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|Quick reference medical handouts used
by Pediatric offices
Menstruation Need Not be Painful
Menstrual cramps, or dysmenorrhea, is the intermittent lower abdominal
pain that takes place with menstruation. It occurs in 60% of teenage girls
in the United States and is severe enough to interfere with normal activities
in 30%, causing missed school days, affecting academic performance and
interfering with outside activities. Because it is so common, many women
and young girls feel that menstrual cramps are "normal." They just have to
be put up with them as part of the monthly "curse." But menstrual cramps
are not a part of menstruation, and modern medical science has new information
about their cause and treatment. In addition to identifiable causes, anemia
("low blood)," obesity, chronic illness, overwork, stress in general, diabetes,
and poor nutrition may make the pain worse.
Two forms of dysmenorrhea have been identified. "Primary spasmodic
dysmenorrhea" is not caused by any medical problem and is the type of menstrual
cramps that occur in 80% of teenage girls. The menstrual discomfort begins
to occur 6-18 months after the first period. It most often affects females
25 years of age or younger and tends to lessen as a woman gets older. Primary
dysmenorrhea is associated with nausea, vomiting, diarrhea and urinary frequency.
The pain is localized to the lower abdomen and recurs in waves probably
corresponding to uterine contractions. It may radiate to the lower back and
inner thighs. The pain usually begins a few hours before bleeding starts,
comes to a peak intensity within a few hours, and fades after 1-2 days of
good menstrual flow.
Primary spasmodic dysmenorrhea is believed to be caused by an increased
production and release of a chemical called prostaglandins. The uterus contains
an abundance of this smooth muscle stimulator and prior to the onset of a
period, prostaglandins in the uterus increase in concentration. At the end
of the monthly cycle as the lining of the uterus begins to break up and shed,
prostaglandins are released in the uterus causing the uterine smooth muscles
to contract. These abnormal contractions squeeze the blood vessels in the
uterus so much that the uterus does not receive enough blood or oxygen, producing
pain, much like an athlete who suffers a muscle cramp from working out too
long or too hard. With the onset of the menstrual flow the prostaglandin
is discharged into the menstrual flow, which explains why the painful symptoms
associated with primary dysmenorrhea tend to fade after the first few days
of the period.
The treatment for primary dysmenorrhea is medication to stop the
production of the pain-causing prostaglandins. One such class of medications are the over-the –counter (OTC) non-
steroidal anti-inflammatory drugs (NSAIDS) like Ibuprofen (nuprin, motrin,advil etc.) or
Naproxen (alleve. These can be taken for mild to moderate cramps. These medications are best started the day before the cramps are expected to begin and continued through the number of days the cramps are expected to last. Check
with the youngster's pediatrician or gynecologist to see what they recommend.
Acetaminophen and medications for cramps that contain it (Tylenol, Pamprin,
Premsyn, and Midol) do not affect prostaglandin production, but may act as
a mild painkiller. Narcotics such as codeine or diuretics (substances which eliminate excess
body fluid) do not really treat the cause of the problem and should be avoided
unless prescribed by the teen's doctor.
Other simple measures to help relieve menstrual cramps include the
use of a heating pad, hot baths, hot drinks, massage, or other stress reduction
techniques. Exercise is another effective method of treatment. Going for
a run, swimming, or taking an aerobics class will increase blood circulation
and relax the teen's abdominal muscles. Exercise will also promote general
Birth control pills, or oral contraceptives (OC's) are often prescribed
for young women and teens with severe cramps, especially for those who are
sexually active. Oral contraceptives act by suppressing the production of
eggs and the growth of the endometrium therefore hindering formation of high
levels of prostaglandins. This treatment often results in complete pain relief
for 90% of teens with menstrual cramps.
Twenty percent of teens and young women have menstrual cramps caused
by a pelvic lesion (secondary dysmenorrhea). Examples of medical problems
that can cause painful menstruation include gonorrhea or chlamydia, endometriosis
(a condition where part of the endometrial lining is found outside of the
uterus, i.e., in the abdomen), uterine growths, abnormal anatomy of the uterus
or cervix, psychological problems from sexual abuse, and others. These problems
require specific medical interventions.
To make sure a teen's menstrual cramps are not due to one of the
above causes, young women should see their pediatrician or a gynecologist
for a complete checkup, including a pelvic exam. If everything appears to
be normal, and the symptoms fit, their doctor will treat them for primary
spasmodic dysmenorrhea. And young adolescent women can expect great pain
relief, so that menstruation need no longer be "the monthly curse."
As a reminder, this information should not be relied on as
medical advice and is not intended to replace the advice of your childs pediatrician.
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