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Should periods be painful?

Ashley Dougvillo 
March 2, 2023

I think it is time to bring some attention to our monthly menstrual cycles.  Did you know that although they are annoying, they should not be debilitating?  Heavy cramps, heavy bleeding, excruciating low back pain or pelvic pain?  Somehow these symptoms have been normalized over the years, but missing school or work due to your period should not be the norm (and neither should these symptoms).  I want to break down a few things that could be at play because hey, knowledge is power!
First off, we are going to touch on just two big players that can affect your monthly period.  Let’s chat about endometriosis first. Endometriosis is a condition where tissue similar to the lining of the uterus can grow outside of the uterus.  “Endometriosis affects 10-15% of all women of reproductive age and 70% of women with chronic pelvic pain.”  Most women won’t receive a diagnosis for over 6 years!1  

Common symptoms of endometriosis include:

  • Dysmenorrhea (pain with your period) 
  • Heavy bleeding
  • Pelvic pain/groin pain (including between monthly cycles)
  • Constipation, difficulty with bowel movements
  • Pain with urination
  • Bloating/nausea/vomiting
  • Pain with intercourse 
  • Low back pain/abdominal pain

Above are some common symptoms associated with endometriosis and in some cases one of the first signs people may notice is actually changes in their digestive system!  But let’s switch gears and talk about another player called PCOS (polycystic ovarian syndrome) as this also can manifest in symptoms outside of the reproductive system. 

PCOS is also referred to as Stein- Leventhal Syndrome and has been shown to affect 8-13% of US women who are of reproductive age.  Guidelines are not always clear in the ways in which to firmly diagnose this condition. 2

Common symptoms of PCOS include: 

  • Acne
  • Difficulty losing weight/ weight gain
  • Skin tags
  • Male pattern hair growth
  • Darkened thickened skin
  • Pelvic pain
  • Infertility issues
  • Emotional issues
  • Dysregulation in monthly periods (or no period)
  • Insulin/metabolism issues 

In both of these examples,  there is still need for more research and better diagnostics.  I think a big takeaway is to know your family history as well as know your own body.  If you feel that something does not seem right (with yourself or your daughter), advocate to find the answers.  As is the case in most things, the earlier something is addressed, the easier it is to find the solution.  Feel free to consult with a pelvic floor physical therapist as well who can be a good resource to help you on your path to a healthy life. 


  1. Parasar P, Ozcan P, Terry KL. Endometriosis: Epidemiology, Diagnosis and Clinical Management. Curr Obstet Gynecol Rep. 2017;6(1):34-41. doi:10.1007/s13669-017-0187-1

      2. Teede HJ, Misso ML, Costello MF, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome [published correction appears in Hum Reprod. 2019 Feb 1;34(2):388]. Hum Reprod. 2018;33(9):1602-1618. doi:10.1093/humrep/dey256

Meet the Author
Ashley Dougvillo joined Smith Physical Therapy and Running Academy in 2019. She graduated from Marquette University in Milwaukee, WI in 2008, receiving her Bachelor of Science degree with a concentration in Biomedical Sciences. She then went on to attend Northwestern University in Chicago, IL to complete her Doctorate of Physical Therapy in 2010. She is a Certified Manual Therapist and has additionally obtained specialty certifications in the Pose Method of running, kinesiotaping, FMS/SFMA, ASTYM, and Women's Health.