Period pain: what really helps and when to see a GP

The same thing every month: cramps in your lower tummy, a pulling pain into your back, sometimes nausea or diarrhoea. Here you can read where period pain comes from, what really helps according to studies and what does not, how to use ibuprofen properly and how to tell when something more is behind it.

Data box: How common is period pain?

In a review of 15 large studies, 16 to 91 out of 100 women of childbearing age had period pain, depending on the study, and 2 to 29 out of 100 had severe pain (Ju 2014). For about 1 in 10 women, the pain is so bad that they cannot manage their daily life for 1 to 3 days every month (IQWiG 2024).

What is period pain?

Period pain, also called period cramps or menstrual pain, is cramping or pulling pain in the lower tummy during your period. The medical term is dysmenorrhoea. It usually starts shortly before or when the bleeding begins and is worst on the first and second day (NHS 2023).

The pain can spread to your back and thighs. Many women also have nausea, vomiting, diarrhoea or headaches, or feel exhausted (IQWiG 2024).

What causes period pain?

At the end of each cycle, the womb sheds its lining. To do this, it produces chemicals called prostaglandins. They make the muscles of the womb contract so that the lining comes away and flows out with the blood. The cramps briefly squeeze the blood vessels in the wall of the womb shut. The muscle gets less oxygen, and that hurts.

Women with severe period pain produce more prostaglandins or are more sensitive to them (IQWiG 2024). This is exactly where painkillers such as ibuprofen work: they block the production of prostaglandins.

Primary and secondary period pain

	Primary period pain	Secondary period pain
Cause	no illness, only the cramps of the womb	a condition such as endometriosis, adenomyosis, fibroids or polyps
Onset	with the first periods in your teens	often only after years of periods with little pain
Course	eases with age and often after giving birth	tends to get worse over the years
Timing	shortly before and during the first 1 to 3 days of bleeding	also before, after or between periods, during sex, when opening your bowels
Painkillers	usually work well	often only help partly

Primary period pain is more common in women under 30, with heavy bleeding and when it runs in the family (IQWiG 2024). Older women, women who have given birth and women who take the pill have period pain less often. In studies, severe stress increased the risk (Ju 2014).

How bad is normal period pain?

A pulling pain or cramps on the first and second day that you can manage well with a painkiller or heat and that do not stop you from getting on with your day are common and usually harmless. It is not normal if you regularly have to stay in bed, painkillers barely help, or you vomit or faint because of the pain. A simple guide on a scale from 0 to 10:

Severity	How it feels	What to do
1 to 3	noticeable, no limits on daily life	heat, movement, painkillers if needed
4 to 6	hard to concentrate, breaks needed	painkillers early and regularly, heat
7 to 10	daily life not possible, nausea, vomiting	have it checked by a gynaecologist or GP

What helps with period pain?

Much of the advice around periods is well meant but not backed by evidence. The following overview ranks the best-known remedies by the evidence from systematic reviews:

What helps with period pain, according to studies

Ibuprofen, naproxen (NSAIDs)

strong effect

Clear relief in 45 to 53 out of 100 women, with a dummy pill in 18 out of 100.

Cochrane, 80 studies (Marjoribanks 2015)
Combined pill

strong effect

Relieves period pain, but more often causes bleeding between periods, headaches and nausea.

Cochrane (Schroll 2023)
Heat

clear effect

A heat patch at 39 °C worked as well as 400 mg of ibuprofen three times a day.

Akin 2001, review Jo 2018
Regular exercise

clear effect

45 to 60 minutes, three times a week: about 25 out of 100 points less pain.

Cochrane, small studies (Armour 2019)
Paracetamol

moderate effect

Helps, but less well than NSAIDs in direct comparisons.

Cochrane (Marjoribanks 2015)
Acupuncture, acupressure

effect unclear

Studies small and contradictory.

Cochrane (Smith 2016)
Ginger, magnesium, vitamins

effect unclear

No high-quality evidence that they work.

Cochrane (Pattanittum 2016)

Rating by our editorial team based on the size of the effect and the quality of the studies in systematic reviews. Take painkillers as directed in the patient leaflet; if you have other health conditions or are pregnant, check with a doctor first.

Painkillers: ibuprofen and naproxen

The best evidence is for anti-inflammatory painkillers from the NSAID group, such as ibuprofen, naproxen or diclofenac. A Cochrane review of 80 studies found: of women taking a dummy pill, 18 out of 100 had moderate to excellent pain relief, compared with 45 to 53 out of 100 with NSAIDs (Marjoribanks 2015). No NSAID was clearly better than another.

How to use them properly:

Take them early: ideally at the first signs of your period or the pain, not once the cramps are in full swing. NSAIDs slow down the production of prostaglandins and work less well against those already made.
Regularly over 1 to 2 days: as directed in the patient leaflet, rather than only at the peaks.
With some food: stomach problems were the most common side effect. With NSAIDs, 11 to 14 out of 100 women had side effects, with a dummy pill 10 out of 100 (Marjoribanks 2015).
Not without advice: if you have stomach ulcers, asthma that reacts to painkillers, kidney disease or a blood clotting disorder, or if you are pregnant.

Paracetamol worked less well than NSAIDs in the few direct comparisons (Marjoribanks 2015). It is an option if you cannot tolerate NSAIDs.

Heat

A hot water bottle, a wheat bag or a heat patch on your lower tummy is the best-known home remedy, and it is well supported by evidence. In a US study with 81 women, a heat patch at 39 °C worn for twelve hours worked as well as 400 mg of ibuprofen three times a day (Akin 2001). A review of three studies with 274 women found similar results (Jo 2018).

Take care not to burn yourself: put a cloth between your skin and the hot water bottle and do not fall asleep with a very hot heat source.

Movement and exercise

Woman in light clothing in child's pose on a yoga mat in a bright living room

Regular exercise clearly reduces period pain. In a Cochrane review, exercise for 45 to 60 minutes, three times a week or more, reduced pain by about 25 points on a scale from 0 to 100. Whether it was yoga, running or strength training made little difference (Armour 2019). The studies were small, and the effect builds up over weeks, not during an acute flare.

The pill and other hormones

The combined pill makes the lining of the womb thinner, so fewer prostaglandins are produced. A Cochrane review confirms that it relieves period pain. On the other hand, more women had bleeding between periods, headaches or nausea (Schroll 2023). The hormonal coil or progestogen-only methods can also help (IQWiG 2024).

If you are trying to get pregnant, you cannot use hormonal contraception. That leaves painkillers, heat and exercise. When you are trying for a baby in particular, it is worth having severe period pain checked, because endometriosis can affect fertility.

What has little or no evidence

Dietary supplements: according to Cochrane, there is no high-quality evidence for ginger, vitamin B1, vitamin E, magnesium, omega-3 or fish oil (Pattanittum 2016).
Acupuncture and acupressure: the studies were small and contradictory (Smith 2016).
Teas, herbs and homeopathic remedies: effectiveness not proven (IQWiG 2024).

That does not mean a herbal tea cannot feel good. But it does not replace an effective painkiller when the pain knocks you out.

Quick tips for the first day

Take a painkiller at the first signs, not once the pain is at its worst.
Put a hot water bottle or heat patch on your lower tummy.
Gentle movement, such as a walk, if you can manage it.
Drink plenty, especially if you have diarrhoea or are vomiting.
If possible, do not schedule demanding appointments for the first days. The period calculator shows when your next period is due.

When should period pain be checked?

You do not have to simply put up with severe period pain. See a gynaecologist or your GP if

painkillers and heat do not help enough
you regularly cannot go to work, school or university because of the pain
the pain gets worse over the years or only starts after years of periods with little pain
you also have pain between periods
sex, opening your bowels or passing urine hurts during your period
the bleeding is very heavy and you have to change your pad or tampon every one to two hours
you have been trying to get pregnant for more than a year without success

Get medical help straight away if you have sudden, very severe pain, a fever, foul-smelling discharge or if you could be pregnant. Severe pain on one side of your lower tummy and unusual bleeding with a positive test can be signs of an ectopic pregnancy.

At the appointment, the doctor will ask about your symptoms, feel your tummy and usually do an ultrasound scan. A pain diary over two to three cycles helps: when does the pain start, how bad is it on a scale from 0 to 10, what helps?

Period pain and endometriosis

In endometriosis, tissue similar to the lining of the womb grows outside the womb, for example on the lining of the abdomen, on the ovaries or on the bowel. It bleeds with every period and causes inflammation and adhesions. Endometriosis affects about 10 out of 100 women of childbearing age (Zondervan 2020).

Typical signs are period pain that gets worse over the years, pain during sex, when opening your bowels or passing urine during your period, and pelvic pain outside your period too. Many women with endometriosis have problems getting pregnant (Zondervan 2020). It often takes years to get a diagnosis, because severe period pain is seen as normal.

Endometriosis can often only be diagnosed for certain with keyhole surgery (laparoscopy). Some forms can be seen on an ultrasound or MRI scan. How endometriosis affects your chances of getting pregnant and which treatment may be an option is explained in the guide Endometriosis and fertility.

Other causes of secondary period pain

Adenomyosis: the lining grows into the muscle wall of the womb. Typical are heavy, painful periods, often from 35.
Fibroids: non-cancerous muscle lumps in the womb, often with heavy bleeding.
Polyps: growths of the lining.
Copper coil: can make period pain and bleeding worse (IQWiG 2024).
Pelvic inflammation: often caused by chlamydia, with pain, fever or discharge.

Period pain, ovulation or pregnancy?

Not every pain in the lower tummy is period pain:

Ovulation pain (mittelschmerz): about two weeks before your period, on one side, usually lasting only hours. More on this under signs of ovulation.
Pulling pain in early pregnancy: can feel like period pain but comes without a period. If your period is late, a pregnancy test will tell you, and the pregnancy test calculator shows the earliest day you can test.
Implantation bleeding: light spotting around the time your period is due, more under implantation bleeding.
PMS: symptoms in the days before your period that ease once the bleeding starts.

Period pain without a period

Cramps like during your period, but no bleeding: this can have many causes. Often it is ovulation pain, PMS in the days before your period or early pregnancy. Constipation, wind or a bladder infection can also sometimes feel similar. Recurring pain in the lower tummy between periods is typical of endometriosis or adenomyosis. If the pain lasts or keeps coming back, have it checked.

Period pain after stopping the pill

The pill stops ovulation and keeps the lining of the womb thin. Many women only notice after stopping how bad their period pain is without the pill. Sometimes the pain was already severe before the pill, and the pill masked endometriosis for years. If the pain is clearly worse after stopping than it was before the pill, or if painkillers do not treat it well, talk to your gynaecologist or GP. Especially if you stopped the pill because you want a baby, it is worth having it checked early.

Period pain over 40

Primary period pain usually gets weaker with age. If the pain gets worse after 40, however, fibroids or adenomyosis are more often the cause, often together with heavier bleeding. In the years before the menopause, hormones fluctuate and the gaps between periods and how heavy the bleeding is change. At this age, always have new severe period pain or bleeding between periods checked.

What happens at the gynaecologist?

Talk: how long have you had the pain, how bad is it, when in your cycle does it come, what helps? Do you have pain during sex or when opening your bowels, or problems getting pregnant?
Internal examination: the doctor feels your womb and ovaries. Tenderness or lumps can point to endometriosis or fibroids.
Transvaginal ultrasound: shows fibroids, ovarian cysts, adenomyosis and some endometriosis patches.
Swab and chlamydia test, if an infection is possible.
Keyhole surgery (laparoscopy): only if endometriosis is likely and treatment does not help, or if you want to get pregnant. Patches can be removed during the same operation.

Period pain that makes you unable to work is a valid reason for a sick note or medical certificate. You do not have to keep it quiet.

Period pain in teenagers

In girls and young women under 20, period pain is usually worse than later in life (IQWiG 2024). Ibuprofen and naproxen are also suitable for teenagers, at the right dose according to the patient leaflet. If your daughter regularly misses school because of the pain or painkillers do not help, have her examined by a gynaecologist or GP. Endometriosis can be behind it in teenagers too.

Frequently asked questions

What is the fastest relief for period pain?

A painkiller such as ibuprofen or naproxen, taken early, together with heat on your lower tummy. Both are well supported by studies (Marjoribanks 2015, Akin 2001).

Is paracetamol suitable for period pain?

Yes, but in studies it worked less well than ibuprofen or naproxen (Marjoribanks 2015). It is an alternative if you cannot tolerate NSAIDs.

What is period pain comparable to?

Many women describe it like the cramps you get with diarrhoea or a dull, pulling pressure in the lower tummy. Severe period pain can be so intense that daily life and work are not possible (IQWiG 2024).

Is diarrhoea during your period normal?

Yes, it is common. Prostaglandins also act on the bowel. Pain when opening your bowels during your period should be checked, though, because it can be a sign of endometriosis.

Why is my period pain suddenly so bad?

If period pain appears for the first time after years of light periods or becomes much worse, a condition such as endometriosis, adenomyosis or a fibroid may be behind it. Have it checked by a gynaecologist or GP.

Do home remedies help with period pain?

Heat is well supported by evidence and in one study worked as well as ibuprofen (Akin 2001). Regular exercise also helps (Armour 2019). For teas, ginger or magnesium there is no high-quality evidence (Pattanittum 2016).

Can I get pregnant if I have period pain?

Yes. Primary period pain does not affect fertility. If endometriosis or fibroids are behind it, it may take longer. If it has not worked after a year, or after six months if you are 35 or over, get checked. The ovulation calculator shows when your fertile days are.

How long does period pain last?

Usually one to three days, worst on the first and second day of bleeding (NHS 2023).

Does period pain get better after giving birth?

For many women, yes. Women who have already had a child have period pain less often (Ju 2014, IQWiG 2024).

Sources

Guidelines and product information

Studies

About this article

Fertilio Editorial Team

The Fertilio Editorial Team researches fertility topics using specialist sources such as the German IVF Registry (Deutsches IVF-Register, D.I.R.), medical guidelines, and statutes. The sources are listed at the end of each article. The content does not replace medical advice.

Period pain (dysmenorrhoea): what helps, causes and warning signs

What is period pain?