30-day guarantee
PMS, PMDD and pain
Summary
Pain is one of the most common yet often overlooked symptoms of PMS and PMDD. From headaches and cramps to breast tenderness and joint pain, hormonal fluctuations, changes in serotonin, and inflammation all play a role. This article explores the science behind premenstrual pain, the role of oestrogen and prostaglandins, and practical strategies for relief: from simple at-home remedies like heat and stretching to medical treatments and alternative therapies. It also highlights when pain might signal an underlying condition such as endometriosis or fibroids, and why it is important not to normalise severe pain.
Jump to a section
🌿 Key takeaways
PMS and PMDD pain: what to know
- The most common types of PMS and PMDD pain are headaches and migraines, joint and muscle pain, abdominal cramps, and breast tenderness
- The main drivers are hormonal fluctuations (particularly falling oestrogen), prostaglandins, changes in serotonin, and fluid retention
- At-home remedies, over-the-counter pain relief, prescription medications, and alternative therapies can all help
- Severe pain that interferes with daily life is never something to normalise and should be investigated by a healthcare professional
- Underlying conditions such as endometriosis, adenomyosis, or fibroids can cause or worsen premenstrual pain
Common types of PMS and PMDD pain
The most common types of pain experienced during PMS and PMDD are:
- Hormone headaches and menstrual migraines
- Joint, muscle, and back pain
- Abdominal pain and uterine cramps
- Breast pain and nipple sensitivity
There are over 150 recognised symptoms of PMS and PMDD, and no one has yet managed to write them all down. So if something hurts or aches in the two weeks leading up to your period and subsides afterwards, it could well be a result of PMS or PMDD.
PMS headaches and menstrual migraines
Around 60 to 70% of people experience headaches with PMS and PMDD. These are not average headaches; experts have found that menstrual migraines can be stronger, last longer, and occur more frequently than non-menstrual migraines. While the exact cause is not completely understood, several factors are known to contribute.
Joint, muscle, and back pain with PMS
Before a period, muscle pain and joint aches can occur in specific areas of the body, particularly the lower back, neck and shoulders, hips, and thighs. This can sometimes present as pain in the kidney or ovary areas. More research needs to be done to fully understand the role of the menstrual cycle on joint and muscle pain, as this type of pain can also be a symptom of a chronic condition. For example, people who have suffered a slipped disc tend to experience significantly increased pain during PMS compared to other points in their cycle. One small study also found that people with conditions such as osteoarthritis, rheumatoid arthritis, fibromyalgia, and lupus may experience increased pain before or during their periods.
Abdominal pain and uterine cramps
Although most people associate cramps with their period rather than PMS and PMDD, uterine cramps can start during the luteal phase. It is thought that up to 91% of people experience period pain at some point. This typically refers to the cramping sensation in the abdomen, back, pelvis, and sometimes down to the thighs. It occurs as the wall of the uterus begins to contract, helping shed its lining.
Breast pain and nipple sensitivity
Cyclical breast pain, characterised as tenderness or a heavy ache in both breasts along with sensitive nipples, is another common type of pain associated with PMS and PMDD. As many as two-thirds of people with periods experience it, with 10% reporting it as moderate to severe.
Breast pain can start as early as two weeks before a period, essentially as soon as the luteal phase begins, and can last until and throughout menstruation before subsiding.
⚠️ Worth noting: If you experience breast pain or lumps that do not follow a clear cyclical pattern, or that persist beyond your period, always speak to a healthcare professional to rule out other causes.
What causes PMS and PMDD pain?
There are several key reasons why pain is more pronounced during the luteal phase.
Hormones
Oestrogen protects against pain perception, so when levels drop in the luteal phase, sensitivity to pain increases. People with PMDD may also have altered oestrogen receptors, which could help explain why they experience higher levels of pain than those without the condition.
Prostaglandins
A decrease in progesterone triggers an increase in prostaglandins, which are involved in the inflammatory response. Prostaglandins directly stimulate pain-sensing nerve endings (nociceptors), effectively lowering the pain threshold so that even minor stimulation can trigger discomfort.
Serotonin
Serotonin helps regulate mood, sleep, and pain perception. Oestrogen increases serotonin production and the number of serotonin receptors in the brain. When oestrogen falls, serotonin activity drops, making the body more sensitive to pain.
Fluid retention
Fluid retention during PMS and PMDD can increase pressure in the head and contribute to headaches. It can also lead to bloating and swelling that puts pressure on joints and muscles, and can cause breast tissue to feel tender, heavy or painful.
🧪 What the science says: Oestrogen protects against pain, prostaglandins amplify it, and serotonin modulates it. In the luteal phase, all three shift in ways that increase pain sensitivity. This is why PMS and PMDD pain is not imagined - it has a clear, well-evidenced biological basis.
Headache-specific factors
Beyond the general hormonal picture, several factors contribute specifically to menstrual headaches and migraines.
Blood vessel changes
Prostaglandins can cause blood vessels in the brain to constrict and dilate, triggering headaches and migraines. They can also cause inflammation and swelling in blood vessels, which activates pain receptors.
Stress
Emotional stress and tension can exacerbate PMS and PMDD symptoms, including headaches and migraines. The heightened nervous system reactivity in the luteal phase means that stress is more likely to tip into a migraine during this time.
Diet
Certain foods and drinks can trigger headaches and migraines, and these sensitivities may be heightened during PMS and PMDD. Common triggers include alcohol, caffeine, chocolate, aged cheeses, and processed foods containing additives such as monosodium glutamate (MSG).
Muscle, joint, and cramping-specific factors
Magnesium levels
Some studies suggest that low magnesium levels may contribute to PMS and PMDD muscle pain. Magnesium helps relax muscles and regulate the nervous system, so insufficient levels can contribute to muscle tension and cramping in the luteal phase.
🌿 Good to know: Magnesium citrate and bisglycinate in Evelyn's Revive formula are specifically included to support muscle relaxation, nervous system regulation, and reduction in cramping before your period.
Abdominal and uterine-specific factors
As the uterine wall squeezes to shed its lining, it compresses blood vessels, temporarily cutting off the blood supply. Without oxygen-rich blood, the uterine tissues release prostaglandins, which trigger pain. This is why NSAIDs (which block prostaglandin production) are often effective for menstrual cramps.
🧠 In simple terms: Menstrual cramps are not just your uterus being dramatic. They are the result of a real chemical process - prostaglandins triggering uterine contractions that temporarily reduce blood flow. The pain is physiological, and it can be addressed.
Breast tenderness and nipple sensitivity-specific factors
Progesterone causes swelling and enlargement of milk-producing ducts in the breasts. This can be triggered in the two weeks leading up to a period, causing tenderness and pain as breast tissue changes in size and composition.
Treating PMS and PMDD pain
While PMS and PMDD pain can be uncomfortable and at times overwhelming, there are many approaches that can help.
At-home remedies
Whether you have been caught out with sudden onset pain or you would like to try non-medical relief first, there are several things you can try at home. Heating pads, hot water bottles, warm showers and baths, gentle massage, and relaxation techniques such as yoga or pilates can all help reduce stress and pain. Some people find TENS (transcutaneous electronic nerve stimulation) helpful for abdominal cramps, and products such as Myoovi have been designed specifically for uterine cramping.
Exercise can also help when pain is mild. Physical activity stimulates the production and release of endorphins, which work to reduce pain and increase feelings of wellbeing.
Over-the-counter pain relief
Over-the-counter medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen, naproxen, and aspirin can be helpful in relieving pain and inflammation caused by prostaglandins. They work by blocking the enzymes that produce prostaglandins, directly addressing one of the main drivers of PMS pain.
Prescription medications
If over-the-counter options do not provide sufficient relief, speaking to a healthcare provider is the right next step. They may discuss hormonal contraceptives to regulate hormone levels, or prescription-strength NSAIDs for more severe pain.
Alternative and complementary therapies
Some people find relief from PMS pain through alternative therapies such as acupuncture, chiropractic treatments, or herbal remedies.
Pain relief options at a glance
- Heat - hot water bottle, heated pad, warm bath
- Movement - gentle yoga, pilates, walking
- TENS - transcutaneous electronic nerve stimulation for cramps
- NSAIDs - ibuprofen, naproxen, aspirin (over the counter)
- Prescription options - hormonal contraceptives, stronger NSAIDs
- Complementary therapies - acupuncture, chiropractic, herbal
When to seek medical advice
While experiencing pain during PMS and PMDD is relatively common, it is essential to know when to seek medical advice. If pain is severe or interferes with daily activities, please consult a healthcare professional to rule out any underlying conditions or discuss alternative treatment options.
Severe pain during menstruation can be a sign of an underlying condition such as endometriosis, adenomyosis or uterine fibroids. Rather than normalising that pain and continuing to live with it, seeking an accurate diagnosis is essential to get the right treatment.
⚠️ Speak to a healthcare professional if:
- Your pain is severe or is disrupting work, sleep, or daily activities
- Pain does not respond to over-the-counter pain relief
- You experience pelvic pain outside of your luteal phase or period
- You notice any new or unexplained symptoms alongside your pain
Final thoughts
PMS and PMDD pain is common, but it is not something you simply have to put up with. Understanding the causes and types of pain you experience is the first step toward managing it effectively. From at-home remedies to over-the-counter medications, prescription options, and alternative therapies, there are many approaches worth exploring.
You are not alone in this. Sometimes even knowing that others share the same experience, and learning how they manage it, can help. Join the Evelyn community to access advice, support, and resources about all things PMS and PMDD.
Disclaimer: This content is for informational purposes only and is not intended as medical advice. Always speak to a qualified healthcare professional about any health concerns.
