Period ImPact and Pain Assessment (PIPPA)

Our Period ImPact and Pain Assessment (PIPPA) tool can help you identify how much of an impact your period is having on your life.

Take the PIPPA online screening test

Try these ideas to help manage your period pain and other period related symptoms.

Pain and other physical symptoms

There are lots of things you can try to manage your pain. These include both pharmacological options like painkillers, and non-pharmaceutical options, which don't involve medications.

Popular non-pharmacological options you can try to help manage your symptoms include:

• heat (heat packs or hot baths)
• yoga
• exercise, movement and stretching (this flushes out inflammatory chemicals and releases endorphins – the body’s natural painkillers)
• meditation/relaxation/deep belly breathing (with long, slow ‘out’ breaths)
• massage
• magnesium for muscle cramping pain (including cramping of the uterus [womb] with periods) – can be taken as an oral tablet or powder, or sprayed onto your skin
• distractions such as music, reading, movies, hobby or activity you enjoy doing
• managing your stress levels (as stress increases inflammation and pain in the body)
• avoiding inflammatory foods such as sugars, gluten or anything that your body doesn’t tolerate so well at the time of your period
• eating healthy, nourishing foods
• getting enough sleep and rest

The above options will help manage the symptoms. There are also supplements available that are designed especially for menstrual symptoms that contain magnesium, pyridoxine (also known as Vitamin B-6) and/or Vitex agnus-castus (also known as Chaste tree). However, effectiveness varies from one person to another and being on hormone medication like the pill (COCP) can also alter the effectiveness of these. You can discuss use of these with a qualified health practitioner or pharmacist.

Moods

You might find that your mood changes before or during your period and this is often called ‘PMS’ (pre-menstrual syndrome). Symptoms include feeling irritable, teary, easily overwhelmed, wanting to withdraw, anxious, down or depressed. These symptoms can interfere with school, studies and work performance and also your relationships if you feel grumpy and irritable.

Try some of the following suggestions to help manage your moods:

• exercise (hot and sweaty is best for releasing great chemicals and improving your mood and energy level)
• stress reduction/monitoring (e.g. simplify activities, delay big decisions if possible)
• meditation/relaxation/deep belly breathing (with long, slow ‘out’ breaths)
• creative outlet such as writing, music, art, craft or photography
• distractions such as music, reading, movies or activity you love doing
• the supplements mentioned above can help with mood symptoms

What's next?

We have developed a self-management pathway that you can use to help you manage your period pain and symptoms. You can also use a period tracker app to monitor your pain and symptoms to see which symptoms are most bothersome and which actions help.

In many cases, the suggestions on this web page and in the self-management pathway will help you manage your pain and period symptoms.

However, if you get minimal improvement with managing your pain symptoms yourself, are concerned about your periods or have a high PIPPA score, you should consult a healthcare professional such as your school nurse, school counsellor or GP. We have developed a Primary Health Care pathway which you can take with you, and a note for your doctor to help you with these conversations.

There are many reasons why you might be having painful periods. Some of the reasons could be temporary and not related to anything serious. However, some period pain may be related to an underlying condition that may be more of a problem.

There are other symptoms that you may experience in addition to period pain and pelvic cramps, like: bloating, back pain, headaches, constipation or diarrhoea, breast tenderness, aching down your legs, acne, cravings, fatigue and changes to your sleep.

The following information is designed to help you understand a bit more about your period and period pain. There are also some links you can look at for more information in the resources section.

If you have tummy pain but you don't have your period yet, you should talk to your school nurse or GP.

Period pain and symptoms

The most common reason for painful periods is the chemicals (prostaglandins, cytokines) released by the lining of the uterus making the uterus muscles contract and cause cramping (a normal process to help shed the lining). Some people release more chemicals than others and therefore have more severe cramping pain. The release of these chemicals can also cause other symptoms including nausea/vomiting, diarrhoea, headaches and feeling faint.

This type of period pain usually starts at the same time as the bleeding starts, is worse for the first day or two (usually while the period is at its heaviest) then settles. It usually settles with heat packs or some help from medications such as paracetamol (Panadol™) or non-steroid anti-inflammatory drugs (NSAIDs)* such as Ibuprofen (Nurofen™), Naproxen (Naprogesic™/Naprosyn™), or Mefenamic Acid (Ponstan™) or similar that can be bought over the counter from the chemist. NSAIDs are the most effective drug at relieving this type of period pain as they reduce the painful chemicals released with your period, however they should not be taken for more than three days at a time and always with food. Period pain may also improve when using the Combined Oral Contraceptive Pill (COCP) also known as 'the pill'.

*NOTE: NSAIDs should always be taken with food and as instructed by your doctor or pharmacist. Some asthmatics or people with bleeding issues cannot take NSAIDs and should discuss alternative options with their GP or pharmacist.

Period pain - what's normal?

Around 75% of teens report 'normal' cramping period pain. It is related to the normal process of having periods. It can be easily managed and doesn't interfere too much with life. The good thing about this type of pain is that it usually settles over the years as the uterus gets used to having periods.

Around 25% of teens report period pain that may interfere with daily activities and cause them to stay home from school or work with some or all periods. Approximately half of this group have more severe and significant pain and symptoms that interfere greatly with living life, attending school and completing schoolwork. It is possible that the last group of teens have pain that is related to another cause or multiple causes. This means there may be another cause such as endometriosis or tight pelvic muscles that can spasm and add to the period pain, making it more severe.

Other symptoms they may experience with periods include heavy bleeding, painful bowel motions and bladder pain. In addition to painful periods these teens may experience painful sexual intercourse or a flare up of pain mid-cycle around when they ovulate that lasts longer or is more painful than the normal 'mittelschmerz' pain that can be experienced with ovulation.

So - what's 'normal' for period related symptoms?

*Menstrual Disorder Of Teenagers study 2016 N=1066 girls (aged 15-19 years) surveyed

Your first period

The average age most girls get their first period is around 12-13 years old. However, some girls can get their period as young as 8 years old.

If you are 16 years old and have not started your period, or your periods have stopped for several months, it may be a good idea to talk to a health professional. There are many things that can affect your periods including: hormones, body weight, diet, eating disorders, stress, emotional upset and amount of exercise you do.

Regularity of period

Your menstrual cycle is the hormonal change your body goes through each month. Regular periods in the years between puberty and menopause mean that your body is working normally. Most girls will have a period around once in a calendar month, but some girls have short cycles where their period may come every 21 days and others may only have a period every 35 days. These differences are completely normal. It can take a couple of years after your first period for your menstrual cycle to settle into its regular pattern.

Length of menstrual bleeding and heaviness

Girls can bleed from anywhere between two to 10 days, but the average length of bleeding is six days.

Some girls have very light periods and change their regular pads or tampons every four to eight hours, while some girls have heavy flooding periods and may need to change their pads or tampons every one to two hours, especially on heavy days.

Heavy periods can make you feel lightheaded and faint. Over time you can become anaemic or have low levels of iron in your blood. If this happens, we suggest you see your school nurse or GP.

Period pain and school absence

Having some discomfort during your period is common but extremely bad period cramps are not normal.

Many girls feel cramping pain in their lower abdomen (below the belly button) during their periods.

• 25% of girls can experience moderate to severe period pain and around the same number take time off school with some of their periods (usually just for a day or two).
• 2% of girls have extremely severe period pain and need to stay home with every period, sometimes up to three to five days.

If you regularly need to take time off school for period pain, it is a good idea to talk to your school nurse or GP.

Endometriosis

For approximately 10% of girls who menstruate, simple pain management measures don't work. In this case, it is important to consider other causes of pain such as endometriosis, or 'endo' for short.

Endometriosis is a condition where tissue similar to the lining of the inside of the uterus (the endometrium), is found growing outside the uterus - usually in the pelvis.

Endometriosis can have a serious impact on your life if it is painful (not all endometriosis is painful) and can also affect fertility. Those who have severe pain around the time of a period may need to take time out of school or work on a regular basis. It is important to recognise symptoms sooner rather than later in order to develop a long-term management plan. Studies show that it takes on average six to10 years to get a diagnosis because symptoms are not recognised early enough.

If you'd like to find out more, the Canberra Endometriosis Centre runs group information sessions approximately every four weeks. Visit the Canberra Endometriosis Centre webpage.

Another type of tummy (pelvic) pain

Endometriosis can cause pain with periods, bowel and bladder symptoms and pain with sexual intercourse. But there are a number of other things that can cause moderate to severe pain in the pelvis. For example, the muscles of the pelvis can be overactive and go into spasm and become very tight causing random sharp, stabbing pain and/or dull aching pain on any day. It can lead to constipation or difficulty starting a wee. Sex (with penetration) may be painful or not possible. Pelvic muscle pain can also get worse with high impact exercise (e.g. running or jumping), sitting for too long or it can increase the pain with your periods. Specialised pelvic physiotherapists can help with problems like this so it is important to see your GP to be thoroughly investigated for all possible causes of pain in the pelvis. Some doctors may not be aware of this problem. More information is available on the Pelvic Pain Foundation of Australia website.

Active self-management of your health

It is important that whatever the reason for your painful periods, you work out a way to reduce the pain and disruption to your life. There are several solutions that can be used in a combined approach and may be different for each person. Healthy lifestyle measures such as exercise, healthy eating and bowel function, good sleep and stress management can really help period pain and overall health.

For more information see the websites listed in the resources section.

1. Parker MA, Kent AL, Sneddon A, Wang J, Shadbolt B. The menstrual disorder of teenagers (MDOT) study No 2: Period ImPact and Pain Assessment (PIPPA) tool validation in a large population based cross-sectional study of Australian teenagers. Published:June 22, 021DOI:https://doi.org/10.1016/j.jpag.2021.06.003
2. Parker M, Sneddon A, Arbon P. The menstrual disorder of teenagers (MDOT) study: determining typical menstrual patterns and menstrual disturbance in a large population-based study of Australian teenagers. BJOG 2009; DOI: 10.1111/j.1471-0528.2009.02407.x.
3. Aredo, Heyrana, Karp, Shah and Stratton. Relating Chronic Pelvic Pain and Endometriosis to Signs of Sensitization and Myofascial Pain and Dysfunction. Semin Reprod Med. 2017; 35(1): 88-97. Doi:10.1055/s-0036-1597123

Downloads

• Note for your doctor
• Managing period pain and symptoms with your doctor
• Self-managing period pain and symptoms

Websites

• Canberra Endometriosis Centre
• Canberra Sexual Health Centre
• Endometriosis Australia
• Endo Active
• Find a General Practitioner
• Global Forum for Endometriosis
• Jean Hailes Foundation
• Pelvic Pain Foundation of Australia
• QENDO
• Reach out
• Women’s Centre for Health Matters