Dysmenorrhea (dis-meh-nuh-ree-ah), more commonly known as “period pain” is pain that usually occurs in the area below your belly button.

There are two kinds of dysmenorrhea.

• Primary (the most common and caused by hormonal changes) and
• Secondary (caused by other conditions like endometriosis).

This section talks about primary dysmenorrhea. There is a spectrum of pain and symptoms that can be experienced during menstruation. It’s useful to understand what symptoms and level of pain are expected and those symptoms and levels pain that might signal you need to see a doctor.

There are some resources in this section to help you figure out if you might need to speak with your doctor about potential causes of secondary dysmenorrhea, like endometriosis.

Our colleagues at the Canberra Endometriosis Centre have developed a screening questionnaire called the PIPPA tool (short for Period ImPact and Pain Assessment). If you fill in these five questions they will give you an indication if you can try and manage your symptoms with self-care or if you should speak to your doctor.

Period pain caused by primary dysmenorrhea can feel different from individual to individual, but it’s commonly described as cramping or aching. Sometimes it can feel sharp, like a stabbing sensation, or a feeling of something dragging.

Sometimes this pain will feel like it’s in your lower back as well as your tummy. It’s not as common but some people will feel like the pain goes down into their thighs, which can feel very heavy or stiff.

Pain usually starts within a few hours after your period starts, but some individuals can feel the pain begin anywhere from a few hours or a day before their period starts. This pain usually lasts for the first one to two days once your period starts. If your pain starts more than a day before your period and lasts more than the first two days, you may need to speak with your doctor about this.

The pain that occurs during your period can often come and go, or get worse at certain times, often at night. This cramping sensation is often described as coming in ‘waves’. This is mostly due to changes in levels of some of the hormones involved in causing period pain (see section what causes dysmenorrhea) at different times.

Primary Dysmenorrhea has other symptoms that can come either at the same time, or just before, the period pain.

Common symptoms are:

• Feeling tired
• Having emotional changes (like feeling angry or sad)
• Headaches
• Breast tenderness
• Bloating

These are discussed more in ‘what is normal – what other symptoms might I be getting’ section.

Endometriosis

Endometriosis is a very common cause of secondary dysmenorrhea. Endometriosis is the presence of tissue similar to the lining of the uterus that is found outside the uterus, where it shouldn’t be. There are a number of theories as to what causes endometriosis but at this stage we don’t know why some people get it, but if your mum or sister or other close relative has it, its more likely you will have it as well.

Endometriosis is quite common, with around 1 in 9 women and those who were assigned female at birth having a diagnosis of endometriosis. Some people with endometriosis have pain that starts with or soon after their first period, while some people with endometriosis have relatively painless periods at first, and then as they get older they have more pain. So just because you are young doesn’t mean you can’t have endometriosis!

The most common symptom of endometriosis is severe period pain. This pain can feel like ‘cramps’ but can also feel sharp, stabbing, burning or like electric shocks. While those with primary dysmenorrhea can also have moderate to severe pain, having severe pain, especially if you vomit or feel faint, is usually a sign that you need to speak to your doctor.

One type of pain that isn’t common in primary dysmenorrhoea is pain below your belly button that occurs on a regular basis when you are not having your period. It might not be every day but commonly at least a couple of times per week. This type of pain is very common in women with endometriosis, especially among young women but isn’t common in those with primary dysmenorrhea.
Pain in your bowels or bladder is common with endometriosis – this means when you need to go for a wee or poop you might feel some pain, either before or during. Some people report bowel and/or bladder pain only during their period, while others experience the pain outside of their period. While having changes in your bowels (either loose/softer/runny or feeling more constipated) is common with primary dysmenorrhea, if you have pain you should speak to your doctor.

Pain with or after sex is experienced by about three quarters of those with endometriosis. It often feels like the pain is deep inside the tummy and can last for up to 24 hours afterwards. Pain with or after sex should always be checked out by your doctor, as there are a number of different conditions, like endometriosis and vulvodynia, that can cause painful sex.

You can read more about symptoms of endometriosis here and Endometriosis Australia is an excellent resource for more reliable information and support – https://www.endometriosisaustralia.org
Only your doctor can diagnose endometriosis, so if you have any of the symptoms that might be endometriosis then you should speak to them.

• Period Pain (Dysmenorrhea)
  • There are two kinds of dysmenorrhea, primary dysmenorrhea is the most common and caused by hormonal changes and secondary is caused by other conditions like endometriosis.
  • Period pain (caused by dysmenorrhea) usually starts within a few hours or after your period starts, but some people can feel the pain begin anywhere from a few hours or a day before their period starts.
  • Period pain usually lasts for the first one to two days once your period starts.
  • Primary dysmenorrhea is caused by the hormone prostaglandin (PGF2_a) in the cells that make up the lining of your uterus gets released at the start of your period it causes the characteristic ‘cramping’ feeling.