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Within a year or two of their first period, 50 to 75 percent of young women begin to experience painful menstrual cramps, or dysmenorrhea.

Some cases of dysmenorrhea are eventually traced to the gynecologic disorder endometriosis, in which endometrial tissue is located in sites within the pelvic cavity other than the uterus. However, the majority of girls can be reassured that the cramping is related to the production of prostaglandins by the uterus, which is easily remedied, emphasizes Dr. Jennifer Johnson, a specialist in adolescent medicine at the University of California at Irvine.

“Some parents can be remarkably fatalistic about menstrual cramps, like it’s something their daughters have to endure,” she says. “I’ll see girls who are missing a day of school every month because of dysmenorrhea, and when I ask if they’re taking anything to relieve the symptoms, they’ll shake their heads no. We have extremely effective, inexpensive medications for treating dysmenorrhea.”

Heavy and irregular bleeding, referred to as dysfunctional uterine bleeding (DUB), can indicate serious underlying medical problems in teens. Dr. Johnson explains, “DUB is caused by a disturbance involving the hormones that regulate menstruation, but it is generally painless. But if it’s not treated, patients can lose so much blood that they develop severe anemia.”

Symptoms That Suggest Dysmenorrhea May Include:

  • Severe cramping
  • Occasional sharp pains in the lower abdomen, lower back and thighs
  • Sweating
  • Fatigue
  • Headache
  • Faintness
  • Nausea and vomiting
  • Diarrhea

Symptoms That Suggest Dysfunctional Uterine Bleeding May Include:

Bleeding more frequently than every twenty-one days (counting from the first day of one period to the first day of the next), less frequently than every thirty-five to forty-two days, or longer than seven days. Teens with these types of menstrual bleeding patterns should be medically evaluated.

How Dysmenorrhea is Diagnosed

Physical examination and thorough medical history (including menstrual history).

How Dysfunctional Uterine Bleeding is Diagnosed

Physical examination, including pelvic exam, and thorough medical history, plus one or more of the following procedures, to test for related complications or evidence of a mass or a sexually transmitted disease (STD).

  • Complete blood count (CBC)
  • Thyroid function tests
  • STD laboratory tests
  • Pregnancy test
  • Measurement of gonadotropins, prolactin and androgens

How Menstrual Disorders are treated with Drug Therapy

After exclusion of specific medical conditions, girls may be placed on medications. The cramping of dysmenorrhea is typically addressed with NSAID (nonsteroidal anti-inflammatory drug) analgesics such as ibuprofen, ketoprofen or naproxen. These medications block the uterus from releasing prostaglandins, naturally occurring chemicals that cause cramps. Oral contraceptives can also be used to relieve severe menstrual cramps. Hormone treatments, such as oral contraceptives, can also be used for dysfunctional uterine bleeding. NSAIDs may reduce bleeding to some extent, as well.


Last Updated
Caring for Your Teenager (Copyright © 2003 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.