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Having cramps is one thing. Having cramps so bad that you can’t carry out your daily functions is another thing entirely.

Severe cramps are common, but they aren’t normal. In most cases, they represent endocrinological dysfunctions. Common culprits include anovulation, low progesterone levels, high estrogen levels, disregulated cortisol or insulin, or any combination of those problems!

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I could speak ad nauseum about these large scale issues (and I will, in separate posts) but that’s not what I want this post to be about. I wanted to create an action plan for when you are actually experiencing severe cramps on a regular basis. In my experience, having an arsenal of things to try is not only nice from a pain management perspective but helps to alleviate some of the anxiety associated with not knowing if you’ll be able to finish your workday once a month!

This list is a combination of things I personally have tried and have found effective, anecdotal success stories I’ve heard from other women,  as well as treatments that I found supported by scientific research. I’ve added the article citation(s) in the post in case anyone wanted to delve deeper into them.

Note: it’s a fact that there is a spectrum of quality when it comes to research papers.  I looked for the following:  1) pain relief from a treatment (compared to placebo) that could apply to a general population of women with dysmenorrhea (not just a subset) and 2) is that pain relief treatment safe? While I think those are the key questions, it’s important to note that not all these studies are large scale and have been validated. The reason I chose to include them anyways is because I believe it’s better to have options when you’re talking about options that have a favorable safety profile.  Further, I personally focus on getting nutrients from whole food sources rather than as the supplements that appear in the studies which I feel helps to regulate how our bodies utilize the nutrients.

In short, these are things to try.  As always, though, please proceed cautiously and seek out the help of a qualified health professional before experimenting.

1. Raspberry Leaf

When I feel really sever cramps heading my way, I brew up a huge cup of raspberry leaf tea. It’s been well studied in pregnancy and labor as being a good herb for healthy uterine tone (as in, can it function properly? Is it contracting as it should?) so many women have tried it for the same reason in menstrual cramps with positive results.

I have found that I get the pain relieving results when I start drinking it several days before the onset of my period and throughout the first 2 days. I drink about 3 cups a day but that’s just a personal preference.

2. Coconut oil mixed with lavender, rose, peppermint, clary sage, chamomile, and/or cinnamon

Aromatherapy has been studied a surprising amount when it comes to menstrual pain relief. Luckily for all of is, there are quite a few essential oils that have been scientifically suggested to help and those include lavender, rose, peppermint, clary sage, chamomile, and lavender.

I normally take a scoop of coconut oil in my palm and then add 3-5 drops of each essential oil into my palm before mixing…then apply to my lower abdomen and back. You can use each individually or mix them all together. Believe me, it’s not a great smell when you mix them all together but I really have have gotten relief from that combination so I’m not going to be too picky about the smell.

Han SH, Hur MH, Buckle J, Choi J, Lee MS. Effect of aromatherapy on symptoms of dysmenorrhea in college students: A randomized placebo-controlled clinical trial. J Altern Complement Med. 2006 Jul-Aug;12(6):535-41. PubMed PMID: 16884344

Marzouk TM, El-Nemer AM, Baraka HN. The effect of aromatherapy abdominal massage on alleviating menstrual pain in nursing students: a prospective randomized cross-over study. Evid Based Complement Alternat Med. 2013;2013:742421. doi: 10.1155/2013/742421. Epub 2013 Apr 11. PubMed PMID: 23662151; PubMed Central PMCID: PMC3638625

3. Fenugreek seed powder

The study I looked at took was researching the efficacy of 900 mg of fenugreek powder in capsule form for women struggling with dysmenorrhea. They had the women take the fenugreek 3 times per day for the first 2-3 days of cycle and found that the women on this protocol had lower pain levels by the second menstrual cycle as compared to the placebo group.  I have seen fenugreek in capsule form and tincture form at The Vitamin Shoppe, Whole Foods, and on Amazon.

Younesy S, Amiraliakbari S, Esmaeili S, Alavimajd H, Nouraei S. Effects of fenugreek seed on the severity and systemic symptoms of dysmenorrhea. J Reprod Infertil. 2014 Jan;15(1):41-8. PubMed PMID: 24695380; PubMed Central PMCID: PMC3955423

4. Valerian

In this study, the researchers studied the effect of 225 mg of valerian root on dysmenorrhea. They have women 225 mg of valerian 3 times per day for the first 3 days of their cycle and found that those women had lower pain level scores as compared to the placebo group.  Since valerian root tends to make me sleepy, I focus my supplement intake of valerian over the second half of the day although I do add dried valerian to my tea mixtures in the morning for add AM relief.

Mirabi P, Dolatian M, Mojab F, Majd HA. Effects of valerian on the severity and systemic manifestations of dysmenorrhea. Int J Gynaecol Obstet. 2011 Dec;115(3):285-8. doi: 10.1016/j.ijgo.2011.06.022. Epub 2011 Sep 28. PubMed PMID:21959068

5. Topical or oral magnesium

Several studies have shown that magnesium can play a role in alleviating menstrual cramps because of its relaxing effects on muscle (including smooth muscle in the body). While the studies looked at oral magnesium (and they did find it to be effective), I prefer to use a topical magnesium spray because it then doesn’t effect my gastrointestinal system like oral magnesium can. When I use it during my menstrual cycle, I spray it on my abdomen, back, and legs about 2-3 times per day. It does a remarkable job of making you sleepy, however, so I tend to use it later in the day more than I do in the mornings.

Proctor ML, Murphy PA. Herbal and dietary therapies for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev. 2001;(3):CD002124. Review. PubMed PMID: 11687013

6. Proper hydration

I’ve found adequate hydration helps to alleviate the severity of my cramps. As is so common in women, however, improper hydration technique can aggravate preexisting gastrointestinal symptoms that often accompany dysmenorrhea. In short, I’ve found that I do better when I continually slowly sip water (I like warm, with lemon) throughout the day rather than gulping down an entire glass in one sitting (causes gut upset).

The thinking behind this suggestion is that menstruation depends on many functions in the body going smoothly…and water is important for all those functions. Secondly, severe cramps are often correlated with heavy blood flow (your body knows this which is why sometimes women have bloating before their periods), so good hydration will diminish symptoms associated with poor hemodynamics status.

7. Heat

It’s fairly well known that heat helps to alleviate cramps and that anecdotal experience is supported in the literature.

I prefer to use 2 homemade aromatherapy heat packs, one on my lower stomach and one on my lower back over the course of the day.  As for the aromatherapy portion of these, I use the essential oils I mentioned in #2 of this list (cinnamon, lavender, chamomile, clary sage, rose, and peppermint) but I tend to focus on just a few that I think smell good together.  I simply add a couple drops of the essential oils onto my heatpacks after they have been warmed up…then I find a nice spot on the couch and park my rear and the heatpacks in there.

Potur DC, Kömürcü N. The Effects of Local Low-Dose Heat Application on Dysmenorrhea. J Pediatr Adolesc Gynecol. 2014 Mar 18. pii: S1083-3188(13)00335-5.doi: 10.1016/j.jpag.2013.11.003. [Epub ahead of print] PubMed PMID: 24656704

8. Removing toxins from hygiene products

I’ve read quite a few anecdotal stories on the internet of women who found at least some pain relief from switching from conventional feminine hygiene products to more natural versions.  This includes 100% cotton pads, reuseable cloth pads, sponges, and cups.  I personally like 100% cotton pads and reuseable cloth pads since anything internal seems to make my cramps worse but that is just my experience.

9. Nutrient dense foods

It’s tempting to drown yourself in junk food leading up to and during your menstruation (believe me, I’ve tried).  Unfortunately, processed sweets or junk food deplete nutrient stores in the body because the nutrients act as cofactors in the processes that require your body to breakdown the sweets (magnesium is really effected strongly by this).

As a result, everything that your body is trying to do to make menstruation go more smoothly will fail in the face of poor nutrition.  You can enjoy your chocolate in moderation (dark chocolate actually has magnesium, so that’s good!) but make the rest of your food as high-quality as possible.  I try to stick with tender (usually slow cooked) pastured meats, healthy starches, a large variety of veggies, and colorful fruits.

10. Walking

Low impact exercise has not been shown to effectively reduce menstrual pain after the onset of symptoms but there is a vast body of a anecdotal evidence to show that low impact exercise that is done before the onset of symptoms can decrease the peak severity of pain. In short, it can be a good idea to take a walk just as you feel cramps starting to come on but before they get out of control.

While the mechanism of action hasn’t been demonstrated in the literature, I feel that the changes in hormonal status, blood flow, and biochemical markers with low impact exercise could be responsible for explaining the very prevalent anecdotal evidence that’s out there. And in any case, I can’t imagine that getting in an extra walk won’t improve your health overall!

11. Vitamin B1

Some studies have suggested that 100 mg daily of Vitamin B1 for the first 2-3 days of your cycle can help to alleviate dysmenorrhea. With this in mind, I try to focus on whole food sources of Vitamin B1 rather than taking a supplement so I normally eat liver once or twice a day over the first few days of my period. (That meets the “eat nutrient dense foods” criteria in #9 as well so that’s two birds with 1 stone!)

Proctor ML, Murphy PA. Herbal and dietary therapies for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev. 2001;(3):CD002124. Review. PubMedPMID: 11687013

12. Fennel extract and vitamin E combo

One study compared the effects of fennel extract along with vitamin E and ibuprofen in women with dysmenorrhea. The study suggested that the fennel and vitamin E were equally as good as ibuprofen at controlling pain but with fewer side effects. In keeping with our real food theme, I try to obtain my vitamin E from green, leafy veggies and nuts/seeds and incorporate fennel into my recipes and tea mixtures (I will throw in dried fennel into whatever other teas I’m brewing).

Nasehi M, Sehhatie F, Zamanzadeh V, Delazar A, Javadzadeh Y, Chongheralu BM. Comparison of the effectiveness of combination of fennel extract/vitamin E with ibuprofen on the pain intensity in students with primary dysmenorrhea. Iran J Nurs Midwifery Res. 2013 Sep;18(5):355-9. PubMed PMID: 24403936; PubMed Central PMCID: PMC3877456

Bokaie M, Farajkhoda T, Enjezab B, Khoshbin A, Zarchi Mojgan K. Oral fennel (Foeniculum vulgare) drop effect on primary dysmenorrhea: Effectiveness of herbal drug. Iran J Nurs Midwifery Res. 2013 Mar;18(2):128-32. PubMed PMID: 23983742; PubMed Central PMCID: PMC3748568

13. Tylenol and Ibuprofen combo

I’m all for completely natural remedies but truth be told, I’ve have never gone a period without having to resort to over-the-counter analgesics because of such intense pain.  Luckily, I’ve gotten the dosage much lower than what I was using before (I used to have to take 4 ibuprofen 3 times a day plus 2 tylenol 3 times a day and an occasional aleve to get through my day!) but I still need some.

Nowadays, I don’t always need to take a lot of pain medication but there are still days where I can’t do my job unless  I take higher doses.  In that case, I split the pain medication between 2 different types so that I’ m not hurting my kidneys and stomach by taking too much ibuprofen or hurting my liver by taking too much tylenol. So when I need to break out the bigger guns, I alternate taking 2 ibuprofen and 2 Tylenol…and this approach would work if you require even more analgesics for pain control.