What is the treatment for dysmenorrhea?

Treatment for Dysmenorrhea

NSAIDs are the first-line treatment for dysmenorrhea, with ibuprofen 400 mg every 4-6 hours as needed being the most effective option. 1, 2

First-Line Pharmacological Treatment

• NSAIDs are recommended as first-line treatment due to their ability to inhibit prostaglandin synthesis, which is the primary cause of menstrual pain 2, 3
• Ibuprofen 400 mg every 4-6 hours as necessary for pain relief is FDA-approved specifically for dysmenorrhea 1
• Alternative NSAIDs include naproxen 440-550 mg every 12 hours, which has shown superior pain relief compared to acetaminophen and ibuprofen in some studies 2, 4
• Treatment should be short-term (5-7 days) during days of bleeding 5, 2
• NSAIDs work by reducing elevated levels of prostaglandin activity in menstrual fluid and decreasing uterine contractions 1

Second-Line Treatment Options

• If NSAIDs are ineffective or contraindicated, hormonal treatments should be considered:
  • Combined oral contraceptives (COCs) or other hormonal contraceptives for women who also desire contraception 5, 2
  • For heavy or prolonged bleeding with dysmenorrhea, low-dose COCs or estrogen for 10-20 days can be effective 5
• Approximately 18% of women with dysmenorrhea are unresponsive to NSAIDs and may require alternative treatments 2

Non-Pharmacological Adjunctive Treatments

• Heat therapy applied to the abdomen or back can effectively reduce cramping pain 2, 3
• Acupressure on specific points (LI4 on hand dorsum and SP6 above medial malleolus) can provide pain relief 2
• Peppermint essential oil has shown effectiveness in decreasing dysmenorrhea symptoms 2
• Regular physical exercise may help reduce symptoms, though evidence is less robust than for heat therapy 3

Treatment Algorithm

1. Start with NSAIDs at appropriate dosing:

   • Ibuprofen 400-800 mg every 4-6 hours (not exceeding 3200 mg daily) 1
   • Naproxen 440-550 mg every 12 hours 2
   • Take with food to minimize gastrointestinal side effects 1

2. If inadequate relief after 1-2 menstrual cycles with NSAIDs:

   • Consider hormonal contraceptives if not contraindicated 5, 2
   • For women with heavy bleeding, add hormonal treatment (low-dose COCs or estrogen) for 10-20 days 5

3. For persistent symptoms despite medical treatment:

   • Evaluate for secondary causes of dysmenorrhea (endometriosis, adenomyosis, fibroids) 6, 7
   • Consider referral to gynecologist if secondary dysmenorrhea is suspected 3

Important Considerations

• NSAIDs are significantly more effective than placebo for pain relief (OR 7.91,95% CI 5.65-11.09) but have more adverse effects (OR 1.52,95% CI 1.09-2.12) 8
• Take NSAIDs with food to minimize gastrointestinal side effects 1
• If bleeding irregularities persist and are unacceptable to the patient despite treatment, consider alternative contraceptive methods 5
• Primary dysmenorrhea should be distinguished from secondary dysmenorrhea, which requires treatment of the underlying condition 6, 7