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Period Pain and Fertility: Are Painful Periods a Sign of Good Fertility?

Zoe Kaplan
Zoe Kaplan

Painful periods are an uncomfortable and common symptom during the menstrual cycle. But what do they mean for your fertility? Here’s what you need to know.

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Dec 20, 2024
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Painful periods are an uncomfortable and common symptom during the menstrual cycle. But what do they mean for your fertility? Here’s what you need to know.

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Painful periods are an uncomfortable and common symptom during the menstrual cycle. But what do they mean for your fertility? Here’s what you need to know.

If you’re experiencing pain during your menstrual cycle, specifically your period, you may wonder what exactly is going on inside your body. Could these uncomfortable symptoms be a sign of something positive? Is the a relationship between period pain and fertility? Are painful periods a sign of good fertility?

Unfortunately, the link between painful periods and good fertility is generally a misleading myth.

If you’re experiencing painful periods while trying to conceive or planning for future pregnancy, here’s what you need to know.

What are painful periods?

Painful periods are periods that cause you pain, typically in your lower abdomen, during your menstrual cycle. Menstrual pain (medically known as dysmenorrhea) affects many women during their reproductive years. There are two main types of dysmenorrhea that can impact your monthly cycle in different ways.

  • Primary dysmenorrhea: characterized by cramping pain in the lower abdomen that typically begins a day or two before your period and can last for several days. This pain occurs without any underlying medical condition and often starts during adolescence.
  • Secondary dysmenorrhea: develops later in life and is caused by specific reproductive disorders or conditions. The pain may begin earlier in the menstrual cycle and last longer than typical period cramps.

If you experience painful periods, you’re not alone. According to WHO data, as many as 94% of young girls aged 10-20 experience menstrual pain, and a little under 10% (8.8%) of women 19–41 experience the same.

What causes pain during your periods?

The primary cause of menstrual pain lies in your body's natural response to the menstrual cycle. 

During your period, your uterus actively works to shed its lining through a complex series of muscular contractions. These contractions are orchestrated by natural compounds called prostaglandins, which your body produces in response to falling progesterone levels at the end of your cycle. 

When prostaglandin levels rise, they trigger stronger uterine contractions. These contractions serve an important purpose: they help detach and expel the uterine lining. However, these same contractions can temporarily reduce blood flow to the uterus, similar to how squeezing a muscle can briefly reduce its blood supply. This reduction in blood flow can cause the pain-sensing nerves in your uterus to become more sensitive, leading to the cramping sensation many women experience.

Some women naturally produce higher levels of prostaglandins, which can result in more intense contractions and stronger pain. 

Beyond the basic mechanism of uterine contractions, several other factors can contribute to menstrual pain:

  • Hormonal fluctuations: hormonal changes can affect how sensitive your body is to pain and influence the strength of uterine contractions. 
  • Anatomical variations: the position and size of your uterus can influence how you experience menstrual pain. For instance, a tilted uterus (retroversion) might cause increased discomfort during menstruation because it can affect how easily menstrual blood flows out of the body.
  • Inflammatory responses: During menstruation, your body releases inflammatory substances beyond just prostaglandins. These compounds can cause swelling and increased sensitivity in the pelvic region, contributing to pain and discomfort.
  • Stress and emotional factors: Your mental and emotional state can influence how you experience physical pain. Stress can increase muscle tension and lower your pain threshold, potentially making menstrual cramping feel more intense.
  • Underlying medical conditions: While some menstrual pain is normal, excessive pain might signal underlying conditions such as endometriosis, adenomyosis (where the uterine lining grows into the muscle wall of the uterus), or uterine fibroids. These conditions can intensify the normal pain of menstruation by creating additional inflammation, pressure, or anatomical changes that affect how your uterus functions during your period (more on those and fertility in the next section). 

What’s the link between painful periods and fertility?

Unfortunately, having painful periods is not inherently a sign of good fertility. The intensity of menstrual pain doesn't correlate with your ability to conceive or carry a pregnancy. Many women with minimal menstrual pain conceive easily, while others with severe pain may also have no difficulty getting pregnant.

However, it's important to understand that some causes of painful periods can affect fertility. The relationship isn't with the pain itself, but rather with potential underlying conditions.

Painful periods and infertility

Sometimes, severe menstrual pain can be a symptom of conditions that may impact fertility, including:

  • Endometriosis: a condition where tissue similar to the uterine lining grows outside the uterus. This can potentially affect reproductive organs through inflammation and make it harder for an embryo to implant.
  • Uterine fibroids: Non-cancerous growths in the uterus that can cause pain. When fibroids are near the fallopian tubes, they can block the path of eggs or sperm. They can also affect blood flow to the uterine lining, making it more difficult for a pregnancy to establish and grow. 
  • Pelvic inflammatory disease: An infection that can lead to scarring of reproductive organs if left untreated. If scarring occurs in your fallopian tubes, it can partially or completely block these paths—making it harder or impossible for sperm to reach the egg or for a fertilized egg to reach the uterus. 

These conditions often require medical attention not just for pain management, but also to protect your reproductive health and overall wellbeing. 

How to know if you’re fertile

Fertility isn't determined by how much pain you experience during menstruation. Instead, the main factor of fertility is ovulation—when you’re ovulating, you’re fertile.

Ovulation is crucial for fertility because you need to be ovulating in order to conceive. Ovulation is the moment when your ovaries release an egg to potentially be fertilized and become a pregnancy. 

Other factors that indicate healthy fertility include: 

  • Regular menstrual cycles (even if your cycle length varies)
  • Healthy fallopian tubes
  • Good egg quality
  • Good overall health

If you're concerned about your fertility, tracking your menstrual cycle and ovulation can provide valuable insights. The Oova kit offers personalized insights into your reproductive hormones—by measuring your specific hormone levels—so you can confirm if you’re ovulating with confidence. 

Finding relief from painful periods

Whether or not you're trying to conceive, you shouldn't have to suffer through intense menstrual pain.

Home remedies for painful periods include:

  • Heat therapy with a heating pad or warm bath
  • Gentle exercise and stretching
  • Over-the-counter pain relievers (consult your healthcare provider if trying to conceive)
  • Relaxation techniques and stress management
  • Dietary changes to reduce inflammation

While some period pain may be best treated with home remedies, it’s important to seek medical attention if you have severe pain that interferes with daily activities, pain that gets worse, or pain outside of your normal pattern. 

Your healthcare provider can help determine if there are underlying conditions causing your pain and develop an appropriate treatment plan that aligns with your fertility goals.

For underlying conditions causing painful periods, treatment options might include:

  • Hormonal medications (though these may not be appropriate when trying to conceive)
  • Physical therapy for pelvic pain
  • Surgical interventions for conditions like endometriosis or fibroids
  • Alternative therapies such as acupuncture 

Are painful periods a sign of good fertility? The bottom line

Painful periods, while common, aren't a reliable indicator of fertility. Every woman's body is different, and the intensity of menstrual pain doesn't predict your ability to conceive—the main indicator of your fertility is whether you’re ovulating or not.

If you're experiencing severe pain or have concerns about your fertility, don't hesitate to seek professional medical advice. Your reproductive health deserves attention and care, and there are many treatment options available to help you manage pain while protecting your reproductive health and overall wellbeing.

About the author

Zoe Kaplan
Zoe Kaplan is a writer and content strategist passionate about creating content that helps people navigate the world a little more easily. Zoe has worked across verticals, from women's career development to reproductive health. You can check out more of her work at zoeakaplan.com.

Sources

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https://www.oova.life/blog/progesterone-supplementation-guide
Can I take progesterone if I'm breastfeeding?
Yes, progesterone is generally safe while breastfeeding and doesn't significantly affect milk supply. However, always discuss with your healthcare provider before starting any hormone supplementation while nursing.
https://www.oova.life/blog/progesterone-supplementation-guide
Is it safe to take progesterone throughout pregnancy?
Yes, when prescribed by your healthcare provider. Progesterone supplementation in early pregnancy is safe and can reduce miscarriage risk in women with low progesterone or a history of pregnancy loss. Most providers continue supplementation through the first trimester (weeks 10-12) when the placenta takes over.
https://www.oova.life/blog/progesterone-supplementation-guide
Can progesterone supplementation cause weight gain?
Progesterone can cause temporary water retention and bloating, which may show up as a few pounds on the scale, but it doesn't cause true fat weight gain. Most women don't experience significant weight changes from progesterone supplementation.
https://www.oova.life/blog/progesterone-supplementation-guide
Can I switch from pills to suppositories or vice versa?
Yes, but only under your doctor's guidance. The dosing and timing may need adjustment when switching between forms since they're absorbed differently. Never switch on your own, especially if you're pregnant or undergoing fertility treatment.
https://www.oova.life/blog/progesterone-supplementation-guide
Will progesterone supplementation delay my period?
Yes, progesterone keeps the uterine lining intact, so if you're not pregnant and continue taking progesterone, your period will be delayed. Once you stop taking it, your period should start within 2-10 days. If you are pregnant, progesterone helps maintain the pregnancy and you won't get a period.
https://www.oova.life/blog/progesterone-supplementation-guide
Should I take progesterone pills orally or vaginally?
For fertility and pregnancy support, vaginal progesterone is usually preferred because it delivers higher concentrations directly to the uterus. For perimenopause or general hormone balance, oral progesterone often works well and is more convenient. Your doctor will recommend the best route based on your specific needs.
https://www.oova.life/blog/progesterone-supplementation-guide
When should I start taking progesterone after ovulation?
Typically, progesterone supplementation for luteal phase support starts 2-3 days after ovulation (confirmed by LH surge or temperature rise). Your doctor will give you specific timing based on your protocol. Some women start immediately after a positive ovulation test.
https://www.oova.life/blog/progesterone-supplementation-guide
What's better: progesterone cream or pills?
Pills (oral micronized progesterone) are generally more effective and reliable than creams because absorption from creams is inconsistent. For medical conditions like fertility issues, low progesterone, or HRT, prescription pills or suppositories are strongly recommended over over-the-counter creams.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
How can I tell if I have low or high progesterone?
The only definitive way to know is through hormone testing via blood tests or at-home urine tests that measure progesterone metabolites. However, symptom patterns can provide clues: anxiety and irregular periods suggest low progesterone, while bloating and extreme fatigue suggest high progesterone.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
When during my cycle should I test progesterone levels?
Test progesterone levels during the luteal phase, typically 7 days after ovulation or around day 21 of a 28-day cycle. This is when progesterone should be at its peak, making it easier to identify if levels are too low or too high.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
What are the main differences between low and high progesterone symptoms?
Low progesterone typically causes irregular or heavy periods, anxiety, hot flashes, and sleep issues. High progesterone causes bloating, fatigue, intense breast tenderness, and depression-like mood changes. Low progesterone symptoms persist throughout your cycle, while high progesterone symptoms are most intense during the luteal phase.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
Can you have symptoms of both low and high progesterone?
Some symptoms like breast tenderness and mood changes can occur with both low and high progesterone, making it confusing. However, the timing, intensity, and accompanying symptoms differ. Hormone testing is the best way to determine which imbalance you're experiencing.
https://www.oova.life/blog/10-dpo
Can stress affect 10 DPO symptoms?
Yes, stress can worsen or mimic 10 DPO symptoms. Stress increases cortisol, which can cause cramping, fatigue, and mood changes similar to both PMS and early pregnancy. During the two-week wait, try stress-reduction techniques like gentle exercise, meditation, or spending time with loved ones.
https://www.oova.life/blog/10-dpo
Is it better to test at 10 DPO or wait?
It's better to wait until 12–14 DPO for more accurate results. Testing at 10 DPO often leads to false negatives because hCG levels may still be too low. If you absolutely can't wait, use a sensitive early detection test with first morning urine, and be prepared to retest in 2–3 days if negative.
https://www.oova.life/blog/10-dpo
What does implantation bleeding look like at 10 DPO?
Implantation bleeding at 10 DPO is typically light pink or brown, much lighter than a period, and lasts 1–2 days. It's often just spotting when you wipe or a few drops on a panty liner. However, only 15–20% of pregnant women experience implantation bleeding—most don't have any bleeding at all.
https://www.oova.life/blog/10-dpo
Why am I cramping at 10 DPO?
Cramping at 10 DPO can be caused by elevated progesterone (whether you're pregnant or not), implantation (if you're pregnant), or premenstrual cramping. Unfortunately, cramping alone can't tell you if you're pregnant since progesterone causes similar symptoms in both scenarios.
https://www.oova.life/blog/10-dpo
What are the chances of a BFP at 10 DPO?
If you're pregnant, you have about a 50–60% chance of getting a positive test at 10 DPO. This means there's a 40–50% chance of a false negative even if you conceived. Chances improve significantly by 12–14 DPO.
https://www.oova.life/blog/10-dpo
What DPO is most accurate for pregnancy testing?
14 DPO (the day of your missed period) is the most accurate time to test, with 99% accuracy. 12 DPO offers 80–90% accuracy. 10 DPO has only 50–60% accuracy. For best results, wait as long as you can—ideally until 12–14 DPO.
https://www.oova.life/blog/10-dpo
Is 10 DPO too early to test?
10 DPO is considered early for pregnancy testing. While some women get positives at 10 DPO, accuracy is only 50–60% if you're pregnant. For best results, wait until 12 DPO (80–90% accuracy) or 14 DPO/missed period (99% accuracy).
https://www.oova.life/blog/10-dpo
Can you have implantation at 10 DPO?
Yes, implantation can still occur at 10 DPO, though 84% of women have already implanted by this point. Late implantation at 10–12 DPO is normal. If implantation happens at 10 DPO, you won't get a positive pregnancy test for another 2–3 days.
https://www.oova.life/blog/10-dpo
What does a negative test at 10 DPO mean?
A negative test at 10 DPO does not mean you're not pregnant. It's very common to get negatives at 10 DPO even if you conceived. Your hCG levels may still be too low, or implantation may have occurred later. Wait until 12–14 DPO to retest for more accurate results.
https://www.oova.life/blog/10-dpo
Can you get a positive pregnancy test at 10 DPO?
Yes, but only about 50–60% of pregnant women will get a positive at 10 DPO. The other 40–50% have hCG levels that are still too low to detect. If you test negative at 10 DPO, wait 2–3 days and test again.
https://www.oova.life/blog/high-progesterone-symptoms
Can high progesterone cause weight gain?
Yes, elevated progesterone can cause temporary weight gain through water retention and bloating. This is a normal part of the luteal phase and early pregnancy.
https://www.oova.life/blog/how-to-increase-estrogen
Does stress affect estrogen levels?
Yes, chronic stress elevates cortisol, which can suppress estrogen production and disrupt hormonal balance. Stress reduction through meditation, yoga, adequate sleep, and self-care practices helps maintain optimal estrogen levels.
https://www.oova.life/blog/how-to-increase-estrogen
When should I consider medical treatment for low estrogen?
Consider medical intervention if natural methods don't improve symptoms after 3 months, if symptoms severely impact quality of life, if you're experiencing early menopause (before 40), or if you have fertility concerns. Hormone replacement therapy may be appropriate in these cases.
https://www.oova.life/blog/how-to-increase-estrogen
What are the signs that my estrogen is increasing?
Signs of rising estrogen include more regular menstrual cycles, reduced hot flashes, improved vaginal lubrication, better mood stability, increased energy, and improved skin elasticity. You may also notice reduced symptoms that originally indicated low estrogen.
https://www.oova.life/blog/how-to-increase-estrogen
Can exercise increase estrogen levels?
Yes, moderate exercise stimulates estrogen release and helps maintain hormonal balance. Aim for 150 minutes of moderate cardio weekly plus strength training twice per week. However, excessive exercise can actually lower estrogen, so balance is key.
https://www.oova.life/blog/how-to-increase-estrogen
How long does it take to increase estrogen naturally?
With consistent dietary and lifestyle changes, you may notice improvements in symptoms within 4-8 weeks. However, significant hormonal changes typically take 2-3 months. Tracking your cycle and symptoms can help you monitor progress.
https://www.oova.life/blog/how-to-increase-estrogen
What foods increase estrogen levels naturally?
Foods high in phytoestrogens can help increase estrogen naturally. The best options include flax seeds (high in lignans), soy products (tofu, tempeh, edamame), lentils, chickpeas, whole grains (oats, quinoa, brown rice), and garlic. These plant compounds mimic estrogen's effects in the body.
https://www.oova.life/blog/perimenopause
What helps relieve hot flashes quickly?
Cool environments, layered clothing, herbal teas, and medical treatments like gabapentin or HRT may help—depending on severity. Lifestyle changes like reducing caffeine and alcohol can also provide relief.
https://www.oova.life/blog/perimenopause
Are there tests to confirm perimenopause?
Yes. Tests measuring estradiol, LH, and FSH levels can indicate hormonal shifts—but diagnosis is often symptom-based since hormone levels fluctuate widely during perimenopause.
https://www.oova.life/blog/perimenopause
How do I know it's perimenopause and not something else?
A doctor may recommend hormone testing (like LH, E3G, and PdG) and track symptom timing. Diagnosis is often based on symptoms combined with age and menstrual pattern changes.
https://www.oova.life/blog/perimenopause
What's the earliest age perimenopause can start?
Some women begin experiencing symptoms as early as their mid-30s, though perimenopause typically starts between ages 38-45.
https://www.oova.life/blog/perimenopause
Does perimenopause affect mental clarity?
Yes. Brain fog and difficulty concentrating are common during hormone fluctuations in perimenopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
What happens after the last sign of perimenopause?
After your final period, you enter postmenopause. You'll need 12 consecutive months without a period to confirm menopause. Many symptoms gradually improve, though some like vaginal dryness may persist without treatment.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
When do perimenopause symptoms finally stop?
Some symptoms like brain fog improve after menopause, while others like hot flashes may continue for up to 10 years post-menopause. Vaginal symptoms often persist or worsen without treatment. Each person's timeline is different.
https://www.oova.life/blog/high-progesterone-symptoms
Is high progesterone a sign of pregnancy?
Yes, high progesterone is one of the earliest indicators of pregnancy. Progesterone levels rise significantly after conception to support the developing embryo and reach their peak during the third trimester.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
Can you still get pregnant in late perimenopause?
Yes, you can still get pregnant during perimenopause as long as you're having periods, even if they're infrequent. Continue using birth control until you've gone 12 consecutive months without a period and have officially reached menopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
Do symptoms get worse before perimenopause ends?
Yes, most perimenopause symptoms intensify in the final 1-2 years before menopause. Hot flashes peak around your final period, vaginal symptoms worsen, and mood changes increase. However, brain fog typically improves in late perimenopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
How long does late perimenopause last?
Late perimenopause typically lasts 1-3 years before your final period. However, the exact duration varies significantly from person to person. You've reached menopause after 12 consecutive months without a period.
https://www.oova.life/blog/high-progesterone-symptoms
What are the symptoms of high progesterone?
High progesterone symptoms include fatigue, bloating, breast tenderness, weight gain, anxiety, depression, headaches, and food cravings. During pregnancy, you may also experience increased nipple sensitivity and muscle aches.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
What are the first signs that perimenopause is ending?
The earliest signs include longer gaps between periods (60+ days), intensifying hot flashes that peak around your final period, and worsening vaginal dryness. These symptoms typically increase in late perimenopause before you reach official menopause.
https://www.oova.life/blog/high-progesterone-symptoms
When should I be concerned about high progesterone?
Consult a healthcare provider if you experience high progesterone symptoms outside your luteal phase when not pregnant, or if symptoms include severe pelvic pain, abnormal vaginal bleeding, or rapid weight gain while on hormone therapy.
https://www.oova.life/blog/high-progesterone-symptoms
How do you test progesterone levels?
Progesterone can be measured through blood tests at your doctor's office or at-home urine tests that measure PdG (a progesterone metabolite). Testing is typically done during the luteal phase, about 7 days after ovulation.

About the Oova Blog:
‍Our content is developed with a commitment to high editorial standards and reliability. We prioritize referencing reputable sources and sharing where our insights come from. The Oova Blog is intended for informational purposes only and is never a substitute for professional medical advice. Always consult a healthcare provider before making any health decisions.

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