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Getting your period can already be a pain, but when you feel like tossing your cookies before your period even starts? Give a girl a break. The good news is there’s a list of usual suspects that can cause nausea before your period, and there’s a bunch of treatment options to kick queasiness to the curb.

For some women, the hormonal fluctuations associated with the second phase of their cycle can trigger a long list of uncomfortable and sometimes debilitating symptoms, including nausea.

But your sour stomach could also be caused by other issues that may or may not be related to your good ol’ Aunt Flo.

PMS 101

Premenstrual syndrome (PMS) hits around the second half of your menstrual cycle, after ovulation and 1 to 2 weeks before you start bleeding.

Fortunately, these symptoms tend to dissipate once your period starts, but that doesn’t make dealing with them a walk in the park. Experts believe hormonal fluctuations are the main reason so many women experience PMS.

The symptoms include:

As if the physical symptoms weren’t enough, there are also some emotional ones to contend with:

If you’re experiencing similar symptoms, but they’re severe and impacting your day-to-day life, you might want to ask your doctor about premenstrual dysphoric disorder (PMDD). It’s a severe, chronic form of PMS that can require treatment, lifestyle changes, or both.

Endometriosis

Endometriosis is a tissue disorder that can flare up around your period.

Before you bleed, your endometrium (the lining of your uterus) thickens. When your period starts, this lining breaks down and is shed through menstruation.

In women who have endometriosis, tissue similar to endometrium tissue also grows outside the uterus in places like the fallopian tubes and ovaries, but it can grow in other places in the body too.

Unlike the tissue in the uterus, the tissue in other places isn’t cleared out by period bleeding, so it just gets thicker. This expansion can cause a lot of pain, which in turn can cause nausea and vomiting. This is especially true if the tissue grows near your intestines.

Here are some other symptoms of endometriosis:

In sickness and in health

Even if nausea strikes before your period, that doesn’t mean it’s period-related. You could be up against a stomach bug or some kind of infection.

If you don’t usually get nauseated before your period, reach out to your doctor, especially if you have other symptoms, such as a fever.

In some cases, nausea can be a symptom of pelvic inflammatory disease (PID), which is a condition that affects the upper reproductive tract. PID most commonly happens when bacteria from a sexually transmitted infection like chlamydia or gonorrhea spread to other reproductive organs, but it can also occur with douching or after giving birth.

If your nausea is PID-related, you may also feel sick at times that aren’t close to your period. PID is most commonly treated with antibiotics.

Baby on board

If your pre-period nausea turns out to be notably period-free, you may actually be experiencing morning sickness. Despite the name, nausea and vomiting during pregnancy can happen at any time of day, and it usually strikes early on (before 9 weeks).

Feeling sick to your stomach can be the first sign of pregnancy, before a missed period. This kind of nausea tends to calm down after week 14, but some women deal with bouts of nausea for their whole pregnancy.

If you’re pregnant and experiencing severe nausea that affects your daily life, ask your doctor about any baby-safe treatments you can try.

When it comes to relief, both modern medicine and Mother Nature can offer assistance.

Medication

Depending on the underlying cause of your nausea, your doctor may suggest an over-the-counter medication or write you a prescription to treat this symptom.

No scrip necessary

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a go-to for handling period pain — no prescription required.

You probably know these medications by brand names like Advil and Motrin (ibuprofen) or Aleve (naproxen). NSAIDs work by decreasing the pesky prostaglandins that can cause cramping, which in turn can help with nausea.

Doctor’s orders

If your nausea is the result of PMS or PMDD, your doctor may prescribe a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI), which works by increasing the amount of the serotonin in your brain.

While SSRIs are typically used to treat depression and anxiety, for some women they can effectively treat period-related nausea with minimal side effects.

Birth control pills are another prescribed option that can help alleviate your pre-period queasiness. Designed to prevent pregnancy, oral contraceptives work by manipulating certain hormones in your body.

Some women rely on birth control pills to relieve other period-related woes, including:

  • PMS
  • PMDD
  • endometriosis
  • abnormal bleeding
  • painful periods
  • heavy periods

Natural remedies

Mother Nature has a variety of options when it comes to nausea relief:

  • Ginger. Pretty much the OG of natural nausea remedies, ginger can help regulate prostaglandins, offering a defense against both cramps and nausea. Some research suggests ginger can help reduce nausea and vomiting related to chemotherapy or pregnancy.
  • Cinnamon. Like ginger, cinnamon can put the kibosh on prostaglandins thanks to a compound called eugenol. In addition to helping with nausea, it can reduce menstrual pain and bleeding.
  • Fennel. This licorice-tasting root vegetable has anti-inflammatory properties that can alleviate period pain and nausea. Try sipping on fennel tea the next time your stomach turns sour. You can find fennel in capsule and tincture form as well.
  • Aromatherapy. A 2012 study found aromatherapy to be effective at treating post-operative nausea and vomiting. Participants in the study inhaled peppermint oil or saline vapor. Like ginger and cinnamon, peppermint can suppress prostaglandins. Peppermint tea may also offer relief.

However unpleasant it may be, if your nausea is tolerable, there’s probably no need to see a doctor. But if the nausea is bad enough that you’re having trouble going about your daily life, check in with your doc.

If you’re experiencing other symptoms like vomiting, diarrhea, severe stomach cramps, chills, or a fever, seek medical attention to rule out anything more serious than an impending period.

While premenstrual nausea can be uncomfortable and annoying, it’s usually nothing to worry about, and there are quite a few treatment options to choose from.

Only you know what’s normal for your body. If your nausea feels more aggressive than you’re used to, period or no period, talk to your doctor about what to do next.