When you have your period, your womb tightens (contracts) to shed its lining, causing blood loss. During these contractions, less oxygen can get to your womb via your blood vessels. It’s the lack of oxygen in the tissue of your womb that causes the pain.

The contractions are triggered by a substance in your body called prostaglandins. Generally, the higher the level of prostaglandins you have, the more painful your periods will be.

The medical name for period pain is dysmenorrhoea. There are 2 types of dysmenorrhoea: primary and secondary.

Primary dysmenorrhoea is when you experience pain during your period but there is nothing medically wrong with you. No matter how mild or strong your pain is during your period, the medical name for the experience is primary dysmenorrhoea.

Secondary dysmenorrhoea is the name given to period pain that is caused by a secondary condition. These might include:

• endometriosis
• fibroids
• pelvic inflammatory disease
• adenomyosis

If you have secondary dysmenorrhoea it's important to talk to a doctor so you can identify any medical conditions you're experiencing, and see if you can treat them directly.

The best way to work out if you have primary or secondary dysmenorrhoea is to talk to a doctor.

The doctor will ask you about your periods and general health, and may also have a look at your tummy, and feel inside your vagina. They may also suggest having tests. These could include:

• taking a sample from your vagina using a swab
• blood and urine tests
• having an ultrasound scan which looks inside your vagina, womb, and the area around it

Primary dysmenorrhoea: usual symptoms

• Usually starts 6 to 12 months after your periods start, once they have become regular
• Pain is below your belly button but may also be in your back and inside your thigh
• Cramps start just before your period and last for a few days, getting less painful as the period goes on
• You may feel sick, be sick, have diarrhoea, be tired, irritable, dizzy, bloated, have a headache, and feel more emotional than usual

Secondary dysmenorrhoea: usual symptoms

• Pain starts after several years of painless periods
• You might get pains at other times, not just during your period
• You may have other symptoms, like pain or bleeding when you have sex, unusual vaginal discharge, heavy or irregular bleeding, and pain and bleeding in your bottom (anus)

The best way to get rid of period cramps will be different for different women. Sometimes it can take a while to work out what is best for you.

Over-the-counter painkillers

The most effective over-the-counter painkiller for period cramps is usually ibuprofen. If you cannot take ibuprofen for any reason, paracetamol can also work. For some women, these painkillers are enough, but for others they may just 'take the edge off' the pain.

Who can use these?

• Suitable for most women

Prescribed painkillers

If you find that ibuprofen or paracetamol do not help to ease the pain, a doctor can prescribe you a different medication. These might include:

• mefenamic acid
• naproxen

Who can use these?

• Usually prescribed for primary dysmenorrhoea if over-the-counter painkillers do not work
• Can be prescribed for secondary dysmenorrhoea if you've talked to a doctor about any secondary conditions and they recommend this treatment

Hormonal contraceptives

Some women manage their period pain by using a hormonal contraceptive. These contraceptives can help in 2 ways:

• making the lining of the womb thinner
• stopping you releasing eggs (ovulating), which can stop your periods altogether

Hormonal contraceptives include the:

• pill
• implant
• injection
• IUS (intrauterine system; hormonal coil)

Who can use these?

• Suitable for a wide range of women
• Women who are not trying for a baby

The right hormonal contraceptive for you depends on a range of things, and it can take some time to find a method that suits you. A doctor can talk through the options with you.

ZAVA can prescribe the combined pill to treat painful periods. Our range of combined pills includes: Microgynon, Yasmin, Cilest, and Marvelon among others.

The Lowdown is a good source of information on other women's experiences of different methods of contraception.

Managing the pain without medicine

There are a number of ways to relieve period pain without using medication. Some women find these methods can work well alongside painkillers and contraception, while for others they are enough on their own.

Studies have shown that some of these methods help soothe period pain. But for some methods there is no scientific proof – women have simply reported that they have helped.

Many of the methods work in a similar way, or a combination of ways. These include:

• relaxing the muscles of the womb, and raising the blood flow and oxygen to the tissues
• helping produce more endorphins, a chemical released in the body that changes the way the brain feels pain
• reducing stress, which has been linked to reducing pain during periods

Who can use these?

• The following are suitable for a wide range of women

TENS machine TENS stands for transcutaneous electrical nerve stimulation. A TENS machine is used to send electrical pulses through your skin to your nerves. It's thought that these pulses confuse signals from the brain which means you feel less pain. It's also believed that these machines make you produce more endorphins.

Companies like Livia have developed TENS machines specifically to treat period pain.

Heat Applying heat to the muscles that are contracting can help to relax them, and let the blood flow more easily. Many women put a hot water bottle over their tummy but you can also use heated pads, or take a hot bath.

Exercise Not everyone feels like exercising when they have their period but it can help by releasing endorphins, increasing the blood flow around your body, and making you feel more relaxed.

Sex and orgasm Like exercise, sex or masturbation releases endorphins, reduces stress, and increases blood flow. For some women period pains stop while they orgasm, and for a time afterwards.

Massage This can be a good way to reduce stress as well as soothe muscles.

Food, drink, and supplements Some women have found that the following help to reduce period pain:

• drinking more water and avoiding alcohol, salty foods, and caffeine – this will reduce bloating which can make cramps worse
• eating less meat and fat – a study has shown that a vegetarian, low-fat diet can reduce period pain
• including more ginger in your diet – which has been shown to relieve period pain

Acupuncture A Chinese medicine, acupuncture works on the basis that you can stimulate the body's energy when it has got 'stuck'. This is done using needles applied to the skin.

CBD CBD is short for cannabidiol which is a chemical taken from cannabis. Although cannabis is illegal in the UK, CBD is legal. There has been very little research done into the effects of CBD on period pain, and no scientific proof that they help, but companies are starting to sell CBD to treat menstrual cramps.

It can be used in different ways:

• oil drops into your mouth
• lotions and gels to rub on your skin
• capsules that you swallow
• suppositories (a block of medicine put into the vagina)
• on tampons
• in bath salts