Dr Margaret answers e-mailers' embarrassing problems in this biweekly problem page.

Painful periods

Dear Dr Margaret
I am 30 years old, and started my periods when I was 13. I still find it difficult to cope with the pain. I would appreciate any advice to relieve the symptoms.

If you have had painful periods almost since they started, you are very unlucky. This problem usually peaks in the late teenage years, and then improves and the pain is usually worse on the first day of bleeding. Chemicals called prostaglandins, that are produced naturally in the body, are largely to blame. They are made in the wall of the uterus (womb) in the few days before your period starts. Prostaglandins increase muscle contraction in the uterus, causing the waves of horrible, cramping pain.

Some painkillers, such as ibuprofen, mefenamic acid and naproxen, interfere with the production of prostaglandins, so are well worth trying. These drugs are known as NSAIDs (non-steroidal anti-inflammatory drugs) and, in the UK, you can buy ibuprofen from a chemist without a prescription. An NSAID does the trick in about 70% of people, but you need to start taking it a day or two before your period, because this is when the prostaglandins are being formed.

If you try a NSAID and it doesn't work for you, change to another (for which you may need a doctor's prescription), because people respond differently to different NSAIDs. Otherwise, you might consider the contraceptive pill. In about 90% of people this deals with the problem (by reducing the formation of prostaglandins).

Of course there are a lot of things you can do to reduce the pain. If possible, go to bed and hold a hot-water-bottle (not too hot!) against your tummy, or take a warm bath. You could also try breathing exercises to help you ride the pain as if it were a surf wave. Breathe slowly, taking deep breaths as the pain begins, and then shallower and shallower breaths as the pain reaches its peak. As the pain ebbs away, breathe more and more deeply again.

Some people think that magnesium helps prevent period pains, but I haven't found any convincing scientific evidence to support this. If you want to try boosting your magnesium level, eat plenty of sardines, pasta, nuts, soya beans, brown rice and green vegetables. Some women find that avoiding red meat and fatty foods for a few days before a period is helpful. Avoiding caffeine (coffee and cola drinks) may also be beneficial.

If the pain comes on several days before your period, lasts throughout the bleed, or you had a few years without any period pains, you should definitely see your doctor for advice. A gynaecological disorder, such as endometriosis or infection in the Fallopian tubes, could be the culprit. An intrauterine contraceptive device (IUD) can also cause period pain.

Any more questions?
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