Possible treatments include:

• Surgery
Women with very severe secondary dysmenorrhoea may think about having surgery. There are two procedures: uterine nerve ablation and presacral neurectomy (PSN). These are out-patient procedures so you don't have to stay in hospital overnight. The aim of surgery is to reduce painful periods by interrupting cervical sensory nerve fibres and so block the pain pathway (PRODIGY 2006). However, a Cochrane Review found that there was only limited evidence to support the use of these techniques as a treatment for dysmenorrhea (Proctor et al 2005).

A hysterectomy (removing the womb) will, of course, cure the problem of painful periods once and for all, but is not an option for women who want to start a family or have more babies.

• TENS (transcutaneous electronic nerve stimulation)
The TENS unit, which is about the size of a cassette box, passes tiny pulses of electricity through electrodes placed on the body (often on the lower back). The pulses can be high or low frequency. Research has shown that high frequency TENS is quite effective in relieving painful periods (Proctor et al 2002). You might like to talk to your doctor about the best TENS unit to buy or rent, or whether you could be prescribed a unit.

• Acupuncture
Unfortunately, there is very little research into the use of acupuncture for painful periods. However, a Cochrane Review (Proctor et al 2002) reported one high-quality, but small study that found it had a very positive effect. If you don't like taking any kind of drugs, acupuncture might be worth a try instead.

• Spinal manipulation
Some people think that manipulating the bones of the lower spine eases pressure on the nerves and blood vessels which go to the pelvis and that this makes periods less painful. However, the research which has been carried out to date does not show that spinal manipulation has any effect on either primary or secondary dysmenorrhea (Proctor et al 2006).

• Herbal therapies, vitamins and minerals
Although there has been a lot of interest in recent years in the use of herbs and vitamin supplements for painful periods and other "female" complaints, there's very little evidence to say that they are effective. Vitamin B6, vitamin E, fish oil (omega-3 fatty acids) and Japanese herbs have all been investigated and reviewed by the Cochrane collaboration, but no firm conclusions reached (Proctor and Murphy 2001). Vitamin B1, however, was shown to be an effective treatment taken at 100 mg daily, and magnesium may also help reduce the pain of dysmenorrhoea (Proctor and Murphy 2001).