TEEN DOC: Menstrual Cramps Got You Down?
by Dr. Ann L. Engelland
7, 2004) Menstrual cramps or dysmenorrhea is the leading cause
of absenteeism among American teenage high school girls.
many as 30% of teens miss at least one day of school or
work each month. Acceptable? Something we just have to
live with? I think not. This brief article will explain
what dysmenorrhea is and describe current thinking about
Dysmenorrhea is a whole constellation or syndrome of symptoms
that includes pelvic cramping but also gastrointestinal symptoms
(nausea, vomiting, loss of appetite, diarrhea) and aches
elsewhere (head, back, legs, stomach or just plain all over)
irritability, dizziness and sleep disturbances.
But I’ve had my period for two years and never felt
At the outset of a girl’s menstruation she usually
does not have accompanying cramps or significant symptoms
because she will not begin ovulating until one to three years
after the first period (menarche). Ovulation causes the body
to produce progesterone and it is this hormone which in turn
makes the body produce prostaglandins which stimulate cramping
and contraction of the uterine muscles.
So what happens once a girl starts ovulating?
Once ovulation begins, periods become more predictable
and regular but they also may be accompanied by any or all
(or none) of the symptoms of dysmenorrhea. 90% of dysmenorrheal
is “functional” and part of normal physiology.
Severe cramping from the outset of menarche warrants an
evaluation to rule out “secondary” or more
complicated causes of pain.
Don’t most girls know what to do for cramps?
Research shows that most girls do not seek medical advice
for their cramps. Most try heat, rest, exercise or “distraction” but
only 40% of them say this works.
What about taking over the counter pain medication?
Many of the “OTC” medications work, but most
girls do not take them often enough or in strong enough doses
to get the maximal benefit.
So what is the trick with OTC medications like Ibuprofen?
The trick is to take the medication at the FIRST HINT that
the period is coming and then every 4-6 hours afterwards.
Some may need up to 600mg at each dose. A medical caregiver
should be consulted if you think you need doses this
Are there other medications?
Yes, there are prescription NSAID’s (non-steroidal
anti-inflammatory drugs) such as Naproxen sodium, mefenamic
acid, and a new class of NSAID’s which work differently.
Vioxx and Bextra are brand names which are new and approved
for girls and women over 18.
What else can a woman try?
Regular exercise plus specific pelvic exercises are often
helpful in managing cramps.
What about nutrition?
There is some interesting recent evidence from Denmark
showing that a diet high in omega 3 fatty acids (from fish
fish oil supplements) may reduce the production of prostaglandins
in the uterine tissue and lead to less cramping and the
need for less medication.
I’ve heard that birth control pills help cramps?
For many girls, oral contraceptive pills reduce cramping
because they stop ovulation (remember that’s why
they work as a contraceptive) and progesterone production.
Most clinicians don’t start girls on pills until
they have tried correct doses of the other medications.
Unless of course they need the contraception or the other
benefits of hormone pills (say, for acne treatment).
What is Tricycling?
Tricycling means taking hormone pills continuously for
three months before having a period. Effectively, girls get
period four times a year on this regimen. The problem in
using pills this way for adolescents is that we do not have
with it yet and there can be a lot of unpredictable “break-through” bleeding
when you least expect or want it.
Overall, the outlook is good for girls and women with dysmenorrhea
or menstrual syndrome. It is my philosophy that teens, their
mothers and their clinicians should strive for minimal discomfort
and absence from school, work or social life. There are a
number of tools available to us now, and by working together
we can make adjustments in lifestyle, exercise and medication
that can really make a difference.
Dr. Ann L. Engelland has
a practice in Mamaroneck devoted to
Adolescent Primary Care.
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