What is the best treatment for menstrual cramps?

Treatment of Menstrual Cramps (Dysmenorrhea)

NSAIDs are the first-line treatment for dysmenorrhea, with naproxen 440-550 mg every 12 hours or ibuprofen 600-800 mg every 6-8 hours being the most effective options. 1

First-Line Pharmacological Treatment

• NSAIDs work by inhibiting prostaglandin synthesis, which reduces uterine contractions, pressure, and pain during menstruation 1, 2
• Ibuprofen 400-800 mg every 4-6 hours is FDA-approved specifically for dysmenorrhea treatment 2
• For optimal effect, start medication at the earliest onset of menstrual pain or 1-2 hours before expected pain 1, 3
• Treatment should be short-term (5-7 days) during days of bleeding 1
• Prophylactic administration starting 24 hours before expected menstruation can significantly reduce pain intensity 4
• Take NSAIDs with food to minimize gastrointestinal side effects 1, 2

Non-Pharmacological Adjunctive Treatments

• Heat therapy applied to the abdomen or back can effectively reduce cramping pain 1, 3
• Acupressure on specific points (Large Intestine-4 point on hand, Spleen-6 point above medial malleolus) can help with pain relief 1, 3
• Aromatherapy with peppermint or lavender essential oils may decrease dysmenorrhea symptoms 1, 3
• Cold, wet towels on the forehead may provide additional comfort during painful episodes 3
• Slow-rhythm music can reduce pain and anxiety during episodes 3

Second-Line Treatment Options

• If NSAIDs are ineffective (occurs in approximately 18% of women), hormonal contraceptives may be considered 1, 5
• Combined oral contraceptives can reduce dysmenorrhea pain with moderate effectiveness (SMD -0.58) compared to placebo 5
• Continuous use of OCPs (without the usual 7-day break) may be more effective than standard regimens for pain reduction 5

Important Considerations and Precautions

• Lifestyle factors that may influence dysmenorrhea include:

  • Being overweight doubles the odds of having longer pain episodes 6
  • Smoking tends to increase the duration of menstrual cramps 6
  • Regular physical activity may help reduce symptoms, though evidence is limited 7

• Common side effects of NSAIDs include:

  • Gastrointestinal irritation (less with ibuprofen than aspirin) 2
  • Potential interaction with aspirin's antiplatelet activity 2
  • Risk of cardiovascular events with prolonged use 2

• Combined oral contraceptives have increased risks of:

  • Irregular bleeding (RR 2.63) 5
  • Headaches (RR 1.51) 5
  • Nausea (RR 1.64) 5
  • Contraindicated in women with migraine with aura due to increased stroke risk 8

Treatment Algorithm

1. Start with NSAIDs (naproxen 440-550 mg every 12 hours or ibuprofen 600-800 mg every 6-8 hours) at earliest onset of pain 1
2. Add non-pharmacological approaches (heat, acupressure, aromatherapy) 1, 3
3. If inadequate relief after 2-3 menstrual cycles, consider:
   • Prophylactic NSAID administration starting 24 hours before expected menstruation 4
   • Combined oral contraceptives if not contraindicated 5
4. For severe cases unresponsive to above measures, consider continuous OCP regimen 5

Special Considerations

• For women with pure menstrual migraine, perimenstrual preventive treatment with NSAIDs may be beneficial 8
• Women with suspected endometriosis may require specialized medical management 1, 5
• Persistent severe pain despite appropriate treatment warrants further evaluation for underlying conditions 3