From the Guidelines
For menstrual cramps, I recommend starting with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours or naproxen sodium (Aleve) 220mg every 8-12 hours, beginning 1-2 days before your period starts and continuing through the first few days of bleeding. These medications work by reducing prostaglandin production, which causes uterine contractions and pain 1. For more severe cramps, hormonal contraceptives like birth control pills, patches, rings, or hormonal IUDs can be prescribed to reduce menstrual flow and pain. Applying heat to the lower abdomen with a heating pad (15-20 minutes at a time) can also help relax uterine muscles. Some key points to consider when treating menstrual cramps include:
- Staying hydrated
- Regular exercise
- Avoiding caffeine and alcohol around your period may provide additional relief
- If over-the-counter medications don't provide adequate relief or if cramps are severely impacting your daily activities, consult a healthcare provider as this could indicate conditions like endometriosis or fibroids that require different treatment approaches. It's also worth noting that individuals with painful menses may have significant improvement of their symptoms with the levonorgestrel IUD 1. However, the primary treatment approach should prioritize NSAIDs and other non-invasive methods before considering hormonal contraceptives or IUDs. In cases where heavy or prolonged bleeding is a concern, treatment options during days of bleeding can include NSAIDs for short-term treatment, hormonal treatment with low-dose COCs or estrogen, or alternative contraceptive methods if bleeding persists 1.
From the FDA Drug Label
Dysmenorrhea: For the treatment of dysmenorrhea, beginning with the earliest onset of such pain, ibuprofen tablets should be given in a dose of 400 mg every 4 hours as necessary for the relief of pain. The treatment for dysmenorrhea (menstrual cramps) is ibuprofen tablets 400 mg every 4 hours as necessary for relief of pain 2.
- The dose should be given at the earliest onset of pain.
- The treatment is for the relief of pain associated with dysmenorrhea.
From the Research
Treatment Options for Dysmenorrhea
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, and ketoprofen are effective in relieving primary dysmenorrhea symptoms 3, 4, 5, 6, 7
- These drugs work by inhibiting prostaglandin production, which is responsible for causing uterine contractions and pain
- Estrogen-progestin oral contraceptive pills (OCPs) are also effective in reducing menstrual prostanoids and relieving primary dysmenorrhea symptoms 3, 5
- NSAIDs have been shown to be more effective than placebo and paracetamol in relieving pain, but may be associated with more adverse effects 6, 7
Mechanism of Action
- Prostaglandins play a key role in the pathophysiology of primary dysmenorrhea, causing uterine contractions and pain
- NSAIDs inhibit prostaglandin production, reducing uterine contractions and pain
- OCPs inhibit endometrial development and decrease menstrual prostanoids, also reducing uterine contractions and pain
Efficacy and Safety
- NSAIDs are effective in relieving primary dysmenorrhea symptoms in up to 80% of patients 4
- However, NSAIDs may be associated with adverse effects, and women using them should be aware of the risks 6, 7
- There is insufficient evidence to determine which individual NSAID is the safest and most effective for the treatment of dysmenorrhea 6, 7