The Holland Clinic — For Young Women
This guide was written for you — a young woman experiencing period pain and wanting to understand it properly. Not to scare you, not to overwhelm you. To give you real information, clearly explained.
From The Holland Clinic, for women of every age and their daughters
Before we begin
Period pain is one of the most common experiences young women have, and one of the least well explained. You are often told it is normal, given a painkiller, and sent on your way. Sometimes that is enough. But if your pain is significant, recurring, or affecting how you live each month, you deserve a real explanation — not just management.
This guide does not tell you what you must do. It gives you the information that allows you to understand your own body and make your own choices. That is what good medicine looks like.
Dr Kirstey Holland works primarily with women in perimenopause — typically their forties and fifties. But she is deeply committed to the idea that the earlier a young woman understands her hormonal health, the better equipped she is for the decades ahead. This guide exists in that spirit. What you learn now can change the experience of your cycle for the rest of your life.
The science, simply explained
Period pain has a specific name — dysmenorrhoea. And it has a specific cause. It is not random, not inevitable, and not a character test. It is chemistry.
Each month, the lining inside your uterus thickens in preparation for a possible pregnancy. When pregnancy does not occur, that lining breaks down and leaves your body as your period. That process is what causes the pain — but not because shedding a lining is inherently painful. It is because of the chemical messengers involved.
Imagine your uterus receives a signal that says: "Time to clear out." That signal comes in the form of chemical messengers called prostaglandins. The more prostaglandins your body releases, the stronger the signal — and the more intense the cramping.
Prostaglandins cause two things at once. First, they make the uterine muscle contract — the cramping you feel. Second, they cause the blood vessels inside the uterus to tighten, which briefly reduces blood flow. When muscle does not get enough blood (and therefore oxygen), it produces intense pain. This is the same type of pain as a severe muscle cramp, but inside the uterus.
Some prostaglandins also enter the bloodstream, which is why period pain often comes with nausea, loose bowels, headache, or just feeling terrible all over. Those are not separate problems. They are the same chemistry, affecting more of your body.
Traditional Chinese Medicine has been treating period pain for over 2,000 years. Its understanding is different in language but remarkably consistent in practice. TCM describes period pain as arising when blood does not flow freely through the uterus — a concept called Blood stagnation. It also identifies cold (in the body and in food) as a trigger, and emotional stress as a driver of the pattern it calls Liver Qi stagnation.
Modern research has now confirmed the mechanism behind these observations. The blood vessel constriction and oxygen deprivation that TCM calls Blood stagnation is exactly what the prostaglandin cascade produces. Cold exposure measurably increases prostaglandin production. Emotional stress disrupts the hormonal system in ways that worsen the period. Two completely different starting points. Same destination.
The amount of prostaglandins your body produces is not fixed. It is influenced by what you eat, how you move, how much you sleep, how stressed you are, and the nutritional state your body is in going into each cycle. That means period pain is changeable. That is the whole point of this guide.
Understanding the causes
Period pain is not random. Several specific factors cause the body to produce more prostaglandins than it needs to. Understanding them is the first step to reducing them.
Stress is not just a feeling. It is a physical state that raises a hormone called cortisol. Elevated cortisol disrupts the hormonal system that governs your cycle and raises inflammation throughout the body — which increases prostaglandin production. It also lowers your pain threshold, so the same amount of pain is experienced as more intense.
TCM identified this connection thousands of years ago. The Liver meridian in TCM is responsible for the smooth flow of energy and blood. When someone is under chronic stress or suppressing emotions, the Liver becomes stagnant — and this manifests directly in the menstrual cycle as pain, clots, and irregularity.
The culture around menstruation matters. Being told period pain is normal and just something to manage means many young women never investigate what is driving it or try to change it. Work and school schedules that do not allow rest during a painful first day add physical stress to the physiological one. A diet shaped by convenience and not nutrition contributes to the fatty acid imbalance that worsens pain. These are real inputs, not excuses.
The reason it matters
Reducing period pain is not just about the days you are in pain. Addressing the underlying causes changes the experience of your cycle and, beyond that, sets up your hormonal health for the decades ahead.
When oestrogen and progesterone are balanced and inflammation is low, the period becomes regular, moderate in flow, and largely free of significant pain. The week before your period stops feeling like something to dread. Energy does not crash. Mood is more stable. The cycle becomes — as it is meant to be — a monthly signal about how your body is doing, not a monthly disruption to endure.
The nutritional and gut health work that reduces period pain also improves skin, mood, energy, and sleep. None of it is isolated. Hormonal health is whole-body health.
There is also something more personal. Many women describe feeling a different relationship with their body when they understand what is happening and feel able to influence it. That is not a small thing. Understanding your own biochemistry is a form of freedom that belongs to every young woman.
The full picture at a glance
Before we go through each area in detail, here is how it all connects — what is driving the pain and what you can actually change about it.
Each of these areas is explained in detail in the guide below.
The Vitality Protocol
The following seven areas all directly influence period pain. None of them require you to be perfect. Small consistent changes in each area compound over a few cycles into a meaningfully different experience.
Because prostaglandins are made from fat, what you eat directly determines how much pain-producing chemistry your body has available.
If you are on or have been on the combined oral contraceptive pill, it is important to know that it affects your gut bacteria in specific ways. It reduces the diversity of gut bacteria, increases how porous your gut lining becomes, and impairs the gut bacteria that are responsible for clearing oestrogen from the body. This means oestrogen that should be excreted is instead reabsorbed, adding to the hormonal load. The gut is also where approximately 90% of the body's serotonin is produced — which partly explains why mood changes are so commonly reported on the pill. This does not mean you should not take the pill. It means that gut health deserves attention if you are on it or have been. A daily probiotic, adequate dietary fibre, and fermented foods are a practical starting point.
Poor sleep raises cortisol and inflammation — two of the main drivers of prostaglandin excess. Good sleep in the days before and during your period genuinely reduces pain the following month.
Your body does most of its hormonal regulation and repair during sleep. The progesterone that should calm the second half of your cycle works better when you are resting adequately. The inflammation that drives prostaglandin production is directly regulated during sleep.
Practically: aim for at least eight hours in the days before your period. Avoid screens for an hour before bed — the blue light suppresses melatonin, which delays the hormonal cascade your body needs for restorative sleep. Keep your room cool and dark. These are not optional comfort preferences. They are inputs into the chemistry that determines how much pain you experience each month.
Regular movement between periods reduces the overall inflammatory load and improves the hormonal environment that determines prostaglandin production. It does not need to be intense — consistent moderate movement (walking, swimming, cycling, yoga) over the course of a month is more relevant to period pain than any single workout.
During the period itself, gentle movement helps. A short walk increases pelvic blood flow, which directly addresses the ischaemia — the blood vessel constriction causing the oxygen deprivation — that produces cramping. Restorative yoga postures that open the pelvis (child's pose, reclined butterfly, pigeon pose) provide mechanical relief and activate the part of the nervous system that reduces pain perception.
TCM advises against vigorous cold-exposure exercise during the bleed — no icy swimming, no extremely high-intensity training on the first two days. Not because exercise is bad, but because cold and extreme exertion add to the cold-stagnation and blood movement demands the uterus is already managing.
First thing in the morning, even a ten-minute walk outside sets your body clock correctly for the day — which supports sleep that night, which supports hormone balance, which reduces period pain. The circadian rhythm is not separate from the hormonal system. It is part of it.
Stress worsens period pain. Not because period pain is "in your head" — the pain is absolutely real and biochemically driven — but because stress raises cortisol, which disrupts the hormonal axis that governs your cycle, promotes inflammation, and lowers your pain threshold. All three make the same prostaglandin load more painful.
The nervous system also directly controls muscle tension. Chronic low-grade tension in the pelvis and lower back — the kind that accumulates with sustained stress or poor posture — compounds the cramping that is already happening. Releasing this tension through movement, breath, or bodywork genuinely reduces the pain experience.
Your cycle is a monthly report card on your body's health. The amount of pain, the colour and flow, the presence of clots, how you feel in the days before — all of this is information. A painful period with heavy flow and significant premenstrual symptoms is not a punishment. It is a signal that something in the underlying environment deserves attention. Learning to read that signal is one of the most useful things you can do for your long-term health.
Simple practices that work: slow breathing (breathe in for 4 counts, out for 6 to 8) activates the parasympathetic nervous system and measurably lowers pain. Applying heat to your lower abdomen is as effective as ibuprofen for mild to moderate cramping — not as a distraction but as a direct physiological mechanism (warmth activates the same nerve receptors that pain signals travel through). A consistent wind-down routine before sleep reduces the cortisol that would otherwise worsen the next month's cycle.
Being told your pain is normal — by a doctor, by a culture, by people around you — has real consequences. Women who have their pain minimised delay seeking help, underreport symptoms, and internalise the message that endurance is the correct response. None of this is biologically neutral. The stress of being dismissed adds to the physiological burden.
Finding people who understand the mechanism — practitioners who take the investigation seriously, community that validates the experience — is part of the healing environment. That is why guides like this one exist. You should not have to accept significant recurring pain as the price of having a period.
Talk to your mum, if she is someone you can talk to. If she is in perimenopause, she may be experiencing her own version of oestrogen dominance and period changes. The biochemistry is related. What helps you may also help her — and what she is learning about her own hormonal health is directly relevant to yours.
Most period pain in young women responds well to the nutritional and lifestyle changes in this guide. Investigation becomes important when pain is severe, non-responsive to those changes, or when specific features are present that suggest a structural cause (see red flags below).
If you are investigating, the most relevant things to check are:
A pelvic ultrasound is warranted when pain is severe, non-responsive to treatment, or when the red flag features below are present. Endometriosis in particular is frequently undiagnosed for years in young women because their pain is normalised rather than investigated.
These are the supplements and botanical medicines with the best evidence for period pain in young women. They work alongside — not instead of — the dietary and lifestyle foundations above.
| Supplement | What it does and when to take it |
|---|---|
| Magnesium glycinate | Relaxes uterine muscle directly. Reduces cramp intensity and duration. Take 300mg daily in the evening; increase to morning and evening in the week before and during your period. This is the supplement with the most immediate and reliable impact on cramping. |
| Omega-3 (fish oil) | Shifts the prostaglandin balance from the pain-producing type to a gentler version. Take daily, not just around the period. The effect builds over 6–8 weeks of consistent use. 1–2g combined EPA/DHA daily from a quality source. |
| Zinc | Reduces the enzyme (COX-2) that makes prostaglandins. Also supports progesterone production. 15–25mg daily with food. Do not take on an empty stomach. |
| Ginger | Multiple clinical trials show 1g daily from two days before the period is as effective as ibuprofen for pain reduction. Works both as anti-prostaglandin and as a warming botanical addressing the cold-stagnation pattern. Can be taken as capsule, tea, or fresh ginger in food. |
| Vitamin B6 (P5P form) | Supports progesterone production and reduces premenstrual symptoms. Particularly important if you are on or have been on the combined pill, which depletes B6. 25–50mg daily as pyridoxal-5-phosphate. |
Heat — a heat pack or hot water bottle applied to your lower abdomen and lower back. Research shows this is as effective as ibuprofen for mild to moderate cramping. It is not a distraction. It is a direct physiological mechanism.
Ginger tea — make it strong, with fresh ginger, and drink it warm from the day before your period. The warming effect is therapeutic, not just comforting.
Ibuprofen — when you need it, take it at the very first sign of cramping, before the pain establishes. It works by blocking prostaglandins and is significantly more effective taken early. Use occasionally as needed; regular monthly use over years starts to affect gut integrity, which worsens the oestrogen-clearance problem that drives pain.
What you should know
These work by blocking the COX enzymes that produce prostaglandins. They are effective and appropriate when used occasionally and when taken early — before the prostaglandin cascade peaks. Used every single month for days at a time, they gradually affect gut integrity. The same prostaglandins they block are also the ones that protect the stomach lining. This is worth knowing, not to create fear, but to understand why addressing the root cause reduces reliance on them over time.
The pill suppresses ovulation and thins the uterine lining, which reduces prostaglandin production and therefore reduces pain. For many young women it is effective. Here is what does not usually get explained at the time of prescribing.
The pill works by switching off the communication between your brain and your ovaries. Your brain sends a signal every month; the pill blocks that signal. The ovaries do not receive the instruction to ovulate, so they do not produce the progesterone that follows ovulation. What you experience as a period on the pill is not a real period — it is a withdrawal bleed from the synthetic hormones in the pill. This is not necessarily a problem, but it means that the pill is not treating the underlying hormonal imbalance. It is replacing the cycle with a different one.
The pill also affects the gut microbiome in specific ways: it reduces diversity of gut bacteria and increases intestinal permeability (how porous the gut wall becomes). Because the gut bacteria are responsible for clearing oestrogen, this impairment leads to oestrogen being reabsorbed rather than excreted. Over time, this can compound the oestrogen dominance that was driving the pain in the first place. The gut is also where most of the body's serotonin is produced — which is part of why mood changes are commonly reported. None of this is a reason to not take the pill. It is a reason to know, and to support your gut health if you do.
When the pill is stopped, the original pattern usually returns. Ideally, the time on the pill is also time spent building the nutritional and lifestyle foundation that means the pain does not return at full intensity when you stop.
Important
Most period pain responds to what is in this guide. But some features warrant investigation by a doctor rather than self-management. Please seek medical assessment if you experience any of the following.
These features may indicate endometriosis, adenomyosis, or other structural causes that require clinical investigation. Endometriosis in particular is often diagnosed years after symptoms begin, because pain is normalised. If pain significantly disrupts your daily life, that is enough reason to ask for further investigation.
Dr Kirstey Holland works with women who want to understand and address what is driving their hormonal and metabolic health, at every stage of life.