PCOS Pain Relief: Understanding Causes, Symptoms, and Effective Treatments

PCOS-related pain, including cramps, back pain, and pelvic discomfort, can significantly impact daily life. This guide explains the various types of pain associated with PCOS and their causes and offers strategies for managing symptoms. Learn about lifestyle changes, treatments, and how to differentiate PCOS pain from other conditions like endometriosis.

What is Polycystic Ovary Syndrome (PCOS)?

Polycystic Ovary Syndrome, or PCOS, is a group of symptoms that occur together in some women of reproductive age due to underlying hormonal imbalances. This syndrome affects up to 13% of women, with 70% of women remaining undiagnosed. [1] If you have or suspect you have PCOS, you may notice traits and physical symptoms that relate to increased levels of male hormones, like a tendency to grow coarse facial hair or unexplained weight gain.

Many of the underlying causes of PCOS contribute to inflammation and pain. This can include PCOS pain around your period, along with chronic pain issues that affect your abdomen, back, pelvic area, joints, and more. 

Overview of PCOS

Because PCOS is a syndrome, the symptoms of this condition are essential in diagnosis. Doctors look for tell-tale signs of PCOS using specific criteria. You must meet at least two of these criteria to be diagnosed with PCOS:

• Ovulation issues/irregular periods

• Hyperandrogenism, or elevated male hormone levels

• Pelvic ultrasound evidence of ovarian cysts
  

This means you could show signs of hyperandrogenism and ovulation issues without having ovarian cysts—and still meet the criteria for PCOS diagnosis. Doctors look for other signs and symptoms in women with PCOS that include unexplained weight gain, acne, infertility, certain mental health conditions, and hair thinning or loss.

Key Symptoms of PCOS

Though PCOS affects millions of women worldwide, its telltale signs often go unrecognized as part of a larger pattern, with an estimated 70% of cases remaining undiagnosed. Recognizing these common symptoms early can be life-changing, as it allows women to seek appropriate medical care and begin managing this treatable condition sooner rather than later.

The key symptoms of PCOS include:

• Menstrual irregularities: Missed periods, lengthy or very heavy periods, and fertility issues
  

• Hirsutism: Coarse, dark facial and body hair growth in women

• Weight gain: PCOS interferes with metabolism, making weight gain and fat accumulation around the waist and midsection more common
  

• Hair loss: Female pattern hair loss (FPHL), thinning, and excess breakage
  

• Acne: Increased levels of male hormones can lead to severe acne, which is 25% more common in women with PCOS than those without it
  

• Inflammation and pain: Higher levels of inflammatory biomarkers in women with PCOS may contribute to chronic inflammation and pain, along with lower pain tolerance
  

• Mental health concerns: Mood swings, anxiety, depression, ADHD, and bipolar disorder are more common in women with PCOS
  

PCOS creates a complex cascade of effects in the body - while some symptoms stem directly from hormonal imbalances, others develop as secondary impacts from managing the condition. What begins as physical changes can significantly affect emotional well-being. Struggling with changes in your appearance or fertility challenges can weigh heavily on your mental health, often leading to anxiety and depression in a way that many women find overwhelming.

How PCOS Affects Hormone and Metabolic Balance

While every woman produces both female and male hormones, women with PCOS typically have elevated levels of androgens or male hormones. Hormones are chemical messengers in the body that send important signals to regulate processes like menstruation, fat accumulation, and metabolism.

This means that hormonal imbalances associated with PCOS can interrupt your body's normal processes and lead to hormonal and metabolic issues such as:

• Hormonal acne

• Weight gain

• Excess facial/body hair

• Thinning hair on the scalp

• High blood pressure or cholesterol

• Chronic fatigue or low energy levels

• Intense mood swings and mental health conditions

• Increased risk of metabolic disorders, like type 2 diabetes or hypothyroidism
  

Many of these issues stem from your body producing too much or too little of certain hormones and neurotransmitters. As a result, signals in the body can get crossed or scrambled, leading to the physical and mental symptoms you experience.

Causes of PCOS Pain

PCOS inflammation and pain are some of the most commonly reported symptoms among women with PCOS, representing roughly 28% of complaints at PCOS-related healthcare visits [2]. Doctors believe PCOS pain stems from a few different causes, including:

• Increased inflammation

• Ovarian cysts

• Lower pain tolerance

• Obesity

• Oxidative stress

• Hormonal imbalances

• Digestive discomfort
  

Ovarian Cysts and Ovarian Pain

Pain stemming from ovarian cysts and ovary inflammation tends to occur in the lower abdomen or pelvis. It can feel sharp or dull, coming in waves that may not be predictable. You might experience pain during sex or intense, acute pain if an ovarian cyst ruptures. 

Chronic Inflammation and Its Link to Pain

PCOS often leads to increased inflammation in the body due to higher levels of inflammatory proteins like cytokines, chemokines, and C-reactive proteins in the bloodstream. Fat tissue can further increase this inflammatory response, which helps explain why many women with PCOS experience chronic joint pain, back pain, and ongoing inflammation throughout their bodies.

Research has revealed that women with PCOS typically experience pain more intensely than others, suggesting that the condition affects how the body processes pain signals. This difference in pain sensitivity provides important context for why many women with PCOS struggle with chronic pain management.

The connection between PCOS, pain, and inflammation involves oxidative stress - a condition where the body has too many free radicals and not enough antioxidants to counter them. This understanding is particularly valuable because it points to practical solutions: increasing antioxidant intake through diet or supplements may help reduce PCOS-related pain and inflammation.

Hormonal Imbalances Causing Pain

The hormonal imbalances common in PCOS - including higher levels of androgens, estrogen, and luteinizing hormone - can significantly affect how women experience pain and inflammation. Studies have found a connection between hormone levels and internal and musculoskeletal pain, suggesting that the imbalances seen in women with PCOS are associated with issues like chronic lower back pain and pain in the arms.

Insulin resistance, which frequently occurs alongside PCOS, adds another layer to pain experiences. Research has established a link between chronic pain and insulin resistance, suggesting that managing blood sugar levels might be an important part of pain management for women with PCOS.

PCOS-Related Nausea and Digestive Discomfort

You may be more likely to have Irritable Bowel Syndrome (IBS) with PCOS, leading to ongoing digestive discomfort and pain that may be worse with certain food or lifestyle triggers. IBS can cause nausea, abdominal pain, bloating, constipation, or diarrhea.

Because PCOS throws your internal systems off-balance, you may deal with higher levels of harmful gut bacteria that interfere with digestion or have digestion issues that stem from increased permeability of your intestines and higher levels of hormones like follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

Types of Pain Associated with PCOS

While not every woman with PCOS will experience pain and inflammation, it's very common. You might have pelvic, abdominal, menstrual, back, joint, or intestinal pain with PCOS. Sometimes, PCOS can make sex, physical activity, and going to the bathroom more painful.

Pelvic Pain and Abdominal Discomfort

PCOS pelvic pain and abdominal pain can overlap. Your pelvic region is part of your lower abdominal area, which is where pain with PCOS tends to develop. This may be due to ovarian cysts, cramping, bloating, or inflammation. 

• PCOS pelvic pain: May be linked to large ovarian cysts, ovulation, and pelvic floor dysfunction.
  

• Lower abdominal pain with PCOS: Issues with constipation, diarrhea, menstrual cramps, and inflammation can cause lower abdominal pain.
  

• Abdominal cramps and bloating: Hormonal imbalances, irregular menstrual cycles, and possible IBS are PCOS issues associated with cramps and bloating.
  

Menstrual Pain

Women with PCOS often experience menstrual cramps that are notably more severe than typical period pain, primarily due to several factors that intensify the discomfort. While regular menstrual cramps occur from normal uterine contractions, PCOS-related period pain tends to be more intense because it is amplified by heavier menstrual flow, ongoing inflammation in the body, and the presence of ovarian cysts.

• Heavy periods and PCOS: Irregular menstrual cycles can lead to heavy bleeding, which may make uterine contractions more intense and painful
  

• PCOS period cramps and painful periods: Women with PCOS might make more prostaglandins, hormone-like substances that trigger inflammation and period cramps [3]
  

• Cramps without a period (PCOS): Lower abdominal or pelvic cramps that feel like period cramps without menstruation can occur with PCOS due to imbalances of hormones and an irregular ovulation cycle
  

Back Pain and Joint Pain

PCOS back pain, including lower back pain and joint pain, are common symptoms that can cause discomfort due to higher levels of certain hormones, increased risk of chronic pain or autoimmune conditions, and widespread inflammation.

• PCOS lower back pain: A link between lower back pain and the higher levels of two inflammatory hormones, FSH and LH, in women with PCOS has been established.
  

• PCOS and joint pain: Obesity, inflammation, and a higher likelihood of being diagnosed with autoimmune or chronic pain conditions like fibromyalgia can lead to joint pain and arthritis in women with PCOS.

Nausea and Digestive Issues

If you often feel sick to your stomach or deal with digestive issues like bloating, cramping, gas, or constipation, it's possible that PCOS could be associated. 

• PCOS and nausea: IBS, higher androgen levels, and symptoms like insulin resistance can cause nausea with PCOS, as can some medications used to treat PCOS, like metformin or spironolactone.
  

• Abdominal pain linked to PCOS: Pain in your abdomen can be related to inflammation, digestive issues, IBS, menstrual cramps, or irregular hormone levels with PCOS.

PCOS Symptoms vs. Other Conditions

Some PCOS symptoms overlap with or closely mimic other conditions, so it can be hard to differentiate without the help of a healthcare professional. Let's address some conditions that are commonly confused with PCOS or have very similar symptoms to better understand the difference. 

PCOS vs. Endometriosis Symptoms

Endometriosis occurs when the uterine lining grows and builds up outside the uterus, sometimes connecting your reproductive organs together or leading to the formation of cysts. It can be painful, like PCOS, and lead to scar tissue formation over time. 

Endometriosis and PCOS are similar in a few ways:

• Hormonal imbalances 

• Painful or irregular periods

• Possible pain during sex

• Fertility issues

• Gastrointestinal issues
  

However, PCOS is associated with an increase in male hormones, while endometriosis is linked to higher estrogen levels. Only PCOS is linked to the development of abnormal ovarian cysts, and only endometriosis is linked to abnormal growth of the uterine lining outside the uterus. 

Can PCOS Make Periods Worse?

PCOS can make your periods worse by causing heavier, irregular, or painful periods with increased cramping and inflammation. Hormonal imbalances, which can cause estrogen, testosterone, and progesterone levels to fluctuate abnormally, may be responsible.

As a result, you might have missed periods, very heavy periods with intense cramping, or painful ovulation cycles. Lingering chronic inflammation and a tendency to have a lower pain tolerance can also influence how you experience a period with PCOS. 

Does PCOS Cause Back Pain or Pelvic Pain?

Back and pelvic pain is common among women with PCOS. As you'd expect, these issues aren't usually caused by a single factor with PCOS—instead, they might result from a combination of factors.

PCOS back pain and pelvic pain may be caused by one or more of these:

• Obesity

• Irregular menstruation and ovulation

• IBS and digestive issues

• Large ovarian cysts

• Chronic inflammation

• Lower pain tolerance

Diagnosing PCOS Pain

Only a doctor can officially diagnose PCOS pain and what causes it, but doing some research before a doctor's visit will help you familiarize yourself with what's happening in your body. Learn how to identify PCOS pain types, how doctors use differential diagnosis to determine the source of your pain, and how to track your symptoms over time to get the most accurate diagnosis.

To get started on your PCOS journey, take the  PCOS Symptoms Quiz.

Identifying PCOS-Related Pain

PCOS pain tends to show up in specific areas of the body, and noting where you feel discomfort can be helpful in identifying the root cause. When you track both the location of your pain and other symptoms like irregular periods or excess facial hair, you can present your healthcare provider with valuable information for making an accurate diagnosis

• Pelvic or lower abdominal pain

• Back pain

• Intestinal discomfort or pain

• Joint pain

• Pain that worsens or fluctuates around your menstrual cycle

• Intense period cramps
  

Having just one type of pain, such as back pain, isn't enough to suggest PCOS by itself. What's important is noticing when these types of pain occur alongside other typical PCOS symptoms, as this pattern can help identify whether PCOS might be the underlying cause.

Differential Diagnosis: PCOS vs Endometriosis

Differential diagnosis can help doctors determine whether you're experiencing PCOS, endometriosis, or another condition with ultrasound imaging, pelvic exams, laparoscopy, and blood work.

• Diagnosing PCOS: Doctors may use pelvic ultrasound, a pelvic exam, and blood tests to diagnose PCOS if you present with typical symptoms (like excess facial or body hair and irregular periods). Blood work might show higher levels of total testosterone, LH, and FSH with PCOS.
  

• Diagnosing Endometriosis: Looking at the uterus and endometrium with pelvic laparoscopy and ultrasound are the most common ways to diagnose endometriosis when you present with symptoms like painful periods, painful intercourse, and fertility issues.
  

Your doctor may want to check for other substances in your blood, including DHEAS (adrenal gland hormones), to exclude conditions like adrenal virilism, amenorrhea, Cushing's syndrome, or ovarian tumors.

When diagnosing endometriosis, your doctor will want to exclude other possibilities, like urinary tract infections, Pelvic Inflammatory Disease (PID), and IBS. Blood tests won't usually help diagnose endometriosis.

The Importance of Symptom Tracking and Testing

Getting a PCOS diagnosis relies on giving your healthcare provider a full picture of your symptoms, but when you're in the middle of a stressful medical appointment, important details can be easy to overlook. Tracking your symptoms before your appointment ensures you can share all the necessary information with your doctor, helping them order the right tests and develop an effective treatment plan that addresses everything you're experiencing.

Treatment Options for Managing PCOS Pain

You don't have to accept PCOS pain as your new normal. There are a variety of treatments to help you manage and soothe PCOS-related pain and discomfort, and it's a good idea to explore your options and see what works best for you. 

Medications

You can treat intense or chronic pain with PCOS by using different medications, including over-the-counter (OTC) and prescription options.

• For mild to moderate cramping, joint pain, back pain, and abdominal or pelvic pain, try OTC pain relievers like ibuprofen (Advil), naproxen sodium (Aleve), or acetaminophen (Tylenol).
  

• Your doctor can prescribe hormonal drugs to treat intense PCOS period pain, heavy bleeding, and physical symptoms like hirsutism and acne. These can include hormonal birth control, spironolactone, oral progesterone, or GnRH medicines that help balance your hormone levels. 

Lifestyle Changes

Making a few changes to your lifestyle can be an effective way to take control of your PCOS pain and boost your quality of life long-term. Consider adjusting how much activity you get, modifying your diet, and learning new techniques to manage stress on your journey to reduce PCOS pain.

• Make time for exercise: You can help manage pain and inflammation by getting enough exercise (aim for at least 30 minutes/day, 3-5 days/week). Exercise can reduce joint stiffness, combat pain signals in the brain, and help you maintain a healthy weight to reduce inflammation [4].
  

• Modify your diet: Many women with PCOS have reduced pain and inflammation by following the Dietary Approach to Stop Hypertension (DASH) diet, which focuses on whole grains, low-fat dairy, vegetables, and fruit [5].
  

• Learn new stress management techniques: Stress is unavoidable, but elevated cortisol levels in PCOS make it essential to manage stress effectively to reduce symptoms like pain and inflammation. Study meditation and mindfulness, join a support group, or start therapy to manage stress healthily.
  

Physical Therapy and Other Treatments

Physical therapy and simple home remedies can also help you deal with pain from PCOS more effectively. You can visit a licensed physical therapist or try at-home exercises that may help reduce back and pelvic pain with PCOS. Heat therapy can be a great option to soothe acute pain like period cramps and lower back pain.

• Pelvic floor physical therapy (PFPT): A physical therapist can teach you exercises that strengthen and coordinate your pelvic floor muscles to treat pelvic floor dysfunction, a symptom that can cause PCOS pain.
  

• Heat therapy for cramps and back pain: Heat therapy, like submerging in hot water or applying heat pads, can inhibit inflammation, improve insulin resistance, and significantly decrease testosterone levels in women with PCOS.

Natural Remedies for PCOS Pain

If you'd prefer treating pain that stems from PCOS naturally, consider using herbal supplements, acupuncture, or intentional diet changes to manage discomfort and pain at home. 

Herbal Supplements for Pain Management

These herbal supplements are well-documented as being anti-inflammatory with pain-relieving qualities that may be helpful for PCOS.

• Curcumin: This compound found in turmeric is shown to have anti-inflammatory action similar to NSAIDs that can help reduce pain with PCOS.
  

• White mulberry leaf: Multiple studies have shown white mulberry leaf is a potent anti-inflammatory that may help with PCOS-related pain management.
  

• Polyphenols: These are plant compounds proven to reduce pain and inflammation in women with conditions that cause chronic pain, like fibromyalgia and PCOS.
  

• Willow bark: Contains a natural aspirin alternative to reduce inflammation and pain.
  

• Magnesium: Helps reduce muscle tension and menstrual cramps, and can help with overall pain management. 

• Ginger: A 10-year trial study of ginger found it helpful in reducing pain from period cramps to migraines thanks to anti-inflammatory effects.

Acupuncture and Other Alternative Therapies

Acupuncture has been used for over 3,000 years by the Chinese people to regulate hormone levels, combat sickness, and address mental health issues. Modern research has found that it's particularly helpful for PCOS when practiced on the inner ankle and groin area. It can regulate hormonal levels, encourage regular ovulation, decrease painful inflammation, and increase insulin sensitivity.

Other alternative therapies like Traditional Chinese Medicine, tai chi, and yoga have been linked to the improvement of PCOS symptoms like chronic inflammation and hyperandrogenism. Tai chi and yoga can be very effective by providing gentle stretch and movement opportunities. 

Omega-3s, Anti-Inflammatory Diets, and Supplements

Making impactful changes to your diet by increasing foods with omega-3 fatty acids and anti-inflammatory properties or taking supplements to get these benefits is a simple, effective way to fight PCOS-related pain.

• Omega-3s: Known to reduce total cholesterol and lower insulin resistance, two factors that contribute to chronic inflammation in PCOS. You can take fish oil supplements to get an omega-3 boost.
  

• Anti-inflammatory diets: Can limit the histamines you consume and help quell chronic inflammation with PCOS for reduced pain. The Mediterranean Diet, rich in tomatoes, green vegetables, fatty fish, and fruit, can be helpful. Additional anti-inflammatory foods, like garlic, turmeric, black pepper, ginger, rosemary, and cinnamon, may be helpful for PCOS pain.
  

When to Seek Medical Help

While you may be able to manage or treat PCOS symptoms on your own, it's crucial to know when to seek medical help. Watch for these red flags and learn how to get ready for a doctor's visit if PCOS pain becomes severe. 

Red Flags Indicating the Need for Medical Attention

You should see a doctor as soon as possible if you notice any of the following red flags with PCOS-related pain.

• Pain that becomes severe or increases significantly

• Pain that prevents you from doing normal activities

• New discomfort during or after sex, using the bathroom, or exercising

• Elevated blood pressure 

• Radiation of pain to other parts of your body

• Appearance of other symptoms, like fever, swelling, numbness

How to Prepare for a Doctor's Visit to Discuss PCOS Pain

It's critical to be prepared when you visit the doctor to discuss the pain you're experiencing with PCOS. You can prepare yourself for a doctor's visit about PCOS pain by keeping track of your symptoms with a calendar, making a list of questions and concerns you want to address with your doctor, and researching possible tests your doctor could use to diagnose you with PCOS. 

Living with PCOS Pain

While there are plenty of ways to mitigate and reduce PCOS pain, it doesn't always have a quick fix—instead, consider it part of a condition that you can intentionally manage. You can build a PCOS pain-relieving toolkit with coping strategies, support resources, and a plan to consistently track your pain and symptoms to receive the best care possible. 

Coping Strategies for Chronic Pain

While PCOS and other chronic pain conditions can feel overwhelming, there are effective ways to manage and reduce your discomfort. Through a combination of targeted strategies, you can enhance your body's natural pain-relief mechanisms, reduce inflammation, and develop practical approaches to improve your daily comfort and quality of life.

• Try low-impact exercises, like tai chi or yoga, to gently stretch your muscles and boost pain tolerance over time.
  

• Engage in physical therapy for your pelvic floor muscles to build strength that reduces PCOS pain.
  

• Try heat therapy to get anti-inflammatory and pain relief benefits with soothing hot water or compresses.
  

• Schedule regular massages to release muscle tension.
  

• Engage in meditation or deep breathing exercises to increase your pain tolerance and lower stress levels that can contribute to discomfort. 

Support Resources and Mental Health Considerations

Getting outside support from mental health professionals, people you trust, and other women with similar experiences can be incredibly beneficial on your journey to better health.

Make a note of these resources to start building a stronger PCOS network and get the support you need:

• Ovii Facebook Support Group: Join our community of women supporting each other through PCOS challenges, sharing experiences, and offering encouragement.
  

• PCOS Symptoms Quiz: Free online assessment tool developed by Dr. Thais Aliabadi to help identify potential symptoms related to PCOS.

• American Society for Reproductive Medicine (ASRM): Connect with providers specializing in PCOS treatment.