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Painful Periods: Causes, Diagnosis and Treatment in South Delhi

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Painful Periods (Dysmenorrhea): Causes, Diagnosis and Treatment in South Delhi - Dr Sunita Arora

Painful Periods

Period pain is so common that many women, and even some doctors, treat it as something to put up with. Mild cramps are indeed normal. But pain that makes you miss school or work, forces you to cancel plans, or leaves you doubled over despite painkillers is not something you simply have to accept. Painful periods, medically called dysmenorrhea, have identifiable causes and many effective treatments.

This page explains the types and causes of painful periods, when the pain may signal an underlying condition, how it is evaluated, and the treatment options from simple home measures to medicines and procedures. It is general educational information. Your own plan can only be made after a personal consultation.

What Is Dysmenorrhea?

Dysmenorrhea is pain in the lower abdomen, often cramping, that occurs before or during menstruation. It may spread to the lower back and thighs and can be accompanied by nausea, vomiting, loose stools, headache, tiredness or dizziness. It is one of the most common gynaecological complaints in women of reproductive age, and it is a leading reason for missed days of school and work.

There are two types, and the difference matters because their causes and treatment differ.

Primary Dysmenorrhea

Primary dysmenorrhea is period pain that is not caused by any other pelvic disease. It is thought to be related to prostaglandins, chemicals produced by the uterine lining that make the uterus contract during menstruation. Higher levels cause stronger contractions and more pain. Primary dysmenorrhea typically:

• Begins within a year or two of the first period, once ovulation is established.

• Starts just before or at the onset of bleeding and lasts for one to three days.

• Tends to improve with age and sometimes after childbirth.

Risk factors include early start of periods, heavy or long periods, a family history of painful periods, smoking and, in some women, stress.

Secondary Dysmenorrhea

Secondary dysmenorrhea is pain caused by an underlying condition of the reproductive organs. It often begins later in life, may get worse over time and may occur outside periods too. Common causes include:

Endometriosis, in which tissue similar to the uterine lining grows outside the uterus. Please see our page on endometriosis.
Adenomyosis, in which this tissue grows into the muscle wall of the uterus, causing heavy, painful periods.
Uterine fibroids, particularly those that distort the cavity. Please see our page on uterine fibroids.
Pelvic inflammatory disease and chronic pelvic infection. Please see our page on pelvic inflammatory disease.
Uterine polyps, adhesions or a narrow cervical opening.
An intrauterine device, particularly a copper device, in some women.
Congenital differences of the uterus or vagina that obstruct menstrual flow, which may be found in teenagers with severe, cyclical pain.

Treatment of Painful Periods

Treatment is directed at relieving pain and, in secondary dysmenorrhea, at the underlying cause.

Self-Care and Home Measures

• Heat from a hot-water bottle or heating pad applied to the lower abdomen or back.

• Regular physical activity, which is associated with less period pain over time.

• Rest, adequate sleep, relaxation techniques and stress management.

• Staying hydrated and eating a balanced diet. Avoiding smoking is also helpful.

Pain Relievers

Anti-inflammatory pain relievers, which reduce prostaglandin production, are often the first-line medicine and tend to work best when started at the first sign of pain or bleeding and taken regularly with food for the first couple of days, as advised by your doctor. They are not suitable for everyone, for example women with stomach ulcers, kidney problems, asthma triggered by such medicines, or bleeding disorders, and they should be used as directed. Please do not exceed recommended doses.

Hormonal Treatment

Hormonal contraceptive pills, a hormone-releasing intrauterine system and other hormonal medicines reduce the thickness of the uterine lining and prostaglandin production, which lessens pain and bleeding. They are commonly used when pain is not controlled with simple measures, or when contraception is also desired. They are not suitable for women trying to conceive, and your doctor will choose the one that fits your health and plans.

Other Measures

Some women find benefit from transcutaneous electrical nerve stimulation (TENS), and certain supplements and herbal remedies are popular. The evidence for most is limited, so please discuss them with your doctor before use.

Treating the Underlying Cause

When endometriosis, adenomyosis, fibroids, polyps or infection are found, treatment is aimed at these conditions and may include medicines, antibiotics or minimally invasive surgery, such as hysteroscopy or laparoscopy. Please see our pages on hysteroscopy, laparoscopy and endometriosis.

How Painful Periods Are Evaluated

A systematic evaluation helps distinguish primary dysmenorrhea from underlying pelvic conditions and guides targeted treatment.

Step 01

History and Examination

Your doctor will ask when the pain starts, how long it lasts, how severe it is, how it affects your life, what relieves it, your cycle pattern, bleeding, pain during intercourse, previous infections, contraception and family history. A pelvic examination may be done when appropriate; it is not necessarily needed in young women who have not been sexually active.

Step 02

Pelvic Ultrasound

Ultrasound can show fibroids, cysts, adenomyosis, endometriomas and some structural differences of the uterus. A normal scan does not exclude all causes, particularly early or superficial endometriosis.

Step 03

Tests for Infection

Swabs and urine tests may be advised if infection is suspected.

Step 04

MRI and Laparoscopy

MRI can provide more detail when the diagnosis is unclear. If severe pain persists despite treatment, or if endometriosis is suspected, laparoscopy allows the pelvis to be examined directly and treated at the same time. Please see our page on laparoscopy.

Fertility, Teenagers & When to See a Doctor

Important considerations regarding fertility, period pain in adolescents, and signs that require prompt medical evaluation.

Clinical Guidance

Painful Periods and Fertility

Primary dysmenorrhea does not by itself reduce fertility. Secondary causes, particularly endometriosis, adenomyosis, fibroids and pelvic infection, can affect the chance of conceiving, which is a reason to seek evaluation of severe pain, especially if you are planning pregnancy. Please see our page on female infertility.

Period Pain in Teenagers: Painful periods are very common in adolescents and are most often primary dysmenorrhea. However, severe pain, pain that does not respond to treatment, or pain with heavy bleeding, should be evaluated rather than dismissed, since conditions such as endometriosis can start in adolescence. Please see our page on adolescent gynaecology.

Prompt Evaluation

When Should You See a Doctor?

Please consult a gynaecologist if your period pain:

Is severe or keeps you from school, work or normal activities.
Does not improve with usual pain relievers, or needs more and more medicine.
Started or became worse after the age of 25, or has gradually worsened over the years.
Is accompanied by heavy bleeding, bleeding between periods, pain during intercourse or pain with bowel movements or urination.
Occurs together with fever, foul-smelling discharge or unusual vaginal discharge.
Occurs while you are trying to conceive and have not succeeded.

Seek urgent care for sudden, severe abdominal pain, fainting, or pain with heavy bleeding or fever.

Specialist Expertise

Consult Dr. Sunita Arora for Painful Periods in South Delhi

Dr. Sunita Arora is an obstetrician, gynaecologist and laparoscopic surgeon with more than 23 years of experience. She holds an MBBS from Lady Hardinge Medical College, New Delhi, and an MD in Obstetrics and Gynaecology from UCMS and GTB Hospital, and she is a Fellow of the Indian College of Obstetricians and Gynaecologists (FICOG) and a Fellow of the International College of Surgeons (FICS). She completed a fellowship in Reproductive Medicine at D.Y. Patil University, Mumbai.

Her special interests include endoscopic surgery and infertility, so both the relief of pain and the investigation of its cause can be handled together.

If period pain is affecting your daily life, or if you are unsure whether your pain is normal, a careful evaluation can find the cause and a treatment that works.

Clinic Locations

Book a Consultation

She consults at Safdarjung Enclave and is also associated with Fortis La Femme, Greater Kailash II, serving women across South Delhi, including Greater Kailash, Green Park, Hauz Khas and nearby areas.

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Safdarjung Enclave

Dr Sunita Arora Fertility and Gynae Clinic

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Greater Kailash II

Fortis La Femme, South Delhi

Book an appointment with Dr. Sunita Arora, and bring any previous scans and reports.

Frequently Asked Questions

Find answers to common questions about period pain, dysmenorrhea causes, evaluation, fertility, and treatment options.

Mild to moderate cramps are common and normal. Pain that is severe, disrupts your life, gets worse over time or does not respond to usual treatment is not something you need to accept, and deserves evaluation.

Increasing pain over the years can point to a secondary cause such as endometriosis, adenomyosis or fibroids, rather than primary dysmenorrhea, and it should be checked.

Primary dysmenorrhea does not affect fertility. Underlying conditions that cause secondary dysmenorrhea may do so, which is why evaluation matters, particularly if you are trying to conceive.

Occasional use as directed is generally safe for most women, but regular or high-dose use can have side effects. If you need painkillers every cycle or they do not work, please see a doctor to look for a cause and better options.

They often do, by making the uterine lining thinner and reducing prostaglandins. They are not suitable for everyone or for women trying to conceive, so they should be taken only after medical advice.

Not always. Some conditions, such as early endometriosis, may not be visible on ultrasound. If pain is significant, further evaluation may still be needed despite a normal scan.

Medical disclaimer: This page is for general educational purposes and does not replace personalised medical advice, diagnosis or treatment. Please consult a qualified doctor about your own health. If you have severe abdominal pain, heavy bleeding, fainting or fever, seek urgent medical care.