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About WoW Back

A. Women's health

Women's reproductive life stages
Painful periods and heavy menstrual bleeding
Preventing cervical cancer
Understanding breast cancer
Respectful healthcare for women
Female genital mutilation

B. Contraception and sexual health

Contraception
Abortion care
Sexually transmitted infections

C. Getting pregnant and early pregnancy issues

Preparing for pregnancy
Bleeding and pain in early pregnancy
Infertility – difficulty in getting pregnant

D. Pregnancy

Antenatal care for healthy pregnancy
Diet and nutrition in pregnancy
Common complaints in pregnancy
Danger signs in pregnancy
Pre-eclampsia
Severe infection and sepsis

E. Childbirth

Preterm labor
Labor and birth
Cesarean section
Obstetric fistula

F. Postnatal and newborn care

Breastfeeding
Danger signs in newborn babies
Postnatal care
Jaundice in the newborn
Postnatal family planning (contraception)

G. Women's health in later years

Menopause
Postmenopausal bleeding
Bladder and pelvic floor problems
Women's health in later years

Painful periods and heavy menstrual bleeding

An educational
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Written by experienced doctors, midwives and other medical professionals – and approved by a specialist Editorial Board

Enhancing the Welfare of Women

Expert Health Information for Women

Painful periods and heavy menstrual bleeding

Women and girls can have pain and heavy bleeding during their monthly periods. This is a very common problem which can be treated.

The pain usually comes from the uterus (womb) tightening and squeezing, often because of chemicals the body produces called prostaglandins.

Most pain can be treated with simple painkillers (such as paracetamol and ibuprofen) and heat pads.

A normal period should last no more than 8 days and come roughly every month. Some women may feel sick, tired or tearful but, again, this should not be severe.

If you are unable to go to school or work because of your periods, or you have bleeding after sex or in between periods

you should see a doctor who may offer an internal examination and tests to check whether other problems are causing the pain or heavy bleeding.

Your healthcare worker may check the neck of the womb (cervix) with a plastic tube, called a speculum, or feel the womb with an internal examination through the vagina.

The examination should not be painful and you should always give consent before an examination happens. Sometimes an examination is recommended, but sometimes it is not needed.

Other tests may include blood tests, urine tests, swabs and scans, which can be done internally or externally.

Causes of heavy bleeding can include growths in the womb muscle or in the lining of the womb, or womb-lining cells growing in the wrong place.

If tests show that your blood count is low, iron tablets can be used to treat anemia and increase your blood count.

Different forms of contraception which contain hormones, such as the pill, implant, injections and hormone coil are often used.

They can reduce pain and lessen bleeding but may take a few months to work.

For some women, an operation may be needed

Sometimes operations can be used to look inside your womb or abdomen to diagnose and treat the problem or to remove growths.

As women get older, in severe cases, the womb can be removed if needed.

Remember, you do not need to suffer with heavy bleeding or pain during your period.

There are many treatment options that you can discuss with your healthcare worker.

The authors of this PAINFUL PERIODS AND HEAVY MENSTRUAL BLEEDING program are:

Dr Winnie Mwebia
Obstetrician Gynecologist/Assistant Principal Clinical Research Scientist, KEMRI Centre for Global Health Research, Kenya
Dr Dorcus Muchiri
Consultant Obstetrician Gynaecologist/Reproductive Medicine Specialist/Women's Health Researcher and Educator, The George Institute for Global Health, Imperial College London NHS Hospitals Trust, London, UK; and Bonita Centre for Women's Health, Nairobi, Kenya

The Welfare of Women program has been created under the General Editorship of Dr Kate Lightly, University of Liverpool, UK and is overseen by an expert International Editorial Board

The cost of producing this resource has been partly funded by an educational grant from GSK

Painful periods and heavy menstrual bleeding

Painful periods (also known as dysmenorrhea), is the painful cramping felt in the lower abdomen (tummy), lower back and/or inner thighs during periods (menses).

Period pains are grouped into two groups; normal period pains and pain due to an underlying pelvic problem such as endometriosis or fibroids.

What is normal bleeding?

Normal periods usually last less than 8 days.

They come roughly every month, and can be between 24 and 38 days.

The pain sets in within the first few months of periods starting.

The pain is usually mild and does not stop with normal daily functioning.

It is not associated with underlying health problems, and gets better with time and after childbirth in many women.

Other symptoms which may come with periods include mood changes, nausea, vomiting, tiredness and diarrhea.

What is considered abnormal bleeding?

Heavy menstrual bleeding (enough to affect your quality of life)

Irregular gaps between periods

Long periods (more than 8 days)

Bleeding in between periods

Bleeding after sex

Infrequent periods or no periods

What are the other symptoms to look out for?

Pain or heaviness of the lower abdomen outside the time of having a period

Painful sexual intercourse

Pain passing urine or opening bowels

Severe pain which interferes with normal functioning

Difficulty getting pregnant

Repeated pregnancy losses

What causes the pain in periods?

The body produces chemicals called prostaglandins during the time of the period. These make the uterus contract and tighten. Abnormal pain is often because of other conditions like fibroids, adenomyosis (abnormal placement of uterine muscle cells), endometriosis (where the uterine cells are outside the uterus), infection, or blockage of the cervix, vagina or genital opening.

wow-l2-painful-periods-and-heavy-menstrual-bleeding-id10068-01.jpg

When should you seek help?

If the pain or bleeding makes you take lots of medications.

If the pain or bleeding makes you not go to school or work.

If the pain or bleeding is getting worse month by month.

If the pain or bleeding occurs at times when you are not expecting your period.

If the pain or bleeding lasts longer than 8 days.

What will a healthcare provider do when they see you?

They will ask you some questions to understand the problem.

They may check your blood pressure and pulse rate.

Examinations can vary and are not always needed. Your healthcare worker may examine your tummy and may sometimes recommend an internal examination. They can check the neck of the womb (cervix) with a device called a speculum, or feel the womb with an internal examination through the vagina. The examination should not be painful and you must always give consent before you have it.

They may organize scans, blood tests, urine tests or swabs to help with the diagnosis.

wow-l2-painful-periods-and-heavy-menstrual-bleeding-id10068-02.jpg

Depending on what they find, they may very occasionally ask for more complex imaging tests like CT or MRI.

How is period pain treated?

For mild period pain, some simple measures may help relieve symptoms:

use of warm compresses such as a heating pad or hot water bottle on the lower abdomen and lower back, and massage of the lower back;

having a healthy lifestyle, with regular exercise, no smoking, reduced caffeine and animal-fat intake and good rest.

How is more severe pain treated?

Medication for period pain ranges from simple pain medication such as brufen, hyoscine (buscopan) and paracetamol to other pain relievers such as diclofenac, mefenamic acid, ketoprofen and naproxen, which can be used for moderate-to-severe pain in some cases.

Different forms of contraception such as the hormonal contraceptive pill, implant, injectectable contraceptive and hormone intrauterine devices, such as Mirena, are often used to reduce pain and bleeding. Contraceptives which contain hormones can make your periods lighter or less frequent. These treatments are very safe for most women but take a few months to work.

Antibiotics may be required if the cause of pain is found to be an infection.

wow-l2-painful-periods-and-heavy-menstrual-bleeding-id10068-03.jpg

Different drugs can be used in combination, as deemed necessary.

When might surgery be needed?

For some women, surgery may be necessary for growths of the uterus such as fibroids, polyps or adenomyosis, endometriosis or blockage of any part of the genital tract.

The type of surgery depends on what the problem is, and can involve open surgery (cut to the tummy), laparoscopy (keyhole surgery) or hysteroscopy (camera into the womb).

wow-l2-painful-periods-and-heavy-menstrual-bleeding-id10068-04.jpg

Surgery can be as simple as removal of small endometriotic tissues, removal of fibroid or adenomyoma or the complete removal of uterus and ovaries (hysterectomy). This is usually a last resort, and is more likely in older women who have completed their family.

What else should I know?

Normal period pain tends to reduce after childbirth. Also, pain from endometriosis or adenomyosis may reduce after childbirth.

Normal period pain does not affect fertility. However, if the pain is due to other underlying problems fertility may be affected. Be aware that the non-steroidal anti-inflammatory medications such as brufen, ketoprofen and diclofenac may affect fertility during the cycle when they are taken. It is therefore important to discuss fertility concerns with your medical provider if you have any concerning symptoms.

In rare cases in which there is a blockage of the cervix, vagina or the vaginal opening, pelvic pain can be experienced around the time when your period is due, without any bleeding. If you experience this, please visit your medical provider to check this out.

Painful and heavy periods are very common and can be normal or abnormal. If your periods are affecting your quality of life, see your healthcare worker to get advice.

The authors of this PAINFUL PERIODS AND HEAVY MENSTRUAL BLEEDING program are:

Dr Winnie Mwebia, Obstetrician Gynecologist/Assistant Principal Clinical Research Scientist, KEMRI Centre for Global Health Research, Kenya
Dr Dorcus Muchiri, Consultant Obstetrician Gynaecologist/Reproductive Medicine Specialist/Women's Health Researcher and Educator, The George Institute for Global Health, Imperial College London NHS Hospitals Trust, London, UK; and Bonita Centre for Women's Health, Nairobi, Kenya

The Welfare of Women program has been created under the General Editorship of Dr Kate Lightly, University of Liverpool, UK and is overseen by an expert International Editorial Board

The publishing reference for this program is: DOI 10.3843/GLOWM.w10068

The Welfare of Women information program is an attempt to provide women everywhere with access to reliable information about key health issues that may be relevant to them. Information is offered at three separate levels which women may select according to their preferences; firstly, short video animations with voice commentary, secondly, more detailed text-based descriptions, and thirdly, links to recommended further reading. With the animated videos, women can also select the images that they feel most comfortable in viewing from a short range of very generalized and non-specific ethnicity options. Because of the special programming used, both the videos and the text information can – when authorized – be translated into any language in a simple and rapid manner.