Severe period pain: when should you see a gynaecologist?

English version

When is period pain more than a normal cramp?

Mild cramping for a day or two around the beginning of a period is common. However, severe, worsening or persistent pain may need a medical assessment—particularly when it begins to control your work, sleep or daily routine.

What can cause painful periods?

The uterus contracts during menstruation to shed its lining. These contractions can cause lower-abdominal cramps that spread to the back or thighs. In some women, significant pain may be associated with endometriosis, adenomyosis, fibroids, pelvic infection, an ovarian cyst, cervical narrowing, an intrauterine contraceptive device or another pelvic condition.

Endometriosis can be associated with severe menstrual pain, persistent pelvic pain, heavy bleeding, pain during sex and difficulty conceiving. These symptoms do not prove that a particular condition is present; they indicate that the cause deserves assessment.

Arrange a consultation if

• Pain stops you working, studying, sleeping or doing normal activities.
• Your periods are becoming progressively more painful.
• Pain continues beyond the first few days or occurs at other times.
• You have pain during sex, urination or bowel movements.
• Your periods have also become heavy or irregular.
• You bleed between periods or are having difficulty conceiving.

Prepare for your consultation

Keep a diary for two or three cycles. Record when pain starts and ends, its severity from 0–10, its effect on work and sleep, bleeding duration, related bowel or urinary symptoms, and medicines taken. Depending on the history, a gynaecologist may recommend an examination, blood tests or an ultrasound. A normal ultrasound does not always exclude conditions such as endometriosis.