Dysmenorrhea

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Dysmenorrhea, follow-up

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PainChoose one

Atypical features presentChoose any

Atypical features absentChoose any

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Medication planChoose one

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Note when inserted as is

Dysmenorrhea, follow-up
November 2026: Doing well.
• Pain improved
• No pain since the first period, pain worsening at the end of bleeding or between periods, pain with stooling or urination during periods, or family history of endometriosis
• Continue scheduled motrin starting 1-2 days before the period is expected and through the first days of bleeding
• No medication change planned at this time
• Follow up in 3 months or sooner as needed

Period cramps usually improve with an anti-inflammatory medicine started before the period begins, and hormonal treatment can reduce or stop painful periods when that is not enough. Recommended supportive care with scheduled motrin or aleve with an emphasis on starting it 1-2 days before the period, heat to the lower belly, and staying active. Return precautions given including severe pain that is not relieved by the medicine, fever, unusual discharge, pain between periods, missing school despite treatment, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Pain improved; controlled; unchanged; persistent after 3-6 months
Atypical features present or absent (incl. pain at the end of bleeding or between periods)
Continue NSAIDs with menses; switch to aleve
Hormonal plan and continuous pills
Ultrasound; GC and chlamydia

Return precautions in the template

severe pain that is not relieved by the medicinefeverunusual dischargepain between periodsmissing school despite treatment

Sources

RCH Melbourne: Dysmenorrhoea
Contraceptive Counseling and Methods for Adolescents: Clinical Report. Pediatrics 2025;156(1):e2025072218. (current; companion to policy)

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Counseling

Period cramps are common and usually improve with motrin started early. Recommended supportive care with an emphasis on heat, regular exercise, and tracking periods and symptoms. Return precautions given including pain that causes missed school despite treatment, fever, pain between periods, very heavy bleeding, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Dysmenorrhea
• Primary dysmenorrhea without signs of an underlying condition
• Recommended scheduled motrin starting 1-2 days before the period is expected
• Heat to the lower belly as needed
• Follow up as needed

Period cramps are common and usually improve with motrin started early. Recommended supportive care with an emphasis on heat, regular exercise, and tracking periods and symptoms. Return precautions given including pain that causes missed school despite treatment, fever, pain between periods, very heavy bleeding, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Primary vs secondary
Hormonal start or defer
STI testing, imaging for secondary

Return precautions in the template

pain that causes missed school despite treatmentfeverpain between periodsvery heavy bleeding

Sources

Contraceptive Counseling and Methods for Adolescents: Clinical Report. Pediatrics 2025;156(1):e2025072218. (current; companion to policy)

Few formal guidelines cover this topic, so the template also leans on expert opinion.