When Period Pain Isn’t “Normal”: The Mind-Body Menstrual Connection
Many of us have experienced the cramping, bloating, and discomfort that come with our periods, but what if your painful periods are more than just a regular part of your cycle?
There is common misconception that pain is something that a menstruating person should be able to deal with. Often the level of pain is often undermined and dismissed as a normal part of the menstrual cycle. This, coupled with the taboo of periods and the normalisation of painful period cramps has led to people being misdiagnosed or delays in treatments for conditions such as endometriosis [8]. Menstrual cramps typically occur a few days before the period or during it, they typically last 3 days[7], however, if period cramps are intense enough to interfere with your daily activities, this isn’t something you should have to just put up with.
The Science Behind Painful Periods:
Dysmenorrhea, or painful period cramps, is one of the most reported gynaecological symptoms experienced by a menstruating person [8], unfortunately this is also the most commonly dismissed symptom.
Cramps are the bodies way of shedding the uterine lining. [2,7] Period cramps manifest in different ways such as lower abdominal pain, cramping and a sharp or dull pain, it can radiate to the legs and thighs too.[2,6] There are many causes of painful period cramps, these can be categorised into primary dysmenorrhea and secondary dysmenorrhea.[6]
Primary dysmenorrhoea: caused by an increase in prostaglandins[6,11].Prostaglandins are a hormone-like compound, pain resulting in painful cramping of the uterus before or during menstruation. [11]
Secondary dysmenorrhea: pain that is caused by another condition.
Figure 1- graph[14] showing the hormonal changes throughout the menstrual cycle.
The impact of past emotional distress on dysmenorrhea is not well known.
So, How does the Brain link to My Menstrual Cycle?
The menstrual cycle consists of 28 days with four phases, follicular phase, ovulating, luteal and finally menstruation Phase.[7] During each phase, there are various hormonal and chemical shifts, resulting in the physical and emotional responses associated with each phase of the cycle, see figure 1.[7] The main two areas of the brain that are involved hypothalamus and the pituitary. They secrete the necessary hormones for the cycle. LH, and FSH[1,3] The ovaries secrete progesterone and estradiol.
So, because the brain is necessary for the menstrual cycle, a history of stressful experiences could alter the physiological responses of the menstrual cycle.
Can Emotional Distress Impact Period Pain: The Clinical Evidence
One study found that during certain phases of the menstrual cycle, individuals with a history of past emotional distress were 4.89 times more likely to experience heightened emotional responses, including sensations linked to past experiences. This reflects how hormonal shifts can influence the way the brain processes emotional memory, activating stress pathways and increasing cortisol levels - which can heighten pain sensitivity [1,4]
Stress activates the hypothalamus-pituitary adrenal (HPA) axis, releasing cortisol [1,3,4,5]. While cortisol helps regulate stress and inflammation, chronic or intense stress may lead to cortisol dysregulation, increasing prostaglandin production and uterine contractions - both linked to more severe period pain [3,9–11].
Dysregulated cortisol has also been associated with hormonal imbalances, which may contribute to menstrual irregularities and conditions like dysmenorrhea, Endometriosis, PMDD, and PCOS [9,10,12,13]. Some studies report a higher incidence of emotional distress among individuals with endometriosis, suggesting a potential link worth further exploration [8,12].
Emotional stress has also been linked to changes in menstrual pain perception, with the premenstrual phase often marked by increased stress and emotional reactivity [3–5].
Self-Care Tips for Menstrual Well-being
Your mental health and stress levels can influence your nervous system - and in turn, your menstrual cycle. Taking care of your emotional well-being is part of supporting your overall health.
Evidence-backed self-care methods (NHS²):
Track your cycle
Use a hot water bottle or heating pad
Try CBT or other therapy if needed
Practice mindfulness, journaling, or meditation
Engage in gentle movement like yoga
Consider anti-inflammatory dietary changes
While painful periods are common, they don’t have to be your norm. If you’re seeking help from a medical professional, ensure your concerns are heard, respected, and taken seriously. You know your body best - and if something feels wrong, you have every right to advocate for yourself.
Disclaimer: It’s also important to remember that not all painful periods are linked to emotional distress, and not everyone who’s experienced this will face menstrual issues. Every body is different.
For tips on advocating for yourself in medical settings, visit: Slater & Gordon’s Women’s Health Toolkit
Bibliography:
[1]M. Wolfram, S. Bellingrath, and B. M. Kudielka, “The cortisol awakening response across the female menstrual cycle,” Psychoneuroendocrinology, vol. 36, no. 6, pp. 905–912, Jul. 2011, doi: https://doi.org/10.1016/j.psyneuen.2010.12.006.
[2]NHS, “Period pain,” nhs.uk, Oct. 19, 2017. https://www.nhs.uk/conditions/period-pain/ (accessed Apr. 30, 2025).
[3]T. Ozgocer, C. Ucar, and S. Yildiz, “Cortisol awakening response is blunted and pain perception is increased during menses in cyclic women,” Psychoneuroendocrinology, vol. 77, pp. 158–164, Mar. 2017, doi: https://doi.org/10.1016/j.psyneuen.2016.12.011.
[4]R. A. Bryant, K. L. Felmingham, D. Silove, M. Creamer, M. O’Donnell, and A. C. McFarlane, “The association between menstrual cycle and traumatic memories,” Journal of Affective Disorders, vol. 131, no. 1–3, pp. 398–401, Jun. 2011, doi: https://doi.org/10.1016/j.jad.2010.10.049.
[5]E. Montero-López, A. Santos-Ruiz, M. C. García-Ríos, M. Rodríguez-Blázquez, H. L. Rogers, and M. I. Peralta-Ramírez, “The relationship between the menstrual cycle and cortisol secretion: Daily and stress-invoked cortisol patterns,” International Journal of Psychophysiology, vol. 131, pp. 67–72, Sep. 2018, doi: https://doi.org/10.1016/j.ijpsycho.2018.03.021.
[6]H. Nagy and M. A. Khan, “Dysmenorrhea,” PubMed, Nov. 12, 2023. https://www.ncbi.nlm.nih.gov/books/NBK560834/ (accessed Apr. 30, 2025).
[7]B. G. Reed and B. R. Carr, “The normal menstrual cycle and the control of ovulation,” Nih.gov, Aug. 05, 2018. https://www.ncbi.nlm.nih.gov/books/NBK279054/ (accessed Apr. 30, 2025).
[8]J. Wiggleton-Little, “‘Just’ a painful period: A philosophical perspective review of the dismissal of menstrual pain,” Women’s health, vol. 20, Jan. 2024, doi: https://doi.org/10.1177/17455057241255646.
[9]K. E. Hannibal and M. D. Bishop, “Chronic Stress, Cortisol Dysfunction, and Pain: a Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation,” Physical Therapy, vol. 94, no. 12, pp. 1816–1825, Jul. 2014, doi: https://doi.org/10.2522/ptj.20130597.
[10]L. Thau, J. Gandhi, and S. Sharma, “Physiology, Cortisol,” National Library of Medicine, Aug. 28, 2023. https://www.ncbi.nlm.nih.gov/books/NBK538239/ (accessed Apr. 25, 2025).
[11]K. Malik and A. Dua, “Prostaglandins,” PubMed, 2020. https://www.ncbi.nlm.nih.gov/books/NBK553155/ (accessed Apr. 20, 2025).
[12]“Link found between endometriosis and childhood abuse | Harvard T.H. Chan School of Public Health,” Harvard T.H. Chan School of Public Health, Jul. 19, 2018. https://hsph.harvard.edu/news/abuse-linked-endometriosis/ (accessed Apr. 30, 2025).
[13] K. Vincent and I. Tracey, “Hormones and Their Interaction with the Pain Experience,” Reviews in Pain, vol. 2, no. 2, pp. 20–24, Dec. 2008, doi: https://doi.org/10.1177/204946370800200206.
[14]Angea, “Our Menstrual Cycle,” Angea, May 20, 2013. https://angea.com.au/our-menstrual-cycle/ (accessed Apr. 29, 2025).
