When Periods Are Painful: ‘Fixing’ Your Teen’s Cramps


By adolescent medicine specialist Ellen Rome, MD, MPH

“Can you fix my cramps?” is a question I often hear from adolescent girls. Menstrual cramps are extremely painful for some young women. Fortunately, we have lots of options for relieving them.

Menstrual cramps result from the body making prostaglandins — specifically one called PGF2alpha. The body releases these prostaglandins from the egg sac mid-cycle and from the uterine lining during periods.

As prostaglandins run through the bloodstream, they cause uterine cramps, headaches and nausea.

What to do for simple cramps

For simple cramps, the first-line option is ibuprofen, 400 milligrams four times a day. If that is not working, or if twice a day works better for your teen’s schedule than four times a day, try naproxen sodium, 500 milligrams twice a day.

Both schedules only work when no doses are missed, starting from when you know your period is coming through the number of days of cramps you usually get.

Another option is Ponstel®, or methanimic acid, 500 milligrams as a loading dose and then 250 milligrams every six hours.

When to try menstrual manipulation

Preventive use of NSAIDS can help “turn off” prostaglandin formation, preventing the cramps from happening. We can also manipulate how many periods a teen has in a year; menstrual manipulation has become an art form.

Long-acting, reversible contraceptives (LARCs) — such as the intrauterine device or system (IUD/IUS) or the Nexplanon® hormonal arm implant — are first-line options for “forgettable contraception” and for menstrual manipulation.

Pills, vaginal rings and shots

Other options include birth control pills, the Nuvaring® (a removable hormone-releasing vaginal ring) and medroxyprogesterone shots.

It’s worth pointing out that the birth control pills we would prescribe for a 16-year-old differ from those we would prescribe for a 45-year-old.

This sophisticated strategy should be directed by, or done in partnership with, a physician well-versed in adolescent health and menstrual manipulation.