What Makes Period Cramps Worse?Smoking, Stress and Sleep Studies
PeriodsArticlePainful periods run in families, but everyday factors seem to matter too. Pooling 24 studies with 27,091 women, smokers were about 1.45 times as likely to have painful periods as non-smokers. A review of 77 studies linked cramps with stress, sleeping under 7 hours, going to bed after 11 p.m. and being underweight. These are associations, not proof, but several are things you can change.
In this article
Why do some women breeze through their periods while others are flattened by cramps? Some of it is out of your hands, but large reviews have also found everyday factors linked to more painful periods.
Smoking
A review pooled 24 studies with 27,091 women.1
| Odds of painful periods | |
|---|---|
| Smokers versus non-smokers | About 1.45 times1 |
| Current smokers versus never-smokers | About 1.5 times1 |
| Former smokers versus never-smokers | About 1.3 times1 |
The lower figure in former smokers is interesting, though these studies can’t show that quitting reduces pain. A second review of 77 studies also linked smoking with more severe cramps.2
Other factors
The 77-study review found these linked to painful periods:2
| Factor | Odds of painful periods |
|---|---|
| Family history of painful periods | About 3.8 times |
| Stress | About 1.9 times |
| Underweight (BMI under 18.5) | About 1.5 times |
| Going to bed after 11 p.m. | About 1.3 times |
| Irregular cycles | About 1.3 times |
| Sleeping under 7 hours | About 1.2 times |
Being underweight was also linked to more severe pain.2
How to read this
These are associations from observational studies. Stress or poor sleep could make cramps worse, or bad cramps could cause stress and poor sleep. Family history you can’t change. Still, several of these are habits worth adjusting for their own sake.
What may help
UK health advice says cutting down on alcohol and not smoking may help period pain, alongside heat, gentle exercise and painkillers.3
- Stopping smoking is the change with the most evidence behind the link.
- Protecting sleep, including an earlier bedtime.
- Managing stress where you can.
See why your period cramps are so bad, what 80 trials found on painkillers and exercise for cramps.
Try: “My mum and sister had terrible periods too, and mine are getting harder to manage. What can I try beyond painkillers, and should we check for endometriosis?”
Period, Handled covers why cramps happen in Chapter 7, “Cramps That Stop You,” in a section called “The Chemistry of a Cramp.” Its Period Scorecard rates pain from 0 to 10 each period, so you can see whether a change in sleep or smoking makes a difference. See the book.
This article is for general educational purposes only and is not medical advice. It isn't a substitute for diagnosis or treatment from a qualified healthcare professional who knows your health history. See a doctor if period pain stops your usual activities, is getting worse, or comes with heavy or irregular bleeding, pain during sex, or bleeding between periods, since these can point to conditions like endometriosis. Girl Playbook does not endorse any specific product, test, or provider.
Girl Playbook sells this book. It provides education and worksheets, not individualized medical care.
Sources
The research behind this article, in the order it’s cited. How we source our articles.
- PLOS ONE journal (via PubMed Central), 2020Association between cigarette smoking and the risk of dysmenorrhea: A meta-analysis of observational studies (opens in a new tab)abcd
- International Journal of Environmental Research and Public Health (via PubMed Central), 2022Factors Associated with the Prevalence and Severity of Menstrual-Related Symptoms: A Systematic Review and Meta-Analysis (opens in a new tab)abc
- NHS, 2025Period pain (opens in a new tab)↩
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