Why are my cramps so bad on the first day

• 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

• 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.

• 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.

• 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.

• Pregnant or could be pregnant
• 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

• 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

• 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

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. 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

And remember, contact your doctor if your child develops any of the 'Call 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.

Last Reviewed: 07/28/2022

Last Revised: 01/13/2022

Copyright 2000-2022. Schmitt Pediatric Guidelines LLC.

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Questions every woman wonders about her health, body, and mind. This is "Am I Normal?" on The Scope.

Interviewer:

We're talking with women's expert Kirtly Parker Jones. She's the expert on all things woman. Here is the scenario, Dr. Jones, it is that time of the month and I know menstrual cramps are normal. I know that. But for whatever reason, it just feels more painful this time compared to any other time. Or so it seems like. I know I won't die for menstrual cramps, but it feels pretty darn close. Am I normal?

Dr. Jones:

Okay. First of all, let's talk about how common period cramps are and that is about 16 percent to 90 percent of women have cramps. So that's a big range, depends on which study you do. Of those people, about 2 percent to 29 percent of them have severe dysmenorrhea, meaning severe pain, enough that it disrupts their life.

Why Are Your Periods Different?

Well, why would one period be different than the other? Well, it could be the amount of exercise you had. It could have been how much sleep you had. It could have been your pain tolerance. Maybe your hormones were a little bit different. Maybe you made two eggs that month so you made a little more estrogen that month. So not all months are exactly the same with respect to cramps. So what happens with the really bad ones? Well, you're not going to die, but there are people . . .

Interviewer:

That's the good news.

Dr. Jones:

. . . particularly and you're such a young voice. I'm going to assume that you're a young person. Young people can have a number of symptoms that go along with the period cramps that can make it even worse. So the hormone that makes the uterus cramp, that pushes out that dead uterus lining so that it's all cleaned out, so you can start again, is called prostaglandins.

And it's vital to the health of the uterus that you make it, but it makes not only the blood vessels constrict, so the lining will come out, it makes the uterus cramp. But prostaglandins also can cause diarrhea and it can cause fainting. And when you're dizzy and you're feeling nauseated and throwing up, then everything hurts more. So sometimes it's enough that people actually throw up and pass out. Sometimes, they don't.

Are Your Periods Getting Heavier or More Painful?

Now, if you told me that your periods were getting heavier and heavier or not heavier but more and more painful, I would begin to think that as each period got worse, there was something going on. So a woman who said, "I just had one of the worst periods of my life." I'd think, "Fine." If you said, "My periods are getting worse and worse," I'd think of two conditions:

1. One are fibroids in the uterus. So the uterus is kind of trying to contract around a little muscle ball.
2. And the other one is endometriosis. A condition where little bits of uterine glands are growing around the pelvis and that causes pain too.

So for women who are having really bad periods but they're getting worse and worse and worse, (a) we have very good therapy for periods, but (b) we may need to do a little investigation. If it's just the worst period of your life and it's only this one, it's probably not going to be so bad next time. And the good news is you're probably normal.

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updated: August 2, 2018

originally published: February 3, 2017

Many people get emotional and have cramps before and during their periods. This is sometimes called PMS. Cramps and PMS are normal and can be treated.

Menstrual cramps can be really uncomfortable and painful, but they do happen for a reason. During your period, your uterus contracts — meaning it squeezes or cramps up. This makes the lining come off the walls of your uterus and leave your body. When your uterus cramps up, it’s helping the period blood flow out of your vagina.

Most people get cramps during their periods at some point in their lives. They usually feel like throbbing pains in your lower belly. They can start a couple of days before your period comes, and sometimes continue throughout your period. Cramps are usually worse during the first few days of your period, when your flow is the heaviest.

You can get cramps as soon as you get your first period. Your periods may get more or less painful throughout your life. For many people, cramps become less painful as they grow older.

Menstrual cramps can be painful and irritating, but they're super common and there are lots of ways to treat them.

What helps with cramps?

Here are a some things that can help ease cramps:

• Over-the-counter pain medicine like ibuprofen (Advil), naproxen (Aleve), or acetaminophen (Tylenol). Always follow the instructions on the bottle. Talk with your doctor before taking pain medication if you have an allergy to aspirin or severe asthma.

• Exercise.

• Putting a heating pad on your belly or lower back.

• Taking a hot bath.

• Having an orgasm (by yourself or with a partner).

• Rest.

• Hormonal birth control (like the pill, patch, ring, implant, and hormonal IUD).

• Acupuncture and acupressure.

• Transcutaneous electric nerve stimulation (TENS) — therapy that uses mild electric currents to stimulate your nerves to relieve pain.

• Certain vitamins and herbs like vitamin B1, fish oil, fenugreek, ginger, valerian, zataria, and zinc sulfate.

Cramps are a pretty normal part of getting your period, but sometimes people have period cramps that are so painful it’s hard to do everyday things (like go to school or work). If your period pain is really bad, and over-the-counter medicine doesn’t help, talk with your doctor. They can help with other ways to manage the pain, or they may want to check to see if there’s something more serious going on.

Cramps that are really bad may be a sign of:

• Pelvic Inflammatory Disease — an infection in your reproductive organs.

• Endometriosis — a condition where the lining of your uterus grows outside of your uterus.  

• Adenomyosis — when the tissue that lines your uterus grows into the muscle wall of your uterus.

• Uterine fibroids — non-cancerous tumors that grow inside your uterus, in the walls of your uterus, or on the outside of your uterus.

Cramps caused by these conditions may start when you’re older. And they might get worse as time passes. They can also last longer than other cramps or last longer than the last day of your period.

If you have super bad cramps that you can’t treat, or other period symptoms that are hard to deal with, call your doctor or local Planned Parenthood health center.

What’s PMS?

PMS stands for premenstrual syndrome — the emotional and physical symptoms that some people feel right before and during their periods. PMS is caused by the hormonal changes that your body goes through during your menstrual cycle.

Some people get PMS every time they have their periods. Others only get PMS every once in a while. You may have all or just some of the common PMS symptoms. And some people don't get PMS at all.

There are two main kinds of PMS symptoms: the ones that affect you physically and the ones that affect you emotionally.

Physical symptoms of PMS include:

• Craving certain foods or being more hungry than usual

• Tender, swollen, or sore breasts

• Feeling bloated (puffy or full in your stomach)

• Gaining a little weight

• Headaches

• Dizziness

• Swelling in your hands or feet

• Aches and pains in your joints or muscles

• Feeling more tired than usual or needing more naps

• Skin problems, like pimples

• Upset stomach

• Cramps or pain in your belly

Emotional symptoms of PMS include:

• Feeling sad, depressed, tense, or anxious

• Mood swings

• Feeling more irritable or angry than normal

• Crying suddenly

• Not feeling very social or wanting to be around people

• Having trouble concentrating

• Trouble falling asleep or staying asleep

• Changes in your desire to have sex

It’s common to have some of these symptoms and not others. For example, you might have bloating and sore breasts, but not mood swings or skin problems. It may also change from month to month: you could be tired and cranky one month but not the next, or have cramps one month but not the next. It's different for every person.

In order for a doctor to officially diagnose you with PMS, you need to have PMS symptoms for at least 3 months in a row. They must start in the 5 days before your period and interfere with some of your normal activities, like school, work, or exercise. If you think you may have PMS, keep a record of your period and symptoms each day for at least 2-3 months. You can use a calendar or our app to track your PMS symptoms.

Other conditions, like depression and anxiety, perimenopause, and thyroid disease can act like PMS, so visiting a doctor is the only way to know for sure what’s going on.

Some people have really severe PMS that’s called Premenstrual Dysphoric Disorder (PMDD). PMDD symptoms can be really scary and may include feeling out of control, depressed, having panic attacks, or even feeling suicidal. If you think you’re experiencing symptoms of PMDD, see a doctor as soon as possible.

What I can do to relieve PMS?

Many of the things that help ease cramps can also help with PMS. Here are some different ways to relieve PMS symptoms:

• Take over-the-counter pain medicine like ibuprofen (Advil), naproxen (Aleve), or acetaminophen (Tylenol). Always follow the instructions on the bottle. Talk with your doctor before taking pain medication if you have an allergy to aspirin or severe asthma.

• Do aerobic exercise, like walking, running, riding a bike, swimming, or any activity that gets your heart rate up. Regular exercise (at least 30 minutes most days of the week) is ideal.

• Do breathing exercises, meditation, or yoga.

• Get plenty of rest. Sleeping regularly every night can help with stress, mood changes, and feeling tired or fatigued.

• Eat healthy foods like fruits, veggies (especially the leafy green ones), whole grains, and yogurt.

• Limit fat, salt, sugar, caffeine, and alcohol.

• Make sure you get enough vitamins in your diet, or take vitamin supplements. If you don’t get enough calcium, take a supplement of 1200 mg of calcium daily. Magnesium and Vitamin E might also help.

• Use hormonal birth control (like the pill, patch, ring, implant, and hormonal IUD). Your doctor can help you find a birth control method that can help with PMS.