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Period Problems & Menopause (Women’s Health)

Cramps, PMS, heavy or irregular periods, and the changes of perimenopause and menopause are very common — but severe pain, heavy bleeding or symptoms that disrupt your life are not something you just have to put up with. Most can be treated, and a few warning signs need care right away.

Get emergency care (call 911 or go to the emergency room) if you have:

See a doctor promptly for any bleeding or spotting after menopause (after 12 months with no period). It is not normal, and although most causes are not serious, it can be an early sign of endometrial (uterine) cancer (Office on Women’s Health, NHS, National Cancer Institute); the FDA calls it a possible sign of an urgent problem (FDA).

Don’t wait for an acupuncture, massage, chiropractic or herbal appointment for any of these signs.

The common problems

Some period pain and heavy bleeding come from another condition, such as endometriosis, fibroids or ovarian cysts (Office on Women’s Health); see our endometriosis and cysts guides. Guides on pregnancy, osteoporosis, thyroid problems and fibrocystic breasts are planned.

What’s a “normal” cycle?

A cycle runs from the first day of one period to the first day of the next. Sources draw the lines a little differently: the Office on Women’s Health says the typical cycle is 28 days and periods are “regular” if they come every 24 to 38 days (Office on Women’s Health), while the NHS says it’s common for periods to come every 21 to 35 days, with a period lasting 2 to 7 days (NHS). Cycles are often irregular for a few years after periods start and again in perimenopause (Office on Women’s Health). Menopause is reached after 12 months in a row without a period, usually between 45 and 55 (Office on Women’s Health).

When to see a doctor or nurse

Severe pain or bleeding that makes you miss regular activities is not normal and can be treated (Office on Women’s Health).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Anti-inflammatory pain relievers (NSAIDs); hormonal birth control, including the hormonal IUD; SSRIs for PMDD; tranexamic acid and procedures for heavy bleeding; hormone therapy or FDA-approved nonhormone medicines for hot flashes; vaginal estrogen for dryness; pelvic floor physical therapy for leaks. Hormonal IUD: $0–$1,800 depending on insurance. Physical therapy with Medicare Part B: 20% of the Medicare-approved amount after the deductible. Other costs: cost estimate being researched. Strong evidence for many options. NSAIDs relieve period pain for many women but have side effects; hormone therapy is the most effective treatment for hot flashes, with benefits most likely to outweigh risks before age 60 or within 10 years of menopause.
Chiropractic Spinal manipulation has been tried for period pain. It has no established role for PMS, heavy or irregular periods, or menopause symptoms. Without insurance, about $90–$200 for a first visit and $55–$100 for follow-ups. A Cochrane review found no evidence that spinal manipulation works for painful periods. The Menopause Society does not recommend chiropractic care for hot flashes.
Acupuncture Fine needles (or finger pressure, acupressure) for period pain and menopausal hot flashes. About $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90. Mixed, low-quality evidence. It beats no treatment in some studies but generally does no better than sham (fake) acupuncture for hot flashes, and less well than hormone therapy.
Herbal medicine Black cohosh and soy for hot flashes; chasteberry for PMS. Evening primrose oil and dong quai are also promoted. Avoid compounded “bioidentical” hormones. Cost estimate being researched. Weak or inconsistent evidence. Black cohosh has rare reports of liver damage, chasteberry isn’t safe with hormone medicines, and dong quai may interact with warfarin.
Massage therapy Abdominal massage (sometimes with aromatherapy oils) for cramps; relaxation massage for PMS and menopause symptoms. One national chain: $125–$160 for 60 minutes (nonmember); prices vary by location. Small studies suggest short-term relief of period pain and of mood symptoms around menopause. It doesn’t treat heavy bleeding or the cause of pain.
MBHA Wellness Coach Cycle and symptom tracking, regular exercise, sleep habits, heat for cramps, less alcohol and caffeine, cooling tactics for hot flashes, bone-friendly food and weight-bearing exercise, Kegel exercises and mood support. MBHA coaching cost estimate being researched. Supports — never replaces — medical care. Exercise can ease PMS symptoms, and good records help your provider find the cause and the right treatment.

Approach 1 of 6

Conventional medicine (AMA)

Most of these problems are handled by a primary care provider or an obstetrician–gynecologist (ob-gyn). Treatment depends on the cause, so finding it comes first. We name medicine types, not doses.

Pain relievers (NSAIDs)

NSAIDs such as ibuprofen and naproxen lower prostaglandins, the chemicals that make the uterus cramp, and can be started when symptoms first appear or when your period starts (MedlinePlus). A Cochrane review of 80 trials found them very effective for period pain but with a real risk of side effects; no single NSAID was clearly best (Cochrane review, 2015). They may also lessen heavy bleeding (Office on Women’s Health). Don’t take them if you have ulcers or other stomach problems, bleeding problems, liver disease or an aspirin allergy (MedlinePlus).

Hormonal birth control

The pill, patch, ring and hormonal IUD can be used for painful periods (MedlinePlus); the pill, implant and injection thin the womb lining, making periods lighter and less painful (NHS). Hormonal birth control can also help control an irregular cycle (Office on Women’s Health). For PMS they may help physical symptoms but can worsen others (Office on Women’s Health).

SSRIs for PMDD

SSRI antidepressants are a treatment for PMDD; the FDA has approved three SSRIs and one birth control pill for it (Office on Women’s Health). A 2024 Cochrane review found SSRIs probably reduce premenstrual symptoms, probably more when taken all month, but increase side effects such as nausea, low energy and sleepiness (Cochrane review, 2024). Cognitive behavioral therapy (CBT) is another treatment option for PMS (NHS).

Heavy bleeding

Menopausal hormone therapy

Hormone therapy is the most effective treatment for hot flashes and night sweats (Menopause Society, 2022); it also relieves vaginal dryness and painful sex and helps prevent bone loss (Office on Women’s Health). With a uterus, you also need a progestogen to protect the uterine lining from cancer (Office on Women’s Health). Risks include blood clots, stroke, heart attack and certain cancers, depending on your age, health and the type and form of hormone (Office on Women’s Health); the NHS says hormone tablets can raise the risk of blood clots but patches, sprays and gels do not (NHS). It is usually not recommended with unexplained vaginal bleeding, hormone-receptor-positive breast cancer, liver disease, or a current or recent clot, stroke or heart attack (Office on Women’s Health).

For women under 60 or within 10 years of menopause without these problems, The Menopause Society says the benefits outweigh the risks for bothersome hot flashes and preventing bone loss; starting later is less favorable (Menopause Society, 2022). It should not be taken just to prevent heart disease (Office on Women’s Health).

2025–2026 label changes. In November 2025 the FDA began removing statements on heart disease, breast cancer and probable dementia from hormone therapy’s “boxed warning,” and in February 2026 it approved the first six updated labels (FDA). Heart disease and breast cancer risks are still described elsewhere in the label, and the endometrial cancer boxed warning remains on whole-body estrogen-only products (Office on Women’s Health). Older FDA and NIA pages advise the lowest dose for the shortest time (FDA, 2023, NIA); the Office on Women’s Health now says there is no single time limit, with regular reviews (Office on Women’s Health).

Nonhormone medicines for hot flashes

The FDA has approved three: a low-dose form of paroxetine, fezolinetant (Veozah) and elinzanetant (Lynkuet) (Office on Women’s Health); elinzanetant was approved in October 2025 (FDA). Fezolinetant acts on the brain’s temperature control; its label warns of liver injury and calls for blood tests (FDA), and it now carries an FDA warning about rare, serious liver injury (Office on Women’s Health). Other antidepressants and gabapentin are sometimes used off-label, and CBT and clinical hypnosis can make hot flashes less bothersome (Office on Women’s Health).

Vaginal estrogen and pelvic floor therapy

Vaginal estrogen (cream, tablet, insert or ring), vaginal DHEA and the pill ospemifene treat dryness and painful sex; moisturizers and water-based lubricants give temporary relief, and laser treatments are not recommended (Office on Women’s Health). Vaginal treatments give the rest of the body a lower hormone dose than a pill or patch (NIA); if you have had breast cancer, ask your cancer team first (Office on Women’s Health). For bladder leaks, pelvic floor muscle training can cure or improve symptoms (Cochrane review, 2018), often with a pelvic floor physical therapist (Office on Women’s Health).

What it costs

  • IUD: $0 to $1,800; many insurance plans and some government programs make it free or low cost (Planned Parenthood).
  • Physical therapy: with Medicare Part B, you pay 20% of the Medicare-approved amount after the deductible for medically necessary outpatient physical therapy (Medicare.gov). Cash prices: cost estimate being researched.
  • Visits, medicines, hormone therapy and procedures: cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic is a licensed profession whose care often involves spinal manipulation (NCCIH). Some chiropractors treat period pain on the idea that the spine affects nerves to the pelvis. The evidence is thin:

We found little research on chiropractic care for PMS or heavy or irregular periods. In the Cochrane review, side effects were no more common than with sham (Cochrane review, 2006). Ask about the chiropractor’s education and license (NCCIH).

What it costs

Without insurance, a first appointment commonly runs about $90–$200 and a follow-up visit about $55–$100 (The Pricer).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture and acupressure are often tried for painful periods and hot flashes, and the NHS lists acupuncture among complementary therapies for PMS, though it says there’s not much evidence they work (NHS). The research is large but mostly low quality.

Some people feel better with it, but it hasn’t been shown to beat a convincing placebo. Relatively few complications have been reported; the FDA requires sterile, single-use needles, and most states license acupuncturists (NCCIH).

What it costs

About $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90 (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb or supplement has clearly been shown to relieve menopause symptoms, and little is known about long-term safety (NCCIH); The Menopause Society does not recommend them for hot flashes (Menopause Society, 2023). We don’t list doses.

“Bioidentical” compounded hormones

Many products sold as “bioidentical hormones” are compounded drugs that are not FDA-approved, and the FDA has no evidence they are safe and effective or safer than approved hormone therapy (FDA). The FDA recommends FDA-approved hormone therapies, which are evaluated for safety and effectiveness (FDA).

Interactions

Tell every provider about supplements you take. St. John’s wort interacts with birth control pills and warfarin, and ginkgo can raise bleeding risk with blood thinners (NCCIH). A label may not match what’s in the bottle (NCCIH).

Approach 5 of 6

Massage therapy

Massage won’t fix heavy bleeding or the cause of pelvic pain, but small studies suggest it may ease some symptoms for a while.

These were small studies, so the results are tentative. Serious problems from massage are rare (NCCIH). Get sudden or severe pelvic pain checked by a doctor first.

What it costs

Prices vary by location. At one national chain, franchise price lists show about $125–$160 for a 60-minute massage for non-members and about $65–$90 for members, whose memberships run about $70–$90 a month (The Pricer). Tips are extra.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you build habits that ease cramps, PMS and menopause symptoms, alongside — never instead of — your medical care.

Another approach

Menopause: what to expect and options

Menopause is a normal part of aging, not a disease. The transition usually starts between 45 and 55, and symptoms can last two to eight years, though this varies a lot (NIA).

Many women don’t need treatment. If you do, options range from lifestyle steps to hormone therapy, nonhormone medicines, CBT and vaginal treatments (see above); review your plan with your doctor every year (NIA).

Another approach

PMS and PMDD

PMS means symptoms in the 5 days before a period, for at least three cycles in a row, that end within 4 days after it starts and keep you from some normal activities (Office on Women’s Health). Common ones are breast tenderness, bloating, headache, cravings, tiredness, irritability, anxiety and sadness (Office on Women’s Health).

PMDD is a severe form, with intense irritability, depression or anxiety in the week or two before a period (Office on Women’s Health); it can include despair and even thoughts of suicide (Office on Women’s Health). It can be treated (Office on Women’s Health).

About half of women who need relief from PMS also have another health problem with similar symptoms, most often depression or an anxiety disorder, which may get worse before or during a period (Office on Women’s Health). Exercise, healthy food, enough sleep and stress relief may ease symptoms, and prescription medicines may help if over-the-counter pain relievers don’t (Office on Women’s Health). Supplements such as vitamin B6, calcium and magnesium may help, but there’s not much evidence (NHS).

Another approach

When periods are heavy or irregular

Heavy periods can come from problems with ovulation, an underactive thyroid, fibroids, polyps, blood thinners, pregnancy problems such as miscarriage or ectopic pregnancy, bleeding disorders and obesity (Office on Women’s Health), and from endometriosis, adenomyosis or pelvic inflammatory disease; rarely, they can be a sign of womb (endometrial) cancer (NHS). For many women, heavy periods are the only sign of an inherited bleeding disorder (Office on Women’s Health).

Irregular periods are cycles shorter than 24 or longer than 38 days, or varying by more than 20 days (Office on Women’s Health). Common causes:

Treatment depends on the cause (Office on Women’s Health).

Another approach

Bladder leaks and vaginal infections

Bladder leaks affect twice as many women as men, because pregnancy, childbirth and menopause can weaken the pelvic floor; leaking is not a normal part of aging and can be treated (Office on Women’s Health). See our bladder problems guide.

Member stories

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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