Period cramps happen because your uterus contracts to shed its lining, and the intensity of those contractions depends largely on one group of chemicals: prostaglandins. Your body produces prostaglandins from a fatty acid in your cells, and higher levels mean stronger, more painful contractions. The good news is that several proven strategies target this process directly, and many of them work just as well as painkillers.
Why Period Cramps Hurt
Prostaglandins are the primary driver of menstrual pain. Your uterine lining releases them to trigger the contractions that push out tissue during your period. In moderate amounts, they do their job without much discomfort. But when your body produces excess prostaglandins, those contractions become intense enough to temporarily cut off blood flow to the uterine muscle, creating that deep, cramping ache in your lower abdomen. This is also why cramps tend to be worst on the first one to two days of your period, when prostaglandin levels peak.
Up to 90% of people who menstruate experience some degree of period pain, with roughly 30% reporting symptoms severe enough to interfere with daily life. Most of this falls under “primary dysmenorrhea,” meaning the pain comes from the period itself rather than an underlying condition.
Anti-Inflammatory Painkillers Work Best
Over-the-counter anti-inflammatory medications are the most reliable first-line option because they directly block prostaglandin production. Ibuprofen is the most commonly used, with a recommended dose of 400 mg every four hours as needed for menstrual cramps. Naproxen sodium is another option that lasts longer per dose, so you take it less frequently.
The key to getting the most out of these medications is timing. Starting them at the first sign of cramps, or even a few hours before you expect your period to begin, prevents prostaglandins from building up in the first place. Waiting until the pain is already severe means you’re playing catch-up against a chemical process that’s already underway. If you find that one anti-inflammatory doesn’t help much, switching to the other is worth trying, since people respond differently to each.
Heat Therapy Rivals Painkillers
Applying heat to your lower abdomen is one of the most underrated options for cramp relief. A 2025 systematic review of 22 randomized trials involving nearly 2,000 women found that heat therapy provided comparable or slightly better pain relief than anti-inflammatory medications, both within the first 24 hours and over longer treatment periods. Heat also carried significantly fewer side effects, with roughly 70% lower risk of adverse reactions compared to oral painkillers.
A heating pad, hot water bottle, or adhesive heat patch set around 40°C (104°F) works well. Place it on your lower abdomen or lower back for 15 to 30 minutes at a time. Heat relaxes the uterine muscle and improves blood flow to the area, counteracting the oxygen deprivation that prostaglandin-driven contractions cause. You can also combine heat with an anti-inflammatory for especially painful days, since they work through different mechanisms.
Exercise and Movement
Moving your body during cramps feels counterintuitive, but moderate exercise increases blood flow to the pelvis and triggers your body’s natural pain-relieving chemicals. Walking, swimming, yoga, and cycling all work. You don’t need an intense workout. Even 20 to 30 minutes of light activity can take the edge off, and the effect often lasts for hours afterward.
Stretching that opens the hips and lower back is particularly helpful. Positions like child’s pose, reclined butterfly, and gentle spinal twists target the muscle groups that tighten during cramping.
TENS Units for Drug-Free Relief
A transcutaneous electrical nerve stimulation (TENS) unit is a small, battery-powered device that sends mild electrical pulses through electrode pads on your skin. For period cramps, the typical setting is 80 to 100 Hz with a pulse width around 100 microseconds. You place four electrode pads on your lower back: two higher up (around the lower rib area) to cover the nerve bundle that supplies the uterus, and two lower down (near the tailbone) to cover the nerves supplying the pelvic region.
TENS works by interrupting pain signals before they reach the brain and by encouraging your body to release its own pain-relieving compounds. The devices cost $25 to $50, are reusable, and have essentially no side effects. They’re a solid option if you want to avoid medication or need something to layer on top of it.
Acupressure You Can Do Yourself
One well-studied pressure point for menstrual pain is called SP6, located on the inner side of your lower leg, about four finger-widths above your ankle bone, just behind the shinbone. In a controlled trial, applying firm, steady pressure to this point for 20 minutes produced a statistically significant drop in pain scores immediately afterward. The study participants were also taught to repeat the technique twice a day during the first three days of their cycle for ongoing relief.
You can try this by pressing the spot firmly with your thumb and holding for 5 to 10 seconds, releasing, then repeating. Some people find circular pressure more comfortable. It’s free, has no risks, and can be done anywhere.
Supplements That May Help
Vitamin B1 (thiamine) at 100 mg per day has shown effectiveness for reducing menstrual pain in clinical trials. Magnesium has also performed better than placebo in multiple studies, though researchers haven’t settled on an ideal dose. Many people start with 200 to 400 mg of magnesium glycinate or citrate daily, which are the forms easiest on the stomach. Both supplements work best when taken consistently throughout the month rather than only during your period.
Hormonal Birth Control
If over-the-counter options aren’t enough, hormonal contraceptives are the next step. They reduce period pain by thinning the uterine lining, which means fewer prostaglandins are produced in the first place. Combined pills, hormonal IUDs, patches, and rings all achieve this effect. Some people skip the placebo week of their pill pack to avoid periods entirely, which eliminates cramps altogether for many users.
When Cramps Signal Something Else
Primary dysmenorrhea is common and manageable. But pain that stops you from going to work, school, or doing normal activities is not something to write off as “just cramps.” Secondary dysmenorrhea, where the pain is caused by a condition like endometriosis or fibroids, affects a significant number of people and typically gets worse over time rather than better.
Signs that your cramps may have an underlying cause include pain during sex, pain with bowel movements, cramps that start more than a day before bleeding begins, and pain that doesn’t respond to anti-inflammatories or hormonal birth control. Endometriosis in particular shares many symptoms with regular period pain, and the two can’t be distinguished by symptoms alone. If conservative treatments aren’t controlling your pain, a gynecologist can evaluate whether something beyond normal cramping is going on.