Children's Hospital Colorado

Menstrual Cramps

  • Cramps in the lower belly or pelvis. They start during the first 1 or 2 days of a girl's period.
  • Cramps only happen during menstrual bleeding
  • Report of similar cramps in the past are helpful
  • Cramps often don't start until periods are present for over 1 year

Cause

  • The medical name for painful cramping during a girl's period is dysmenorrhea.
  • Normal cramps happen in over 60% of girls.
  • This cramping is caused by strong muscle squeezing of the uterus. This is triggered by a high prostaglandin (a hormone) level.
  • An egg release from the ovary (ovulation) is needed to cause cramping. Therefore, the onset is most often 12 months or more after the first period.
  • Medical causes of severe menstrual cramps include pelvic inflammatory disease (PID) and endometriosis. An ovarian cyst can also cause very bad cramping.

Age of Onset of Menstrual Cramps

  • Peak age of onset: 1 to 2 years after periods first start
  • During the first year after periods start, only 7% or less of teens will have cramping. Some of these girls will have a medical cause such as a blockage.

Pain Scale

  • Mild: Your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
  • Moderate: The pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
  • Severe: The pain is very bad. It keeps your child from doing all normal activities.

Call Doctor or Seek Care Now

  • Is pregnant or could be pregnant
  • Not able to walk like normal
  • Fever
  • More severe cramps than ever before
  • Your teen looks or acts very sick
  • You think your teen needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Vaginal discharge that is not normal started before period began
  • Pain only on 1 side
  • You think your teen needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Cramps last more than 3 days
  • Cramps keep your teen from doing normal activities even after using pain medicine
  • Vomiting or diarrhea also present
  • Pelvic cramps happen when not bleeding
  • You have other questions or concerns

Self Care at Home

  • Normal menstrual cramps

Care Advice for Menstrual Cramps

  1. What You Should Know About Menstrual Cramps:
    • Cramps happen in over 60% of girls.
    • Pain medicines can keep cramps to a mild level.
    • Cramps can last 2 or 3 days.
    • Here is some care advice that should help.
  2. Ibuprofen for Pain:
    • Give 2 ibuprofen 200 mg tablets 3 times per day for 3 days.
    • The first dose should be 3 tablets (600 mg) if the teen weighs over 100 pounds (45 kg).
    • Take with food.
    • Ibuprofen is a very good drug for cramps. Advil and Motrin are some of the brand names. No prescription is needed.
    • The drug should be started as soon as there is any menstrual flow. If you can, start it the day before. Don't wait for cramps to start.
    • Note: acetaminophen products (such as Tylenol) are not helpful for menstrual cramps.
  3. Naproxen if Ibuprofen Doesn't Help:
    • If your teen has tried ibuprofen with no pain relief, switch to naproxen. No prescription is needed.
    • Give 220 mg (1 tablet) every 8 hours for 2 or 3 days.
    • The first dose should be 2 tablets (440 mg) if the teen weighs over 100 pounds (45 kg).
    • Take with food.
  4. Use Heat for Pain:
    • Use a heating pad or warm washcloth to the lower belly. Do this for 20 minutes 2 times per day. This may help to reduce pain.
    • A warm bath may also help.
  5. Stay Active:
    • It's fine to go to school.
    • Your teen can take part in sports during her period.
    • She can also swim, bathe, or shower like normal.
  6. What to Expect:
    • Cramps last 2 or 3 days.
    • They will often happen with each period.
    • The cramps sometimes go away for good after the first pregnancy and delivery.
  7. Call Your Doctor If:
    • Neither ibuprofen or naproxen helps the pain
    • Cramps cause her to miss school or other events
    • Pain lasts over 3 days

Disclaimer

The information contained in these topics is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition. Nothing contained in these topics is intended to be used for medical diagnosis or treatment.

  • Not a Substitute - The information and materials in Pediatric HouseCalls Symptom Checker should not be used as a substitute for the care and knowledge that your physician can provide to you.
  • Supplement - The information and materials presented here in Pediatric HouseCalls Symptom Checker are meant to supplement the information that you obtain from your physician. If there is a disagreement between the information presented herein and what your physician has told you -- it is more likely that your physician is correct. He or she has the benefit of knowing your child's medical problems.
  • Limitations - You should recognize that the information and materials presented here in Pediatric HouseCalls Symptom Checker have the following limitations, in comparison to being examined by your own physician:
    • You can have a conversation with your child's doctor.
    • Your child's doctor can perform a physical examination and any necessary tests.
    • Your child could have an underlying medical problem that requires a physician to detect.
    • If your child is taking medications, they could influence how he experiences various symptoms.

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