Painful periods are so common that many people assume they just have to live with them. But common is not the same as normal, and pain that keeps you home from school or work, or has you planning vacations around your cycle, deserves attention.
Period pain can come from medical conditions such as endometriosis or pelvic congestion, and those need a doctor's care. This article focuses on the muscles in and around the pelvis. You'll learn how tight muscles can add to period pain, what that pain can feel like, how pelvic floor physical therapy works, and what you can try at home before, during, and after your period.
During your period, the muscles around the pelvis can become tense, painful, and even spasm. This is more likely if those muscles tend to be tight the rest of the month or if you have other pelvic floor dysfunction.
Tight muscles in and around the pelvis can create referred pain, meaning pain felt in one area that actually comes from another. That referred pain can feel very much like period cramps.
Often the problem starts with an internal issue. Over time, the inflammation and pain from that issue can spread into the surrounding muscles. So while a medical condition may be driving the pain, the muscle tension it creates is something physical therapy can work on directly.
People describe period pain in many ways. Common symptoms can include:
Pain during intercourse can also be a sign that the pelvic floor is tight and contributing to period pain.
Ideally, both. Pain like this during your period is not normal, so a good first step is a gynecologist who specializes in pelvic pain and painful periods. They can look for medical causes.
Pelvic floor physical therapy can run alongside that process. You don't need all the medical answers before starting PT, and it can help lower pain levels while you and your doctor figure out the rest, potentially before anything more invasive like surgery.
Seek out providers who have real experience with this kind of pain. Period pain is often dismissed, and someone familiar with how it works will usually be more helpful.
For period pain, sessions often start about once a week to get symptoms under control. Treatment can include:
There's no special point in your cycle when you need to start. Once you're doing better, sessions are usually spaced out and may be timed for just before you tend to get pain, such as once a month before your period, or twice a month if you also have ovulation pain. The long-term goal is for you to manage symptoms on your own.
Heat. The uterus is a type of smooth muscle, and heat brings blood flow to muscles and helps them relax. Moist heat, like a hot water bottle or a heat pack wrapped in a warm towel, can penetrate deeper and a bit faster than dry heat. An electric heating pad still does the job, so use what you have.
A TENS unit. These small devices use pads on your stomach to create a tingling, tapping sensation that distracts pain receptors from the pain. Some are small enough to wear discreetly at work or when you need to be out of the house.
Legs up the wall. Lying on your back with your legs up the wall can help activate your rest-and-digest nervous system through the vagus nerve, which can help with pain. It may also help normalize blood flow around the uterus, which can matter for people whose blood tends to pool in the pelvis. Even five minutes before bed can help.
Puppy pose. Kneeling with your hips up and chest lowered toward the floor stretches the abdominal wall, the back of the pelvic floor, and the back.
Pelvic rocking. Lying on your back with knees bent and feet flat, gently circling or rocking your hips loosens the hips, stretches the back and abdomen, and may also help calm the nervous system.
A massage gun, used gently. On a low setting, a massage gun over the lower abdomen may help release the abdominal wall muscles that refer pain to the uterus. This is a sensitive area, so less is more. Too much pressure can cause bruising or soreness. It can also be used on the glutes, inner thighs, and other areas around the pelvis.
Ibuprofen (Advil) can help a lot because it is anti-inflammatory and lowers prostaglandins in the uterus. Prostaglandins rise as the uterus cramps, which is a big part of why periods hurt.
The problem is that ibuprofen has side effects, including being hard on the stomach lining. Taking it like clockwork every month is not a long-term solution. Some people alternate ibuprofen with Tylenol, which is easier on the stomach but has its own side effects, and some start before their period begins. These are decisions to make with your doctor.
Taken in moderation and according to the label, ibuprofen should be fine. The bigger goal is to find and address the root cause so you don't have to rely on it.
Your bowels and your period are closely linked. The hormone progesterone rises before your period and can cause constipation. When it drops, everything may come out at once, which can bring diarrhea, rectal pain, and abdominal pain.
Constipation also puts a lot of pressure on the pelvic floor muscles, and bowel episodes alone can cause cramping that feels a lot like period pain. For some people, these bowel changes are among the most distressing parts of their period. Managing them with fiber, water, PT, and releasing the rectal muscles can make a real difference.
Gentle clockwise massage of the abdomen can also help with constipation. Your large intestine starts near the right hip bone and runs up, across, and down to the left in an upside-down U shape, so clockwise strokes follow the direction your colon naturally moves.
These are general educational suggestions, not an individualized treatment plan. A pelvic floor physical therapist or doctor can tailor them to you.
Consider getting evaluated if:
A gynecologist who specializes in pelvic pain and painful periods can look for medical causes, and a pelvic floor physical therapist can help with the muscular side.
Why do tampons make my cramps worse?
Increased cramping with a tampon is often a sign of a tight pelvic floor. Inserting a tampon can irritate the pelvic floor muscles, and those muscles may work harder to hold it in place. Releasing the pelvic floor during the rest of the month can help.
Can an orgasm help with period cramps?
It can help or hurt. An orgasm makes the pelvic floor and uterine muscles pulse, which usually ends in muscle release and brings blood flow to the area. But if you're already inflamed before your period, it can sometimes leave more tension. If you have pain with sex or orgasm, this probably isn't the technique for you.
Does exercise help period cramps?
Regular low-impact exercise like Pilates, yoga, and weight training can help throughout the month. Cycling during your period is harder to recommend, because a bike puts a lot of pressure on the pelvic region and works the hip flexors and glutes, which can make pain worse for some people.
Is moist heat better than a heating pad?
Moist heat tends to penetrate deeper and a little faster, which is why PT clinics often use warm, wrapped heat packs. An electric heating pad still helps, so use whatever you have.
This article draws on insights from a conversation on the Unlock Your Body podcast with pelvic floor physical therapist Dr. Emma Codman. Listen to the full episode below for the complete discussion and additional context.
Painful periods are not something you simply have to accept. Pain often has a muscular side, even when a medical condition is involved, and that means there are things you can do about it. Working with a knowledgeable doctor and a pelvic floor physical therapist, along with heat, stretching, good bowel and bladder habits, and a consistent routine, can give you more control over your cycle and take some of the fear out of the pain.