What Causes Lower Back Pain During Your Period?

• Researched and written by: Vaibhavi Kodnani, UG Dip. (Comm. Design, 4 yrs)
• Medical inputs by: Dr Poonguzhali Liston, MBBS, MS OBG, FMAS, DRM, FRM, CIMP
• Medically reviewed by: Dr Yash Bahuguna, MBBS, MS, DNB, ISGE Certified Practitioner for PCOS

TL;DR

• Period-related back pain is a symptom of premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), and painful periods (dysmenorrhea).[1,2]

• It can start around a week before the period and extend till the first two or three days of menstruation.

• Back pain before periods is likely caused by hormonal fluctuations that lead to fluid retention and increased pain sensitivity. Back pain is severe with PMDD.[3,4,5,6,7]

• Back pain during periods is a type of referred pain aka the cramps in the abdomen radiate to the lower back.[8]

• Self-care strategies, such as specific yoga asanas, gentle walking, heat therapy, proper sleep, posture adjustments, and TENS, can help ease lower back pain.[2,9]

• When pain starts later in life, does not improve with any relief strategies, is persistent throughout the month, and is accompanied by unusual symptoms, it may be due to other causes such as endometriosis, fibroids, or more. It is known as secondary dysmenorrhea.[2]

Period Back Pain: Symptoms and Timing

Back pain usually begins in the week before your period and is a common physical symptom of premenstrual syndrome (PMS). It may occur along with other physical symptoms such as bloating, swelling, tender breasts, and fatigue. Emotional symptoms like depression, anxiety, anger, irritability, crying spells, and insomnia can also be present. Everyone’s experience is different: some may have only back pain, while others may notice a combination of symptoms.[1]

Period back pain continues until the first two or three days of menstruation. You may experience mild discomfort in your lower back, ranging from dull aches to throbbing pain. Additionally, you may experience cramping in your lower abdomen. The pain may also radiate down the legs. Some women may have other symptoms along with severe pain, including diarrhea, nausea, vomiting, headache, and dizziness.[8]

Causes of Lower Back Pain Before Your Period

Back pain is a common symptom of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD).

Premenstrual syndrome (PMS)

Researchers are not clear on why physical PMS symptoms such as back pain occur. However, current evidence suggests that hormonal fluctuations play a key role.

In the week before a period, estrogen and progesterone drop. It may contribute to fluid retention in the body which can cause tissue swelling (edema). When swelling happens in the tissues around the lower back, it increases heaviness or tightness. The swelling may also put pressure on the nerves in the region, leading to pain.[4]

Additionally, estrogen is known for its pain-modulating effects, meaning it can dampen pain signals to the brain. Progesterone supports GABA activity, a neurotransmitter known for its calming effect on the nervous system. So, when both hormone levels decline in the premenstrual phase, the body’s ability to suppress pain reduces, making aches and discomfort more noticeable.[3]

Premenstrual dysphoric disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is a severe form of PMS. Women with PMDD experience intense emotional symptoms such as irritability, anger, depression, and anxiety, which increase stress levels in the body. In turn, it may lead to muscle tension, including increased tightness and soreness in the back muscles.[5]

PMDD also affects how the brain processes pain, especially in the days before a period. As a result, even mild sensations, such as slight discomfort in the back, may feel more intense.[6] In addition, insomnia is common in PMDD. Poor sleep reduces pain tolerance, which can make the back pain feel more severe and persistent.[7]

Causes of Severe Lower Back Pain During Periods

Back pain during periods is one of the symptoms of dysmenorrhea, a medical term used for painful periods.

Painful periods (Primary dysmenorrhea)

Painful periods (primary dysmenorrhea) start soon after menarche, aka the first period, and often continue in the reproductive years. The severity of symptoms reduces with age, particularly after childbirth. Primary dysmenorrhea is relatively common, with more than 50% of menstruating women experiencing some level of pain during their period.[2]

Back pain during periods has been associated with severe dysmenorrhea and higher levels of prostaglandins. During menstruation, as the endometrium, or uterine lining, starts to break down, it releases prostaglandins. The primary function of these hormone-like chemicals is to cause muscle contractions in the uterus. In turn, it helps shed the lining. 

The process narrows the small blood vessels in the lining, reducing proper blood and oxygen supply to the uterus. Prostaglandins also sensitise pain-sensing nerve endings and increase inflammation in the area. The combination of all these effects causes painful cramps in your abdomen, which can then radiate to your back and legs. This is why back pain during periods is often considered referred pain.[2,8]

You may have noticed that your pain typically improves on the third day of your menstrual cycle. It happens because by then, most of the uterine lining that produces prostaglandins has shed. As a result, the level of prostaglandins also reduces, which eases the pain.

Painful periods due to an underlying condition (Secondary dysmenorrhea)

Mild backache and discomfort during the first few days of your period are usually caused by the effects of prostaglandins and are considered normal. However, some women experience severe or persistent back pain that continues even after their period ends. It may occur along with symptoms such as pain during sex, pain during urination, heavy periods, or difficulty getting pregnant.

In such cases, the back pain is often caused by an underlying condition affecting the reproductive organs, such as endometriosis, fibroids, adenomyosis, or pelvic inflammatory disease (PID). This type of period pain is known as secondary dysmenorrhea.[2]

How Do You Know Your Low Back Pain Is Not Related to Your Menstrual Cycle?

Various other factors apart from PMS and dysmenorrhea can cause back pain, such as lack of physical activity, obesity, smoking, and physically demanding jobs.[10] Here are some signs that suggest your pain is not related to your menstrual cycle:

• Your back pain does not follow a monthly pattern and occurs randomly throughout the month.

• You don't have other period symptoms like abdominal pain, mood swings, fatigue, bloating, or breast tenderness.

• You don't have secondary dysmenorrhea symptoms along with back pain, such as pain in the pelvic area, heavy bleeding, pain during sex, or pain during urination.

• Your back pain radiates down one or both legs, along with nerve-related symptoms, including numbness, tingling, and muscle weakness.

• Your pain worsens with movement or changes in posture, rather than improving.

• Your pain does not improve with typical period pain relief strategies such as heat therapy or rest.

Tips to Reduce Lower Back Pain During Menstruation

You can try simple self-care activities backed by guidelines, doctors, and evidence to ease lower back pain during your period.

Heat therapy

Applying heat to the lower back can increase blood circulation in the region and relax the muscles. The warmth may also help calm pain-sensing nerves, creating a soothing effect.[11] Here are the various effective heat therapy methods:[2]

• Take a hot water shower.

• Place a hot water bottle or electric heating pad on your back for 10–30 mins.

• Apply a heat wrap (can use up to 8 hours).

Forward-bending Yoga asanas (poses)

Yoga,[2,12] specifically forward-bending asanas can help relieve lower back pain during the period by releasing muscle tension and improving circulation. You can hold the following asanas for a minimum of 5–10 counts while breathing deeply:

• Child's pose (Balasana)

• Seated forward bend (Paschimottanasana)

• Standing forward fold (Uttanasana)

• Head-to-knee forward bend (Janu sirsasana)

Posture correction and support

Slouching or sitting for extended periods without proper back support can exacerbate period-related back pain. Ensure you sit upright and support your back with a pillow.[14]

7–9 hours of sleep

Getting 7–9 hours of sleep, especially before and during your period, can help relax your back muscles and ease discomfort. If your back pain is making it difficult to fall asleep, consider trying certain supportive sleep positions for relief. The best practice is to sleep on your back, with the pillow under your knees. If you prefer sleeping on your side, keep a pillow between your knees. Avoid sleeping on your stomach as that is the least supportive position for back pain.[12]

Light walking

When experiencing back pain, light walking for 15–20 minutes can help increase blood circulation throughout the body, delivering essential oxygen and nutrients to the affected areas. It can also release endorphins, aka brain chemicals that block pain signals and boost well-being.[2]

Note on preventing back pain: Studies show that practising Yoga and cardiovascular exercises regularly can improve period-related back pain. Here's the recommended regimen:

• Cardiovascular exercises, such as walking, running, cycling, or swimming, should be done at least 3 times a week, with each session lasting 30 minutes.

• Yoga practice, including Surya Namaskara, asanas, and meditation, for 5 days a week, 60 minutes a day.

Berry’s Insights: TENS for Cramping and Back Pain

TENS, short for Transcutaneous Electrical Nerve Stimulation, is a small device that uses low-frequency electric currents to provide pain relief. 

TENS has been widely used in rehabilitation for sports injuries, arthritis, and other musculoskeletal issues. But in recent times, researchers have found it effective for period pain as well. Today, even doctors recommend it as a pain relief strategy for cramps, back pain, and thigh pain.[9]

How does it help with back pain?

TENS works in three ways: stops pain signals from reaching your brain, improves blood circulation, and releases endorphins, your body's natural painkillers. 

A TENS device is a safe and easy-to-use option for use at home. It produces a vibrating sensation that feels like a good massage in the affected area. You can use it for up to 20 minutes at a time for instant relief.

Warning: Before using TENS for period-related back pain, discuss it with your doctor. While it is generally safe, it is not recommended for those who are pregnant, have epilepsy, or have pacemakers. 

When to See a Doctor for Period-Related Back Pain?

PMS or period back pain causes temporary discomfort that eases with home relief strategies such as heat therapy and rest. However, you must not hesitate to approach your doctor in the following situations:

• You have back pain that interferes with daily functioning.

• None of the period pain-relief strategies helps.

• Your back pain continues even after your period ends.

• You notice unusual symptoms along with back pain such as heavy bleeding, pain during sex, pain during urination, or more.

Your doctor will determine the cause and recommend treatment options such as supplements, pain medications, and lifestyle interventions. 

Bottom Line

Hormonal fluctuations and prostaglandins drive pain in the lower back before and during your period. You can manage your pain with heat therapy, forward-bending poses, light walking, and rest. If you incorporate cardiovascular exercise and Yoga into your routine, you may even notice that the intensity of period-related back pain reduces over time. However, if your back pain continues even after your period ends, it may be due to an underlying condition. In that case, you should visit a doctor to determine the cause and receive the appropriate care. 

FAQs on Lower Back Pain Before and During Period

Why causes lower back pain during my period?

During your period, prostaglandins, a hormone-like chemical, are released, which causes cramps, reduced blood supply, nerve sensitivity, and inflammation in the lower abdominal area. The pain radiates to the surrounding regions, including the lower back.  

When does back pain before period start?

Period-related back pain can start during the premenstrual phase, which is around a week before the period.  

What does back pain during your period feel like?

Back pain during PMS and periods can range from dull aches to throbbing pain, especially in the lower back. 

How to reduce back pain?

For instant relief from period-related back pain, you can apply heat, use the TENS + heat device, practice certain Yoga poses, go for a short walk, and get some sleep. 

References

1. American College of Obstetricians and Gynecologists. Premenstrual syndrome. Accessed January 6, 2026.

2. American College of Obstetricians and Gynecologists. Dysmenorrhea: Painful Periods. Accessed January 6, 2026.

3. Rezaii T, Hirschberg AL, Carlström K, Ernberg M. The influence of menstrual phases on pain modulation in healthy women. The Journal of Pain. 2012 Jul 1;13(7):646-55.

4. MSD Manual Professional Edition. Premenstrual syndrome (PMS). Accessed January 6, 2026.

5. Reid RL. Premenstrual dysphoric disorder (formerly premenstrual syndrome).

6. Palit S, Bartley EJ, Kuhn BL, Kerr KL, DelVentura JL, Terry EL, Rhudy JL. Endogenous inhibition of pain and spinal nociception in women with premenstrual dysphoric disorder. Journal of Pain Research. 2016 Feb 11:57-66.

7. DelVentura JL, Terry EL, Bartley EJ, Rhudy JL. Emotional modulation of pain and spinal nociception in persons with severe insomnia symptoms. Annals of Behavioral Medicine. 2014 Jun 1;47(3):303-15.

8. Coco AS. Primary dysmenorrhea. American family physician. 1999 Aug 1;60(2):489-96.

9. https://www.aafp.org/pubs/afp/issues/1999/0801/p489.html/1000

10. NHS. TENS (transcutaneous electrical nerve stimulation). Accessed January 6, 2026.

11. World Health Organization (WHO). Low back pain. Accessed January 28, 2026.

12. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health. Back Pain: Diagnosis, Treatment, and Steps to Take. Accessed January 6, 2026.