Menstrual Cramps (Dysmenorrhea)

What are menstrual cramps?

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.

What is the cause?

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.

How long do they last?

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.

How can I take care of myself?

• Pain relief: Ibuprofen (Advil, Motrin, and Nuprin) or naproxen (Aleve) are excellent drugs for menstrual cramps. They not only decrease the pain but also decrease contractions of the uterus. You do not need a prescription to get ibuprofen in 200 mg tablets or naproxen in 220-mg tablets.

  For ibuprofen, you can take 2 tablets 3 times a day. Take 3 tablets (600 mg) as the first dose. For naproxen, you can take 1 tablet 3 times a day. Start with 2 tablets (440 mg). 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 or naproxen should make you feel well enough not to miss anything important. Never take both drugs together.

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

• 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 or naproxen, ask your healthcare provider about stronger prescription medicine.
• 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.

When should I call my healthcare provider?

Call IMMEDIATELY if:

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

Call during office hours if:

• Ibuprofen or naproxen do not give adequate pain relief.
• The menstrual cramps cause you to miss school or other important activities.
• You have other concerns or questions.