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JSYK: You’re probs taking the wrong meds to treat your period cramps. (I know, I know). But considering the myriad of OTC options on the market, like Tylenol, Midol, Aleve, or whatever your coworker pulls out from their desk, it can be hard to know the difference between what actually works for your body and what’s high-key harmful.

What I mean by super harmful? Well, some OTC meds could delay your relief, aggravate your stomach, and/or chip away at your long-term health, says Kimberly Sackheim, DO, a pain management specialist at NYU Langone’s Rusk Rehabilitation.

So, yes, consider this a sign you need to 1) stop taking those random, unidentifiable pills chilling in the bottom of your work bag when a painful period hit and 2) actually understand the difference between acetaminophen and, well, everything else.

First, let’s start with the two options for OTC pain relief: acetaminophen, aka Tylenol, and NSAIDs, non-steroidal anti-inflammatory drugs, which are all over-the-counter painkillers other than acetaminophen. Let’s dive into each one.

Acetaminophen

Acetaminophen targets the areas of the brain responsible for processing pain and body temperature, says Dr. Sackheim. Apart from cramps, if you’re suffering from a fever, taking acetaminophen as directed will do you a solid. But it won’t reduce inflammation in, say, a sprained ankle. Make sense? Good.

Now, it’s important to note that acetaminophen poses special risks because it’s broken down by the liver (and can seriously damage it), which is the vital organ that filters out toxins including alcohol. That means that you should never ever chase acetaminophen with booze, which could stress out of the liver and contribute to irreversible damage for this reason.

The good thing is that it doesn’t mess with your tummy, so it’s the move when you want to treat period cramps accompanied by an upset stomach, which can go hand-in-hand with PMS because, well, life isn’t fair. Just mind your dosage.

Ob-gyn Tamika K. Cross, MD, recommends starting with the lowest possible dose to treat symptoms. “Dose in milligrams not the quantity of pills, since the amount of pills someone takes is dependent on how many milligrams the pill is.” Her suggestion: 325 to 500 milligrams.

NSAIDs

According to the American College of Obstetricians and Gynecologists (ACOG), NSAIDs are the best defense against painful cramps. (Some studies have found these drugs can actually lighten super-heavy bleeding better than placebo — just not as well as hormonal birth control, so don’t get too excited.)

But NSAIDs provide relief by chilling out the nerve endings that process pain. NSAIDs include ibuprofen (found in Advil and Motrin), naproxen (found in Aleve), celecoxib (aka Celebrex), and aspirin. They don’t include acetaminophen or multiple-symptom medications that contain it, like DayQuil, Midol, and Excedrin.

Unlike acetaminophen, NSAIDs reduce inflammation to reduce joint and muscle pain. And because NSAIDs are metabolized by the kidneys, they pose no risks to the liver whatsoever.

That said, NSAIDs can suppress an enzyme that protects the lining of the stomach, potentially triggering acid reflux, general stomach upset, and GI bleeding or ulcers, says Dr. Cross. It’s one reason why you shouldn’t drink alcohol, another stomach irritant, before or after taking any OTC painkiller.

NSAIDs also thin your blood, which slows blood clotting and reduces the risk of heart attack and stroke. (It’s not a bad perk regardless of whether these conditions are top of mind.) However, because of the blood-thinning effects, you should also be mindful if you have clotting disorders or if you’re freshly out of surgery or on anticoagulants,” says Dr. Cross.” Opt for prescription drug Celecoxib if this is the case (more on this below).

Here is a more in-depth look at your NSAID options:

TL;DR

If you end up treating cramps with whatever’s sitting in your medicine cabinet, be sure you’re actively paying attention to the dose of the OTC med that you’re taking, suggests Dr. Cross. “It’s important that patients aren’t taking more than 3,000 mg of acetaminophen in a 24-hour period, which is why it’s important to remember when taking an unlabeled pill from a friend or coworker.”

And pay attention to the ingredients of your OTC meds—especially for things like Midol and Excedrin (since both medications contain acetaminophen in them, and you should be mindful about how much you’re consuming), suggests Dr. Cross.

Otherwise, “if you have side effects, you won’t know what caused them, and if you feel better, you want to know what helped,” says Dr. Sackheim.

Lastly, if your cramps are really bad and you notice that you have to take a lot of over the counter medication for relief, “you should see your medical provider and discuss your options for pain control,” suggests ob-gyn Heather Irobunda, MD.

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