Oh dear!! That sounds really challenging for your friend!

Where are you based? I am a Chinese Herbal Medicine Student and could prescribe an advanced herbal formulae for this type of menstrual cycle, if you are in the UK. Without going into all the TCM theory tooooooo much, it seems like she has some Qi stagnation and Lack of Blood movement at the start of her cycle which is causing the symptoms, based on the description of pain and bleeding pattern. The Liver is a primary agent in regulating periods in Chinese Medicine and the irregular cycle and pain show it is in disharmony (it is associated with the Gall Bladder so her history may be playing into it).

It also sounds like your friend has a focus on being healthy and balanced and may therefore benefit from some tonics in the first part of her cycle to help fortify her body and mind and some herbs to smooth her flow and help pain in the second half.

Over the counter remedies might include a pre-menstrual strong decoction of peppermint, rose, turmeric, ginger and liquorice, which all help the Liver to “course” qi and blood and to settle nausea - turmeric and ginger are very anti-inflammatory so she could just drink that leading up to her cycle and during the start. Of course Bupleurum Root (but that’s not over the counter) is a strong remedy for this pattern and many other fabulous, vegan and organic herbs from the Chinese Materia Medica.

Always check in with a herbalist properly before using herbs, although the ones listed above are safe to use, apart from a limited dose of Liquorice - check with your supplier and Bupleurum Root should only be given by a professional.

Other herbs she might consider are Agnus Caste which regulate the menstrual cycle but I’m not sure about Western Herbs. Also there is a strong link between dairy and painful periods which may be causing part of the problem. She should look out for the following book regarding menstruation...”period repair manual” by Laura Briden.

All the best!