Cramps and painful periods

“Cramps” is the common name for painful periods or what doctors call dysmenorrhea. Cramps typically start just before and are most severe during the first days of menstrual flow. Younger women and those who have never been pregnant or delivered a baby are more likely to have and to have worse cramps. Interestingly, cramps also seem to increase in perimenopause (the transition to menopause). The pain of cramps is due to increased release by the lining and muscle walls of the uterus of a fatty hormone called a prostaglandin. More prostaglandins are made when the opening of the uterus is very tight (and therefore pressure inside it builds to high levels) and also when estrogen levels are higher. It is likely (but not yet adequately studied) that higher progesterone levels counterbalance estrogen’s effects and decrease cramps. Painful periods can be effectively treated with ibuprofen, an over-the-counter pain pill that is from the “anti-prostaglandin family”. Ibuprofen (400 mg or two 200-mg tablets) must be taken at the first hint of cramps and a further 200 mg tablet taken as soon as the pain begins to return (even if that is only an hour later). If you wait, ibuprofen won’t help because ibuprofen works to prevent the formation of the prostaglandins that the cause the pain.