From the Guidelines
The first line treatment for painful menses is nonsteroidal anti-inflammatory drugs (NSAIDs) for short-term treatment (5–7 days) as recommended by the U.S. selected practice recommendations for contraceptive use, 2013 1. When considering treatment options, it's essential to rule out underlying gynecological problems, such as interactions with other medications, STDs, pregnancy, or new pathologic uterine conditions like fibroids or polyps.
- Key considerations for NSAID treatment include:
- Starting medication at the first sign of menstrual bleeding or pain
- Continuing treatment for 2-3 days as needed
- Taking NSAIDs with food to minimize gastrointestinal side effects
- Switching to another NSAID if one is ineffective after three menstrual cycles
- Alternative treatment options, such as hormonal treatment with low-dose COCs or estrogen, may be considered if NSAIDs are ineffective or if the woman is medically eligible and desires contraception.
- Additionally, complementary relief methods like heat therapy, regular exercise, and stress reduction techniques can be used alongside medication to provide optimal pain management.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... 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 first line treatment for painful menses (dysmenorrhea) is ibuprofen (PO) at a dose of 400 mg every 4 hours as necessary for relief of pain 2.
From the Research
First Line Treatment for Painful Menses
- The first line treatment for painful menses, also known as primary dysmenorrhea, is the use of nonsteroidal anti-inflammatory drugs (NSAIDs) 3, 4, 5, 6, 7.
- NSAIDs are effective in relieving pain by blocking prostaglandin production, which causes uterine hypercontractility and subsequent pain 5, 6, 7.
- For women who wish to use contraception, combined oral contraceptives (COCs) are a preferential therapy for pain relief from dysmenorrhea, as they provide additional non-contraceptive benefits without additional risks 4.
Alternative Treatments
- Alternative treatments, such as topical heat, lifestyle modification, transcutaneous electrical nerve stimulation, dietary supplements, acupuncture, and acupressure, may be an option in cases where conventional treatments are contraindicated 3.
- Hormonal contraceptives, such as ethinylestradiol/chlormadinone acetate, may provide more pronounced relief of dysmenorrheic pain compared to other hormonal contraceptives 4.
Safety and Efficacy
- NSAIDs are associated with a significant risk of adverse effects, including gastrointestinal and neurological adverse effects 5, 6, 7.
- There is insufficient evidence to determine which individual NSAID is the safest and most effective for the treatment of dysmenorrhea 5, 6, 7.
- The quality of evidence for most comparisons is rated as low due to poor reporting of study methods 6.