The Period Problem series: types of period pain

Who out there experiences period pain?  Period pain is super common, but it’s not normal and shouldn’t simply be accepted as part of the female experience. It’s estimated that 45-95% of women experience painful periods. 

So why do we experience period pain? Why is this happening? 

First of all there are actually 2 different types of period pain: primary and secondary. And this is really important as they can be treated very differently, depending on the underlying causes. 

Primary period pain is pain that occurs during your menstrual bleed, that isn’t due to any other identified disease. So you would likely experience pain just prior to period, and then throughout the first couple of days of the bleed. 

This type of period pain occurs due to high levels of prostaglandins, a group of messenger molecules  that control processes such as inflammation, blood flow, the formation of blood clots, and cause the uterus to contract and shed its lining (hence our menstrual bleed). Super strong uterus contractions = pain. Prostaglandins are necessary, but when they are too high this can cause considerable cramping and pain. 

Along with elevated prostaglandins, other causes may be poor liver function, constipation leading to reabsorption of oestrogen from the bowel and subsequent hormonal imbalance,  a uterus that tilts backward (retroverted uterus) instead of forward,  and/or high histamine/mast cell activation.  

Secondary period pain on the other hand, occurs due to underlying pathology or diagnosed medical condition, such as adenomyosis, endometriosis which may cause adhesions and scarring, pelvic inflammatory disease or STIs, ovarian cysts, or maybe even fibroids.  Pain is often severe, not just related to the menstrual bleed, can start weeks before period starts, and can last longer than bleed. This type of pain is often associated with heavy bleeding, spotting, pelvic and abdominal pain.

It’s important to know the cause of your period pain, because the way we treat primary period pain can be very different to the way we treat secondary period pain, because the causes are so different. So please don’t just accept that your period pain is normal - please reach for help, and have it investigated properly.