Is It Normal Period Pain or Endometriosis?

Normal period pain or endometriosisPeriod pain or dysmenorrhea should be mild and respond to simple treatments like ibuprofen, zinc, or a dairy-free diet. If period pain does not respond to simple treatments, it could be endometriosis or adenomyosis.

Debilitating period pain is never normal.

Normal period pain versus endometriosis

Normal period pain (primary dysmenorrhea) is mild cramping in your lower pelvis or back. It occurs during the first day or two of flow and improves with ibuprofen. It doesn’t interfere with your daily activities.

Normal period pain is caused by the release of prostaglandins and usually improves with age.

Severe period pain (secondary dysmenorrhea) is throbbing, burning, searing, or stabbing pain that occurs during the flow and/or between periods. It doesn’t improve with ibuprofen and can be so bad that you vomit or miss school or work.

Severe period pain is caused by an underlying medical condition such as endometriosis or adenomyosis or pelvic floor dysfunction. It tends to worsen with age.

👉 Tip: Pain is not a symptom of PCOS.

How to treat normal period pain

Here are some simple nutritional strategies for normal period pain:

Dairy-free diet. By avoiding normal cow’s dairy, you can avoid the inflammatory protein A1 casein, thereby reducing inflammation, histamine, and period pain.

Magnesium. Taken daily, magnesium reduces menstrual cramps by reducing prostaglandins and relaxing the smooth muscle of the uterus.

Zinc reduces prostaglandins and improves blood circulation to the uterus. It did well in a 2015 clinical trial for the period pain of teenage girls. I usually prescribe 30 mg of daily zinc (taken with food or it can cause nausea).

Turmeric. Taken daily, turmeric or curcumin can reduce the prostaglandins and histamine that cause normal period pain. Turmeric can also lighten periods.

Give yourself three months with the normal period pain treatments. If your pain doens’t improve, ask yourself and your doctor: “Is something else going on?

Do you have endometriosis?

Endometriosis affects one in ten women, and more than just painful periods. It’s actually a whole-body inflammatory disease associated with significant immune dysfunction.

Pain is the main symptom of endometriosis, but it’s not the only symptom. Other symptoms of endometriosis include bleeding between periods, pain with sex, and an array of digestive and bladder problems. For example, one of my patients suffered recurring bladder pain and was given multiple courses of antibiotics that didn’t help. She finally asked her gynecologist: “Could this be endometriosis?” On further investigation, it was discovered that yes, she did have endometriosis lesions on her bladder and urethra, and they were the cause of her bladder problems.

This kind of story is not uncommon. Endometriosis can take ten years to diagnose. Of all the teens who report chronic pelvic pain, 70 percent go on to be diagnosed with endometriosis.

Don’t let that happen to you. Don’t suffer a decade of crippling pain being told it’s “just period pain”, and there’s nothing you can do. Watch the film Endo What? and speak to your doctor. Tell her how many pain-killers you take. Tell her the pain is so bad you miss work. Ask to be referred to a gynecologist to discuss the possibility of endometriosis.

👉 Tip: Your doctor may be able to order a new type of ultrasound investigation to try to detect endometriosis.

Until we have a non-invasive test, laparoscopic or keyhole surgery is the only way to definitively diagnose and treat endometriosis. Early excision surgery is not a cure but can sometimes provide long-term relief. 

For natural treatment ideas, see Immune treatment for endometriosis.

Dr Lara Briden

64 thoughts on “Is It Normal Period Pain or Endometriosis?”

  1. Hello Dr. Briden,
    What are your thoughts about ginger for period pain? Usually, most naturopaths tend to praise it a lot, but you do not seem to mention it on your blog on in your books. How come?

  2. That’s great information! You have put lots of efforts into preparing this wonderful material! It helps lots of people! Useful information. I am very happy to read this. Thanks for giving us this useful information.

  3. Hi Dr. Briden,
    Thank you for another article! About how long does zinc take to have positive results for period pain? I’m 33 and have had debilitating period pain and feel very unwell from ovulation through the third day of my period for the past nine months. I didn’t have a period for a year prior from what I think may have been not eating enough carbs. I eat potatoes and rice with every meal now and I am dairy free and gluten free. I’m taking magnesium, black currant seed oil, and omega 3 and just started iodine and zinc this last week, should I wait to add turmeric?

    Thank you for your time and help!!

  4. Hi Lara,
    Severe dysmenorrhea sufferer currently on desogestrel for about 8 months (feeling extremely heavy legs and varicose rising ever since).
    I tried the supplements you suggest in the past, couldn’t really stick to gluten free (got really constipated), no improvement.
    I’d like to know what are the doses and preferred formats for magnesium, zinc and turmeric as I feel like I need to stop this contraceptive soon and see if I can get a hold of the pain, which only improves with dexketoprofen 25mg every 4-5 hours for the first three days of period…

    Thank you

  5. I bought your book 2 years ago and it helped me so much. I recently was blessed with having a baby in sept 2020. I now have intense period like cramping before and days after the period. I’ve had 2 postpartum periods . The first l period, I had cramps almost as bad as labor. This second one, just intense cramping for days after. I don’t even know where to start with this. Is this normal postpartum? My OB says nothing is wrong

  6. Hi LizB. I recently had excision surgery for suspected endometriosis and a hysterectomy for suspected adenomyosis. Both were confirmed by pathology after surgery. A website that I found really helpful in discerning endo vs adeno symptoms was General symptoms of adenomyosis can be painful menstrual cramps that radiate down upper thighs and lower back, heavy bleeding, and abdominal heaviness and/or bloating. Just like endometriosis, adenomyosis does not typically show up on imaging, and the only definitive cure is a hysterectomy; endometrial ablation typically makes it worse. Dr Briden’s recommendations kept me somewhat comfortable until surgery, but I knew I needed surgery when my quality of life was really suffering. The last thing that I will say is that there are few surgeons with the skills to identify all types/colors of endo lesions and remove them. It is not unusual for a woman to have surgery with a general OBGYN, be told that she doesn’t have endometriosis, and then have it found by a surgeon who specializes in endometriosis.

  7. Hi Dr Lara. I love your book and online posts! I’ve just had a laparoscopy for severe period pain and they’ve ruled out endometriosis but nobody mentioned adenomyosis – how do you know if you have this and how do you treat it please? Also this article mentions zinc. A recent blood test showed I am zinc deficient. I’m coeliac and often low in various nutrients. Many thanks for any advice. All the best and Merry Christmas. Liz.

  8. Hi Lara, Omega 3 was magic for my severe menstrual pain. (paleo diet also helped – no sugar, dairy and gluten free) however prior to eating a paleo diet I was eating dairy and while continuing to eat it, I added omega 3 EPA DHA at 2400mg a day. Within a month I went from severe cramps and vomiting, to a little pain that one nurafen warded off. I found this study and this one I did not have any other gynae issue like endometriosis, just severe period pain. Interestingly it got progressively worse when I ate a mainly vegetarian diet, and stopped eating fish for about 2 years.

  9. Hi Dr.Lara,
    I was recently in introduced to your site. I am going through all your articles one by one. But my main underlying problem is Endometriosis and adenomyosis. I was diagnosed with these two in 2013 March. I am on Novelon on and off. I underwent keyhole surgery on my left side to remove chocolate cysts on my left ovary and an open surgery to remove the same from my right ovary in 2015. The pain is started to occur now again and I was put on Novelon for 3 cycles. I also have hydrosalpinx in my right tube. I have to check the natural treatments on your blog and try to incorporate the same. Thank you for this Dr.Lara.

  10. Hi Lara,

    Thanks a lot for all this great information.

    I am a bit confused about whether my period pain is likely to be endometriosis based on the information in your book and in this blog: my pain only happens on the first day/hours of the period (when the period is arriving). It goes away completely when I take a normal amount of painkillers (250-500 mg paracetamol or naproxen). However, if I don’t take them in time the pain is really bad (laying on the floor folded) and I feel nauseous and my stool is affected: I always need to go to the toilet then and this is painful/causing more cramps.

    I don’t consume cow milk products for years already, and I have recently also stopped gluten, which has improved my stool. I do have an iron deficiency (working on that) and I have an issue with histamine (I am taking extra B6 already, this helps but in general I don’t feel like the source of the histamine problem is gone).

    I would be very happy to receive your feedback on my situation 🙂

    • Maybe I should add this also: I see that you recommend curcumin or turmeric as a remedy against period pain. I have tried to take this a few times, however this is giving me constipation, while I normally don’t have issues with that.

  11. Since reading your book I’ve been confused on what bad oils are. I eat coconut, avocado and olive oil. Is peanut oil a vegetable oil? When I research oils it seems to be a black pit of for whatever opinion there is on the internet regarding oils – there is always the opposite opinion. Can you tell me where to look for good oil information?

    • Most vegetable oils are inflammatory because they’re too high in omega 6. Olive oil, avocado, and coconut oil are the exceptions.
      So, no, peanut oil is not a good choice.

  12. I have read your book cover to cover multiple times now and haven’t found the answer to this specific question so I was hoping you could possibly help.

    Do you know the root cause or have any suggestions to fix extreme unbearable pain that I get during exercise when I’m on my period. I don’t get much pain otherwise, but as soon as my heart rate goes up I end up on the floor in pain for 15-20 mins before it goes away.

    Besides that my cycle is regular I do get some bloating but that’s it.

    I also already supplement with magnesium and zinc as noted in this article and have been for about 6 months

    Thanks so much for your help!

  13. Hello Lara!! I’ve applied A LOT of concepts in your book and have also done other research and have to ask…what are our thoughts on red raspberry leaf for menstrual problems/pain?

  14. Hi Lara. What about period pain that is from scar tissue on the uterus? I had a hysteroscopy b/c of suspected fibroids but the doctor said the inside of my uterus was covered in scar tissue. We are thinking it is from either cryosurgery or an abortion, both procedures I had years ago. I have tried everything mentioned above and nothing has really helped. I have such bad pain and bleeding that I miss work, take handfuls of advil and my ferritin is at 8. Hormonal birth control makes me depressed. Considering a hysterectomy. Just wondered if you had addressed this particular cause of pain and heavy bleeding.

    • That is a tricky one. It’s probably still worth trying the things I suggest in this article (dairy-free, zinc, turmeric). But if that doesn’t work after 3 months, then you might have to speak to your doctor about Mirena IUD or a surgical option.

    • yes, endometriosis can improve with the natural drop in estrogen that occurs with menopause. But estrogen replacement therapy can keep the disease going.

  15. Hi Lara,
    thankyou so much for this post and your book! I really cant tell you how much your book transformed my period health.

    I have a question regarding the tumeric extract… is it enough to have organic tumeric powder every day, say in smoothies or cooking? Or how about compared to the bioceuticles capsuel form?
    Ive heard the body doesnt efficiently absorb tumeric so is the extract a better option/where do you get it?

    thanks 🙂

    • I hope Dr. Briden will address this, b/c there is so much (mis)information out there regarding turmeric and curcumin; pill v. powder form; with or without pepper/piperine… Why can’t we just use the much cheaper powder version instead of spending tons of money on the supplement form and then trying to decipher which one to buy and read the strange dosing on the various labels, etc. etc. It’s so confusing and in the end you wonder if most of these companies are just out to make a buck on the latest health craze. It’s like hit and/or miss when finally selecting one to try and see if it works.

  16. Dear Lara,
    Why do some sources say NAC, Milk Thistle, Schisandra are good for liver health and others say it can be problematic for liver health? Which is true?

  17. Hi Lara,

    My latest blood work results are as follows:

    DHEAS 420 (normal range 35-256);
    Testosterone 37.5 (normal range <57.7);
    Progesterone <0.22 (postmenopausal <0.22);
    Estradiol <16.3 (postmenopausal <55);

    TSH 0.94 and 0.89 after one week (normal range 0.35-5);
    T4 free 17 and 18 after one week (normal range 12-22);
    T3 free 3.7 and 3.8 after one week (normal range 2.6-5.7).

    I am a 46 year old female. My main symptoms are hair loss, absence of periods and 15-20 lb of excess belly fat which is hard to lose.

    I would appreciate any advice and suggestions you can give me.

    Thank you very much.


      • Thank you for your reply, Lara.

        My fasting glucose level was 88.3 mg/dL. My ferritin level is normal. I don’t eat processed foods, dairy, sugar or gluten. I supplement with iodine, zinc, cod liver oil and magnesium. Do you think that elevated DHEAS can be the problem?


  18. Can you combine peony&licorice with turmeric (curcuma) when you have a combination of endometriosis and PCOS? I started to wonder because turmeric seems to have aromatase inhibitory properties, while peony&licorice encourage the conversion of testosterone to estradiol by stimulating aromatase activity.

    Also, can you combine peony&licorice with bioidentical progesterone? Do you have a general advise which supplements work well when you are suffering from both endometriosis and PCOS?

    Thanks for your help.

    • Just to make clear: I guess adressing inflammation will be benefical for both conditions, but I’m not sure about supplements/herbs working on hormonal imbalances. Working on lowering/balancing estrogen is probably beneficial for endometriosis, but at the same time increasing testerone excess effects and worsens PCOS?

      Thanks again.

    • Turmeric is only mildly aromatase-inhibiting. I don’t think it would interfere with the action of peony and licorice.
      Depending which type of PCOS you have, a general anti-inflammatory approach should help both conditions.

  19. Hi Lara,

    Thanks for your post. I eat almost completely dairy/gluten free and I take selenium, magnesium and zinc. I used to take vitex but have recently stopped because I read it is not good to take it longer than 6-8 months. I have been diagnosed with PCOS, however, I am thin, not insulin resistant, and do not have many of the typical symptoms. I have symptoms of increased androgens but my testosterone was only slightly elevated. I just begged my doctor for an ultrasound as my cramps every month make me unable to function — I overdose on ibuprofen every month to avoid going to the hospital. Its bad. Could this be caused by PCOS or is more likely to be endometriosis?

  20. Hi Lara!
    I suffer from severe cramps on the first day of my period, despite eating no dairy or gluten and a generally anti-inflammatory autoimmune diet (I have Hashimoto’s) and taking magnesium. I used to also suffer from painful IBS while the cramps were going on, and, for a number of years after eliminating gluten/dairy, that symptom went away and my cramps lessened, though were still bad enough to need ibuprofen.

    However, the past few years, my periods have gotten heavier (I’m 39), in the form of flooding for just a couple of hours on day two or three and, this year, I started having more severe pain again (to the point of needing 800 mg of ibuprofen to make a dent in the pain), as well as IBS. I’ve been able to reduce my ibuprofen intake back down to normal doses by starting serrapeptase, high dose curcumin, and Xiao Yiao Wan the week before my period, but the pain never completely goes away.

    Could this be endometriosis? I don’t have any symptoms anywhere else, nor during any other time of the month, other than that first day of my period. Or could it be related to my Hashimoto’s?

  21. Dr. Lara,

    Is the heart disease/high blood pressure effect of Licorice inevitable? Just wondering if everyone taking it will (is it retain or lose?) too much potassium and how you would use it. I wanted to use it for my PCOS. Can I take it with Saw Palmetto? Is Licorice tea safer than pills? Thank you!

    • Licorice elevates blood pressure to some degree in most people. It depends on the dose and how long you take it.

  22. Can you have endometriosis if you don’t have bad period pain? I just have cramping on the first day of my period that goes away with tylenol.

    • Yes, you can have endometriosis without having period pain. But there would usually be other symptoms like bladder or digestive problems or pain with sex. In your case, you have not mentioned anything that would suggest endometriosis.

  23. Hi Lara, thanks for this helpful post! Can you say what are your thoughts on a possible link between the pill and endometriosis? Do you have suspicions that the pill, especially the higher estrogen dose, might be responsible for causing endometriosis in some people?

    • Hi Donna,

      I had surgery in July 2016 to diagnose & remove endometriosis lesions at a certified endometriosis center ( I’m from Germany, we do have spezialized centers at hospitals here focusing on endometriosis). I had been taken high-estrogen dose pills (30 µg ethinylestradiol) for 10 years to reduce the pain during my periods. The doctors told me that in some women they have noticed that it could have worsend the endometriosis as the estrogen is promoting growth of the lesions. However, I don’t think it’s the cause for endometriosis. The doctors recommend gestagen-pills (e.g. Visanne) after surgery to try to prevent reoccurence of endometriosis.

      I have stopped any kind of pill after surgery and am currently fine on bio-identical progesterone capsules (taken vaginally), zink, selen, magnesium, optimized vitamin D levels. I had a mild to moderate endometriosis phenotype (ASRM II) with several small lesions in the peritoneum, bladder and two deeper lesions at my left fallopian tube. Unfortunately, no pain does not mean that lesions are not coming back, so although I’m currently happy about my treatment it could well be that new lesions are growing.

      I hope I could help,
      kind regards,

  24. Yes, I have spoken with several doctors and always receive the same Western advice from doctors: hormones or surgery. Neither of which I will agree to and which is how I found you, in search of natural cures. I am so strict in my diet much to the grief of those around me. I have had some relief with TCM and acupuncture but can’t always afford it. I just wish there was a simple plan as there is so much alternative information online and how to know which ones truly work and which ones are either a waste of money or just worked for someone else. Also, how many different combinations of different herbs, supplements et. al. can one put in their body and hope for results. I will try more religiously the turmeric (I only drink the powdered spice version now) and berberine and hope these in combination with my diet, mag, and zinc will finally work. I just will hope we can receive help someday soon that really works.

      • No, because what I have heard and also just re-read in your book is that surgery is only temporary and needs supplemental hormone treatment to last… If it were that surgery could work without the additional aid of hormones, I would more likely consider it, but if you still need hormones it seems pointless.

        • Actually, what I say in my book is that endometriosis often grows back without further treatment. And by “further treatment”, I mean with hormonal suppression and/or natural treatment. With my own patients, I often encourage patients to undergo skilled surgery and then follow it up with natural treatment to prevent recurrence.

          And in this post, I say: “Even when surgery isn’t a cure, it significantly reduces pain and inflammation, and can give you an opportunity to find other pharmaceutical and/or natural treatments.”

          • 🙂 Nina, it’s my mistake for not communicating more effectively. I do think that surgery can be helpful for some, and I now see I might not have made that as clear as I should have. That’s one of the reasons I wrote this post.

      • Dr. Briden, i hope you’ll answer this question out of context but a month later (since I wrote this last question) and i’m still in pain again. i am 48.3 and considering to go back on Lutera since I used it previously for endo with results but some side effects. My pain is now so invasive in my life that I may go back on it in spite of side effects and given that I’m almost 50 so hopefully done with all this soon. I am hoping for a year or two it wouldn’t be that bad to go back on the pill. Please reply. I value your opinion on this matter as I have no where else to turn. Natural isn’t working and surgery won’t be an option for me. Thank you in advance.

          • Thank you so much for your honesty, Dr. Briden. I am going to give my natural methods a few more months (or one) and then I will take the leap back to the dreaded pill. Thank you again. I thought I was going insane to think that.

          • Just to re-summarise. The most effective natural treatments for endometriosis are (in descending order of importance): strictly dairy-free (including yogurt, cheese etc, but butter is ok), strictly gluten-free, zinc, high-dose turmeric extract.

  25. my pain is so bad. i have given up wheat and dairy, and take magnesium and zinc. I guess i’ll try the turmeric and berberine also. I keep to a strictly anti-inflammatory diet. i keep hoping for new information that really works. i am so frustrated. i can’t work as my pain, headaches, constipation are so bad i lose days of my life. i also have pain after my period with digestion. it’s so painful. i just want something to work.


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