It's Just Cramps - or Is It?

The majority of young girls have experienced menstrual cramps - the aching, dull sensations associated with a period. Unfortunately, some girls also experience additional symptoms such as pain down the legs, diarrhea, nausea, vomiting, headaches, worsening migraines and passing out.

These symptoms are due to hormone-like lipids called prostaglandins that are released from the ovary after ovulation. They are often treated with non-steroidal anti-inflammatory medications (NSAIDS) that block prostaglandin production and action. NSAIDS include ibuprofen, aspirin and medications that are specifically marketed for period symptoms which may also contain anti-histamine, diuretic, pain reliever or caffeine.

Some of these medications work better than others and girls can usually find one that works well for them. If NSAIDs do not relieve the pain, hormonal therapies in the form of birth control will prevent ovulation and alleviate most, if not all, symptoms. A combination of NSAIDs and hormonal contraceptives are required for some girls.

But, what happens when medications don’t work? When young girls continue to have pain despite these first-line therapies, it is important to consider that the pain may be more than just cramps. For adolescent girls and young adult women, additional diagnoses should be considered, including:

• Endometriosis (growth of the menstrual tissue outside of the uterus)
• Adenomyosis (growth of the menstrual tissue into the wall of the uterus)
• Ovarian cysts

All of these conditions cause significant pain that can start several weeks before the menstrual cycle. Girls often describe the pain from these conditions as burning, sharp, tightening or dull, and the pain often moves down the legs or into the back. It is also important to rule out bowel, bladder and musculoskeletal causes that can mimic or be associated with pelvic pain. For some young adults, it is important to rule out fibroids (benign muscle tumors of the uterus). Early evaluation by a health care provider will help distinguish these conditions, encourage appropriate treatment and get young girls back to living a full life.