What are the treatment options for dysmenorrhea?

Treatment Options for Dysmenorrhea

NSAIDs (such as ibuprofen 400-800 mg every 4-6 hours) are the first-line treatment for dysmenorrhea, followed by hormonal contraceptives which can be used independently or in combination with NSAIDs. 1, 2

First-Line Pharmacological Treatments

NSAIDs

• Ibuprofen 600-800 mg every 6-8 hours with food for the first 24-48 hours of symptoms 2
• Take at earliest onset of pain for maximum effectiveness 1
• Mechanism: Inhibits prostaglandin synthesis, which reduces uterine hypercontractility 1
• For dysmenorrhea specifically, the FDA-approved dosing is 400 mg every 4 hours as necessary for pain relief 1
• Important: Use the lowest effective dose for the shortest duration to minimize side effects 1

Hormonal Contraceptives

• Levonorgestrel-releasing intrauterine system (LNG-IUD) is particularly effective for severe dysmenorrhea 2
  • Approximately 50% of users experience amenorrhea or oligomenorrhea by 2 years of use
  • Efficacy >99% (typical failure rate 0.1-0.2%)
• Combined oral contraceptives (COCs)
  • Efficacy 91-95% with typical use
  • Regularizes cycles and reduces dysmenorrhea symptoms
• Other options include progestin-only pills, contraceptive implants, and injectable contraception (DMPA) 2

Non-Pharmacological Approaches

Evidence-Based Options

• Heat therapy: Application of heat to abdomen or back reduces cramping pain 3
• Physical exercise: Regular physical activity has shown significant benefits 4
• Transcutaneous electrical nerve stimulation (TENS): Effective for pain relief 4
• Self-acupressure at specific points:
  • "Large Intestine-4" (LI4) point on the hand 3
  • "Spleen-6" (SP6) point located approximately 4 fingers above the medial malleolus 3

Additional Supportive Measures

• Aromatherapy with lavender or peppermint essential oils 3
• Yoga-based breathing techniques during painful episodes 3
• Music therapy, particularly "slow-rhythm music" 3
• Mind-body techniques such as guided imagery 3

Treatment Algorithm

1. Start with NSAIDs

   • Begin ibuprofen 400-800 mg at earliest onset of pain
   • Continue every 4-6 hours as needed for 24-48 hours
   • If inadequate relief, consider increasing dose (not exceeding 3200 mg daily) 1

2. Add hormonal contraception if:

   • NSAIDs provide insufficient relief
   • Patient desires contraception
   • Symptoms are severe or recurrent
   • LNG-IUD is particularly effective for severe cases 2

3. Incorporate non-pharmacological approaches

   • Heat therapy to abdomen
   • Regular exercise
   • Self-acupressure at LI4 and SP6 points 3

4. Consider secondary dysmenorrhea if:

   • Pain progressively worsens
   • Pain is accompanied by abnormal uterine bleeding
   • Presence of dyspareunia or vaginal discharge
   • Pain is not responding to first-line treatments 5
   • Proceed with pelvic examination and ultrasonography if secondary dysmenorrhea is suspected 5

Important Considerations

• Dysmenorrhea affects 50-90% of women of reproductive age and is a leading cause of school/work absenteeism 5
• Primary dysmenorrhea is menstrual pain without underlying pathology; secondary dysmenorrhea is associated with conditions like endometriosis 5
• Combination therapy (NSAIDs plus hormonal contraceptives) may provide better relief than either treatment alone 5
• Regular assessment of treatment response is recommended after 3 months 2
• Referral to gynecology is warranted if symptoms suggest secondary dysmenorrhea or if first-line treatments fail 5

By following this evidence-based approach, most patients with dysmenorrhea can achieve significant pain relief and improved quality of life.