Period pain: what is normal, what helps and when to get help

SASian Anderson, Writer and editor, MyGLP. Sources checked 5 November 2026.

What usual period pain looks like

The NHS period pain page describes the common pattern. Pain usually starts around the time your period begins and lasts up to 3 days. It happens when the muscle of the womb tightens. Doctors call this primary dysmenorrhoea when no condition sits behind it.

Pain caused by a condition such as endometriosis, adenomyosis or fibroids is called secondary dysmenorrhoea. The two can feel alike at first, which is why the pattern over months matters more than one bad day.

Normal or not: a side by side

Painkillers: what the evidence shows

Anti-inflammatory painkillers, called NSAIDs, include ibuprofen, naproxen and mefenamic acid. A Cochrane review of NSAIDs for period pain pooled 35 trials and found women on an NSAID were about four times more likely to get good pain relief than those on a placebo. In 3 trials comparing NSAIDs with paracetamol, NSAIDs did a little better. The trade-off is stomach upset, which was more common on NSAIDs than placebo. The review rated much of the evidence as low quality, but the direction is consistent.

• Read the leaflet, and ask a pharmacist before taking an NSAID if you have a long-term condition or take other medicines.
• Paracetamol is the alternative if NSAIDs do not suit you. NICE says the two can be used alone or together.
• Keep a note of what you took and whether it helped. Your GP will ask.

The NICE endometriosis guideline, NG73, suggests a trial of about 3 months of paracetamol or an NSAID, alone or combined, when endometriosis is suspected. If that does not give enough relief, NICE says to look at other treatment and consider referral. Three months is a fair yardstick for you as well.

Things to try at home

The NHS lists these self-help steps:

• A warm bath or shower.
• A heat pad or a hot water bottle wrapped in a tea towel on your tummy.
• Massage of your tummy and lower back.
• Gentle exercise such as yoga, swimming, walking or cycling.
• Cutting down on alcohol and stopping smoking.

If self-help and painkillers are not enough, ask your GP about hormonal options. NICE lists the combined pill or a progestogen as treatment when endometriosis is suspected. The NHS notes a copper coil (IUD) can make periods more painful, in particular in the first 3 to 6 months after fitting.

When pain points to endometriosis

NICE tells clinicians to suspect endometriosis when period pain affects daily activities and quality of life, or comes with chronic pelvic pain, deep pain during or after sex, painful bowel movements or pain peeing around your period. In a 2024 survey by Endometriosis UK, the average wait for diagnosis was 8 years and 10 months. Our endometriosis guide covers what your GP should do and what to ask for.

When pain points to adenomyosis

In adenomyosis the womb lining grows into the muscle wall of the womb. The NHS adenomyosis page says it usually affects women over 35, and the risk appears higher after childbirth and in women with endometriosis. Symptoms are painful periods, which can be severe, heavy periods, pelvic pain at any point in the cycle, bloating or a heavy feeling in the tummy, and pain during or after sex.

The NICE heavy bleeding guideline, NG88, says women with significant period pain or a bulky, tender womb should be offered a transvaginal ultrasound in preference to other scans, because these signs suggest adenomyosis. NICE also suggests the hormonal coil as a first treatment for suspected or diagnosed adenomyosis with heavy periods. If your periods are heavy as well as painful, see our heavy periods guide.

Other causes your GP will think about

• Fibroids, non-cancerous growths in or around the womb.
• Pelvic inflammatory disease, an infection of the womb, fallopian tubes and ovaries. A sexual health clinic can test and treat it.
• A copper coil in the first months after fitting.

Why women wait

In the evidence gathered for the Women's Health Strategy for England (2022), women said they were often told heavy and painful periods were "normal" or that they would grow out of them. The strategy notes particular concern about women not being listened to where pain is the main symptom. Period pain is common. Disabling period pain is not something you have to accept. Nobody is at fault for asking, and a good GP will want the full picture.

Period pain on a weight loss medicine

Weight loss can shift your cycle, and some women notice worse cramps for a month or two before things settle. Our guide to periods on weight loss injections covers the changes. The stomach pain listed as a side effect of Mounjaro on the NHS tirzepatide page is a separate thing. A note of the date, your cycle day and your dose day helps tell the two apart.

What to take to the appointment

1. A pain score out of 10 for each day of two cycles, with the cycle day.
2. Which painkillers you took, the dose on the pack and whether they helped.
3. Days missed from work, school or plans.
4. Any pain with sex, peeing or pooing, and any bleeding between periods.
5. The question to ask: "Could this be endometriosis or adenomyosis, and what is the plan if this treatment does not work?"

Sources

1. Period pain (NHS)
2. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea (Marjoribanks et al, Cochrane Database of Systematic Reviews, 2015)
3. Endometriosis: diagnosis and management (NG73), recommendations (NICE)
4. Heavy menstrual bleeding (NG88), full recommendations (NICE)
5. Adenomyosis (NHS)
6. Dismissed, ignored and belittled: diagnosis survey, March 2024 (Endometriosis UK)
7. Women's Health Strategy for England (2022) (Department of Health and Social Care)
8. Tirzepatide (NHS)