Menstrual Cramps

Is this your child's symptom?

  • 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

Cause

  • 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 him or her up from sleep.
  • Severe: The pain is very bad. It keeps your child from doing all normal activities.

When to Call for Menstrual Cramps

Call Doctor or Seek Care Now

  • Is pregnant or could be pregnant
  • 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

Call 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

Call 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

Seattle Children's Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Care Advice for Menstrual Cramps

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

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

Last Reviewed: 10/15/2018

Last Revised: 03/31/2018

Copyright 2000-2018. Schmitt Pediatric Guidelines LLC.