Menstrual pain is common. Many women have some discomfort on the first days of their period. However, pain that is strong, that lasts many days or that limits your daily life is not something you have to accept as normal.
Menstrual pain can have different causes. Sometimes it is related to the way the uterus contracts. In other cases it is linked to conditions such as endometriosis, adenomyosis, fibroids or pelvic infections.
In Lisbon, Dra. Joana Faria offers consultations about menstrual pain in Portuguese, English, French, and Spanish. The goal is to understand your history, identify what may be behind the pain and build a step by step plan with you.
This page focuses on menstrual pain. For more information about irregular or heavy periods and genital infections you can also read the pages on menstrual cycle alteration and genital infections.
What it is
Menstrual pain, also called dysmenorrhea, is pain in the lower abdomen that appears before or during menstruation. It can be felt as cramps, heaviness, stabbing pain or pain that radiates to the back or thighs.
Doctors usually describe two main types:
- Primary dysmenorrhea pain that is not caused by another disease. It often starts in adolescence, a few years after the first period, and is related to the way the uterus contracts and to substances called prostaglandins.
- Secondary dysmenorrhea pain that is caused by an underlying condition such as endometriosis, adenomyosis, fibroids, pelvic inflammatory disease or other problems.
In real life, the distinction is not always obvious. This is why a structured evaluation is important, especially when pain is getting worse, appears later in life or does not improve with basic measures.
Main symptoms and when to worry
Mild cramps that last one or two days and improve with simple painkillers are often considered acceptable. You do not need to tolerate pain that is stronger than this or that stops you from doing what matters to you.
You should consider a gynecology consultation if you notice:
- Menstrual pain that makes you miss school, work or usual activities.
- Pain that does not improve with simple painkillers taken correctly.
- Pain that is getting worse over time.
- Pain that starts several days before the period and continues after it ends.
- Pain during sexual intercourse or when passing stool.
- Associated symptoms such as very heavy bleeding, bleeding between periods or fertility difficulties.
You should seek urgent care if you have sudden severe pain on one side of the pelvis, pain with fever and feeling unwell, or pain with very heavy bleeding, dizziness or fainting. These can be signs of emergency situations and require immediate evaluation.
Diagnosis: exams and what to expect
The first step is to listen to how your pain behaves. Details such as when it starts, how long it lasts, where exactly it is located and what helps or worsens it are very important.
During a consultation about menstrual pain, the evaluation may include:
- Clinical history
Questions about your cycle, the beginning of the pain, its intensity, previous treatments, pregnancies, contraception, sexual life and family history of endometriosis or fibroids. - Gynecologic examination
Assessment of the vulva, vagina, cervix and pelvic organs. Dra. Joana Faria explains each step and adapts the exam to your comfort. - Pelvic ultrasound
Transvaginal or abdominal ultrasound to evaluate the uterus and ovaries, identify fibroids, ovarian cysts, adenomyosis signs or other changes. - Additional imaging when needed
In some cases, exams such as pelvic MRI can give more detail about endometriosis or adenomyosis. - Laboratory tests
Blood tests to check for anaemia or inflammation when indicated.
Most women do not need very invasive exams. The plan is adapted to your symptoms, your age and how severe the pain is.
Treatment options and follow up
The aim of treatment is to reduce pain and to prevent it from controlling your life. Options depend on the suspected cause, on whether you need contraception and on your plans for pregnancy.
Examples of treatments that may be discussed include:
- Simple pain relief
Non steroidal anti inflammatory drugs and other medicines taken at the right time and dose can be very effective for many women when there is no contraindication. - Hormonal contraception
Pills, patches, vaginal rings, implants or hormonal intrauterine devices can reduce menstrual pain by making periods lighter or by stopping ovulation and menstruation. - Targeted treatment of underlying diseases
Specific hormonal treatments or surgery for endometriosis, adenomyosis, fibroids or other causes when needed. - Supportive measures
Local heat, light physical activity and some lifestyle changes can complement medical treatment.
Follow up is important to see how much the pain has improved, to monitor side effects and to adjust treatment if your life situation or your plans change. It is normal for the plan to evolve over time.
How Dra. Joana Faria approaches menstrual pain in practice
Dra. Joana Faria knows that period pain can affect school, work, relationships and self confidence. Many patients have been told for years that they simply have a low pain threshold or that it is part of being a woman.
In her daily practice she:
- Takes your pain seriously and gives you time to describe it in your own words.
- Explains what is known and what is still uncertain about menstrual pain and conditions such as endometriosis.
- Chooses tests that add useful information instead of ordering every possible exam.
- Builds a treatment plan that you feel comfortable with and that you can actually follow.
- Works in coordination with the gynecologic surgery and fertility teams when more complex care is needed.
Many women feel relieved to have their pain recognised and to leave the consultation with a clear plan instead of being told that everything is normal despite their symptoms.
