Painful Periods (Dysmenorrhoea): You Don't Have to Suffer
Painful periods: causes & treatment – gynaecologist Basel
FMH Gynecology
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Spalenvorstadt 3
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Severe period pain is common – but it is not normal, and you do not have to endure it every month. Mild discomfort during menstruation can occur. But once pain limits your daily life or regularly requires painkillers, it is worth having it assessed.
In most cases, symptoms can be effectively treated – often even before a definitive diagnosis is reached. Many women already plan their daily life around their period. That doesn't have to be the case.
Women of all ages are affected. Young women who have not yet given birth more often have primary cramps; increasing or newly occurring pain later in life should raise suspicion of a secondary cause such as endometriosis or adenomyosis.
Key facts
At a glance.
- Severe period pain is common, but not something to simply accept.
- The most common causes are uterine cramps (primary dysmenorrhoea) and endometriosis.
- A thorough conversation and an ultrasound are usually sufficient for assessment.
- Hormone testing is generally not necessary for painful periods.
- Effective treatment is possible even without a final diagnosis.
- Modern therapies can significantly improve quality of life.
Causes
Background and risk factors.
The most common cause is primary uterine cramping
increased production of prostaglandins causes the uterine muscle to contract strongly. In women who have not had a vaginal birth, the cervix is naturally somewhat narrower – opening against this narrower passage during bleeding can intensify the cramps. Secondary causes are mainly endometriosis (endometrium-like tissue outside the uterus), and less often adenomyosis, fibroids, ovarian cysts, adhesions or inflammation.
Risk factors
- Young age, early menarche
- No previous vaginal birth (narrower cervix)
- Family history of endometriosis
- Smoking
- Heavy or prolonged bleeding
Frequency
Period pain is among the most common gynaecological complaints. A significant proportion of affected women regularly miss school, studies or work because of their period – a clear signal for medical assessment.
Symptoms & findings
How does it present?
Typical symptoms
- Cramp-like lower abdominal pain
- Pulling pain in the back, sometimes radiating into the legs
- Nausea or diarrhoea
- Fatigue
- Absence from work, studies, school or sport
Common incidental findings
- Pain starting several days before the period (suggestive of endometriosis)
- Pain during intercourse
- Pain during bowel movements or urination during the period
- Unfulfilled desire to have children
When is it detected?
Emergency
seek immediate medical help or an emergency department for sudden, very severe one-sided lower abdominal pain, fainting/circulatory collapse, fever with lower abdominal pain, or if the pain is completely different from usual.
Diagnostics
How the diagnosis is made.
Most women do not need extensive investigations. The focus is on a thorough conversation (onset, duration, location and intensity of pain, pain during intercourse, desire to have children, what has helped so far), a gynaecological examination depending on age and symptoms, and an ultrasound.
Examinations
- Thorough conversation (medical history)
- Gynaecological examination (age-dependent)
- Transvaginal or abdominal ultrasound
What do the findings mean?
Ultrasound can identify or rule out many anatomical causes – fibroids, larger endometriosis cysts, ovarian cysts, adenomyosis and other changes. Hormone testing generally provides no useful information for painful periods and is not part of the standard work-up. If no anatomical cause is found and the symptoms are typical, effective treatment can already begin – you don't have to endure years of pain or first go through every conceivable test.
Treatment
Possible approach.
Watchful waiting
Quick self-help
heat (hot water bottle, heat patch) on the lower abdomen relaxes the muscles and works about as well as a painkiller for many women. Light movement, stretching or a walk promote circulation; bed rest tends to worsen symptoms for many. These measures treat the symptoms, not the cause.
Medication
Anti-inflammatory painkillers (NSAIDs) such as mefenamic acid, ibuprofen or naproxen inhibit prostaglandin production and are most effective when taken at the first signs or shortly before the expected bleeding – not only once the pain is already severe. Do not take on an empty stomach; observe the maximum dose on the package. If the pain occurs regularly or painkillers are not sufficient, hormonal treatment may be worthwhile: the combined pill (if needed in extended cycle), progestogen-only preparations, or a hormonal IUD. These suppress the build-up of the uterine lining and often reduce both bleeding and pain. Young women can also benefit. The decision is individual – what matters is not age, but how much the symptoms affect your quality of life.
Surgery
A surgical assessment (laparoscopy) may be worthwhile if there is a well-founded suspicion of endometriosis or other anatomical causes – but it is not a prerequisite for starting effective treatment.
Prevention
What you can do yourself.
- Take NSAIDs early – at the first signs or shortly before bleeding begins
- Apply heat locally to the lower abdomen
- Light movement instead of bed rest
- Avoid smoking
- Discuss hormonal options with your gynaecologist for persistent symptoms
One appointment. One main concern. So we can give you our full, unhurried attention, we address one main topic per appointment. We're happy to schedule additional or complex questions in a separate appointment. This is what allows consultations to run on time and without long waiting times – thank you for your understanding.
Frequently asked questions
FAQ.
Related topics
Keep reading.
- Annual check-up and Pap smear
Work-up of the underlying causes at the annual check-up in Basel.
- Endometriosis
- Hormonal IUD (Mirena)
- Bioidentical Hormone Therapy
- Gynaecological Ultrasound
Medically responsible.
Dr. med. Anna Margareta Wagner is a board-certified FMH specialist in gynecology and obstetrics with her own practice at Spalenvorstadt 3 in Basel. Special focus on surgical gynecology; further focus areas: gynecological check-ups, colposcopy and dysplasia consultations, intimate surgery, pregnancy care, and consultations for girls and adolescents.
- FMH specialist certification in gynecology and obstetrics
- Special focus: surgical gynecology
- SGGG member
- Certified colposcopy diploma
- Languages: German, English
- Service area: Basel-Stadt, Basel-Landschaft, northwestern Switzerland
The content on this page is reviewed regularly against current specialist medical recommendations.
Sources
Scientific references.
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Every situation is individual. During your consultation, we take the time to review your findings and find the right next step together.