Menstruation is a whole-body affair, TBH. It can affect your hydration levels, your mood, your poops, and some folks even experience nausea during period time. As common as your menstrual cycle symptoms may feel (considering you’ve likely been living with them for a while), what you need to remember is that, according to Sophia Yen, MD, MPH, co-founder and CEO of Pandia Health, it isn’t normal to suffer every month. With that in mind, she reminds folks with periods that there are ways to treat the various symptoms that arise and, perhaps more importantly, that there are crucial red flags to pay attention to if your period is interfering with your quality of life.

If you’re frequently seasick from your crimson tide (ahem, nauseous during your period), Dr. Yen and three other OB/GYNs break down what’s going on, what to do about it, and when to be concerned.

Why you might feel nauseous during your period

Unfortunately, there isn’t a one-size-fits-all answer to menstrual nausea causes because everyone is different. Out-of-the-ordinary menstrual cycle symptoms usually fall under the umbrella of dysmenorrhea, the term for abnormally painful periods, according to the Cleveland Clinic. Where it gets tricky is that while nausea is considered to be an out-of-the-ordinary period symptom, dysmenorrhea can be caused by other more serious disorders.

Dr. Yen says that most people who experience nausea on their period have prostaglandins to thank. Essentially, prostaglandins are hormone-like chemicals that initiate contractions which can, in turn, cause pain that people know as “cramps.”

“Before menstruation begins, the inner lining of the uterus starts to make prostaglandins,” says OB/GYN Gunvor Ekman-Ordeberg, co-founder of DeoDoc Intimate Skincare. “When the inner lining breaks down during menstruation, prostaglandins are released and cause an inflammatory process as well as uterus contraction and painful cramps.”

Bodily functions don’t happen in a vacuum, Dr. Yen explains; menstrual symptoms like period poops, for instance, are a result of your colon’s proximity to your uterus. The muscle contractions can loosen stool and trigger the gastrocolic reflex in the anus, she says. The same thing can be said for your nausea: Sometimes, prostaglandins affect other areas of the body, and when they impact the stomach, nausea is a common result.

According to a 2020 study published in the international journal Environmental Research and Public Health, researchers observed that people with increased prostaglandin levels experienced nausea during menstruation. According to board-certified OB/GYN Michael Krychman, MDCM, chief medical officer at HerMD, an increase in prostaglandins can also result in vomiting, diarrhea, and headaches.

Fluctuating levels of estrogen and progesterone can also cause nausea, says Alyssa Dweck, MD, a gynecologist and chief medical officer at Bonafide.

Another reason you may be feeling nauseous leading up to your period? It’s possible you may have endometriosis (which a doctor will be able to determine). “One underdiagnosed and under-recognized cause of period-related nausea may be endometriosis that is on or near the colon,” says Dr. Krychman. “Patients who have endometriosis in association with their gastrointestinal system may also have menstrual-related nausea.”

Who is most likely to experience nausea during period?

There’s no set-in-stone subset of people who will experience nausea during their menstrual cycle. That said, Dr. Ekman-Ordeberg, says that hormonal changes and nausea typically go hand in hand for younger and/or pre-pregnant menstruators. The reason? Your body changes after pregnancy.

“We know that nausea during menstruation is more common before women get pregnant,” she reveals. “The reason for this is not yet known, but there are studies that indicate that it is likely due to the fact that the uterus changes after a pregnancy and is used to more pressure.”

She also says there might be a genetic component involved. “Studies show that women with pain-related diseases are more prone to nausea during menstruation,” says Dr. Ekman-Ordeberg.

What gets rid of period nausea?

There are a few remedies for menstrual nausea that you can try.

1. Anti-inflammatories

Dr. Ekman-Ordeberg says that anti-inflammatory medication (like Midol Complete, $7) is the OTC solution of choice, as it will quell the inflammatory process and reduce pain . That said, Dr. Dweck advises lessening your dosage while your stomach is upset, as in some cases, ibuprofen can lead to further stomach discomfort.

2. Anti-nausea medications

In addition to period-specific OTC medication, Dr. Dweck says that typical nausea treatments (like Pepto-Bismol and Tums) work for menstrual-related nausea.

3. Herbal anti-inflammatories

There’s also the option to take a more natural approach with Dong Quai Extract, an herbal remedy used in traditional Chinese, Korean, and Japanese medicine to reduce inflammation. The time-honored ingredient can be found in Goli Nutrition’s Women’s PMS Relief Gummies ($16)

4. Heating pad

Lastly, Dr. Ekman-Ordeberg says that reaching for a trusty heating pad can also help. “If the nausea is related to pain, the use of a heating pad and rest are two good options,” she says. “The heat from a heating pad increases vascularization and increases blood flow, which suppresses the pain.”

Can certain foods exacerbate menstrual nausea?

They sure can! Dietary triggers during your period are a very real thing and Dr. Krychman says that eating spicy food is ill-advised if nausea is at play during your period (just as it is when menopausal symptoms are present). “Some experts have advised that spicy foods should be avoided during menstruation as they may irritate the stomach,” Dr. Krychman says. “Spicy foods are known to cause burning and stomach irritation, and in others, it may cause diarrhea and nausea.”

He adds that some research has demonstrated that meat, sugar, and coffee may also increase menstrual cramps, which can potentially in turn lead to nausea.

Instead, consider eating mellow foods and staying properly hydrated—both can help mitigate any additional symptoms of hunger or dehydration, which can lead to the sensation of an upset stomach. Ginger can help, too.

When to see a doctor

While OTC medication, staying hydrated, and eating nausea-reducing foods often put an end to the period-related digestive issues, in some instances these steps are not enough. After all, there’s always the chance that you’re feeling nauseous from something else.

For example, if you use tampons and ever experience nausea along with a fever, rash, and/or vomiting, you should seek emergency care promptly, Dr. Yen says. Vomiting, fever, rash, and dizziness are all signs of toxic shock syndrome, a life-threatening bacterial infection. Keep in mind, though, that cases of TSS are quite rare thanks to tampon regulations and education about usage.

If you think endometriosis may be behind the nausea during your period, you should also check in with a doctor who will be able to determine if that’s the case.

Or, you might not actually be menstruating at all: Nausea is an early pregnancy symptom, as well. If your period is late or you’re experiencing other symptoms like cramps without bleeding or tender breasts, Dr. Dwec says that taking a pregnancy test is a good idea.

Other frequently asked menstrual questions

Why do I feel weak and shaky on my period?

In addition to cramping and feeling nauseous, it’s possible to feel weak and shaky while menstruating. According to Dr. Krychman, this occurs because heavy vaginal bleeding can cause iron deficiency anemia.

“When a person is without enough iron stores or is iron deficient, they are unable to make adequate levels of hemoglobin that red blood cells need to carry oxygen to the cells,” he says. This in turn can lead to feelings of physical fatigue. If you think you may be anemic, it’s important to touch base with a doctor for the best next steps.

Another reason you might be feeling shaky during your period is due to imbalanced blood sugar levels. “In addition to bleeding, several studies have shown that hormonal changes during the menstrual cycle can impact blood sugar levels,” Dr. Krychman says. With this in mind, try having a snack and monitoring how your symptoms improve. According to UCSF Health, optimal snacks for treating low blood sugar include 12 gummy bears, five Life Savers, four Starburst, or 15 Skittles. The reason these not-so-healthy snacks can help in the moment is that they’re fast-absorbing carbs that will work to rebalance your blood sugar in a pinch.

How do I know if I have PMDD or just PMS?

“PMS (premenstrual syndrome) means that you get mood changes and other symptoms in the days before menstruation,” Dr. Ekman-Ordeberg says. “The symptoms vary from person to person and you can also feel PMS differently from month to month.” Generally speaking, though, she says that PMS is common in women of childbearing age and up to 30 percent have moderate symptoms. “PMDD (Premenstrual Dysphoric Disorder) is a more difficult form of PMS that significantly affects relationships, social function, and working life,” Dr. Ekman-Ordeberg adds. “This affects three to five percent of menstruators.”

In case you’re wondering, PMDD is not the same thing as dysmenorrhea. Where dysmenorrhea refers to painful periods, PMDD, which is considered to be a chronic medical condition, is largely tied to mental symptoms.

To determine if you have PMDD, Dr. Krychman says that “in the majority of menstrual cycles, at least five key symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week post menses.”

Those symptoms include: “Marked affective lability (e.g., mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection); marked irritability or anger (or increased interpersonal conflicts); markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts; and/or marked anxiety, tension, and/or feelings of being keyed up or on edge,” he shares. In addition to these symptoms, one or more of the following symptoms must be present to equate to a PMDD diagnosis.

“Decreased interest in usual activities; subjective difficulty in concentration; lethargy, easy fatigability, or marked lack of energy; marked change in appetite, overeating, or specific food cravings; hypersomnia or insomnia; a sense of being overwhelmed or out of control; and/or physical symptoms, such as breast tenderness or swelling, joint or muscle pain, and/or a sensation of ‘bloating’ or weight gain.”

Given how many factors play into a PMDD diagnosis, it’s best to consult your doctor if you fear this may be the cause of your physical and mental menstrual discomfort.

The takeaway

Overall, listening to your body and being gentle with it can go a long way—especially when you’re not feeling well. If you find that something feels truly off—if menstruation is significantly disrupting your life—consult a doctor, if only to ease your mind. While speaking with them, be sure to discuss birth control options, since many contraceptives dull menstrual symptoms, which means they can help with period-related nausea, too. “If the nausea caused by your period is difficult and affects your everyday life, you should consult a doctor,” Dr. Ekman-Ordeberg says. “I would also recommend considering contraceptive medication or hormonal IUD, as this will flatten out the hormonal changes.”