Period pain, known medically as dysmenorrhoea, is one of the most common reasons people of reproductive age seek help from a pharmacist or GP. For many it is a mild, predictable ache; for others it is severe enough to disrupt work, study or sleep every month. The good news is that most period pain responds well to the right combination of self-care and medication, and effective options are readily available in the UK. This guide explains what causes the pain, what you can do at home, which medicines tend to work best, and the signs that mean it is worth speaking to a clinician.
What period pain is and why it happens
During a period, the lining of the womb is shed, and to help this happen the womb muscle contracts. These contractions are driven by natural chemicals called prostaglandins. Higher prostaglandin levels tend to mean stronger contractions, reduced blood flow to the womb muscle, and more pain. This is why cramping, lower back ache and a dragging feeling in the pelvis often peak in the first day or two of bleeding, then ease as the days go on.
The pain is typically felt as a cramping or gripping sensation low in the tummy, but it can spread to the lower back and the tops of the thighs. Some people also notice nausea, loose stools, headache, tiredness or lightheadedness around the same time, because prostaglandins affect more than just the womb. Symptoms usually begin shortly before or as bleeding starts and settle within two to three days, following a pattern that is familiar from one cycle to the next.
Primary and secondary dysmenorrhoea
When there is no underlying gynaecological cause, this is called primary dysmenorrhoea and it is extremely common, often starting within a year or two of the first period and easing with age or after having a baby. Pain that begins later in life, changes in character, becomes steadily worse, or comes with other symptoms may be secondary dysmenorrhoea, linked to conditions such as endometriosis, fibroids, pelvic inflammatory disease or the presence of a non-hormonal (copper) coil. Understanding which pattern fits you helps your clinician decide whether simple pain relief is enough or whether further assessment is sensible.
Self-care and over-the-counter options
Practical measures help many people, and they are a reasonable place to start for milder pain. A heat pad or hot water bottle on the lower abdomen can ease cramping, and some people find a warm bath equally soothing. Gentle activity such as walking, swimming, yoga or light stretching may reduce the intensity of pain, even though exercise can feel like the last thing you want to do. Staying well hydrated is worthwhile, and some people find it helps to cut back on very salty or heavy food in the days when bloating is worst. A TENS machine, which delivers a mild electrical tingle across the skin, is another drug-free option some people use for cramps.
Tracking your cycle so that you can start pain relief early — before the pain has had a chance to build — often makes medication more effective, because it is easier to keep discomfort down than to bring severe pain back under control. Rest, warmth and a hot drink in the first few hours can also take the edge off while other measures take effect.
For medication, anti-inflammatory painkillers (NSAIDs) are usually the most effective first step because they target prostaglandins directly rather than simply masking pain. Ibuprofen is widely available over the counter and is a reasonable starting point for many. Naproxen is also available over the counter from pharmacies specifically for period pain, where a pharmacist can check it is suitable for you. Paracetamol is gentler on the stomach and can be combined with an NSAID, but on its own it tends to be less effective for cramping because it does not reduce prostaglandins.
Getting the most from painkillers
How and when you take a painkiller matters as much as which one you choose. NSAIDs generally work best when started at the first sign of pain, or even a little before your period is due if your cycle is predictable, and then taken regularly at the recommended dose for the first day or two rather than waiting until the pain is severe. Take NSAIDs with or just after food to reduce the chance of stomach upset, and always keep within the dose on the packet unless a clinician has advised otherwise. If an NSAID alone is not quite enough, paracetamol can be added, as the two work in different ways. If you find you are reaching for painkillers on most days of your cycle, or need them for more than the first few days, that is a good prompt to seek advice rather than simply increasing the dose.
Prescription NSAIDs — mefenamic acid and naproxen
When over-the-counter options are not enough, a clinician may consider a prescription NSAID. Mefenamic acid is a prescription-only NSAID often used for period pain. For menstrual cramps it is typically started around two to three days before the period is due, or as soon as bleeding and pain begin, and continued for a few days while symptoms last — usually up to about seven days in a cycle. Taking it with food helps protect the stomach. Because it is used only around the time of the period rather than every day, many people take it for just a handful of days each month.
Naproxen works in the same way and can also be prescribed at higher strengths than the pharmacy pack. Both medicines reduce prostaglandin production, so alongside easing pain they can also make bleeding a little lighter for some people. NSAIDs are not suitable for everyone: they may not be recommended for people with stomach ulcers, certain kidney or heart conditions, uncontrolled high blood pressure, or asthma that is worsened by anti-inflammatories, and they can interact with some other medicines such as blood thinners. Your clinician will advise based on your individual circumstances and may suggest a stomach-protecting medicine if you need an NSAID regularly.
How hormonal options can help
If pain is persistent, or if you also want contraception, hormonal treatment can be a helpful longer-term option. Hormonal contraception — including the combined pill, the progestogen-only pill, the contraceptive implant, the injection and the hormonal coil — works partly by thinning the lining of the womb. A thinner lining generally means fewer prostaglandins and lighter, less painful periods, and some methods can reduce the number of bleeds altogether or stop them for a time.
Hormonal options tend to work over weeks to a few months rather than instantly, so it is worth giving a method a fair trial and continuing simple pain relief in the meantime. Different methods suit different people, and the choice depends on your health, your preferences and whether you need contraception. Our guides on combined versus progestogen-only contraception and how norethisterone is used to delay a period explain some of these options in more detail. A clinician can help you weigh them up and review how you are getting on.
When to see a clinician
Period pain that you can manage with simple measures is usually nothing to worry about. It is worth seeking a review, though, if pain regularly stops you doing normal daily activities, if it is new or getting noticeably worse, or if painkillers that used to help no longer control it. You should also seek advice if pain comes with very heavy bleeding, bleeding between periods or after sex, pain during sex, unusual vaginal discharge, or difficulty getting pregnant — these can point to a secondary cause that benefits from assessment.
At a consultation, a clinician will usually ask about the timing, severity and pattern of your pain, how it affects your daily life, your bleeding, and what you have already tried. Depending on the picture, they may suggest a prescription NSAID, discuss hormonal options, or arrange further checks such as an examination, swabs or a scan if a secondary cause seems likely. Bringing a short note of your recent cycles and symptoms can make this conversation quicker and more useful.
For general information about hormonal changes across life, including how periods change over time, you may also find our overview of menopause and treatment pathways useful, and you can browse more articles in our Women's Health section.
A Farmeci consultation is a straightforward way to talk through your symptoms. A UK-registered clinician can review what you have already tried, check whether a prescription NSAID or a hormonal option may be considered for you, and flag anything that needs an in-person examination.