Exploring symptoms – 2. What causes Period Pain and how to reduce this symptom

Period pain is the most commonly experienced symptom related to the menstrual cycle. Research suggests over 90% of women who menstruate will experience menstrual cramps at some point in their life. You may hear or read menstrual pain called dysmenorrhea. Medically dysmenorrhea is defined as primary dysmenorrhea (focus for this post) or secondary dysmenorrhea.

  1. Primary dysmenorrhea – cramping pain caused by menstruation.
  2. Secondary dysmenorrhea – menstrual related pain that accompanies another medical or physical condition such as endometriosis or uterine fibroids.

Symptom cause

For primary dysmenorrhea, pain occurs in the lower abdomen but can spread to the lower back and thighs. Pain usually begins several hours or just after the onset of menstruation and is often more severe on the first and/or second day of menstruation. Other symptoms associated may be nausea and vomiting, fatigue, diarrhoea, lower backache, headache and in some cases fainting. The pain should not persist beyond 2 or 3 days.

The cause of menstrual cramps is still uncertain, attributed to several factors including lack of blood flow (ischemia) and therefore oxygen deficiency of the uterus caused by increased intrauterine pressure and vessel constriction, behavioural or psychological factors and increased production and release of prostaglandins. Prostaglandins (specifically PGF2-alpha and PGE-2 if you are interested) cause uterine contractions, the higher the level of prostaglandins the more severe the menstrual cramps can be. These contractions are caused by constriction of small endometrial (layer of tissue that lines the uterus) blood vessels which cause tissue ischemia, endometrial disintegration, bleeding and result in pain. Levels rise shortly before and during the onset of a period which has suggested the increase in prostaglandins may be related to a decline in progesterone and/or estradiol.

Note: Prostaglandins are a hormone like substance that affect several bodily functions including inflammation, pain and uterine contractions. The uterine contractions help release the uterine lining from your uterus and result in a period. Prostaglandins are hormone-like because they coordinate different functions in your body and tell your body what to do and when to do it. Prostaglandins are different from hormones because your endocrine system glands don’t release them into your bloodstream, instead, your tissues make prostaglandins at the site of the action, damage or infection. Prostaglandins play a very important role in the body, are natural and necessary. However, sometimes your body can have excessive amounts as is the case with painful or heavy periods.

Ways to help manage period cramps

  • Over the counter anti inflammatories (ibuprofen) can reduce inflammation and pain if taken the day before periods start. Check there are no underlying medical conditions or contraindications prior to taking, check with your GP if you are unsure.
  • Heat applied to the lower abdomen can relax the contracting muscles in the uterus
  • Physical activity can reduce pain, such as swimming, walking or yoga (suggested poses and video for yoga and period cramps).
  • Think about food you are eating to reduce inflammation. Sugar/sugary foods and processed foods can increase inflammation in the body compared to food such as fruit and vegetables which are anti-inflammatory and can reduce the severity of pain and symptoms experienced.

In this series exploring symptoms, up next I am going to cover low motivation…


  • Hudson T. Using nutrition to relieve primary dysmenorrhea. Alternative and Complimentary Therapies, 2007. 13(3), 125.
  • Rosenwaks Z. & Seegar-Jones G. Menstrual pain: its origins and pathogenesis. The Journal of Reproductive Medicine, 1980. 25(4), 207-212.
  • Begum M., Das S. & Sharma HK. Menstrual disorders: causes and natural remedies. Journal of Pharmaceutical, Chemical and Biological Sciences, 2016. 4(2), 307-320.

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Dr Natalie Brown

Hey! I am Natalie, a research associate exploring all things menstrual cycle and sport related, whether that is Olympic performance or factors affecting participation in physical activity. When I am not talking about the menstrual cycle, I love climbing and being active outside. I have a background in physiology and research related to hormonal responses in athletes (male and female), combined with my own personal experience in sport, I am passionate to share information on the menstrual cycle with you.

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