Your Microbiome and Menstrual Cramps

PMS Microbiome

Facing those familiar uterine contractions that let you know your period is on its way? This pain, or dysmenorrhea, can have an impact upon work, relationships and ultimately your quality of life. I remember all too well how pain used to impact my life and I am so grateful that this is not my everyday anymore. There is nothing quite like lecturing to a room of 300 students while feeling as though your insides are being ripped out!

I definitely do not recommend pushing through the pain as your health is priority one and hopefully with the knowledge from this post you can make a difference to your pain! Read on to find out what causes menstrual cramps and the role your microbiome plays.


Prostaglandins and Pain

The cause of menstrual cramps is yet to be entirely understood but we do know that our hormones, vascular system and immune system all contribute. One proven contributor to menstrual pain that has been well researched are a group of lipids called prostaglandins.


  Menstrual Pain Prostaglandin

Prostaglandins promote narrowing of the blood vessels in the uterus, instigate uterine contractions, reduce blood flow to the uterus and increase the sensitivity of nerves in the uterus. As you can imagine all of these factors combine to produce menstrual cramps.

Just before our period arrives our uterine lining gets ready to shed. There are chemical messengers that help us break down the cells of the top layer of the uterus. As these cells breakdown they release fatty acids that from their cell membrane. One of these fatty acids is the omega-6 arachidonic acid. Arachidonic acid is then broken down by an enzyme to form the pain promoting prostaglandins.

Higher levels of arachidonic acid (the omega-6 found in cell membranes) can lead to more prostaglandin production. These levels are higher in the reproductive tract and ovaries in individuals with endometriosis or PCOS [1].

Prostaglandins are part of the chemical chain of communication between inflammatory stimulus and menstrual symptoms such as pain and gastrointestinal disturbances. The good news? There are steps to dampen the production of prostaglandins for more manageable menstrual periods!



Microbiome Matters

Our microbiome helps regulate sex hormone concentration, immune function, mood and pain perception so it is intricately linked to the health of our menstrual cycle.

Females experiencing pain and gastrointestinal symptoms at the time of menstruation had different vaginal microbiomes compared to those experiencing mild pain. Greater pain and premenstrual symptoms were associated with a reduction in beneficial lactobacilli and a higher abundance of Prevotella, Atopobium, and Gardnerella.

Higher levels of Prevotella, Atopobium, and Gardnerella are seen with infertility and have been associated with reduced pregnancy rates following an IVF embryo transfer.[2, 3]

From balancing progesterone and oestrogen to modulating immune function and pain, our microbiome plays a role.


Menstrual Pain

Your Microbes Produce Beneficial Short Chain Fatty Acids 


With a diverse gut community on board you have more microbes that produce short chain fatty acids. Short chain fatty acids reduce inflammation by regulating the production of prostaglandins and dampening the release of inflammatory compounds from cells.

The short chain fatty acid butyrate has even been shown to reduce endometrial lesion size, which means less inflammation!


Your Microbiome Impacts Micronutrient Absorption 

Beneficial bacteria in your gut enhances the bioaccessibility and bioavailability of iron, selenium, calcium and zinc, just to name a few micronutrients! Lactobacillus species increase calcium and magnesium availability, and your microbiome also influences vitamin D metabolism.

Nurturing a healthy gut and increasing calcium intake to 1300 mg a day has been associated with a 30% less chance of experiencing menstrual symptoms compared to lower intakes of 530 mg. A lot of clients that come to work with us at The IVF Project are identified as having calcium intakes of less than 530 mg a day (we always undertake a comprehensive analysis with our clients with this level of detail).

Having at least 700 IU of Vitamin D from food sources also reduces the risk of menstrual symptoms by 41% compared to intakes of 110 IU a day. [4]  

Research shows us that adequate vitamin D during preconception and pregnancy also contributes to a healthy microbiome for your future bub too! [5]


Your Microbiome Modulates Essential Fatty Acids

A healthy diet contains a balance of omega-3 and omega-6 essential fatty acids. Omega-6 fatty acids are found in vegetable oils such as sunflower, safflower, maize, cottonseed, peanut, grape seed, as well as in margarines.

While omega-6 fatty acids are not "bad" fats, including too much omega-6 and not enough omega-3 can lead to an increase in inflammation. For good health the body needs a balanced intake of omega-6 to omega-3.

If your cell membranes contain higher levels of Omega-6 fatty acids, you will have more arachidonic acid to convert to prostaglandins. This can mean more inflammation and menstrual cramps.

Limiting omega-6s in your diet will support a healthy balance of omega-3 and omega-6. A healthy microbiome will also work for you to convert extra dietary omega-6s to a compound that can limit inflammation, and even increase beneficial Lactobacillaceae in the gut![6] This means less omega-6 to be converted to prostaglandin, less inflammation and less menstrual pain.


Nature’s Goodness

A healthy diverse gut reduces inflammation to limit the production of prostaglandins. Optimal reproductive health starts in your gut and emerging research is showing that a healthy gut also helps reduce pain hypersensitivity.

The gut loving compounds Cynara scolymus [4], alpha linolenic acid [5], flavonoids [6], policosanols [7] and tricin [8] have all been scientifically proven to reduce prostaglandin production. These effective, prostaglandin reducing compounds are all naturally occurring in Fertile Gut Microbiome Essentials!

We love supporting you with better menstrual periods and optimal reproductive health!



Grab your copy of our new book so you can nurture your gut microbiome for pregnancy success with Create a Fertile Gut!

Cerate a Fertile Gut Book




  1. 1. Bulun, S.E., et al., Endometriosis. Endocr Rev, 2019. 40(4): p. 1048-1079.
  2. 2. Chen, C.X., et al., Associations Between Dysmenorrhea Symptom-Based Phenotypes and Vaginal Microbiome: A Pilot Study. Nurs Res, 2021. 70(4): p. 248-255.
  3. 3. Haahr, T., et al., Abnormal vaginal microbiota may be associated with poor reproductive outcomes: a prospective study in IVF patients. Human Reproduction, 2016. 31(4): p. 795-803.
  4. 4. Bertone-Johnson, E.R., et al., Calcium and vitamin D intake and risk of incident premenstrual syndrome. Arch Intern Med, 2005. 165(11): p. 1246-52.
  5. 5. Talsness, C.E., et al., Influence of vitamin D on key bacterial taxa in infant microbiota in the KOALA Birth Cohort Study. PLoS One, 2017. 12(11): p. e0188011.
  6. 6. Miyamoto, J., et al., Gut microbiota confers host resistance to obesity by metabolizing dietary polyunsaturated fatty acids. Nat Commun, 2019. 10(1): p. 4007.
  7. 7. Li, J., et al., Endometrium metabolomic profiling reveals potential biomarkers for diagnosis of endometriosis at minimal-mild stages. Reprod Biol Endocrinol, 2018. 16(1): p. 42.
  8. 8. Owen, P.R., Prostaglandin synthetase inhibitors in the treatment of primary dysmenorrhea. Outcome trials reviewed. Am J Obstet Gynecol, 1984. 148(1): p. 96-103.


About the Author

Hi, I'm Dr Cecilia Kitic founder of Fertile Gut. We can't wait to help support you on your journey to improving your gut health! Having spent over 20 years researching in the areas of immunonutrition, physiology, biochemistry and gut health we now get to translate science into practice, sooner. Our gut microbiome provides a foundation for our immune system, metabolism, brain and heart health, and hormone balance. With our scientifically crafted natural formulations you will be creating a Fertile Gut!

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