Dr Phil Green: Menstrual Pain & You

Dr Phil Green: Menstrual Pain & You

Experiencing painful periods is a significant issue, impacting women's performance at school and work. In extreme cases, about 10% of women may need bed rest due to severe symptoms. Painful periods, known as dysmenorrhoea, can be categorized into two types:

Primary Dysmenorrhoea:

  • Begins about a year after the onset of periods, most common between ages 15 and 25.
  • Symptoms include cramping pain in the lower abdomen, potentially moving to thighs and lower back.
  • Usually noticed about a day before the period starts, with symptoms typically decreasing with age.
  • Treatment includes anti-inflammatory medication, combined oral contraceptives, paracetamol, alverine citrate, and other non-drug options like TENS devices.

Secondary Dysmenorrhoea:

  • Uncommon before the age of 25.
  • May involve heavy bleeding, painful intercourse, or infertility.
  • Causes include endometriosis, pelvic inflammatory disease, fibroids, womb polyps, pelvic congestion syndrome, intra-uterine contraceptive device, and ovarian cysts.


  • Affects about 10% of reproductive-age women.
  • Symptoms can be non-specific, often mimicking other conditions.
  • Causes pelvic pain, menstrual cramps, fatigue, and depression.
  • Associated with infertility, heart disease, arthritis, and more.
  • Diagnosis involves considering symptoms, a pelvic examination, and an ultrasound scan.
  • Medical management includes pain relief, hormonal therapies, and sometimes surgery for severe cases.
  • Endometriosis may impact fertility and tends to resolve during menopause.


  • Presence of womb lining tissue in the muscle layer of the womb.
  • Commonly diagnosed in women aged 40 to 50.
  • Symptoms include painful, heavy, or abnormal periods and an enlarged womb.
  • Treatments involve hormonal contraceptives, high-dose progesterone-based medications, and the intra-uterine system (e.g., Mirena coil).

In summary, painful periods are a common concern with various causes and treatment options. Seeking medical advice for persistent symptoms is crucial, and there are resources available for additional support and information, such as Endometriosis UK, NICE, and RCOG.

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