Yoga for period pain and cramps: poses that help, and yoga on your period

The NHS suggests it

For period pain, the NHS says to "try some gentle exercise like yoga, swimming, walking or cycling", alongside heat, massage and painkillers. Women's Health Concern also suggests gentle exercise such as yoga.

Sources 1, 2

Yoga reduced period pain in trials

In small trials, mostly in students, women who did yoga had less period pain than women who didn't. The trials were small and the women knew which group they were in, so how big the effect really is remains uncertain.

Sources 3, 4, 5

Practise through the month

The trials used exercise regularly, about three times a week, through the whole month, not just on painful days. Benefits showed after 4 to 8 weeks.

Sources 5, 4

Painkillers, the pill and heat have stronger evidence

Anti-inflammatory painkillers helped about half of women in 80 trials, and the combined pill reduced period pain in high-quality trials. Use yoga alongside them, not instead.

Sources 6, 7, 1

Upside down on your period: your choice

We found no study that tested going upside down during a period. The worry is blood flowing backwards, but that happens around a period in about 90% of women with open fallopian tubes anyway. Avoiding inversions is a custom in some yoga schools.

Sources 8, 9, 10

Know when it's more than period pain

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

Sources 1, 11

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

Prostaglandins, and when something else is the cause

Women's Health Concern explains that the cramps "are caused by the effect of prostaglandins", substances made in the womb lining that make it contract; the pain can start 1 to 3 days before a period, peak about 24 hours after it starts and ease within 2 to 3 days. Sometimes painful periods are caused by endometriosis, adenomyosis, fibroids or pelvic inflammatory disease, and an intrauterine device (IUD) can cause period pain in its first 3 to 6 months. Pain from another condition "may not start until your mid-twenties or later".

Sources 2, 1

How the yoga trials ran

Cobra, cat and fish poses in the second half of the cycle for 3 cycles; 60 minutes once a week for 12 weeks of poses, relaxation and meditation; 30 minutes twice a week at home for 12 weeks; a weekly class for 12 weeks; 3 supervised sessions a week for 2 cycles; and 12 weeks against no yoga. Most of the women were students aged 18 to 25 with ordinary period pain.

Sources 12, 13, 14, 15, 16, 17, 4

Relaxation counts

In a network of 29 exercise trials, the best-ranked group was relaxation exercises (progressive muscle relaxation and self-massage of the tummy), which also had the fewest dropouts. Women's Health Concern suggests "a regular relaxation programme before the period is due and on the first few days". The slow breathing and supported rest in a yoga class are close to this.

Sources 4, 2

Yoga reduced period pain in trials, but by how much is uncertainEmerging evidence

In 92 students, cobra, cat and fish poses reduced how bad and how long period pain was, compared with no yoga, and weekly or twice-weekly programmes reduced pain in trials of 40, 34 and 60 women. The direction is consistent.

The size is not settled: the trials were small and the women knew which group they were in. Pooling 4 trials (230 women) gave a very large average effect (a standardised mean difference of 2.09, where 0.8 is usually called large) with a wide margin of error, and a network of 29 trials put yoga at about 2.75 points less pain on a 10-point scale after 8 weeks. Treat both numbers as rough, and probably too high, because small unblinded trials tend to overestimate.

Sources 12, 13, 14, 15, 3, 4

Exercise of any kind helpsEmerging evidence

A Cochrane review of 12 trials (854 women) found exercise may reduce period pain by about 25 points on a 100-point scale, from low-quality evidence. The trials used about 45 to 60 minutes, three times a week or more, "regardless of intensity", through the month. In network analyses of 29 and 49 trials, every type of exercise helped by about 8 weeks, with relief starting from about 4 weeks, and a network of 33 trials of non-drug treatments found exercise, acupuncture, heat and yoga all reduced pain compared with placebo or no treatment.

Sources 5, 4, 18, 19

The newest trialsMixed evidence

In 44 women, yoga and aerobic exercise, 3 supervised sessions a week for 2 cycles, eased pain about equally, and aerobic exercise improved fitness more. In 36 women, pain fell over 12 weeks in both the yoga group and the comparison group, with no clear difference between them, though women doing yoga woke less at night.

Sources 16, 17

Painkillers and the pill have stronger evidenceStrong evidence

In 80 trials, anti-inflammatory painkillers gave moderate or excellent relief to 45% to 53% of women, against 18% with a placebo, though with more side effects. The combined pill reduced period pain moderately in high-quality trials. Only one very low-quality trial compared exercise with a painkiller. The NHS says a GP may recommend stronger anti-inflammatory medicines, a TENS machine (a small device that uses mild electrical pulses) or contraception such as the pill.

Sources 6, 7, 5, 1

Quality of lifeEmerging evidence

Across 14 studies (8 trials and 6 without random allocation) in 1,409 women and girls aged 13 to 45, quality of life improved after yoga, with a moderate risk of bias.

Source 20

PMSMixed evidence

A review of 14 studies found yoga improved PMS scores, except physical symptoms, but the studies varied widely and the authors flagged possible publication bias. Our exercise and the menstrual cycle guide covers PMS.

Source 21

EndometriosisMixed evidence

In the largest trial (334 people), 8 weeks of online yoga improved period symptoms and pain during sex compared with education, but not quality of life, and online cognitive behavioural therapy (CBT) did better. In 40 women, 8 weeks of hatha yoga twice a week lowered daily pain. Endometriosis UK says gentle exercise, yoga or Pilates can help rehabilitation after surgery. Our exercise for endometriosis guide covers more.

Sources 22, 23, 24

Heavy periodsMixed evidence

We found no trial that tested yoga for heavy periods. The NHS lists feeling tired or short of breath a lot among the signs of heavy periods, and says to see a GP if they're affecting your life, as treatment can help.

Sources 25, 26

How often

The yoga trials used 20 to 60 minutes, once to three times a week, for 2 cycles to 12 weeks; the wider exercise trials used 45 to 60 minutes three times a week. Our editorial starting point: 20 to 30 minutes, 2 or 3 times a week through the month, plus gentle practice on painful days if it helps. Judge it over 2 or 3 cycles.

Sources 5, 4, 14, 16

On a painful day

We found no study that tested a single yoga session during cramps. Women's Health Concern suggests gentle yoga "on the first few days", and the NHS suggests a warm bath, a heat pad or hot water bottle, massaging your tummy and back, and painkillers. Choose supported poses, knees to chest, a gentle twist and slow breathing, and skip anything that hurts.

Sources 27, 2, 1

Tummy and back massage

The NHS suggests massaging your tummy and back, and self-massage was part of the best-ranked group of exercises. There's no 3D demo, so here are the steps (our editorial wording):

• Lie on your back with your knees bent, or sit comfortably, and warm your hands or use a heat pad.
• With a flat hand, stroke your lower tummy in slow circles for 3 to 5 minutes, pressing gently.
• Then rub your lower back on both sides with your knuckles or the heels of your hands.
• Breathe slowly throughout, and stop if anything hurts.

Sources 1, 4

Fast breathing on heavy days

Kundalini teaching itself says not to do breath of fire "During the first or second days of your menstruation, depending on the intensity of the flow". Slow breathing suits painful days better.

Source 28

If you feel faint, or bleeding is heavy

Lie on your side or sit down, and skip hot rooms and standing balances that day (our suggestion). Heavy periods can leave you tired or short of breath, and a GP can check for iron deficiency anaemia; our exercise with anaemia guide covers training with it.

Source 26

We found no study that tested itMixed evidence

Our search found 4 records, and none tested going upside down during a period. The worry is that blood flows backwards through the fallopian tubes, but in a study of women having keyhole surgery, blood was found in the pelvis around their periods in 90% of those with open tubes, and in 15% of those whose tubes were blocked.

Sources 8, 9

A custom in some yoga schools

Iyengar Yoga UK says "closed twists and inversions (head stand, shoulder stand, hand stand) should be avoided during menstruation". In Mysore Ashtanga, "traditionally, women rest for 3 days during menstruation", and Kundalini teaching leaves out breath of fire on the first heavy days. These are teaching customs, not findings from studies, and our Iyengar, Ashtanga and Kundalini yoga guides present them that way.

Sources 10, 29, 28

What to do

If a headstand or shoulder stand is already part of your practice and feels fine, carrying on is your choice: we found no study that tested whether it does harm on your period. If it feels wrong, or bleeding is heavy, skip it. The other reasons to skip full inversions still apply: glaucoma (head-down positions raise eye pressure), blood pressure that isn't controlled, and neck problems. The US National Center for Complementary and Integrative Health (NCCIH) advises beginners to avoid headstands and shoulder stands.

Sources 30, 31

Call 999 or go to A&E

The NHS says to call 999 for an ambulance or go to 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" and "looking very pale". These can mean an ectopic pregnancy has ruptured, which needs surgery as soon as possible.

Also 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.

Sources 11, 32, 33

If you could be pregnant

The NHS says to contact your GP or call NHS 111 if you think you might be pregnant, even without a positive pregnancy test, and you have a combination of symptoms such as a missed period, tummy pain low down on one side, vaginal bleeding that's different from your usual period, pain in the tip of your shoulder, or discomfort when peeing or pooing. These can be signs of an ectopic pregnancy.

Sources 32, 33

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. Get help from NHS 111 for pelvic pain with difficulty peeing or pooing, blood in your pee or poo, unusual discharge or bleeding, pain when peeing, a very high temperature, or vomiting and diarrhoea or feeling sick.

Sources 1, 33

Premenstrual dysphoric disorder

As our exercise and the menstrual cycle guide says: call 999 or go to A&E if you have symptoms of premenstrual dysphoric disorder (PMDD) and are feeling suicidal. In the US, call 911, or call or text 988.

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, 26, 34, 24

In class

Stop a pose that brings on sharp pain rather than a stretch, and if you feel faint, lie on your side (our suggestion).

"Don't do yoga on your period"Strong evidence

The NHS suggests gentle exercise like yoga for period pain, and Women's Health Concern suggests gentle yoga on the first few days. Our exercise and the menstrual cycle guide answers the same myth.

Sources 1, 2

"Going upside down on your period is harmful"Mixed evidence

We found no study that tested it, backward flow happens around a period in about 90% of women with open tubes anyway, and avoiding inversions is a teaching custom. Do what feels right on the day.

Sources 8, 9, 10

"Yoga works as well as painkillers"Mixed evidence

Only one very low-quality trial has compared exercise with a painkiller, while anti-inflammatory painkillers relieved pain in about half of women in 80 trials. Use yoga as well as, not instead of, painkillers and heat.

Sources 5, 6

"A few poses give instant relief"Mixed evidence

We found no study that tested a single session during cramps; in the trials, relief came after 4 to 8 weeks of regular practice. A gentle session with a heat pad may still feel good on the day.

Sources 27, 4

"Yoga lowers prostaglandins"Mixed evidence

Prostaglandins cause the cramps, but we found no study that measured them after yoga in period pain; the closest record was a study protocol, with no results.

Sources 35, 2

"Yoga can bring on a late period"Mixed evidence

We found no study that tested it. The NHS lists pregnancy, stress, perimenopause, PMOS, sudden weight loss, being overweight and doing too much exercise among the common causes of a late or missed period.

Sources 36, 34

"Period pain that stops you doing things is just normal"Strong evidence

The NHS says to see a GP if your period pain is stopping you doing your usual daily activities, and Women's Health Concern says that if you start to get period pain as an adult, you should not hesitate to see a healthcare professional.

Sources 1, 2