What is the management of dysmenorrhea?

Management of Dysmenorrhea

NSAIDs are the first-line treatment for dysmenorrhea, with ibuprofen 400-800 mg every 6-8 hours or naproxen 440-550 mg every 12 hours being most effective for pain relief. 1, 2

Pharmacological Management

First-Line Therapy: NSAIDs

• Start with NSAIDs at the earliest onset of menstrual pain 3
• Recommended regimens:
  • Ibuprofen 400-800 mg every 6-8 hours with food for pain relief 1, 4
  • Naproxen 440-550 mg every 12 hours with food 2, 4
• NSAIDs work by blocking prostaglandin production, which are responsible for uterine cramping and pain 5
• Short-term treatment (5-7 days) is typically sufficient for symptom management 4
• A loading dose (typically twice the regular dose) should be used as initial treatment, followed by regular dosing until symptoms abate 6

Second-Line Therapy: Hormonal Methods

• If NSAIDs fail to provide adequate relief after three menstrual cycles, consider hormonal contraceptives 6
• Combined hormonal contraceptives (pills, patch, ring) can be effective for dysmenorrhea management 4
• Hormonal methods work by suppressing endometrial growth and reducing prostaglandin production 7

Non-Pharmacological Management

Heat Therapy

• Application of heat to the abdomen or back can effectively reduce cramping pain 4, 3
• Heat therapy can be used alongside pharmacological treatments 4

Acupressure

• Stimulation of specific acupressure points may help relieve dysmenorrhea 4
• Recommended points:
  • Large Intestine-4 (LI4) on the dorsum of the hand 4
  • Spleen-6 (SP6) located approximately 4 fingers superior to the medial malleolus 4
• Patients can perform self-stimulation at home to reduce cramping 4

Other Complementary Approaches

• Physical exercise has strong evidence for reducing dysmenorrhea symptoms 3
• Aromatherapy with peppermint essential oil may decrease dysmenorrhea symptoms 4
• Mind-body techniques such as guided imagery or relaxation techniques may provide additional benefit 4

Management Algorithm

1. Start with NSAIDs at the earliest onset of pain:

   • Ibuprofen 600-800 mg every 6-8 hours OR
   • Naproxen 440-550 mg every 12 hours 4, 1, 2

2. Add non-pharmacological approaches:

   • Heat application to abdomen/back 4
   • Acupressure at LI4 and SP6 points 4

3. If no improvement after 3 menstrual cycles with NSAIDs:

   • Consider hormonal contraceptives 6
   • Rule out secondary causes of dysmenorrhea (endometriosis, fibroids) 3

4. For heavy or prolonged bleeding with dysmenorrhea:

   • Consider combined hormonal contraceptives if medically eligible 4
   • Rule out underlying gynecological problems 4

Special Considerations

• For severe dysmenorrhea unresponsive to NSAIDs and hormonal treatments after 6 months, laparoscopy should be considered to evaluate for endometriosis 6
• Approximately 10% of females with severe dysmenorrhea may have underlying pelvic pathology 6
• NSAIDs are significantly more effective than placebo for pain relief, but users should be aware of potential adverse effects 5
• If bleeding irregularities persist and are unacceptable to the patient, consider alternative contraceptive methods 4