Cramps (PIOG)
Menstrual cramps are a common menstrual concern among tween and teen girls. I have fielded several questions lately about what causes cramps, how best to treat them, and what is or isn't normal. I am writing this post to cover the basic issues. As an introduction, I realize it will not answer every question.
Please share your daughter's experience and what has or has not worked for her. Also, feel free to reply with questions or to PM me directly.
OVERVIEW
Menstrual cramps, also known as dysmenorrhea, often do not occur with the first few menstrual periods a girl experiences. However, over 60% of girls do experience menstrual cramps during adolescence. Dysmenorrhea comes in two forms: primary and secondary.
Primary accounts for almost all cases with adolescents. It typically begins 6 to 24 months after menarche (her first period). It is caused by prostaglandins and is not associated with significant structural or anatomic problems. It will be the focus of all that follows (aside from a quick explanation of secondary). The pain begins within the 24 hours before a new period begins and is most intense for the first 1-2 days of flow. Cramps are caused by hormones called prostaglandins, which cause painful cramping of the uterus during menstruation. The prostaglandins made in the uterus make the uterine muscles contract and help the uterus shed the lining that has built up during the menstrual cycle. Some girls produce more prostaglandins than others, which in turn cause more severe pain. For most girls, the pain is in the lower abdomen and comes in waves. For others, it radiates to the lower back and inner thighs. Additionally, the prostaglandins can cause headaches, nausea, vomiting and diarrhea.
Secondary is far less common at this age and is a symptomatic result of an underlying condition. The pain can begin much further in advance of a new period and can linger throughout the flow. It can even occur apart from menstruation. In these cases what needs diagnosing and treating is the underlying condition (i.e. endometriosis).
TREATMENT
All cramps are not created equally. Some girls will almost always characterize the pain in the same way: mild, moderate or severe while for others the pain may be much worse on occasion than is normative for her.
Since we know prostaglandins are the cause, the most effective medications will be those designed to impact prostaglandins. In this case, I recommend only using drugs known as NSAIDs or non-steroidal anti-inflammatory drugs. Two NSAIDs are available over the counter: ibuprofen (i.e. Advil) and naproxen (i.e. Aleve). Additional NSAIDs are available with a prescription. (Note: Acetemenophen - Tylenol - is NOT a NSAID). To prevent stomach irritation, take the medication with a small snack or a meal.
I am often asked about Midol, Pamprin and other medications marketed for menstrual symptoms. The simple answer is that for cost and effectiveness, I would always recommend just buying a NSAID (ibuprofen or naproxen). Midol and Pamprin and others come in a variety of "formulas" each of which contains multiple ingredients. The main one is typically ibuprofen or acetemenophen. Additional ones often include caffeine and a mild diuretic. If selecting one of these, be sure to check the ingredients and chose one with a NSAID.
In addition to medication, there are several other ways to help relieve cramps including heating pads, drinking hot beverages, abdominal massage, and exercise. Often girls feel the last thing they want to do is work out when in pain however doing so tends to provide temporary relief.
ADVANCED TREATMENT and WHEN TO BE CONCERNED
Most girls find that the basic treatment options are adequate to lower the pain level and make cramps tolerable. If, however, you find that your daughter continues to miss school, sports or activities due to menstrual pain it is important to follow up with her doctor. The next steps beyond the basic treatment are far from radical, but often provide considerable relief for girls with moderate to severe menstrual cramps.
Ideally, for all girls but especially those with more severe pain NSAIDs should be taken before the cramps begin since they block the production of prostaglandins. A loading dose (just a higher dosage level of the same medication) is taken first to provide adequate blood levels of the medication. Also, the medications are more effective when taken on a scheduled basis (i.e. every 6 hours with ibuprofen) than if used only when she experiences pain. For most girls, this regiment can end after the first two days of flow.
Most doctors will move gradually from the initial options toward progressively more powerful ways to alleviate pain in order to provide the least medication needed to achieve the desired result. Moving from over the counter meds taken in response to pain to taken proactively is a first step. A second step will be to stronger dosages of the over the counter medications that exceed what is used without a doctor's supervision over the counter. A third step will be to a prescription strength medication. Ponstel is an increasingly common option that works well for most girls. A final step or an alternative treatment option is to use birth control pills.
I am surprised that you did not mention that wearing tampons can make cramps worse; the body cramps up to remove the foreign object.
There is also a lot of evidence that a change in diet can reduce both cramps and PMS.
Robin in Chicago
I forgot to add that even a slight magnesium deficiency can cause a host of issues, like migraines and making menstrual cramps worse. My daughter and I take a cal/mag/D daily, and it really helps!!!
Robin in Chicago
Is your teen obsessed?
- MistyandZoesMom
on Jul. 17, 2010 at 3:17 PM