Believe it or not, there are some distinctive pros to getting a period every month — seriously. For one thing, the American College of Obstetricians and Gynecologists (ACOG) considers the monthly cycle an important indicator of overall health, so a regular flow can mean your body’s doing a great job staying on track. And if you’re sexually active and not trying to make a baby, getting your period every month could be a cause for celebration. But it’s also true that menstruation can be plagued with plenty of cons. Chief among them? Cramps. Not everyone knows the signature tightening, poking, aching hell of period pain, but for those who do, this info is for you.
What are period cramps and why, why, why do I get them?
“When you have them, you know what they are,” says New York-based OB/GYN, Alyssa Dweck, MS, MD, FACOG. “But it’s kind of random who gets them and who doesn’t. For the most part, unless there’s an underlying problem that causes pain, like fibroids or endometriosis, period cramps can just be random — some people get bad ones and others get ones that aren’t so bad.”
“Period cramps come from contractions in your uterus, which is essentially one giant muscle,” says Kate White, MD MPH, director of the Family Planning Fellowship and associate professor of OB/GYN at Boston University. “Natural chemicals called prostaglandins start to build up in your uterus before your period starts, and as these prostaglandins reach high levels, they start to cause more intense contractions of your uterus that lead to that familiar cramping feeling.” White says that when these contractions really rev up, they temporarily cut off the blood supply to the uterus. When that muscle is starved for oxygen, it lets you know loud and clear — by cramping.
Need a super clear visual? “I always like to equate it with trying to wring out a wet towel by twisting it in the center so all the water comes out — that’s kind of what the uterus is doing,” Dweck says.
And if you’ve ever wondered why your uterus feels under attack even before the bleeding starts, you can thank those inflammation-inducing prostaglandins. “The contractions come as a result of the high prostaglandin levels — it’s normal for cramps to begin 1-2 days before bleeding starts, as your uterus begins the process of shedding the lining,” White explains.
Why some people have killer cramps and others barely feel them
If you’ve ever been that member of the friend group, who’s writhing in pain and canceling plans once a month, you might wonder why your pals seem to get off the hook. The sucky truth is that for the most part, who gets cramps and who doesn’t is pretty much a crapshoot. “Pain is really misunderstood — we don’t know why some people feel more pain with the same physical process than others,” White says. There are, however, a few factors that can influence how much you’re hurting every month.
“People younger than 30 tend to have worse cramps, as do people who smoke, so that’s just one more reason not to,” Dweck says. “People who have a family history of cramps also tend to have them.”
Occasionally feeling achy is one thing, but feeling truly excruciating, devastating, debilitating pain is something else entirely — and it’s not just a “normal” part of womanhood. More than half of women who menstruate have some type of pain associated with their periods for one or two days a month — a condition called “dysmenorrhea” — according to ACOG, but some experience something far more intense. “About 15 percent of girls and women have what is called ‘severe dysmenorrhea,’ meaning their ‘regular’ cramps are incredibly painful, and often come with nausea, vomiting, and fatigue,” White says. As with so many medical mysteries (especially those related to female biology), experts don’t know why severe dysmenorrhea occurs or why it affects only some people and they also don’t understand why it tends to improve with age and/or after pregnancy.
Inexplicable improvement is still an improvement, but agonizing cramps don’t inevitably get better for everyone. “Other women find that their period cramps get worse over time, not better,” White says. “These women often have developed a condition, such as endometriosis, adenomyosis, or uterine fibroids, that can lead to severe cramping with periods.”
All of these issues are known as “secondary dysmenorrhea,” meaning the pain is due to an underlying disorder of the reproductive organs. Run-of-the-mill pain that’s not a by-product of another condition is considered “primary dysmenorrhea.” Fibroids are non-cancerous growths on the inner walls of the uterus, adenomyosis is the growth of the uterine lining into the uterine muscle, and endometriosis is the implantation of uterine lining cells outside of the uterus. “If that happens, then every month when the uterine tissue responds to hormonal changes, so does the tissue that’s implanted outside the uterus — it starts to bleed and shed and cause all kinds of pain,” Dweck says. “Since it has nowhere to go, the blood is excreted into the pelvic cavity and can cause scarring or cause the tissue to implant in other places. Endometriosis tends to have a familial cause, so if your mother had it, you might have it or you might not.” Another cause of secondary dysmenorrhea includes pelvic inflammatory disease (PID), a bacterial infection that starts in the uterus but can spread to other organs. Another cause of secondary dysmenorrhea is cervical stenosis, which is a narrowing of the uterus opening.
Pain is subjective, so how do you know if what you’re feeling is “normal” or if it’s off-the-charts uterine terror? If you try the management methods below and they don’t even make a dent in your discomfort, then it’s time to see a doctor. And if your period pain extends beyond your pelvic region and severely impacts other parts of your body, you’ll also want to make an appointment STAT.
Methods for combating killer cramps
If you’re reading this during a menstrual meltdown, then you’re probably ready to get to the good stuff: how to squash the pain, or at least soften its blow. First, let’s get the bad news out of the way, which is that there’s just one surefire way to permanently eliminate cramps — “only by removing your uterus,” White says. But! There’s good news too. If your cramps aren’t the product of an underlying cause like the ones mentioned above, then there are some pharmaceutical and natural techniques that may help you. Dr. Dweck shared the treatments she most frequently recommends to her patients. Before you try these or any other remedies, be sure to talk to your doctor about your cramps and what treatments she thinks would work best for you.
If you’re dealing with menstrual pain every month, then you’ll want to be armed and ready every time a new cycle starts. “The best treatment for cramps is actually prevention: start taking an anti-inflammatory on a scheduled basis (round the clock, according to the directions on the label) the day before your cramping usually begins,” White says.
Dweck says she advises patients with recurring cramps to set monthly reminders to take nonsteroidal anti-inflammatory drugs (NSAID) before the pain hits. NSAIDs include medications like ibuprofen or aspirin. “The reason these medications work so well is because they counteract the effects of prostaglandins,” she says. NSAIDs are not safe for everyone, so be sure to talk to your doctor about whether they’re a good option for you. If you have certain conditions or if you’re on medications that could interact with an NSAID, your doctor might recommend something different.
Another medicinal method many doctors recommend in cases of severe cramps is hormonal contraception. “Starting a hormonal birth control method is what I recommend to my patients with the most severe cramps, or to anyone who would like to experience life without cramping every month!” White says. A 2011 study titled “Beyond Birth Control: The Overlooked Benefits of Oral Contraceptive Pills” found that about 31 percent of women rely on oral contraceptive pills (OCPs) to help mitigate their monthly pain.
If your doctor recommends it, “birth control pills and hormonal IUDs [intrauterine devices] can be a way to manage significant cramps,” Dweck says. “The pill prevents ovulation, so those big variations in hormones don’t occur. Even though there’s still shedding of the lining, there’s much less because the lining is thinner. The hormonal IUD does the same thing with a hormone called progestin — it creates a very thin lining, so the uterus doesn’t shed as much. A lot of women also don’t menstruate at all on the pill or IUD, which gets rid of the cramps. So many women use birth control to help their cramps, even if they don’t need it to prevent pregnancy.”
Natural remedies to soothe menstrual pain
While NSAIDs and hormonal medications are the scientifically proven pharmaceutical methods to manage menstrual pain, there are other options. Health professionals like Dweck and White also realize that some people would prefer to exhaust their natural options first (or combine pharmaceutical and natural remedies). Luckily, there are some tried and true methods that do seem to at least reduce pain to a more manageable level in some people.
The first thing to do if you’re looking to alleviate cramps the natural way is to analyze your daily habits and see if there’s room for improvement. “I recommend avoiding or reducing caffeine intake and avoiding foods with high amounts of salt,” White says. “Regular exercise seems to reduce cramps too.”
Dweck agrees that despite the pervasive myth that menstrual workouts are a bad idea, getting your sweat on during that time in your cycle may have a major impact on your pain levels. “It’s actually a very well known phenomenon that exercising vigorously or with gusto, especially on a regular basis and particularly during the menstrual week can help with cramps,” she says. “That’s because exercise encourages your body to secrete endorphins, which are the natural painkillers in your brain.” Dweck says heart-pumping cardio is the key to boosting those feel-good chemicals. And like most good-for-you habits, exercise has to be consistent; you can’t attend a single SoulCycle class and expect to be cured of cramps forever.
Another simple trick for soothing cramps is gentle heat — either in the form of a hot water bottle, heating pad, or steamy bath. “Heat helps to relax the muscles, and it will also bring more blood flow to the area which might feel soothing,” Dweck says. “There are now these charcoal-activated products you can buy that aren’t your grandma’s heating pad. You shake them up, and they emit heat, and you can wear them under your jeans, and no one knows.”
Dweck says another little tool some people find helpful is a transcutaneous electrical nerve stimulation (TENS) unit. This tool delivers small electrical impulses to the body and helps reduce pain signals while boosting endorphins. A small 2015 study found that women who used a TENS unit saw an improvement in their menstrual pain over seven days with no adverse effects. And in 2017, a study found that TENS therapy safely relieved the symptoms of women with primary dysmenorrhea.
There are also plenty of products on the market from teas and tinctures to herbal supplements and creams that claim to ease menstrual pain, but Dweck says that as an evidence-based medical professional, she’s refraining from recommending these until there’s enough research to prove safety and effectiveness. Your doctor can help you sort through all of the options. “There are some herbs and spices that people claim can help, like turmeric, or even something like CBD, which Whoopi Goldberg touts in her products specifically for cramps.” Whoopi & Maya, which the actress co-founded with entrepreneur Maya Elisabeth, is a medical cannabis company that offers products like “RUB,” a topical salve “specially formulated for menstrual relief,” which contains essential oils and cannabidiol (CBD), the non-psychoactive ingredient found in cannabis. While some claim the substance may help lower pain and inflammation, Dweck says more studies are necessary to back that up. “I’m optimistic and I’d love to see more research.”
Until then, talk to your doctor about what’s causing your cramps, stock up on over-the-counter pain relievers, and snuggle up with a heating pad. Pain is a common, sucky consequence of menstruation for many people, but it shouldn’t wreck your life. You should speak up, advocate for yourself, and know that relief is out there — it’s sometimes just a matter of working with a professional who can help pinpoint what works for you.