The symptoms are painful abdominal cramps that occur during the menstrual period. About one-third of all menstruating women have these period pain. The cramps are felt in the mid-abdomen sometimes spreading to the back. It may be associated with nausea and vomiting. There are two types of period pain. One is called primary dysmenorrhea and starts within three years of the onset of menstruation. It is due to excessive production of the hormone prostaglandin when the ovaries produce an egg.

Prostaglandin causes the uterus to go into spasms. Cramps usually begin a few hours before menstrual flow and gradually decrease by the end of the period. The other type of period-pain is called secondary dysmenorrhea. It starts more than three years after the onset of menstruation and usually after the age of 30. It is due to underlying conditions such as fibroids, endometriosis or infection of the fallopian tubes. Cramps may start few days before the period and continue for some days after the period. It may even progress to continuous pain that is worse during the period.

One day before your period, you may start to take aspirin or other over-the-counter pain relievers such as Advil. Continue for the first two to three days of the menstruation. These pain killers also decrease the production of prostaglandins. Take the medicines with food to prevent stomach upset. If Advil is not effective, your doctor should prescribe a strong but gentle anti-inflammatory medication called Tolmetin sodium. It is 10 times stronger than Advil and much more effective. In severe pain, strong short acting painkillers such as Vicodin ES or Norco 10 may be given. Exercising daily for just 20 minutes also helps. If your cramps are aggravated by caffeine, avoid foods such as coffee, tea and sodas during the first few days of your period. For the primary period-pain , your doctor may prescribe birth control pills to decrease egg production and change the hormonal balance. Birth control pills may be associated with other risks such as high blood pressure and your doctor should discuss this with you. Primary period-pain usually stops or decreases after the first pregnancy.

Apply a hot water bottle to your tummy or take hot baths. Get plenty of rest. Take pain relievers, such as Advil or Tylenol. Drink mint or other herbal teas such as yogi tea, which decrease the spasms. Relaxation or yoga-type exercises may also relieve the pain. Your doctor may give you a Toradol injection at the beginning of your period. This is an anti-inflammatory medication like Motrin but can be given as an injection. Or your doctor may prescribe stronger painkillers such as Codeine if necessary. For the secondary period-pain, your doctor will need to examine you and perform laboratory tests to find out if you have fibroids or any other medical conditions. Sometimes you may need to have a laparascopy, which is a minor operation to put a tube and look into your abdomen. Your doctor will recommend treatment based on the diagnosis.

Call your Doctor if you have had menstrual periods for fewer than three years and the pain is not relieved by over-the-counter pain killers. Also get medical advice if you spend a day or more in bed each month. If you have had menstrual periods for more than three years and there is a change in your pain or an increase in blood flow, see your doctor right away.

Note: All medications mentioned on this site--including, specialty compounded ointments such as Capsaicin, Gabapentin, Ketamine, Vitamin E--may be ordered directly from L.A. Pain Clinic.