What helps with dysmenorrhea (menstrual cramps)?

Effective Treatments for Menstrual Cramps (Dysmenorrhea)

NSAIDs such as ibuprofen (400-800 mg every 6-8 hours) or naproxen (440-550 mg every 12 hours) are the most effective first-line treatments for menstrual cramps, taken with food for the first 24 hours of pain onset. 1

Pharmacological Treatments

First-Line Options:

• NSAIDs work by inhibiting prostaglandin synthesis, which directly addresses the underlying cause of primary dysmenorrhea 2, 3
• Ibuprofen: 400-800 mg every 6-8 hours with food 1, 2
• Naproxen: 440-550 mg every 12 hours with food 1, 4
• Start medication at the earliest onset of pain for maximum effectiveness 1, 5
• Continue for the first 24 hours of menstruation or as needed for pain relief 1

Second-Line Options:

• Hormonal contraceptives (if contraception is also desired) can reduce menstrual pain by suppressing endometrial growth and development 3, 5
• Extended or continuous hormonal contraceptive regimens may be particularly helpful for severe dysmenorrhea 1

Non-Pharmacological Approaches

Heat Therapy:

• Apply heat to the abdomen or lower back using a heating pad or hot water bottle 1, 6
• Heat therapy works by improving blood flow and reducing uterine muscle spasms 1

Acupressure:

• Self-stimulation of specific acupressure points can help reduce cramping 1
• Large Intestine-4 (LI4) point: located on the dorsum of the hand, between the thumb and index finger 1
• Spleen-6 (SP6) point: located approximately 4 fingers above the medial malleolus (inner ankle) 1

Other Non-Pharmacological Methods:

• Regular physical exercise can help reduce the severity of menstrual cramps 6
• Relaxation techniques and yoga-based breathing may help manage pain 1
• Aromatherapy with lavender or peppermint essential oils may provide some relief 1
• Slow-rhythm music may help reduce pain perception 1

Treatment Algorithm

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

   • Ibuprofen 400-800 mg every 6-8 hours with food, OR
   • Naproxen 440-550 mg every 12 hours with food 1, 2

2. Combine with non-pharmacological approaches:

   • Apply heat to abdomen/lower back 1
   • Use acupressure at LI4 and SP6 points 1

3. If inadequate relief or contraception is desired:

   • Consider hormonal contraceptives 5, 6

4. For persistent, severe pain unresponsive to above measures:

   • Evaluate for secondary causes of dysmenorrhea (endometriosis, fibroids, etc.) 5, 6

Common Pitfalls and Caveats

• Waiting too long to start medication reduces effectiveness; begin at earliest onset of pain 5, 6
• Taking NSAIDs without food increases risk of gastrointestinal side effects 2
• Accepting severe menstrual pain as normal rather than seeking treatment 5
• Not ruling out secondary causes of dysmenorrhea when pain is severe or unresponsive to treatment 5, 6
• Failing to use the appropriate NSAID dosage—underdosing is common and reduces effectiveness 2, 4

Research shows that naproxen may provide longer-lasting relief (up to 12 hours) compared to acetaminophen for menstrual pain 4, making it particularly useful for overnight pain control.