What is the best treatment for menstrual cramps?

Treatment for Menstrual Cramps

NSAIDs such as ibuprofen are the first-line treatment for menstrual cramps, taken for 5-7 days starting at the earliest onset of pain or 24 hours before expected menstruation. 1, 2

First-Line Treatment: NSAIDs

Mechanism of Action

• NSAIDs work by inhibiting prostaglandin synthesis, which are hormones that cause uterine contractions and pain during menstruation 2
• Reduced prostaglandin levels lead to decreased uterine contractions and associated pain

Recommended NSAID Options

• Ibuprofen: 400mg every 4-6 hours as needed for pain relief 2
  • Can be taken prophylactically starting 24 hours before expected menstruation
  • Continue for the first 3-4 days of menstruation
  • Maximum daily dose: 3200mg (though typically lower doses are effective for menstrual pain)
• Other NSAIDs that may be effective include:
  • Naproxen
  • Mefenamic acid
  • Diclofenac

Timing of NSAID Administration

• For optimal effect, start NSAIDs at the earliest onset of pain or 24 hours before expected menstruation 3
• Continue for 5-7 days during menstruation 1
• Prophylactic administration has been shown to significantly reduce pain intensity compared to taking medication after pain begins 3

Second-Line Options

If NSAIDs are ineffective or contraindicated:

Hormonal Methods

• Combined hormonal contraceptives (pills, patches, rings)
  • Reduce endometrial growth and prostaglandin production
  • May be used in extended or continuous regimens to reduce frequency of menstruation

Non-Pharmacological Approaches

• Heat therapy (heating pad or hot water bottle on lower abdomen)
• Regular physical exercise
• Adequate rest during menstruation

Nutritional Supplements (Limited Evidence)

• Vitamin B1: May be effective for pain relief 4
• Magnesium: Shows promise but optimal dosing is unclear 4
• Omega-3 fatty acids: Limited evidence suggests potential benefit 4
• Zinc: Some evidence suggests zinc supplementation before menses may prevent cramping 5

Important Considerations

When to Suspect Secondary Dysmenorrhea

• Pain that begins several years after menarche
• Pain that is not relieved by NSAIDs or hormonal contraceptives
• Abnormal pelvic examination findings
• Heavy menstrual bleeding

Cautions with NSAID Use

• Use the lowest effective dose for the shortest duration
• Take with food to minimize gastrointestinal side effects
• Avoid in patients with:
  • History of gastrointestinal bleeding or ulcers
  • Renal impairment
  • Aspirin-sensitive asthma
  • Significant cardiovascular disease

Common Pitfalls

1. Waiting until pain is severe before starting medication
2. Inadequate dosing of NSAIDs
3. Discontinuing medication too early during the menstrual cycle
4. Failing to recognize signs of secondary dysmenorrhea requiring further evaluation

Treatment Algorithm

1. Start with NSAIDs at first sign of pain or 24 hours before expected menstruation
2. If inadequate relief after 1-2 cycles, consider:
   • Different NSAID
   • Adding hormonal contraception
   • Evaluation for secondary causes of dysmenorrhea
3. For severe, refractory cases, refer to gynecologist for further evaluation

Remember that early intervention with appropriate dosing of NSAIDs provides the best chance for pain relief for most women with primary dysmenorrhea.