Black pepper (Piper nigrum) has a long history of use in traditional medicine systems such as Ayurveda and Unani. In these traditions, black pepper is often combined with other herbs and prescribed for a variety of women's health concerns, including menstrual irregularity. The rationale is usually based on its reputed ability to "stimulate circulation," "balance doshas," or promote the flow of "vata" and "pitta," which are believed to influence reproductive health. Some formulations, such as "Trikatu" (a blend of black pepper, long pepper, and ginger), are traditionally used to "stimulate digestion and metabolism," which is sometimes linked to hormone regulation and menstrual health in these paradigms.

However, scientific evidence directly supporting the use of black pepper for menstrual irregularity is minimal. While black pepper contains piperine, which has documented effects on bioavailability of other compounds, and some animal studies suggest possible hormonal or uterine effects, there are no robust clinical trials in humans demonstrating efficacy for menstrual irregularity. Thus, its use for this purpose is primarily justified by tradition rather than modern scientific validation, and the rating for evidence remains low.