Women's Health Series: Painful Periods

Our Women's Health Series is back this week with the lowdown on painful periods: an extremely common complaint in women, in fact around 80% have experienced period pain during their life and in about 10% of those women, the pain is bad enough to affect their lives.

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There are two types of period pain. The first is the kind teenage girls and young women experience at the beginning of their cycle and is caused by contraction of the womb. The second usually starts later and may be unrelated to the beginning of the cycle. In this case it can be due to other underlying causes and should be discussed with your GP.

If you’ve had the all-clear from your doctor, but still suffer from painful periods, there are things you can do to improve your pain:

  • Smoking cessation: I can only hope that if you’re reading this, you are health conscious enough to not need to be told this, but smoking causes inflammation and that leads to pain
  • Reduce your sugar intake. Cut-out sweets, cakes and sugary drinks
  • Reduce alcohol use
  • Reduce salty food (to reduce water retention)
  • Eat lots of fibre & vegetables
  • Try taking the following supplements/vitamins:
    • Vitamin E (not exceeding the recommended daily allowance)
    • Vitamin B6
    • Evening Primrose oil
  • Try a hot water bottle or a hot bath
  • Gentle exercise and/or a relaxation programme before your period is due

If none of the above work for you, then your GP may be able to prescribe medication, the pill or a coil – all of which can help relieve pain.

Heavy periods

Heavy menstrual bleeding is defined as regular, excessive periods over several cycles. There is no definition on the amount, as this is very subjective and what one woman may find heavy another may not. Generally though if you find that you’re bleeding through to clothes, using a lot of sanitary towels or tampons, passing clots or if the bleeding interferes with your daily activities, then see your GP. Sometimes there may be a cause for the heavy bleeding such as fibroids, endometriosis or a polyp, but a lot of the time there isn’t.

The doctor may need to do an internal examination and may arrange for you to have an internal ultrasound scan. If the bleeding is particularly heavy they may arrange for you to have a blood test, to ensure you are not anaemic as a result of your blood loss - this is very common and easily treated.

Treatment options for a heavy flow include medication that reduces the amount of blood produced, the pill or the coil. Occasionally surgery is required but this depends on the underlying cause.


Premenstrual syndrome (PMS)

Premenstrual syndrome (PMS) or Premenstrual Tension (PMT) is a series of symptoms that women may experience prior to her period. There are lots and lots of symptoms that have been associated with this and a third of women have or will experience some of these. The list is too big to go into now as there are about 100 various symptoms.

The cause of PMS is not exactly known, but is almost certainly as a result of changes in hormone levels. Symptoms broadly speaking can be classified as psychological ones, such as tiredness, mood swings, anxiety etc and physical, such as weight gain and bloating, aches and pain, skin changes etc.

What to do about it?


Address any stress and anxiety in your life. This can make symptoms much worse than they are. Get educated on the condition. Just understanding why you’re experiencing symptoms may in itself alleviate a lot of your stress and anxiety. Make sure you’re getting enough sleep and that the quality of the sleep is good. Have a look at my previous blog on sleep here.


You are far more likely to experience symptoms if you are overweight or unfit. Remember that exercise is a great cure for lots of ailments. Make sure you’re exercising regularly and remember exercise doesn’t need to be an hour jog, or two hours in the gym. A shorter higher intensity session is usually more effective.


Try to maintain a healthy diet. The dietary advice above for painful periods also applies here. A lot of problems are caused by bloating and fluid retention. Make sure you avoid salt, alcohol and fizzy drinks. Ensure you’re getting all the right vitamins and minerals. Try and eat little and often as opposed to large meals that may make you feel bloated and avoid food that can do the same thing, such as High GI carbohydrates.

Vitamins and Minerals

Although not very well proven, make sure you’re getting enough Magnesium, Vitamin B6, Calcium, Vitamin D and Folic Acid. See the article on Micronutrients for information on how to top these up.

Other Therapies

Evening primrose oil, black cohosh and dong quai have been reported to help but the evidence is not very strong. 

If you’re unsure if your symptoms are related to your cycle, arrange to see your GP, as there can be lots of other causes for the symptoms women experience during their periods. Also if your symptoms are so severe that they interfere with your daily activities, see your GP as there are treatments that may help. These include:

  • The pill or other contraceptive methods
  • The coil or (IUS)
  • SSRI Anti-depressants. There is some evidence to suggest that SSRI antidepressants improve symptoms, not necessarily prescribed for depression
  • Cognitive-behavioural therapy (CBT)

I find generally that women are reluctant to talk about a lot of these menstrual issues with their doctors, in particular to male GP’s. All I can say is that your doctor will understand your issues and do their best to help you. There are lots of options out there, so just ask!


This blog is written by friend of Neat, Dr Nick Ambatzis MB BS, MSc (SEM), MRCGP.

Nick is a General Practitioner specialising in Sports and Exercise Medicine. He completed his medical degree at University College London Medical School in 2002. Nick worked for almost ten years as a junior surgeon and spent three years in Trauma & Orthopaedics. He attained a Masters in Sports and Exercise Medicine and subsequently trained as a GP practising in Paddington.

From an early age, Nick has been both a keen cross-country runner and water-polo player, having competed at college level. Nick is also an accomplished ultra-marathon runner, having competed in many cross-country and cross-alpine races, ranging from 50-100 miles. He has also been a Crossfit and Crossfit Endurance coach.  

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