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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 body fitness.

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."

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As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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