Period pain guide: Reasons & relief

Do you get severe period pain every month? Here are 5 reasons it could be happening.

Most women experience period pains every month but for 10% of women, that pain is so severe it puts their lives on hold – period pain is thought to be the biggest cause of absences from school, college or work for women under 30.¹

Find out what could be causing your painful periods and how to tackle them.

Why do women get period cramps?

Females of menstruating age (from around age 12 until around age 50) will experience a period approximately each month.

During this time, the ovaries release the female hormones oestrogen and progesterone. These send a chemical message to the brain, which triggers an egg to release.

The uterus lining also receives instructions from these hormones - to build up and become thicker.

This tissue is there for the embryo to implant to, should the egg become fertilised and the woman become pregnant.²

If the egg is not fertilised, chemicals called prostaglandins then trigger the uterus lining to shed through the vagina as a period. This lining includes cells, tissues and blood.

The uterus lining doesn’t simply shed itself and make its way through the cervix and out of the vagina. It needs a little help. This is unfortunately where the cramping part comes in.

The muscular wall of the uterus sheds its lining through a series of contractions, which encourage the lining to become loose and expel. This happens involuntary – we are not able to control this process.

Unsurprisingly, these muscular contractions are what causes the cramping.

The cramping also causes a temporary restriction to the blood flow to the walls of the uterus.

This triggers the release of biochemicals which contribute to the number of muscle contractions.³

What is period pain?

Those monthly tummy cramps are caused by contractions of the womb wall, ranging from feelings of dull pain to intense spasms.⁴

The contractions are stimulated by hormone-like substances called prostaglandins.

A 2006 study, published in medical journal The BMJ, reported that women experiencing the most pain have more prostaglandins, and levels are highest during the first two days of menstruation.^5,6

You’re more likely to experience severe cramping if you started your periods before the age of 11 years, have never been pregnant, are overweight, or you smoke or drink alcohol.⁷

Painful cramps can also occur during the perimenopause, the transition leading up to menopause, due to an increased release of prostaglandins.⁸

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What else can trigger severe period pains?

Some women just have painful periods, with no underlying conditions.

But for others, the pain during menstruation could be linked to certain medical conditions, including:

1. Endometriosis

Scientists still aren’t sure why it happens but in women with endometriosis, the lining of the womb appears in parts of the body where it shouldn’t; around the bladder, on ovaries or inside the bowel, for example.

In endometriosis, the normal monthly hormonal changes trigger the breakdown of this womb lining into scar tissue, causing intense pain before, during and/or after the period.^9,10

2. Polycystic ovary syndrome (PCOS)

PCOS is caused by high levels of insulin, which triggers a hormonal imbalance.

This causes symptoms like irregular periods, hair growth and the formation of polycystic ovaries – when your ovaries become enlarged and contain lots of fluid-filled sacs.¹¹

A study published in Clinical Medicine & Research in 2004 found that PCOS may cause more painful periods.

This is because your periods become so irregular that when they do happen, there’s a much heavier blood flow that leads to more intense cramping.¹²

3. Ovarian cysts

An ovarian cyst is a fluid-filled sac, found inside the ovary.

These cysts are usually harmless, but a 1990 study by researchers at the University of Illinois found that they can cause period pain.^13,14

4. Fibroids

These are growths in and around the womb. Women with fibroids tend to experience heavy, painful periods.¹⁵

Scientists aren’t sure why some women develop fibroids, but they might be linked to oestrogen as the growths tend to shrink after the menopause when oestrogen levels are low.¹⁶

5. Pelvic inflammatory disease (PID)

PID is an infection of the womb, fallopian tubes and ovaries.

It’s usually caused by a bacterial infection, and symptoms include heavy and painful periods.¹⁷

If you think you may have one of these conditions, talk to your GP to make sure you get the right treatment.

What other symptoms might accompany period cramps?

Unfortunately, period cramps are sometimes accompanied by other unwelcome symptoms.

These include:

• Diarrhoea 

The chemicals which trigger the contractions of the uterus can also affect the intestines.

This has a laxative effect and can cause diarrhoea during menstruation for some women.¹⁸

• Nausea 

The presence of extra prostaglandins (the chemicals which trigger muscle contractions) in the body can cause nausea in some women.¹⁹

• Emotional symptoms 

Fluctuating hormone levels during a period can cause sadness, anxiety and irritability.²⁰

That’s why you should be extra kind to yourself during this time of the month.

Simple ways to help period pain

Try these tips to help relieve the pain of menstrual cramps:

• Consider taking thiamine (vitamin B1) – a 2001 review by the National Women’s Hospital in Auckland showed both nutrients could help fight period pain.²¹
   
• Do some exercise – in 2017, Iranian researchers found that aerobic exercise could ease period pain by boosting circulation and relieving mental stress.²²
   
• Wallow in a warm bath or place a hot water bottle against your tummy – the heat relaxes the muscles of the uterus, reducing the pain.²³

Our top 5 remedies for painful periods

While menstrual cramps can be painful, you can take many routes to relieve and get rid of the pain.

We've given you our top 5 remedies to help you get through the monthly visit.

1. A hot water bottle

This is more than just an old wives’ tale. A soothing hot water bottle placed on the abdomen or lower back can work wonders for period pain.

Not only does it promote feelings of comfort and relaxation, but topical heat can also actually block the effect of chemical messengers that cause your body to detect pain.

Researchers from University College London discovered that if heat of over 40° is applied to the skin near where it hurts, your pain receptors can actually be switched off as your heat receptors activate instead.

This decreases the transmission of pain signals to the brain.²⁴

Make sure you use a hot water bottle cover so it doesn’t get too hot. You could also use a microwaveable rice bag.

2. Exercise

It might be the last thing you feel like doing when those cramps hit, but exercise can actually help to relieve them.

Even if it’s just getting away from your desk at lunchtime for a brisk walk, you will benefit from the endorphin rush and it will take your mind off that nagging pain.

Exercise helps psychologically too and will promote a sense of wellbeing as well as helping you to sleep better at night.

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3. Peppermint tea

Menstrual cramps are caused by contractions and spasms of the uterus as it expels its lining.

Not only can this be painful, it’s also responsible for nausea and diarrhoea some women experience around their time of the month.

The active ingredient in peppermint tea is menthol, which is an anti-spasmodic and can calm your cramps from within by soothing the internal spasms.²⁵

You could buy peppermint tea bags or brew fresh peppermint leaves in hot water, crushing them first to help release their potent oils.

4. Cinnamon and ginger

Much like peppermint, there are active ingredients in some spices which can might be able to help alleviate the symptoms of a painful period.

Both cinnamon and ginger are widely used as digestive and anti-nausea aids, and both also have anti-spasmodic and anti-inflammatory properties.

This explains why they seem to work so well to ease some of the most common symptoms of dysmenorrhea, which is the term for problematic and painful menstruation.

A great way to enjoy the benefits of these delicious spices is to add them to your cooking and brew them in hot water to make hydrating teas.

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5. Dark chocolate

The chocolate cravings some women get around the time of their period are more than a myth.

Dark chocolate is rich in magnesium, a nutrient which is lost during menstruation.

Magnesium is a mineral which helps turn the food we eat into energy, as well as playing a role in the transmission of nerve impulses.

Studies show that ensuring you have enough magnesium can help significantly reduce premenstrual symptoms, when in combination with vitamin B6.²⁶

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While it’s true that other foods are also high in magnesium, such as spinach and lentils, the positive associations many of us have with treating ourselves to chocolate can boost our mood and comfort us when we might not be feeling our best.

Unfortunately for fans of milk chocolate, it doesn’t have anywhere near as much magnesium in it, plus it’s very high in sugar.

Try adding cacao powder to smoothies or raw food desserts for a magnesium-rich chocolate hit without as much sugar.

Last updated: 6 October 2021