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

Last Updated: October 8, 2006

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. Michelle
    4 years ago

    Is there a brand of vitamins that you recommend?

  2. Linda
    5 years ago

    Dr Northrup’s books and all of you women who have posted here are a huge help to other women whose bodies are behaving in unpredictable ways ( always!!). Thanks for sharing.

  3. Friederike
    5 years ago

    Dear Dr. Northrup,

    I’m interested in why you recommend hormonal birth control despite its (side) effects (depression, migraines, increased risk of breast cancer and blood clots, hair loss, etc.)? I’ve been reading Dr. Lara Briden’s blog for a while, she is a firm advocate of avoiding hormonal birth control wherever possible and healing the underlying problem of a disturbed menstrual cycle naturally instead of shutting it down. Do you see this differently and if so, to which extent and why?

    Thank you very much, and kind regards,

  4. Ms Myra
    7 years ago

    omg Im so glad I ran across this site! I see my sudden feelings are not unusual. I just turned 45 have had short cycles for about 7 years now. When I say short meaning 1 to 3 days max. They are regular every 24 to 25 days… Never had regular cramps during cycle. I would get mild ones during the onset of the flow but then they would tapper off by the middle of the day. Now since turning 45 I have gas all the time,bloating until I let the gas out,appetite is on and off,pelvic area doesn’t hurt but it feels like something is pulling it down all the time. I got to the gym,stretch work out then I feel better but then later in the evening I’m tired,bloated again..mild pms like cramps again!! this had gone on for about a month now. I am scheduled to see a OB soon. I just got a PCP check up and all my blood work was fine except I had a vitamin deficiency of 9….I was other wise health until I literally turned 45 smh

    1. Ursula
      6 years ago

      Ms Myra, did you ever get answers? My circumstances are just like yours. I have never had children, have you? Do you have fibroid tumors?

  5. Ruth
    7 years ago

    Hello. I’m 59 and have been in menopause for 7 years. In the last two months, I have noticed some body changes. More feelings of sexual desire, more nipple sensation. In recent days, I weirdly had menstruation cross my mind a couple times. I also had the diarrhea that used to precede my period. Yesterday at noon I started to menstruate with all the old familiar sensations that went with it. Mild cramps, tiredness. I used a tampon; the blood was fresh. Bleeding diminished overnight and seems to have stopped as of today. My lifestyle is healthy with daily walking, taking Dr. Northrup’s recommended supplements, no changes in weight (I’m 5’7″ and 120 lbs), appetite, or sleep. Has anyone had an experience like mine? Any advice? I don’t have a regular physician or insurance.

  6. Jennifer Copeland
    7 years ago

    I am nearly 43, and have begun experiencing early symptoms of menopause. For a few years; however, I’ve been experiencing bouts of constipation, and even obstipation. It has come to a point where I often need to physically help the movement by pushing on the inside of my vaginal wall.
    Today I felt a severe stabbing pain that I thought was being caused by a suddenly full bowel. When I tried pushing on the vaginal wall I could feel that the bowel as empty. At the same time I brushed my cervix and felt a wave of shooting, stabbing pain.

    I do know a visit to the doctor is necessary, but I currently lack the health insurance to do so. Also, as it’s been a number if years, I’m a bit scared of the results, to be quite honest.

    1. simonne
      7 years ago

      That sounds terrible Jennifer. I am not a doctor but I would suggest taking Psyllium Husk Fibre in water every day just to get your bowels moving again. Hope everything works out ok for you.

  7. Chrissy
    7 years ago

    I’m 48 years old. I haven’t had my period since August so about 4 months . I went to the Dr he ran a blood a test female pituitary hormone level in menopausal range. I have very bad cramps it feels like im getting my period . My Dr put me on Motrin 550. I was wondering how long do these cramps last for?
    Thank You

  8. Jenna
    7 years ago

    I’m 48 as well and like today, for example, my left ovary hurts again and my period ended days ago. I have never had cramps until my late 40’s and sometimes in between periods. Doc gave me 500 mg Nyprosyn (I think it’s called) and it helps but I hate taking anything but I have to because my cramps are so intense but my cycles are still regular, but shorter, only about 3-4 days max.

  9. Rose
    7 years ago

    I am 48. Peri menopause , have been having cramps two weeks to my period. It gets soo painful and unbearable . I am glad to have read it’s a normal process.

  10. Linda
    8 years ago

    OMG, I thought I was the only one that was suffering,I am Menopausal have not had a period in three years.I have been cramping for a bout a month now,had a Pap smear done it was normal. I thought I had a bladder infection test came out normal. I i’m so frustrated with this I don’t know what to do!!!

  11. Michele
    8 years ago

    Dear Dr. Northrup,
    I am 48, and must be perimenopausal. I had 2 incidences of sudden cramps, so intense it caused me to vomit. This happened twice about a week apart, right before a 43 day cycle then a week later right before a 20 days cycle. I had an abdominal ultrasound, and another vaginal one, and they showed no problems. My thyroid is normal. I can only guess that it must be related to perimenopause. Last year has been any where from 20-49 days apart- unpredictable, cramps, heavy flow for at least 2 days. Other thank advil every month, I am on no medication, healthy, happily married, stress free. I guess I have been in denial of my aging. I usually just put things on hold for that week, and wont exercise, and I get miserable. I have considered taking birthcontrol again, after being off it for 13 years, but so far have not been able to make myself do it. I am really afraid of getting those intense cramps again, so I keep Zofran on had in case it happens away from home. Looking forward to reading some of you books.

  12. SuQ
    8 years ago

    I am a healthy 53 year old, normal weight, good blood pressure, etc, My last period was 2 years ago. This week I felt some cramping, almost like I was going to have a period, and then I had some slight brown mucus discharge for a few days. I had a pap in August 2015 that was normal. I have had migraines a lot lately and have been under a lot of stress. I am making an appointment to be sure, but in the meantime, I am nervous about why this just happened. Any ideas? Thank you.

  13. Maria Jasmine Freeman
    8 years ago

    My last menstrual period was twelve years ago with no breakthrough bleeding whatsoever, while flashes started one year prior. My symptoms were extreme, of repeated seizures n gasping, over excruciating neuropathic pain, since then. My uterine cramps were no less excruciating; every now n then coming back for one to two days, vanquishing, invalidating and conducing to tears, over despair. There, after so long, they are coming back today. I do not know which of my symptoms was the worst; won’t menopause ever quit?! I am a physician, which is why perhaps I refrained from Hormonal therapy, and there came the Deuce to pay, in a “recommendoma” of menopause- a crucifixion!
    Maria Jasmine Freeman

    1. Tabitha Packard
      8 years ago

      I am 37 and just starting this process, Your post scared me!!!! I really hope that its not that bad. I have been experiencing some cramps after my monthly which this is the first month that has ever happened..

      Tabitha Packard

  14. Amy Peck
    8 years ago

    I’m 52 and it has been confirmed that I am in menopause. I have always cramped during my period and always on the left side. Now I still cramp but they are sharp and intermittant and when I do I have some bleeding then is stops for a day or two then it happens again. I don’t bleed enough to need a pad just on the toilet tissue. When I take motrin in the pain is relieved for 12+ hours. What’s up with this. Is it a sign of cancer?

  15. Monique
    8 years ago

    I am peri menopausal and have been having abdominal cramping and major bloating on and off for the past year. I had my period eight months ago, but none since. I recently went to the Dr. and had a trans vaginal ultrasound. They found a cyst on my left ovary and will send the images to my OBGYN. In the interim, all of the bloating and cramping has been getting pretty consistent and now has me very nervous! I’m now starting to think the cyst could mean something more serious is going on. Anyone else have something similar and what was your outcome.

    1. Michelle
      7 years ago

      Wondering how everything went? I’m in that boat and awaiting a pelvic ultrasound. My period hasn’t come in 6 weeks and I’m thinking this is the start of perimenopause. I am 47 years old. I am having ongoing mild cramping with the occasional sharp stabbing pain, and I’m bloated. Thank you.

  16. shaunie
    9 years 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.

  17. Pam
    9 years 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!

  18. Cindy
    9 years 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
      8 years 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?

      1. Helen Lane
        7 years ago

        Hi Erica…I have also been experiencing pain in my pelvic area and tenderness with my breast moreso the nipples. My last menstrual was in December. Just as you I saw my GYN doctor and she said im in the peri stage of menopause. The pain in my pelvic area has gotten me to the point where its hard to walk and when im trying to relax in bed it hurts to turn from side to side. I rather deal with having a monthly period than dealing with this.

      2. Ursula
        6 years ago

        I have all your symtoms, and am also a teacher. Here’s to relief for us all. I’m glad you at least have heard of other women with the same, odd symptoms.

      3. Kelly
        6 years ago

        I am having the low level cramp it is continues. Pain relieve doesn’t help. It has been going on for about a week. I had my pap last week, and my Dr. still hasn’t given me my results. I have called twice with no response back. This cramp/ache in my uterus/bladder region is worrying me to death. I haven’t had a period since Oct 2017. This just feels like a continuous ache/cramp. I never felt this before.

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