What Our Health Expert Advisory Board Wants You to Know About Period P

Period pain is one of the most common health experiences among people who menstruate and one of the most consistently under-treated.

Research suggests that up to 90% of people who menstruate experience dysmenorrhea at some point in their lives,[1] yet the conversation around period pain remains strikingly limited. Many people have been told their pain is normal. Some have rearranged their lives around their cycle for years before asking a single question in a doctor's office.

We asked our Health Expert Advisory Board what they wish more people understood about period pain — why it happens, why it goes unaddressed, and what the evidence actually says about managing it. Here is what they shared.

Period Pain Is Real, Common, and Often Under treated

The medical term is dysmenorrhea (painful menstruation) and it affects an estimated 50 to 90 percent of people who menstruate.[1] Primary dysmenorrhea refers to period pain without an identifiable underlying condition. Secondary dysmenorrhea is pain linked to a diagnosable cause, such as endometriosis or adenomyosis.[2] In both cases, the experience is real and the impact on daily life can be significant.

Despite how common it is, period pain remains under-prioritized in clinical settings and in public conversation. People normalize it because they were taught to. Providers sometimes move quickly to symptom management without exploring root causes. The result is that many people spend years in pain without answers.

Dr. Holly Miller, MD, FACOG, Board-Certified Obstetrician and Gynecologist, sees this pattern regularly. We asked her about the gap between how common period pain is and how rarely it gets taken seriously, and here’s what she said:

How common is period pain, and how often do you see patients who have normalized it for years before seeking help?
"Period pain is incredibly common, but suffering in silence is even more common. I see women every single week who have been told for years that severe cramps are "just part of being a woman." Many have missed school, work, sports, vacations, or important life moments because of their cycle. Some have built their entire schedule around their period. What strikes me most is how often women assume they just need to be tougher, when in reality their symptoms deserve attention. Pain may be common, but that does not mean it should be ignored or accepted."

Why does period pain get dismissed so often; by patients, and sometimes by providers too?
"For generations, women were taught to expect pain and push through it. If your mom, sister, or friends all struggled, it can feel "normal" even when it is not. Many women also become experts at functioning while uncomfortable, so others underestimate what they are carrying. On the medical side, providers are often working within short visits and may first focus on quick symptom relief rather than asking deeper questions about the implications of pain or the cause. The good news is that this conversation is changing. We are getting better at listening and looking for answers."

What is the difference between period discomfort that is "normal" and pain that warrants a deeper conversation with a provider?
"A mild ache, cramping that improves with over-the-counter medication, or temporary discomfort that does not disrupt your life can be part of a normal cycle. But pain that causes vomiting, fainting, heavy bleeding, missed work or school, pain with sex, pain between periods, worsening symptoms over time, or needing to plan your life around your cycle deserves a deeper evaluation. Your body is giving you information. You do not need to wait until it becomes unbearable to ask for help."

What Is Actually Happening in Your Body

Understanding the biology behind period pain does not make it hurt less, but it does help explain why some people experience it far more intensely than others, and why standard interventions do not always work.

We asked Dr. Ashley Davis, MD, FACOG, Minimally Invasive Gynecologic Surgeon and Endometriosis Excision Specialist, to walk us through the role of prostaglandins, the hormone-like compounds produced in the uterine lining that is the primary driver of period pain.

How would you explain prostaglandins and their role in period pain to someone who has never heard the word?
“Prostaglandins are chemical messengers your body releases when the uterine lining breaks down during menstruation. Think of them as the “signal” that tells your uterus to contract and shed its lining. Those contractions are what cause cramping. Higher prostaglandin levels mean stronger, more frequent contractions, and more pain. They can also cause the nausea, diarrhea, and headaches many people experience alongside cramps, because they affect smooth muscle throughout the body, not just the uterus.”

Why do some people experience significantly more pain than others, even without a diagnosed condition?
“Several factors drive this variation. Genetics plays a role; some people naturally produce higher levels of prostaglandins. Individual differences in pain sensitivity and nervous system regulation matter enormously; some people have what’s called central sensitization, where the nervous system becomes amplified in how it processes pain signals. This can happen in patients with a history of trauma or chronic pain. Hormonal fluctuations, stress, and even gut microbiome differences can all influence how intense period pain feels. Just because you do not have a diagnosis does not mean there is nothing wrong. Dismissing severe pain as “just bad cramps” is a mistake. Significant pain always deserves evaluation. Many patients' pain is not taken seriously.”

The nervous system plays a central role in this picture as well. The autonomic nervous system, which governs the body's stress and recovery responses, is closely connected to menstrual physiology.[5,6] During menstruation, increased sympathetic nervous system activation (the "fight or flight" state) can amplify how the body experiences physical sensations, including pain. Elevated stress hormones, faster heart rate, and disrupted digestion are all associated with heightened sympathetic activity and can compound the discomfort of menstruation.

Conversely, when the parasympathetic nervous system (the "rest and digest" state) is more active, the body tends toward steadier regulation: slower heart rate, deeper breathing, and calmer physical responses. This is one reason why practices that support parasympathetic activity—from heat therapy to breath work—can offer some relief for period pain. It is also part of the science behind emerging drug-free approaches like transcutaneous auricular neurostimulation (tAN), which engages vagal and trigeminal nerve pathways to support this shift in autonomic balance.[10,11]

Not everyone experiences the same level of period pain, even among people with similar hormone profiles. Genetics, stress levels, sleep, inflammation, and underlying conditions all influence how the body processes and responds to menstrual changes. This is why a one-size-fits-all approach to period pain rarely works, and why understanding your specific pattern matters.

When Period Pain Signals Something More

Not all period pain is primary dysmenorrhea. For a significant number of people, pain that has been chalked up to "just bad periods" is actually a symptom of an underlying condition, one that is often undiagnosed for years.

Three of the most common are endometriosis, adenomyosis, and polycystic ovary syndrome (PCOS). Each involves distinct physiological mechanisms, but all share a troubling commonality: they are frequently missed, minimized, or diagnosed only after prolonged suffering. And Dr. Ashley Davis, MD FACOG sees this regularly with her patients. Here’s what she says about what the pain might mean and helpful tips for patients seeking help.

What are the most common signs that period pain may point to endometriosis or adenomyosis?
- Pain that starts before bleeding begins and persists after it ends
- Pain severe enough to miss work, school, or daily activities
- Pain that doesn’t respond to ibuprofen or other OTC medication
- Deep pain with intercourse (dyspareunia)
- Painful bowel movements or urination during your period
- Chronic pelvic pain outside of menstruation
- Heavy or irregular bleeding, particularly with adenomyosis
- Progressive worsening over time, pain that gets worse each cycle, not better
"Fibroids, non cancerous tumors of the uterus, can be the cause of heavy bleeding and pain with periods. These can be diagnosed with ultrasound and grow over time so we suspect them if there is a recent change in your periods. Endometriosis pain can be more variable depending on where the lesions are located. Usually patients have a history of severe pain with their cycles since they were very young. Most endometriosis lesions cannot be seen on ultrasound, which contributes in delay in diagnosis. With adenomyosis specifically, patients often describe a heavy, pressure-like, pelvic pain that radiates to the back and down the legs, alongside heavy bleeding.”

What do you wish patients knew before their first appointment, about advocating for themselves and getting these conditions taken seriously?
“First: your pain is real, and it is not normal to suffer every month. The average diagnostic delay for endometriosis is still 7–10 years, largely because patients are told to push through it. Don’t accept that. Come prepared: track your symptoms in detail when pain starts relative to your cycle, severity on a scale of 1–10, what helps or doesn’t, and how it impacts your daily function. That documentation is powerful. Be direct with your provider: say “I want to be evaluated for endometriosis or adenomyosis.” If you’re dismissed without a real conversation, seek a second opinion ideally from a specialist in minimally invasive gynecologic surgery or an endometriosis excision specialist. Diagnosis often requires surgery; imaging alone can miss endometriosis entirely. You deserve a provider who takes your pain seriously.”

The takeaway: if your period pain is severe, worsening, or disrupting daily life, it deserves a real conversation with a provider. Symptoms like pain during sex, pain between cycles, pain with bowel movements, or heavy bleeding are all worth raising directly. You are not being dramatic. You are paying attention to the information your body is giving you.

What Your Options Actually Are, and What the Evidence Says

The standard toolkit for period pain has not changed dramatically in decades: NSAIDs, heat, rest, and for more persistent or severe cases, hormonal interventions. Each of these has its place. But the landscape is expanding, and the conversation around what constitutes evidence-based, drug-free support is getting more substantive.

Dr. Sarah E. Hill, PhD, evolutionary psychologist and author of research on how hormones shape health and behavior, has thought deeply about how we approach menstrual pain management and what it means to expand the options available to people who menstruate.

How do you think about hormonal birth control as a pain management tool, and what do you want people to understand before going that route?
"Hormonal contraceptives can be genuinely effective for conditions like endometriosis, PCOS, and severe dysmenorrhea. And for some people, they are life-changing. I do not want to minimize that. But I do think we have gotten into a habit of reaching for the prescription pad before we fully understand the root cause of women's period pain. Hormonal birth control suppresses the symptoms; it does not resolve the underlying issues creating the pain. So when someone comes off it years later, the pain is often right where they left it, and sometimes worse, because the condition has continued progressing under the surface. What I want people to understand is that this is a legitimate tool, but it should be part of an informed conversation about what is happening beneath the surface. Ask what is causing the pain, what the trade-offs are with suppressing the symptoms using birth control, and what monitoring looks like over time."

How do you think about the growing interest in drug-free, hormone-free options for menstrual symptom support, and what does the evidence say so far?
"I love that people are asking these questions. It reflects a real appetite for understanding the body rather than just quieting it when it misbehaves. The honest answer is that the evidence base for most of these approaches is still developing. There is reasonable data for things like omega-3s, magnesium, and heat therapy for primary dysmenorrhea. And one emerging area I find genuinely interesting is vagus nerve stimulation. Products like OhmBody are built on the idea that activating the vagus nerve can modulate pain signaling and inflammation—mechanisms with real biological plausibility. The research is early, but the underlying science is not fringe. My general rule: low risk, plausible mechanism, some evidence? Then it is reasonable to try. What I appreciate about this category of solutions is that they ask a different question than "how do we suppress symptoms?" They ask how we support the body's own systems to improve women's experiences."

Dr. Hill's framing reflects a broader shift in how people are thinking about menstrual health; not as a set of symptoms to be suppressed, but as a physiological system worth understanding and supporting. Drug-free options are not a replacement for medical care. They are an expansion of the toolkit, grounded in a different question: what can we do to work with the body rather than around it.

You Deserve More Than "Just Push Through It"

Period pain is common. That does not make it inevitable (or normal). And it certainly does not mean you are out of options.

The experts on our Health Expert Advisory Board are saying the same thing we built OhmBody around: people who menstruate deserve real answers, real support, and real choices. That means better conversations with providers. It means understanding what is happening in your body. And it means having access to tools that are grounded in science, not just convention.

OhmBody's tAN technology uses transcutaneous auricular neurostimulation to engage the vagus and trigeminal nerve pathways, supporting a shift toward parasympathetic balance during menstruation. It is hormone-free, drug-free, and designed to work with your body's own regulatory systems. No prescriptions. No recurring costs. HSA and FSA eligible.

References

Ju H, Jones M, Mishra G. The prevalence and risk factors of dysmenorrhea. Epidemiologic Reviews. 2014;36(1):104-113. doi:10.1093/epirev/mxt009.
American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 760: Dysmenorrhea and Endometriosis in the Adolescent. Obstetrics & Gynecology. 2018;132(6):e249-e258. doi:10.1097/AOG.0000000000002978.
Dawood MY. Primary dysmenorrhea: advances in pathogenesis and management. Obstetrics & Gynecology. 2006;108(2):428-441. doi:10.1097/01.AOG.0000230214.26638.0c.
Tenan MS, Brothers RM, Tweedell AJ, Hackney AC, Griffin L. Changes in resting heart rate variability across the menstrual cycle. Psychophysiology. 2014;51(10):996-1004. doi:10.1111/psyp.12250.
Roy S, Agordati E, Wilcockson TD. Autonomic nervous system, cognition, and emotional valence during different phases of the menstrual cycle—a narrative review. NeuroSci. 2025;6(3):78. doi:10.3390/neurosci6030078.
Kizkin ZY, Yildiz R, Ozden AV. Effects of transcutaneous auricular vagus nerve stimulation in individuals with primary dysmenorrhea: a randomized controlled trial. Neuromodulation: Technology at the Neural Interface. 2025. doi:10.1016/j.neurom.2025.01.006.
Mercante B, Deriu F, Rangon CM. Auricular neuromodulation: the emerging concept beyond the stimulation of vagus and trigeminal nerves. Medicines. 2018;5(1):10. doi:10.3390/medicines5010010.

OhmBody is a wellness device designed to support menstrual health and comfort. Individual results may vary. This product is not intended to diagnose, treat, cure, or prevent any disease or medical condition. The expert opinions shared in this article represent the individual views of each advisor and are provided for educational purposes only. Consult your healthcare provider before use if you have any medical conditions or concerns.

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What Our Health Expert Advisory Board Wants You to Know About Period Pain