The most common types of pain experienced during PMS/PMDD are:

• Hormone headaches/menstrual migraines
• Joint, muscle, and back pain
• Abdominal pain and uterine cramps
• Breast pain and nipple sensitivity

Although, as we know, there are over 150 different symptoms of PMS and PMDD, and no one has yet managed to write them all down. So, chances are, if something hurts or aches in the two weeks leading up to your period, and subsides after, it could be a result of PMS or PMDD.

PMS Headaches

Around 60-70% of females get headaches with PMS and PMDD. But they’re not your average headache; experts have found that these migraines can be stronger, last longer, and occur more frequently than non-menstrual migraines. While the exact cause of PMS migraines and headaches is not completely understood, several factors likely contribute (see ‘causes’ below).

Joint, muscle, and back pain with PMS

Before our period, PMS muscle pain and joint aches can occur in certain areas of the body, particularly the lower back, neck and shoulders, hips, and thighs. Sometimes this can present itself 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 be a symptom of a chronic condition rather than PMS/PMDD. For example, people who have suffered a slipped disc tend to experience significantly increased pain during PMS compared to other times in their cycle. Additionally, one small study found that people with medical 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/PMDD, uterine cramps (aka period pains) can start during the luteal phase of our cycle.

It’s thought that up to 91% of us experience period pain. Period pain typically refers to the cramping sensation we might experience in our abdomen, back, pelvis, and even down to the thighs around the time of our period. Again, this can sometimes present itself as pain in the kidney or ovary areas. It occurs as the wall of the uterus begins to contract, helping shed its lining during the period.

Breast pain and nipple sensitivity

Cyclical breast pain, characterised as tenderness or a heavy ache in both breasts as well as sensitive nipples, is another type of pain we can experience as part of PMS/PMDD. As many as two-thirds of people with periods can experience it, with 10% reporting it as moderate to severe.

You may be wondering how long can PMS breast pain last? Uncomfortably, breast pain can start as early as two weeks before our period, so essentially as soon as the luteal phase begins. Sore breasts can last up until and throughout menstruation but should subside once your period is over.

There are many reasons why we may experience pain during PMS/PMDD, and many additional factors that may contribute to/exacerbate it. The main reasons we experience all kinds of pain during the luteal phase are:

• Hormones: the primary cause of PMS/PMDD pain is thought to be fluctuations in hormone levels, particularly a drop in oestrogen levels. Oestrogen protects against feelings of pain, so when levels are low, our perception of pain may be higher. It’s also been noted that people with PMDD may have altered oestrogen receptors, which could go part way to explaining why these people experience higher levels of pain than those without PMDD.
• Prostaglandins: a decrease in progesterone 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, prostaglandins effectively lower the pain threshold, causing even minor stimulation to trigger pain/a pain response.
• ‍Serotonin: (the happy hormone) 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, 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. Further, fluid retention may result in breast swelling and increased sensitivity, causing breast tissue to feel tender, heavy, or painful.

Headache-specific factors

Blood vessel constriction: prostaglandins can make blood vessels in the brain constrict and dilate, which can cause headaches/migraines. They can also make the blood vessels in the brain inflamed and swollen, activating pain receptors and resulting in headaches. 

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

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

Muscle-, joint-, and cramping-specific factors

Magnesium levels: some studies suggest that low magnesium levels may contribute to PMS/PMDD experiences. Magnesium helps relax muscles and regulate the nervous system, so insufficient levels could contribute to muscle tension and pain.

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.

Breast tenderness/nipple sensitivity specific factors

Progesterone causes swelling and enlargement of milk-producing ducts in our breasts. This can be triggered in the two weeks leading up to our period, and cause tenderness and pain as our breasts change size.

While PMS pain can be uncomfortable (and at times unbearable), there are lots of ways to help ease it.

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. Heating pads, hot water bottles, warm showers/baths, gentle massages, and relaxation techniques such as yoga or pilates all reduce stress and pain 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.

Exercising can also help if the 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) 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.

Alternative and complementary therapies

Some people find relief from PMS pain through alternative therapies like acupuncture, chiropractic treatments, or herbal remedies.

While experiencing pain during PMS is relatively common, it's essential to know when to seek medical advice. If your pain is severe or if it interferes with your daily activities, it's crucial to consult with a healthcare professional to rule out any underlying conditions or discuss alternative treatment options.

In some cases, severe pain during menstruation could be a sign of an underlying condition like endometriosis, adenomyosis, or uterine fibroids. Rather than normalising that pain and continuing to live with it, it's essential to seek medical advice for an accurate diagnosis and appropriate treatment.