on the cause, for example antibiotics for a pelvic infection or medicine or surgery for fibroids.
Medicines in Pakistan
Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| NSAID painkillers (non-steroidal anti-inflammatory drugs) | First choice for period pain; they ease pain and reduce prostaglandins. They work better than paracetamol, and no single NSAID has been shown to be clearly better than the others. Not suitable with stomach ulcers, bleeding problems, liver disease or aspirin allergy | Ibuprofen (378 brands), Naproxen (5 brands), Mefenamic acid (2 brands) |
| Simple painkillers | Used when NSAIDs are not suitable or not tolerated, or added to an NSAID when it is not enough on its own | Paracetamol (350 brands) |
| Hormonal contraceptives | Second-line option for people who do not want to get pregnant, usually tried for three to six months; they thin the womb lining so periods are lighter and less painful. A combined pill containing levonorgestrel is a common first choice; injectable progestogen is another option. Your doctor chooses the type | Levonorgestrel + Ethinyl estradiol (2 brands), Medroxyprogesterone acetate (9 brands) |
Also used (not yet in our price list): Flurbiprofen (another NSAID), Desogestrel progestogen-only pill, Contraceptive implant, Levonorgestrel intrauterine system (hormonal coil)
Self-care and prevention
Self-care
- Put a heat pad or a hot water bottle wrapped in a towel on your lower tummy, but do not fall asleep with a heat pad on
- Take a warm bath or shower
- Gently massage your lower tummy and back
- Do gentle exercise such as walking, swimming, cycling or yoga
- Try relaxation such as breathing exercises, meditation or yoga
- Lie down with your legs raised, or on your side with your knees bent
- Cut down on alcohol and stop smoking
- Keep a diary of your periods and pain to share with your doctor
Prevention
- Regular exercise and keeping a healthy weight may help reduce period pain
- Avoid smoking and limit alcohol
- Manage stress with relaxation techniques such as yoga or meditation
- If you need contraception, ask your doctor whether a hormonal method could also ease your period pain
Common questions
Is period pain normal?
Some cramping and discomfort with periods is very common and normal. It happens because the womb muscle tightens during a period. Pain that stops you from going to school or work, keeps getting worse, or comes with other symptoms is not normal and should be checked by a doctor.
Which painkiller works best for period pain?
Anti-inflammatory painkillers (NSAIDs) such as ibuprofen work better than paracetamol for most people. Research has not shown one NSAID to be clearly better than another. Paracetamol is an option if you cannot take NSAIDs, for example because of a stomach ulcer or an aspirin allergy. Ask a pharmacist or doctor which one is safe for you and how to take it.
Can the contraceptive pill help period pain?
Yes. Hormonal contraception, such as the combined pill, injection, implant or hormonal coil, makes the womb lining thinner, so periods are lighter and usually less painful. Doctors often suggest trying it for three to six months. It is only suitable if you do not want to get pregnant, and your doctor will help you choose the right type.
Could my period pain be endometriosis?
It might be if the pain is severe, gets worse over time, starts before your period or carries on after it, or if you also have pain during sex or when passing urine or stools. Other causes include fibroids and pelvic infection. A doctor can examine you and arrange tests such as an ultrasound scan.
Does period pain get better with age?
Primary period pain, which starts soon after periods begin, often gets better as you get older and may ease after having a baby. Pain that starts later in life, in someone whose periods were not painful before, is more likely to have another cause and should be checked.
Sources
- Cochrane. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea (2015).
- Humber and North Yorkshire Patient Pathways (York and Scarborough Teaching Hospitals, Vale of York; based on NICE CKS). Dysmenorrhoea (2025).
- NHS 111 Wales. NHS 111 Wales - Health A-Z : Periods, painful (n.d.).
- MedlinePlus. Painful menstrual periods: MedlinePlus Medical Encyclopedia (2026).
- MedlinePlus. Period Pain | Menstrual Cramps | MedlinePlus (n.d.).
- Journal of Shifa Tameer-e-Millat University (JSTMU). Dysmenorrhea in students: Characteristics and predictors (2020).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.