Menstrual cramps can range from a mild nuisance lasting a day or two to several days of unbearable pain that interferes with everyday activities. They’re one of the most common causes of pelvic pain and many experiences them just before and during their period.

The pain is caused by uterine contractions that happen just before or during the onset of your period. But what makes the pain more severe for some people?

Read on to learn more about the potential causes of severe cramps and how to manage the pain.

How do I know if my cramps are severe?

Menstrual cramps feel like a throbbing or cramping pain in your lower abdomen. You may also feel pressure or a continuous dull ache in the area. The pain may radiate to your lower back and inner thighs.

Cramps usually begin a day or two before your period, peaking around 24 hours after your period starts. They typically last for two to three days.

Menstrual cramps can be accompanied by other symptoms, including:

Typical menstrual cramps are painful, but they usually respond well to over-the-counter (OTC) pain relievers, including ibuprofen.

Severe cramps, however, tend to begin earlier in the menstrual cycle and last longer than typical cramps do.


Not sure if your cramps are typical or severe? Generally, severe menstrual cramps:

  • don’t improve when you take OTC pain medication
  • interfere with your daily activities
  • are often accompanied by heavy bleeding or clotting

What causes them?

During your period, your uterus contracts to help shed its lining. These contractions are triggered by hormone-like substances called prostaglandins. Higher levels of prostaglandins are associated with more severe menstrual cramps.

Some people tend to have more severe menstrual cramps without any clear cause. For others, severe menstrual cramps may be a symptom of an underlying medical condition.


Endometriosis is a condition that causes the tissue that usually lines your uterus to grow in other parts of your body, outside your uterus.

Pelvic pain is the most common symptom. Others include:

Polycystic ovary syndrome (PCOS)

PCOS is a common hormone disorder affecting approximately 1 in 10Trusted Source women of childbearing age. Higher levels of androgens, which are male hormones, and irregular periods are common symptoms.

Other symptoms of PCOS include:


Fibroids are noncancerous growths that develop inside or outside of the uterus. They range in size from as small as a seed to large masses that can cause an enlarged uterus. You can have one or more fibroids, often without symptoms.

When fibroids do causes symptoms, the symptoms vary depending on the number of fibroids, their size, and location.

In addition to severe mensural cramps, fibroids can also cause:

Pelvic inflammatory disease (PID)

PID is a bacterial infection of the female reproductive organs. It’s usually caused by sexually transmitted infections (STIs), such as chlamydia and gonorrhea. Other infections that aren’t sexually transmitted can also cause it.

Pelvic pain is the most common symptom of PID. Other symptoms include:

Cervical stenosis

Cervical stenosis, which is also called a closed cervix, happens when the opening of your cervix is narrow or completely closed. You can be born with a cervical stenosis or develop it later.

A closed cervix can prevent menstrual blood from exiting your body, making your periods very light or irregular. It can also lead to fertility issues.


Adenomyosis is a thickening of the uterus. It occurs when the endometrial tissue that lines your uterus grows into the muscles of your uterus.

The tissue continues to function as it usually would throughout your cycle — thickening, breaking down, and exiting your body. This causes your uterus to grow two to three times its normal size.

Adenomyosis doesn’t always cause symptoms. When it does, you may notice severe menstrual cramps that get increasingly worse, as well as heavy or prolonged menstrual bleeding.

Intrauterine device (IUD)

An IUD is a small birth control device that’s inserted into your uterus. There are different types of IUDs available, some containing hormones while others are hormone-free.

They’re safe for most people, but they can occasionally cause side effects, including:

  • severe menstrual cramps
  • irregular periods
  • heavy menstrual bleeding

There’s also a small risk of the IUD perforating your uterus during insertion or bacteria entering your uterus during insertion, causing PID. Expulsion is another rare possibility, which is when the IUD moves out of place. All of these can cause severe pelvic pain.

How do I know what’s causing them?

If you have very painful menstrual cramps or cramps that last longer than two or three days, make an appointment with your healthcare provider.

They’ll likely start by reviewing your medical history and performing a physical exam, including a pelvic exam. They may also give you a Pap test.

Depending on your other symptoms, they may recommend additional tests, including:

  • an ultrasound to check the size and thickness of your uterus as well as detect fibroids or cysts
  • CT scan, which can provide a detailed view of your reproductive organs
  • gynecologic laparoscopy, a minimally invasive surgical procedure, to confirm a diagnosis of endometriosis

How can I manage the pain?

Severe menstrual cramps are typically hard to treat on your own, but these tips may help while you work with your healthcare provider to narrow down an underlying cause:

  • Get regular exercise. Results of a 2015 studyTrusted Source showed that doing 30 minutes of aerobic exercise three times a week significantly reduced the severity of menstrual cramps over the course of 8 weeks.
  • Use a heating pad. There’s evidence that heat may be as effective as ibuprofen for relieving menstrual cramps. Place a heating pad on your lower abdomen for relief.
  • Manage your stress. Work and general life stress has been linked to menstrual cramps. Breathing exercisesyoga, and spending time doing things that you enjoy can help keep your stress down.
  • Soak in a hot bath. Soaking in a hot bath soothes your lower abdomen and back. It’s also relaxing and a great way to relieve stress.
  • Take supplements. Certain supplements may help reduce the severity of menstrual cramps. These include omega-3 fatty acidsmagnesium, and vitamins B-1 and B-6.
  • OTC pain medication. OTC pain relievers, such as ibuprofen and acetaminophen, often aren’t enough to completely eliminate severe menstrual cramps. If you take them a day before you usually start to experience cramps, they may be more effective.
Bottom Line:

You don’t have to power through severe menstrual cramps. If your pain interferes with your ability to go on about your day or lasts longer than two or three days, talk to your healthcare provider. They can help you get to the bottom of what’s causing your severe cramps and recommend a plan to keep the pain under control.

Why menstrual cramps happen

It’s common to feel discomfort around your abdomen, lower back, and thighs when you’re menstruating.

During your period, the muscles of your womb contract and relax to help shed built-up lining. Sometimes you’ll experience cramps, which are your muscles at work. Some women and girls may experience nausea, vomitingheadaches, or diarrhea as well.

Doctors aren’t sure why some women experience painful menstruation and others don’t. But some factors that are associated with more intense pain include:

  • having a heavy blood flow
  • having your first child
  • being under the age of 20, or just starting your period
  • having an overproduction of or sensitivity to prostaglandins, a hormone that influences your womb

Other factors include growths in your wombendometriosis (abnormal uterine tissue growth), and use of birth control.

For mild to temporary cramps, some home remedies can help provide relief. Read on for tips on getting fast relief and learn how to potentially lessen the pain during your next cycle.

  1. Taking over-the-counter (OTC) medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the primary over-the-counter (OTC) form of pain relief recommended for menstrual pain and heavy menstrual bleeding. NSAIDs include ibuprofen (Advil) and naproxen (Aleve).

These drugs help lower your body’s production of prostaglandin. NSAIDs aren’t as effective as oral contraception, but they can help reduce pain.

  1. Applying heat

Applying heat to your abdomen and lower back may relieve pain. A 2012 study focused on 147 women 18 to 30 years old who had regular menstrual cycles found that a heat patch at 104°F (40°C) was as effective as ibuprofen.

If you don’t have a hot water bottle or heating pad, take a warm bath or use a hot towel. Or you can make your own heating pad:

  1. Cut and sew together two pieces of fabric, leaving a hole at the top.
  2. Fill with uncooked rice and sew up the hole.
  3. Microwave for a few minutes to the desired temperature. Don’t overheat!
  4. Let cool, if necessary. Or wrap your homemade pad in a towel to reduce heat transfer. Reuse as necessary.

You can also purchase a heating pad online.

  1. Massaging with essential oils

Massage therapy for about 20 minutes can help reduce menstrual pain.

One 2010 study looked at 23 women with period pain caused by endometriosis. The researchers found that massages significantly reduced pain immediately and afterward.

Massage therapy for menstruation involves pressing specific points while the therapist’s hands move around your abdomen, side, and back.

Watch this video for a tutorial on massaging for menstrual pain:

Adding essential oils for an aromatherapy style of massage may have additional benefits.

A 2012 study divided 48 women experiencing menstrual pain into two groups: One group received a cream containing essential oils, while the other received a cream containing a synthetic fragrance.

The group who used essential oils experienced a significant reduction in amount and duration of pain. The researchers used a blend of lavenderclary sage, and marjoram oil in this study. You can buy a scented massage oil with similar ingredients or make your own.

You should always dilute your essential oil with a carrier oil. Examples include vegetable or nut oils such as grapeseed or sweet almond oil. A safe concentration is one drop of essential oil per teaspoon of carrier oil.

  1. Having an orgasm

While there are no clinical studies on the direct effect of orgasms on menstrual cramps, science suggests it may help.

Vaginal orgasms involve your whole body, including your spinal cord, which signals the release of neurotransmitters. A vaginal orgasm can trigger your brain to release neurotransmitters such as endorphins and oxytocin. Endorphins can decrease pain perception.

Dr. Barry Komisaruk, a psychology professor at Rutgers University who studies the female orgasm, told the BBC, “Vaginal orgasms [are described] as being internal and involving the whole-body; that’s probably because the nerves that carry sensations from the clitoris are different from the nerves from the vagina.”

His 1985 study with Dr. Beth Whipple was the first to find that vaginal self-stimulation doubled women’s tolerance for pain.

  1. Avoiding certain foods

During menstruation, it’s a good idea to avoid foods that cause bloating and water retention. Some of the biggest culprits include:

Reducing or cutting out these foods can help alleviate cramps and decrease tension. Instead, try soothing (caffeine-free) ginger or mint teas or hot water flavored with lemon. If you need a sugar fix, snack on fruits such as strawberries or raspberries.

  1. Adding herbs to your diet

These herbal remedies contain anti-inflammatory and antispasmodic compounds that experts believe can reduce the muscle contractions and swelling associated with menstrual pain.

Herb or supplement


Does it work?

chamomile tea

Sip two cups of tea per day a week before your period. You may benefit more if you drink it every month.

A 2012 review of studies reports chamomile tea increases urinary levels of glycine, which helps relieve muscle spasms. Glycine also acts as a nerve relaxant.

fennel seeds

When your period starts, take 30 mg of fennel extract four times a day for three days.

A 2012 study looked at girls and women 15 to 24 years old. The group that took the extract reported feeling relief. The placebo group reported none.


Take 840 mg of cinnamon capsules three times a day during the first three days of your period.

In 2015, women who took cinnamon capsules in a study reported less bleeding, pain, nausea, and vomiting compared to the placebo group.


Try grating a small piece of ginger into hot water for a warm cramp-relieving drink.

One study of university students found that 250 mg of ginger powder four times a day for three days helped with pain relief. It also concluded ginger was as effective as ibuprofen.

French maritime pine bark extract (Pycnogenol)

Take 60 mg of French maritime pine bark extract per day during your cycle. This can help with more moderate menstrual pain.

A 2008 study found that women who took 60 mg of French maritime pine bark extract per day during their cycle reported less pain. According to the study, the benefits increase as you take the pill and continue even after you stop.


Try 1,000 mg of dill for five days, starting two days before your cycle.

A 2014 study concluded 1,000 mg dill was as effective for easing menstrual cramps as mefenamic acid, an OTC drug for menstrual pain.

Relief for premenstrual syndrome symptoms

Curcumin, a natural chemical in turmeric, may help with symptoms of premenstrual syndrome (PMS). One 2015 study looked at 70 women who took two capsules of curcumin for seven days before their period and three days after. Participants reported significant reduction in PMS.

If you want to give curcumin a try, check out this recipe by In Jennie’s Kitchen for turmeric tea. Curcumin supplements are also available online.


Always make sure you’re buying herbs and supplements from a reputable source as they aren’t regulated. While most of these herbal remedies have few side effects, check with your doctor before trying them.

Some herbs may also cause unintended side effects, especially if you’re taking medication. Most of these herbs and supplements also don’t include specific instructions for menstrual periods. Your doctor may have more information on dosage recommendations.

How diet and exercise can help in the long run

Maintaining a healthy diet and keeping up a regular exercise regimen can go a long way toward preventing menstrual pain. A 2016 study of 250 women found significant differences between period pain in women who maintained a healthy lifestyle and those who didn’t.

Read on for specific diet and exercise tips.


Generally, a diet geared toward decreasing menstrual pain should be high in minimally processed foods, fiber, and plants.

Give these foods a try:

Boron: This mineral helps your body absorb calcium and phosphorus. It also reduces menstrual cramps: A 2015 study that looked at 113 university students found that boron reduced the intensity and length of menstrual pain. Foods with high concentration of boron include:

You can also take boron supplements, if your diet doesn’t provide enough. However, you should consult your doctor before taking boron supplements. Discover how boron helps the brains and bones, too.

Water: It sounds odd, but drinking water keeps your body from retaining water and helps to avoid painful bloating during menstruation. Warm or hot water is usually better for cramps, as hot liquids increase blood flow to your skin and may relax cramped muscles.

You can also eat water-based foods to increase your hydration, including:

Calcium: This mineral can help reduce muscle cramping during menstruation. The Mayo Clinic recommends at least 1,000 milligrams (mg) per day for women between the ages of 19 and 50. Foods high in calcium include:

Calcium is also available in supplement form. But speak to your doctor before taking supplements to find out if it’s safe for you.


The idea of exercise immediately before or during your period may not appeal to you. But exercise releases endorphins.

Research suggests exercise is effective at reducing menstrual pain to the extent it may also eliminate or reduce the need for pain-relief medication. Moderate activity such as walking can be beneficial during your period in place of more strenuous activity.

Yoga is a gentle exercise that also releases endorphins and helps prevent or reduce menstrual symptoms. In one 2011 study, researchers found three different yoga poses — Cobra, Cat, and Fish — significantly reduced intensity and duration of pain during menstruation for young women ages 18 to 22.

Which tried-and-true home remedy has worked for you?

Plus, find out what others found most effective below:

The most popular answers have been applying a hot compress (23%), OTC medication (21%), and having an orgasm (20%). Based on your answer you may find this related reading useful:

The most useful home remedies so far have been applying a hot compress (23%), OTC medication (21%), and having an orgasm (20%). Based on your answer you may find this related reading useful:

The most popular answers have been applying a hot compress (23%), OTC medication (21%), and having an orgasm (20%). Based on your answer you may find this related reading useful:

The most popular answers have been applying a hot compress (23%), OTC medication (21%), and having an orgasm (20%). Based on your answer you may find this related reading useful:

The most popular answers have been applying a hot compress (23%), OTC medication (21%), and having an orgasm (20%). Based on your answer you may find this related reading useful:

The most popular answers have been applying a hot compress (23%), OTC medication (21%), and having an orgasm (20%). Based on your answer you may find this related reading useful:

The most popular answers have been applying a hot compress (23%), OTC medication (21%), and having an orgasm (20%). Based on your answer you may find this related reading useful:

The most popular answers have been applying a hot compress (23%), OTC medication (21%), and having an orgasm (20%). Based on your answer you may find this related reading useful:

When to see a doctor

You should contact your doctor if you have severe pain and very heavy bleeding. See a doctor if:

  • the pain consistently prevents you from doing day-to-day activities
  • the pain worsens, or bleeding gets heavier, over time
  • you’re over 25 and severe cramps are a new development
  • OTC medication doesn’t work

For severe cases, the best way to get treatment is for a doctor to diagnose the cause of your menstrual pain. If you’re interested in learning more ways to relieve painful menstruation, check out this article on pain relief.

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Written by the Healthline Editorial Team— Updated on May 5, 2020
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Photo Credit: Sydney Sims


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