From the FDA Drug Label
Dysmenorrhea: For the treatment of dysmenorrhea, beginning with the earliest onset of such pain, ibuprofen tablets should be given in a dose of 400 mg every 4 hours as necessary for the relief of pain. The first line treatment for primary dysmenorrhea is ibuprofen 400 mg every 4 hours as necessary 1.
- The treatment should begin with the earliest onset of pain.
- The dose of ibuprofen can be adjusted based on the patient's response to the treatment.
- It is essential to use the lowest effective dose for the shortest duration consistent with individual patient treatment goals.
From the Research
The first line treatment for primary dysmenorrhea is nonsteroidal anti-inflammatory drugs (NSAIDs) due to their ability to inhibit prostaglandin synthesis, which reduces uterine contractions, blood flow, and pain, as supported by the most recent and highest quality study 2.
Key Points to Consider
- NSAIDs such as ibuprofen, naproxen sodium, or mefenamic acid should be started at the onset of menstrual bleeding or when pain begins and continued for 2-3 days or until symptoms resolve.
- For optimal effectiveness, NSAIDs should be taken with food to minimize gastrointestinal side effects.
- If one NSAID is ineffective after 2-3 menstrual cycles, switching to a different NSAID may be beneficial.
- Combined hormonal contraceptives (pills, patches, or rings) can be added as a second-line treatment if NSAIDs alone are insufficient.
Mechanism of Action
- NSAIDs work by inhibiting cyclooxygenase enzymes, thereby blocking prostaglandin formation, which is a key mediator of primary dysmenorrhea, causing increased uterine contractions and local pain sensitization.
- Prostaglandins play a large role in the pathophysiology of dysmenorrhea by causing myometrial contraction and vasoconstriction.
Patient Advice
- Patients should be advised that NSAIDs may take 30-60 minutes to begin working, so timing the first dose appropriately is important for pain management.
- Other pharmacologic treatment options include Paracetamol, as well as Gonadotrophic Release Hormone Analogs, which are typically used in the treatment for endometriosis.
- Non-pharmacologic treatments with strong evidence include heat therapy and physical exercise, which can be used in conjunction with first-line therapy after a discussion of risks and benefits.