Secondary dysmenorrhoea: painful periods caused by another condition

Dysmenorrhoea is the medical term for painful periods. Patient explains that most women have some pain during periods, which is often mild, but in about 1 in 10 women the pain is severe enough to affect day-to-day activities. Primary dysmenorrhoea is the most common type and occurs where there is no underlying problem of the womb or pelvis.

Secondary dysmenorrhoea is the other category. The pain is caused by a problem of the womb or pelvis, so treating that problem is key. Patient says it often appears after several years of normal periods and is less common than primary dysmenorrhoea.

The NHS describes period pain as pain in the tummy at the start of or just before a period, often painful cramps that spread to the back and thighs, usually lasting up to 3 days. When the cause is a condition, the pattern often changes from this.

The NHS lists conditions that can cause painful periods. These are the main ones used to explain secondary dysmenorrhoea.

• Endometriosis and adenomyosis, where womb-like tissue grows in other places (endometriosis) or within the muscle of the womb (adenomyosis).

• Fibroids, which are growths in and around the womb.

• Pelvic inflammatory disease, an infection of the womb, fallopian tubes and ovaries.

• An intrauterine device (IUD), which the NHS says can cause period pain, particularly during the first 3 to 6 months after it is put in.

Patient lists features that may indicate secondary dysmenorrhoea: a change in the usual pattern of pain, such as periods becoming more painful or lasting longer; pain that starts several days before the period and lasts all the way through it, which is uncommon with primary dysmenorrhoea; and other symptoms.

Those other symptoms include irregular periods, bleeding between periods, pains between periods, heavier bleeding than before, vaginal discharge, pain during sex and pain in the back passage. The NHS adds pain when peeing or pooing, a swollen tummy, loss of appetite and losing weight without trying as reasons to see a GP.

NHS information on endometriosis adds that symptoms can include severe period pain that stops normal activities, heavy periods, pain in the lower tummy and back at any time, pain during or after sex, extreme tiredness and difficulty getting pregnant.

The NHS says to see a GP if your periods become more painful, heavier or irregular, your period pain is stopping you doing your usual daily activities, you have pain during sex or when peeing or pooing, you are bleeding between periods, you have noticed a change in how much you are peeing or pooing, you have a swollen tummy, loss of appetite, or are losing weight without trying.

It says to ask for an urgent GP appointment or get help from NHS 111 if your pelvic pain or period pain is severe or worse than usual and painkillers have not helped.

Patient advises seeing a doctor for fever, unusual vaginal discharge or sudden severe pain, and suggests keeping a diary of symptoms to help your doctor understand the cause.

Patient says that if a doctor suspects secondary dysmenorrhoea they will usually examine you, which may involve an internal examination to check the womb and pelvis as well as the tummy, and may take swabs to look for infection. They may arrange further tests, such as an ultrasound scan, or refer you to a gynaecologist.

Investigations depend on the likely underlying problem and may include an ultrasound scan of the womb and pelvis, hysteroscopy (a telescope to see inside the womb) and laparoscopy (a telescope to examine the pelvic organs).

The NHS endometriosis page explains that it can take a long time to diagnose, that several tests may be needed because symptoms overlap with adenomyosis, fibroids, pelvic inflammatory disease and irritable bowel syndrome, and that a laparoscopy can confirm endometriosis and sometimes allow it to be removed at the same time.

The NHS says that if a condition is found, treating it will help. Pain relief is also offered while the cause is investigated. If you have severe period pain, a GP may recommend anti-inflammatory medicines such as naproxen, flurbiprofen or mefenamic acid, a TENS machine, or contraception like the pill, implant or injection, which thin the womb lining, making periods lighter and easing the pain.

The NHS suggests warmth from a bath, shower or heat pad, massaging the tummy and back, gentle exercise such as yoga, swimming, walking or cycling, and cutting down on alcohol and not smoking, which may also help ease period pain.

For endometriosis, the NHS says there is support for living with the condition, and that if treatment is not working or symptoms are very severe, you may be referred to a specialist endometriosis service. Persistent symptoms deserve a second look rather than being accepted as normal, particularly if they stop you doing everyday things.

On the NHS the first step is a GP, who can start treatment and arrange ultrasound or refer you to a gynaecologist or specialist endometriosis service. Waiting times for scans and procedures vary by area.

Some people choose private gynaecology for quicker access to scans and consultations. The investigations are the same, and it is sensible to share results with the GP so that medicines and follow-up stay joined up.