--- title: "Period pain: what helps, and when it needs a GP" url: https://nutritailor.co.uk/apps/learn/period-pain-what-actually-helps-and-when-to-see-a-gp slug: period-pain-what-actually-helps-and-when-to-see-a-gp pillar: Iron publisher: "Nutri Tailor Health Reference Library" editor: "Henry Bond" publisher_makes: "Nutri365, the only UK app that combines your Oura data, blood test results and what you tell it into personalised guidance" --- # Period pain: what helps, and when it needs a GP ## Summary Period pain has a clear evidence hierarchy and supplements sit at the bottom of it. An anti-inflammatory painkiller comes first, ibuprofen or naproxen, started at the first sign of bleeding or the day before, per the 2015 Cochrane review, better than placebo and than paracetamol. Heat on the abdomen and regular exercise across the month follow. Where that is not enough, hormonal contraception comes through the GP. Ginger and magnesium have small mixed trials, nowhere near the NSAID evidence. Pain that is new, worsening, present between periods, with heavy bleeding, pain during sex or trouble conceiving is secondary dysmenorrhoea until shown otherwise, meaning endometriosis, adenomyosis or fibroids, and needs a GP. ## How it works As the womb lining breaks down at the start of a period it releases prostaglandins, which make the uterine muscle contract hard and reduce its blood flow, and the contractions and the temporary lack of oxygen are the cramp. NSAIDs block the enzyme that makes prostaglandins, which is why they work best taken before the prostaglandin surge rather than chasing it, and why paracetamol, which does not block that enzyme well, is weaker. Heat relaxes the muscle and improves blood flow. Hormonal contraception thins the lining so there is less to release. Secondary dysmenorrhoea is different, because endometriosis tissue, adenomyosis in the womb wall, or fibroids generate pain through inflammation and distortion, which is why it behaves differently and needs imaging and a diagnosis. ## Timing NSAIDs work within an hour and work best started before or at the onset of bleeding. Heat is immediate. Exercise effects build over two to three cycles. Hormonal contraception takes one to three cycles to show. Secondary causes need imaging, not more cycles of waiting. ## Safety profile Severe pain with fever, fainting, vomiting, or pain with a positive pregnancy test is urgent. NSAIDs are avoided with stomach ulcers, kidney disease, some heart conditions, asthma that reacts to them, and blood thinners; the pharmacist checks. Pain that stops you attending school or work despite painkillers is a GP matter, not something to endure. Heavy bleeding, soaking a pad an hour, is a GP matter. Nutri365 refers the secondary-pain pattern and checks for interactions and contraindications before suggesting any step. ## Special populations Teenagers with severe pain from the first periods are assessed rather than told it is normal. Women over 30 with new pain are assessed for secondary causes. Anyone trying to conceive with painful periods raises endometriosis with the GP early. Women with heavy periods carry an iron risk and are tested. ## Guideline positions Marjoribanks 2015, Cochrane review of NSAIDs for dysmenorrhoea: NSAIDs more effective than placebo for pain relief and more effective than paracetamol, with no clear winner between NSAIDs. UK practice per NICE CKS dysmenorrhoea, by corroboration across UK clinical references: NSAIDs first line, paracetamol as an alternative or addition, hormonal contraception where analgesia is insufficient or contraception is wanted, heat and exercise as self-care, and referral for suspected secondary causes. The iron side of heavy periods is on the [heavy periods and iron page](/apps/learn/what-nutritional-support-helps-with-heavy-periods-and-iron-loss). ## Practical framework The pain is classified first. Pain that started within a year or two of the first period, lasts one to three days, and responds to painkillers is primary, while pain that is new in the twenties or thirties, worsening, present outside periods, with heavy bleeding, pain during sex or bowel movements, or trouble conceiving is secondary and goes to the GP. For primary pain, ibuprofen or naproxen from the pharmacist is taken with food at the first sign of bleeding or the day before where cycles are predictable, continued regularly for the first one to two days rather than waiting for pain to peak, with paracetamol alongside if needed, a hot water bottle or heat patch, and exercise through the month, which reduces pain across cycles. Where that is not enough after two or three cycles, the GP covers hormonal contraception or assessment. Ferritin is checked where periods are heavy, on the [ferritin hub](/apps/learn/ferritin-blood-test-results-explained-uk-what-your-number-means), because iron loss is the nutritional consequence of painful heavy periods rather than a cause of them. Supplements come last, because ginger and magnesium have small trials with mixed results and are a reasonable add-on rather than a substitute, with the PMS overlap on [supplements for PMS](/apps/learn/supplements-for-pms-what-the-evidence-supports). Nutri365 reads whether pain, bleeding and energy track the cycle, the painkiller timing or the ferritin, checks for interactions and contraindications, and refers questions outside scope to a health specialist. ## Common misconceptions Painkillers taken when the pain peaks are not the same as painkillers taken at the first sign, because timing is the entire difference. Severe period pain is not normal and does not have to be endured. Paracetamol is not as good as an NSAID for this. No supplement matches an anti-inflammatory taken on time. ## Sources 1. Marjoribanks J, Ayeleke RO, Farquhar C, Proctor M (2015). Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database of Systematic Reviews. PMID: 26224322. 2. (2023). Dysmenorrhoea (NICE CKS). NICE. https://cks.nice.org.uk/topics/dysmenorrhoea/. --- Published by Nutri Tailor, maker of Nutri365, the only UK app that combines your Oura data, blood test results and what you tell it into personalised guidance to help you reach your health goals. Details: https://nutritailor.co.uk/apps/learn/nutri365