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.

"The menstrual cycle has its ups and downs of hormones, and different people react differently to hormonal swings," says Lisa Rarick, M.D., a gynecologist in FDA's Center for Drug Evaluation and Research. She explains that just before and during menstruation, levels of the female hormones estrogen and progesterone are low. That's when some women feel bloated, irritable or blue, or "just crummy," she says.

"Just crummy" might mean cramps, sore breasts, backache, headache, nausea, and feeling tired.

"A day or two after your period starts you begin to feel better. Hormone levels go back on the upswing and you get back to what you're accustomed to during the rest of your cycle," Rarick explains.

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.

"Many girls have cramps severe enough to keep them home from school," Rarick says. In fact, according to Danforth's Obstetrics and Gynecology, dysmenorrhea is the most frequent cause of absenteeism from school among younger women. Rarick says women seem to go through phases when cramps are severe, then get better for several years, and then maybe worsen again. She adds that most women find they have less menstrual pain after having children.

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 doesn't have to contract as much to discharge the menstrual flow, so there is less cramping.

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.

Charles Debrovner, M.D., associate clinical professor of obstetrics and gynecology at New York University School of Medicine, explains that exercising during menstruation lessens pain because it causes release of brain chemicals called endorphins, which are natural painkillers. He says exercise may also decrease pain by affecting prostaglandin metabolism.

Rarick adds that 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, the American College of Obstetricians and Gynecologists recommends seeing a doctor, who 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," says Rarick. "They prevent the lining of the uterus from building up so much, so there's less bleeding. This means less prostaglandin production and blood vessel narrowing because there's less lining to separate, and fewer contractions because there's less tissue to push out."

Over-the-Counter Relief

In 1984, FDA approved ibuprofen in over-the-counter (OTC) strengths to be sold without a prescription. It's 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's often not as effective as other NSAIDs for menstrual pain. Aspirin should never be used by children or teenagers who have chickenpox 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 chickenpox or flu.

Tags: Women's Health

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