Illness & Symptoms

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 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

When to Call for Menstrual Cramps

Call Doctor or Seek Care Now

  • Pregnant or could be pregnant (late or missed period)
  • 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

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

Call Doctor or Seek Care Now

  • Pregnant or could be pregnant (late or missed period)
  • 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

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

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

    • Remember! Contact your doctor if you or your child develop any "Contact 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.

Copyright 2000-2025 Schmitt Pediatric Guidelines LLC.

Reviewed: 5/1/2025 Updated: 1/25/2025