Why do I have period pain/stomach cramps before my period? A doctor explains the causes of PMS and how to relieve it.
目次
"I get abdominal pain before my period," "My abdominal pain is so severe during PMS every month that I can't concentrate on work," "Painkillers don't work"—many women suffer from abdominal pain due to PMS.
Abdominal pain from PMS differs from menstrual cramps (dysmenorrhea) in its onset, causes, and treatment. To address it properly, it's essential to first accurately determine whether the abdominal pain is due to PMS or menstrual cramps.
In this article, a doctor from Jujo Station Haru Internal Medicine and Dermatology Clinic explains the causes of PMS-related abdominal pain, when it starts, self-care tips to alleviate it, and treatment with low-dose birth control pills.
- Accurate assessment through interviews, physical examinations, ultrasound, and blood tests
- No appointment needed, same-day visits welcome | Open daily from 9 AM
👉 Same-day visits without an appointment are also possible. Please feel free to consult us first.
What is PMS-related abdominal pain?
PMS (Premenstrual Syndrome) is a general term for physical and psychological symptoms that begin 3 to 10 days before menstruation and improve once menstruation starts. In addition to physical symptoms such as abdominal pain, bloating, lower abdominal heaviness, and back pain, mental symptoms like irritability, low mood, and difficulty concentrating can also occur.
PMS-related abdominal pain is characterized by a dull ache, heaviness, and bloating in the lower abdomen that occurs before menstruation (luteal phase). Typically, symptoms lessen or disappear once menstruation begins.
Main symptoms of PMS
| Symptom Type | Physical Symptoms |
|---|---|
| Main Content | Abdominal pain, bloating, lower abdominal heaviness, breast tenderness, swelling, headache, back pain, fatigue |
| Mental Symptoms | Irritability, low mood, anxiety, difficulty concentrating, overeating, sleep disturbances |
| Severe Type (PMDD) | Mental symptoms that interfere with daily life, work, and relationships. Requires specialized treatment |
Approximately 70-80% of Japanese women are said to experience some form of PMS symptoms, and about 5% of these are severe enough to be diagnosed as PMDD (Premenstrual Dysphoric Disorder).
When does PMS-related abdominal pain start? How long does it last?
PMS-related abdominal pain typically begins after ovulation and just before menstruation (luteal phase: 3-10 days after ovulation), and improves within 1-2 days of menstruation starting.
| Timing | Condition |
|---|---|
| Ovulation (around 14 days before menstruation) | Some people experience ovulatory pain. This can be the start of PMS. |
| 3-10 days after ovulation (mid-luteal phase) | Period when PMS abdominal pain begins. Lower abdominal heaviness, dull ache, bloating |
| 3-5 days before menstruation (late luteal phase) | Symptoms often peak. Abdominal pain, back pain, and swelling combine |
| Menstruation onset to 1-2 days | Abdominal pain improves or disappears. If symptoms persist here, consider coexisting dysmenorrhea |
| During menstruation to after menstruation | PMS symptoms disappear (if they don't, it could be another condition) |
"Pain before menstruation, relieved once menstruation starts" → Pattern of PMS abdominal pain. "Pain starts after menstruation, peaks during menstruation" → Pattern of dysmenorrhea (menstrual cramps).
Causes of PMS abdominal pain
The direct cause of PMS abdominal pain is not fully understood, but the following mechanisms are thought to be involved:
| Cause | Details |
|---|---|
| Fluctuation of Progesterone (Luteal Hormone) | Progesterone, which surges after ovulation and drops sharply before menstruation, suppresses intestinal peristalsis, causing abdominal bloating, constipation, and abdominal pain. |
| Prostaglandin Production | The uterine lining produces prostaglandins in preparation for menstruation, leading to uterine contractions and abdominal pain due to intestinal irritation. |
| Decreased Serotonin Secretion | Serotonin decreases in the late luteal phase, increasing pain sensitivity. Mental symptoms (irritability, low mood) also appear simultaneously. |
| Changes in Gastrointestinal Motility | Hormonal changes in the luteal phase slow down intestinal movement, and gas, constipation, and abdominal bloating combine to worsen abdominal pain. |
| Stress and Autonomic Nervous System Imbalance | Stress and lack of sleep disrupt the autonomic nervous system, exacerbating PMS abdominal pain. |
Difference from dysmenorrhea (menstrual cramps)—how to distinguish
PMS abdominal pain and dysmenorrhea (menstrual cramps) are often confused, but they differ in onset, cause, and treatment.
| Comparison Item | PMS Abdominal Pain | Dysmenorrhea (Menstrual Cramps) |
| Timing of pain onset | From 3-10 days before menstruation (luteal phase) | Just before menstruation to the 1st-2nd day of menstruation |
| Period when pain peaks | Just before menstruation | 1st-2nd day of menstruation |
| When menstruation starts | Relieves or disappears | Pain gets stronger (or continues) |
| Nature of pain | Dull ache, heaviness, bloating in the lower abdomen, intestinal discomfort | Strong, cramping pain in the lower abdomen to lower back |
| Other symptoms | Often accompanied by breast tenderness, swelling, irritability, low mood | May be accompanied by nausea, vomiting, diarrhea, cold sweats |
| Cause | Luteal hormone fluctuations, serotonin decrease | Uterine contractions due to prostaglandins, endometriosis, etc. |
| First-line treatment | Low-dose birth control pills (overall PMS improvement), lifestyle review | Painkillers (NSAIDs), low-dose birth control pills (LEP) |
Both can occur simultaneously. If you experience "pain before menstruation and also during menstruation," it's possible that PMS and dysmenorrhea coexist.
Self-care to alleviate PMS abdominal pain
Mild to moderate PMS abdominal pain can sometimes be alleviated with the following self-care methods.
Warmth
Warming the abdomen and lower back improves blood circulation and helps relax the uterus and intestines. Heat packs, hot water bottles, and warm drinks are effective. Soaking in a warm bath can also be beneficial.
Light exercise and stretching
Walking, yoga, and light stretching promote blood flow and stimulate the release of endorphins (natural pain relievers). Vigorous exercise can be counterproductive, so please exercise within a comfortable range.
Dietary Review
| Recommended | Things to Avoid |
|---|---|
| Foods containing magnesium (nuts, legumes, seaweed): Relaxes muscle tension | Caffeine (coffee, green tea): Exacerbates PMS by constricting blood vessels and stimulating nerves |
| Foods containing vitamin B6 (chicken, bananas, sweet potatoes): Aids serotonin production | Alcohol: Disrupts hormone balance and worsens PMS |
| Dietary fiber (vegetables, fruits, whole grains): Improves bowel movements and reduces abdominal bloating | Salty foods: Worsens swelling |
| Drink plenty of water (aim for 1.5-2L per day) | High-fat, high-sugar foods: Affect hormone balance |
Sleep and Stress Management
Lack of sleep and stress further reduce serotonin secretion and worsen PMS. Pay particular attention to sleep quality during the luteal phase (two weeks before menstruation).
Use of over-the-counter medications
If lower abdominal pain is severe, NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen and loxoprofen can be effective. However, if symptoms are severe every month or painkillers are not very effective, please visit a clinic.
When to see a doctor — guidelines for seeking medical attention
If any of the following apply to you, we recommend visiting a clinic in addition to self-care.
- Abdominal pain does not improve even after taking over-the-counter painkillers
- PMS abdominal pain disrupts work, school, or daily life every month
- In addition to abdominal pain, irritability and low mood are severe and affecting relationships (suspected PMDD)
- Abdominal pain continues from before menstruation until during menstruation (suspected co-occurrence with dysmenorrhea)
- Symptoms worsen each month
- Have been diagnosed with endometriosis or uterine fibroids
- Want to improve PMS while also using contraception
Many people endure it, thinking "it's just how it is every month," but in most cases, symptoms can be controlled with treatments such as low-dose birth control pills.
Clinic Treatment — PMS Improvement with Low-Dose Birth Control Pills (LEP)
One of the most effective treatments to fundamentally control PMS abdominal pain and psychological symptoms is low-dose birth control pills (LEP: low-dose estrogen-progestin combination pills).
Why low-dose birth control pills work for PMS
PMS is caused by hormonal fluctuations in the luteal phase (rapid increases and decreases in estrogen and progesterone). Low-dose birth control pills suppress these hormonal fluctuations, maintaining constant hormone levels throughout the menstrual cycle, thereby improving overall PMS symptoms.
| Treatment Content | Details |
|---|---|
| Low-dose birth control pills (LEP/OC) | Suppresses hormonal fluctuations and improves overall PMS. Also effective for dysmenorrhea, reducing menstrual blood flow, and suppressing the progression of endometriosis. |
| Yaz (fourth generation) | Contains drospirenone with anti-aldosterone action. Less likely to cause swelling, breast tenderness, or weight gain, and highly effective for PMS/PMDD. |
| Painkillers (NSAIDs) | Used adjunctively during severe abdominal pain. Effective when started preventively before menstruation. |
| Herbal medicine (Kampo) | Toki-shakuyaku-san and Kami-shoyo-san are used to alleviate PMS symptoms. Few side effects, suitable for those who cannot take pills. |
LEP (for the treatment of dysmenorrhea and endometriosis) can be prescribed with insurance coverage. If the purpose is menstrual pain or PMS, insurance coverage is possible by stating that it is "not for contraceptive purposes."
PMS Diagnostic Criteria and Self-Checklist
PMS is diagnosed by confirming that symptoms repeatedly appear before menstruation (2 weeks to just before menstruation) and improve after menstruation begins. If the following symptoms persist for 3 or more cycles, PMS may be present:
【Physical Symptoms】
- Abdominal (lower abdominal) pain and bloating
- Headache, malaise
- Breast tenderness and pain
- Swelling, feeling of weight gain
【Mental Symptoms】
- Irritability, low mood
- Difficulty concentrating
- Tendency to cry easily
If symptoms begin two weeks before your period and ease when your period starts, and this cycle repeats, it is highly likely to be diagnosed as PMS.
About PMS Abdominal Pain
Abdominal pain due to PMS differs from menstrual cramps, and is characterized by its onset 1 to 2 weeks before menstruation.
It can manifest as a combination of dull lower abdominal pain, bloating, and intestinal discomfort (constipation or diarrhea). Many individuals manage with over-the-counter painkillers, but if symptoms are severe or recur monthly, treatment with oral medications such as low-dose birth control pills or herbal remedies may provide relief.
For PMS diagnosis and treatment, visit Internal Medicine or Gynecology
Our clinic (Jujo Haru Clinic) offers consultations for menstrual problems in addition to internal medicine and dermatology. If you feel "it's tough every month but maybe not serious enough for a gynecologist," please feel free to consult us first. We may be able to provide treatment covered by insurance.
Frequently Asked Questions
Q. When does PMS abdominal pain start?
It generally begins 3-10 days after ovulation (3-10 days before menstruation) and improves with the onset of menstruation. "Pain before menstruation that gets better when menstruation starts" is characteristic of PMS abdominal pain.
Q. What is the difference between PMS abdominal pain and menstrual cramps?
The biggest difference is the timing of onset. PMS abdominal pain starts 3-10 days before menstruation and subsides with the onset of menstruation. Menstrual cramps (dysmenorrhea) peak just before menstruation to the 1st-2nd day of menstruation. Many people experience both.
Q. Are low-dose birth control pills effective for PMS abdominal pain?
Yes. Low-dose birth control pills suppress hormonal fluctuations, thereby improving overall PMS (abdominal pain, swelling, breast tenderness, irritability). Yaz (a fourth-generation pill) is particularly noted for its high effectiveness against PMS and PMDD. It can also be prescribed with insurance coverage for dysmenorrhea.
Q. Every month I can't do without painkillers for PMS abdominal pain. Should I see a doctor?
Yes, we recommend seeing a doctor. Needing painkillers every month can be considered a "level of PMS/dysmenorrhea that requires treatment." In many cases, continuous treatment with low-dose birth control pills or herbal remedies can lead to being able to manage without painkillers.
Q. Can I consult an internal medicine doctor for PMS and get a birth control pill prescription?
Yes, we do. Low-dose birth control pills can be prescribed by internal medicine doctors. At our clinic, after a consultation and blood pressure measurement, we prescribe LEP (covered by insurance) for the purpose of dysmenorrhea and PMS. Please feel free to consult us even if you are uncomfortable with gynecology.
Q. What is the difference between PMS and PMDD?
PMS is a general term for physical and psychological symptoms before menstruation. PMDD is a severe form of PMS, where mental symptoms such as severe depression, intense anger, and hopelessness significantly interfere with daily life, work, and relationships. Antidepressants (SSRIs) and low-dose birth control pills are effective for PMDD, and specialized treatment is required.
Q. Are herbal medicines effective for PMS abdominal pain?
They can be effective. Toki-shakuyaku-san (improves blood circulation, reduces swelling), Kami-shoyo-san (for PMS with irritability and low mood), and Keishi-bukuryo-gan (improves blood circulation, abdominal pain) are used for PMS. They can be prescribed as an option for those who cannot take birth control pills or are concerned about side effects.
Q. Why do I gain weight before my period?
Weight gain due to PMS is mainly caused by progesterone making the body more prone to retaining water. This is not an actual increase in fat, and the weight usually returns to normal within a few days after menstruation begins. If swelling is severe, it is recommended to reduce salt intake and drink water frequently.
Q. Is feeling sleepy and sluggish before my period a sign of PMS?
Yes, severe sleepiness and fatigue are also common symptoms of PMS. An increase in progesterone during the luteal phase causes a rise in body temperature, leading to sleepiness and fatigue. If you are "abnormally sleepy only before your period," suppressing hormonal fluctuations with low-dose birth control pills often improves the condition.
Q. Why do I get diarrhea before my period? What is its relationship with pregnancy?
Diarrhea before menstruation is one of the symptoms of PMS, caused by progesterone affecting intestinal peristalsis. As menstruation approaches, prostaglandins increase and act not only on the uterus but also on the intestines, causing diarrhea and loose stools. If you only experience diarrhea before your period, it's likely PMS, and while it can be difficult to distinguish from early pregnancy symptoms, the recurring pattern linked to the menstrual cycle is characteristic of PMS.
Q. Are there any ways to improve pre-menstrual diarrhea and stomach discomfort?
For pre-menstrual diarrhea and intestinal discomfort, dietary measures (avoiding caffeine, fats, and spicy foods), warming the abdomen, and getting enough sleep are effective. If it's severe every month, suppressing hormonal fluctuations with low-dose birth control pills often improves the condition. Please feel free to consult us.
Q. Why do I experience abdominal bloating and fullness before my period?
A. Abdominal bloating and fullness before menstruation are primarily caused by the action of progesterone, which suppresses intestinal peristalsis. Gas tends to accumulate, and constipation exacerbates abdominal distension. Excessive water and salt intake also worsen swelling. Stabilizing hormonal fluctuations with low-dose birth control pills often leads to improvement.
Consultation Hours / Access
| Item | Details |
|---|---|
| Clinic Name | Jujo Station Haru Internal Medicine and Dermatology Clinic |
| Consultation Hours | Monday - Sunday 9:00 - 21:00 |
| Closed | None (irregular holidays) |
| Location | J&MALL 1F, 2-27-1 Kami-Jujo, Kita-ku, Tokyo 114-0034 |
| By Train/Walk | Approx. 1-2 minutes walk from JR Saikyo Line "Jujo Station," J&MALL (Jet Mall) 1st floor |
| By Bus | Right in front of the Kokusai Kogyo Bus "Jujo Station" bus stop |
| By Car | Please use nearby coin parking facilities |
| Contact Us | TEL: 03-6698-2509 ／ Official LINE:https://lin.ee/AL0fp3z |
