Dysmenorrhoea is a medical condition involving the cyclical occurrence of painful cramps in the lower abdomen and pelvis during the menstrual cycle. These cramps can be dull and constant, or sharp and throbbing, and sometimes radiate to the lower back and legs. The disorder tends to peak about 24 hours after the onset of menstruation and subsides within two to three days. In around 5–15% of cases, the cramps are so severe that they interfere with normal daily activities, resulting in absences from school or work. In some cases, prescribing the contraceptive pill which blocks the cycle, may be the treatment of choice. Let’s take a look at how this works.
Symptoms of dysmenorrhoea related to premenstrual syndrome
In addition to cramps, dysmenorrhoea may come with other symptoms such as headaches, nausea, constipation or diarrhoea.
Menstrual bleeding might include clots, and some women notice an increased need to urinate during their period. Painful periods are often accompanied by typical premenstrual syndrome (PMS) symptoms—irritability, nervousness, low mood, fatigue, and abdominal bloating—which, in some cases, may last throughout the entire menstrual cycle.
Causes of dysmenorrhoea
Dysmenorrhoea is thought to be linked to the release of high levels of prostaglandins—substances that trigger uterine contractions and reduce blood flow.
Several factors can increase the likelihood and intensity of painful periods, including early onset of menstruation, long or heavy cycles, smoking, and a family history of dysmenorrhoea. These symptoms, however, often improve with age and tend to ease after a first pregnancy.
Primary dysmenorrhoea is the most common form, usually starting in adolescence and not tied to any specific underlying condition. Secondary dysmenorrhoea, on the other hand, typically begins in adulthood and is often associated with underlying medical issues such as endometriosis, adenomyosis, uterine fibroids, or the use of an intrauterine device (IUD).
Less common causes include pelvic inflammatory disease, cervical stenosis, ovarian cysts, or, more rarely, congenital abnormalities of the reproductive system.
Treating dysmenorrhoea: what helps relieve painful periods
Painful menstruation can be managed with various approaches. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain and inflammation. Hormonal contraceptives, such as the birth control pill, may also be prescribed to suppress menstruation and ease symptoms. Some women find relief through acupuncture.
If the cramps are linked to an underlying medical condition, it’s essential to address the root cause with targeted treatment.
One of the most effective ways to relieve menstrual pain is through hormonal contraceptive therapy. Options include combined oestrogen-progestin pills or progestin-only pills. In some cases, the pill is taken continuously—skipping the usual 7-day break—to prevent the onset of menstruation, which is the main trigger for dysmenorrhoea.
There are also specific contraceptive regimens designed for continuous use, such as the seasonal birth control pill, which contains 84 days of active levonorgestrel tablets followed by 7 days of ethinylestradiol (instead of the typical placebo pills). This schedule results in just four planned menstrual periods per year, significantly reducing the frequency of painful episodes.
Beyond pain relief, the continuous intake of hormones can also help reduce tissue inflammation and may offer additional benefits for overall health.
The cycle-blocking pill, without prejudice
It’s important to reassure women that suppressing menstruation with hormonal contraceptives is safe and does not pose any health risks. On the contrary, continuous use of the pill can have protective effects: for instance, it can reduce the risk of ovarian cancer by up to 50% if taken without interruption for at least ten years. Many women also report an improvement in their overall physical and emotional well-being.
Some patients worry that not menstruating is “unnatural”. But if we look back historically, women in the past had fewer menstrual cycles—they often had several children, breastfed for extended periods (sometimes up to three years per child), and spent much of their fertile life in a natural state of amenorrhoea.
Today, women tend to have their first—often only—child after the age of 30, and may experience around 400 menstrual cycles over a reproductive lifespan of 30 to 35 years. This increased exposure to menstruation is linked to higher risks of endometriosis, anaemia, and endometrial disorders. In many ways, it’s actually more physiological to have fewer periods, rather than monthly cycles over decades.
In conclusion, the menstrual-suppressing pill can be a highly effective solution for managing menstrual cramps caused by dysmenorrhoea, as well as other cycle-related conditions. Beyond symptom relief, it offers multiple health benefits and can contribute to a woman’s overall physical and emotional well-being.
As always, it’s essential to consult with your gynaecologist before starting any new therapy. Every woman is different, and your doctor will help you evaluate your individual health profile and needs to find the most appropriate treatment for you.
If you’d like to book a gynaecological consultation—online or in person—you can contact me here or book directly online.
I see patients weekly in my clinics in Milan and Florence and am always available to support you in choosing the best path for your health and comfort.
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