From the Research
For menstrual cramps, acetaminophen immediate release is generally more effective than extended release, but the most recent and highest quality study 1 suggests that naproxen sodium is more effective than acetaminophen for relieving menstrual pain. The study found that a single dose of naproxen sodium (440mg) provided significantly greater pain relief than acetaminophen (1000mg) over 12 hours, with a least-squares mean difference of 4.31 (p < 0.001) in total pain relief. Some key points to consider when treating menstrual cramps include:
- The use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen sodium, which have been shown to be effective in reducing menstrual pain by inhibiting the production of prostaglandins 2
- The importance of choosing the right formulation, with immediate release formulations generally providing faster relief than extended release formulations
- The potential benefits of combining acetaminophen with an NSAID like ibuprofen (400mg every 6-8 hours with food) for better relief, as NSAIDs specifically target prostaglandins that cause uterine contractions 3 It's also worth noting that the evidence suggests that NSAIDs are associated with more adverse effects than placebo, including gastrointestinal and neurological adverse effects 2. Therefore, the recommended treatment for menstrual cramps is 440mg of naproxen sodium every 8-12 hours as needed, not exceeding 1320mg in 24 hours, or combining 650mg of acetaminophen (two 325mg tablets) every 4-6 hours as needed with an NSAID like ibuprofen (400mg every 6-8 hours with food). If acetaminophen or naproxen sodium alone doesn't provide adequate relief, consider consulting a healthcare provider about other options, such as estrogen-progestin oral contraceptive pills (OCPs), which have been shown to be effective in reducing menstrual pain by inhibiting endometrial development and decreasing menstrual prostanoids 3.