Treatment Options For Painful Periods

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If you are having painful periods, you are in good company. Menstrual pain or dysmenorrhea is one of the most common gynecologic complaints reported by women. Doctors divide dysmenorrhea into two types, primary and secondary dysmenorrhea.

If you have always had painful periods it is likely that you have primary dysmenorrhea. This type of menstrual pain is actually uterine muscle contractions triggered by prostaglandins released by the lining of your uterus.

Often this type of menstrual pain gets better as you get older. 

If you develop painful periods at some time in your 30's or 40's, you probably have an underlying gynecologic condition that is causing your menstrual cramps. This type of dysmenorrhea is called secondary dysmenorrhea. 

Obviously, there can be some overlap in the cause of your painful periods.Younger women can be diagnosed with secondary dysmenorrhea and older women can develop perimenopausal primary dysmenorrhea. Regardless of the cause, the initial treatment options are fairly similar. 

Treatment Options

There are many options for managing your painful periods, from simple lifestyle changes to hormonal medications. Consider trying lifestyle changes first. However, you may find that a combination of these treatment options gives you the best pain relief.

1. Diet

Never underestimate the importance of a healthy well-balanced diet.

It is a crucial part of achieving and maintaining good health. Following the general principles of a healthy diet is key but there are limited studies suggesting that certain dietary changes may be helpful in reducing painful periods:

  • Follow a low-fat vegetarian diet.
  • Increase your dairy intake to 3-4 servings daily.

    Although more studies are needed to make absolute recommendations you may consider giving these dietary modifications a try.

    2. Supplements

    There is limited data from small studies looking at the use of supplements to improve painful periods. The results of these studies appear to be encouraging. Each of these supplements appears to provide better pain relief than placebo. Be sure to discuss the use of these supplements with your healthcare provider before you decide to start taking them.

    • Vitamin E (500 units once daily or 250 units twice daily)
    • Vitamin B1 (100 mg daily)
    • Vitamin B6 (200 mg daily)
    • Fish Oil Supplement (1080mg EPA/720 mg DHA daily)

    3. Exercise

    Along with maintaining a healthy diet, regular aerobic exercise is a pretty standard recommendation for good health. Again, there is limited evidence looking at the effect of exercise on painful periods but the studies that have been done suggest that exercise helps.  

    Aerobic exercise releases endorphins that help block pain centers in your brain.

    The positive effect might be greatest for women who have sedentary lifestyles and usually get little to no regular aerobic exercise.

    Yoga may also be of benefit to provide relief for painful periods. Certain postures are recommended to get relief for painful periods.

    4. Sex

    Yes, you read it correctly. It has been suggested that sexual activity (including masturbation) can improve painful periods. Sexual activity increases blood flow to your uterus, which is thought to help diminish cramping. When you achieve orgasm your brain releases chemicals like dopamine and endorphins that act like natural pain relievers. And yes, it is safe to have sex during your period!

    5. Heat

    Whether it’s a big rubber water bottle, a warm bath, or a homemade heating pad, applying heat to your lower abdomen can help relieve menstrual cramps.  It is not completely clear how heat helps with menstrual cramps. Some researchers suspect it has to do with improved blood flow to the uterus. But whatever the mechanism, heat is a simple option to help manage your menstrual cramps.

    6. NSAIDs (nonsteroidal anti-inflammatory drugs)

    NSAIDs are pain relievers that are very effective for treating dysmenorrhea. They work by blocking the inflammatory factors known as prostaglandins that contribute to menstrual pain. There are several different types of prostaglandins but ibuprofen is a good place to start.

    • A typical dosing regimen is 400 to 600 mg every 4-6 hours or 800 mg every 8 hours. You should start the ibuprofen when the discomfort starts or when your bleeding starts.You will likely need to continue using it for 2 or 3 days until your symptoms improve.

     It’s important not to take ibuprofen on an empty stomach.

    Remember to discuss any medications with your healthcare provider before you start taking them. If you have been using ibuprofen and you are not having any improvement in your menstrual pain your health care provider may suggest another type of NSAID.

    7. Hormonal Contraceptives

    Your healthcare provider may suggest that you try a hormonal contraceptive to help manage your painful periods.

    Because of how they work to prevent pregnancy, any hormonal contraceptive option should bring you some relief from your menstrual cramps. There are two types of hormonal contraception: 

    Combined estrogen and progesterone methods:

    • oral contraceptive pill
    • contraceptive patch
    • contraceptive ring

    These contraceptive options work by suppressing your ovulation. This, in turn, interrupts the second half of your cycle so that the lining of your uterus doesn't build up and produce the inflammatory factors like prostaglandins that cause menstrual cramps. Also, the progesterone component of these methods works independently to promote thinning of the lining of the uterus. If you tend to have mid cycle pain when you ovulate in addition to painful periods, you probably will want to try one of these options.

    There is limited research available to suggest that one of these options is better than the other. However, the pill has been studied much more extensively and is proven to work well. Other very small studies suggest that the ring may be as good as the pill and the patch slightly less effective than the pill at relieving menstrual cramps.

    Progesterone only

    • progesterone only pill (mini pill)
    • Depo Provera
    • Mirena
    • Nexplanon

    These contraceptive options work directly on the lining of the uterus. They cause the uterine lining to become very thin. In fact, you will see a significant drop in you menstrual flow or even stop getting your period if you use one of these methods. Again, preventing the lining of the uterus from building up prevents the release of menstrual cramp causing prostaglandins.

    Making the Decision That's Right for You

    Often women will combine different treatment options in order to get the best relief of their menstrual pain.

     If you aren’t getting enough relief from the natural remedies you may want to consider adding one of the medical treatments to help ease your menstrual pain.

    If you have tried these treatment options and you have not seen much improvement in your period pain it is very important that you discuss this with your health care provider. It is likely that you have an underlying condition that will require additional testing and treatment. 

    A Word from Verywell

    As if bleeding every month isn't already bad enough, painful periods add a whole new challenge to managing your menstrual flow. There is no reason to suffer silently. It is not normal to miss school or work because of painful periods. Talking with your doctor and finding the treatment option that works best for you will help you live well with menstrual cramps.


    Smith,RS et al. Treatment of Primary Dysmenorrhea in Adult Women. In:UpToDate,PostTW(Ed), UpToDate, Waltham, MA.

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