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
- 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.
- 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 for Menstrual Cramps
Call Doctor or Seek Care Now
- Pregnant or could be pregnant
- Not able to walk like normal
- 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
Seattle Children's Urgent Care Locations
If your child’s illness or injury is life-threatening, call 911.
Care Advice for Menstrual Cramps
- 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
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: 05/30/2023
Last Revised: 12/30/2022
Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.