You’ve probably noticed that period pain tends to fluctuate depending on how far into your period you are. But what’s behind this common experience? Read on to find out why period pain is severe in the beginning and why it changes.
Anyone who has periods knows they can be anything from a roller coaster of feelings, to mentally and physically exhausting, to downright annoying. Plus, periods can be painful.
Multiple millions of people (yes, that many!) experience period pain—and often, it’s worse at the beginning. In fact, it’s common to have the most severe period pain on the first day of your period. So, why is that?
In this article, we’ll take a look into what period pain is, what causes period pain, why pain tends to be most severe on the first day, and how to get relief from severe period pain.
What is period pain? Period pain covers any and all physical symptoms you may get right before and/or during your period. This experience is shockingly common: up to 9 out of 10 people experience painful period symptoms.
In medical terms, period pain is called “dysmenorrhea.” Dysmenorrhea is classified into two categories:
Primary dysmenorrhea Secondary dysmenorrhea The vast majority of the time, pain on the first day of your period is due to primary dysmenorrhea, triggering symptoms like:
Emotional period symptoms are also common, including anxiety, irritability, sadness, and mood swings.
>>MORE: Why You Should Track Your Cycle Beyond Your Period
What causes period pain? When you have pain and period cramps (aka primary dysmenorrhea), your symptoms are related to what’s happening in your body.
Chemicals called prostaglandins are thought to be the main cause. Prostaglandins are produced in the uterine lining (or endometrium), among other places. During your period, you shed the endometrium, which causes endometrial cells to release prostaglandins.
What do these prostaglandins do, once released? They trigger uterine contractions, and those contractions in turn help the uterus continue to shed its lining. It’s a self-propelling cycle: your endometrium sheds and releases prostaglandins, which make the endometrium shed more and release more prostaglandins, and so on.
But these rising prostaglandin levels and increasing uterine contractions also have another effect: period pain and cramping—in particular, the pain you get on the first day or so of your period.
What about secondary dysmenorrhea? Secondary dysmenorrhea pain is reproductive system pain, caused by underlying reproductive health conditions such as endometriosis, ovarian cysts, or fibroids.
Secondary dysmenorrhea symptoms can occur at any point throughout your cycle. Pain may ramp up during your period.
Why do I get severe period pain on the first day? Now that we understand what causes period pain, let’s take a look at timing.
Can pain levels vary depending on what day of your period you’re on? Yes —pain tends to be worse in the beginning of your period, then slowly ease toward the middle and end.
That means that many people experience the most severe period pain on the first day or so. In fact, when symptoms are related to primary dysmenorrhea, pain peaks on days one and two (and generally, symptoms stop around day three).
This timing is no coincidence. Instead, it has everything to do with what causes period pain and how period pain functions—meaning it all comes back to prostaglandins and uterine contractions.
Prostaglandins + uterine contractions = period pain Let’s start with prostaglandins. Prostaglandin levels are highest during the first days of your period, as the endometrium starts shedding and the cells release wave after wave of these chemicals.
Now to uterine contractions. Not only are uterine contractions triggered by prostaglandins, they also become more frequent with higher prostaglandin levels. Since prostaglandin levels peak at the beginning of your period, that’s also the window of time when uterine contractions are most frequent and intense .
How does this all relate to your period pain level?
Period pain severity is proportional to prostaglandin levels and uterine contraction frequency. That means that the higher the prostaglandins and the more frequent the uterine contractions, the more severe your pain.
At the start of your period, both these factors are present at once: high prostaglandin levels combined with frequent and strong uterine contractions. This double whammy creates the perfect storm for period pain and cramps, making you experience severe period pain on the first days of your period.
If your pain is related to secondary dysmenorrhea, pain may be even more severe during your period. Symptoms may worsen over time if the underlying condition isn’t treated.
How to treat severe period pain on the first day Period pain is frustrating, uncomfortable, and can even be debilitating. But the good news is, it does get better.
As your period continues, prostaglandin levels decrease and uterine contractions become less frequent. This makes pain and other symptoms ease around midway through your period, then disappear entirely by the end.
Still, even though period pain resolves with time, that doesn’t mean you have to suffer during the beginning of your period!
To get relief from symptoms and treat severe pain on the first days of your period, try these strategies:
Pain relievers, like ibuprofen, aspirin, and acetaminophen Heat on the abdomen Gentle exercise Gentle massage (but stop if anything hurts) Acupuncture or acupressureHydration Try to rest, relax, and recuperate as possible until you feel ready to do more!
>>MORE: Is It Implantation Bleeding or Just My Period?
When to talk to a doctor about severe period pain Talk to your doctor if your period pain:
Is so severe you can’t function Doesn’t improve with at-home treatment Continues after your period ends Occurs at other moments in your cycle, unrelated to your period These may be signs of secondary dysmenorrhea, meaning your pain may stem from an underlying reproductive health condition. Your doctor can help you get to the bottom of your severe pain, so you can treat the cause and manage your symptoms.
