Clinical Reference Systems: Pediatric Advisor 10.0
Spanish version

DESCRIPTION

• cramps during the first 1 or 2 days of a menstrual period
• pain in lower abdomen
• pain that sometimes radiates to lower back or both thighs
• similar cramps in the past with menstrual periods
• nausea, vomiting, diarrhea, or dizziness in some girls.

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.

EXPECTED COURSE

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 the first pregnancy and delivery, probably because the opening of the uterus (the cervical os) has stretched.

HOME CARE

1. Ibuprofen (Advil, Motrin, and Nuprin are three brand names)

   Ibuprofen is an excellent drug for menstrual cramps. It not only decreases the pain but also decreases contractions of the uterus. It can be obtained without a prescription in 200-mg tablets.

   You can take 2 or 3 tablets four 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 until you can get ibuprofen.

2. Local 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 reduce the pain.

3. 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.

4. 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.

5. 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 YOUR PHYSICIAN 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 YOUR PHYSICIAN DURING OFFICE HOURS IF:

• Ibuprofen doesn't give adequate pain relief.
• The menstrual cramps cause you to miss school or other important activities.
• You have other concerns or questions.