If menstrual pain is severe, initial treatment can often include heat therapy, such as using a hot water bottle or applying a warm bottle to the abdomen, and soaking feet in warm water. Heat therapy generally provides quick relief from the spasm of smooth muscles, and alleviates pain. Menstrual pain is primarily caused by the contraction and spasm of smooth muscles. In severe cases, painkillers may be necessary, but they can potentially harm the stomach and have other side effects, so they are generally not the first choice. To manage menstrual symptoms, it is important to keep warm before and during the menstrual period, avoid getting chilled, maintain regular exercise, and work on improving overall physical health.