Pilates for period pain and cramps: Pilates on your period, heavy days, which moves to change, what the evidence shows, and a class

Pilates on your period is fine

If it feels right, including on the first day. The NHS suggests gentle exercise for period pain, and on average your period makes only a trivial difference to how you perform.

Sources 1, 2

Small trials found less pain

In small trials, mostly in students, women who did Pilates twice a week for 6 to 12 weeks had less period pain than women who didn't exercise. The trials were small, the women knew which group they were in, and none compared Pilates with another class, so the size of the effect is uncertain.

Sources 3, 4, 5

Regular exercise of any kind helps

A Cochrane review found exercise may reduce period pain by about 25 points on a 100-point scale, from low-quality evidence. The trials used exercise about three times a week through the whole month, and relief showed after 4 to 8 weeks.

Sources 6, 7

Painkillers, the pill and heat have stronger evidence

Use Pilates alongside them, not instead.

Sources 8, 9, 10

Upside down on your period is your choice

No study has tested it. The worry is blood flowing backwards, but that happens around a period in about 90% of women with open fallopian tubes anyway.

Sources 11, 12

Know when it isn't ordinary period pain

See a GP if period pain stops your usual activities or your periods become more painful, heavier or irregular: it can be endometriosis. Call 999 for sudden, severe tummy pain with dizziness or fainting if you could be pregnant.

Sources 1, 13, 14

Period pain

The NHS describes pain in your tummy at the start of your period or just before it, cramps that can spread to your back and thighs, and "a sharp pain or a dull ache". It usually lasts up to 3 days. "Period pain happens when your womb tightens during your period. It's often a normal part of the menstrual cycle."

Source 1

When it's something else

The NHS lists endometriosis, adenomyosis, fibroids and pelvic inflammatory disease as causes of painful periods, and an intrauterine device (IUD) can cause period pain in its first 3 to 6 months. NICE (the National Institute for Health and Care Excellence) asks doctors to suspect endometriosis with "period-related pain (dysmenorrhoea) affecting daily activities and quality of life". Endometriosis UK puts the average time from first seeing a GP to a diagnosis at over 9 years, and a 2025 review found doctors were the main cause of the delay.

Sources 1, 13, 15, 16

How common it is

In 38 studies of 21,573 young women under 25, 71% had period pain, 1 in 5 had missed school or university because of it, and 41% said it affected their concentration or performance.

Source 17

Heavy periods and iron

The NHS signs of heavy periods include changing a pad or tampon every 1 to 2 hours, periods lasting more than 7 days, clots larger than about 2.5 cm, avoiding things like exercise because of your period, and feeling tired or short of breath a lot. Heavy periods were reported by 36% of London Marathon runners who answered a survey, and in 1,042 active women, heavy periods went with past iron deficiency. NICE asks doctors to offer a blood count to everyone with heavy periods.

Sources 18, 19, 20, 21

Where Pilates fits

The exercise trials tested regular exercise through the month, which a weekly or twice-weekly Pilates class gives you. Slow breathing and relaxation ranked well in a network of 29 exercise trials, and Pilates starts with breathing. Gentle rounding, side bending and back extension often feel good on a painful day, though no trial has tested single moves (our reading).

Sources 6, 22

Who the trials included

Most were students or young women with ordinary period pain. Women with endometriosis, fibroids, very heavy bleeding or anaemia weren't studied, so the results may not apply if your pain has another cause.

Sources 3, 4, 5, 23

Pilates: small trials found less pain, but the size is uncertainEmerging evidence

In South Korea, 30 women aged 19 to 39 did mat Pilates for 50 minutes twice a week for 12 weeks, or nothing. Pain fell from 7.6 to 2.4 on a 10 cm scale with Pilates and stayed about the same without, though the Pilates group started with more pain and painkillers were allowed. In Turkey, 45 women did reformer Pilates, mat Pilates or nothing, 60 minutes twice a week for 12 weeks. In India, Pilates beat gym ball exercises in 30 women, and in 28 schoolgirls Pilates and yoga both helped more than nothing. A Korean trial of 39 women found Pilates eased pain more than treadmill running.

Every trial points the same way, but they were small, the women knew which group they were in, and none compared Pilates with another class to rule out the effect of attention. Treat the size of the effect as uncertain.

Sources 3, 4, 5, 23, 24

Problems with these trialsMixed evidence

In a Turkish trial of online Pilates in 22 women, menstrual symptom scores improved, but the summary reports no pain result although pain was a planned main measure, and a published letter criticised the lack of a comparison class and of painkiller records. The 45-woman trial's registry entry gives 56 women and 14 weeks, against 45 women and 12 weeks in the paper. A 2025 review pooled just 2 Pilates trials of 48 women, too few to give a reliable size. At least five more registered Pilates trials have no published results.

Sources 25, 26, 4, 27, 28

Reformer or mat?Mixed evidence

In the 45-woman trial, pain fell clearly with reformer Pilates (from 6.0 to 2.3) but not clearly with mat Pilates (5.9 to 4.9, p = 0.051), and the reformer beat the mat for pain and sleep. That's one small trial whose registry entry doesn't match the paper, so it doesn't show the reformer is better. Mat Pilates eased pain in other trials.

Source 4

Pilates against other exerciseMixed evidence

In 24 women in India, chair aerobics 4 days a week for 8 weeks helped period symptoms more than Pilates. In schoolgirls, Pilates and yoga helped about equally. No trial shows Pilates beats other exercise.

Sources 29, 23, 24

Exercise of any kindEmerging evidence

The Cochrane review (12 trials, 854 women) found exercise may reduce pain by about 25 points on a 100-point scale, from low-quality evidence, at "about 45 to 60 minutes each time, three times per week or more, regardless of intensity". It included no Pilates trial. In networks of 29 and 49 trials, every type of exercise helped by about 8 weeks, and relaxation ranked best, with the fewest dropouts. Later reviews agree, at low to very low certainty.

Sources 6, 22, 7, 30, 31

Painkillers, the pill, heat and TENSStrong evidence

In 80 trials, anti-inflammatory painkillers gave good relief to 45% to 53% of women, against 18% with a dummy pill, with more side effects. The combined pill reduced period pain in high-quality trials. In 57 trials, heat beat no treatment and worked about as well as anti-inflammatories, with fewer side effects. A TENS machine (mild electrical pulses on the skin) helped a little in low-certainty trials. Only one very low-quality trial has compared exercise with a painkiller.

Sources 8, 9, 10, 32, 1

YogaEmerging evidence

Yoga reduced period pain in 4 small trials, and in 44 women it eased pain about as much as aerobic exercise. Our yoga for period pain guide covers it.

Sources 33, 34

It's fine to do Pilates on your periodStrong evidence

The NHS suggests gentle exercise for period pain, and a review of 78 studies found performance "might be trivially reduced" around your period, with advice to go by how you feel. US gynaecologists say "Exercising most days of the week can make you feel better". Some trials told women not to exercise during their period, but that was a trial rule, not a finding of harm.

Sources 1, 2, 35

The first day and heavy days

If day 1 is your heaviest or most painful, choose the painful-day moves below or a shorter class, and use whichever period product you trust (our suggestion). Heavy periods can leave you tired or short of breath, so go gently on those days.

Source 18

Hot and reformer classes

Both are fine if you feel well. Skip hot Pilates on a heavy or faint day and drink plenty (our suggestion). Reformer Pilates eased pain in one trial; it isn't needed.

Sources 18, 4

If you feel faint or tired

Lie on your side or sit down, and skip standing balances that day (our suggestion). If heavy periods often leave you tired or breathless, ask a GP about a blood test for iron deficiency anaemia; our exercise with anaemia guide covers training with it.

Sources 18, 36, 21

Upside down on your periodMixed evidence

The Pilates moves that take your legs over your head (the roll-over, jack knife, control balance and boomerang) are the nearest thing to inversions. Our searches found no study that tested going upside down during a period. In women having keyhole surgery around their periods, blood was found in the pelvis in 90% of those with open fallopian tubes and 15% of those with blocked tubes, so backward flow happens anyway. If these moves feel fine, carrying on is your choice; if they don't, skip them. Their own cautions for the neck, the eyes and blood pressure apply on any day.

Sources 11, 12

Strong curl-up work and long holds

The roll-up, teaser, double straight-leg stretch and criss-cross can wait for a day you feel better; use the knee fold and other head-down moves instead. Our Pilates for endometriosis guide gives the same advice for pain: leave out curl-ups or long holds if they bring on pain.

Source 37

Lying on your tummy when bloated

The swan, swimming and the single-leg and double-leg kicks press on your tummy. If that's uncomfortable, swap to cat-cow or the bird dog, as our exercise and the menstrual cycle guide suggests.

Squeezing the pelvic floor while cramping

Let go rather than squeeze: try the pelvic floor relaxation breath instead of squeezes on a cramping day.

The legs-overhead moves

The roll-over, jack knife, control balance and boomerang: your choice on your period, but their own cautions apply on any day, including neck problems, osteoporosis, glaucoma, blood pressure that isn't controlled and pregnancy.

Call 999 or go to A&E: a possible ectopic pregnancy

The NHS says to call 999 for an ambulance or go to your nearest A&E immediately if you have a combination of:

• A sharp, sudden and intense pain in your tummy.
• Feeling very dizzy or fainting.
• Feeling sick.
• Looking very pale.

Sources 14, 38

Call 999 or go to A&E: severe pelvic pain

The NHS says to call 999 or go to A&E if you have pelvic pain and:

• It's severe, getting worse, or hurts when you move or touch the area.
• You feel faint, dizzy or lightheaded, or pass out.
• You have pain in the tip of your shoulder.
• You have difficulty breathing.
• You have heavy bleeding from your vagina.
• You suddenly feel confused.

Source 39

Call 999 or go to A&E: premenstrual dysphoric disorder

Call 999 or go to A&E if you have symptoms of premenstrual dysphoric disorder and are feeling suicidal. In the US, call 911, or call or text 988.

Source 40

Urgent GP appointment or NHS 111

Ask for an urgent GP appointment or contact NHS 111 if pelvic or period pain is severe or worse than usual, and painkillers haven't helped.

Contact your GP or call NHS 111 if you have a combination of symptoms such as a missed period, tummy pain low down on one side, vaginal bleeding, pain in the tip of your shoulder or discomfort when peeing or pooing, and you think you might be pregnant, even if you haven't had a positive pregnancy test: these can be signs of an ectopic pregnancy.

Get help from NHS 111 if you have pelvic pain and you find it difficult to pee or poo, there's blood in your pee or poo, you have unusual discharge, fluid or bleeding from your vagina, you have pain when peeing or need to pee more than usual, you have a very high temperature (or you feel hot, cold or shivery), you have vomiting and diarrhoea or feel sick, or you are pregnant or may be pregnant.

Sources 1, 38, 39

See a GP

• Periods that become more painful, heavier or irregular, or pain that stops your usual activities.
• Pain during sex or when peeing or pooing, a swollen tummy, loss of appetite, or losing weight without trying.
• Bleeding between periods, after sex or after the menopause.
• Heavy periods that affect your life, or signs such as changing a pad every 1 to 2 hours or passing large clots.
• Missing 3 periods in a row, periods not starting by 15, or cycles that are often longer than 45 days.
• Possible endometriosis, or period pain that hasn't improved after 3 to 6 months of treatment.
• PMS that self-help hasn't eased, or that affects your daily life.
• Worries about eating or exercising too much.

Sources 1, 18, 41, 40, 13

Endometriosis

• You think you might have endometriosis, or your symptoms affect your daily life, work or relationships.
• Treatment from a GP isn't helping.

Sources 37, 13

During Pilates

Stop a move that brings on sharp or worsening pelvic pain, and leave out pelvic floor squeezes, curl-ups or long holds if they bring on pain. Pain during or after pelvic floor exercises, or trouble emptying your bladder or bowel, is a reason to ask your GP about a pelvic health physiotherapist.

Chest pain or fainting: call 999

• You get sudden pain or discomfort in your chest that doesn't go away; it can feel like squeezing or pressure, burning or indigestion.
• The pain spreads to your left or right arm, or your neck, jaw, stomach or back.
• You have chest pain and feel sweaty, sick, light-headed or short of breath.
• Someone faints while exercising, can't be woken within 1 minute, or has chest pain or a pounding, fluttering or irregular heartbeat.

Sources 42, 43, 44

Breathlessness

Call 999 or go to A&E (accident and emergency) straight away for severe difficulty breathing (gasping, choking or not able to get words out), a chest that feels tight or heavy, pain that spreads to your arms, back, neck and jaw, lips or skin turning very pale, blue or grey, or sudden confusion. If you're more short of breath than usual, or your heart is racing, fluttering or skipping beats, contact NHS 111.

Source 45

Stop the session if

You feel any pain or become unwell, as the NHS advises for its Pilates videos, and especially for chest pain or pressure, unusual breathlessness, dizziness or fainting. If you have a health problem, an injury or any symptoms, get advice from a healthcare professional, such as a GP, before you start.

Source 46

Before you start

The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.

Source 46

"You shouldn't do Pilates on your period"Strong evidence

The NHS suggests gentle exercise for period pain, average changes in performance across the cycle are trivial, and no study shows harm. Do what feels right on the day.

Sources 1, 2

"Upside-down moves on your period are dangerous"Mixed evidence

No study has tested it, and backward flow happens around a period in about 90% of women with open tubes whatever they do.

Sources 11, 12

"Pilates works as well as painkillers"Mixed evidence

The Pilates trials compared Pilates with doing nothing. Only one very low-quality trial has compared any exercise with a painkiller, while anti-inflammatory painkillers helped about half of women in 80 trials. Use Pilates as well as, not instead of, painkillers and heat.

Sources 6, 8

"Pilates balances your hormones"Mixed evidence

The Pilates trials measured pain and symptoms, not hormones, so there's no evidence for it.

Sources 3, 4

"Your period shouldn't hurt"Strong evidence

Period pain is common, affecting about 7 in 10 young women, and the NHS says it's often a normal part of the cycle. What needs a GP is pain that stops your usual activities or gets worse.

Sources 17, 1

"A few moves give instant relief"Mixed evidence

The trials judged regular exercise over 6 to 12 weeks; none tested a single session during cramps. A gentle session with a heat pad may still feel good on the day.

Sources 6, 3