Some young women feel it coming days before they get it. Others are hardly
aware they have it. Friends who compare notes about their periods will
probably find that menstruation -- the monthly shedding of the lining
of the uterus, or womb -- affects each of them a little differently, both
physically and emotionally.
Cramps -- A Common Complaint
More than half of menstruating women have cramp-like pain during their
periods. The medical term for menstrual pain is dysmenorrhea. Cramps are
usually felt in the pelvic area and lower abdomen, but can radiate to
the lower back or down the legs.
Mechanically, cramps are like labor pains. Just as the uterus contracts
to open up the cervix (neck of the uterus) and push out a baby, it contracts
to expel menstrual blood. Often, after several years of menstruating or
after childbirth, the cervical opening enlarges. The uterus does not have
to contract as much to discharge the menstrual flow, so there is less
Menstrual pain may also come from the bleeding process itself. When the
uterine lining separates from the wall, it releases chemicals called prostaglandins.
Prostaglandins cause blood vessels to narrow, impeding the supply of oxygen
to the uterus. Just as the pain of a heart attack comes from insufficient
blood to the muscles of the heart, too little blood to the uterine muscle
might cause the pain of menstrual cramps.
Menstrual pain can have other causes, although these are rare among teenagers.
They include tumors, fallopian tube infection, and endometriosis, a condition
in which fragments of the lining of the uterus become embedded elsewhere
in the body.
Pain, Pain Go Away
Sometimes, simple measures are all that's needed to feel better. Cutting
down on salt might help reduce fluid buildup, and support hose may alleviate
swelling in the legs or ankles. Crawling into bed for some extra rest
or sleep is one way to deal with fatigue, and taking along a heating pad
or hot water bottle eases cramps for some. Exercising also helps reduce
pain in many young women, and may lift a blue mood as well.
Exercising during menstruation lessens pain because it causes release
of brain chemicals called endorphins, which are natural painkillers. Exercise
may also decrease pain by affecting prostaglandin metabolism.
Exercise may also help because it increases blood flow, and because it
just makes a lot of people feel better in general.
If symptoms interfere with work, school or sleep, see a doctor. A doctor
may suggest taking one or more medicines.
Certain anti-inflammatory drugs called NSAIDs (an abbreviation for nonsteroidal
anti-inflammatory drugs) inhibit prostaglandin production, thus easing
cramps. Prescription NSAIDs include naproxen (Naprosyn, Anaprox), ibuprofen
(Motrin, IBU), indomethacin (Indocin), and mefenamic acid (Ponstel).
If needed, your doctor may prescribe stronger painkillers or diuretics,
or even oral contraceptives. One side effect of birth control pills is
relief of menstrual cramps.
Birth control pills work two ways to lessen cramps. They prevent the
lining of the uterus from building up too much, so there's less bleeding.
This means less prostaglandin production and blood vessel narrowing because
there is less lining to separate, and fewer contractions because there
is less tissue to push out.
In 1984, FDA approved ibuprofen in over-the-counter (OTC) strengths to
be sold without a prescription. It is the active ingredient in medicines
such as Advil, Nuprin and Motrin IB. In 1994, the agency approved naproxen
for OTC marketing in lower doses than the prescription strength. OTC naproxen
is sold under the brand name Aleve.
Like NSAIDs, aspirin also suppresses prostaglandins, but it is often
not as effective as other NSAIDs for menstrual pain. Aspirin should never
be used by children or teenagers who have chicken pox or flu symptoms
before checking with a doctor. This is because Reye syndrome, a rare but
sometimes deadly illness, may develop in children and teenagers who have
taken aspirin or products that contain it while they were sick with chicken
pox or flu.
Several OTC products, such as Midol and Pamprin, are specifically formulated
for menstrual symptoms. Read the labels of these medicines before you
buy them, because different formulations often contain different ingredients
or strengths of ingredients. For example, Teen Formula Midol contains
acetaminophen for pain and pamabrom (a mild diuretic) for fluid retention.
Pamprin contains acetaminophen, pamabrom and pyrilamine maleate (an antihistamine)
for tension and irritability. Cramp Relief Formula Midol IB contains as
its sole ingredient ibuprofen. Manufacturers may change their products'
ingredients from time to time, so it is a good idea to check the label
each time you buy the product.
Plain acetaminophen products like Tylenol, Datril, and Aspirin-Free Anacin
also may help menstrual pain. It takes time for pain relievers to work,
so it is best to take them before the pain gets bad and continue for one
or two days, as needed.
Some 20 to 40 percent of menstruating women have PMS, or premenstrual
syndrome. Starting anywhere from mid-cycle to a few days before menstruation
begins, women with PMS may have one or all of a virtual laundry list of
physical and emotional symptoms. They include breast swelling and tenderness,
fluid retention, increased thirst or appetite, craving for sweets and
salty foods, headaches, anxiety, restlessness, irritability, depression,
hostility, and loss of self confidence. Experts say PMS does not usually
affect teenagers, though. It increases with age and is more prevalent
in the 30s and 40s.
From Menarche to Menopause
In the United States, the average age of menarche -- a girl's first period
-- is 12 years, although it is normal to start as early as 10 or as late
as 16. Menopause -- when periods stop -- usually occurs around age 50,
although that, too, can vary by several years. Except perhaps for the
first two years of menstruation-and barring pregnancy, nursing, and certain
illnesses or other problems-the reproductive cycle repeats with predictable
regularity every month.
Exercise, diet and stress can delay the onset of menstruation or alter
cycles once they've been established.
Gymnasts, ballerinas and others who exercise strenuously can sometimes
delay the onset of their periods, so it is not surprising to find a 16-
or 17-year-old in that group who has not started menstruating. Some experts
believe the connection between exercise and amenorrhea [the absence of
menstrual periods] is related to body fat content, because fat affects
estrogen. Young women who are very thin from malnourishment may not start
menstruating until they gain weight, with a certain portion of that weight
being fat. So, girls who exercise a lot -- who are all bone and muscle
with no fat -- may delay their periods.
Similarly, young women with severe eating disorders such as anorexia
or bulimia often do not menstruate.
The American College of Obstetricians and Gynecologists recommends that
a girl see her doctor if she hasn't started menstruating by age 16, or
if by age 13 or 14 she hasn't begun to develop breasts or pubic and underarm
Just Like Clockwork?
Many young women have very irregular periods the first couple years of
menstruating -- even skipping some months, until, the system is well-tuned.
In addition, young women do not always ovulate every month when they
first get their periods. There is no sure way for a young woman to know
which month she is ovulating and which she is not. So, from the time her
periods begin, a young woman should assume she can get pregnant each and
every month, even if her periods are irregular.
Eventually, periods become regular, but even when they do, a missed or
late period once a year -- especially at a stressful time -- is considered
Also, just as strenuous exercise and eating disorders can delay the onset
of menstruation, they can also cause previously regular menstrual cycles
to become irregular or stop completely.
Menstruation is just one part of the menstrual cycle, in which a woman's
body prepares for pregnancy each month. A cycle is counted from the first
day of one period to the first day of the next. An average cycle is 28
days, but anywhere from 23 to 35 days is normal.
Estrogen and progesterone levels are very low at the beginning of the
cycle. During menstruation, levels of estrogen, made by the ovaries, start
to rise and make the lining of the uterus grow and thicken. In the meantime,
an egg (ovum) in one of the ovaries starts to mature. It is encased in
a sac called the Graafian follicle, which continues to produce estrogen
as the egg grows.
At about day 14 of a typical 28-day cycle, the sac bursts and the egg
leaves the ovary, traveling through one of the fallopian tubes to the
uterus. The release of the egg from the ovary is called ovulation. Some
women know when they're ovulating, because at mid-cycle they have some
pain--typically a dull ache on either side of the lower abdomen lasting
a few hours. The medical word for this is mittelschmerz, from the German,
meaning middle pain. Some women also have very light bleeding, or spotting,
After the egg is expelled, the sac -- now called a corpus luteum -- remains
in the ovary, where it starts producing mainly progesterone. The rising
levels of both estrogen and progesterone help build up the uterine lining
to prepare for pregnancy.
The few days before, during and after ovulation are a woman's "fertile
period" -- the time when she can become pregnant. Because the length of
menstrual cycles vary, many woman ovulate earlier or later than day 14.
It is even possible for a woman to ovulate while she still has her period
if that month's cycle is very short. (Stress and other things can sometimes
cause a cycle to be shorter or longer.) If a woman has sex with a man
during this time and conception occurs (his sperm fertilizes the egg),
she becomes pregnant.
The fertilized egg attaches to the uterus, and the corpus luteum makes
all the progesterone needed to keep it implanted and growing until a placenta
(an organ connecting the fetus to the mother) develops. The placenta then
makes hormones and provides nourishment from the mother to the baby.
If an egg is not fertilized that month and the woman does not get pregnant,
the corpus luteum stops making hormones and gets reabsorbed in the ovary.
Hormone levels drop again, the lining of the uterus breaks down, menstruation
begins, and the cycle repeats.
In the illustration below, an egg has left an ovary after ovulation and
is on its way through a fallopian tube to the uterus.
What's Normal, What's Not
Most menstrual periods last from three
to five days, but anywhere from two to seven days is normal. The amount
of blood flow varies, too, but for most women, bleeding starts out light
at first, followed by heavier flow for a day or two and then another light
day or two. Sanitary pads or tampons, which are made of cotton or another
absorbent material, are worn to absorb the blood flow. Sanitary pads are
placed inside the panties; tampons are inserted into the vagina.
The amount of bleeding varies from woman to woman because everybody's
body has a different way of building up the lining of the uterus. A lighter
flow or heavier flow does not mean you can't get pregnant as easily or
you're never going to get pregnant, or that your periods will always stay
the same way. But if you're bleeding excessively -- soaking one or more
tampons or pads an hour -- you should see a doctor to see if there's a
Lisa Rarick, MD, a gynecologist with Federal Drug Administration's Center
for Drug Evaluation and Research, says teenagers often are concerned if
they expel blood clots during their periods. She says this is not dangerous;
they are clumps of pooled blood in the vagina. Sometimes, instead of flowing
freely, blood drains from the uterus and stays in the vagina until there's
a change in position -- say, from sitting to standing.
Women who use tampons should be aware of toxic shock syndrome, or TSS,
a rare but serious -- and sometimes fatal -- disease that has been associated
with tampon use. Tampon packages carry information about TSS on the box
or inside. Because TSS mostly affects 15- to 19-year-olds, it is especially
important for teenagers to know what signs to look for. If you develop
the following symptoms while menstruating, remove the tampon and get medical
help right away:
- sudden fever over 102 degrees Fahrenheit
- dizziness, fainting, or near fainting when standing up
- a rash that looks like a sunburn.
amenorrhea: the absence of menstrual periods
dysmenorrhea: pain or discomfort during menstruation
fallopian tubes: two slender tubes -- one on either side of the
uterus -- that carry the egg (ovum) from the ovary to the uterus
menarche: a young woman's first period
mittelschmerz: pain or discomfort during ovulation
ovaries: two female reproductive organs--one on either side of
the uterus--that contain the eggs, or ova, and make hormones
ovulation: release of an egg from the ovary
prostaglandin: a chemical made by the body that causes the muscle
of the uterus to contract, often causing cramps
uterus (womb): the female organ in which a fertilized egg grows
and develops into a baby
Source: US Food & Drug Administration
For More Information
Visit the American College of Obstetricians
Visit the US Food & Drug Administration