There are different theories about what causes PMS/PMDD pain, but underlying them all are hormones and our individual sensitivity to them.

Hormones: The main cause of PMS/PMDD pain is thought to be fluctuations in hormone levels during the luteal phase, especially a drop in oestrogen. Oestrogen protects against feelings of pain, so when levels are low, our perception of pain may be higher.

Prostaglandins: a decrease in progesterone during the late luteal phase triggers an increase in prostaglandins, which are involved in the inflammatory response. Prostaglandins can directly stimulate pain-sensing nerve endings, called nociceptors, leading to increased pain perception. By sensitising these nerve endings, we lower the pain threshold, causing even minor stimulation to trigger pain/a pain response.

Serotonin: sometimes called the ‘happy hormone,’ serotonin is a neurotransmitter which helps regulate mood, sleep, and pain perception. Oestrogen increases serotonin production and the number of serotonin receptors in the brain. This means that when oestrogen is low (aka during the luteal phase), we produce less serotonin and there are fewer receptors that can be activated. This makes us more sensitive to pain.

Fluid retention: experienced during PMS/PMDD may increase pressure in the head and cause headaches. It can also lead to bloating and swelling, which can put pressure on joints and muscles, causing discomfort. Fluid retention may result in breast swelling and increased sensitivity, causing breast tissue to feel tender, heavy, or painful.

‍Stress: emotional stress and tension can exacerbate PMS and PMDD symptoms, including headaches and migraines.

‍Diet: certain foods and drinks can trigger headaches in some individuals, and these sensitivities may be heightened during the luteal phase. Common triggers include alcohol, caffeine, chocolate, aged cheeses, and processed foods containing additives like monosodium glutamate (MSG).

While PMS pain can be uncomfortable, there are lots of ways to help manage it.

Lifestyle changes: one of the first things your healthcare provider may suggest is making changes to your daily routine, such as doing more exercise, eating a healthy, balanced diet, and trying to reduce and manage stress. It’s tough to make lots of changes at once, so try making one change first, and then starting on the next.

At-home remedies: whether you’re caught out with a sudden onset of pain, or you’d like to try non-medical pain relief first, there are a number of things you can try at home. Options that apply heat (heating pads, hot water bottles, warm showers/baths) work as heat has been found to ‘switch off’ some pain receptors. Gentle massages and relaxation techniques such as yoga or breathwork have also been found to reduce stress and pain perception levels. Some people find TENS (transcutaneous electronic nerve stimulation) helps to relieve abdominal cramps, and products such as Myoovi have been designed specifically for uterine cramps.

Over-the-counter pain relief: over-the-counter medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, or aspirin can be helpful in relieving pain and inflammation caused by prostaglandins.

Prescription medications: if over-the-counter pain relief methods don't provide sufficient relief, speak to a healthcare provider about prescription medications. These may include hormonal contraceptives (birth control pills, patches, or rings) to regulate hormone levels or even prescription-strength NSAIDs. Diuretics (water pills) such as spironolactone may help with physical bloating-related pain.

‍Alternative and complementary therapies: some people find relief from PMS pain through alternative therapies like acupuncture, chiropractic treatments, or herbal remedies.