Periods can hurt. For some of us, that means an annoying ache and a hot-water bottle. For others, it means cancelling plans, missing work, lying curled up in bed or wondering whether everyone else secretly feels this terrible once a month too.
Here’s the important bit: period pain is common, but that doesn’t mean every level of pain should simply be accepted as “part of being a woman”. In fact, the World Health Organization (WHO) estimates that more than two out of three women and girls experience pain with menstrual bleeding, while for a smaller number that pain can be very severe.[1]
Severe menstrual pain can sometimes be associated with conditions such as endometriosis, adenomyosis or fibroids.[1] And even when there is no underlying condition, pain that regularly interferes with your life deserves to be taken seriously.
So, let’s talk about what period cramps are, why they happen and when period pain is worth discussing with a healthcare professional.
Why do period cramps happen?
The medical term for painful periods is dysmenorrhoea.
During your period, the muscular wall of the uterus contracts to help shed its lining. Substances called prostaglandins play a role in triggering these contractions. Higher prostaglandin activity is associated with uterine contractions and menstrual pain.
This type of period pain, when there is no underlying pelvic condition causing it, is known as primary dysmenorrhoea.
Cramps often begin shortly before or around the start of menstrual bleeding and may be strongest during the first couple of days. The pain is typically felt in the lower abdomen, but it can also spread to the lower back and thighs.
And because apparently cramps weren't enough, some people also experience symptoms such as nausea, diarrhoea, headaches, tiredness or dizziness around their period.
Thank you, uterus. Very comprehensive.
How much period pain is “normal”?
This is where things become more complicated.
There isn't a magical pain score at which period cramps suddenly become abnormal. People experience and describe pain differently, and what feels manageable to one person may be completely debilitating to another.
Mild to moderate cramping around the beginning of menstruation is common. But being common isn't the same thing as being something you simply have to put up with.
The WHO specifically notes that very painful periods, particularly when symptoms disrupt normal activities, can suggest an underlying health condition and deserve to be evaluated by a healthcare professional.[1]
So a useful question is not only:
“How much does it hurt?”
But also:
“What is this pain stopping me from doing?”
If period pain regularly prevents you from going to work or school, exercising, sleeping, socialising or generally getting on with your life, that is worth paying attention to.
Needing to reorganise your entire existence around your uterus every month shouldn't automatically be dismissed as just periods.
When should you speak to a healthcare professional about period pain?
You don't need to wait until pain becomes completely unbearable before asking for medical advice.
Consider speaking to a doctor or another qualified healthcare professional if your period pain is severe, getting worse, affecting your everyday activities or simply feels different from what is usual for you.
It is particularly worth seeking medical advice if you experience symptoms such as:
- period pain that regularly stops you carrying out normal daily activities
- pain that has become noticeably worse over time
- periods that become significantly heavier, longer or more irregular
- bleeding between periods
- pain during or after sex
- pain when urinating or having a bowel movement, particularly around your period
- pelvic pain at other points in your menstrual cycle
- abdominal swelling or persistent bloating
- difficulty becoming pregnant alongside significant menstrual or pelvic symptoms
- new or severe period pain that develops after previously having relatively manageable periods.[1][2]
Some symptoms require more urgent medical attention. Sudden or unusually severe pelvic pain, particularly if accompanied by heavy bleeding, fainting, fever, vomiting or the possibility of pregnancy, should be assessed promptly.
You know what is usual for your body. A significant change is worth mentioning.
Primary versus secondary dysmenorrhoea
Healthcare professionals generally distinguish between primary dysmenorrhoea and secondary dysmenorrhoea.
Primary dysmenorrhoea is period pain without an identifiable underlying pelvic condition. Secondary dysmenorrhoea refers to period pain associated with another condition.
This distinction matters because significant or changing menstrual pain can sometimes be a symptom rather than the whole story.
Some conditions associated with painful periods include the following.
Endometriosis
Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows outside the uterus. The WHO estimates that it affects around 10% of women of reproductive age worldwide.[2]
Symptoms vary considerably. They can include severe period pain, heavy menstrual bleeding, chronic pelvic pain, pain during sex, pain during bowel movements or urination, bloating, nausea and difficulties becoming pregnant.[2]
One particularly frustrating thing about endometriosis is that diagnosis can take time. The WHO notes that delays in diagnosis are common and that menstrual pain can be ignored or downplayed because of stigma and social beliefs.[2]
So no, you do not need to “look ill enough” for your symptoms to matter.
Adenomyosis
Adenomyosis occurs when tissue similar to the lining of the uterus grows into the muscular wall of the uterus.
It can be associated with painful periods, heavy menstrual bleeding, pelvic pain, bloating or a feeling of heaviness or fullness in the abdomen.[1]
Not everyone with adenomyosis experiences symptoms, and symptoms can overlap with other gynaecological conditions.
If your periods have become progressively more painful or heavier, it is worth bringing that change up with a healthcare professional.
Fibroids
Uterine fibroids are non-cancerous growths that develop in or around the uterus.
Many people with fibroids have no symptoms at all. When symptoms do occur, they can include heavy or painful periods and pelvic discomfort or pressure.[1]
Fibroids can vary considerably in size, number and location, which is one reason experiences differ so much from person to person.
Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. It can be associated with pelvic or lower abdominal pain, unusual vaginal discharge, pain during sex, unusual bleeding and fever.
Unlike an ordinary bout of menstrual cramps, PID requires medical assessment and treatment. If you think your symptoms could be related to an infection, speak to a healthcare professional.
What if your doctor says everything looks normal?
This can be an incredibly frustrating experience.
Tests that do not identify an obvious cause do not mean that the pain you experience isn't real. Primary dysmenorrhoea itself can cause significant pain, and some conditions associated with pelvic pain can take time to diagnose. The WHO, for example, specifically acknowledges that delays in endometriosis diagnosis are common.[2]
If symptoms continue to affect your life, it is reasonable to go back to your healthcare professional, explain what is happening and ask what the next step should be.
Keeping a period and symptom diary can be useful. Record when pain starts, where you feel it, how severe it is, how long it lasts, bleeding patterns, other symptoms and whether it prevents you doing particular activities.
“Pain was bad” is useful information.
“Pain started the evening before bleeding, woke me twice during the night and meant I couldn't go to work the following morning” gives your healthcare professional much more to work with.
What can you do about period cramps?
How period pain is managed depends on its severity, your individual circumstances and whether there is an underlying cause.
Common approaches can include heat and appropriate pain-relieving medicines. Anti-inflammatory medicines such as ibuprofen are commonly used for menstrual pain, although they aren't suitable for everyone. Hormonal treatments may also be recommended for some people, depending on the symptoms and underlying cause.[2]
A doctor or pharmacist can advise you on suitable options, particularly if you take other medicines or have existing health conditions.
And then there are the rituals that aren't medical treatments but can make a miserable period day feel a little more human: the hot-water bottle, enormous pants, sofa nest and obligatory cup of tea.
If tea is part of yours, you can also read our guide to What Tea Is Good for Period Cramps?, where we look at ginger, chamomile, fennel, peppermint, raspberry leaf and other herbs, what has actually been studied and where the evidence is still limited.
A note on the research gap
There’s another piece of context that matters when we talk about periods: menstrual health itself is still under-researched.
In 2026, the WHO stated that although an estimated 2.1 billion women and adolescent girls worldwide menstruate, robust research into menstruation remains limited. It has specifically called for more high-quality evidence to improve menstrual healthcare.[1]
Endometriosis is a particularly striking example. Despite affecting an estimated 190 million women of reproductive age worldwide, significant knowledge gaps remain, including around diagnosis and treatment.[2] Research organisations have also highlighted the historic underfunding and under-research of the condition.[3]
Under-researched means not well understood and often accompanied by myths rather than facts. Which is part of the reason why even severe period pain is often not properly investigated and simply put into the category of "simply part of being a woman". This brings us to the next part:
Your pain doesn't need to win an award before it deserves attention
There can be a strange cultural tendency to treat period pain as something to endure quietly.
Periods hurt. Everyone gets cramps. Take a painkiller. Get on with it.
Except sometimes, “getting on with it” means people spend years normalising symptoms that significantly affect their quality of life.
The WHO recognises this problem in relation to endometriosis, noting that normalisation and stigmatisation of pain can contribute to symptoms being ignored or downplayed.[2]
Period pain being common does not mean severe period pain should be ignored.
If you're routinely cancelling plans, missing work or school, losing sleep, struggling to function or dreading your period because of the pain, talk to a healthcare professional.
And if you've already asked for help and your symptoms continue? It is reasonable to ask again.
Your uterus does not need to submit a formal written complaint before you're allowed to take it seriously.
References
[1] World Health Organization (2026). Menstrual health. WHO notes that more than two out of three women and girls experience pain with menstrual bleeding, that severe or disruptive menstrual symptoms can be associated with underlying conditions, and that robust research on menstruation remains limited.
WHO: Menstrual health
[2] World Health Organization (2025). Endometriosis. Information on prevalence, symptoms, diagnosis, treatment, research gaps and the normalisation and stigmatisation of menstrual and pelvic pain.
WHO: Endometriosis
[3] Society for Women's Health Research. Assessing Research Gaps and Unmet Needs in Endometriosis. Overview of identified research gaps, unmet needs and historic underfunding of endometriosis research.
Society for Women's Health Research: Research gaps in endometriosis
This article is for general information only and is not intended to diagnose, treat or replace individual medical advice. If you're concerned about period or pelvic pain, speak to a qualified healthcare professional.
