What Helps Period Pain? What Research Supports and When to See a Doctor

In brief:

• Period pain comes from the womb contracting during menstruation and is often a normal part of the cycle.
• The strongest evidence is for over-the-counter painkillers and heat; evidence for exercise is weaker.
• No supplement has strong supporting evidence; data on ginger and vitamin B1 are limited.
• Pain that worsens, changes or comes with other symptoms needs medical assessment.

What causes period pain?

During a period, the womb contracts to shed its lining. This causes cramping pain in the lower abdomen, which may spread to the back and legs (NHS). Pain usually starts at or just before the beginning of a period and lasts up to three days.

Period pain without an underlying condition is called primary period pain; it usually starts in adolescence, soon after the first periods. Sometimes another condition is responsible; this is called secondary period pain. Causes listed by the NHS include:

• Endometriosis and adenomyosis: tissue similar to the womb lining growing in other places
• Fibroids: non-cancerous growths in and around the womb
• Pelvic inflammatory disease: infection of the womb, fallopian tubes and ovaries
• An intrauterine device (coil): it may increase pain, especially in the first 3–6 months after insertion

How common is it?

Very common. A review of 15 studies found that the prevalence of period pain in women of reproductive age ranged from 16% to 91% across studies; severe pain limiting daily life affected 2–29% (Ju et al., 2014). The same review associated older age, having given birth and use of the contraceptive pill with lower risk, and high stress and a family history of period pain with higher risk.

What helps period pain?

1. Over-the-counter painkillers

This is the most extensively studied approach to period pain. A Cochrane review of 80 randomised studies involving 5,820 women found that nonsteroidal anti-inflammatory painkillers appeared very effective; evidence quality was low for most comparisons, and the authors also noted the risk of side effects (Marjoribanks et al., 2015). The NHS also recommends over-the-counter painkillers for period pain.

Ask your pharmacist which option suits you and how to use it. Tell them if you have stomach or kidney problems or asthma, are pregnant or take regular medicine. Do not exceed the dose on the packaging or in the patient information leaflet.

2. Applying heat to the abdomen

A hot-water bottle, heating pad or warm shower is one of the most accessible options. A meta-analysis of six randomised studies found that heat reduced pain more than an unheated placebo patch in two studies; in three studies, a heating pad was at least as effective as pain-relief medicine (Jo and Lee, 2018). The authors also stressed the small number of studies.

Do not put a hot-water bottle directly on your skin; wrap it in a towel (NHS). Do not leave a heater on while you sleep.

3. Regular gentle exercise

Gentle exercise such as walking, swimming, cycling or yoga is among the NHS recommendations. A Cochrane review of 12 studies involving 854 women suggested that regular exercise might reduce the severity of period pain (Armour et al., 2019). Evidence quality was low: studies were small and their findings varied. Exercise has other benefits too, making it an option worth trying.

4. Massage

Gentle massage of the abdomen and lower back is among the NHS recommendations for self-care.

5. Stopping smoking and reducing alcohol

The NHS notes that reducing alcohol and not smoking may also help.

6. Ginger and other supplements

A Cochrane review of 27 studies involving 3,101 women found no high-quality evidence supporting any supplement for period pain. Ginger and vitamin B1 were among the supplements with evidence suggesting possible benefit, although very limited; all the evidence was low or very low quality (Pattanittum et al., 2016).

If you are considering a supplement, speak to your pharmacist first; mention any regular medicine, especially blood thinners. Some herbs can interact with medicines (NCCIH).

7. Options your doctor may recommend

If these approaches do not relieve the pain, a doctor may consider prescription painkillers, contraceptive methods that thin the womb lining or a TENS machine, which delivers gentle electrical stimulation through electrodes on the skin (NHS). Your doctor bases these decisions on the cause of the pain and your individual circumstances.

When should you see a doctor?

According to the NHS, seek help promptly if pelvic or period pain is severe or worse than usual and painkillers have not helped.

Also see a doctor if (NHS):

• Your periods have become more painful, heavier or irregular
• Pain stops you doing everyday activities
• You have pain during sex or when passing urine or stools
• You bleed between periods
• You notice changes in bladder or bowel habits
• You have abdominal swelling, loss of appetite or unintentional weight loss

For other signs related to periods, see What Is Your Menstrual Cycle Telling You? and Irregular Periods: When and Why Do They Happen?.

Frequently asked

How many days does period pain last?

It usually starts at or just before the beginning of a period and lasts up to three days (NHS). Speak to a doctor about pain that lasts longer or gets worse each month.

Does period pain decrease after childbirth?

Research has associated having given birth and older age with a lower risk of period pain (Ju et al., 2014). This does not apply to everyone; if pain increases again, its cause should be investigated.

What should I be careful about when using a hot-water bottle?

Do not put the bottle or heating pad directly on your skin; wrap it in a towel (NHS). Take care if skin sensation is reduced and while sleeping.