From early childhood, many women are taught to loathe their menstrual cycle. From cramps to headaches to lower back pain, periods are filled with discomfort. But what if you could make them a little less terrible? As a board-certified OB-GYN, I’ve got some proven tips for soothing cramps (which one in eight women suffers from) and other ailments menstruation may present. Skeptical? Stick with me here.

Understanding the Connection Between Menstruation and Pain 

Before we can jump into how to soothe period pain, it’s important to understand why it happens in the first place. First of all, menstruation is controlled by hormones. In each phase of the menstrual cycle, the increasing and decreasing of certain hormone levels trigger the next phase. 

During the first phase, follicular stimulating hormone from the brain causes your ovaries to develop an egg, which then releases estrogens. The surge of another hormone, luteinizing hormone, then leads to the release of the egg. (a.k.a. ovulation). This is also when the lining of the uterus will start to thicken. 

Read More: 9 Lifestyle Tweaks To Make For Healthier Hormones

During the second phase, progesterone tells the uterus to prepare for the implantation of a developing embryo. Once the egg travels down the fallopian tubes, if pregnancy does not occur, levels of estrogen and progesterone decrease and the shedding of the uterine lining begins. It is during this time that many experience cramps or other painful side effects. 

The causes of period pain have a lot to do with the muscles and blood vessels in the uterus. In order to shed its lining, the uterine muscles begin to contract, which can cause cramping in the lower abdomen or back. And while most women say this cramping is mild, if they feel it at all, others suffer from cramping so severe that performing daily tasks becomes a struggle. (FYI: Intense menstrual cramps can be a sign of other underlying health issues, which I’ll touch on later.)

The Spectrum Of Period Pain Culprits

Now that you’re familiar with the basics of what’s happening behind the scenes throughout the menstrual cycle, let’s get familiar with a number of the potential contributors to painful periods.

1. PMS

Premenstrual syndrome, or PMS, refers to the physical and emotional symptoms that can be associated with periods. It is common for some women to experience PMS before or during every period, while others may rarely have symptoms. 

PMS can include physical changes, such as:

• Craving certain foods 
• Being hungrier than usual
• Tender, swollen, or sore breasts
• Feeling bloated 
• Gaining weight
• Headaches
• Dizziness
• Swelling in hands or feet
• Aches and pains in your joints or muscles
• Feeling more tired than usual 
• Acne
• Gastrointestinal issues
• Cramps or pain in the lower abdomen

Emotional symptoms of PMS include:

• Feeling sad, depressed, tense, or anxious
• Mood swings
• Feeling more irritable or angry than normal
• Crying suddenly
• Not feeling very social or wanting to be around people
• Trouble concentrating
• Difficulty falling asleep or staying asleep
• Changes to libido 

A woman may not experience all of these symptoms, and the ones that she does experience can change from month to month. 

While there is no single test that can diagnose premenstrual syndrome, symptoms must meet certain requirements. A doctor will look for symptoms that only occur during the second half (luteal phase) of the menstrual cycle. In addition, a woman must experience both physical and emotional symptoms.

2. PMDD

A severe form of PMS, PMDD (Premenstrual Dysphoric Disorder) is typically a chronic condition and can have a serious impact on a woman’s quality of life. The most common symptoms include anger, irritability, and depression which are severe enough to interfere with daily activities. 

While it’s unclear why some women develop PMS or PMDD, some studies have shown a connection between the rising and falling of hormone levels and how this influences chemicals in the brain such as serotonin. Studies have also shown that women who develop PMDD are highly sensitive to normal changes in hormone levels. 

3. Ovarian Cysts

An ovarian cyst is a sac filled with fluid that forms on or inside an ovary. These cysts are more common in childbearing years up until menopause. Women who have gone through menopause are less likely to have ovarian cysts.  

There are two common types of ovarian cysts, follicular cysts and corpus luteum cysts.  A follicle houses an egg in the ovary and can become a cyst when the follicle fails to break open and release the egg once it’s matured. Fluid stays in the follicle and forms the cyst.

Corpus luteum cysts form after the egg has been released and may contain a small amount of blood as well as fluid. These cysts are common to every menstruating female. They remain after ovulation to produce hormones should the egg be fertilized. If that doesn’t happen they typically shrink—but, in some cases, a corpus luteum cyst can continue to grow instead of shrinking when it has completed its function. That’s when it causes trouble. 

Symptoms of ovarian cysts can include:

• Bloating or swelling in the abdomen
• Pain during bowel movements
• Pain with intercourse or pelvic pain during movement
• Pelvic pain that is dull, achy, or constant
• Sudden and severe pelvic pain, often with nausea and vomiting

While ovarian cysts have a number of symptoms, one of the most common is pain in the pelvis shortly before or after the beginning of the menstrual period. 

4. Fibroids

Affecting 70 to 80 percent of women in their lifetime, fibroids are tumors made of smooth muscle cells and fibrous connective tissue. These tumors develop in the uterus and can cause severe pain during a woman’s period. 

Fibroids are almost always benign (noncancerous) and most women may not experience any symptoms at all or even know they have them. However, large or numerous fibroids can cause the following symptoms:  

• Heavy or prolonged periods
• Bleeding between periods
• Pelvic pain and pressure
• Frequent urination
• Low back pain
• Pain during intercourse
• Difficulty getting pregnant

Fibroids can sometimes be felt during a physical exam, and then an ultrasound will be used to confirm the diagnosis. 

7 Ways to Relieve Period Pain

No matter the cause of your period pain, having tips for relief can go a long way. While everyone is different and each woman’s body reacts differently, these seven tips can help alleviate the pain a period can cause.

1. Fuel Your Body with Nutrition

There aren’t many situations a healthy diet can’t help! In fact, certain vitamins and nutrients such as vitamin B1 (thiamine) and magnesium have been shown to help ease menstrual cramp pain. Both of these can be obtained by eating a well-balanced diet each day and regularly including nuts, whole grains, spinach, avocado, and legumes such as chickpeas or lentils. You can also consider supplementation to fill in any gaps in your diet. 

2. Avoid Caffeine

Unfortunately for java lovers, women who want menstrual pain relief should refrain from drinking coffee during their periods. This is because coffee has been proven to aggravate menstrual cramps. Since caffeine constricts blood vessels, which increases tension levels and can increase the intensity of pain, coffee and other highly-caffeinated drinks should be avoided during your period. 

3. Apply Heat

Heat relaxes muscles and, by weight, the uterus is the strongest muscle in a woman’s body. Applying heat via a heated blanket or warm towel can help ease period cramps while you relax in bed or on the couch. Heating pads can be used as well and are especially useful when you’re trying to minimize cramps while out of the house. 

4. Stay Hydrated

Being dehydrated around the time of menstruation can worsen cramps. And while staying hydrated is one of the easier home remedies for period pain, it can be a real obstacle if you’re not a big water drinker. Adding orange or lemon, or even making chamomile tea, can not only help with period cramps but also help keep your body hydrated during that time of the month. I recommend drinking a minimum of two to four liters of water a day whenever possible. 

5. Reduce Stress

While this tip won’t stop period pain immediately, it’s important to know that high levels of stress can reduce a woman’s threshold for pain. This means that when you’re stressed, mild cramps that may not typically cause any inconvenience could leave you laid up in bed all day.

Read More: 6 Ways Stress Affects Your Long-Term Health

Reducing the stress in our lives is easier said than done, of course, but taking steps to do so can help reduce period pain over time. Journaling, meditation, and talk therapy are all great ways you can work to reduce stress. Daily walks are another great way to work against stress and soothe cramps. 

6. Exercise

Probably the last thing anyone would want to do while in pain, but one of the most effective ways when it comes to reducing it, is exercise. And yes, there are specific exercises you should turn to while on your period. Yoga is a popular technique for alleviating menstrual cramps, but many other types of movement can provide relief, too, such as: 

• Lower back and glute stretches 
• Kneeling abdominal twists
• Glute bridges 
• Swimming 

In this video, I demonstrate five yoga moves I personally use to help with period pain. 

7. Over-the-Counter Pain Relief

When other methods have failed, or if you’d just prefer a different kind of pain management, over-the-counter pain relief can be a great choice. It can also understandably be a hard one to make. With so many options on the store shelves knowing where to start can be overwhelming. 

Some of the best medicines for menstrual cramps are NSAIDs. NSAIDs, or non-steroidal anti-inflammatory drugs, are medicines that are used to relieve pain, reduce inflammation, or bring down fevers. Ibuprofen falls into this group and is a common medication for period pain. (It helps block the production of prostaglandins, which are hormone-like substances involved in causing cramps.)

To help relieve period pain, start Ibuprofen at the recommended dosage the day before you expect to begin your period or whenever you first experience symptoms.

When Period Pain Warrants A Visit With Your Doctor

A woman’s menstrual cycle can come with a lot of symptoms, some more severe than others. However, if you experience unbearable period pain, see a physician. Cramps or pain that stop you from doing day-to-day tasks—or simply make you wonder if your period is normal—should be checked.  

Your doctor will ask you a variety of questions and possibly do a physical exam to diagnose what may be causing such pain. I recommend journaling any symptoms experienced during your period and sharing them with your physician. This will provide a clearer picture of what you are experiencing and help with determining a diagnosis. 

Dr. Perkins is a board-certified OB/GYN with extensive expertise in global maternal health, female reproductive health, contraceptive care, and minimally invasive surgery. In addition to working with patients at her medical practice, she is a Major in the United States Army Reserve and an award-winning scientific researcher. Through her functional, holistic approach to health, she aspires to help women feel their best in mind, body, and spirit.