If you’ve ever seen a list of common PCOS symptoms, painful periods often aren’t listed. If you struggle with heavy bleeding or painful periods with PCOS, you may be wondering if that’s a typical symptom of PCOS. 

This article will dive into how PCOS can affect your periods, what may be causing painful periods with PCOS, and how to manage this menstrual pain. 

If you’re new here, hi! I’m Alyssa, a registered dietitian who specializes in PCOS (I also have PCOS too!). My goal is to bring you realistic and sustainable approaches to manage your PCOS symptoms.

What Is PCOS?

Polycystic ovary syndrome (PCOS) is a common medical condition and hormone imbalance that affects approximately 6-12% of women of reproductive age.

Although the exact cause of PCOS remains unknown, insulin resistance, chronic inflammation, and higher levels of androgens (aka male hormones like testosterone) are common. 

Common PCOS Symptoms:

• Irregular periods
• Infertility
• Acne, oily skin
• Weight gain
• Hirsutism (excessive hair growth, both facial and body hair)
• Hair loss

Additionally, those with PCOS have a higher risk of developing other health conditions such as type 2 diabetes, heart disease, high blood pressure and even endometrial cancer.

What Is Period Pain & What Causes It?

Dysmenorrhea is pain associated with your menstrual cycle. There are two types of dysmenorrhea: primary and secondary.

Primary Dysmenorrhea

Primary dysmenorrhea is cramping or mild pain in the lower abdomen or lower back that accompany your period. 

Menstrual cramps are usually caused by a rise in a hormone-like substance called prostaglandins that create an inflammatory response (1). Prostaglandins cause the uterine muscles to contract and shed the lining of the uterus. 

Prostaglandin levels are highest at the beginning of your period. That’s why it’s common to feel cramping before and during the first couple of days of your period, and then the pain gradually lessens as prostaglandin levels decrease.

More severe pain with primary dysmenorrhea is thought to be related to an imbalance in prostaglandins levels.

Secondary Dysmenorrhea

Secondary dysmenorrhea is menstrual pain that is caused by a disorder of the reproductive system.

This type of dysmenorrhea may cause severe pain for some people. It’s often not isolated to a couple of days around the beginning of your period like primary dysmenorrhea. 

Some conditions that may cause secondary dysmenorrhea: 

• Endometriosis
• Adenomyosis
• Uterine Fibroids
• Pelvic inflammatory disease

The Bottom Line: Dysmenorrhea

Some mild discomfort and cramping before and during your period is normal. This occurs due to the rise of prostaglandins, which are necessary to allow your uterus muscles to contract and shed the uterine lining.

Severe period pain is not considered normal and may be a sign of an underlying health condition. If your period pain disrupts your ability to complete your everyday activities, it’s a good idea to seek medical treatment from your healthcare provider. 

How Does PCOS Affect Your Periods? 

The average menstrual cycle length is 28 days, but anywhere between 21 to 35 days is considered to be normal. 

One of the hallmark symptoms of PCOS is irregular menstrual cycles. High levels of androgens can delay or stop ovulation from happening, which causes irregular periods. 

Polycystic ovaries are often seen on ultrasound in PCOS. Despite the name though, these ovarian cysts aren’t actually cysts at all. Instead, they’re follicles (or fluid-filled sacs) that contain a developing egg. 

Due to abnormal hormone levels with PCOS, the follicle does not mature appropriately and instead of releasing an egg at ovulation, these follicles accumulate on the ovaries. These are the “ovarian cysts” that are seen on ultrasound. 

This lack of ovulation leads to irregular periods or sometimes completely absent periods for some people with PCOS. 

PCOS and Painful Periods: What’s The Link?

While some people experience irregular or absent periods, some experience ongoing, heavy bleeding that doesn’t seem to stop. One study showed that 70% of PCOS sufferers report heavy bleeding and cramping. 

Menorrhagia is the medical term for heavy periods or prolonged bleeding lasting more than 7 days. This can also cause severe cramping. Menorrhagia can happen for a variety of reasons, but one reason it may happen is because of an imbalance with estrogen and progesterone levels.. 

Another reason for increased pain may be due to underlying inflammation with PCOS. The production of prostaglandins is increased in inflamed tissues (1). Since PCOS is largely recognized as an inflammatory condition, this may cause higher amounts of prostaglandins, which may worsen period pain. 

Managing Painful Periods with PCOS

There are several ways to manage mild period pain. Short term management options focus on what you can do in the moment to help ease your symptoms. Long term management strategies, such as diet and lifestyle changes, focus on improving the underlying hormonal imbalance. 

At-Home Period Pain Management Options

• Apply heat such as a heating pad or heated blanket can help to reduce pain
• NSAIDs, such as ibuprofen
• Gentle movement such as yoga or walking can help to relieve period pain in the moment, if you’re feeling up to it 

Diet Changes 

A healthy diet can play a big role in the long-term management of your hormone levels and overall health. 

Some key diet changes you may want to incorporate:

• Balance your blood sugar levels. Combine complex carbohydrates, protein, and fat at all of your meals to maintain balanced blood sugar and insulin levels 
• Include anti-inflammatory foods. Examples include fatty fish, fruits, vegetables, beans, nuts, seeds, and olive oil 
• Herbal teas such as cinnamon tea may be helpful

Seed cycling is another popular approach for hormone balance. Read more about how seed cycling affects PCOS.

To learn more about how to implement a healthy diet for PCOS management, check out The PCOS Playbook!

Lifestyle Changes

Gentle movement such as yoga or walking can help to relieve painful periods in the moment, if you’re feeling up to it. 

Including regular exercise, as part of a healthy lifestyle, can also help reduce insulin resistance, inflammation, androgens, and stress levels.  

Hormonal Birth Control 

Hormonal birth control pills may be an option that can lessen painful periods and make them more regular and predictable. 

Oral contraceptives can also provide an added benefit of lowering androgen levels, which can reduce common PCOS symptoms such as hair loss and excess hair growth. 

Talk to your doctor if you’re interested in this approach. 

Supplements

Certain supplements have been shown to help improve symptoms of dysmenorrhea or painful periods. 

Studies were conducted using supplements, however, increasing your intake from food sources is also beneficial: 

• Zinc: oysters, crab, beef, oats, pumpkin seeds, cashews
• Vitamin D: eggs, salmon, sardines, fortified dairy products
• Magnesium: pumpkin seeds, almonds, spinach, chocolate, yogurt
• Omega 3 fatty acids: walnuts, chia seeds, flaxseeds, hemp hearts, and fatty fish such as salmon, sardines, and herring

The Bottom Line

The medical term for painful periods is dysmenorrhea; there are two types of dysmenorrhea: primary and secondary. 

Primary dysmenorrhea is pain linked to before and during your periods. Severe pain linked to this is thought to be due to an imbalance in hormone-like substances called prostaglandins. 

Secondary dysmenorrhea is pelvic pain that is caused by a disorder of the reproductive system, such as endometriosis, fibroids, or adenomyosis. 

Different ways to treat period pain include applying heat, NSAIDs (such as ibuprofen), and gentle exercise like stretching, walking, or yoga. 

Diet changes that aim to balance blood sugar levels and include anti-inflammatory foods are also helpful. Herbal teas, hormonal birth control, and supplements may also be helpful in reducing period pain.

If you have any concerns about your period pain or pelvic pain, it’s best to see your doctor to rule out any other serious health problems.

Disclaimer: This is for educational purposes only and should not be used as medical advice. This information is not intended to be used to evaluate, diagnose, or treat polycystic ovarian syndrome or its associated symptoms. Talk to your health care provider for personalized medical advice and effective treatment options.

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