Menstrual and cycle problems: what can an osteopath do?

In short Many complaints follow the rhythm of your cycle: painful or heavy periods, headaches, mood swings or feeling worse just before your period. At the osteopath, you first gain insight into your cycle and into which hormones play a part in causing or maintaining your complaints. The osteopath then treats your abdominal and pelvic area, and you get exercises and lifestyle advice. If something points to a condition a doctor needs to look at, such as endometriosis, adenomyosis, PMOS or PMDD, we refer you specifically to your GP or gynaecologist. Osteopathy works alongside your doctor's care, not instead of it.

Which complaints can an osteopath help with?

You are welcome at any stage of life: as a teenager with complaints around your first periods, as a young adult, and in the run-up to and during the menopause.

• Painful periods (dysmenorrhoea) or heavy bleeding
• An irregular cycle
• Hormonal headache or migraine around ovulation or your period
• Feeling worse just before your period (premenstrual syndrome, PMS), such as bloating, tender breasts or tiredness
• Mental complaints that follow your cycle: low, emotional, irritable or angry. When these complaints are so severe that they disrupt your life every month, doctors call it PMDD (premenstrual dysphoric disorder).^[1]
• Endometriosis and adenomyosis: tissue like the lining of the inside of the womb is also found elsewhere in your abdomen (endometriosis) or grows into the muscle wall of the womb (adenomyosis)^[2][28]
• PMOS, known until 2026 as PCOS (polycystic ovary syndrome): a hormonal condition with, among other things, an irregular cycle and often insulin resistance (your body responds less well to insulin)^[3][4]
• Vulvodynia: persistent pain at the vulva, for example during sex or when inserting a tampon^[5]
• Complaints around the menopause (perimenopause and menopause)

Does this sound familiar?

• Your complaints get worse in a particular phase of your cycle, at roughly the same time every month.
• You take painkillers every month and sometimes miss school, work or sport.
• You feel like a different person in the week before your period.
• Your abdomen or lower back feels tense, bloated or "stuck" around your period.
• Your cycle has become irregular or stopped since you started doing a lot of sport or eating less.
  What does that mean?

  It may point to Relative Energy Deficiency in Sport (RED-S). When your body takes in less energy than it uses, it turns down functions that are not strictly needed to survive, including your cycle. You produce less oestrogen, you stop ovulating, and your cycle becomes irregular or stops. That is not harmless: in the long term your bones become weaker. It does not only affect elite athletes. The osteopath recognises the signs, refers you to a doctor or sports physician and a dietitian, and supports you along the way.^[29]

• You have had complaints for a long time, but nobody found a clear cause.

That last one is common. For endometriosis, studies show it still takes years on average before the diagnosis is made.^[6] Taking complaints seriously and referring on time is therefore an important part of our work.

When should you see your GP or gynaecologist straight away?

See a doctor first if you:

• bleed so heavily that you need to change your pad or tampon every hour, or feel dizzy or very tired;
• bleed between periods, after sex or after the menopause;
• suddenly have severe abdominal pain, or abdominal pain with a fever;
• could be pregnant and have abdominal pain or bleeding;
• have had no period for three months or longer while not pregnant.

If you have dark thoughts around your period or are thinking about suicide, talk to your GP straight away or call the Belgian suicide prevention line on 1813 (free, day and night, in Dutch). In an emergency, call 112.^[1]

Can you see an osteopath without a referral?

Yes. You do not need a prescription and can book directly with the osteopath. If you have new or severe complaints that no doctor has looked at yet, we recommend that you also see your GP or gynaecologist in parallel. They can rule out serious causes while you already get started with us. Most health insurance funds reimburse part of an osteopathy session through their supplementary insurance. Read more about reimbursement.

What does an osteopath do for cycle problems?

1. Conversation and insight into your cycle

The osteopath asks about your complaints, your cycle, your medical history, your sleep, diet, stress and exercise. You get an explanation of what happens in each phase of your cycle and how lifestyle affects it.

We often ask you to keep track of your complaints for a few cycles. That way you learn when in your cycle your complaints appear, and which hormones may cause or maintain them. Doctors also use such a diary to diagnose PMS and PMDD.^[1] Feel free to start before your first appointment, even if you are still unsure whether to book. Bring it to your first visit so we can get to work with it straight away. The official, scientifically tested diary used by doctors and researchers is the Daily Record of Severity of Problems (DRSP).^[1][34] The International Association for Premenstrual Disorders (IAPMD) offers it for free, in English: DRSP diary from IAPMD. We also have a simple cycle diary (pdf, in Dutch) in our own words. Your GP or gynaecologist can also give you a diary.

2. Recognising warning signs and referring

The osteopath looks out for signs of, among other things, endometriosis, adenomyosis and PMOS. Only a doctor can diagnose or rule these out. If we see such signs, you get referral advice that you can discuss with your GP, for example for a gynaecologist, endocrinologist (hormone specialist), gastroenterologist or urologist. Your GP decides on the next steps together with you. Osteopathy does not replace medical tests or medication, but it can run alongside them.

3. Treatment

• Freeing up the lower abdomen. With gentle techniques on the lower abdomen, the osteopath aims to improve blood flow and mobility around the pelvic organs (bladder, womb, bowel).
• Relaxing the pelvis. Treatment of the muscles around the pelvis and, where needed, the pelvic floor.
• Calming the nervous system. Techniques and breathing exercises aimed at the vagus nerve, the nerve that helps your body relax and recover.
• Liver and bowel. The osteopath also treats the area of the liver and bowel. These organs play a role in breaking down hormones.
• Review of diet and supplements. The osteopath looks at what you eat and which supplements you may be taking. You can discuss the outcome further with your doctor. The osteopath does not prescribe anything.

4. Getting started yourself

You get exercises for at home, for example:

• psoas stretch: a stretch for the deep hip flexor, which runs from your lower back through the pelvis;
• hip openers: exercises that loosen the muscles around your hips and pelvis;
• breathing and relaxation exercises, such as slow breathing.

What works? (evidence-based treatment)

Research sometimes looks at one technique on its own, and sometimes at a combination of treatments. In practice we usually combine several techniques. That is why we show both separately.

Single techniques: what does research say about one treatment on its own?

Treatment	What does research say?	Evidence
Exercise and sport for period pain	Regular exercise (stretching, yoga, aerobic training) clearly reduces period pain, often as much as or more than painkillers.[7][8][9]	Strong evidence*
Heat (hot-water bottle, heat pad) for period pain	Reduces pain moderately.[8][9]	Limited evidence*
Manual treatment techniques on their own (such as osteopathic and other manual techniques, without any other treatment) for period pain	Small studies find less pain and fewer days with pain, but there are few studies and they often lack a sham treatment for comparison.[10][11][12]	Limited evidence*
Exercise, or psychological support, for PMS	Each on its own reduces PMS complaints, including low mood, anxiety and irritability.[13][14]	Strong evidence*
Vitamin B6, calcium or zinc for PMS	May somewhat reduce the mental complaints of PMS, but the studies vary in quality.[15]	Limited evidence*
Pelvic floor therapy for vulvodynia	Appears to help, but the studies are small.[5][19]	Limited evidence*
Cognitive behavioural therapy for menopause symptoms	Reduces hot flushes, night sweats, low mood and anxiety.[20] This therapy is given by a psychologist; we refer you for it, preferably through your GP.	Strong evidence*

Combined approach (multimodal): what does research say about a combination?

Treatment	What does research say?	Evidence
Multimodal physiotherapy (a combination of exercises, manual therapy and education) for chronic pelvic pain	Reduces pain.[16]	Strong evidence*
Physiotherapy, exercise and education for endometriosis	Less pelvic pain and pain during sex, better quality of life.[17][18]	Limited evidence*
Healthy lifestyle for PMOS	The international guideline puts a healthy lifestyle (diet, exercise, sleep) first.[3]	Strong evidence*

Popular treatments, but little evidence

• Techniques on the organs (visceral therapy). Osteopaths use them often, including at our practice. A review of studies has so far found little evidence that they work for organ-related complaints.^[21] One small study in women with PMOS found fewer menstrual complaints when these techniques were added to a diet.^[22] Limited evidence\*
• Treating the liver and bowel for better hormone breakdown. It is true that the liver and bowel break down hormones. Whether osteopathic treatment changes that breakdown has not been studied. No evidence\*
• Relaxation via the vagus nerve. Slow breathing demonstrably increases the activity of the vagus nerve.^[23] Whether that reduces cycle complaints has not yet been studied. No evidence\* for cycle complaints. It is safe, though, you can do it anywhere and many people find it calming.
• Magnesium, vitamin D or multivitamins for PMS. There is not enough evidence for these.^[15] No evidence\*

No evidence does not mean that something is harmful or helps nobody. It means we do not know for sure. That is why we use a combination of techniques, monitor how you are doing so we can follow your progress personally, and always give you advice to discuss with your GP.

What can you expect?

• Insight into your menstrual cycle and how your complaints relate to it
• Less pain, for most people
• Referral advice when needed, which you can discuss with your GP (for example for a gynaecologist or endocrinologist), and collaboration with the doctors and care providers who already follow you

How soon will you notice results?

That depends on how severe your complaints are and on the cause. Because complaints follow your cycle, we look across several cycles. At the start we set concrete goals together, and we follow them up together. We usually evaluate them after about three cycles. If there is no improvement by then, or your complaints get worse, we discuss the next step with your GP or gynaecologist.

Your osteopath for menstrual and cycle problems

Book with the gold "Make an appointment" button at the top right. Not sure whether the osteopath can help you? Send us a message via WhatsApp.

Frequently asked questions

Can an osteopath feel or diagnose endometriosis?
No. Endometriosis is diagnosed by a doctor, with a consultation, an examination and imaging such as an ultrasound or MRI.^[2] The osteopath can recognise signs that point to it, and then refer you.

Does an osteopath help with period pain?
Small studies find less pain after a few osteopathic treatments, but the evidence is still limited.^[10][11] Exercise and heat are better studied; you get those as advice as well.^[7][8]

Can an osteopath balance my hormones?
We do not promise that. The osteopath helps you understand which hormones may play a part in your complaints, treats your pelvic and abdominal area and gives lifestyle advice. If there is a hormonal condition, such as PMOS or a thyroid problem, we always refer you to your GP.

Can I see an osteopath with PCOS or PMOS?
Yes, alongside your GP or specialist, who makes the diagnosis and follows you up. The guideline puts a healthy lifestyle first.^[3] We help with education, exercise and treatment of your complaints.

Does an osteopath help with menopause symptoms?
The osteopath can help with physical complaints such as tension and pain, and gives lifestyle advice. For hot flushes and mood, cognitive behavioural therapy is the best studied.^[20] Your doctor can also suggest hormonal or other medication.

How do you recognise a hormonal headache, and in which phase of your cycle does it occur?
Hormonal headache or migraine usually comes around the start of your period, when your oestrogen drops. In some women it also comes around ovulation, when oestrogen dips briefly. About 60% of women with migraine have migraine around their period.^[25] Keep track of when you have headaches for a few cycles: if they always come around the same time, your cycle is probably involved. Also discuss migraine with your GP; there is medication that works specifically around the period. If you suddenly get the worst headache you have ever had, or a headache with paralysis, confusion or problems seeing or speaking, call 112 straight away.

In which phase of your cycle are you most tired?
For many women, in the week before their period. Tiredness is one of the complaints of PMS.^[1] If you are exhausted all month long, ask your GP to check, for example your iron or thyroid.

Is neck pain a symptom of your period?
Not directly, but some women have more headache, neck or back pain and muscle tension in the week before their period (luteal phase). In that phase your hormones fluctuate strongly. Women with PMS usually do not have a hormone deficiency, but are more sensitive to those normal fluctuations.^[1] Exactly how that leads to more muscle tension has not been well studied yet. If it comes back every month, write it down in your diary. The osteopath can treat that tension too. If the pain is severe or new, have your GP check it first.

Can stress change your cycle?
Yes. And stress is not only mental: physical stress counts too, such as illness or inflammation, poor sleep, hard training or eating too little. Under stress, your body produces stress hormones. They inhibit the hormones in your brain that control your cycle and ovulation.^[32] As a result, your cycle can become irregular, your period can come earlier or later, and with prolonged or severe stress your period can even stop.^[24][33] Relaxation, breathing exercises and enough food and sleep can help. If your period stays away for three months or longer, see your GP.

Why has my cycle suddenly become irregular?
Stress, losing a lot of weight, doing a lot of sport (see relative energy deficiency in sport, RED-S) and the years before the menopause can change your cycle.^[24][27] But pregnancy, PMOS or a thyroid problem can also be behind it. If your cycle is suddenly different from usual, have it checked by your GP or gynaecologist first.

Why do my period complaints get worse as I get older?
In the years before the menopause (perimenopause, often from your forties) your hormones fluctuate more. Your cycle can become more irregular and your bleeding heavier.^[27] Conditions such as adenomyosis also come to light more often then. That is why you should always have worsening complaints checked by your GP or gynaecologist.

Can an osteopath help with stress?
Possibly. A recent review of studies found indications that osteopathic treatment may reduce stress, anxiety and low mood.^[26] The research is still young. Limited evidence\* Slow breathing demonstrably helps your body calm down.^[23] For severe stress or burnout, we also refer you to your GP or a psychologist.

What are the downsides of osteopathy?

• For some techniques the evidence is still limited; we tell you that honestly (see above).
• You may feel a bit sensitive or tired for a day after a treatment.
• Osteopathy is only partly reimbursed through supplementary insurance. Read more about reimbursement.
• An osteopath does not replace a doctor. That is why we refer you when needed.

Can I see the osteopath during my period?
Yes. If you do not feel up to it, we simply move the appointment.

Is osteopathy reimbursed?
Most health insurance funds give a contribution through their supplementary insurance. How much differs per fund. Read more about reimbursement.

Reviewed by Eefje Coomans, osteopath D.O. Last updated: November 2026.

What do the labels mean? Strong evidence: several good studies or reviews reach the same conclusion. Limited evidence: there are few or small studies, or the results contradict each other; it may help, but it is not certain. No evidence: good studies find no effect larger than a placebo, or there are no good studies yet. No evidence does not mean that something is harmful. We base ourselves on reviews and guidelines published in 2019 or later.

Glossary

Difficult words on this page, explained in plain language. The explanations are written in our own words, based on the source given.

Sources

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