Breathe Away Menstrual Pain- A Simple Practice That Brings Relief *

Adapted from: Peper, E. Harvey, R., Chen, & Heinz, N. (2025). Practicing diaphragmatic breathing reduces menstrual symptoms both during in-person and synchronous online teaching. Applied Psychophysiology and Biofeedback, Published online: 25 October 2025.  https://rdcu.be/eMJqt  https://doi.org/10.1007/s10484-025-09745-7

“Once again, the pain starts—sharp, deep, and overwhelming—until all I can do is curl up and wait for it to pass. There’s no way I can function like this, so I call in sick. The meds take the edge off, but they don’t really fix anything—they just mask it for a little while. I usually don’t tell anyone it’s menstrual pain; I just say I’m not feeling well. For the next couple of days, I’m completely drained, struggling just to make it through.

Many women experience discomfort during menstruation, from mild cramps to intense, even disabling pain. When the pain becomes severe, the body instinctively responds by slowing down—encouraging rest, curling up to protect the abdomen, and often reaching for medication in hopes of relief. For most, the symptoms ease within a day or two, occasionally stretching into three, before the body gradually returns to balance.

Another helpful approach is to practice slow abdominal breathing, guided by a breathing app FlowMD. In our study led by Mattia Nesse, PhD, in Italy, the response of one 22-year-old woman illustrated the power of this simple practice.

“Last night my period started, so I was a bit discouraged because I knew I’d get stomach pain, etc. On the other hand, I said, “Okay, let’s see if the breathing works,” and it was like magic — incredible. I’ll need to try it more times to understand whether it consistently has the same effect, but right now it truly felt magical. Just 3 minutes of deep breathing with the app were enough, and I’m not saying I don’t feel any pain anymore, but it has decreased a lot, so thank you! Thank you again for this tool… I’m really happy!”

The Silent Burden of Menstrual Pain

Menstrual pain, or dysmenorrhea, affects most women at some point in their lives — often silently. For many, the monthly cycle brings not only physical discomfort but also shame, fatigue, and interruptions to work or school. It is one of the leading causes of absenteeism and reduced productivity worldwide (Itani et al., 2022; Thakur & Pathania, 2022).  In addition, the estimated health cost ranged from US $1367 to US$ 7043 per year (Huang et al., 2021). Yet, despite its prevalence, most women are never taught how to use their own physiology to ease these symptoms.

The Study (Peper et al, 2025)

Seventy-five university women participated across two upper-division Holistic Health courses. Forty-nine practiced 30 minutes per day of breathing and relaxation over five weeks as well as practicing the moment they anticipated or felt discomfort; twenty-six served as a comparison group without a specific daily self-care routine. Students rated change in menstrual symptoms on a scale from –5 (“much worse”) to +5 (“much better”). For the detailed steps in training,  see the blog: https://peperperspective.com/2023/04/22/hope-for-menstrual-cramps-dysmenorrhea-with-breathing/ (Peper et al., 2023).

 What changed

The results were striking. Women who practiced breathing and relaxation showed significant decrease in menstrual symptoms compared to the non-intervention group (p = 0.0008) as shown in Figure 1.

Figure 1. Decrease in menstrual symptoms as compared to the control group after implementing slow diaphragmatic breathing.

Why does breathing and posture change have a beneficial effect?

When you stay curled up, your abdomen becomes compressed, leaving little room for the lower belly to relax or for the diaphragm to move freely. The result? Tension builds, and pain often increases.

To reverse this, create space for relaxation. Gently loosen your waist and let your abdomen expand as you inhale. Uncurl your body—lengthen your spine and open your chest, as shown in Figure 2. With each easy breath, you invite calm and allow your body to shift from tension to ease.

Figure 2. Curling up compresses the abdomen and prevents relaxation of the lower belly. In contrast, lying flat with the body gently expanded allows the abdomen to move freely with each breath, which can help reduce menstrual discomfort.

In contrast, slow abdominal or diaphragmatic breathing activates the body’s natural relaxation response. It quiets the stress-driven sympathetic nervous system, calms the mind, and improves circulation in the abdominal area. With each slow breath in, the abdomen gently expands while the pelvic floor and abdominal muscles relax. As you exhale, these muscles naturally tighten slightly, helping to massage and move blood and lymph through the abdominal region. This rhythmic movement supports healing and ease, as illustrated in Figure 3.

Figure 3. The dynamic process of diaphragmatic breathing.

The process of slower, lower diaphragmatic breathing

When lying down, rest comfortably on your back with your legs slightly apart. Allow your abdomen to rise naturally as you inhale and fall as you exhale. As you breathe out, imagine the air flowing through your abdomen, down your legs, and out through your feet. To deepen this sensation, you can ask a partner to gently stroke from your abdomen down your legs as you exhale—helping you sense the flow of release through your body.

Gently focus on slow, effortless diaphragmatic breathing. With each inhalation, your abdomen expands, and the lower belly softens. As you exhale, the abdomen gently goes down pushing the diaphragm upward and allowing the air to leave easily. Breathing slowly—about six breaths per minute—helps engage the body’s natural relaxation response.

If you notice that your breath is staying high in your chest instead of expanding through the abdomen, your symptoms may not improve and can even increase. One participant experienced this at first. After learning to let her abdomen expand with each inhalation while keeping her shoulders and chest relaxed, her next menstrual cycle was markedly easier and far less uncomfortable. The lesson is clear: technique matters.

“During times of pain, I practiced lying down and breathing through my stomach… and my cramps went away within ten minutes. It was awesome.” — 22-year-old college student

“Whenever I felt my cramps worsening, I practiced slow deep breathing for five to ten minutes. The pain became less debilitating, and I didn’t need as many painkillers.” — 18-year-old college student

These successes point out that it’s not just breathing — it’s how you breathe by providing space for the abdomen to expand during inhalation.

Practice: How to Do Diaphragmatic Breathing

1. Find a quiet space. Lie on your back or sit comfortably erect with your shoulders relaxed.
2. Place one hand on your chest and one on your abdomen.
3. Inhale slowly through your nose for about 3–4 seconds. Let your abdomen expand as you breathe in — your chest should remain relaxed.
4. Exhale gently through your mouth for 4—6 seconds, allowing the abdomen to fall or constrict naturally.
5. As you exhale imagine the air moving down your arms, through your abdomen, down your legs, and out your feet
6. Practice daily for 20 minutes and also for 5–10 minutes during the day when menstrual discomfort begins.
7. Add warmth. Placing a warm towel or heating pad over your abdomen can enhance relaxation while lying on your back and breathing slowly.

With regular practice and implementing it during the day when stressed, this simple method can reduce cramps, promote calm, and reconnect you with your body’s natural rhythm.

Implement the ABCs during the day

The ABC sequence—adapted from the work of Dr. Charles Stroebel, who developed The Quieting Reflex (Stroebel, 1982)—teaches a simple way to interrupt stress reactions in real time. The moment you notice discomfort, pain, stress, or negative thoughts, interrupt the cycle with a simple ABC strategy:

A — Adjust your posture

Sit or stand tall, slightly arch your lower back and allowing the abdomen to expand while you inhale and look up. This immediately shifts your body out of the collapsed “defense posture’ and increases access to positive thoughts (Tsai et all, 2016; Peper et al., 2019)

B — Breathe

Allow your abdomen to expand as you inhale slowly and deeply. Let it get smaller as you exhale. Gently make a soft hissing sound as you exhale while helps the abdomen and pelvic floor to tighten.  Then allow the abdomen to relax and widen which without effort draws the air in during inhalation. As you exhale, stay tall and imagine the air flowing  through you and down your legs and out your feet.

C — Concentrate

Refocus your attention on what you want to do and add a gentle smile. This engages positive emotions, the smile helps downshift tension.

The video clip guides you through the ABCs process.

Integrate the breathing during the day by implementing your ABCs

When students practice relaxation technique and this method, they reported greater reductions in symptoms compared with a control group. By learning to notice tension and apply the ABC steps as soon as stress arises, they could shift their bodies and minds toward calm more quickly, as shown in Figure 4.

Figure 4. Change in symptoms after practicing a sequential relaxation and breathing techniques for four weeks.

Takeaway

Menstrual pain doesn’t have to be endured in silence or masked by medication alone. By practicing 30 minutes of slow diaphragmatic breathing daily and many times during the day, women may be able to reduce pain, stress, and discomfort — while building self-awareness and confidence in their body’s natural rhythms thereby having the opportunity to be more productive.

We recommend that schools and universities include self-care education—especially breathing and relaxation practices—as part of basic health curricula as this approach is scalable. Teaching young women to understand their bodies, manage stress, and talk openly about menstruation can profoundly improve well-being. It not only reduces physical discomfort but also helps dissolve the stigma that still surrounds this natural process,

Remember: Breathing is free—available anytime, anywhere and is helpful in reducing pain and discomfort. (Peper et al., 2025; Joseph et al., 2022)

See the following blogs for more in-depth information and practical tips on how to learn and apply diaphragmatic breathing:

REFERENCES

Itani, R., Soubra, L., Karout, S., Rahme, D., Karout, L., & Khojah, H.M.J. (2022). Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates. Korean J Fam Med, 43(2), 101-108. https://doi.org/10.4082/kjfm.21.0103

Huang, G., Le, A. L., Goddard, Y., James, D., Thavorn, K., Payne, M., & Chen, I. (2022). A systematic review of the cost of chronic pelvic pain in women. Journal of Obstetrics and Gynaecology Canada, 44(3), 286–293.e3. https://doi.org/10.1016/j.jogc.2021.08.011

Joseph, A. E., Moman, R. N., Barman, R. A., Kleppel, D. J., Eberhart, N. D., Gerberi, D. J., Murad, M. H., & Hooten, W. M. (2022). Effects of slow deep breathing on acute clinical pain in adults: A systematic review and meta-analysis of randomized controlled trials. Journal of Evidence-Based Integrative Medicine, 27, 2515690X221078006. https://doi.org/10.1177/2515690X221078006

Peper, E., Booiman, A. & Harvey, R.  (2025). Pain-There is Hope. Biofeedback, 53(1), 1-9. http://doi.org/10.5298/1081-5937-53.01.16

Peper, E., Chen, S., Heinz, N., & Harvey, R. (2023). Hope for menstrual cramps (dysmenorrhea) with breathing. Biofeedback, 51(2), 44–51. https://doi.org/10.5298/1081-5937-51.2.04

Peper, E., Harvey, R., Chen, S., & Heinz, N. (2025). Practicing diaphragmatic breathing reduces menstrual symptoms both during in-person and synchronous online teaching. Applied Psychophysiology and Biofeedback. Published online: 25 October 2025.  https://rdcu.be/eMJqt  https://doi.org/10.1007/s10484-025-09745-7

Peper, E., Harvey, R., & Hamiel, D. (2019). Transforming thoughts with postural awareness to increase therapeutic and teaching efficacy.  NeuroRegulation, 6(3),153-169.  https://doi.org/10.15540/nr.6.3.1533-1 

Stroebel, C. (1982). The Quieting Reflex. New York: Putnam Pub Group. https://www.amazon.com/Qr-Quieting-Charles-M-D-Stroebel/dp/0399126570/

Thakur, P. & Pathania, A.R. (2022). Relief of dysmenorrhea – A review of different types of pharmacological and non-pharmacological treatments. MaterialsToday: Proceedings.18, Part 5, 1157-1162. https://doi.org/10.1016/j.matpr.2021.08.207

Tsai, H. Y., Peper, E., & Lin, I. M. (2016). EEG patterns under positive/negative body postures and emotion recall tasks. NeuroRegulation, 3(1), 23-27.   https://doi.org/10.15540/nr.3.1.23

*Edited with the help of ChatGPT 5