Menstrual Cramps and Pelvic Pain

by Christiane Northrup, M.D.

Pelvic Health

Starting in the teenage years, half of all women suffer from menstrual cramps (dysmenorrhea). During perimenopause, the tendency toward cramping may worsen because of hormonal imbalance and the conditions associated with it, such as fibroids and adenomyosis.

Sometimes, cramps are a sign from your body that you need to slow down, rest, and tune in to yourself. In many ancient cultures, and even in some contemporary societies such as parts of India, women were expected to take it easy during their periods. But in our society all of us have been taught to try to be efficient, upbeat, and at 100 percent energy all the time. No wonder our wiser bodily processes try to get our attention!

Though this has been considered a sign of female weakness, once you begin to listen to your body, you will find that your cyclic energy shifts are a source of inspiration. If we have not been doing this regularly in our twenties and thirties, our pain can become particularly acute during perimenopause, when the wake-up call to health becomes louder. As you learn to slow down during your premenstrual and menstrual times, your cramps diminish, and in addition you will often find your intuition at an all-time high.

What Causes This

Cramps result when the uterine muscle and the endometrial produce too much of the eicosanoids called prostaglandin E2 and F2- alpha. When these prostaglandins are released into your bloodstream (usually within an hour or two after the onset of your period, but sometimes even before) you begin to experience the effects of these hormones: spasm in the uterine muscle, sweating, hot flashes, feeling cold alternating with feeling hot, loose stools, and possibly feeling faint. This eicosanoid imbalance is affected by the food you eat and the amount of stress you’re under, among other factors.

Healing Alternatives

Birth control pills often help menstrual cramping. All pelvic conditions tend to quiet down when the natural hormonal cycles are put to sleep by the steady state synthetic hormones in birth control pills. Take the lowest dose pill available. However, avoid birth control pills altogether if you are a smoker.

Spiritual and Holistic Options

Follow a diet high in protein and healthy fats and low in high-glycemic carbohydrates. Avoid trans fats found in partially hydrogenated oils.

Try eliminating all dairy foods (including cheese, ice cream, cream, milk, and yogurt) for two months. Though I do not have any statistics on this, I’ve seen many women get rid of their menstrual pain altogether (even in cases of severe endometriosis) by eliminating dairy foods, which are high in arachidonic acid, from their diets. Some are able to prevent cramps by avoiding dairy just for the two weeks before their periods. During perimenopause, when periods so often become irregular, you may need to stop dairy altogether for a few months to experience the benefits.

Try eliminating red meat. Red meat, like dairy foods, is high in a fatty acid eicosanoid precursor known as arachidonic acid, which results in symptoms such as cramps and arthritis in susceptible individuals. Eliminating it from your diet can cut down on the inflammatory eicosanoids associated with cramping and endometriosis pain.

Take a good multivitamin and mineral supplement, with special attention to the following:

  • Magnesium: 100 mg taken as frequently as every two hours during times of actual pain has been shown to help relax smooth muscle tissue and therefore decrease cramping. Do not exceed 1,000 mg per day, otherwise stools may become too loose.
  • Omega-3 fatty acids: Omega-3 fats are precursors for series 1 and 3 eicosanoids. Consume one of the following: fatty fish (3–4 oz) three or four times per week; fish oil, 1,000 to 2,000 mg per day; DHA, 100–400 mg per day; 4 tbsp ground fresh whole organic flaxseed per day; 1 tbsp fresh flaxseed oil daily.
  • Vitamin C: 1,000–5,000 mg per day. Increase when cramping occurs.
  • Vitamin B-6: 100 mg per day, in combination with B complex.
  • Vitamin E: 50 mg. in the form of d-alpha tocopherol three times a day during the entire cycle.

Acupuncture has been scientifically shown to alleviate menstrual cramps and pelvic pain. If you cannot locate a trained practitioner of Traditional Chinese Medicine near you, it is safe to try Bupleurum (Xiao Yao Wan, also known as Hsiao Yao Wan). This patent medicine is widely available, and many of my patients have done very well with it. Take four or five of the tiny tablets four times per day during the two weeks before your period is due, and continue through the first day of bleeding. It may take two to three months to see full results. Yun Nan Bai Yao is a traditional Chinese medicine that can stop heavy bleeding within one to two weeks—sometimes sooner. Take one to two capsules, four times daily.

The active ingredient in Menastil (an over-the-counter, topically applied, homeopathic product) is calendula oil—an essential oil extracted from marigold petals. The United States Food and Drug Administration and the Homeopathic Pharmacopoeia U.S. recognize this pure grade of essential oil for the temporary relief of menstrual pain. This all-natural product, which comes in a small roll-on applicator bottle, is designed to relax the uterine muscle, which increases the flow of blood and oxygen to the uterus, which in turn reduces pain.

Black cohosh, or “cramp bark,” can also be used as a preventive. This herb is available in tablet or tincture form in natural food stores.

Lying down with a castor oil pack on your lower abdomen for sixty minutes two to four times per week is often very helpful for both treatment and prevention of cramps and pelvic pain.

Moderate exercise helps lower stress hormone levels, which decreases cellular inflammation. Yoga is also good and often relieves cramps.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil), naproxen sodium (Anaprox, Aleve), and ketoprofen (Orudis) work by partially blocking your body’s production of prostaglandin F2-alpha. (So do aspirin and acetaminophen [Tylenol], but through a slightly different mechanism.) For best relief, NSAIDs must be taken before you get uncomfortable. If you take them only after the pain has begun, the prostaglandin will already be in your bloodstream. The drug stops production of prostaglandin F2-alpha, but it cannot stop the effect on your cells once the prostaglandin has been released.

Maya Traditional Massage is another helpful treatment. Indigenous Mayan healers in Central America have long used a technique called Maya abdominal massage to treat many conditions of the pelvic organs, including painful periods. The technique involves a gentle massage of the muscles and ligaments in the pelvic region and realignment of any pelvic organs that have shifted position (such as in a tilted or prolapsed uterus). When these organs are not properly aligned, the flow of blood, lymph, nerve, and Qi (roughly translated as “life-force”) is disrupted, which then compromises the function of other pelvic organs.

Learn More — Additional Resources

Christiane Northrup, M.D.

Christiane Northrup, M.D.

Christiane Northrup, M.D., is a visionary pioneer and a leading authority in the field of women’s health and wellness. Recognizing the unity of body, mind, and spirit, she empowers women to trust their inner wisdom, their connection with Source, and their ability to truly flourish.


Add comment
  1. shaunie
    6 months ago

    I am sharing a similar experience, Pam. I haven’t had my period in over a year; last night I started experiencing a light bleeding followed with extreme pelvic cramping with occasional shooting pain in the lower abdomen area. I don’t understand this! I’m hoping this doesn’t continue to happen every month. I use the estrogen patch to manage my menopausal symptoms in the past, and have never experienced anything like this before.

  2. Pam
    6 months ago

    Hi. I just read your post and was sorry to see there was no responce. I have a similar experience. I have not had my period for over a year and then got it about 5 months ago. Recently about 3 or 4 weeks ago I have started having cramps almost daily too. I had all the usual tests also and everyting came back ok. It’s really frustrating!

  3. Cindy
    7 months ago

    Hi. I love your outlook and approach to women and their health. I need help…before this Sept 2014, I had not had a menstrual period for 2 years. In Sept I had a full period that was just like I used to have. I had another one 3 weeks later and one more 3 weeks after that although that one was very light and only lasted a few days. Since then I have had no bleeding. I also started having low pelvic cramping starting just around the last light cycle and it lasted til mid Nov. They went away and I was feeling back to normal. 3 months later I started cramping again and its been going on almost daily for 5 weeks. Back in Sept and Oct I had a pap test, ultrasound (both types) and a uterine biopsy. All came back normal. I am still concerned about the cramping because everything I read says it isn’t normal. What can you tell me about this?? Please help!!

    1. Erica
      3 months ago

      Yikes! i’m having the same thing, exactly. Five weeks of daily cramping so bad i often can hardly walk, let alone think, work or teach. Best i can do is hot water bottles front and back while i sit and meditate. Also had a pap, ultrasound, bloodwork, to no avail. So investigation and therefore any possibility of help has come to a grinding halt and yet … the cramping is daily. What can we do?

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