Breakouts, emotional outbursts and feeling like a chronically exhausted husk are just a few of the evils you can expect from PMS. But why is your lower back throbbing when your uterus is the one apparently doing all the work?
Unless your uterus is tilted backwards (which is the case in around 20% of women and will probably cause period pains to happen in the lower back) your uterus is located towards the front.
But an estimated three quarter of people who menstruate experience pain in their back reports Dr Sherry A. Ross. So why does that happen?
"Period pain is a normal and common part of your menstrual cycle. It is caused by contractions in the uterus as it prepares to shed its lining which can refer pain throughout the pelvis as a result of the 'shared' nerve supply between organs and muscles," explains Kate Walsh, Specialist Pelvic Physiotherapist at Mallucci London.
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The pain happens when blood and oxygen supply to tissues is cut off by the contractions. The tissues don't have access to oxygen and release pain-releasing chemicals and a type of hormone called prostaglandins, which cause further cramping.
"This can cause muscle spasms often felt radiating in the lower back as a dragging ache or pain, as well as the lower tummy area and inner thighs."
Some experts, including Dr Sherry, also believe that this pain could be due to something called 'referred pain'. She writes: "Due to nerve fibres in the pelvis, you can perceive pain in another part of your body." Translation: the pain isn't in your back, but your mind thinks it is.
Chances are, if you've always had similar period pains, it's nothing to worry about. "But there are a few signs that the pain could be more serious," explains Narendra Pisal, consultant gynaecologist at London Gynaecology.
- Intensity: If you need to take constant painkillers or cannot do your day to day activities, you need to seek medical attention.
- Other symptoms: Such as fainting, loose bowel movements (BMs), painful BMs and vomiting also indicate that you need to see a doctor.
- Taking time off work or school: If your periods are affecting the quality of life in a major way, it is important to take steps to alleviate the symptoms.
- Heaviness of periods: If the pain is associated with heavier periods with clots and flooding, that can indicate a physical problem such as uterine fibroids.
- Pain during sex: Deep pain during sex associated with painful periods can sometimes indicate a condition called 'endometriosis'
Book an appointment with your GP if you're worried.
If they're just a monthly pain (pun intended) and nothing serious, is there anything that you can do to prevent symptoms? "We don't know what lifestyle factors (if any) cause period pains - but we know what can help," says Narendra. "Exercise, maintaining a healthy body mass index and nutritional changes like avoiding sugars and dairy will reduce period pains."
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And if you're already suffering Narendra has a few suggestions to feel better faster, but always speak to your doctor beforehand:
- Simple painkillers can help, but don't underestimate the power of a hot water bottle.
- Prescription medications such as tranexamic acid (to reduce the amount of bleeding) and mefenamic acid (great for relieving spasms) are effective.
- Taking the combined contraceptive pill often can make the periods lighter and less painful.
- If your mood's affected this can be due to hormonal changes. It is important to keep a symptoms diary and see if this is definitely the case. Simple medications such as evening primrose oil tablets or vitamin B supplements can help.
"If these steps aren't helping, it's probably best to see your a gynaecologist [or go via your GP] for an assessment and a pelvic ultrasound scan."
A medical professional can then offer advice or search for the root cause of the problem.