Joint pain and the menstrual cycle

Top things to know about joint pain and the menstrual cycle:

• Many people experience joint and/or muscle pain during their luteal phase and period

• Changes in hormone and chemical levels in the body may be the cause of this menstrual joint pain

• Most joint pain can be managed with over-the-counter pain relievers, light exercise, and heat or ice application

• Clue members can track joint pain and its intensity under the pain category to notice patterns

Joint pain and the menstrual cycle 

Have you noticed aching hips and knees each month before your period? Hormonal changes throughout the menstrual cycle can lead to a variety of experiences. While you might think of breast tenderness and cramping as common premenstrual symptoms, joint pain also affects many people with cycles.

Why do my joints ache during my period?

It’s not exactly clear why some people are bothered by joint pain before and during their periods, and some are not, but it’s likely influenced by hormones, age, existing medical conditions, and other individual factors. 

A review of menstrual cycle hormones

The menstrual cycle is characterized by shifts in hormones (1):

• During your period, estrogen and progesterone levels are at their lowest

• In the follicular phase after your period, estrogen levels gradually rise

• Estrogen peaks just before ovulation, when an egg is released from the ovary

• After ovulation, the luteal phase begins, and progesterone levels increase

• In the days before your period, estrogen and progesterone levels drop, signaling the uterine lining to shed 

Your hormones, joint, and muscle pain 

Hormonal changes during the menstrual cycle may contribute to joint and muscle pain.

In the late luteal phase, estrogen and progesterone levels begin to drop (1). This signals the uterine lining to shed and triggers the release of chemicals called prostaglandins (1).

Prostaglandins cause uterine contractions and reduced blood flow to the uterus (2,3). High levels of prostaglandins in the body can lead to more painful periods, nausea, vomiting, and diarrhea (2). 

The medical diagnosis for painful periods is called dysmenorrhea, and it can include more than just period cramps (3). High prostaglandin levels lead to increased inflammation and joint damage in the body (4). Many people with dysmenorrhea experience muscle and joint pain, including knee, leg, or lower back pain (3). 

Estrogen levels may also play a role in joint pain. Estrogen is linked to inflammation (5). Some research has shown that joint symptoms are more likely during times of low estrogen, like during perimenopause (5).

More research is needed on exactly how hormone fluctuations in the luteal phase might affect joint pain in those experiencing perimenopause.

Premenstrual Syndrome (PMS)

Premenstrual syndrome (PMS) is the group of physical and/or psychological symptoms that people may experience just before and during the menstrual period (6). It may happen as a result of the hormone shifts during the luteal phase (7). 

PMS is a true and valid medical diagnosis (5). Just having an occasional symptom during your luteal phase is not enough for a diagnosis. People with PMS have one or more symptoms during at least three menstrual cycles in a row, and symptoms must substantially interfere with quality of life and normal activities (5,6). 

Around 1 in 4 people with cycles are affected by PMS (8). Age, sociocultural factors, education, income, diet, substance use, and stress are some of the factors that may influence PMS risk (9). 

Joint pain is one of the many possible PMS symptoms (8). Other common symptoms include fatigue, bloating, breast tenderness, and mood changes (8). 

Some studies estimate that as many as 4-5 out of 10 people with PMS experience muscle and joint pain (10-12).

Who is more likely to experience joint pain around their period?

Some people may be more likely to experience joint pain before or during their period, including those with:

• PMS or PMDD: People with PMS may have joint pain before and during their periods (8,13). Joint pain is also a symptom among people with premenstrual dysphoric disorder (PMDD), which is a severe form of PMS affecting up to 5 out of 100 women (13) 

• Higher body weight: Obesity (having a body mass index over 30) may contribute to pressure and strain on joints (14). People with obesity are also at higher risk for PMS and PMDD (15).

• Perimenopause: During perimenopause, people can be more likely to experience joint pain (16). This may be due to lower estrogen levels, which affect bones and cartilage in the body (16). Low estrogen is also associated with higher levels of inflammation. Physical activity levels and the effects of aging may impact joint pain in this group of women (16-18).

• Endometriosis: Endometriosis may contribute to joint pain if endometrial lesions spread to different joints in the musculoskeletal system (19). 

Certain medical conditions are also linked to painful periods and joint pain, including:

• Arthritis (including psoriatic or rheumatoid arthritis) (20)

• Connective tissue diseases (such as systemic lupus erythematosus or antiphospholipid syndrome) (20)

• Fibromyalgia (21)

Science-based tips to manage joint pain

Joint pain may leave you feeling low for several days of the month. The good news is that there are several evidence-based ways to reduce your pain levels and improve your quality of life.

Diet

*Note: The data on diet changes for managing period-related pain is limited, and there are no universal guidelines. 

A diet rich in whole foods and nutrients may be helpful for people with chronic pain (22). “Whole foods” is a term that refers to food that is minimally processed and without added sugars, salts, or other ingredients.

Whole food diets like the Mediterranean Diet, vegan or vegetarian diets, or elimination diets may help with pain, possibly due to anti-inflammatory effects (22, 23). But more research is needed.

Over-the-counter medications

Over-the-counter pain medications can be used to manage pain. Non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen, work by reducing prostaglandins and overall levels of inflammation (24). 

NSAIDs work best if taken 1–2 days before your period and continued for the first 2–3 days of your period (2).

Acetaminophen (or paracetamol) is a pain medication that may also reduce joint pain. It does not impact inflammation levels as strongly as NSAIDs (25). 

Supplements

Magnesium is a mineral found in leafy greens, nuts, seeds, and whole grains (26). It is important for many processes in the body. Magnesium may reduce prostaglandin production and relax uterine muscles (27). 

Adequate magnesium intake may be associated with lower levels of chronic pain, especially in women (28). Magnesium supplements could be helpful for people with painful periods (27).

Vitamin D is another important nutrient for bone health and inflammation (29). Some research has shown that vitamin D supplementation can reduce period pain and PMS symptoms in people who are vitamin D deficient (29,30). 

If you plan to try supplements for your pain, consult a nutritionally trained practitioner. Supplements, like medications, can have side effects in the body.

Exercise

Light exercise can help manage premenstrual symptoms and painful periods. Aerobic exercises like walking, jogging, biking, and swimming can produce chemicals in your body to counteract pain (2). Low-impact exercises like dancing or tai chi are sometimes recommended for people with joint conditions to reduce pain and improve function (31). 

Relaxation techniques

Biofeedback and relaxation exercises may be helpful for people with painful periods (2). Biofeedback is a technique where people use monitoring devices to get information to help them learn to control their bodily functions (32). 

Some research has shown that progressive muscle relaxation practice can be helpful in reducing PMS symptoms, including joint pain (33). Yoga or meditation may also help people cope with painful periods (2). 

Some studies show that physiotherapy methods, like massage therapy or stretching, can reduce menstrual pain (34). Acupuncture, acupressure, or physical therapy are other potentially useful tools (2). 

Heat or ice application

Cold therapy works by reducing inflammation (35). In people with arthritis, ice application is often recommended (36). Ice can be applied for up to 20 minutes at a time (35). 

Heat therapy may also be a helpful tool for reducing musculoskeletal pain (37). Research has shown that heat therapy is effective for treating painful periods (38).

It promotes blood flow and reduces stiffness (35). You can use a warm bath, heating pad, or hot water bottle as heat therapy (2). Heat can be applied wherever you feel pain, including your lower abdomen, upper or lower back, or legs.

Try not to apply heat or ice directly to your skin to reduce your risk of injury (35). 

When to see a healthcare provider 

Cyclic muscle and joint pain may be fairly common, but that does not mean you have to suffer through it alone. Consider reaching out to your healthcare provider if you have:

• Joint pain primarily in the morning, accompanied by swelling, warmth, or redness around the joints (39)

• Other symptoms including fevers, weight loss, or changes in appetite (39)

• Joint pain alongside other symptoms of endometriosis: heavy, painful periods; or pain during sex, bowel movements, or urination (40)

• Joint pain alongside significant mood symptoms or anxiety (13)

• Joint or muscle pain that interferes with your quality of life 

Tracking your pain with Clue

Tracking your symptoms with Clue can help you identify trends to bring to your healthcare provider. You can track your pain and its intensity alongside any supplements, medications, exercise, and other cycle experiences. 

This data may empower you to recognize what triggers your pain—and to be consistent with the small routine changes that help you feel your best. 

FAQs

Can your period cause joint inflammation?

Yes, hormonal changes before and during your period may contribute to inflammation and joint pain (1). When estrogen and progesterone levels drop, the body releases chemicals called prostaglandins as the uterine lining begins to shed (1).

Prostaglandins are linked to inflammation, and high levels are associated with pain (3,4). Low estrogen levels may also be linked to higher inflammation (5). 

Which joints are most affected by the menstrual cycle?

Joint pain related to the menstrual cycle is commonly reported in the knees, legs, and lower back (3). 

Does magnesium help with period joint pain?

Magnesium may be helpful for muscle and joint pain during the period, but more research is needed. Magnesium reduces prostaglandin levels in the body and may help protect against chronic pain (28). Vitamin D is another important nutrient that may help with period pain (30).