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Menstrual Cramps


  • 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


  • 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.

When To Call

Call Doctor or Seek Care Now

  • Pregnant or could be pregnant (late or missed period)
  • Not able to walk like normal
  • Fever
  • More severe cramps than ever before
  • Your teen looks or acts very sick
  • You think your teen needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Vaginal discharge that is not normal started before period began
  • Pain only on 1 side
  • You think your teen needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Cramps last more than 3 days
  • Cramps keep your teen from doing normal activities even after using pain medicine
  • Vomiting or diarrhea also present
  • Pelvic cramps happen when not bleeding
  • You have other questions or concerns

Self Care at Home

  • Normal menstrual cramps

Care Advice

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.

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.

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.

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.

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.

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.

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


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