Dysmenorrhea

Period Pain Taking Over Your Month? It May Be More Than “Just Cramps”

Pelvic health for every body

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You check your calendar and realize your period is coming. Before the bleeding even starts, you are already preparing for the cramps, back pain, nausea, fatigue, pain medication, heating pad, and possibly a day away from work, school, exercise, or social plans.

Maybe you have always been told:

“It’s just part of having a period.”

“Everyone gets cramps.”

“You have a low pain tolerance.”

But pain that regularly stops you from functioning deserves attention.

Painful periods are medically known as dysmenorrhea. Mild cramping can happen during menstruation, but severe, worsening, or disruptive period pain should not automatically be dismissed as normal.

Dysmenorrhea can happen because of the natural chemicals involved in menstruation, but it can also be associated with conditions such as endometriosis, adenomyosis, fibroids, pelvic inflammatory disease, or pelvic floor dysfunction.

Pelvic floor physiotherapy cannot diagnose or treat every cause of menstrual pain. However, it may be a valuable part of care when pelvic floor tension, abdominal or hip pain, scar restriction, nervous-system sensitivity, breathing patterns, or movement limitations are contributing to your symptoms.

At Peloraa

An internal pelvic floor assessment may be offered when clinically appropriate, but it is not mandatory. Your physiotherapist will explain your options, discuss alternatives, and ask for your consent before proceeding.

Understand your journey

What You Should Know About Dysmenorrhea

Find clear, supportive answers to common questions about urinary incontinence, bladder leakage, symptoms, treatment, and pelvic health physiotherapy.

What is dysmenorrhea?

Dysmenorrhea means painful cramping shortly before or during menstruation.The pain is usually felt in the lower abdomen or pelvis, but it may also spread into the:Lower…

Dysmenorrhea means painful cramping shortly before or during menstruation.

The pain is usually felt in the lower abdomen or pelvis, but it may also spread into the:

Lower back
Hips
Groin
Inner thighs
Buttocks
Abdomen

Some people describe the pain as cramping, aching, pulling, pressure, heaviness, stabbing, burning, or a deep throbbing sensation.

Period pain may also occur alongside:

Nausea
Vomiting
Diarrhea
Headaches
Dizziness
Fatigue
Bloating
Sweating
Difficulty sleeping
Pain with bowel movements
Pain during or after intimacy

Dysmenorrhea is divided into two main types: primary dysmenorrhea and secondary dysmenorrhea.

What is primary dysmenorrhea?

Primary dysmenorrhea is menstrual pain that occurs without another identifiable pelvic condition.During menstruation, the body releases substances called prostaglandins. These…

Primary dysmenorrhea is menstrual pain that occurs without another identifiable pelvic condition.

During menstruation, the body releases substances called prostaglandins. These help the uterus contract so it can shed its lining. Higher prostaglandin activity can contribute to stronger uterine contractions, inflammation, cramping, nausea, diarrhea, and other symptoms.

Primary dysmenorrhea often:

Begins during adolescence or within a few years of the first period
Starts shortly before or when bleeding begins
Is strongest during the first one or two days
Improves as the period ends
Occurs in a relatively predictable pattern
Is not caused by another pelvic disease

Even when no underlying condition is identified, the pain can still be significant and deserving of treatment.

What is secondary dysmenorrhea?

Secondary dysmenorrhea is period pain caused by or associated with another medical condition.Possible causes include:EndometriosisAdenomyosisUterine fibroidsPelvic inflammatory…

Secondary dysmenorrhea is period pain caused by or associated with another medical condition.

Possible causes include:

Endometriosis
Adenomyosis
Uterine fibroids
Pelvic inflammatory disease
Ovarian cysts
Cervical narrowing
Pelvic adhesions or scar tissue
Certain intrauterine devices, particularly after insertion
Other reproductive or pelvic health conditions

Secondary dysmenorrhea may:

Begin after years of relatively manageable periods
Become progressively worse
Start well before bleeding
Continue after the period ends
Occur at other times in the menstrual cycle
Be accompanied by heavy or irregular bleeding
Cause pain with bowel movements or urination
Cause pain during or after intimacy
Affect fertility
Respond poorly to usual pain-relief strategies

ACOG notes that painful periods that worsen over time may be associated with endometriosis. ACOG Endometriosis FAQ

How much period pain is normal?

There is no single “normal” period experience, and pain cannot be judged by a number alone.Mild or moderate cramping that is short-lived and does not significantly disrupt daily…

There is no single “normal” period experience, and pain cannot be judged by a number alone.

Mild or moderate cramping that is short-lived and does not significantly disrupt daily life can occur during menstruation. However, your symptoms deserve medical attention if period pain repeatedly causes you to:

Miss work or school
Stay in bed
Cancel social plans
Avoid exercise
Wake from sleep
Vomit or faint
Take more medication than recommended
Use heat constantly to function
Avoid intimacy
Experience fear or anxiety before every period
Organize your entire month around the pain

Your ability to function is often more meaningful than whether you rate the pain as a six, seven, or eight out of ten.

If your period regularly controls your schedule, it is worth discussing with a qualified healthcare provider.

What does dysmenorrhea feel like?

People commonly describe painful periods as:“My uterus feels like it is twisting.”“The cramps spread into my back and legs.”“I feel pressure throughout my pelvis.”“I cannot stand…

People commonly describe painful periods as:

“My uterus feels like it is twisting.”
“The cramps spread into my back and legs.”
“I feel pressure throughout my pelvis.”
“I cannot stand up straight.”
“It hurts to have a bowel movement.”
“I have to curl into a ball.”
“My abdomen feels tight and guarded.”
“The pain comes in waves.”
“My whole body feels exhausted.”
“Pain medication barely touches it.”

These descriptions help your healthcare provider understand more than a pain-scale number can.

Consider tracking where the pain occurs, when it begins, how long it lasts, what else happens with it, and how it affects your activities.

Why are my period cramps getting worse?

Period pain can change because of hormonal, medical, musculoskeletal, or nervous-system factors.Worsening pain may be associated with:EndometriosisAdenomyosisFibroidsOvarian…

Period pain can change because of hormonal, medical, musculoskeletal, or nervous-system factors.

Worsening pain may be associated with:

Endometriosis
Adenomyosis
Fibroids
Ovarian cysts
Pelvic inflammatory disease
Pelvic adhesions
Increased pelvic floor muscle tension
Abdominal or surgical scars
Changes in physical activity
Poor sleep or ongoing stress
Increased nervous-system sensitivity
Another pelvic or reproductive health condition

Pain that begins after several years of painless periods, continues outside menstruation, or becomes progressively worse is a reason to speak with a physician. NICE dysmenorrhea assessment guidance

Could painful periods be endometriosis?

They can be, but painful periods do not automatically mean you have endometriosis.Endometriosis should be considered when period pain is accompanied by symptoms such as:Pain that…

They can be, but painful periods do not automatically mean you have endometriosis.

Endometriosis should be considered when period pain is accompanied by symptoms such as:

Pain that affects daily activities
Pain that becomes worse over time
Chronic pelvic pain
Pain during or after intimacy
Painful bowel movements
Pain when urinating during your period
Heavy or irregular bleeding
Difficulty becoming pregnant
A family history of endometriosis

Endometriosis symptoms vary. Some people have severe pain with limited visible disease, while others have extensive disease with fewer symptoms.

Pelvic floor physiotherapy cannot confirm or rule out endometriosis. Diagnosis and medical management require an appropriate healthcare provider. Physiotherapy may be used alongside medical care to address pelvic floor tension, painful movement, abdominal or hip restrictions, and persistent pelvic pain.

Why do my back, hips or legs hurt during my period?

The uterus and other pelvic structures share nerve pathways with areas of the lower back, abdomen, hips, and thighs. This can cause menstrual pain to be felt beyond the lower…

The uterus and other pelvic structures share nerve pathways with areas of the lower back, abdomen, hips, and thighs. This can cause menstrual pain to be felt beyond the lower abdomen.

Pain may also cause your body to tense or guard. Over time, this can contribute to:

Pelvic floor muscle overactivity
Abdominal tension
Lower-back stiffness
Hip muscle tension
Shallow or guarded breathing
Reduced movement
Sensitivity to pressure or touch

These musculoskeletal responses may not be the original cause of dysmenorrhea, but they can add another layer to the pain experience.

Can a tight pelvic floor make period pain worse?

A tight or overactive pelvic floor does not cause every case of dysmenorrhea. However, it may contribute to the overall pain experience for some people.Your pelvic floor may begin…

A tight or overactive pelvic floor does not cause every case of dysmenorrhea. However, it may contribute to the overall pain experience for some people.

Your pelvic floor may begin guarding in response to recurring menstrual or pelvic pain. Muscles that remain tense may contribute to:

Deep pelvic aching
Vaginal, vulvar, or rectal pain
Pain with penetration
Pain with bowel movements
Difficulty relaxing during urination
Hip or lower-back discomfort
A feeling of pelvic pressure
Pain that continues after menstruation

Pelvic floor treatment should not automatically focus on strengthening. When muscles are already overactive, treatment may prioritize relaxation, coordination, desensitization, breathing, and gradual movement.

Can pelvic floor physiotherapy help painful periods?

Pelvic floor physiotherapy may help reduce the musculoskeletal and nervous-system factors contributing to menstrual pain.ACOG notes that physical therapy aimed at easing trigger…

Pelvic floor physiotherapy may help reduce the musculoskeletal and nervous-system factors contributing to menstrual pain.

ACOG notes that physical therapy aimed at easing trigger points may help painful periods. It also identifies heat, exercise, medications, hormonal treatment, acupuncture, acupressure, and nerve-stimulation therapies among possible management approaches. ACOG Dysmenorrhea FAQ

Physiotherapy should be considered supportive care. It does not replace medical investigation when symptoms suggest endometriosis, adenomyosis, fibroids, infection, or another underlying condition.

Your treatment may include the following.

Pelvic floor relaxation

If your pelvic floor is overactive or guarding, treatment may help you learn how to release unnecessary tension.

This may include:

Diaphragmatic breathing
Pelvic floor down-training
Supported relaxation positions
Pelvic and hip mobility
Body-awareness exercises
Strategies to reduce clenching or gripping

Manual therapy

When appropriate and performed with your consent, manual therapy may address painful or restricted tissues around the:

Abdominal wall
Lower back
Pelvis
Hips
Pelvic floor
Surgical scars

Manual therapy does not treat conditions such as endometriosis directly, but it may help with associated muscle guarding, trigger points, mobility restrictions, or pain.

Exercise and movement

Remaining active can feel difficult when you are in pain. Your physiotherapist can help you find movements that feel manageable and gradually build from there.

Your program may include:

Gentle aerobic activity
Hip and pelvic mobility
Yoga-inspired movement
Stretching
Core coordination
General strengthening
Graded return to regular exercise

Research suggests exercise may reduce pain intensity in people with primary dysmenorrhea, although study quality and exercise protocols vary. Systematic review of exercise interventions

Breathing and pressure management

Pain often causes people to hold their breath, brace their abdomen, or tighten their pelvic floor.

Breathing strategies may help:

Reduce unnecessary muscle tension
Improve pelvic floor movement
Encourage abdominal wall relaxation
Support nervous-system regulation
Make gentle movement more comfortable

TENS and other pain-management tools

Transcutaneous electrical nerve stimulation, or TENS, uses low-level electrical stimulation to help manage pain.

TENS may be considered as part of dysmenorrhea management when appropriate. It does not diagnose or eliminate an underlying medical condition, but it may provide symptom relief for some people. NICE includes TENS and local heat among non-pharmacological options considered for primary dysmenorrhea. NICE primary dysmenorrhea management

Education and symptom tracking

Understanding your symptoms can help you communicate more clearly with your healthcare team.

Your physiotherapist may help you track:

Pain location
Pain intensity and duration
Menstrual timing
Bleeding patterns
Bowel and bladder symptoms
Pain with intimacy
Exercise tolerance
Medication use
Factors that improve or worsen symptoms

A clear symptom history can support conversations with your family physician, nurse practitioner, gynecologist, or other specialist.

What happens during a pelvic floor physiotherapy assessment?

Your first appointment begins with a private conversation about:When the pain startedWhere you feel itHow long it lastsWhether it is becoming worseYour menstrual cycle and…

Your first appointment begins with a private conversation about:

When the pain started
Where you feel it
How long it lasts
Whether it is becoming worse
Your menstrual cycle and bleeding pattern
Bowel and bladder symptoms
Pain with intimacy
Pregnancy, birth, and surgical history
Endometriosis, fibroids, or other diagnoses
Medications and current treatments
Exercise and daily activities
How the pain affects your life
What you hope to improve

Your physical assessment may look at:

Breathing patterns
Abdominal wall movement
Lower-back and hip mobility
Pelvic movement
Muscle guarding
Scar mobility
Core and pelvic floor coordination
Nervous-system sensitivity
Movements related to your symptoms

How we support you

The Peloraa Way

What happens during a pelvic floor physiotherapy assessment?

Your first appointment begins with a private conversation about:

When the pain started
Where you feel it
How long it lasts
Whether it is becoming worse
Your menstrual cycle and bleeding pattern
Bowel and bladder symptoms
Pain with intimacy
Pregnancy, birth, and surgical history
Endometriosis, fibroids, or other diagnoses
Medications and current treatments
Exercise and daily activities
How the pain affects your life
What you hope to improve

Your physical assessment may look at:

Breathing patterns
Abdominal wall movement
Lower-back and hip mobility
Pelvic movement
Muscle guarding
Scar mobility
Core and pelvic floor coordination
Nervous-system sensitivity
Movements related to your symptoms

A little more clarity

Frequently Asked Questions About Inguinal Hernias

Why are my period cramps so painful?

Period pain may be related to prostaglandins that cause the uterus to contract. Severe or worsening pain may also be associated with endometriosis, adenomyosis, fibroids, infection, or another condition. Muscle guarding and nervous-system sensitivity can add to the pain.

Is it normal for period cramps to make me cry or miss work?

Pain that prevents you from attending work, school, exercise, or normal daily activities should not be dismissed. Speak with a healthcare provider about further assessment and treatment options.

Why do I feel period pain in my back and legs?

Menstrual pain may be referred into the lower back, hips, groin, or thighs because these regions share related nerve pathways. Muscle tension and protective movement patterns may also contribute.

Why does it hurt to poop during my period?

Prostaglandins can affect the bowel as well as the uterus. Pain with bowel movements may also be associated with constipation, pelvic floor overactivity, endometriosis, or another pelvic condition. Recurring or severe pain should be medically assessed.

Can dysmenorrhea cause nausea or diarrhea?

Yes. Prostaglandins and other physiological changes during menstruation may contribute to nausea, diarrhea, headaches, dizziness, sweating, and fatigue.

Are painful periods always caused by endometriosis?

No. Primary dysmenorrhea can occur without an identifiable pelvic condition. However, endometriosis should be considered when pain is severe, worsening, affects daily life, occurs outside the period, or is accompanied by bowel, bladder, sexual, or fertility concerns.

Can physiotherapy cure dysmenorrhea?

Physiotherapy cannot promise a cure and does not treat every underlying cause. It may help manage muscle tension, restricted movement, trigger points, pain sensitivity, and exercise intolerance as part of a broader treatment plan.

Do I need an internal pelvic floor examination?

No. An internal assessment may offer useful information for some people, but it is never mandatory. You can choose an external assessment, ask to delay the examination, or decline it.

When should I speak with a doctor about period pain?

Arrange a medical assessment if:

Your pain regularly disrupts your activities
Your cramps are becoming more severe
Pain begins well before your period or continues afterward
You experience pelvic pain at other times of the month
Your periods suddenly become painful after previously being manageable
You have pain during intimacy
You have pain with bowel movements or urination
Your bleeding is unusually heavy or irregular
You experience bleeding between periods
Usual pain-relief strategies are no longer helping
You are having difficulty becoming pregnant
You are concerned about endometriosis, adenomyosis, or fibroids

Seek urgent medical care for severe or sudden pelvic pain, fainting, fever, persistent vomiting, possible pregnancy with significant pain or bleeding, or bleeding that is unusually heavy and causing weakness or dizziness.

Your Period Should Not Put Your Life on Pause Every Month

You should not have to schedule work, exercise, travel, or important moments around the expectation that period pain will take over.

Peloraa offers private, personalized pelvic floor physiotherapy for painful periods, pelvic pain, and dysmenorrhea in Ottawa and Etobicoke.

We take time to understand your symptoms, assess the whole body–pelvic connection, and coordinate with your medical care when further investigation is needed.

Book a pelvic floor physiotherapy assessment with Peloraa.

Book an assessment

References & Clinical Credits

National Institute of Diabetes and Digestive and Kidney Diseases. Inguinal Hernia. National Institutes of Health.
Stabilini C, van Veenendaal N, Aasvang E, et al. Update of the International HerniaSurge Guidelines for Groin Hernia Management. BJS Open. 2023;7(5).
Shakil A, Aparicio K, Barta E, Munez K. Inguinal Hernias: Diagnosis and Management. American Family Physician. 2020;102(8):487–492.
European Hernia Society. International HerniaSurge Guidelines for Groin Hernia Management.
National Health Service. Inguinal Hernia Repair.
Guy’s and St Thomas’ NHS Foundation Trust. Recovery After Inguinal Hernia Repair.

Medical Disclaimer‍

This page is provided for general educational purposes only. It is not intended to diagnose an inguinal hernia, replace an examination by a qualified healthcare provider, or provide individualized medical or surgical advice.

Physiotherapy cannot close or repair an inguinal hernia. It may support movement, physical conditioning, abdominal pressure management, and rehabilitation before or after surgery when medically appropriate.

A new or unexplained groin lump should be assessed by a physician or other qualified medical provider. Seek emergency medical care for sudden or severe pain, vomiting, fever, abdominal swelling, difficulty passing stool or gas, skin discolouration over the lump, or a firm and painful bulge that does not become smaller when lying down.

Always follow the advice and postoperative restrictions provided by your physician or surgeon.