Menstrual Cramps (Dysmenorrhea)

Menstrual cramps cause pain in your the lower abdomen during the first few days of your menstrual period. Sometimes the pain radiates to lower back or both thighs. Some girls also have nausea, vomiting, diarrhea, or dizziness along with cramps.

More than 50% of girls and women have cramps during their menstrual periods. The cramps are caused by strong contractions (and sometimes spasms) of the muscles in the uterus as it expels menstrual blood.

Menstrual periods usually are not painful during the first 1 to 2 years after a girl has started having periods. However, once ovulation (the release of an egg from the ovary) begins, the level of progesterone in the bloodstream increases and leads to stronger contractions and some cramps.

Cramps last 2 or 3 days and usually occur with each menstrual period. There are several drugs that can lessen the pain to a very mild level. The cramps often disappear permanently after your first pregnancy and delivery, probably because the opening of the uterus has stretched.

• Pain relief: Ibuprofen (Advil, Motrin, and Nuprin) is an excellent drug for menstrual cramps. It not only decreases the pain but also decreases contractions of the uterus. You do not need a prescription to get ibuprofen in 200-mg tablets.

  You can take 2 or 3 tablets 4 times a day. Always take 3 tablets (600 mg) as the first dose. Start taking the drug as soon as there is any menstrual flow, or even the day before, if possible. Don't wait until your menstrual cramps begin. Ibuprofen should make you feel well enough not to miss anything important.

  If you don't have ibuprofen, you can take acetaminophen (Tylenol) until you can get ibuprofen.

• Heat: A heating pad or warm washcloth applied to the area of pain may be helpful. A 20-minute warm bath twice a day may also reduce the pain.
• Aggravating factors: If you are tired or upset, the pain will seem more severe. Try to avoid getting exhausted or too little sleep during menstrual periods. If you have troubles or worries, talk to someone about them.
• Full activity during menstrual cramps: Do not miss any school, work, or social activities because of menstrual cramps. If the pains are limiting your activities even though you are using ibuprofen, ask your physician about stronger prescription medication.
• Common mistakes: A common mistake is to go to bed when the cramps are bad. However, people who are busy usually notice their pain less. There are absolutely no restrictions on your activities. You can go to school, take gym, swim, take a shower or bath, wash your hair, go outside in bad weather, date, etc. during your menstrual periods.

Call IMMEDIATELY if:

• The pain becomes severe and is not relieved by ibuprofen.
• You develop an unexplained fever (over 100 degrees F).
• You start feeling very sick.

Call during office hours if:

• Ibuprofen doesn't give adequate pain relief. Talk to your health care provider about using naproxen for menstrual cramps.
• The menstrual cramps cause you to miss school or other important activities.
• You have other concerns or questions.