It's Just Period Pain" — Or Could It Be Endometriosis?

Medically reviewed by Prof. Dr. Kristina Jariene, MD, PhD, Consultant Obstetrician and Gynaecologist.

Somewhere along the way, a lot of women were taught that period pain is simply the price of admission for having a uterus — something to grit your teeth through, not something to question. That framing does real harm. Pain severe enough to keep you off school, off work, or off your feet is not a normal part of menstruation, and it deserves to be taken seriously rather than pushed through in silence.

Two Very Different Kinds of Pain

Not all menstrual cramping is the same, and learning to tell the difference is the first step toward getting the right help.

Ordinary period cramps (primary dysmenorrhea) typically show up:

• Not long after periods first start, in the teenage years
• As a result of prostaglandins — natural compounds that trigger the uterus to contract
• For one to two days at most
• In a way that responds reasonably well to anti-inflammatories like ibuprofen, plus heat

Cramps can feel sharper in the teenage years while the body is still finding its hormonal rhythm — but even then, they shouldn't be severe enough to derail school, work, or daily life.

Endometriosis becomes a more likely explanation when:

• Pain gets worse over successive cycles rather than staying steady
• It lasts well beyond two or three days
• Pelvic pain shows up before your period even starts, or lingers between periods
• Standard anti-inflammatories barely touch it

Other signs worth flagging to a doctor include pain during sex, pain with bowel movements or urination, ongoing fatigue paired with abdominal bloating (often nicknamed "endo belly"), and difficulty falling pregnant.

Why Diagnosis Takes So Long

Roughly one in ten women is thought to have endometriosis, and yet the average time to diagnosis still stretches into years. Part of the problem is that symptoms look different from one woman to the next, so there's no single "typical" presentation to screen for. Part of it is that surgery is sometimes the only way to confirm the diagnosis definitively. And part of it, frankly, is that research into a condition affecting hundreds of millions of women globally has historically been underfunded relative to its impact — a gap that's slowly starting to close, but not fast enough.

In South Africa specifically, access to a gynaecologist for a proper work-up can also come down to medical aid coverage or public healthcare waiting times, which makes it even more important to advocate clearly for yourself when something feels wrong.

Managing Symptoms Day to Day

Whether you're dealing with straightforward period pain or waiting on a longer diagnostic process, a few approaches tend to help:

• Don't wait out the pain. Taking an NSAID at the first sign of cramping works better than trying to catch up once pain has set in — always within the dosing guidance on the label or from your healthcare provider.
• Heat helps. A hot water bottle or heat patch on the lower abdomen can ease muscle tension.
• Look after the basics. Regular movement, decent sleep, and stress-lowering practices like yoga or breathwork all play a supporting role.
• Mind what you eat and drink. Cutting back on caffeine in the days before your period and eating a generally balanced diet helps some people, though results vary.
• Ask before supplementing. Magnesium and omega-3s come up often in this context, but check with a healthcare professional first, particularly if you're pregnant, breastfeeding, or on other medication.

A Note on Herbal Support

Herbalist Dr. Gabriele Balciunaite-Murziene points to several plants traditionally used to ease menstrual discomfort, particularly in the days leading up to a period — though as with any supplement, it's worth checking in with a healthcare professional first, especially if you're pregnant, breastfeeding, or taking medication:

• Ginger — traditionally used for its anti-inflammatory, pain-easing properties
• Fennel and peppermint — often used to settle cramping and bloating
• Yarrow — long used in traditional practice for menstrual comfort
• Milk thistle and dandelion — generally used to support liver and digestive function

The Real Takeaway

Track how long your pain lasts, whether it's trending worse rather than better, and whether it's actually getting in the way of your life. If the answer to any of that is yes, that's a reason to see a healthcare professional — not a reason to push through quietly for another cycle.

Severe period pain is common. Common is not the same as normal.

Comfort for Heavier, Harder Days

Choosing period care suited to how your body actually behaves that week can make a real difference:

• Heavy Flow range — built for higher-absorbency days
• Full pad and liner range — certified, gentle options designed for sensitive skin