Painful Periods Are NOT Normal - A Gynaecologist Explains What’s Really Going On

‘Just take a painkiller and lie down’ is the advice most girls and women hear about period pain, often from other women who were told the same thing. It is advice that treats severe menstrual cramps as an inconvenience to be managed rather than a symptom to be understood – and it has meant that genuinely painful periods go unexplained for years, sometimes decades, before anyone investigates why.

Some menstrual discomfort is expected. Mild cramping in the first day or two of a period, manageable with an over-the-counter painkiller and a hot water bottle, is a normal part of the uterus contracting to shed its lining. What is not normal is pain severe enough to miss school, work, or plans; pain that doesn’t respond to standard painkillers; or pain that has been getting worse over time. That pattern has a cause, and it is usually one that a gynaecologist can identify and treat.

Primary vs. Secondary Dysmenorrhea – Why the Distinction Matters

Primary dysmenorrhea is period pain without an underlying pelvic condition – driven by prostaglandins, hormone-like compounds that trigger uterine contractions. It typically starts within a year or two of a girl’s first period, is worst on day one or two, and responds reasonably well to NSAIDs like mefenamic acid or ibuprofen taken at the right dose and timing.

Secondary dysmenorrhea is period pain caused by an identifiable gynaecological condition. It tends to start later in life, often worsens year on year rather than staying the same, may not respond to standard painkillers, and can be accompanied by pain outside the period itself. This is the category that gets missed most often – because it is dismissed as ‘just bad periods’ rather than investigated as a symptom with a cause.

The Conditions Behind Severe Period Pain

Endometriosis

Endometriosis – tissue similar to the uterine lining growing outside the uterus, commonly on the ovaries, fallopian tubes, and pelvic lining – is one of the most underdiagnosed causes of severe period pain, with an average diagnostic delay of several years from symptom onset. Classic features: pain that starts before bleeding and lasts throughout the period, pain during intercourse, painful bowel movements around the period, and in some cases, difficulty conceiving. Diagnosis is suspected clinically and on ultrasound, and confirmed with laparoscopy when needed. Treatment ranges from hormonal therapy to laparoscopic excision, tailored to symptom severity and fertility plans.

Adenomyosis

Adenomyosis occurs when endometrial tissue grows into the muscular wall of the uterus itself, causing the uterus to enlarge and become tender. It produces increasingly heavy, painful periods, often in women in their thirties and forties, and is frequently diagnosed on ultrasound once suspected. Management includes hormonal treatment, pain control, and in some cases surgical options depending on age and fertility goals.

Fibroids

Uterine fibroids – benign growths in the uterine wall – can cause painful, heavy periods depending on their size and location, particularly when they distort the uterine cavity. Many fibroids are asymptomatic, but symptomatic ones are readily identified on ultrasound and have several treatment pathways, from medication to minimally invasive procedures to surgery.

PCOS and Pelvic Inflammatory Disease

Polycystic ovary syndrome can produce painful, irregular periods alongside its other hormonal features and benefits from a structured management plan rather than painkillers alone. Pelvic inflammatory disease, usually from an untreated infection, causes pelvic pain that can worsen around periods and needs antibiotic treatment – delaying this increases the risk of long-term fertility complications.

When to See a Gynaecologist

• Period pain that stops you from going to school, work, or daily activities
• Pain that doesn’t improve with standard painkillers taken correctly
• Pain that has been getting worse over months or years
• Pain during intercourse, or pain outside your period
• Heavy bleeding alongside the pain – soaking through protection hourly, or passing large clots
• Difficulty conceiving alongside a history of painful periods
  
  

Gynaecology Consultations at Sayee Specialty Hospital, Padappai

Sayee Specialty Hospital’s Obstetrics & Gynaecology department provides thorough evaluation for painful periods – including pelvic ultrasound and a personalised treatment plan, whether the cause is primary dysmenorrhea, endometriosis, adenomyosis, fibroids, or something else entirely. You don’t need to keep living around your pain. It has a cause, and that cause has a treatment.

Book a gynaecology consultation at Sayee Specialty Hospital, or call us at 9 976 976 976. Serving Padappai, Vandalur, Chromepet, and South Chennai.