Does PCOS Cause Cramps?

Polycystic ovary syndrome (PCOS) is a common hormonal disorder that can occur in people assigned female at birth when they reach reproductive age. It’s characterized by irregular menstrual cycles, higher levels of androgens (“male” hormones like testosterone), and the formation of cysts on the ovaries. Some people with PCOS experience more severe menstrual cramps. It’s thought that this is due to the imbalance in hormones seen in PCOS.

Can PCOS cause cramps?

Cramping is the spasming or involuntary contraction of a muscle. Abdominal and pelvic cramping is seen in many conditions of the female reproductive system. Cramping can occur during menstruation, medically referred to as dysmenorrhea. However, cramping can occur even without menstrual bleeding and may evolve into chronic pelvic pain in some cases.

Generally, it’s considered normal to have some level of cramping and pain during your periods. This is because, during menstruation, the womb muscles contract in order to shed the lining of the womb. When there are no underlying health conditions, this is described as primary dysmenorrhea. The cramps will improve on their own, though some people may benefit from home care, such as taking anti-inflammatories or using heat packs.

Dysmenorrhea that’s related to an underlying medical condition is called secondary dysmenorrhea. Common causes of secondary dysmenorrhea include endometriosis, fibroids, or pelvic inflammatory disease.

Excessive cramping isn’t always listed as a typical symptom of PCOS. However, one study of 735 patients demonstrated that 70% of PCOS sufferers reported cramping, and many considered it severe.¹

What is the potential link between PCOS and cramping?

The exact reason why PCOS causes excessive cramping is not yet known. In fact, PCOS remains a poorly understood condition overall. 

Cramping tends to be more common in people who have irregular periods and don’t regularly ovulate — which generally describes those with PCOS. This might be because going longer between periods results in higher levels of chemicals called prostaglandins, which trigger uterine contractions that can cause pain when the womb lining is shed. 

In general, women with PCOS have been found to have higher levels of prostaglandins than those without PCOS, and prostaglandins are associated with increased uterine muscle contraction and inflammation.

More research is needed to establish the exact nature of the association between PCOS and cramps.

What are the symptoms of PCOS?

Although it’s common in people with the condition, menstrual cramping isn’t considered a definitive symptom of PCOS, as it can be caused by several different conditions. Here are some other symptoms that may indicate PCOS:

• Excessive hair growth (hirsutism), especially on the face, back, and buttocks

• Acne or oily skin

• Irregular or absent menstruation

• Weight gain

• Hair loss from the scalp

• Difficulty getting pregnant

Not everyone with PCOS will have the same symptoms, and they can be highly variable.

Other causes of menstrual pain

Some degree of menstrual pain is normal for one or two days each month. However, if your menstrual pain is severe or significantly impacting your life, talk to your doctor. You may have a medical condition that causes increased pain with menstruation (secondary dysmenorrhea). Some of these causes may include:

• Ovarian cysts. Most ovarian cysts cause no symptoms, but cysts can cause pain during your period and unusual vaginal bleeding, as well as pain in the lower abdomen on the side of the cyst, which may be sharp or dull and come and go. Sudden, severe pain can indicate an ovarian cyst has ruptured and is a medical emergency. You should also treat it as a medical emergency if your pain is associated with fever and vomiting.

• Endometriosis. In people with endometriosis, tissue similar to the lining of the uterus grows elsewhere in the body. This tissue may grow in or around the ovaries, in the fallopian tubes, and around the outside of the uterus. It can also affect your bowel or bladder. Very painful menstrual cramps, which tend to worsen over time, are a distinguishing symptom of endometriosis.

• Uterine fibroids. These are noncancerous growths that develop in or around the uterus, made up of muscle and fibrous tissue. While they often don’t cause symptoms, some people experience heavy or painful periods or lower back pain.

• Pelvic inflammatory disease. This is an infection of the female reproductive system. It can cause heavy and painful periods as well as other symptoms, such as fever.

All of these conditions are ones for which severe cramps are a common symptom. It’s certainly possible to have both PCOS and another condition at the same time. In fact, people with PCOS are more likely to be diagnosed with certain other conditions, including endometriosis. People with PCOS are less likely to have uterine fibroids, but it can happen.

Again, if you have heavy periods and severe menstrual pain, it’s best to talk to your doctor about it.

Managing menstrual pain with PCOS

Many women with PCOS experience cramps. One effective treatment that can be used to reduce menstrual cramping and pain is hormonal contraceptives. These affect the levels of various hormones, which reduces the production of prostaglandins and thus reduces cramping. However, not everyone is willing or able to take hormonal contraceptives. In addition, they’re not an option if you’re attempting to get pregnant.

Note that intrauterine devices (IUDs) can actually increase period pain, especially for the first few months after they’re placed. If you’re experiencing severe cramps and you have an IUD, it’s worth considering that the IUD may be causing or contributing to your symptoms.

Other treatments for menstrual cramps include:

• NSAIDs, such as ibuprofen. These help reduce pain and also lower prostaglandin production. These medications may be unsafe for certain people (such as those with kidney or liver disease), so it’s important to talk with your doctor before using them.

• Quitting smoking. This is recommended for everyone, especially people with PCOS.

• Exercise. Gentle exercise can help relax the muscles.

• Applying heat. Placing a heating pad over the lower abdomen and pelvis or taking a warm bath or shower can help.

• Using a TENS (Transcutaneous electrical nerve stimulation) device. This is a battery-operated device that delivers a mild electrical current. Studies have confirmed this treatment is effective, although it may not work for everyone.

All of these treatments can reduce the amount of pain you’re experiencing, but they don’t resolve the underlying condition. Properly managing your PCOS can, however, reduce menstrual irregularity and pain.

What about heavy bleeding?

Menstrual cramps are often associated with unusually heavy periods. If your blood loss during your period is greater than normal, this can cause iron deficiency and anemia, so it’s important to address it.

In addition to helping with cramps, hormonal contraceptives typically reduce the amount of blood loss during your period, reducing your risk of anemia. NSAIDs can also reduce the amount of blood loss.

If you regularly have heavy periods, consult your doctor, as other remedies are available. These include prescription medications to reduce bleeding and a hormonal IUD that can help to thin the lining of the uterus and reduce menstrual blood loss.

When to call a doctor

If you’re experiencing debilitating menstrual cramps, whether or not they’re associated with symptoms of PCOS, it’s important to talk to your doctor. While some cramping is not unusual, it is not normal for it to be so severe that it interferes with your life.

Your doctor may perform a pelvic exam to look for large ovarian cysts or endometriosis. If you have engaged in unprotected, non-monogamous sexual activity, then you may need testing for infections like gonorrhea and chlamydia, which are common causes of pelvic inflammatory disease.

Don’t let yourself suffer with severe menstrual cramps, as it could be a sign of an underlying condition, and many treatments are available.

The lowdown

Many people with PCOS experience bothersome menstrual cramping. It’s unclear exactly why this is the case. Severe menstrual cramping can also be a sign of other significant reproductive health conditions, like endometriosis.

Although menstrual cramps are normal, it’s not normal for them to be severe enough to interfere with your life. If your cramps are associated with other symptoms of PCOS, such as excessive hair growth, talk to your doctor about PCOS. If they aren’t, then they may be caused by another medical condition. It’s important to get an evaluation in order to determine the best way to deal with your menstrual cramps.

If you have PCOS, it’s best to talk to your doctor about ways to reduce menstrual pain and cramping.