My periods are late and very painful. How can I get relief?

Question

Hello doctor,

I am 18 years old and usually do not take painkillers during my period because I am worried they might stop it.

My periods are two months late, and I am experiencing very severe menstrual pain. I tried using a heating pad today, but it did not work.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

At 18, having periods delayed for two months and experiencing heavy cramps is not unusual, especially if your cycles are still settling or if there is an underlying hormonal imbalance, such as PCOS (polycystic ovary syndrome) or thyroid issues.

If the heating pad is not helping today, it indicates that the pain is stronger during this cycle. Painkillers do not permanently stop periods; they may slightly reduce flow for a day, so there is no need to worry about that.

The probable causes are hormonal imbalance (like PCOS or thyroid issues) and sporadic anovulatory cycles, where the uterine lining builds up and sheds with more pain. And the probable diagnosis is secondary dysmenorrhea with irregular cycles.

However, a few other differential diagnoses include

Primary dysmenorrhea.
PCOS (polycystic ovary syndrome).
Thyroid dysfunction.
Endometriosis.

The investigations I would suggest include:

Pelvic ultrasound to assess the ovaries and uterus.
Blood tests: TSH (thyroid-stimulating hormone), prolactin, LH (luteinizing hormone), FSH (follicle-stimulating hormone), and serum testosterone.
CBC (complete blood count) to rule out anemia.

For treatment, NSAIDs (non-steroidal anti-inflammatory drugs) such as Mefenamic acid or Ibuprofen (taken with food) can safely relieve pain.

Antispasmodic medicines may help if cramps are severe, and warm compresses are supportive, but sometimes not enough. If cycles continue to be irregular, hormonal evaluation and short-term regulation may be needed based on test results.

For follow-up, share your ultrasound and hormone test reports when available. Seek medical attention if pain persists every cycle or if bleeding becomes very heavy or prolonged. A local gynecological check-up can help rule out any structural issues.

To prevent this from recurring, kindly follow the steps suggested below:

Keep a detailed cycle diary.
Exercise regularly and maintain a healthy weight.
Ensure adequate sleep and manage stress.
Stay hydrated during periods.

I hope this information helps you.

Thank you.