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A guide to period pain: why it happens and how to relieve symptoms
Reviewed by Dr Shree Datta, MA MD MRCOG LLM BSc (Hons) MBBS, Consultant Obstetrician and Gynaecologist, London
02 Apr 2024 • 5 min read
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- A guide to period pain: why it happens and how to relieve symptoms
If you experience pain during your periods, you’re not alone.
While most women will experience some form of period pain each month, severe symptoms can put your life on hold entirely. In fact, did you know that period pain is the leading cause of absences from school, college or work for women under 30?1
But what exactly causes period pain? And what can you do to relieve symptoms when they appear?
In this guide, we answer both of these questions and more, providing you with all the advice and information you need to know.
Why do we get period pain?
Period pain, also known as menstrual pain, is a painful cramping sensation felt in the lower abdomen either before or during your period.
However, to understand why we get these painful symptoms, we first need to look at what changes happen in the body during our cycle.
During your menstrual cycle, your body releases two hormones – oestrogen and progesterone. These send chemical messages to release an egg and thicken the lining of your uterus in case you become pregnant.
However, unless you do become pregnant, this egg won’t be fertilised. And when your body realises this is the case, it’ll release chemicals known as prostaglandins to shed the uterus lining through your vagina.2
But this shedding doesn’t happen on its own. To move the process along, the muscles in your uterus will start to involuntarily contract. And it’s these contractions that cause the cramping sensation you’ll often experience during your period.2
This pain can be felt in different ways, ranging from a dull ache to cramping and sharper pains. You’ll also most commonly feel it in your lower abdomen, but it can spread throughout your body – from your stomach to your lower back, groin, and thighs.3
What are the different types of period pain?
Period pain can affect you completely differently from someone else you know. While one of your friends may only get mild cramping, you might experience much more painful symptoms.
This is because there are two different types of period pain, known as primary and secondary dysmenorrhea.
- Primary dysmenorrhea: this is the most common type of period pain and will usually start a day or two before you get your period, bringing with it symptoms like headache, back pain, fatigue, nausea, anxiety, and irritability.1
- Second dysmenorrhea: this is a more serious type of period pain that’s often, but not always, caused by an underlying medical condition. It also usually starts before your menstrual cycle and continues after it’s ended, with your cramps becoming more painful or changing in pattern over time.4
If your period pain is severe and affecting your ability to perform everyday tasks, talk to your doctor.
What causes severe period pain?
There’s all sorts of reasons why you might have severe period pain. For example, you're more likely to have painful periods if you:5
- started your periods at a younger age
- experience heavy bleeding
- have periods that last a long time
- have a family history of painful periods
- haven’t had children
- smoke
- are overweight
- have depression
Sometimes, intense cramping and other painful symptoms can also be brought on by underlying medical conditions (known as secondary dysmenorrhea, as mentioned above). These can include conditions like:
Endometriosis
Scientists still aren’t sure what causes endometriosis – a condition that causes tissue similar to the lining of the uterus to grow outside of the uterus itself, around the bladder, on the ovaries, or inside the bowel.6
When this happens, severe period pain can be felt because of the various hormonal changes that become triggered during your cycle. In other words, the release of progesterone and oestrogen can cause the uterus lining to break down into scar tissue, leading to more feelings of intense pain.6
Fibroids
Fibroids are non-cancerous growths located in and around the uterus that tend to cause heavy, painful periods.
While the reason behind their growth remains unknown, it’s thought to be linked to oestrogen. This is because research has found that fibroids will typically shrink after menopause (when your periods stop and oestrogen levels start to decline).7
Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is an infection of one or more of the upper reproductive organs, including the womb, fallopian tubes, and ovaries.
It’s typically caused by a bacterial infection and is associated with a number of symptoms, including painful periods, heavy discharge, and discomfort while ovulating.8
Polycystic ovary syndrome
Like endometriosis, the exact cause of polycystic ovary syndrome (PCOS) remains relatively unknown. However, it’s thought to be related to high levels of insulin, which can cause your hormone levels to become unbalanced.9
When this happens, it can affect how your ovaries work, leading to irregular periods, hair growth, and the formation of polycystic ovaries – enlarged ovaries that contain a large number of harmless fluid-filled sacs.9
Research shows that having PCOS can also correlate with the severity of period pain, with some studies suggesting that having irregular periods can lead to a heavier blood flow and contribute towards more intense cramping.10,11
Period pain treatments: how to relieve your symptoms
Living with period pain isn’t an enjoyable experience. But there’s a few things you can try to help relieve the pain and get back to enjoying your day-to-day life.
1. Get yourself nice and warm
Having a warm bath or using a hot water bottle to relieve period pain is much more than an old wives’ tale.
Back in 2006, researchers at University College London, found that when heat over 40°C is applied to the skin where any internal pain is felt, this switches heat receptors on and blocks the chemical messengers that cause pain to be detected by the body.12
Applying some gentle heat to your abdomen or lower back using a hot water bottle or heat pack can not only help you relax and feel more comfortable, but it can also prevent pain signals from being sent to your brain. Having a nice, warm bath can do the same as well.
Just make sure to avoid any accidental burns by making sure your hot water bottle has a suitable cover and the water you use isn’t too hot.
2. Nibble on some dark chocolate (yes, seriously!)
While period pain may be associated with bingeing on comfort foods like ice cream and chocolate, there’s some surprising science behind one of these go-to snacks.
Studies have shown that having small amounts of dark chocolate can help ease period pain and cramping and boost our mood when we might not be feeling our best.13
This is because dark chocolate is rich in two key things. Firstly, magnesium – a nutrient lost during menstruation that plays an important role in turning the food we eat into energy. And secondly, flavonoids – an anti-inflammatory chemical that helps stop your body from producing prostaglandins (the chemicals that cause cramping).13
3. Brew yourself a nice cup of tea
If you’re looking for something to wash your dark chocolate down with, try brewing a pot of peppermint or ginger tea. These can both act as a natural remedy for period pain through the active ingredients they contain.
Peppermint tea, for example, contains menthol as its active ingredient which is well-known for its potential health benefits.14
While there's limited evidence to support using peppermint for menstrual cramps specifically, some studies have shown that the menthol contained in peppermint oil can calm your cramps by soothing your internal muscle spasms.15
Other spices, like ginger, work in a similar way, containing specific anti-inflammatory properties that can help ease both pain and bloating.
Some studies have even suggested that taking 200mg of ginger once every six hours is as effective as taking over-the-counter pain relief to reduce period pain.16
4. Eat a diet rich in vitamins
It’s not just magnesium that can help relieve period pain. Several other vitamins and minerals, including thiamine (vitamin B1) and vitamin E, have been shown to reduce symptoms as well.17,18
But, it’s not just what you’re eating that you need to consider – it’s when you’re eating it too.
Since your liver plays such an important role in regulating your hormones, for instance, you should try to prioritise foods that support its function in the lead-up to your period.
Whether that’s artichokes, turmeric or lean protein, eating foods like these before your oestrogen and progesterone levels start to fluctuate can help your liver keep things more in balance when they do.
During your period, it’s important to stay well hydrated, eat regularly, and get those all-important nutrients in. To find out more, read our article on what you should eat during your menstrual cycle.
5. Get fit and enjoy the endorphin rush
Exercise may be the last thing you feel like doing when period cramps hit, but it can actually help to relieve them.
In 2017, for example, Iranian researchers found that performing aerobic exercise three times a week for a minimum of 30 minutes improved period pain.19
It can also help psychologically, reducing other symptoms associated with periods like anxiety, depression or irritability, and helping encourage a better quality of sleep.
4. Raid the medicine cupboard
Over-the-counter pain relief medications like ibuprofen or aspirin can help deal with the aches, cramps and severe discomfort associated with period pain.20
These medications have been shown to relieve period pain by stopping the release of prostaglandins and reducing the intensity of the cramps you feel.20
However, if you take them and find that they don’t help your period pain, speak to your doctor as they may be able to prescribe you an alternative form of medication.
The final say
While period pain may be a common experience for a lot of women, there are several ways you can reduce the severity of your cramps.
By maintaining a healthy diet, exercising regularly and using over-the-counter medications when required, you can take back control of not just your periods but also your quality of life.
However, if your period pain starts to become really severe, consult your doctor. While it may be a one-time thing, it could also be due to an underlying condition so it’s always important to check.
1. Itani, R., et al. ‘Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates’. Korean Journal of Family Medicine, 2022;43(2):101–08. https://doi.org/10.4082/kjfm.21.0103.
2. Thiyagarajan, D., et al. ‘Physiology, Menstrual Cycle’. StatPearls, StatPearls Publishing, 2024. http://www.ncbi.nlm.nih.gov/books/NBK500020/.
3. NHS. Period Pain [Internet]. [cited 2024 Jan 31]. Available from: https://www.nhs.uk/conditions/period-pain/.
4. Nagy, H., et al. ‘Dysmenorrhea’. StatPearls, StatPearls Publishing, 2023. http://www.ncbi.nlm.nih.gov/books/NBK560834/.
5. Bupa UK. Painful periods (dysmenorrhoea). [Internet]. [cited 2024 Jan 31]. Available from: https://www.bupa.co.uk/health-information/womens-health/dysmenorrhoea.
6. World Health Organization. Endometriosis [Internet]. [cited 2024 Jan 31]. Available from: https://www.who.int/news-room/fact-sheets/detail/endometriosis.
7. NHS. Fibroids: overview. [Internet]. [cited 2024 Jan 31]. Available from: https://www.nhs.uk/conditions/fibroids/.
8. NHS. Pelvic inflammatory disease: overview. [Internet]. [cited 2024 Jan 31]. Available from: https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/.
9. NHS. Polycystic ovary syndrome: overview [Internet]. [cited 2024 Jan 31]. Available from: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/.
10. Jeong, J., et al. ‘Polycystic Ovarian Morphology Is Associated with Primary Dysmenorrhea in Young Korean Women’. Obstetrics & Gynecology Science, 2019;62(5):329–34. https://doi.org/10.5468/ogs.2019.62.5.329.
11. Sheehan, M. ‘Polycystic Ovarian Syndrome: Diagnosis and Management’. Clin Med Res, 2004;2(1):13–27. https://doi.org/10.3121%2Fcmr.2.1.13.
12. ScienceDaily. Heat Halts Pain Inside The Body. [Internet]. [cited 2024 Jan 31]. Available from: https://www.sciencedaily.com/releases/2006/07/060705090603.htm.
13. Nuha, K., et al. 'Single-Blind Randomized Controlled Trial: Comparative Efficacy of Dark Chocolate, Coconut Water, and Ibuprofen in Managing Primary Dysmenorrhea'. Int J Environ Res Public Health. 2023;20(16):6619. doi: 10.3390/ijerph20166619.
14. Farco, J., et al. 'Menthol--pharmacology of an important naturally medicinal "cool"'. Mini Rev Med Chem. 2013;13(1):124-31. Available from:https://pubmed.ncbi.nlm.nih.gov/23061635/.
15. Sanagapalli, S., et al. 'Antispasmodic drugs in colonoscopy: a review of their pharmacology, safety and efficacy in improving polyp detection and related outcomes'. Therap Adv Gastroenterol, 2017;10(1):101–113. doi: 10.1177/1756283X16670076.
16. Rad, H., et al. 'Effect of Ginger and Novafen on menstrual pain: A cross-over trial'. Taiwanese Journal of Obstetrics and Gynecology. 2018;57(6):806-809. doi: 10.1016/j.tjog.2018.10.006.
17. Proctor, M., et al. 'Herbal and dietary therapies for primary and secondary dysmenorrhoea'. Cochrane Database Syst Rev, 2001;3:CD002124. doi: 10.1002/14651858.CD002124.
18. Alikamali, M., et al. 'The effects of vitamin E on the intensity of primary dysmenorrhea: A systematic review and meta-analysis'. Clin Nutr ESPEN, 2022;52:50–59. doi: 10.1016/j.clnesp.2022.10.001.
19. Dehnavi, Z., et al. ‘The Effect of aerobic exercise on primary dysmenorrhea: A clinical trial study’. J Educ Health Promot. 2018;7:3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791467/.
20. Institute for Quality and Efficiency in Health Care (IQWiG). ‘Period Pains: Can Anti-Inflammatory Drugs Help?’ InformedHealth.Org [Internet], [cited 2024 Jan 31]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279323/.
MA MD MRCOG LLM BSc (Hons) MBBS, Consultant Obstetrician and Gynaecologist, London
Dr Shree Datta is a Consultant Obstetrician and Gynaecologist in London with over 20 years of experience in the NHS. Her key interests include general gynaecology, including fibroids and abnormal periods, fertility and pregnancy care (including elective Caesarean section), and cervical screening.
Through her passion for healthcare education, Shree has published numerous textbooks and articles and has been invited to teach and present internationally. She also received the national Helen Lawson Award for her research in ovarian cancer and was made an honorary fellow of the British Medical Association.
Shree is also well known for her interactive and personable approach, addressing each of her patient’s individual needs in a tailored, supportive manner.
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