Period Pain: Relieving Back Discomfort During Your Menstrual Cycle

Your back may hurt before, during, or just after your menstrual period. Back pain is associated with several conditions that affect the reproductive organs, such as: 

• Premenstrual syndrome (PMS), which refers to several symptoms women experience in the week or to before their menstrual periods (1).
• Uterine contractions due to prostaglandins, hormone-like lipid compounds (2).
• Primary dysmenorrhea, which is commonly referred to as menstrual cramps (3).
• Endometriosis, a condition that occurs when tissue like that which grows in the uterus grows elsewhere in the body (4).
• Uterine fibroids, also known as leiomyomas or myomas, which are growths that develop in the uterus (5).
• Adenomyosis, which occurs when the endometrium (or inner uterine lining) breaks through the myometrium (or muscular uterine wall) (6).
• Pelvic inflammatory disease, which is an infection of the reproductive organs that is often caused by sexually transmitted bacteria (7). 
• Ovarian cysts, which occur when a sac fills with ovarian fluid or tissue (8).
• Early pregnancy, which can cause abdominal and back discomfort as hormone levels fluctuate (9).
  

Many women experience back pain due to premenstrual syndrome, uterine contractions, and dysmenorrhea. Menstrual cramps and related back pain occur more frequently in girls and women who had their first periods at a young age, experience long-lasting periods, have a heavy menstrual flow, or have a family history of dysmenorrhea (10). 

Manageable, monthly back pain can result from your body shedding the lining of the uterus. In the case of debilitating back pain that accompanies your menstrual cycle, talk to a healthcare provider. Medical conditions such as endometriosis can cause severe lower back pain accompanied by pelvic pain. A gynecologist can help you determine if you are experiencing pain that typically occurs as the uterus contracts and sheds its lining, or if you may have a more serious underlying condition (11).

Start by talking to a healthcare provider about the back pain you are experiencing. Tell them if the pain occurs before, during, or after your period. Describe the pain with explicit terms such as cramping, radiating, or aching. Tell your doctor how long the pain typically lasts, if it varies in intensity, and how it affects your daily life. 

If your pain warrants testing, a gynecologist may perform an ultrasound to look for conditions such as endometriosis—also referred to as “secondary dysmenorrhea”—or polycystic ovarian syndrome  (11, 12). A CT or MRI scan could help assess the health of your reproductive organs (13). In some cases, a gynecologist may conduct a laparoscopy (14) or a pelvic exam (15). 

Ask your doctor questions about which tests, exams, or procedures they recommend. Given the personal nature of menstrual pain and pelvic exams, it’s important that you feel as relaxed as possible during the examination. Request any information you need in order to understand your condition. Questions you may want to ask include:

• How much experience do you have conducting this exam or procedure?
• What types of conditions could this exam or procedure reveal?
• What are the steps involved in this exam or procedure?
• Will the exam be painful? If so, are there exercises I can do to help my muscles relax before the exam? Should I take any pain medication before or after? 
• When in my menstrual cycle should we schedule this exam or procedure? 
• Should someone accompany me to the appointment? 
• How long will it take to get results?

Don’t be afraid to repeat a question or ask for clarification. Especially if you are in pain during the conversation, take your time in asking questions, processing the answers, and coming up with a plan that works for you and your doctor.

There are many options for menstrual back pain relief that you can access online or with a visit to your local pharmacy. We've listed a handful of good options below.

• Exercise therapy can improve and treat primary dysmenorrhea, specifically by relieving thigh and back pain (16). Studies show that yoga, jogging, and Pilates, in particular, may alleviate symptoms of dysmenorrhea (17, 18). Stretching, strengthening, and aerobic exercises can have similar positive effects  (19, 20, 21).  Women who participated in dance exercise classes experienced pain that was both milder and shorter duration than pain experienced by women who did not participate in dance classes (22).
• Nonsteroidal anti-inflammatory drugs, called NSAIDs (such as diclofenac and ibuprofen), inhibit prostaglandins, which trigger uterine contractions and cause back pain during menstrual periods (23). NSAIDs can also provide pain relief to patients who suffer from secondary dysmenorrhea caused by endometriosis (24). Several NSAID pain relievers are available over-the-counter, while some stronger forms require a prescription. A particular class of NSAIDs known as COX-2 inhibitors show similar therapeutic effects to other anti-inflammatories but carry fewer gastrointestinal side effects, and may be worth considering if you have a healthy heart (25).
• Heat therapy has a positive therapeutic effect on menstrual cramps (26). You may find that placing a heating pad or hot water bottle on your lower abdomen or lower back provides substantial relief. A wearable heat wrap, disposable heat pad, or microwaveable heat pack that can be placed under your clothes can offer discreet relief. Whether you need to travel, sit at a desk, or walk around a lot during your menstrual period, there’s a heat therapy option that could provide you with pain relief.

Hot baths offer similar therapeutic effects for pain (27). Heat patches containing iron have been shown to provide similar analgesic effects to ibuprofen in treating menstrual pain (28). Similarly, a sericite-belt or body wrap with an infrared heat pack might effectively and safely treat women suffering from dysmenorrhea (29).

• Electrotherapy methods have been used to effectively treat period pain (30). Transcutaneous Electrical Nerve Stimulation—commonly administered by a TENS Unit—relieves symptoms of dysmenorrhea and the portable, disposable TENS device offers the same positive effects for women suffering from painful menstrual cramps (31, 32). 
  

If these methods do not alleviate your pain, talk to your doctor about other options. They may suggest treatment options such as:

• Birth control pills (or oral contraceptive pills, referred to as OCPs) treat period pain (33). According to the Mayo Clinic, patients taking combination birth controls that contain both estrogen and progestin experience less severe menstrual cramps (34). Birth control pills also help alleviate pain from endometriosis (35).
• In extreme cases, surgery may be required to relieve some types of back pain associated with menstrual periods. An OB-GYN may determine that fibroids or endometriosis tissue need to be surgically removed (36). If you have surgery, your doctor may prescribe pain relievers or birth control pills as part of your recovery process.

As with any treatment, medications for treating back pain from periods carry side effects. NSAIDs, often the first line of treatment in cases of pain, generally carry minor side effects in the form of stomach pain and heartburn (37). COX-2 inhibitors can increase your risk of stroke and lead to abdominal pain, diarrhea , and dyspepsia (indigestion)  (38, 39). Oral contraceptive pills can cause nausea, headaches, and breakthrough bleeding (40). Surgery carries a risk of reaction to anesthesia as well as a risk of infection.

Consider your healthcare provider's advice as you decide which treatment is right for you, and be sure to discuss all available options and their pros and cons. As you discuss your medical history, typical responses to medications, and current pain level, your doctor can help you determine the side effects that present the least risk to you personally.

Many underlying causes—from standard menstrual cramps to endometriosis—could be the source of your back pain. Consider starting with some accessible steps for pain management such as exercise, a heating pad, or an over-the-counter NSAID like ibuprofen. You may find that your body responds well to treatments like these and that no further intervention is necessary.

If your pain does not respond to these treatments, is particularly severe, or keeps you from participating in normal activities, consult a doctor. Reactions to pain such as vomiting, fainting, sleep disruptions, or inability to sit or stand are all signs that you should seek professional medical care. Your healthcare provider can recommend the right exams and tests for diagnosing a more complicated case. 

Although back pain that accompanies cramps is a normal part of menstruation, crippling pain is not. Work with your health care provider to find a solution that enables you to participate in your daily life as fully as possible, and that alleviates stress about your menstrual period approaching each month.