Severe period cramps: what actually helps, and when pain is a signal

If you are in pain right now, the short version is this. Take an NSAID such as ibuprofen or naproxen if you can safely use one, and take it now rather than waiting for the pain to peak. Put covered heat on your lower abdomen or back. Get into whatever position eases the pull, often lying on your side with knees drawn up. Everything else in this article is detail.

Most cramps respond to that combination within an hour or two. The NHS says period pain usually lasts up to three days, is worst at the start, and may spread to your back and thighs. That is ordinary, even when it is miserable.

What is not ordinary is pain that keeps stopping your day, barely moves when you take painkillers properly, or arrives with bowel or bladder symptoms. Those patterns are not a sign you are failing to cope. They are a reason to be assessed, and this article explains why and what to bring to that appointment.

A woman sitting on a bed with both hands pressed to her lower abdomen. Photo by Andrea Piacquadio on Pexels.

The order that works: painkiller first, then heat, then position

Cramps are driven by prostaglandins, the chemicals that make the uterus contract. The American College of Obstetricians and Gynecologists (ACOG) explains that prostaglandin levels are highest at the start of bleeding, which is why pain usually eases after the first couple of days. NSAIDs work by blocking prostaglandin production, so they do most good before levels have climbed.

That gives you a practical sequence rather than a list of options:

Take the NSAID early, at the first sign of bleeding or the first twinge, and keep to the dose on the packet. ACOG's advice is that this timing matters more than which NSAID you choose.
Add heat straight away, because it acts on the muscle rather than the chemistry, and it costs nothing to combine.
Change position rather than lying rigid. Side-lying with knees bent, or on your back with a pillow under the knees, takes strain off the lower abdomen. There is little formal evidence here; it is simply low-risk.
Move gently if you can. A short walk will not fix a severe cramp, but stiffness tends to make it worse.

If you already take an NSAID and it does not touch the pain, the answer is not more tablets. Note it, and read the section on when pain is a signal.

How much does each option actually help?

Most advice on cramps presents every remedy as equally proven. The evidence is not equal, and it is worth knowing which is which.

Option	What the evidence says	Certainty
NSAIDs	Cochrane's 2015 review of 80 trials (5,820 women) found NSAIDs clearly better than placebo. Roughly 45 to 53 per cent achieved moderate or excellent relief, against 18 per cent on placebo.	Low quality overall, but a large and consistent effect
Heat	A 2018 systematic review found six randomised trials suggesting benefit, including three showing heat pads helped compared with unheated placebo.	Small trials; authors called for rigorous studies
TENS	Cochrane's 2024 review of 20 trials (585 women) found both high- and low-frequency TENS may reduce pain compared with placebo or nothing.	Low to very low
Regular exercise	Cochrane's 2019 review found exercise roughly three times a week may reduce pain intensity, from 12 trials. It was done across the month, not during the period.	Low to very low

Cochrane's NSAID review found no good evidence that one NSAID is safer or more effective than another, so if ibuprofen has not helped, switching to naproxen is a reasonable trial but not a guaranteed upgrade. NSAIDs also appeared to beat paracetamol, from three small trials, and they cause side effects, mainly indigestion, headache and drowsiness, in a small extra proportion of people: 11 to 14 per cent versus 10 per cent on placebo.

The Cochrane exercise review is often misread. The trials had women exercise regularly through the month, around 45 to 60 minutes at least three times a week, and some asked them not to exercise during the period itself. It is evidence for a habit, not for pushing through a bad day.

Who should not take NSAIDs

ACOG is direct that NSAIDs are not for everyone. People with bleeding disorders, asthma, an aspirin allergy, liver damage, stomach disorders or ulcers may need to avoid them. A pharmacist can check what you already take in about two minutes, and most people never ask.

NICE's Clinical Knowledge Summary on dysmenorrhoea sets out the fallback: NSAIDs first-line unless contraindicated, with paracetamol used instead if NSAIDs are unsuitable, or alongside them if an NSAID alone is not enough. It also lists heat and TENS as non-drug measures, and hormonal contraception as an option for people who do not want to conceive, since it thins the lining and reduces prostaglandin production.

Using heat without burning yourself

Heat is the remedy people reach for most and the one that causes the most avoidable harm: scalds from a burst or leaking hot-water bottle, and a mottled brown skin pattern from months of resting heat on the same patch of skin.

Fill with hot, not boiling, water. Boiling water perishes the rubber and makes any leak a scald. Fill to two-thirds at most.
Always use a cover or wrap the bottle in a towel. Never place it directly against skin.
Do not lie on it or fall asleep with it. Pressure plus heat is how most bottle burns happen.
Replace old bottles. Cracks, a chalky surface or a stiff neck mean it is done.
Electric pads and wheat bags need the same rules: fabric between you and the heat, and a timer.

If you do burn yourself, the NHS burns and scalds guidance is to cool the area under cool or lukewarm running water for 20 minutes, cover loosely with cling film, and seek medical help for anything larger than your hand, on the face or genitals, or that blisters badly.

The slower problem has a name: erythema ab igne, which DermNet describes as a net-like reddish-brown discolouration caused by repeated exposure to heat below burning temperature, classically from hot-water bottles or heat pads used on the same site. It often fades if the heat stops, but not always. If you see a lace-like pattern where the bottle usually sits, move it or stop.

When cramps are a signal rather than a symptom

Most period pain is primary dysmenorrhoea: painful contractions with nothing else behind them. ACOG lists the causes of secondary dysmenorrhoea, pain with a condition behind it, as endometriosis, fibroids, adenomyosis and pelvic inflammatory disease among others. The first responds to the steps above; the second often does not, at least not for long.

The NHS period pain page gives an urgent threshold and a routine one. Ask for an urgent appointment if your pain is severe or worse than usual and painkillers have not helped. See a GP routinely if your periods have become more painful, heavier or irregular; if pain stops you doing normal activities; if you have pain during sex, when you pee or when you poo; if you bleed between periods; or if you notice changes in bowel or bladder habit, abdominal swelling, appetite change or unexplained weight loss.

NICE's endometriosis guideline (NG73) is more specific about the pattern that should prompt suspicion: period-related pain that affects daily activities or quality of life, deep pain during or after sex, period-related or cyclical bowel or bladder symptoms, or infertility alongside any of these. Two points from that guideline are worth holding onto. A normal examination or a normal ultrasound does not rule endometriosis out. And the guideline was written partly because diagnosis is often delayed, with symptoms dismissed as normal along the way.

Pattern	What it suggests	What to do
Pain worst on days one to two, eases with an NSAID, gone by day three	Ordinary primary dysmenorrhoea	Keep using what works; no action needed
Pain severe or worse than usual and painkillers have not helped	NHS urgent-appointment threshold	Contact a GP or NHS 111 the same day
Pain that regularly stops you working or leaving the house	NICE says this warrants assessment	Book a routine GP appointment; bring records
Cramping with pain on peeing or pooing, or cyclical bowel or bladder changes	Possible endometriosis or other secondary cause	Book a GP appointment; mention the cycle link explicitly
Pain that has clearly worsened over months or years, or outlasts the bleeding	NHS lists worsening pain as a reason to see a GP	Book a GP appointment

Pain that needs you to plan your life around it is, by NICE's definition, pain that affects daily activities. That alone is enough to ask.

Turning "it's always been bad" into something a doctor can read

The hardest part of these appointments is that severe pain is easy to normalise, both by the person having it and by the person hearing about it. "Bad cramps" gets a shrug. "Eight out of ten on days one and two for the last six cycles, ibuprofen brings it to six, missed work twice" gets a referral.

Scoring pain does that translation. Use a 0 to 10 scale, 0 for none and 10 for the worst you can imagine, and score once a day during the period. Consistency matters more than precision. Alongside the score, three things make a record useful:

What you took and when, and whether it helped. NSAID-resistant pain is a clinical finding, but only if it is written down.
What it stopped you doing. Missed work, cancelled plans, time in bed. NICE's threshold is about function, not about the number.
What came with it. Pain on peeing or pooing, pain with sex, bleeding between periods, bloating that tracks the cycle.

Flowy lets you log cramps as a symptom on any cycle day alongside flow and a free-text note, so a pain score and what you took can sit next to the date without a separate diary. That is a record, not a diagnosis. No app can tell you whether your pain is primary or secondary dysmenorrhoea, and a normal-looking pattern in an app does not rule anything out. What the record does is let you walk in with six cycles of numbers rather than a feeling that it has always been like this. Tracking your cycle without obsessing over it covers how little you actually need to record.

For the background on why cramps happen, the earlier article on period cramps and when pain needs attention covers it. If bowel or bladder symptoms are part of your picture, the guide to endometriosis symptoms worth tracking goes deeper.

Frequently asked questions

Is it safe to take ibuprofen before the pain starts?

ACOG specifically advises starting NSAIDs at the first sign of your period or the first sign of pain, so taking a dose when bleeding begins is the intended use, not jumping the gun. Stick to the packet dose and stop once the pain settles. If you need to take it for more than two or three days every cycle, mention that to a pharmacist or GP.

Ibuprofen does nothing for me. Should I just take more?

No. Cochrane found NSAIDs help roughly half of people reach good relief, which means they do not help everyone, and exceeding the dose raises the risk of stomach and kidney harm without adding much benefit. Trying a different NSAID such as naproxen is reasonable, but pain that consistently ignores a properly timed NSAID is one of the patterns the NHS says should be assessed.

Does a TENS machine work for period pain?

It may. Cochrane's 2024 review found TENS may reduce pain compared with placebo or no treatment, but the certainty is low because the trials were small. It is drug-free and side effects were mostly skin irritation from the pads, so it is a sensible thing to try if you cannot take NSAIDs, not a guaranteed fix.

The line to hold

Ordinary cramps respond to an early NSAID, covered heat and a change of position, and are largely over by day three. Use those steps freely. Pain that repeatedly stops your day, does not respond to painkillers taken properly, or arrives with bowel or bladder symptoms is a different thing, and the right response is a score in a record and an appointment, not another cycle of enduring it.