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Medical Author:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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In this Article

• Menstrual cramps and PMS medication facts
• What are menstrual cramps?
• What is the treatment for common menstrual cramps (primary dysmenorrhea)?
• What is premenstrual syndrome (PMS)?
• What treatments are available for PMS?
• What medications are used to treat PMS?
• What are some guidelines for the safe use of OTC products for menstrual cramps and PMS?
• Find a local Obstetrician-Gynecologist in your town
• Menstrual Cramps and PMS Medication Guide Index

Menstrual cramps are abdominal and pelvic pains experienced by a woman around the time of her menstrual period. Menstrual cramps usually start shortly before the menstrual period, peak within 24 hours after their onset, and subside after a day or two.

Menstrual cramps can range from mild to severe. Mild menstrual cramps may be barely noticeable and short-lived, sometimes felt just as a sense of light heaviness in the belly. Severe menstrual cramps can be so painful that they interfere with a woman's regular activities for several days. The discomfort can extend to the lower back or legs. Menstrual cramps are not the same as the symptoms experienced due to premenstrual syndrome (PMS), although the symptoms of both disorders can sometimes be experienced together. Many women suffer from both PMS and menstrual cramps.

Medical research of menstrual cramps has shown that they are often worse in women who began menstruating early and who have long menstrual periods with heavy menstrual flow. Smoking and a family history of severe menstrual cramps are also associated with painful menstrual cramps.

Treatment options vary and each woman needs to find a treatment that works for her. Non-drug measures that may help include adequate rest and sleep, regular exercise (especially walking), and smoking cessation. Some women find that abdominal massage, yoga, or orgasmic sexual activity can help. A heating pad applied to the abdominal area may also relieve the pain.

For mild menstrual cramps, over-the-counter (OTC) aspirin and acetaminophen (Tylenol), or acetaminophen plus a diuretic (such as Diurex MPR, Midol, Pamprin, Premesyn) may help. However, aspirin has a limited effect in curbing the production of prostaglandin and is only useful for mild cramps. For moderate menstrual cramps, the nonsteroidal anti-inflammatory drugs (NSAIDs) can be helpful. The NSAIDs are more effective than aspirin in inhibiting the production and action of the prostaglandins. The NSAIDs that are available OTC are:

• ibuprofen (Advil, Midol IB, Motrin, Nuprin, and others);
• naproxen sodium (Aleve, Anaprox); and
• ketoprofen (Actron, Orudis KT).

For optimal control of menstrual cramps, a woman should start taking a NSAID before her pain becomes difficult to control. This might mean starting medication 1 to 2 days before her period is due to begin and continuing taking medication 1 to 2 days into her period. The best results are obtained by taking one of the NSAIDs on a schedule rather than on an as needed basis. Therefore, ibuprofen should be taken every 4-6 hours, ketoprofen every 4-8 hours, and naproxen every 8-12 hours for the first few days of the menstrual flow.

Prescription NSAIDs available for the treatment of menstrual cramps include mefenamic acid (Ponstel).