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MANAGEMENT OF MENSTRUAL CRAMPS

Most teenagers and young women have some pain or cramping with their menstrual periods (doctors call this dysmenorrhea). Cramping with periods usually becomes a problem one to three years after a girl's first period occurs. Menstrual cramps or pain usually begin shortly before or just a few hours after the menstrual flow begins. This pain, if not treated, usually continues for two to four days. Nausea, vomiting, diarrhea, lower backache, side pain, headache, fatigue, nervousness, and dizziness may also occur with the cramping.

Some of the more common over-the-counter pain medications do not work very well with menstrual cramps, such as aspirin, acetaminophen (Tylenol), Midol, and Pamprin. In addition to medications alternate therapies include:

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, ask your physician about stronger prescription medication.
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.

At the end of this handout is a list of medications which can help relieve menstrual cramps. Many of these are available over-the-counter. Others require a prescription. The key to relief of menstrual cramping is to take your pain medicine immediately when you feel your period starting (either cramps or bleeding) and use a high dose (see table) for the first dose. Most of these medicines, if taken too late or in too small of a dose, have less effect. The most common side effect of this drug class is stomach discomfort, and it is recommended that you take these medications with food.

Selecting the Right Drug: We recommend that you start with either ibuprofen, 400 to 800 mg., or Naproxen, 440 to 550 mg. as the first dose. A smaller dose then taken regularly for one to three days, according to the schedule, will keep the cramping under control. You should stick with each drug choice through at least three menstrual cycles before giving up and trying another drug.

If you try these over-the-counter medications without significant improvement in your cramping, we recommend that you make an appointment to speak with your health care provider. Sometimes severe menstrual cramping is related to other problems such as endometriosis or stomach or bowel problems. It would be best if you discuss this with your provider so that alternate therapies can be considered.

Generic Drug Name	Brand Name	Prescription needed?	Pill Strength	Initial Dose	Follow-up dose
Ibuprofen	Advil Motrin Ibuprohm Nuprin	No	200 mg.	400 to 800 mg (2 to 4 pills)	400 to 600 mg. every 6 to 8 hours (2 to 3 pills)
Naproxen	Aleve	No	220 mg.	440 mg. (2 pills)	220 mg. every 12 hours (1 pill)
Naproxen	Anaprox	Yes	225 mg.	450 mg. (2 pills)	225 mg. every 12 hours (1 pill)
Naproxen	Anaprox DS	Yes	550 mg.	550 mg. (1 pill)	550 mg. every 12 hours (1 pill)
Naproxen	Naprosyn	Yes	250, 375, or 500 mg.	500 mg.	250 to 500 mg. every 12 hours