Men­strual peri­ods can be light and easy for some teens and young women, but for oth­ers, they can be heavy or accom­pa­nied by painful cramps. Cramps can be a big rea­son why girls are absent from school, why they miss sport prac­tices, and why they may avoid social events with their friends. How do you know if you should be con­cerned? Read on to learn more about painful peri­ods and what you should do if you have them.

What is Dysmenorrhea?

Dys­men­or­rhea (pro­nounced: dis-men-o-ree-a) is a med­ical term that means “dif­fi­cult or painful peri­ods”. There are two types of dys­men­or­rhea, pri­mary and secondary.

Pri­mary dys­men­or­rhea is the most com­mon kind of dys­men­or­rhea. Cramp­ing pain in the lower abdomen (belly) can start from 1–2 days before your period comes and can last 2–4 days, which may include lower back pain.

Sec­ondary dys­men­or­rhea is when cramps and for some, lower back pain are a result of a med­ical prob­lem such as endometrio­sis or pelvic inflam­ma­tory dis­ease.

What causes men­strual cramps?

Men­strual cramps are caused by uter­ine con­trac­tions (when your uterus tight­ens and relaxes allow­ing blood to leave your uterus). The lin­ing of your uterus releases spe­cial chem­i­cals called “prostaglandins”. These sub­stances can increase the inten­sity of the con­trac­tions espe­cially if the lev­els rise. High lev­els of prostaglandins may also cause nau­sea and lightheadedness.

Is it nor­mal to have some mild cramps dur­ing your period?

Yes, it is nor­mal to have mild cramps dur­ing your period because of uter­ine con­trac­tions. The uterus is a mus­cle that tight­ens and relaxes which can cause jab­bing or cramp-like pain. How­ever, if the dis­com­fort is not relieved with over the counter med­ica­tions and causes you to miss school or other daily activ­i­ties, it could mean that there is another rea­son for your symptoms.

When you first get your period, it is com­mon for you not to have reg­u­lar peri­ods and you may not ovu­late for a few months, or even for a few years. So you may not have men­strual cramps when you first begin your period. After one or two or three years, when your hor­mone sys­tem is more mature, you might have more severe men­strual cramps.

What other symp­toms do girls have dur­ing their periods?

In addi­tion to cramp­ing dur­ing their peri­ods, some girls may have other symptoms.

 *Symp­toms may be mild to mod­er­ate and can include:

• Nau­sea (feel­ing like you want to throw up)

• Vom­it­ing (throw­ing up)
• Loose bowel movements/diarrhea

• Con­sti­pa­tion

• Bloat­ing in your belly area

• Headaches

• Light­head­ed­ness– feel­ing faint

Are men­strual cramps the same as PMS (Pre-Menstrual Syndrome)?

Men­strual cramps are not the same as PMS. Symp­toms of PMS such as bloat­ing, weight gain, and mood­i­ness hap­pen before a woman’s period begins, and get a lot bet­ter when her period starts. On the other hand, with dys­men­or­rhea, cramps usu­ally get worse the first day or two of a woman’s period and have a dif­fer­ent cause and treatment.

What med­ica­tions can I take for my men­strual cramps?

If you are hav­ing men­strual cramps, talk with your par­ents or health care provider about your options. If your men­strual cramps are painful, you may think about tak­ing some type of the over-the-counter med­ica­tion for one to two days. These med­ica­tions are “anti-prostaglandins”. They help relieve the dis­com­fort, make your flow lighter, and cause your uterus to cramp less. Look for over-the-counter med­ica­tions that con­tain Ibupro­fen or naproxen. Take this med­i­cine when you first start to feel uncom­fort­able, and con­tinue tak­ing it every 4–6 hours or as rec­om­mended by your health care provider. Since this kind of med­i­cine can upset your stom­ach, you should take it with food. Make sure you read the label as to how much and how often you should take the med­ica­tion. You should not take these prod­ucts if you are aller­gic to aspirin-like med­i­cine or have stom­ach prob­lems. It is impor­tant not to take more med­i­cine than is rec­om­mended or prescribed.

Is there any­thing else I can do to help my men­strual cramps?

Nat­ural reme­dies like a microwav­able warm pack or a heat­ing pad placed on your abdomen (lower belly) may help. Soak­ing in a warm bath may also relieve uncom­fort­able cramps. Some teens find that increas­ing their phys­i­cal activ­ity helps; oth­ers find that rest­ing qui­etly for short peri­ods of time helps.

 Acupunc­ture is an alter­na­tive treat­ment that is some­times rec­om­mended to treat dys­men­or­rhea. You should also eat a healthy diet, drink lots of flu­ids, and get plenty of rest. You can try dif­fer­ent treat­ments to find out what works best for you.

What if noth­ing helps my men­strual cramps?

If your men­strual cramps are not relieved by over-the-counter med­i­cine, make an appoint­ment to see your health care provider (HCP). It is help­ful to bring a “pain diary” (that you have kept for a cou­ple of months) to show your HCP. A pain dairy is a tool to help you keep track of your pain; when it comes, the loca­tion of the pain, how long it lasts, and what relieves it.

For exam­ple: You had pain in the lower area of your belly that lasted for 4 hours. You took 2 Motrin (200 mg) with good relief and you used a heat­ing pad that helped.

Is it okay to exer­cise when I have my period?

Exer­cis­ing is a good way to stay fit and healthy. Some girls like to exer­cise when they have their period because it helps lessen their cramps. Other girls are uncom­fort­able exer­cis­ing when they have their period. You should find what works best for you. Talk to your coach or gym teacher if exer­cis­ing is uncom­fort­able dur­ing your period.

What if I have big clots of blood dur­ing my period?

Dark, chunky clots of blood can be per­fectly nor­mal. Many women get them dur­ing their period when they have days of heavy cramp­ing and heavy bleed­ing. Your body usu­ally makes things called “anti-coagulants,” that keep your blood from clot­ting as it moves to your vagina and out of your body. But dur­ing days of heavy bleed­ing and cramp­ing, your body is push­ing blood so quickly out of you that your body does not have time to release these anti-coagulants. Your blood then clots. If you have clots that are big­ger than a quar­ter, it is a good idea to talk with your health care provider.

What if I get spots of blood on my under­wear between my periods?

Bleed­ing in the mid­dle of your cycle could mean dif­fer­ent things. Some women bleed a lit­tle bit dur­ing the mid­dle of their cycle, when they ovu­late (when a mature egg is released from your ovaries). This is noth­ing to worry about. Other times, “spot­ting” occurs because of an infec­tion such as a sex­u­ally trans­mit­ted dis­ease (if you are hav­ing sex­ual inter­course). Some­times, “spot­ting” can be because of a cer­vi­cal polyp (a tumor that may need to be removed sur­gi­cally). But this is not very com­mon! You should talk to your health care provider if you have bleed­ing when you don’t have your period.