What actually works for period pain: strong evidence for NSAIDs, weaker for exercise
Cochrane reviews rate anti-inflammatory painkillers a very effective treatment for menstrual cramps, roughly doubling the odds of good pain relief. Exercise helps too, but on lower-quality evidence.
For primary period pain — cramps with no underlying disease behind them — the treatment with the strongest evidence is the least glamorous one: non-steroidal anti-inflammatory drugs such as ibuprofen. A Cochrane review of 80 trials rated them "a very effective treatment," roughly doubling the odds of good pain relief compared with placebo [s1]. Exercise also appears to help, but the evidence behind it is weaker and of lower quality [s2].
That ordering matters because the wellness market tends to invert it, promoting supplements, teas and devices while treating the well-evidenced painkiller as an afterthought.
NSAIDs: the well-supported answer
The Cochrane review of anti-inflammatory drugs for dysmenorrhoea pooled 80 randomised controlled trials involving 5,820 women [s1]. Against placebo, NSAIDs produced substantially more pain relief, with an odds ratio of 4.37 (95% CI 3.76 to 5.09) [s1]. The reviewers translated that into plain terms: if 18% of women taking placebo achieve moderate or excellent pain relief, then between 45% and 53% of women taking NSAIDs will do so [s1].
NSAIDs also outperformed paracetamol (acetaminophen) for period pain, with an odds ratio of 1.89 (95% CI 1.05 to 3.43) [s1] — a distinction worth knowing, since the two are often treated as interchangeable. The overall verdict was that "NSAIDs appear to be a very effective treatment for dysmenorrhoea" [s1].
The evidence is not without caveats the review itself raises. The trials were graded low quality, largely because of poor reporting and small size, and 59% of them were commercially funded [s1] — the kind of provenance detail that belongs in any honest summary of a drug's evidence.
The trade-off: more side effects
The same review is clear that this effectiveness comes with a cost. NSAIDs were associated with more adverse effects than placebo overall (odds ratio 1.29, 95% CI 1.11 to 1.51), including more gastrointestinal effects (odds ratio 1.58) and more neurological effects such as headache and drowsiness (odds ratio 2.74) [s1]. In practical terms, the review estimated that if 10% of women on placebo experience side effects, 11% to 14% of those on NSAIDs will [s1]. That is a modest absolute increase, but it is the reason these drugs are not risk-free and why dose and duration are not trivial details.
Exercise: promising, but on weaker evidence
Exercise is the non-drug option with the best supporting data, though "best" here is relative. A separate Cochrane review of exercise for dysmenorrhoea included 12 trials with 854 women [s2]. Compared with no exercise, exercise reduced pain intensity, with a standardised mean difference of -1.86 — an effect the reviewers described as corresponding to about a 25 mm reduction on a 100 mm pain scale [s2].
A 25 mm drop is not trivial, but the finding was rated low-quality evidence, and the trials were small and varied in the type and intensity of exercise studied [s2]. The honest reading is that exercise plausibly helps and carries little downside, but the certainty behind it is far lower than for NSAIDs [s2].
What this leaves out, and what it settles
Neither review addresses secondary dysmenorrhoea — period pain caused by an underlying condition such as endometriosis — where the pain is a symptom of something that needs its own diagnosis and treatment, not just analgesia. Persistent, worsening or unusually severe period pain is a reason to be assessed rather than simply medicated.
For ordinary primary period pain, though, the evidence points to a clear hierarchy: NSAIDs are the best-supported treatment and beat paracetamol, at the cost of a modest rise in side effects; exercise is a reasonable, low-risk addition supported by weaker evidence [s1] [s2]. That is a more useful map than the usual noise, precisely because it says where the evidence is strong and where it is thin.
This article is informational and is not medical advice. Anyone with severe, worsening or persistent period pain, or questions about which pain reliever and dose is appropriate for them, should consult a clinician or pharmacist.
Sources
- Nonsteroidal anti-inflammatory drugs for dysmenorrhoea — Cochrane Database of Systematic Reviews, 2015-07-30
- Exercise for dysmenorrhoea — Cochrane Database of Systematic Reviews, 2019-09-20
Sources
- Nonsteroidal anti-inflammatory drugs for dysmenorrhoea — Cochrane Database of Systematic Reviews , July 30, 2015
- Exercise for dysmenorrhoea — Cochrane Database of Systematic Reviews , September 20, 2019
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