Are Painful Periods Cramping Your Style? How Pelvic Floor Physical Therapy Can Conquer Dysmenorrhea

For many women, the arrival of their period brings with it an unwelcome guest: painful period cramps. Beyond mild discomfort, severe period pain can disrupt daily life, force you to cancel plans, and leave you curled up with a heating pad, praying for relief. Painful periods, also known as dysmenorrhea, is one of the most common gynecological disorders during women’s reproductive years. Despite its high prevalence and impact on daily life, it is often underdiagnosed as women consider dysmenorrhea an embarrassment and perceive the pain as an inevitable response to menstruation (Itani et al, 2022). 

Dysmenorrhea often has two distinct types: 

• Primary dysmenorrhea: period pain without underlying condition. It often begins once before or at the start of the onset of menses, and is often linked to prostaglandins, a hormone-like substance that causes uterine contractions. It is the most common form of dysmenorrhea. 
• Secondary dysmenorrhea: period pain caused by underlying medical conditions such as endometriosis, uterine fibroids, adenomyosis, or pelvic inflammatory disease. 

While over-the-counter pain relievers and hormonal birth control are common options for treatment, pelvic floor physical therapy may be an important part of your treatment plan. 

The Role of Pelvic Floor 

The pelvic floor is a group of muscles that sit at the bottom of the pelvis as a supportive hammock. These muscles play a role in bladder and bowel function, support the pelvic organs, sexual function, and assist with core stabilization. Just like how muscles in your neck and shoulders can become tight and painful, pelvic floor muscles can also develop excessive tension, trigger points, and guarding patterns. 

During menstruation, the uterine contracts to shed its lining, and pain signals can cause a protective tightening within the pelvic floor. This tension can lead to a “squeeze” on the pelvic organs, which amplifies the pain of normal uterine contractions; restriction of blood flow, which can worsen inflammation and the build-up of prostaglandins; and nerve irritation and sensitivity, causing even normal contractions to be perceived as much more painful. 

This can create a cycle: 

1. Menstrual cramps occur 
2. Pelvic floor muscles tighten in response
3. Increased muscle tension contributes to more pelvic pain 
4. The nerve system becomes more sensitive to the pain 
5. Future periods become increasingly painful 

Even after the menstrual cycle ends, the muscles may remain tense, perpetuating the symptoms through the month. Over time, this chronic muscular tension worsens, making pelvic health a critical piece of pain management. Other common contributors to dysmenorrhea include stress, anxiety, previous abdominal or pelvic surgeries, scar tissue, and poor posture. 

How can pelvic floor therapy help? 

A specialized pelvic floor therapist can help you find relief by addressing the structures that may be contributing to your pain. Some common issues and treatment options may include: 

• Releasing Muscle Tension: Therapists can identify and release trigger points and areas of tension through manual therapy techniques, pelvic floor relaxation, and stretching. 
• Improve Blood Flow and Reduce Inflammation: By releasing tension and improving muscle function, therapy can enhance circulation, which helps clear out inflammatory byproducts such as prostaglandins. 
• Postural Imbalances: Poor posture can put additional strain and stress on your pelvic floor and abdominal musculature, exacerbating your pain symptoms. Therapy can assess your alignment and provide exercises to help take the pressure off affected areas. 
• Strengthening and Coordination: Pelvic floor muscle dysfunctions, such as weak or uncoordinated muscles, can impact muscle and nerve function. Therapy can help optimize your mobility and strength. 
• Scar Tissue and Adhesions: Especially for secondary dysmenorrhea, which may stem from conditions such as endometriosis or after pelvic surgeries, scar tissue and adhesions can form, restricting movement and causing pain. Therapists can utilize specific techniques to gently release and mobilize the tissue, improving its flexibility, and reducing discomfort. 
• Self-Management Strategies: Beyond in-session treatment, therapists will equip you with tools to manage your pain at home. 

If you're tired of debilitating period pain and feel like you've exhausted other options, pelvic floor physical therapy could be the missing piece in your pain management puzzle. It's a non-invasive, drug-free approach that focuses on restoring optimal function to your body. Finding a qualified pelvic floor physical therapist in your area can empower you with knowledge and tools to take control of your menstrual pain and reclaim your life.

To explore how these therapies can support your journey, contact our Pelvic Health Navigator at (402) 717-7358 or access our online resources to learn more. 

Sources: 

Itani R, Soubra L, Karout S, Rahme D, Karout L, Khojah HMJ. Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates. Korean J Fam Med. 2022;43(2):101-108. doi:10.4082/kjfm.21.0103