When should I see my GP?

See your GP if you have severe period pain or your normal pattern of periods changes for example,if your periods become heavier than usual or irregular.

You should also see your GP if you have symptoms of secondary dysmenorrhoea,such as intense pain or heavy or painful periods.

The pill

Your GP may try you on the combined oral contraceptive pill .This can ease period pain because it thins the womb lining and reduces the amount of prostaglandin your body releases.

A thinner womb lining means the muscles of the womb don't have to contract as much when it sheds as part of your monthly menstrual cycle. Your period will also be lighter.

If the combined contraceptive pill isn't suitable for you, contraceptive implants or injections are good alternatives. The Mirena intrauterine system (IUS) can also sometimes help with painful periods.

Pelvic examination

Your GP may want to carry out a pelvic examination to help diagnose or rule out other conditions.

They'll insert gloved, lubricated fingers into your vagina to feel for any abnormalities in your womb or ovaries.

Pelvic examinations are only carried out by qualifiedhealthcare professionals, such as GPs or gynaecologists.

The examination won't be carried out without your permission (consent) . You can also choose to have a friend or relative present, ora practice nurse to act as a chaperone.

In some cases your GP may also order a pelvic ultrasound, which will clearlyhighlight any abnormalities.

Referral to a specialist

If your period painhasn't been controlled after three months of treatment with painkillers or the combined contraceptive pill, your GP may refer you to a specialist.

This isfor further investigations to rule out an underlying medical condition.

Further tests

To help determine the cause of your period pain, the gynaecologist may need to carry out:

• a urine or blood test
• pelvic ultrasound where high-frequency sound waves are used to produce an image of the inside of your body; it's painless and will allow any abnormalities in your reproductive organs to be detected
• laparoscopy under general anaesthetic , a small cut is made in your abdomen through which a fibro-optic telescope (laparoscope) is inserted; it can be used to look at your internal organs, as well as take samples of tissue (a biopsy )
• hysteroscopy allows theinside of the womb to be examined using a fibro-optic telescope; it's carefully passed through your vagina and into the womb to check for abnormalities

Treating an underlying medical condition

If your period pain is caused by an underlying condition, your treatment will depend on which condition you have.

For example, pelvic inflammatory disease (PID) may require antibiotics to treat the infection, while fibroids may need to be surgically removed.