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Severe period cramps: What’s normal and what’s not

Severe menstrual cramps are a problem for many menstruating people. See if your discomfort needs additional medical attention and learn how to get relief.

Updated: February 26, 2025 | 4 minutes to read

Written by: Hallie Levine

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In this article:

What causes menstrual cramps?

“Your period pangs are caused by chemicals called prostaglandins that are made in the lining of your uterus,” says Dr. Mary Jane Minkin, MD, an obstetrician gynecologist at the Yale School of Medicine in New Haven, Connecticut. During your period, they cause your uterine muscles to contract, which can potentially result in pain, nausea and diarrhea.

Who’s at risk for severe menstrual cramps?

You’re more likely to get bad menstrual cramps if you:

  • Got your first period before age 11
  • Have long or heavy periods
  • Smoke
  • Are under a lot of stress

“You’re also more likely to get intense menstrual cramps if you have another underlying gynecological condition such as fibroids” — tumors that grow in or on the uterine wall — “or endometriosis,” which is a condition where tissue similar to the uterine lining grows outside of the uterus, says Ann Peters, MD, a gynecologist at Mercy Medical Center in Baltimore, Maryland.

One consolation is that if your cramps aren’t caused by an underlying condition, then chances are they will get better as you get older. You may also notice an improvement after you give birth.

The impact of period pain

91%

Up to 91% of menstruating people have reported experiencing a painful period at some point.

A person puts period products in a drawer.

29%

Up to 29% of menstruating people have described their period pain as severe.

16% to 29%

Approximately 16% to 29% have experienced significant impairment in quality of life due to period pain.

12%

And 12% of school and work activities may be missed due to period pain.

What helps relieve period cramps?

You don’t just have to grin and bear it. The goal is to feel well enough that you can continue daily activities, including school, work, childcare and domestic responsibilities. Here are options that may help:

Over-the-counter (OTC) pain relievers

Products that contain non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, are your best bet, since they help reduce levels of prostaglandins, advises Dr. Peters. They’re most effective if you take them as soon as menstrual bleeding or pain begins, and then take them for one or two days. Two options to try: CVS Health naproxen sodium tablets or CVS Health ibuprofen softgels. Speak with your health care provider before taking any OTC medication because they can interact with other medications or medical conditions.

If you have bad bloating, you can also try a product that contains a diuretic, such as caffeine (like Midol Complete Menstrual Pain Relief Caplets with Acetaminophen). Caffeine can also help with the fatigue experienced with some periods. Just keep in mind that some menstruating people, according to Dr. Peters, report that caffeine itself can worsen their menstrual cramps. If this is the case for you, consider opting for Pamprin Multi-Symptom caplets, which contain pamabrom as a diuretic instead. Use caution when using diuretics with NSAIDs because they may cause kidney problems.

Check out other menstrual pain relief products that may support pain relief.

Applying heat

It might help reduce pain if you apply heat to your lower tummy with a heating pad, hot water bottle or self-heating patch like ThermaCare Advanced Menstrual Pain Therapy Heatwraps. These can be especially helpful when used with an OTC pain reliever. Other products, contain extracts from raspberry leaf, dandelion root and cramp bark. “Anecdotally, some patients report that some herbal therapies help, although there’s not good research to show that they are effective,” says Dr. Minkin.

“These approaches, along with regular exercise, can help keep menstrual cramps in check,” says Dr. Minkin. But if they don’t help, you should make an appointment with your gynecologist. Sometimes going on a form of hormonal birth control, such as the pill, patch or hormone-releasing intrauterine device (IUD), can help because they may decrease the bleeding that causes period pain. Your doctor may recommend further examination to figure out if endometriosis or another condition could be causing your pain.

But it’s important to do something. “Don’t just tough it out,” stresses Dr. Minkin. By working together, you and your provider can come up with ways to find relief.

This content is for informational purposes only and is not medical advice. Consult your health care provider before taking any vitamins or supplements, and prior to beginning or changing any health care practices.

  • FOR CAUSE OF MENSTRUAL CRAMPS SOURCE: Dr. Mary Jane Minkin, MD, interview, August 2022.

  • FOR MENSTRUAL CRAMPS RESULTS SOURCE: The American College of Obstetricians and Gynecologists. Dysmenorrhea: Painful Periods;  see What is primary dysmenorrhea? ACOG.org. Updated December, 2020.

  • FOR WHAT CAUSES INTENSE CRAMPS SOURCE: U.S. Department of Health and Human Services. Period Problems. Updated December, 2020.

  • FOR WHEN CRAMPS MAY IMPROVE SOURCE: The American College of Obstetricians and Gynecologists. Dysmenorrhea: Painful Periods;  see What is primary dysmenorrhea? ACOG.org. Updated December, 2020.

  • FOR PERIOD PAIN STATISTICS & PERCENTAGE WHO EXPERIENCE PAIN SOURCES: Nagy, Hassan, Carlson, Karen, Khan, Moien AB. National Library of Medicine. Dysmenorrhea. NCBI.NIM.NIH.gov Updated November 12, 2023.

  • FOR PRODUCTS WITH NSAIDS SOURCE: The American College of Obstetricians and Gynecologists. Dysmenorrhea: Painful Periods; see What is primary dysmenorrhea? ACOG.org. Updated December, 2020.

  • FOR NSAID EFFECTIVENESS SOURCE: The American College of Obstetricians and Gynecologists. Dysmenorrhea: Painful Periods;  see What is primary dysmenorrhea? ACOG.org. Updated December, 2020.

  • FOR PAIN RELIEF OPTIONS SOURCE: The American College of Obstetricians and Gynecologists. Premenstrual Syndrome. ACOG.org. Updated May, 2021.

  • FOR ALTERNATIVE PAIN RELIEF SOURCE: The American College of Obstetricians and Gynecologists. Dysmenorrhea: Painful Periods.  ACOG.org. Updated December, 2020.

  • FOR EXERCISE CAN HELP SOURCE: The American College of Obstetricians and Gynecologists. Dysmenorrhea: Painful Periods.  ACOG.org. Updated December, 2020.

  • FOR HORMONAL REMEDIES SOURCE: The American College of Obstetricians and Gynecologists. Dysmenorrhea: Painful Periods.  ACOG.org. Updated December, 2020.

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