10 period symptoms: everything you need to know

The main sign your period has come is when you start bleeding, but there are often other signs and symptoms that accompany your period. Some symptoms generally arrive before your period starts and act more like a sign that your period is coming, while other symptoms often occur once you start bleeding. Read on to find out all about the most common period symptoms, what causes them, and what may make you more susceptible to certain symptoms.

1. Period pain or menstrual cramps

Period pain, or period cramps, are one of the most common and uncomfortable menstrual symptoms, that can affect up to 85.4% of women during their period¹. Most women at some point in their life will experience some cramping during, or around their period. It can feel like painful muscle cramps around the abdomen, as a dull or constant pain, or even for some, as intense spasms.

Some women find the intensity of this pain varies between cycles, with some periods causing little to no pain, while others are much more painful.

Period pain most typically begins when you start bleeding, though some women report menstrual cramps in the days leading up to their period as well.

Causes of period pain

During your period, your uterus (or womb) contracts to help shed its lining. To do this, the body releases chemicals called prostaglandins², which are made in the uterine lining and encourage the uterus muscles to contractⁱ. More intense period pain and cramps are actually linked with high levels of prostaglandins³, which make the contractions stronger. 

Health conditions that can make period pain worse

Sometimes pain during menstruation can be more intense due to underlying causes, such as:

• Endometriosis. A condition where the tissues that line the womb (uterus) grow outside the uterus, on spots like the fallopian tube and ovaries. Women with endometriosis can experience intense pain during their period due to the hormones stimulating an inflammatory effect on this tissue at the same time
• Fibroids. These non-cancerous tumours can grow around the uterus and intensify the pain of menstrual cramps.
• Adenomyosis. This is a condition similar to endometriosis, where tissue that normally lines the uterus grows within the muscular uterus wall. This makes periods especially painful as the lining sheds. It tends to occur more in women aged between 35-50 years.
• Physical issues with reproductive organs. Some women may have issues with their uterus or fallopian tubes such as uterine polyps, or pelvic inflammatory disease, which can cause additional pain during their period.
• Other health conditions. There are also some medical conditions not directly linked to the reproductive system that can also make cramps worse, like Crohn’s disease or disorders affecting the urinary tract.

See your doctor if you have severe pain or you notice your normal menstrual patterns change. For example, you get heavier periods than usual, or they become irregular. 

2. Breast pain or tender breasts

Tender breasts or breast pain are common before or during your period. Various large-scale studies have demonstrated between 41 – 70% of women experience this symptom at some time in their life. Breast tenderness or breast pain due to menstruation can:⁴

• Feel like a dull, heavy or aching pain that can range from mild to severe.
• Begin up to two weeks before the period, worsen over time, and then go away once the period is over.
• Affect both breasts (but not always) and can even spread to the area around the armpit.
• Come with swollen breasts that feel full or even lumpy. If you notice any lumps in your breasts, you should always get it checked out by your doctor.

Causes of breast pain during or around your period

The most likely cause of breast pain or breast swelling around your period is hormonal changes during the menstrual cycle. As the start of your period approaches, increased levels of hormones like progesterone are likely to cause tenderness or pain. 

Progesterone levels increase after ovulation and peak around a week after, before falling as the period approaches. Breast pain around this time could be due to changes in the milk glands or ducts in the breasts caused by hormonal changes.⁴

Health conditions that can make breast pain worse

Breast pain can also appear or get worse due to conditions like:

• PMS (premenstrual syndrome). Tender breasts are a common symptom of PMS, which is most likely triggered by hormonal changes⁵.
• Fibrocystic breast disease (a benign breast disease). Women with this condition, in which the breasts have benign rope-like or lump-like tissue, tend to experience increased breast pain or even swelling from ovulation to menstruation⁶.

Although many women experience some breast tenderness leading up to their periods, risk factors may include⁴:

• large breast size
• previous breast surgery
• certain medications such as antidepressants, antipsychotics or medications containing hormones
• too much caffeine (although there is no precise figure for how much caffeine is too much, some women notice a decrease in breast pain when they limit caffeine consumption or cut it out completely).

Most of the time breast pain will go away by the time your period is over. However, if you notice any other symptoms, such as those listed below, see your doctor:

• Discharge from the nipple when not breastfeeding or pregnant
• A new lump in breast or armpits that does not go away after your period
• Persistent and unexplained pain
• Change in shape, size or feel of your breast
• Skin changes like redness, puckering, dimpling
• Changes in the position of the nipple

3. Breakouts

Some women notice they get spots or acne flare-ups around their period, usually before it starts. In fact, acne in the days leading up to one’s period as an adult woman is more common than you might think!

A study of 400 women in 2001 found that 44% experienced premenstrual acne⁷.  In another study from the same year, 65% of the participants reported a perimenstrual acne flare⁷. 

Causes of breakouts

Although men can get acne too, women are more likely to get acne due to changes in hormone levels across the menstrual cycle.

As you approach your period, the levels of estrogen drop and progesterone increases. The hormone progesterone increases the production of the grease-producing glands next to your hair follicles in the skin to produce more oil (sebum)⁸.

Too much sebum can clog the pores in your skin, which can cause bacteria to thrive, resulting in skin inflammation and acne.

Health conditions that can make acne around menstruation worse

Acne can also be a symptom of polycystic ovarian syndrome (PCOS). You should talk to your doctor if you notice any of the following symptoms in addition to acne⁹:

• irregular or no periods
• excessive hair growth on the face, chest, back or rear
• weight gain
• hair loss or thinning hair
• struggling to conceive if you are trying to get pregnant. 

4. Period fatigue

Period fatigue may refer to an episode of tiredness experienced just before the start of your period or during your period itself. A study with more than 40,000 women found that 70.7% reported tiredness or fatigue as a symptom during their period.¹

Fatigue is a common symptom of PMS, which many experts link to hormonal changes. Over the course of the menstrual cycle, levels of estrogen and progesterone change, which can result in feelings of fatigue. This can also cause fluctuations in brain chemicals like serotonin, a mood-boosting neurotransmitter (also known as the happy hormone), leading to tiredness and low energy levels in those with PMS⁵.

Things that can make period fatigue worse

Period fatigue could also be caused by:

• Low iron levels. Sometimes heavy bleeding during a period could lead to anaemia due to an iron deficiency, causing weakness and fatigue because iron is crucial for carrying oxygen in the blood.
• Sudden changes in blood sugar. Some women may get certain cravings around their periods which can lead to eating too many sweets or food with added sugar. This can cause a spike in blood sugar, followed by an energy crash.
• Disturbed sleep. If your period pain keeps you up at night, or mood changes make it hard to stay asleep, it’s natural to feel tired the next day.

If your fatigue is debilitating or interferes with your daily activities, or it doesn’t go away after your period, talk to your doctor to get it checked out. 

5. Abdominal bloating and water retention

If you’ve noticed your jeans are tighter than usual around your period, chances are it’s your period that’s causing the snug fit. One common PMS symptom is bloating or water retention just before the period begins. This symptom can appear one to two weeks before your period is due, making it a sign that your period is coming.

Causes of bloating and water retention around your period

Like with many other PMS symptoms, water retention is likely caused by fluctuating hormones. However, a diet that’s high in salt can also increase water retention around your period.

If this is a recurring issue, talk to your doctor about treatment options It’s common for menstruating women to feel bloated a couple of days before their period starts, while those with PMS may already experience bloating up to five days before the start of their period.

6. Lower back pain

Lower back pain can also be an irritating period symptom, with a 2019 study including 40,000 women finding that back pain was reported in 59.2% of participants, making it the 4th most commonly reported symptom.¹

Causes of lower back pain during your period

During your period, the uterus contracts to shed the old lining. These contractions can cause additional muscular pain (on top of other types of period pain) and it can radiate into the lower back. 

Health conditions that can increase back pain during your period

There are certain medical conditions that can make back pain during your period worse, including:

• Endometriosis
• Uterine fibroids
• Adenomyosis
• Back conditions or injuries.

If your lower back pain is so severe you cannot perform daily activities, consult your doctor to determine the cause and find the right treatment for you.

7. Headaches or migraines

Periods can be a trigger for “hormone headaches.” Headaches or migraines associated with hormonal changes can get worse around the time you expect your period. One study found that headaches are likely to affect 1 in 2 women during their period.¹

Causes of headaches or migraines around your period

Menstrual migraines or hormone headaches are usually caused by a natural drop in estrogen towards the end of the luteal phase and at the beginning of menstruation. This drop in estrogen before your period, can affect chemicals in the brain that can trigger headaches and migraines.⁶

Things that can trigger hormonal headaches

Hormonal headaches can also be triggered by 

• oral contraceptives
• menopause
• pregnancy.

See your doctor if your headaches are persistent, unbearable or continue beyond your period.

8. Mood swings and disorders

Mood swings, anxiety, depressive feelings, and irritability are common signs your period is on its way. These mood changes are classic PMS symptoms, and one study found that psychological complaints affected 77.3% of the 42,879 women surveyed.¹ Some women also experience what’s known as enhanced mood disorders or premenstrual dysphoric disorder (PMDD). This is essentially an extreme form of PMS.

With PMDD, emotions are heightened and mood swings are more severe to a point where it can disrupt life and damage relationships. Both PMS and PMDD typically start around 7 to 10 days before your period starts, lasting until the first days of your period.

Causes of mood swings around your period

As with many other period symptoms, the feelings of anxiety or irritability associated with PMS or PMDD are likely due to the hormonal changes around this time of the month. PMS affects about 12% of menstruating women, while PMDD is rarer and tends to affect between 1.3% to 5.3% of women.⁷

Things that can make mood swings during your period worse

Although the cause of PMDD is unclear, there are a couple of theories as to why some women have worse mood swings and experience more severe forms of mood disorders around their periods, such as:

• having an underlying case of depression
• being very sensitive to hormonal changes 

If you find your moods are extreme or you have suicidal thoughts, discuss your symptoms with your doctor as soon as possible.

9. Gastrointestinal issues

Around your period, you may feel constipated or experience diarrhea. In fact, a 2014 study found that 73% of the women in the study experienced at least one gastrointestinal issue around the time of their period⁸, with diarrhea being one of the most common complaints. 

Causes of menstrual diarrhea and constipation

Like many of the other symptoms of periods, hormones are a likely the culprit here. The build-up of the hormone progesterone—which is responsible for thickening the lining of the uterus—can cause constipation in some women.

The increase in prostaglandins—the hormones that cause the muscle contractions that help the uterus lining shed—around your period, on the other hand, could cause diarrhoea.

When prostaglandin levels are high, some of the hormone may enter the blood stream and travel to other organs like the bowels. High levels of prostaglandin in the bowels can cause contractions of the muscles of the intestines or colon, leading to diarrhoea.

If these gastrointestinal issues persist, talk to your doctor to diagnose or rule out other possible causes.

10. Poor sleep

Whether it’s cramps or mood swings that keep you up at night, poor sleep is a common complaint for women around their period. One reason for this is the menstrual cycle’s relationship with changes in circadian rhythms and sleep; many women report poor sleep quality and greater disturbance during their period or the week leading up to it.⁹ Another possible reason for poor sleep around your period is changes in body temperature.

Causes of poor sleep during your period

Hormone fluctuations can cause your core body temperature to rise about half a degree following ovulation. It’s how the basal body temperature (BBT) method helps you track whether you’ve ovulated or not. This half a degree may not sound like much, but it can affect your sleep because it’s easier to sleep when your body temperature is cooler.

One study found that sleep quality worsened in women with a rise in core body temperature following the rise in progesterone after ovulation. It’s also possible that increased progesterone levels impact sleep quality.¹⁰

11. Heavy bleeding

Heavy bleeding affects up to 50% of menstruating women, and it is one of the main period-related causes of healthcare use. ¹ Heavy bleeding, also known as menorrhagia, is defined as a menstrual bleeding that lasts longer than seven days, soaks through a tampon or a pad within two hours, makes you use 2 types of period products together i.e., a pad and a tampon, bleeds through your clothes or bedding, passes clots larger than 2.5cm and interferes in your daily life by making you avoid activities like exercise or work during the time of your menses. If you experience any of these symptoms, you should see a doctor .¹¹

Causes of heavy bleeding

It’s unclear what exactly causes heavy menstrual bleeding, but there are a number of possible causes:¹²

• Hormone imbalances
• Anovulation (when the ovary doesn’t release an egg)
• Uterine fibroids
• Polyps
• IUDs
• Medications such as birth control or blood thinners
• Certain medical conditions

FAQs about period symptoms

The bottom line

Although many period symptoms can be annoying, try to rest and take it easy at this time. The typical symptoms of cramping, headaches and fatigue are usually just due to hormonal fluctuations and should go away once your period is over. You can also talk to your doctor about any medications or relaxation techniques you can try to ease a few of the symptoms. As you learn more about your symptoms and what to expect, and what method works the best at handling them, you’ll be more prepared for them as your period approaches.