DYSMENORRHOEA - PAINFUL PERIODS

Author: Janine Soo Thow NZRN/AUSRN & Clinical Preceptor - BSci, BHSci(Nursing), PGCertPHCSpecialtyNursing

Dysmenorrhoea, also known as painful periods, is one of the most common gynaecological issues affecting younger women or people assigned female at birth during their menstruating/reproductive years.

Dysmenorrhoea can significantly affect quality of life and daily functioning, including economic, social and educational aspects, regardless of age or ethnicity.

It is estimated that the global prevalence of dysmenorrhoea exceeds 70%, highlighting the need for healthcare providers and health organisations to address this significant issue. However, although a wide range of treatment options exist to help minimise the negative impact that dysmenorrhoea can have on quality of life, there is evidence of low uptake due to several factors.

PRIMARY AND SECONDARY DYSMENORRHOEA

Dysmenorrhoea can be classified as either primary (cause is not known) or secondary (cause is known).

Primary dysmenorrhoea which usually begins before and during menstruation and typically lasts up to 3 days, is characterised by crampy pain in the lower abdominal region or pelvis that can radiate to the back, down the legs and the thighs. Other symptoms that can occur with primary dysmenorrhoea can be nausea (feeling like you want to vomit), vomiting, weakness, fainting, headaches, tiredness, diarrhoea, bloating and insomnia.

Secondary dysmenorrhoea refers to menstrual pain caused by another medical condition, such as endometriosis, fibroids (non-cancerous growths in the uterus), adenomyosis (abnormal tissue growth in the muscular wall of the uterus) and other conditions. Endometriosis is where tissue similar to the lining of your uterus grows outside the uterus and can grow on other organs of your body like the heart, lungs and intestines, causing significant pain.

If you think you may have secondary dysmenorrhoea please see your doctor. Some of the signs and symptoms include but are not limited to, heavy or prolonged bleeding, bleeding between periods, increased pelvic pain, unusual discharge, irregular periods, pain during sexual intercourse, and a lack of response to pharmacological intervention, such as hormonal treatments and non-steroidal anti-inflammatory medications.

It can also be helpful to keep a record of your period dates and symptoms using either a diary, journal, app or calendar.

Important note: each person will experience symptoms differently and some of the symptoms of dysmenorrhoea may look like other medical conditions/problems, so please consult your doctor for a diagnosis.

Image credit: Unsplash Kateryna Hliznitsova

RISK FACTORS

Although any woman can have dysmenorrhoea, there are risk factors that increase the chances of getting this condition. These are:

Being overweight

Smoking

Drinking alcohol during menstruation (prolongs the period pain)

Nulliparity- a medical term for women who have never been pregnant

Family history of dysmenorrhoea

Women who started their first period at a young age (before age 11)

THE HOW AND WHY YOU GET PAINFUL PERIODS

Painful periods are believed to result from the increased production of prostaglandins, hormone-like fatty acids that trigger uterine contractions and inflammation, causing your uterine lining to shed (the blood and tissue that comes out of your vagina) and period pain. When your prostaglandin levels are higher, your uterus contracts more strongly during menstruation causing the cramping and discomfort you feel.

TREATMENT TO MANAGE DYSMENORRHOEA SYMPTOMS INCLUDE BUT ARE NOT LIMITED TO:

For those with primary dysmenorrhoea, the pain can be managed at home with pain relief using pharmacological interventions such as:
as paracetamol and ibuprofen to reduce pain and inflammation (always follow the manufacturer’s instructions) and oral contraceptives. However, please keep in mind that not all pain relief medicines are safe for some people, so please talk to your doctor, nurse practitioner or pharmacist for advice especially if you have very severe pain.

Non-pharmacological interventions to help manage the pain supported by clinical evidence, include using a heat pad for the area of pain, regular exercise, taking a hot bath or shower, dietary changes – decreasing sugar and caffeine intake and abdominal massage, turmeric tea, eating ginger to help reduce the inflammation, taking vitamin supplements (please talk to your doctor first about this). Other options include mindfulness, relaxation techniques and counselling as mental stress can exacerbate period pain.

For the treatment of secondary dysmenorrhoea, this will depend on the type of medical condition you have that is causing your pain.

On the very extreme end of the scale, surgery may be required. However, this will be determined by your healthcare provider based on the extent and severity of your condition.

Important note: the specific treatment for dysmenorrhoea will be determined by your healthcare provider based on medical history, age, overall health, any underlying medical conditions, contraindications to any medications, tolerance for specific medications and therapies, and your preference.

WHEN TO SEEK HELP

Severe pain that stops you from doing day-to-day things– you are unable to go to work or school because of the pain or participate in the activities you usually enjoy.

Pain that is not relieved by non-pharmacological or pharmacological options

If you have any of the following symptoms with the pain and are very worried such as heavy periods, irregular periods, bleeding between periods, painful sex, bleeding after sex, or unusual discharge.

In NZ, if you need help now and you are not sure what to do: call Healthline 0800 611 116, health point, counsellor -1737 (free call or text)

Remember it is okay to ask any questions about your care to help you get the information you need.

Image credit: Unsplash - photographers Anastasiia Chepinska & Mathilde Langevin

Image credit: Unsplash - photographer Virginia Marinova

Author: Janine is a NZ/AUS registered nurse, clinical preceptor & cervical smear test taker who is deeply passionate about education and sharing knowledge on women’s health, mental health & chronic illness.During her time as a GP nurse & women’s health nurse, she helped run multiple women’s health clinics in Auckland.

Drawing from her professional clinical experiences & personal journey as a patient living with dysmenorrhoea, endometriosis, adenomyosis and PCOS, she firmly believes that knowledge is power and that open discussions of women’s health is essential for advocacy and change.

References

Ferries-Rowe E, Corey E, Archer JS. Primary Dysmenorrhea: Diagnosis and Therapy. Obstet Gynecol. 2020 Nov;136(5):1047-1058. doi: 10.1097/AOG.0000000000004096. PMID: 33030880.

de Arruda GT, Barbosa-Silva J, Driusso P, Pathmanathan C, Armijo-Olivo S, Avila MA. Worldwide prevalence of dysmenorrhea: a systematic review and meta-analysis across 70 countries. Pain. 2025 Sep 23. doi: 10.1097/j.pain.0000000000003768. Epub ahead of print. PMID: 41031966.

Nagy H, Carlson K, Khan MAB. Dysmenorrhea. [Updated 2023 Nov 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560834/

Healthify https://healthify.nz/health-a-z/d/dysmenorrhoea

More information

The Royal Women’s Hospital Australia https://www.thewomens.org.au/health-information/periods/periods-overview/problem-periods

Health New Zealand Te Whatu Ora – Women’s health https://info.health.nz/conditions-treatments/womens-health

Australian and New Zealand Journal of Obstetrics & Gynaecology

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists - RANZCOG for college publications/patient resources - https://ranzcog.edu.au/resource-hub/