Painful Periods Are Not Normal: Understanding Primary Dysmenorrhea and What the Body May Be Telling Us

For many women, painful periods are simply part of life. They are told to expect the pain, to manage it with anti-inflammatory medication, and to carry on. In many cases, this advice is followed for years — sometimes decades — without anyone asking why the pain is there in the first place.

This article explores what primary dysmenorrhea actually is, what is currently understood about its causes, and why a broader clinical perspective may offer new answers for women who have not found lasting relief through conventional approaches.

What is primary dysmenorrhea?

Primary dysmenorrhea is defined as recurring lower abdominal pain occurring just before or during menstruation, in the absence of any identifiable pelvic pathology such as endometriosis or fibroids. It accounts for the vast majority of dysmenorrhea cases and is most commonly experienced during adolescence and early adulthood, though it can persist throughout the reproductive years.

It is one of the most common gynaecological conditions worldwide. Research consistently shows that a significant proportion of women of reproductive age experience menstrual pain, with many describing it as moderate to severe. Despite this, it remains underdiagnosed and undertreated. Many women do not seek medical help, either because they have been told it is normal, or because previous consultations have not offered satisfactory answers.

The impact on daily life is considerable. Studies report that menstrual pain is a leading cause of short-term absenteeism from work and education, and that it significantly reduces quality of life across physical, psychological, and social domains during affected days.

What causes the pain?

The most widely accepted explanation involves the role of prostaglandins — hormone-like substances produced by the uterine lining during menstruation. In women with primary dysmenorrhea, prostaglandin levels are elevated, which leads to stronger and more prolonged uterine contractions. These contractions reduce blood flow to the uterine muscle, creating a state of temporary ischaemia and hypoxia that generates pain.

This prostaglandin-mediated process is well supported by research and explains why non-steroidal anti-inflammatory drugs, which inhibit prostaglandin production, are currently the first-line pharmacological treatment. For many women, this approach provides adequate relief.

However, it does not explain why some women experience pain that is disproportionately severe, why pain persists despite appropriate medication, or why symptoms vary so considerably from one cycle to the next and from one woman to another.

More recent research has begun to explore additional mechanisms, including central pain sensitisation — a process in which the nervous system becomes increasingly responsive to pain signals over time. This may help explain why, in some women, menstrual pain intensifies or becomes more complex as the years pass, and why it does not always respond to treatments that address only the local uterine environment.

The fascial perspective

Fascia — the connective tissue network that envelops and connects every muscle, organ, nerve, and bone in the body — plays a role that is increasingly recognised in the context of pelvic and menstrual pain.

The uterus, ovaries, bladder, and intestines are all embedded within and connected by fascial structures. Restrictions or increased tension within these fascial layers can affect organ mobility, local circulation, lymphatic drainage, and the transmission of mechanical forces throughout the pelvic region.

Research into myofascial approaches for pelvic pain suggests that fascial restrictions in the abdominal and pelvic regions may contribute to pain and that manual therapy targeting these tissues can reduce pain intensity and improve local circulation. While this area of research is still developing, the clinical rationale is well grounded in our understanding of fascial anatomy and the role of connective tissue in pain transmission.

What makes the fascial perspective particularly relevant for primary dysmenorrhea is the recognition that the pelvis does not function in isolation. Fascial continuity means that tension originating in distant regions of the body — from old injuries, surgical scars, postural adaptations, or areas of long-standing restriction — can exert influence on pelvic structures. In some cases, the source of increased tension may be far removed from where the pain is felt.

This is consistent with the broader clinical picture seen in chronic pain: the painful area is not always where the problem originates.

What the research currently tells us — and its limits

It is important to be honest about where the evidence currently stands. Non-pharmacological approaches to primary dysmenorrhea — including manual therapy, exercise, and heat therapy — are supported by a growing body of research, and recent systematic reviews have highlighted promising results for several of these interventions.

Specifically regarding fascial and myofascial approaches, a 2025 randomised controlled trial examining myofascial release in women with primary dysmenorrhea found meaningful reductions in pain intensity compared to a placebo intervention. The authors proposed several mechanisms, including improved circulation, reduced fascial tension, and enhanced lymphatic drainage in the pelvic region.

However, research specifically examining Fascial Manipulation® according to the Stecco method in the context of primary dysmenorrhea remains very limited. This is precisely the gap that our current pilot study is attempting to begin addressing.

Our pilot study: early observations

As part of an ongoing pilot study at Physio by K, a small group of women with primary dysmenorrhea are receiving Fascial Manipulation® treatment according to the Stecco method and being followed over several menstrual cycles using validated outcome measures. These include a visual analogue scale for pain, the Short-Form McGill Pain Questionnaire, and the Verbal Multidimensional Scoring System.

It is important to emphasise that this is a pilot study. The sample size is small by design — the purpose is to explore feasibility, refine methodology, and identify trends that could justify and inform a larger study in the future. No conclusions can or should be drawn from pilot data alone.

With that caveat clearly stated, the early observations have been encouraging. Participants have generally reported reductions in menstrual pain intensity across treatment cycles, with improvements visible across multiple outcome measures. The pattern of change — including reductions in both the sensory and affective dimensions of pain — is consistent with what a fascial approach to this condition would be expected to produce.

Several participants also reported changes between treatment sessions, during menstrual cycles that occurred while they were still in the active treatment phase. These observations, while preliminary and anecdotal, are of clinical interest and will be examined more carefully as the full dataset is assembled.

The study is ongoing. Full analysis will only be possible once all participants have completed the treatment and follow-up phases. Results will be shared here, and the intention is to submit the findings for peer review upon completion.

What this means for women living with menstrual pain

If you experience menstrual pain that significantly affects your daily life, the most important first step is a thorough gynaecological evaluation to rule out underlying pathology such as endometriosis, adenomyosis, or fibroids. These conditions require their own specific management and should not be overlooked.

If no pathology is identified and pain persists despite appropriate medical treatment, it may be worth exploring whether connective tissue or fascial factors are contributing. This is not an argument against pharmacological management — anti-inflammatory medications remain effective and appropriate for many women. It is rather an acknowledgement that for some, additional factors may be at play that a broader clinical assessment could help to identify.

As with chronic pain in other regions of the body, the question worth asking is not only how to manage the pain, but why it is there and what the body may be trying to communicate.

This article is written for informational purposes and does not constitute medical advice. If you are experiencing significant menstrual pain, please consult your gynaecologist or healthcare provider.

If you would like to follow the progress of the Fascial Manipulation® and primary dysmenorrhea pilot study, you can read previous updates in the Women's Health Research section of this website.

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