Painful Periods

Period pain (dysmenorrhoea) affects most women at some point and is caused by prostaglandins triggering uterine contractions. Primary dysmenorrhoea starts in the teens and improves with age; pain that starts or worsens later in life, or pain between periods, may signal endometriosis or fibroids and deserves investigation. NSAIDs like ibuprofen taken at the first sign of pain are the best-evidenced treatment, alongside heat. Ginger (750-2000 mg daily in the first days of the period) and magnesium show modest trial support. Pain severe enough to disrupt work or study every month is not something to simply endure.

Evidence synthesis: Prostaglandin overproduction drives uterine cramping, and NSAIDs are strongly evidence-based (Cochrane: significant pain relief versus placebo), most effective when started before pain peaks. Heat therapy performed comparably to ibuprofen in randomised trials. Magnesium has multiple small RCTs showing reduced dysmenorrhoea severity, with a Cochrane review rating evidence as low-to-moderate quality but favourable. Omega-3 supplementation reduced pain intensity and NSAID use in RCTs of young women with primary dysmenorrhoea. The key triage evidence: secondary dysmenorrhoea — new-onset or progressive pain after age 25, pain outside menses, dyspareunia, or infertility — is the presentation pattern of endometriosis, which averages 7-10 years to diagnosis precisely because it is dismissed as normal cramps.