Period Tips from a Pelvic Floor Therapist

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Menstrual Cup

I was ten years old the day I got my first period. My mom handed me a maxi-pad and a book about menstrual cycles and said, “Let me know if you have questions.” And that was it. There were no conversations about options for menstrual care, and my menstrual products were the same ones my mom used. As a pelvic health physical therapist for the past 15 years, I have become much more well-informed about my body, menses, and overall pelvic health. Here are some pelvic health tips for your period that I am super glad I know and think all menstruators should know. 

Period products should not hurt

Often people discover something feels wrong when they try to insert a tampon for the first time. This is because your pelvic floor has two layers of muscles, and the outer layer at the vaginal opening needs to be relaxed to insert a tampon. So if you experience pain, burning, or feel like you are “hitting a wall” when inserting something into your vaginal canal, your pelvic floor muscles may be to blame. Period panties are a great option if you find discomfort wearing tampons. You can also work with a pelvic floor physical therapist on relaxation techniques for your pelvic floor

Tips for cramps 

Pass the peas, please!! If you are having your very first period, your first postpartum period, or just your period in general and feel a super deep ache in your vagina, try lying on your back with your feet up the wall or on a couch with a bag of frozen peas over your vagina. This helps decrease the pressure and blood flow and the peas are an inexpensive ice pack that will help ease that swollen feeling. You can also try lying on your back with your legs elevated and a pillow under your butt to lift your hips to help “decompress” your pelvic floor. This position is excellent for when on your period, especially when gravity has been taking a toll at the end of the day. Then, put a heating pad under your bag and grab the peas! 

You can use this technique for 20 minutes daily. For added comfort, and cramp relief, try drinking herbal teas, putting a warm compress like a heating pad over your vagina, or taking pain relieving medicine as needed.

Stretches to help with period cramps

  1. Cow pose: Inhale- booty and head lift toward the sky, back arches.
  2. Cat pose: Exhale – booty and head tucked under, back rounds.
  3. Child’s pose: Relax your booty back towards your heels. The knees are wide, and the feet are together. Perform each stretch for five big deep breaths and Repeat the cycle three times. 

Tips for your very first period 

It might be a scary time if you are experiencing your very first period. The more you know and understand about your body, the more prepared you will feel. There is nothing to fear, although the pain might be uncomfortable at first. A few things that every vagina owner needs to know:

  1. You have a pelvic floor
  2. You have three holes – one to urinate (urethral), one for bowel movements (anus), and your vagina (where your tampon or menstrual cup will go) 
  3. How to insert and remove a tampon into that pelvic floor during menstruation 

The pelvic floor is a group of muscles located at the bottom of your trunk. They attach to the bones of your pelvis and help support your internal organs (especially the bladder, rectum, and reproductive organs). But that’s not all they do! They also help control bladder, bowel, and sexual function and are an integral part of childbirth

Period tips for school and work 

If the pain is intense, try to breathe through the cramps. Diaphragmatic breathing helps relax your mind and pelvic floor, which can help ease the pain. If your muscles are too tight, you must start with your breath. Inhale with belly puffs and exhale with belly falls. Practice daily and often. This is a great trick you can do at school or work! If able at work, plug in your heating pad, take pain relievers as needed, and sip on some warm herbal tea – and make sure you pack everything on your period survival list! 

Period survival pack

  • Medicine and pain relievers 
  • Frozen peas 
  • Period panties
  • Pads
  • Tampons 
  • Menstrual cup 
  • V2 support
  • Herbal tea
  • Heating pad 

Why your period may be irregular

The average menstrual cycle is 28 days long. Still, it can vary from woman to woman, especially after giving birth, getting closer to menopause, or due to a gynecological condition like hormonal imbalances, endometriosis, or polycystic ovarian syndrome. In addition, ovulation occurs before menstrual bleeding occurs, which means there is a chance you may get pregnant if you are not using contraception or tracking your ovulation window. So heads up! Notify your medical provider if these fluctuations persist, as some blood work and monitoring your cycle may give you some insight into the reasons for the irregularities. 

Your first postpartum period

Your body undergoes many changes after giving birth, and the hormonal rollercoaster is no joke. After giving birth, The average time to resume menstruation is between 45-60 days, even longer if you are breastfeeding or lactating. This is because prolactin, the hormone that aids breast milk production, works inversely with estrogen. So if you are lactating, we want your prolactin to be high, which means estrogen may be low, leading to a delayed cycle onset, increased vaginal dryness, and decreased sexual desire. Using a water-based lubricant for intercourse and working with a pelvic floor physical therapist if you experience painful or uncomfortable sex can help. Your menstrual cycle should return as you get further from birth and your location production decreases. 

And when it does, your first postpartum period will likely be heavy. Like, heavy. You may consider using period panties as a backup throughout the day or night, as a heavier flow is common after giving birth. If you are unsure if your postpartum periods are normal, consult with your healthcare provider or reach out to a pelvic floor specialist today!

Pressure or Heaviness 

A heavy flow or increased pelvic floor laxity may lead to pressure or heaviness in the vaginal area. In addition, all the blood flow may make you feel achy, especially in standing or at the end of the day. Vagina support – the V2 support. This helps decrease heaviness/pressure in your vag during your period. Wear it over your underwear and under your clothes. 

The 411 on period products

Not all period products are created equally. I have been using only tampons since I first got my period, and a lot has changed! I often hear of folks using maxi pads for urinary leakage or incontinence pads as period pantiliners. Incontinence pads hold more fluid and keep moisture away from your skin, keeping it dry and preventing skin breakdown. If you are working with some leaks, you have incontinence undies, pads, liners, and internal and external prolapse supports. And if you have sensitive skin, as I do, bleach-free and organic cotton products are widely available.

For menstruation, you have menstrual cups, discs, tampons with or without applicators, pads, liners, period panties, and some opt to free-bleed. If you are considering a menstrual cup, Put A Cup In It is my all-time favorite resource and has a Fit-finder quiz to help you select the best cup. Other fave brands include the Diva Cup, Cora Women, Lola, and SheThinx for menstrual care. Determining what works best for you may take trial and error. 

What I use as a pelvic floor PT

The Diva Cup has been a game-changer for a heavier flow in the early days and being able to leave in for 12 hours. My SheThinx panties are to use in combo with my cup or tampons. They are also super comfortable and super cute. My Lola tampons and pantiliners are organic, chemical-free products. They are shipped to your home and come in custom packs, so you can pick how many light, regular, or super plus you want each month. 

Menstrual cups

Introducing cups young is essential! It’s a little cup you insert into your vagina and goes around your cervix to collect fluid – a great alternative to tampons. The tricky part is getting them in and out. To insert the cup, put your feet on a squatty potty and insert it into the vaginal canal when your pelvic floor muscles are relaxed. Once inserted, the cup forms a suction and collects fluids throughout the day. To remove, insert a finger and squeeze it to release the suction and pull it out – if you experience leaking, try she thinks panties – collect fluid by themselves, or you can wear in addition- comfortable, don’t smell and super absorbent – I even love the thongs – super smooth against my skin. 

Fold it halfway in a c shape or fold it half – all the way – sit on a squatty potty – it helps relax pelvic floor muscles and then insert it in – once inside top should be open and not still folded. I can wear it for up to 12 hours – empty earlier if needed – get into the shower and clean it off – deep squat position, bear down like I have a bowel movement – exhale through that, grab it by the end and pinch it and take it out. Wash it between use and, at the end of every cycle, boil it in water to sterilize it – I have a dedicated pot. 

What to know about painful periods and what contributes to painful periods

If you have painful menstrual cycles or even have to miss school or work due to your period discomfort, ask your healthcare provider if you have endometriosis. Endometriosis can be a scary and sometimes debilitating diagnosis that affects roughly 10% of menstruating women. Unfortunately, so many women have endometriosis and have pain for years before they receive an official diagnosis. 

How pelvic floor PT can help with painful periods

If your pelvic floor muscles are too weak, too tense, are tense or overactive, if inserting tampons are difficult or painful, or it feels like the tampon is being pushed out, pelvic floor physical therapy can help, can check if you are too tight or tense and decide whether you need to work on strengthening or relaxing. Pelvic PT can help not just with the aches and pain of a period and your provider can address any underlying conditions. Checking in with a pelvic floor physical therapist if you experience heaviness or weakness in the pelvic floor area may help. 

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Interested in more tips on how to prevent or overcome Pelvic Floor Problems?
Download this free guide for some simple, do-able, totally-not-weird tips to take better care of your down there.

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Meet Dr. Sara

Sara Reardon PT, DPT, WCS is the owner of NOLA Pelvic Health and founder of The Vagina Whisperer.

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