Menstrual Cramps

Is this your child’s symptom?

• 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 her up from sleep.
• Severe: The pain is very bad. It keeps your child from doing all normal activities.

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

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.