Adolescent Health

Cramps, cramps, cramps; what to do

Cramps come from contractions of the uterus, which is a smooth muscle. Bad menstrual cramps feel similar to early labor, except that the contractions tend not to be rhythmic in nature. It is currently believed that menstrual cramps arise from the action of prostaglandin on the smooth muscle of the uterus. Prostaglandin is abundant in the uterine muscle and increase in amount just before menses. These chemicals stimulate the uterus to contract. The tightening of the muscle resists blood flow and limits the amount of oxygen available for the tissue. This decrease in oxygen causes the pain women experience as menstrual cramps. As menstrual flow continues, the prostaglandin is released with the discharge. It tends to be that high flow days are crampiest, and then this subsides as the flow lightens.

Interestingly, there is evidence that menstrual cramping and prostaglandin production is related to ovulation. In young girls who are just starting their menstrual cycles, many do not ovulate for the first few cycles. These periods are experienced with much less discomfort and cramping. Ovulation may play a role in the cyclical increasing of the prostaglandin concentration in the smooth muscle of the uterus. Birth control pills prevent ovulation during the menstrual cycle, and may be prescribed in certain situations to control severe cramping.

Tried and true relief measures include:

• Rest either with bent knees curled toward the belly, or supported beneath the knees with 1 or 2 pillows.
• Apply heat, either with heating pads against the lower abdomen or a weighty and warm hot water bottle against the crampy area.
• Analgesics, over the counter medication can be very helpful, but it is most beneficial if taken before the cramping symptoms increase. Ibuprofen, along with other non-steroidal anti-inflammatory medications, has an action that decreases prostaglandin activity and relieves symptoms. There are cautions relating to its potential to be harsh on sensitive stomachs – so read the label of these products thoroughly and consult with your health care provider when necessary. Acetaminophen is another over the counter medication that has analgesic effects and may help to relieve symptoms.

Consult your health care provider if your cramps are –

• regularly severe, incapacitating and last for more than 2–3 days
• bothering you when you don’t have your period.
• more severe on one side or are one-sided only (this may be an emergency!)
• associated with a fever or fainting