Ah, period pain. There’s nothing quite like it — and when it’s bad, it’s really, really bad.

I’ve had my period for over 20 years, and I’m still surprised almost every month by the intensity of my menstrual pain. Cramps, period pain — or primary dysmenorrhea if you want to get fancy — is incredibly common.

Period pain affects daily life in 20 percent of women.Latthe P, et al. (2012). Dysmenorrhea. https://www.aafp.org/afp/2012/0215/p386.html About 1 in 10 women have such severe pain during their menstrual cycles that they have to limit their activities one to three days every month. Institute for Quality and Efficiency in Health Care. (2016). Period pain: Overview. https://www.ncbi.nlm.nih.gov/books/NBK279324/

That’s one day a month (or more) that you have to write off completely just because your uterine lining decided to shed.

Unfortunately, there’s no foolproof way to get rid of period pain fast. But there are ways to reduce cramping, alleviate pain, and possibly stop cramps from getting bad in the first place.

“Period pain is often driven by prostaglandins, hormone-like chemicals that cause uterine contraction,” says Jolene Brighten, medical director at Rubus Health and author of “Beyond the Pill.”

Though it seems like the muscular contractions would cause the pain, it’s actually the prostaglandins that take you to cramp town. Typically, the more prostaglandins in your body, the worse you feel during your period.

Luckily, there are ways to minimize those body chemicals and reduce your pain, though they don’t always give you the fastest relief.

If you want to relieve pain naturally, there’s some bad news. The Institute for Quality and Efficiency in Health Care states that there are only two scientifically proven ways to relieve period pain: birth control pills and nonsteroidal anti-inflammatory drugs (NSAIDS), which includes ibuprofen. Institute for Quality and Efficiency in Health Care. (2016). Period pain: Overview. https://www.ncbi.nlm.nih.gov/books/NBK279324/

That doesn’t mean that these are the only options for pain relief — they just have the best scientific backing. Unfortunately, there’s very little research into cures for severe period pain, which could explain why there are so few medically endorsed solutions.

If you have consistent, severe pain, birth control may be able to alleviate the symptoms. Dmitrovic R, et al. (2012). Continuous compared with cyclic oral contraceptives for the treatment of primary dysmenorrhea: A randomized controlled trial. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3631421/ Obviously, it won’t help right this minute if you’re stuck on the couch with cramp pain, but the pill tends to lessen menstrual symptoms starting in the first month of use.

This doesn’t always work — I still had painful menstrual cramps and I was on birth control for years — but it’s worth asking your doctor about.

If you’re a ball of cramps, the best thing you can do is take some ibuprofen with a coffee chaser. Evidence suggests that 200 milligrams (mg) of ibuprofen plus 100 mg of caffeine (about a cup of coffee) was very effective in relieving acute pain. Derry S, et al. (2015). Single dose ibuprofen plus caffeine for acute postoperative pain in adults. https://www.cochrane.org/CD011509/SYMPT_single-dose-oral-ibuprofen-plus-caffeine-acute-postoperative-pain-adults

If you’re trying to combat cramps, make sure you take an NSAID, not just any pain reliever. You need the anti-inflammatory properties of ibuprofen or naproxen (Aleve) to feel better. If you take Tylenol, you might have less of a headache, but you’ll still have cramps.

If you’re sensitive to NSAIDs or just don’t like taking over-the-counter pills, you still have options for relief.

Heat pads

If you want to avoid medication completely, a heat treatment may be your best option.

Whether you use a hot water bottle, heating pad, or dip into a warm bath, the heat helps your muscles relax and eases pain. Laying down with something warm on your aching stomach or relaxing in the tub can also reduce your general stress.

Though there aren’t a lot of studies about why heated patches work, there’s no downside to doing something that feels nice and relaxing — especially during the worst of your period.

Exercise

“When I have cramps, I love going for a run,” said no one — probably ever. For most of us, exercise is last on the list of things to do when you have period pain — but, it can really help.

“Working out helps reduce the level of prostaglandins and regulate digestion,” says Elizabeth Trattner, licensed acupuncturist. Since prostaglandins cause much of the pain in the first place, anything that reduces prostaglandins will make you feel better. Plus, the workout releases endorphins in the body, which improves your mood.

Trattner says that doesn’t mean you head to a bootcamp class when you’re in extreme pain. Instead, she recommends adding exercise before your period to help alleviate cramps before they start. During your period (when you’re not in pain), try to take a walk or do some light activity, just to thwart those prostaglandins before they wreak havoc.

Magnesium

“In my clinical practice, I recommend women aim for 300 mg nightly of magnesium bysglicinate to help alleviate menstrual cramps,” says Brighten. She says that magnesium can be effective in lowering prostaglandins and reducing pain.

Unfortunately, you can’t just take magnesium and feel better in a few minutes. But a nightly dose often minimizes cramps over the course of your period.

Diet

My dream period diet is a complete cliché — nothing but pizza, chocolate, and ice cream for a full five days. Sadly, this is the worst way to eat if you want to alleviate period pain. Processed and fried foods are high in omega-6 fatty acids, which isn’t good.

“When our diet is high in omega-6s we create stronger prostaglandins,” says Brighten. “To counteract that, you should include anti-inflammatory omega-3 rich foods like salmon, sardines, walnuts and flaxseeds.” These help reduce inflammation, which in turn reduces those dreaded prostaglandins, which then reduces pain.

Trattner recommends keeping a healthy, fiber-rich diet for the last two weeks of your cycle. Sure, that means avoiding junk food when you’re craving it the most, but it can reduce the severity of cramping and pain once your period finally comes to town.

If you’ve tried baths, workouts, and fiber-filled foods and you need something a little more hardcore, you have a few slightly more unusual options to try.

TENS machine

Hooking your stomach up to a shock machine might not sound like fun, but that’s the basic principle behind a transcutaneous electrical nerve stimulation (TENS) machine. You stick some little pads to your stomach and the machine sends electrical impulses to the muscles. This reduces the amount of pain signals that get to the brain, which relieves pain.

It sounds a little scary, but it’s surprisingly mild. The National Health Service in the UK reports that there’s not enough evidence to show that the TENS machine provides pain relief, though a small study found that TENS alleviated cramping. Proctor M, et al. (2002). Transcutaneous electrical nerve stimulation for primary dysmenorrhea. DOI: 10.1002/14651858.CD002123

Livia, a product that claims to “switch off period pain,” is essentially a TENS unit. But, like many women’s products, it’s way more expensive! A Livia kit costs $149 while a TENS machine from Amazon only costs $27. Before you start shocking your abdomen, be sure to consult with your doctor.

CBD

There’s growing evidence that cannabidiol (CBD), the nonpsychoactive part of marijuana, is a powerful anti-inflammatory. Nagarkatti P, et al. (2010). Cannabinoids as novel anti-inflammatory drugs. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828614/ Studies of the drug have been sparse, so there’s not much scientific proof for CBD’s efficacy, however there are plenty of anecdotal reports that CBD works.

Whoopi Goldberg even has a line of medical cannabis products purposely designed to make periods less miserable, so at least that’s a fun fact you can bust out at your next trivia night.

So, the next time the Red Witch comes to visit, you’ll know to stock up on magnesium, ibuprofen, heat pads, healthy foods, and workout videos. Though none of these things can stop period pain completely, they can provide much needed relief from women’s best frenemy.