My daughter suffers from severe menstrual cramps. Heat helps but taking two Advil at a time, does not seem to alleviate the pain. Would you please recommend an over the counter medication? Thanks.

Please note that I am not a physician and cannot diagnose nor treat any medical condition.

Of course I can recommend some over-the-counter possibilities for your daughter, but before I do that, I'd like to mention a few things.

First, some menstrual pain is normal in women but when severe, it can signal that there is something abnormal going on.

Dysmenorrhea (painful periods) is usually caused by an increase in prostaglandins which cause the uterus to contract and help expel the uterine lining each month. Unfortunately, it is also a pro-inflammatory signal and can lead to pain. Most NSAIDs like Advil work by inhibiting prostaglandins and for moderate pain they should be sufficient.

There are other conditions such as ovarian cysts and endometriosis which may also lead to excessive pain, especially as they are stimulated by estrogen and progesterone levels during the menses. Although both conditions can be harmless, they can also be problematic or even dangerous. Sometimes regulation of the menstrual cycles with birth control pills helps lessen the pain and sometimes more invasive treatment may be necessary. The bottom line is that pain is a physiological symptom that something is wrong. My first recommendation is that your daughter visit a doctor and get a clean bill of health.

Once the medical professional gives you a green light that this is only related to dysmenorrhea, here are a few suggestions.

1. Have her limit caffeine intake during her period. Caffeine can increase uterine contractions and thus pain.

2. Make sure she gets plenty of rest. From a biological standpoint, menstruation is a more stressful time on the body, not to mention the pain she is experiencing which increases physiologic stress. Plenty of rest will help her body cope.

3. The maxium dose of ibuprofen (the active ingredient in Advil) is 2.4 grams daily. Perhaps she needs a higher dose of medication. Doctors can prescribe pills at 400mg, 600mg, and even 800mg that can be taken 3 to 4 times daily. They can also prescribe other NSAIDs such as ketoralac, diclofenac, and naproxen. Or, under the advice of your physician, she can take more pills than recommended on over-the-counter packaging.

4. She can combine the Advil she currently takes with acetaminophen. She can take up to 2 extra strength tablets (500mg each for a total dose of 1000mg) up to 4 times daily. Avoid any other products with acetaminophen. The max dose for this medication is 4 grams daily. Above that the liver may be damaged.

5. Continue with the heating packs. She can even use newer heat compresses that are activated by air and are thin enough to wear under clothing. This way she can live her life and be out and about while still experiencing the benefits of heat.

Unfortunately, despeite the seemingly innumerable over-the-counter products on the drugstore shelf, they really only conatin the same 3 or 4 ingredients in various combinations. For anything above and beyond pain that can be treated with ibuprofen, naproxen, or acetaminophen, you will require a prescription. (Aspirin is a poor painkiller and requires dosages too high to recommend for pain relief.)

Excellent advice! We will follow through with the gynecological examination. You covered a lot of the things we were wondering about. Thanks so much.

You could also try Magnetic Therapy, it has been effective for me, and also cost/effective. Its been years since I had to take any Naproxene *I only take it when I forget my magnets!.