Period pain and sport: how much pain is normal, and what actually works

71% of young women under 25 have period pain, and one in five has already missed school because of it. Among athletes, dysmenorrhoea is the most common menstrual cycle disorder. Yet almost nobody tells a 14-year-old two simple things: that period pain has treatments with evidence behind them — exercise, heat, medication — and that pain which keeps making her miss training is not something to endure, it is something to have assessed.

Period pain is the most common health reason a girl misses school or training, and it is also the one least talked about: 71% of young women under 25 have it, and one in five has already stayed home because of it. The good news is that menstrual pain is not something to wait out: it has treatments with evidence behind them, and it has clear thresholds beyond which it should be looked at by a professional.

Key points

  • Dysmenorrhoea affects 71.1% of young women under 25; 20.1% have missed school or university because of the pain, 40.9% report an impact on concentration and performance (Armour et al., 2019 — population under 25, not only adolescents).
  • Among athletes it is the most frequent menstrual cycle disorder: prevalence 32.3% across 60 studies and 6,380 athletes, with a very wide range across studies (7.8-85.6%) (Taim et al., 2023).
  • Among adolescents aged 10-18, between 25.2% and 61.1% avoid or reduce physical activity during menstruation (Harvey et al., 2025).
  • Exercise reduces pain intensity (SMD -1.86; low quality evidence) and heat reduces it by 1.85 cm out of 10 with fewer adverse effects than NSAIDs (low certainty).
  • The threshold to remember: if pain does not improve within 3-6 months of treatment, secondary causes are investigated — endometriosis included (ACOG, 2018).

How many girls actually have period pain?

Around seven in ten. In a systematic review with meta-analysis of 38 studies and 21,573 young women, the prevalence of dysmenorrhoea — the medical term for menstrual pain — was 71.1%. And the pain does not stay confined to the days of menstruation: 20.1% reported being absent from school or university because of it, and 40.9% that it affected their concentration or classroom performance (Armour et al., 2019, Journal of Women's Health).

The usual caveat on age applies: that sample is made up of young women under 25, largely high school and university students. It is the closest population we have to a 14-year-old; it is not exactly her. The direction of the finding is hard to dismiss all the same: period pain is not an exception, it is the statistical norm — and it is already costing one girl in five hours of school.

Is period pain a problem in sport too?

Yes, and it is the most frequent menstrual cycle disorder among athletes. A systematic review of 60 studies and 6,380 athletes not using hormonal contraception found a dysmenorrhoea prevalence of 32.3%, the highest of all the cycle disorders surveyed (Taim et al., 2023, Sports Medicine). The range across individual studies is enormous — from 7.8% to 85.6% — and that is the most honest number to report: change the definition, change the questionnaire, change the sport, and the figure moves by a factor of ten. What the range does not allow you to say is that this is rare.

Then there is the part nobody counts, because it leaves no trace in any injury register. Among adolescents aged 10-18, between 25.2% and 61.1% avoid or reduce physical activity during menstruation, and the recurring reasons are not only pain: fear of leaks and embarrassment are in there too (Harvey et al., 2025, BMC Women's Health). Those are lost training sessions that appear nowhere — the same silent mechanism we described writing about the menstrual cycle and performance and why girls quit sport in adolescence.

How much period pain is "normal"?

The right question is not how much pain is normal, but how much the pain is taking away. The practical criterion is this: pain you manage, that does not stop you doing things, is one thing; pain that every month costs school, training or sleep is another, and it deserves an assessment.

Medicine distinguishes two situations. In primary dysmenorrhoea — by far the most common form in adolescents — the pain arises from the physiology of menstruation itself, with no underlying pelvic pathology. In secondary dysmenorrhoea there is an identifiable cause, and in this age group the leading one is endometriosis. The American College of Obstetricians and Gynecologists document written specifically for adolescents sets a clear operational threshold: when pain does not improve clinically within 3-6 months of starting therapy, secondary causes should be investigated and adherence to treatment checked (ACOG Committee Opinion No. 760, 2018).

Why that threshold matters more than it looks: the sentence "it's just period pain, it passes" is exactly what turns a treatable symptom into years of living with it. It is the same normalisation mechanism that makes low back pain and knee pain invisible in young female athletes — and it is worth remembering that in adolescence pain is not simply "less serious" because the body is young.

A necessary point of method: this article is not here to tell one form from the other. That is a clinician's job. It is here so that the distinction is known, and so that there is a moment at which waiting stops.

What actually works for period pain?

Three routes have evidence behind them, with different quality and different implications. None of the three is a folk remedy, and none is a miracle.

What What the evidence says Quality of evidence Who decides
Exercise Large reduction in pain intensity versus doing nothing (SMD -1.86; 95% CI -2.06 to -1.66), around 25 mm on a 100 mm scale. Dose: 45-60 minutes, ≥3 times a week, any intensity Low (Cochrane, 12 studies, 854 women) The athlete, with her coach
Heat (hot water bottle, self-heating patch) -1.85 cm on a 10 cm scale versus no treatment; no worse than NSAIDs, with fewer adverse effects (RR 0.30) Low for pain, moderate for safety (57 RCTs, 5,359 participants, median of mean ages 22.3 years) The athlete
NSAIDs (anti-inflammatory painkillers) Pain relief around 4 times more likely than with placebo (OR 4.37; 95% CI 3.76-5.09); more adverse effects than placebo (OR 1.29) Low (Cochrane, 80 RCTs, 5,820 women) A doctor or pharmacist

On exercise, the finding deserves a careful read, because it overturns a common intuition. The Cochrane review of 12 studies and 854 women concludes that exercise — low intensity such as yoga and stretching, or high intensity such as aerobics and Zumba — may substantially reduce menstrual pain intensity compared with doing nothing (Armour et al., 2019, Cochrane Database of Systematic Reviews). The authors are explicit about two limits: the quality of the evidence is low, and it is not known whether the benefit persists once regular training stops.

On heat, the largest meta-analysis available — 57 randomised trials and 5,359 participants — estimates a pain reduction of 1.85 cm on a 10 cm visual analogue scale versus no treatment, and analgesic efficacy no worse than NSAIDs with a better safety profile (relative risk of adverse effects 0.30; 95% CI 0.15-0.59) (Yuan et al., 2026, Frontiers in Medicine). Certainty of evidence: low for pain, moderate for safety. The median of mean participant ages is 22.3 years: young women, not 13-year-olds. It remains the cheapest, most accessible option on the list, and the one with the fewest contraindications — a hot water bottle in the kit bag costs less than a pair of socks.

On NSAIDs, the Cochrane review of 80 randomised trials and 5,820 women shows a clear effect: pain relief is around four times more likely than with placebo (OR 4.37; 95% CI 3.76-5.09), with relief rates of 45-53% versus 18% on placebo. In the same review, however, adverse effects are more frequent than with placebo (OR 1.29; 95% CI 1.11-1.51), particularly gastrointestinal (OR 1.58) and neurological ones (OR 2.74), and the overall quality of evidence is rated low (Marjoribanks et al., 2015). For a minor, drug, dose and timing are a decision for a doctor or a pharmacist — never for the coach, and never improvised on the sideline.

Is training with period pain bad for you?

No — and the available evidence points the other way: exercise sits among the studied treatments for menstrual pain, not among its risk factors. That does not mean a girl in pain must train regardless. It means the correct message is not "rest until it passes", but "moving, if you feel up to it, is probably part of the solution".

The difference between those two sentences is enormous in practice. The first authorises skipping, and at 13-14 skipping repeatedly is often not a pause: it is the start of an exit, in a window when girls leave sport more than their male peers do. The second leaves the choice with the athlete, but removes the idea that her body, on those days, is out of order.

One last caveat, for completeness: if menstrual pain is severe enough to prevent normal activities, the answer is neither "grit your teeth" nor "just rest" — it is to have it assessed.

What can a coach do?

Nothing clinical. Three practical things, all free:

And one thing not to do: ask for diagnoses, details or dates. Staff do not need an individual athlete's clinical data — they need to know how to dose today's session.

When to speak to a doctor

These are reasonable reasons to ask for an assessment, without alarm and without waiting:

None of these points is a diagnosis. They are thresholds: they exist to decide when to stop waiting.

BAB helps adolescent athletes recognise and name their body's signals — energy, recovery, pain, cycle — in a private space, and gives families and clubs the tools to support them without ever asking them to expose themselves. So that "it's just period pain" is no longer the end of the conversation.

Sources

This article is for information and education only. It is not medical advice and not a diagnostic tool. If menstrual pain limits normal activities, see a healthcare professional.

How many girls have period pain?

Most of them. In a systematic review with meta-analysis of 38 studies and 21,573 young women, the prevalence of dysmenorrhoea was 71.1%; 20.1% reported being absent from school or university because of the pain and 40.9% reported that it affected their concentration or classroom performance (Armour et al., 2019). Note the population: young women under 25, largely high school and university students — this is not an estimate built solely on 13- and 14-year-olds.

Is it normal to have period pain bad enough to miss training?

Period pain is common, but 'common' does not mean 'to be endured in silence'. The clinical distinction is clear: in most adolescents this is primary dysmenorrhoea, meaning pain without underlying pelvic pathology, and it is treatable. The American College of Obstetricians and Gynecologists document written specifically for adolescents states that when pain does not improve clinically within 3-6 months of starting therapy, secondary causes and treatment adherence should be investigated — with endometriosis the leading cause of secondary dysmenorrhoea in this age group (ACOG, 2018). In practice: pain that costs training sessions or school days every month is not a personality trait to manage, it is a reason to be assessed.

Does exercise help with period pain?

The available evidence says yes, with a caveat about its quality. A Cochrane review of 12 studies and 854 women found that exercise may substantially reduce menstrual pain intensity compared with doing nothing (SMD -1.86; 95% CI -2.06 to -1.66), roughly 25 mm on a 100 mm visual analogue scale; the quality of the evidence, however, is rated low (Armour et al., 2019). The dose used in the studies is well within reach of any team: 45-60 minutes, at least three times a week, at any intensity — from stretching and yoga to aerobics. The authors note it is unclear whether the benefit persists once regular exercise stops.

Does heat really work for menstrual cramps?

It is the simplest option and among the most studied. A systematic review with meta-analysis of 57 randomised trials and 5,359 participants estimated that heat reduces pain by 1.85 cm on a 10 cm visual analogue scale compared with no treatment (95% CI -2.29 to -1.41), with analgesic efficacy no worse than NSAIDs and fewer adverse effects (RR 0.30; 95% CI 0.15-0.59). Certainty of evidence is low for pain and moderate for safety, and the median of mean participant ages is 22.3 years: these are young women, not adolescents (Yuan et al., 2026).

Can a girl take a painkiller before training?

That is not a sideline decision. NSAIDs have solid evidence of efficacy for period pain — in a Cochrane review of 80 randomised trials and 5,820 women, pain relief was around four times more likely than with placebo (OR 4.37; 95% CI 3.76-5.09) — but in the same review adverse effects were more frequent than with placebo (OR 1.29; 95% CI 1.11-1.51), with low quality evidence (Marjoribanks et al., 2015). For a minor, the choice of drug, dose and timing belongs to a doctor or a pharmacist — not to the coach, not to a teammate, and not to this article.

When should period pain be taken to a doctor?

When the pain constrains life and does not respond. Reasonable reasons to seek an assessment: pain that regularly costs school days or training sessions, pain that does not improve after 3-6 months of treatment, pain present outside the days of menstruation, very heavy bleeding, or pain that gets progressively worse month after month. The clinical reference for this age group names exactly that 3-6 month threshold without improvement as the point at which secondary causes, endometriosis included, should be investigated (ACOG, 2018).

Is period pain common among athletes too?

Yes, and it is the most frequent menstrual cycle disorder in this population. A systematic review of 60 studies and 6,380 athletes found a dysmenorrhoea prevalence of 32.3%, with a very wide range across studies (7.8-85.6%) reflecting very different definitions and measurement methods (Taim et al., 2023). Read it with its uncertainty: it says the phenomenon is anything but rare, not that exactly one athlete in three has it.

What can a coach do when an athlete has period pain?

Three things, none of them clinical. First: make the topic sayable, so that 'I'm in pain today' costs no embarrassment — today only 11% of athletes discuss the menstrual cycle with their coach, 4% if the coach is a man (Höök et al., 2022). Second: guarantee the practical conditions — toilet access, menstrual products available, the option to adapt a single session without having to justify it. Third: never turn pain into a judgement about character. Diagnosis and treatment stay with the professionals.