Pain that stops you functioning is not something to put up with.
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Period pain is caused by prostaglandins — chemicals released as the womb lining breaks down, which make the muscle contract to shed it. Strong contractions briefly reduce blood flow, and that is what produces the cramping.
Some discomfort is normal. Pain that stops you working, studying or functioning is not, and the distinction matters because a great many women are told period pain is simply part of being female and spend years accepting something treatable.
There are two separate messages here.
For ordinary period pain, the treatment is usually effective and usually taken wrongly. Anti-inflammatories work by blocking prostaglandin production — so they must be taken before the prostaglandins accumulate, at the very first sign or the day before, and taken regularly for two to three days rather than when the pain gets bad. Timing is the whole difference between them working and not.
For pain that is not ordinary, the concern is delay. Endometriosis takes an average of around eight years to diagnose in the UK, and the commonest reason is that severe period pain gets normalised — by clinicians and by the women themselves. The features that should prompt a closer look are set out below.
Any of these makes an underlying condition more likely, and none should be dismissed:
No underlying condition — simply a strong prostaglandin response. It is more common in younger women, in those with heavier periods, in smokers, and where there is a family history.
Primary period pain is a clinical diagnosis — typical timing, typical pattern, present since periods began, no other features. No test is required, and treatment can start immediately.
Any of the secondary features above warrants assessment:
A pain and cycle diary over two to three months. Record when pain starts relative to bleeding, how severe, what you took and when, days missed from work or study, and any pain with sex or bowel movements.
This does something a consultation alone cannot: it demonstrates the pattern objectively. Women describing severe pain are, demonstrably, taken less seriously than the pain warrants — and a written record is harder to wave away than a description.
We cannot examine you. Pelvic examination is needed where a structural cause is suspected, and we arrange it rather than working around it.
This is where most of the benefit is, and where most people go wrong.
Paracetamol helps less, because it does not act on prostaglandins — though it can be added.
We do not wait for a diagnosis before treating. Hormonal treatment and adequate pain relief can begin immediately, alongside gynaecology referral — because the delay between symptoms and diagnosis is itself the harm, and there is no reason for anyone to be in pain while a referral is processed.
Heat is not a token suggestion. A heat pad or hot water bottle on the lower abdomen has been shown in trials to be comparable to ibuprofen for period pain, and the two together work better than either alone. TENS machines also have reasonable evidence and are inexpensive.
Call 999 or go to A&E for:
Seek same-day assessment for:
Book a routine consultation if:
Take your anti-inflammatory before the pain starts or at the very first twinge, and keep taking it regularly for two to three days. If you can predict your period, start the day before. This single change turns "painkillers don't work for me" into effective treatment for a great many women.
Magnesium, vitamin B1 and omega-3 have modest supporting evidence for period pain. They are cheap and low-risk, and reasonable to try alongside proper treatment rather than instead of it. Ginger has some trial support for pain.
Use a cycle app or a notebook. Record pain scores, days affected, medication taken and timing, and anything else cyclical — bowel symptoms, pain with sex, bloating. Three months of this is the most persuasive thing you can bring to an appointment, and it is what shortens the road to a diagnosis when there is one to find.
Period pain that stops you going to work or school is not normal and should not be endured. Being told to take paracetamol and get on with it is not adequate treatment, and needing to ask twice is unfortunately common. Asking again is reasonable.
The most effective treatment for period pain is available over the counter and costs very little. Ibuprofen and naproxen are genuinely first-line here — more effective than paracetamol, because period pain is prostaglandin-driven and NSAIDs block prostaglandins directly.
The advice that changes outcomes is free and rarely given: start the anti-inflammatory the day before your period is due, or at the very first sign, and take it regularly rather than waiting for the pain to build. Once prostaglandins are established the drug has a much harder job. Most people take their first tablet several hours too late.
Your NHS GP treats period pain free, and the hormonal options that work well — the combined pill, the progestogen-only pill, the hormonal coil — are all free on the NHS, including contraception.
Where a consultation is genuinely worth paying for is pain that is not ordinary period pain. The average delay to a diagnosis of endometriosis in the UK is around eight years, and it starts with period pain being normalised. Pain that stops you working or studying, pain with sex, pain that has changed, or pain not controlled by NSAIDs and hormonal treatment deserves proper assessment rather than reassurance.
NICE Clinical Knowledge Summary, Dysmenorrhoea, is the principal reference. It recommends NSAIDs as first-line pharmacological treatment, started at or just before the onset of symptoms and taken regularly for the first two to three days.
CKS recommends hormonal contraception — combined oral contraceptive, progestogen-only methods, or the levonorgestrel intrauterine system — where NSAIDs are insufficient or contraception is also wanted.
CKS distinguishes primary from secondary dysmenorrhoea, and lists the features suggesting an underlying cause: pain that begins after years of painless periods, pain not related to menstruation, deep dyspareunia, abnormal bleeding, or pain unresponsive to treatment.
NICE NG73, Endometriosis: diagnosis and management, recommends considering endometriosis in women presenting with chronic pelvic pain, period pain affecting daily activities, or deep pain during or after sex — and is explicit about the harm caused by diagnostic delay.
Some cramping in the first day or two, manageable with over-the-counter treatment, without stopping you doing things. Pain that keeps you off work or in bed is not normal, whatever you have been told, and it deserves proper assessment rather than endurance.
Usually timing. Anti-inflammatories block the production of the chemicals causing pain, so they cannot reverse what has already been released. Taken at the first sign, or the day before, and continued regularly for two to three days, they work far better. Also consider whether mefenamic acid or naproxen would suit you better than ibuprofen.
Consider it if your pain started years after your periods did, has worsened over time, occurs outside your period, involves deep pain during sex, or comes with cyclical bowel or bladder symptoms. It affects around one in ten women, and the average delay to diagnosis in the UK is roughly eight years — largely because severe period pain gets treated as normal.
No. Endometriosis is frequently invisible on ultrasound, and a normal scan is one of the commonest reasons a diagnosis is delayed. Where the story fits, referral is still appropriate — laparoscopy remains the definitive test.
Period pain does often improve after childbirth, and this is a real phenomenon. But it is not a treatment, it is not reliable, and advising a woman to have a baby to fix her pain is not medical advice. Endometriosis in particular frequently returns afterwards.
It suppresses the process driving the pain rather than hiding a diagnosis, which is a genuine treatment. Where endometriosis is suspected, hormonal treatment is a recognised first-line approach and is used alongside investigation, not instead of it — there is no reason to be in pain while waiting.
Yes, more than people expect. Trials have found heat comparable to ibuprofen for period pain, and the two together are better than either alone. It is one of the few pieces of traditional advice with solid evidence behind it.
If you feel able to. Regular exercise reduces period pain over time, and gentle movement during a period generally helps rather than harms. Nothing is being damaged by activity — but resting when you need to is also perfectly reasonable.
August 23, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
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If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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