Pijn tijdens de menstruatie is een van de meest voorkomende redenen waarom vrouwen werk en school missen. Het grootste deel ervan betreft primaire dysmenorroe, behandelbare pijn zonder onderliggende ziekte. Deze wordt veroorzaakt door de prostaglandinen die het baarmoederslijmvlies vrijgeeft tijdens het afschilferen. De twee beste behandelingen met wetenschappelijke onderbouwing zijn goedkoop en kunnen gecombineerd worden: een ontstekingsremmer die vroeg wordt gestart, en een warmtekompres op de onderbuik. Hormonale anticonceptie, lichaamsbeweging, een TENS-apparaat en enkele supplementen met een consistente werking vormen een aanvulling op deze basisbasis.
De Chinese geneeskunde beschouwt menstruatiepijn als tong jing en behandelt het op basis van patronen. Eén type pijn is anders. Pijn die pas jaren na het begin van je menstruaties optreedt, in de loop der tijd verergert, tussen de menstruaties door voorkomt, of gepaard gaat met pijnlijke geslachtsgemeenschap of zware bloedingen, wijst op iets anders. Het kan secundair zijn aan endometriose en andere behandelbare aandoeningen. Hiervoor is een arts nodig.
Practice Ranking
Every practice we track for Period Pain (Dysmenorrhea): what eases the cramps, ranked by how well the evidence supports it for this condition. Strength describes the evidence, not our endorsement.
5 practices · 2 to start with
| # | Practice | Evidence | Type | Cost | Effort | Results In | Add to plan |
|---|---|---|---|---|---|---|---|
| 1 | Heat Exposure: What Sauna and Hot Baths Do, and How to Start A heating pad or hot water bottle on the lower abdomen relieves cramps as well as oral painkillers, cheaply and immediately. | Moderate | Self-Directed | Free to $$$ | Easy to Moderate | Weeks to Longer | |
| 2 | Walking: How Many Steps You Need, and Where the Curve Flattens Regular exercise lowers period-pain intensity; a free, self-directed lever between periods. | Emerging | Self-Directed | Free | Easy | Days to Longer | |
| 3 | Magnesium: What It Does, Which Form to Take, and How Much Magnesium beat placebo for period pain across three small trials. | Emerging | Supplement | $ | Easy | Days to Weeks | |
| 4 | Omega-3 and Fish Oil: Clear on Triglycerides, Mixed on the Heart Fish oil had a mild effect on cramp severity in trials. | Emerging | Supplement | $ to $$ | Easy | Weeks to Months | |
| 5 | Acupressure and Self-Massage: The Research, the Points, and How to Use Them Pressing the SP-6 point on the inner ankle modestly cut period pain, and you can do it yourself. | Emerging | Self-Directed | Free | Easy | Days to Weeks | |
Default order puts the best-supported practices first, with self-directed care ahead of clinical options. Click any row to open the practice.
What It Is
Most period pain is primary dysmenorrhea: cramping with no underlying disease. It is the leading cause of recurrent short-term school and work absence in younger women. The pain usually begins within a year or two of the first periods, once cycles settle into ovulating, arriving with the bleeding or just before. It sits low in the abdomen, can spread to the lower back and thighs, and eases over the first day or two. Nausea, loose stools, headache, and tiredness often come with it. The other kind is secondary dysmenorrhea, where a disease drives the pain: endometriosis, adenomyosis, fibroids, or pelvic inflammatory disease, treated by fixing the underlying cause. Endometriosis alone affects about 1 in 10 women of reproductive age.
How It Works
Each month, as the womb lining breaks down, it releases prostaglandins, signaling molecules that make the uterine muscle contract hard and pinch off its own blood supply. Those high-pressure contractions and the brief loss of blood flow are the cramp itself. Women with primary dysmenorrhea release more prostaglandins than women without it, and the heightened pain sensitivity can linger outside the period. An anti-inflammatory blocks that prostaglandin production, so it treats the cause of the cramp. In the largest review (Marjoribanks, 2015), 80 trials across 5,820 women, an NSAID roughly quadrupled the odds of good relief over a dummy pill (odds ratio 4.37). Hormonal contraception and heat act along the same pathway.
What Helps
Most period pain can be brought under control at home, and the first move costs nothing: heat on the lower abdomen. Warmth relaxes the uterine muscle and raises local blood flow, easing the same cramp the drugs target. In pooled trials a warm pack relieved period pain about as well as oral painkillers (standardized mean difference −0.72) and clearly beat no treatment (Jo & Lee, Sci Rep 2018). A hot water bottle, a heat pack, or an adhesive heat patch worn under clothes all work.
An anti-inflammatory is the other mainstay, and it stacks with heat. On a placebo, about 18 in 100 women get moderate or excellent relief. On an NSAID, 45 to 53 in 100 do. In head-to-head trials the NSAID also beat acetaminophen. The lever most women miss is timing.
A dose taken before prostaglandin levels peak works better than the same dose after the pain has peaked.
Start at the first sign of pain or bleeding, take it on a schedule through the first 2 to 3 days, with food. The cost is more side effects than a placebo, mostly stomach upset and headache.
Hormonal contraception is the other first-line option. The combined pill thins the womb lining and cuts prostaglandin release. Pooled trials show a moderate reduction across the whole cycle (standardized mean difference −0.58, high-quality evidence).
Regular exercise lowers cramp pain when kept up as a month-long habit. In trials, 45 to 60 minutes 3 or more times a week cut pain by about 25 mm on a 100 mm scale versus no treatment. The evidence is weak, from small and mixed trials, but the results all pointed the same way. A TENS unit is a small device sending a mild current through skin pads. It may reduce pain and cut the need for extra medication, a reasonable option for anyone who cannot take NSAIDs. Both stack on top of heat.
Several supplements have shown a hint of benefit, but a 2016 Cochrane review of 27 trials (Pattanittum) judged the evidence low or very low quality across the board. Magnesium beat a dummy pill across 3 small trials, with less need for extra painkiller. Fish oil had a mild effect. None of these is settled; all are low-risk to try for a cycle or two.
The Research & Studies
Everything here is based on the research we have collected and checked, sorted into groups and ordered with the strongest evidence first. Click any claim to open the studies behind it.
Menstrual Pain
Anti-inflammatories lifted good pain relief from 18% to 45-53%
Anti-inflammatories like ibuprofen and naproxen are the most effective first-line treatment for period pain. Where about 18 in 100 women get good relief from a dummy pill, 45 to 53 in 100 do on an NSAID.
The 2015 Cochrane review pooled 80 randomized trials in 5,820 women with primary dysmenorrhea. NSAIDs were more effective than placebo for pain relief (odds ratio 4.37, 95% CI 3.76 to 5.09; 35 RCTs), and more effective than acetaminophen (OR 1.89, 95% CI 1.05 to 3.43). No single NSAID was clearly better than the others, though the trials had little power to detect such differences. NSAIDs block cyclooxygenase, cutting the prostaglandin production that drives the cramp, which is why they act on the cause, not masking the pain. Evidence was graded low mainly for poor reporting of methods.
Started at the first sign of pain or bleeding and taken on a schedule through the first two to three days, an NSAID that is already on board when the prostaglandin surge arrives works better than the same dose taken late. Take it with food.
The study · 1
Marjoribanks et al., Nonsteroidal anti-inflammatory drugs for dysmenorrhoea · Cochrane Database Syst Rev 2015
A heat pack eased period pain about as well as oral painkillers
A warm pack on the lower belly works about as well as painkillers for period cramps, and it stacks with them. It is cheap, safe, and can be used alongside anything else.
Jo and Lee's 2018 meta-analysis pooled trials of abdominal heat therapy for primary dysmenorrhea: heat performed about as well as oral analgesics (standardized mean difference -0.72 favoring heat, pooled from two trials (n=274)) and clearly beat no treatment (mean difference -4.04 on a 0 to 10 cm VAS, 95% CI -4.88 to -3.20). An earlier randomized active-controlled trial in 344 women found continuous low-level topical heat superior to acetaminophen 1,000 mg over an 8-hour period. Warmth is thought to relax uterine smooth muscle and raise local blood flow, easing the ischemic cramp. The trials are small and cannot be blinded because a warm pack is felt, so the size of the effect is soft even though the direction is consistent.
Use continuous low heat (a hot water bottle, heat pack, or adhesive heat patch that can be worn at work) on the lower abdomen as needed, alone or on top of an NSAID.
The studies · 2
Jo & Lee, Heat therapy for primary dysmenorrhea: A systematic review and meta-analysis · Sci Rep 2018
Akin et al., Continuous low-level topical heat wrap therapy vs acetaminophen for primary dysmenorrhea · J Reprod Med 2004
The combined pill gave a moderate cut in period pain (SMD -0.58)
The combined pill thins the womb lining, which cuts prostaglandin release and lowers period pain across the whole cycle. Taking it continuously, skipping the break week, probably works better than the usual regimen.
The 2023 Cochrane review pooled 21 randomized trials in 3,723 women. Combined oral contraceptives reduced dysmenorrhea pain more than placebo (standardized mean difference -0.58, 95% CI -0.74 to -0.41; high-quality evidence), with pain improvement more common than on placebo. Continuous dosing was probably more effective than the standard cyclic regimen (low-quality evidence, 2 RCTs). The trade-off is irregular bleeding, more common than on placebo, along with probable headache and nausea. Many women use hormonal treatment across the cycle together with an NSAID on the painful days, though that combination has not been measured well enough to put a number on it.
This is a clinician conversation that depends on your history; expect some irregular bleeding at first, and ask about continuous, not cyclic use if pain control is the goal.
The study · 1
Schroll et al., Combined oral contraceptive pill for primary dysmenorrhoea · Cochrane Database Syst Rev 2023
Dietary supplements overall did not clearly reduce period pain
Most supplements sold for period pain rest on small, low-quality trials. Some show a signal, but no supplement has high-quality evidence that it reliably treats cramps. That does not mean they do nothing; the trials are too small and too weak to tell.
Pattanittum's 2016 Cochrane review pooled 27 randomized trials (3,101 women), mostly in students in their late teens and early twenties, testing 12 herbal medicines (including chamomile, cinnamon, fennel, fenugreek, ginger, valerian) and five non-herbal supplements (fish oil, melatonin, vitamins B1 and E, zinc sulfate). All the evidence was judged low or very low quality, limited by very small sample sizes and poor reporting. The review does not support a blanket recommendation for supplements, and it does not rule them out: it means the strong marketing claims made for specific supplements and anti-inflammatory diets are going beyond what has been measured.
Treat supplements as low-risk experiments layered on top of the well-evidenced steps (an early NSAID and heat), not as replacements for them, and never as a reason to delay looking into pain that is severe or worsening.
The study · 1
Pattanittum et al., Dietary supplements for dysmenorrhoea · Cochrane Database Syst Rev 2016
Regular exercise cut cramp pain about 25 mm on a 100 mm scale
Exercising regularly, about 45 to 60 minutes three times a week, eases period cramps by roughly 25 mm on a 100 mm pain scale, which is enough to notice. It works done through the month, not only on the painful days.
Armour's 2019 Cochrane review pooled 10 trials (754 women) of exercise for primary dysmenorrhea. Exercise may have a large effect on pain versus no treatment (standardized mean difference -1.86, 95% CI -2.06 to -1.66; 9 RCTs), about a 25 mm reduction on a 100 mm VAS, likely clinically meaningful. Trials used low-intensity work (stretching, core strengthening, yoga) or high-intensity work (aerobic training, Zumba); none used resistance training as the intervention. The grade is low: the trials were small, results varied enormously (I-squared 91%), and exercise cannot be blinded, so some of the effect is likely expectation of benefit. Whether the benefit persists after regular exercise stops, or holds in women over 25, is unclear.
Exercise regularly through the cycle, not only during a painful period; the trials asked for 45 to 60 minutes, three or more times a week, at whatever intensity suits you.
The study · 1
Armour et al., Exercise for dysmenorrhoea · Cochrane Database Syst Rev 2019
TENS may cut period pain about 1.39 points on a 0 to 10 scale
A TENS unit, a small device that sends a mild electrical current through skin pads, may ease period pain and cut how much medication you need. It is a reasonable non-drug option for someone who cannot take anti-inflammatories.
The 2024 Cochrane review (Han et al.), which replaces the 2009 version, included 20 randomized trials in 585 women. High-frequency TENS may reduce pain compared with placebo or no treatment (mean difference -1.39 on a 0 to 10 scale, 95% CI -2.51 to -0.28; 10 RCTs; low-certainty evidence, I-squared 88%), with some evidence of less need for rescue analgesia. TENS is thought to work by inhibiting the transmission of painful stimuli, releasing endogenous opioids, and reducing uterine muscle ischemia. Trials were few, small, and inconsistent with one another.
Try a TENS unit during the pain if you want to avoid or cannot take NSAIDs; it is low-risk and can be combined with heat.
The study · 1
Han et al., Transcutaneous electrical nerve stimulation (TENS) for pain control in women with primary dysmenorrhoea · Cochrane Database Syst Rev 2024
Vitamin B1 left 87% of girls free of period pain in one trial
In one large trial, vitamin B1 at 100 mg a day for three months cleared or reduced period pain in most of the girls who took it, and the benefit held after they stopped. It rests on essentially this single trial, so the signal is strong but thinly replicated.
Gokhale's 1996 randomized, double-blind, placebo-controlled crossover trial gave 556 girls aged 12 to 21 with moderate-to-severe spasmodic dysmenorrhea thiamine hydrochloride 100 mg orally daily for 90 days. Combining the active-first and placebo-first groups, 87% were completely cured, 8% relieved, and 5% unchanged, with results unchanged at two-month follow-up off treatment. This is the large trial that later reviews (Proctor 2001, Pattanittum 2016) rest the vitamin B1 recommendation on. The effect looks large, but the evidence base is essentially this one old trial in a young population, and it has not been widely replicated.
B1 is cheap and low-risk to try at 100 mg daily; treat the striking cure rate as promising, not settled, given it comes from a single trial.
The study · 1
Gokhale, Curative treatment of primary (spasmodic) dysmenorrhoea · Indian J Med Res 1996
Ginger beat placebo for cramp pain and matched NSAIDs (SMD -1.13)
Of the supplements, ginger has among the more consistent small-trial signals: it beat placebo for cramp pain and looked about as good as anti-inflammatories, though the underlying trials are of uncertain quality.
The 2024 systematic review and meta-analysis (Moshfeghinia et al.) included 24 studies qualitatively and 12 quantitatively. Ginger was more effective than placebo for pain intensity (standardized mean difference -1.13, 95% CI -1.59 to -0.68; I-squared 81%) and pain duration (SMD -0.29). It showed no difference from NSAIDs (SMD 0.01, 95% CI -0.24 to 0.25) or exercise (SMD 0.06) for pain intensity. Safety data were infrequently reported, and the findings are limited by risk of bias in the included trials and an unclear risk-benefit ratio. As a warming aromatic, ginger also sits inside the Chinese medicine reading of cold-type period pain.
Ginger is a reasonable, low-risk supplement to try for cramps; the doses and preparations varied across trials, so there is no single validated regimen.
The study · 1
Moshfeghinia et al., Ginger for pain management in primary dysmenorrhea: a systematic review and meta-analysis · J Integr Complement Med 2024
Fish oil had a mild effect on cramp severity (SMD -1.08)
Fish oil (omega-3) has a mild effect on period pain in pooled trials (a standardized effect of about -1.08), with the benefit oddly strongest at lower doses. The evidence is limited and comes from small, mostly single-region trials.
De systematische review en meta-analyse uit 2022 (Eur J Clin Pharmacol) poolde RCT's van omega-3-meervoudig-onverzadigde vetzuren bij primaire dysmenorroe. Omega-3 verminderde de pijnintensiteit (gestandaardiseerd gemiddeld verschil -1.075, 95%-BI -1.871 tot -0.279), en meta-regressie vond dat de effectiviteit daalde naarmate de dagelijkse inname steeg en naarmate de leeftijd van de vrouwen steeg. De auteurs beschrijven het effect als mild. Een eerdere Cochrane-review vond eveneens dat visolie effectiever was dan placebo in één klein onderzoek, en gecombineerd met vitamine B1 in een ander. De onderzoeken zijn klein en heterogeen, dus dit staat te boek als een opkomende, geen vastgestelde, optie.
Als je visolie probeert tegen krampen, suggereren de onderzoeken bescheiden doses, geen grote; geef het een paar cycli en beoordeel op basis van je eigen reactie.
The study · 1
Systematic review, The impact of omega-3 polyunsaturated fatty acids on primary dysmenorrhea · Eur J Clin Pharmacol 2022
Magnesium versloeg placebo bij menstruatiepijn in drie kleine onderzoeken
Magnesium kan mogelijk helpen bij menstruatiepijn: drie kleine onderzoeken vonden dat het beter werkte dan een neppil, en vrouwen hadden minder extra pijnstillers nodig. Niemand heeft de beste dosis vastgesteld, dus staat het te boek als een veelbelovende maar onopgehelderde optie.
De Cochrane-review van Proctor en Murphy uit 2001 poolde drie kleine onderzoeken die magnesium met placebo vergeleken: over het geheel genomen was magnesium effectiever voor pijnverlichting en verminderde het de behoefte aan extra medicatie, zonder significant verschil in bijwerkingen. De reviewers noemden het een veelbelovende behandeling maar konden geen dosis of regime aanbevelen omdat de onderzoeken varieerden. Een review uit 2017 over magnesium in de gynaecologische praktijk kwam tot een vergelijkbare voorzichtige conclusie, namelijk dat magnesiumsuppletie effectief is bij de preventie van dysmenorroe, premenstrueel syndroom en menstruele migraine, terwijl werd opgemerkt dat het farmacologische mechanisme niet goed is gekarakteriseerd.
Magnesium is laag risico om te proberen; omdat geen enkel regime is gevalideerd, begin met een standaard supplementdosis en beoordeel over een paar cycli.
The studies · 2
Proctor & Murphy, Herbal and dietary therapies for primary and secondary dysmenorrhoea · Cochrane Database Syst Rev 2001
Parazzini et al., Magnesium in the gynecological practice: a literature review · Magnes Res 2017
Chinese kruidenformules versloegen standaardmedicatie tegen pijn (RR 1.99), in zwakke onderzoeken
Chinese kruidenformules toonden een veelbelovend voordeel voor menstruatiepijn in veel onderzoeken, waarbij ze op de gepoolde cijfers beter presteerden dan standaardmedicatie. Het addertje onder het gras is dat de onderzoeken van slechte kwaliteit waren en de meeste iedereen dezelfde vaste formule gaven, wat niet is hoe de geneeskunde wordt beoefend.
De Cochrane-review van Zhu uit 2008 poolde 39 gerandomiseerde onderzoeken bij 3,475 vrouwen. Chinese kruidengeneeskunde leverde significante verbeteringen op in pijnverlichting (risicoratio 1.99, 95%-BI 1.52 tot 2.60 versus farmaceutische geneesmiddelen; 14 RCT's) en in algehele symptomen, en deed het beter dan acupunctuur en warmtecompressie in kleine vergelijkingen. De reviewers noemden het bewijs veelbelovend maar beperkt door de slechte methodologische kwaliteit van de onderzoeken. Twee structurele problemen blazen het schijnbare effect op: de meeste onderzoeken gaven elke ingeschreven vrouw één vaste formule, terwijl de methode is om de formule af te stemmen op het individuele patroon; en de meeste werden gepubliceerd in Chineestalige tijdschriften, waar het gepubliceerde bestand sterk neigt naar positieve resultaten. Het werkelijke effect is daarom kleiner dan het gepoolde cijfer, met een hoeveelheid die niemand kan kwantificeren.
Kruidenformules worden voorgeschreven door een behandelaar na een patroondiagnose; een vaste vrij verkrijgbare formule is niet hoe de traditie werkt en niet wat de veelbelovende onderzoeken zouden moeten worden gelezen als aanbeveling.
The study · 1
Zhu et al., Chinese herbal medicine for primary dysmenorrhoea · Cochrane Database Syst Rev 2008
Het aandrukken van het SP-6-punt verminderde bescheiden de menstruatiepijn (SMD -0.29)
Het aandrukken van het klassieke gynaecologiepunt SP-6, aan de binnenkant van het onderbeen, verminderde in onderzoeken bescheiden de menstruatiepijn, en het zelf aandrukken werkte beter dan het naalden. Het is de goedkoopste versie van de traditie om te proberen, op zacht bewijs.
De bijgewerkte systematische review en meta-analyse uit 2024 (Med Acupunct) poolde 19 onderzoeken (9 acupressuur, 10 acupunctuur; 1,171 patiënten met primaire dysmenorroe). Stimulatie op Sanyinjiao (Milt-6) verminderde de pijn significant (gestandaardiseerd gemiddeld verschil -0.29, 95%-BI -0.41 tot -0.17), met aanzienlijke heterogeniteit. Acupressuur was effectiever dan acupunctuur op het punt (SMD -0.52, 95%-BI -0.71 tot -0.33). SP-6, het ontmoetingspunt van de drie Yin-meridianen van het been, is het klassieke punt voor gynaecologische klachten, en zelf-acupressuur is iets wat een vrouw zichzelf kan leren toepassen, wat het de goedkoopste optie maakt.
Stevige zelf-acupressuur op SP-6 (een handbreedte boven het binnenste enkelbot, achter het scheenbeen) tijdens pijn is gratis en laag risico om te proberen; het gepoolde effect is bescheiden, dus behandel het als aanvulling.
The study · 1
Updated systematic review, Effect of Sanyinjiao (Spleen-6) acupoint for pain management in primary dysmenorrhea · Med Acupunct 2024
Acupunctuur versloeg schijnnaalden niet bij menstruatiepijn
Het algehele onderzoeksbewijs kan niet zeggen of acupunctuur menstruatiepijn behandelt. Het beste enkele onderzoek vond dat echte acupunctuur niet beter was dan nep- (schijn-) naalden, hoewel beide beter waren dan niets doen, wat het patroon is van een grote placeborespons.
De Cochrane-review van Smith uit 2016 poolde 42 onderzoeken bij 4,640 vrouwen. Bevindingen voor acupunctuur versus schijnbehandeling waren inconsistent en niet doorslaggevend, en het enige onderzoek met een laag risico op bias in alle domeinen vond geen verschil tussen echte en schijnacupunctuur na drie, zes of twaalf maanden. Ten opzichte van geen behandeling deed acupunctuur het beter, maar een voordeel boven niets dat verdwijnt tegenover een overtuigende placebo is de vorm van een grote niet-specifieke respons, wat de reden is waarom een menstruatiepijnonderzoek zonder schijngroep de vraag niet kan beslechten. De kwaliteit was laag of zeer laag bij alle vergelijkingen.
Als je acupunctuur waardeert en er toegang toe hebt, zijn de risico's laag; weeg het gewoon als een optie waarvan het specifieke effect boven placebo niet is vastgesteld, geen eerstelijnsbehandeling.
The study · 1
Smith et al., Acupuncture for dysmenorrhoea · Cochrane Database Syst Rev 2016
How it works
Prostaglandins make the womb muscle cramp and pinch off its own blood supply
Primary period pain comes from prostaglandins, signaling molecules the womb lining releases as it sheds. They make the muscle squeeze and pinch off its own blood supply, and that squeezing is the cramp.
Dawood's foundational pharmacology reviews established that primary dysmenorrhea tracks with raised endometrial prostaglandin release, producing high-pressure uterine contractions and ischemia. A 2015 critical review adds that women with dysmenorrhea show heightened pain sensitivity that persists even outside the menstrual phase, and that dysmenorrhea is a risk factor for later chronic pain conditions such as fibromyalgia. This mechanism is why the treatments with the best evidence, anti-inflammatories, hormonal contraception and heat, each act on that prostaglandin-and-contraction pathway, not only on the sensation of pain.
The studies · 2
Dawood, Dysmenorrhoea and prostaglandins: pharmacological and therapeutic considerations · Drugs 1981
Iacovides et al., What we know about primary dysmenorrhea today: a critical review · Hum Reprod Update 2015
Go Deeper
- Endometriosis, the main disease behind secondary period pain.
- Heat and sauna bathing, the wider evidence on therapeutic heat.
- Magnesium: dose and evidence for the mineral.
- Omega-3 (fish oil), the anti-inflammatory fat.
- Walking and staying active, the simplest form of the exercise lever.
- Pelvic floor training: targeted movement for pelvic pain.
The Chinese Medicine View
The Chinese Medicine View
Period pain, tong jing (痛经), is one of the areas Chinese medicine has worked out in the most detail. Our own differentiation of painful menstruation goes through it pattern by pattern. The reading turns on three things: timing in the cycle, whether warmth or pressure helps, and the nature of the blood. Each points to a different treatment. Both can be true at once: this tradition has lasted a long time and gives a cheap self-help move, the SP-6 point below, while the formal trials are mixed. Early results for Chinese herbal formulas and SP-6 acupressure look promising but are not yet solid. The pattern is read before the formula is chosen.
Distending, stabbing pain before and during the period, worse for pressure. It often comes with clots, and the pain eases once they pass, alongside premenstrual irritability and breast distension. The direction is to move Qi and break Blood stasis. The anchor formula is Xue Fu Zhu Yu Tang.
Cramping pain that eases the moment heat is applied, worse for cold and damp weather, with a cold feeling low in the belly and paler blood carrying dark clots. The direction is to warm the lower burner and dispel cold. Wen Jing Tang, the warm-the-menses decoction, is the anchor. This is the pattern that fits the heat pack and warming spices such as ginger.
A dull, dragging ache during or after the period that feels better for pressure and warmth, with light, pale flow, tiredness and dizziness. The aim is to nourish and build strength, so a strong moving formula used for this pattern only makes it worse.
A dull ache after the period, low back and knee soreness, scanty pale flow. The direction is to supplement the Liver and Kidney.
SP-6 (Sanyinjiao), on the inner lower leg a hand's width above the ankle bone, is the classical point for gynecological complaints, where the three leg Yin channels meet. It is the piece of the tradition a woman can be taught to use herself. In pooled trials, stimulating SP-6 modestly reduced period pain, and pressing the point yourself worked better than needling it (Med Acupunct 2024). That makes firm self-acupressure at SP-6 during pain the cheapest form to try. The effect is small. Pressing a point is also hard to test against a fair sham, so treat SP-6 as an add-on to the main steps.
Cautions
Extra restraintEverything to be aware of is here, in one place. This practice suits most healthy people; a few situations call for real care.
Anti-inflammatories raised side effects from 10% to 11-14%
The 2015 Cochrane review found NSAIDs raised overall adverse effects (OR 1.29, 95% CI 1.11 to 1.51; 25 RCTs), gastrointestinal effects (OR 1.58, 95% CI 1.12 to 2.23) and neurological effects such as headache and drowsiness (OR 2.74, 95% CI 1.66 to 4.53). This is why NSAIDs should be used with caution or avoided by people with a history of stomach ulcers or bleeding, kidney disease, uncontrolled high blood pressure, or aspirin-sensitive asthma, and why they need care alongside blood thinners and some blood-pressure medicines.Marjoribanks et al., Nonsteroidal anti-inflammatory drugs for dysmenorrhoea
Endometriose treft ongeveer 1 op de 10 vrouwen en wordt tot 10 jaar gemist
A 2025 JAMA review reports endometriosis affects up to 10% of women during their reproductive years, with 90% of those affected reporting pelvic pain including dysmenorrhea, and diagnosis often delayed 5 to 12 years, most women consulting three or more clinicians first. A 2025 BJOG systematic review of time-to-diagnosis confirmed delays of up to about 10 years persist despite improved guidelines. Secondary dysmenorrhea, caused by endometriosis, adenomyosis, fibroids or pelvic inflammatory disease, is missed precisely when severe period pain is waved off as normal. Pain that started years after periods began, is worsening, occurs outside menstruation, or comes with pain during sex, heavy or irregular bleeding, or bowel or bladder symptoms, warrants investigation, not a stronger supplement.De Corte et al., Time to diagnose endometriosis: current status, challenges and regional characteristics - a systematic literature reviewEndometriosis: A Review
Supplements are adjuncts, not cures
Ginger, vitamin B1, magnesium and fish oil are low-risk to try, but the evidence behind them is weak. None is a substitute for the well-evidenced steps of an early NSAID and heat. A supplement does harm in one situation: when it becomes the reason a woman keeps medicating serious pain. Severe, worsening, or new pain needs assessment.
Chinese herbal formulas are matched to the pattern
The medicine matches a formula to the pattern in front of it, but the promising trials gave one fixed formula to everyone enrolled. A formula is chosen after a pattern diagnosis by a practitioner. The strong Blood-moving formulas are wrong for deficiency-type pain and are generally avoided in pregnancy. Use these through a qualified practitioner and a regulated supplier.
Most period pain is safe to treat at home with the simple steps above. Consult a licensed practitioner if you have questions, or promptly if any of the warning signs below fit you.
When to See Someone
Most period pain is not a sign that anything is wrong. One rule sits above the rest: pain that is severe, new, worsening, or happening outside your period is a reason to get assessed. See a doctor, and urgently for the marked ones, if you have:
- Sudden, severe pelvic pain, pain with fever and abnormal discharge, or a positive pregnancy test with pain and bleeding. These are reasons to seek care the same day(seek urgent care)
- Period pain that first appears years after your periods began, or that worsens cycle on cycle
- Pain that happens outside your period, at other points in the cycle or between cycles, or that starts several days before bleeding or drags on well after it stops
- Pain during sex (dyspareunia), or pain with bowel or bladder symptoms during your period, both of which point toward endometriosis
- Heavy or irregular bleeding alongside the pain. This can point to fibroids or adenomyosis and is worth assessing on its own
- Pain that does not settle on an anti-inflammatory taken properly, or on hormonal treatment. Endometriosis is diagnosed on average years, sometimes close to a decade, after the pain starts. Those years accumulate when severe period pain is dismissed as normal. Ask to be looked into
None of this is meant to alarm you. Painful periods are common and usually manageable with the simple steps above. Endometriosis is the exception, because spotting its warning signs early changes the outcome.
Common Questions
Does acupuncture treat period pain?
A 2016 Cochrane review (Smith) found the trials too mixed to reach a verdict. The one study at low risk of bias found no difference between real and fake (sham) needling at 3, 6, or 12 months. Both beat doing nothing, consistent with a large placebo response. A null sham-controlled result does not overturn long clinical use. It does mean the evidence cannot support a big effect from the needling itself.
Does ginger help cramps?
Of the supplements, ginger has the best evidence. A 2024 meta-analysis (Moshfeghinia) found ginger beat placebo for cramp pain (standardized mean difference −1.13) and looked about as good as NSAIDs. The underlying trials carry a high risk of bias, so the true effect may shrink as better studies arrive. It is low-risk to try over a cycle or two.
Does vitamin B1 help?
One large trial (Gokhale, 1996) gave girls 100 mg of thiamine a day for 3 months. It cleared or reduced pain in most of them, and the benefit held after they stopped. It rests on essentially that single old study, so the finding is promising but far from settled.
Should the combined pill be taken continuously?
Probably it works better that way. A 2023 Cochrane review (Schroll) found that skipping the pill-free week likely gives more pain relief than the usual monthly regimen. It rated the pill's overall benefit moderate on high-quality evidence. Expect irregular bleeding at first, and probably some headache and nausea early on.
Does heat beat acetaminophen for cramps?
In one trial of 344 women (Akin, 2004), a continuous low-level heat wrap outperformed 1,000 mg of acetaminophen. Heat is drug-free, easy to reach for when you want to avoid or reduce medication. It can also go on top of an anti-inflammatory when one drug is not enough.
How do I tell ordinary cramps from something more serious?
Cramps that started with your first periods and stay about the same each month are almost always primary and safe to treat at home. A pattern that changes points instead toward endometriosis and related disease. Recent reviews (De Corte, BJOG 2025; JAMA 2025) underline that this pain is treatable once found, so the warning signs above are worth acting on early.
All 20 sources on this page independently checked and cross-referenced.
Thomas Dehli, Founder & Editor, Sacred Lotus
Sacred Lotus has published Chinese medicine reference material since 2001. Integrative pages are held to the same standard as the herb and formula library: cite the source, grade the claim at its real strength, and say where the research has not looked. This page is educational and it is not medical advice. Last reviewed and updated August 9, 2026.
Evidence strength
How confidently the research supports a claim. Strength describes the evidence, not our endorsement.