OTC period pain treatments

In My Vagina’s specialist women’s healthcare clinic, menstrual pain is a common presentation and varies from mild cramping to severe, debilitating pain. 

Menstruation is a naturally inflammatory state to expel the endometrial lining from the uterus through the vagina. Cramping is part of this process, where the uterine muscle ‘squeezes’ to get the blood out of the cervix – a cramp. 

Some mild cramping during bleeding is considered normal, but symptoms that require someone to modify their schedule and take strong medication need greater attention. Nobody should have to ‘just tolerate’ period pain.

Mild period pain

Mild period pain is easily tolerated and typically doesn’t need any intervention. It appears and disappears fairly quietly and doesn’t cause distress or require someone to change their daily life to accommodate it. 

Moderate period pain

Moderate period pain presents as uterine cramps, aching lower back, possibly with aching pain radiating down the legs or even the vulva.

Sometimes periods are accompanied by nausea, fatigue, or headaches. These cases require interventions (e.g., medication, time off work, or routine modifications) to manage symptoms. 

Severe period pain

Severe pain suggests that there is more inflammation than is necessary to complete the task of expelling the endometrial lining and that something else may be causing such intense pain.

In these cases, we examine the underlying causes of excessive pain and inflammation and manage the associated symptoms so that people can continue their normal lives. 

There are many lucky people who don’t experience period pain at all, but they are in the minority. 

What are the common causes of menstrual pain or dysmenorrhoea?

There are two main classifications of period pain: primary and secondary dysmenorrhoea.

Primary dysmenorrhoea

Primary dysmenorrhoea is pain with menstruation that isn’t connected to any underlying identifiable condition, but instead is caused by excessive production of prostaglandins, our inflammation-causing compounds. 

Prostaglandin production is an important part of menstruation, but if the body is not able to keep a lid on it (think anti-inflammatory activities, food, herbs, medicines), excess pain and inflammation can be the natural result. 

Secondary dysmenorrhoea

Secondary dysmenorrhoea is menstrual pain caused by an underlying condition such as endometriosis, adenomyosis, fibroids, or pelvic inflammatory disease (PID). This form of pain tends to start before bleeding and lasts longer. It can also be more severe. 

Evidence for first-line OTC options (ibuprofen and Tylenol/Paracetamol) with doses

Non-steroidal anti-inflammatory drugs (NSAIDs) work by directly inhibiting prostaglandin synthesis, thereby preventing the release of inflammatory compounds and their entry into the systemic circulation.

There is very strong evidence that NSAIDs are the most effective first-line drug treatment for period pain. 

How to use ibuprofen for period pain

The recommended dose for ibuprofen is 400mg three times daily at four-hour intervals. For more severe pain, naproxen is dosed at an initial dose of 500mg, then 250mg every 6-8 hours. This dosing regimen can be continued for 1-3 days, depending on the individual’s typical pain pattern. 

It’s most useful to start treatment before pain becomes severe, particularly if the person knows it’s coming. An ounce of prevention in this case can prevent unnecessary suffering, since once prostaglandins enter the circulation, they exert their effects.

Avoid Tylenol/Paracetamol for period pain

Paracetamol is not an effective treatment for period pain and should not be recommended unless you can’t tolerate NSAIDs. In severe cases, paracetamol may be used as an adjunct at safe doses. 

If you don’t tolerate or want to use medication, there is strong evidence for several non-drug options available in pharmacies, healthfood stores and your favourite online retailer. Curcumin with piperine and high-dose fish oils are two such options. 

Using curcumin/turmeric for period pain^​1,2​

To help reduce the severity of period pain over time, thus reducing reliance on NSAIDs, the introduction of 500mg of curcumin with piperine daily for 3-6 months has shown promise.

It’s very important to understand that the addition of the black pepper extract is the key to the efficacy of curcumin/turmeric supplements. Ensure any products chosen include piperine, otherwise the compound is not well absorbed and not as effective.

Using fish oils and omega-3 for period pain^​3,4​

Another well-studied option to reduce NSAID use during menstruation is omega-3 fatty acids, most commonly administered via high-dose high-quality fish oil capsules. Importantly, dose here matters, with the ‘one a day’ mantra being therapeutically ineffective in this case. 

Most fish oil capsules contain around 1000mg of fish oil, but if you look closely, the EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) – the actual omega-3 content – varies considerably between products

To get the therapeutic dose of 1,500mg of omega-3 fatty acids per day required to combat period pain, check the back of the jar of fish oil and add up the EPA and DHA content to see how many capsules are required per day.

A capsule containing EPA of 270mg and DHA of 180mg, the total omega-3 content per capsule is 450 mg, so the patient would need to take approximately three capsules per day for a therapeutic effect. One capsule per day is not enough. Most fish oils contain much less than this example.

Aim for high-quality, non-chemically extracted, odour-free capsules – they are far more tolerable. 

Common dosing mistakes and safety issues with OTC drugs for period pain

Common mistakes when using over-the-counter NSAIDs include doubling up on products that contain the same ingredients or not taking enough for efficacy.

Taking too much of the same drug by mistake

For example, if you are unlucky enough to have your period and the flu, taking ibuprofen for period pain, along with cold and flu tablets that also contain ibuprofen, could exceed the daily maximum dose of 1200mg. 

Many people aren’t aware that aspirin, ibuprofen and naproxen shouldn’t be taken at the same time, since it increases the risk of adverse outcomes and won’t improve pain relief. 

Not taking enough NSAIDs to be effective

By the same token, not taking enough of the drug to have an impact on pain can also occur, due to perhaps feeling unsure or afraid of taking medication.

Overuse of NSAIDs can lead to gastric issues such as bleeding and ulcers, so if you have symptoms, see a doctor.

NSAIDs should not be used in anyone with a history of gastric bleeding or ulcers, severe renal impairment, pregnancy (particularly the third trimester), asthma exacerbated by NSAIDs, or those on anticoagulants. Anyone with cardiovascular disease should be carefully assessed before using NSAIDs. 

How effective is heat, massage, exercise, TENS machine for period pain?

When the uterine muscle cramps, it constricts blood flow, resulting in hypoxic (oxygen-deprived) tissue, which in turn causes further pain. 

Heat therapy

There is strong evidence for heat therapy, which is, for some people, just as effective at reducing period pain as NSAIDs.

A hot water bottle, heat pack or adhesive wraps applied to the lower abdomen work by increasing blood and oxygen flow and relaxing uterine muscles. 

Self massage

Self-massage helps relax the uterine muscle, thereby increasing oxygen delivery to cramped, hypoxic tissue. Gentle abdominal massage may disrupt this cycle. 

Heat and self-massage can be used alongside medication and supplements, and have no side effects. 

TENS machine

TENS (transcutaneous electrical nerve stimulation) machines are another option, especially for those who can’t tolerate medication, though the units are not as robust as NSAIDs when put head-to-head. 

Exercise

Exercising regularly (not just during menstruation) has shown to be helpful in preventing or reducing period pain. The specific mechanism is not known, but it’s likely multifaceted (endorphins, improving blood flow, and reducing prostaglandins). 

Exercise doesn’t have to be vigorous to help reduce period pain, with walking, swimming and yoga all gentle ways to get moving. Pelvic stretching can also help by improving blood flow and relaxing muscles. 

Pain is not something to simply ‘put up with’

Women and people getting periods have been told for aeons that their pain doesn’t matter or that it’s ‘just part of being a woman’. Challenging these old ideas begins with how we talk about pain and our expectations of pain relief.

One of the most persistent myths is that ‘severe period pain is normal’. It’s not. Cramping is common, but severe pain that makes someone feel so unwell that they require time off work or school or strong medication is not normal and needs to be treated as a medical concern. 

We wouldn’t expect anyone to endure equivalent amounts of pain for any other reason. Women tolerating moderate to severe pain – and everyone around them allowing it – means delayed diagnosis and treatment of conditions such as endometriosis (which already takes an average of seven years).

It can also mean the use of potentially inappropriate or inadequate pain relief measures. Or worse, no pain relief measures being taken. 

Severe pain deserves investigation and treatment. Normalise the conversation and make clear that period pain does not have to be tolerated. Ever. There are options. The goal is to identify and treat the root cause while providing adequate pain relief in the moment. 

Period pain red flags

You should see your GP when: 

1. Pain patterns resemble secondary amenorrhea (starts later in life after pain-free periods, worsens over time, starts before menstruation and continues after bleeding stops, or pain that doesn’t respond to NSAIDs adequately). 
2. Symptom profile expands (heavy bleeding, large clots, painful sex, painful bowel movements or urination, abnormal vaginal discharge, bleeding between periods). 
3. Pain impairs life (e.g., time off work, school, or caring activities; disruption to normal daily life; or a significant impact on quality of life despite OTC management). 
4. Symptoms indicative of another condition (pelvic pain between periods, infertility, irregular periods, excess hair growth, acne).
5. You are trying to stop your periods by using regular emergency contraception

Talking to the right people

Periods are still taboo in many cultures, and deeply uncomfortable for many people to talk about. You shouldn’t have to put up with a level of pain that interferes with your life, nor should you feel like you have to beg to be taken seriously by your healthcare providers.

The first step is to discuss your pain with an experienced healthcare provider and get any further investigations that you need. Ruling out more serious conditions is important.

There are many effective treatments for acute symptom management and for reducing period pain severity over time, including natural and pharmacological options and practical strategies. If your case needs escalating, advocate for yourself.

Related Posts

• Understanding and treating period pain
• Interstitial cystitis
• Treating endometriosis

References

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