When is period pain not normal?
The line between a difficult period and a symptom worth investigating, and what to track before your appointment.
Most people who have periods get some cramping. It's so common that many of us grow up believing that any amount of pain is just part of being a woman — something to push through with a hot water bag and a painkiller. But there's a line between a difficult period and a symptom that deserves attention, and too many women are told to put up with pain that could be treated.
What "normal" period pain looks like
Typical period pain (called primary dysmenorrhoea) is a cramping ache in the lower tummy that can spread to the back or thighs. It usually starts just before or as bleeding begins, is worst in the first day or two, and eases after that. Over-the-counter pain relief, heat and gentle movement usually take the edge off, and it doesn't stop you living your life.
Signs your period pain needs checking
It's worth booking an appointment if any of these sound familiar:
- It stops your life. You regularly miss school, college, work or plans because of pain.
- Painkillers don't touch it, or you need them for several days every cycle.
- It's getting worse over months or years, rather than staying the same.
- It happens outside your period — pain mid-cycle, all month, or with bowel movements or passing urine.
- Sex is painful, especially deep inside.
- Your bleeding is heavy — changing a pad every hour or two, passing large clots, or bleeding for more than seven days.
- You're struggling to get pregnant as well as having painful periods.
You have sudden, severe pelvic pain; pain with fever or feeling very unwell; fainting or dizziness; or pain and bleeding when you might be pregnant. Go to your nearest hospital emergency department.
What might be behind it
When period pain is severe or changing, a gynaecologist will think about conditions such as:
- Endometriosis — tissue similar to the womb lining growing outside the womb, which can cause pain, painful sex and fertility difficulties. It often takes years to be diagnosed, partly because pain is dismissed.
- Adenomyosis — similar tissue growing into the muscle wall of the womb, often causing heavy, painful periods.
- Fibroids — non-cancerous growths in the womb that can cause heavy bleeding and pressure.
- Pelvic infection or other causes that need treatment.
Pain also has a physical and emotional knock-on effect. Months of pain can tighten the pelvic floor muscles, disturb sleep and wear down your mood — which is why we sometimes involve our physiotherapist or psychologist too.
What to track before your appointment
Two or three cycles of notes make an appointment far more useful. Use an app or a notebook to record:
- The dates your period starts and ends
- Your pain each day, on a scale of 0–10, and where you feel it
- How heavy the bleeding is (how often you change, any clots)
- What you took for the pain, and whether it helped
- Anything you missed because of your period
- Other symptoms: bowel or bladder pain, pain with sex, mood changes, tiredness
What can help
Depending on the cause, options can include the right pain relief taken at the right time, hormonal treatments, treating heavy bleeding and low iron, pelvic floor physiotherapy, and — for some conditions — surgery. Your gynaecologist will talk you through what fits your symptoms, plans and preferences.
Period pain that takes over your life is not something you have to accept. You don't need to be certain it's "bad enough" to book — describing it to someone who takes it seriously is the first step.
This guide is general education written by the Narika team. For advice tailored to your body and history, book a consultation with our doctors — that's exactly what they're here for.
