Treatment for Dysmenorrhea-Related Backache
NSAIDs are the first-line treatment for backache during periods, with ibuprofen 400 mg every 4-6 hours or naproxen 400-500 mg twice daily started at the earliest onset of menstrual pain. 1, 2, 3
First-Line Pharmacologic Treatment
NSAIDs work by blocking prostaglandin production, which is the primary cause of both menstrual cramping and associated back pain. 2, 4
- Start NSAIDs at the very first sign of menstrual pain or bleeding—do not wait for pain to become severe. 1, 2
- Ibuprofen 400 mg every 4-6 hours (maximum 3200 mg/day) is the standard dosing. 1
- Naproxen 400-500 mg twice daily provides superior pain relief compared to ibuprofen 200 mg and acetaminophen, with longer duration of action. 3
- Take with food or milk to minimize gastrointestinal side effects. 1
Acetaminophen is less effective than NSAIDs for menstrual-related back pain and should only be used if NSAIDs are contraindicated. 5, 3
Second-Line Treatment: Hormonal Contraception
If NSAIDs alone provide inadequate relief, add combined oral contraceptives or other hormonal contraception. 2, 4
- Hormonal contraceptives reduce endometrial prostaglandin production by thinning the endometrial lining. 2
- This is particularly appropriate for women who also desire contraception. 2, 4
Non-Pharmacologic Adjuncts
Heat therapy provides short-term relief and can be used alongside NSAIDs. 6, 7
- Apply heating pads or heated blankets to the lower back and abdomen. 6
- Heat is safe, inexpensive, and has no drug interactions. 6
Regular aerobic exercise and stretching reduce dysmenorrhea severity over time. 8, 7
- Encourage ongoing physical activity, not just during menstruation. 8
Critical Pitfalls to Avoid
Do not prescribe systemic corticosteroids—they have no proven efficacy for dysmenorrhea. 6, 9
Do not use opioids for primary dysmenorrhea. The evidence supports NSAIDs and hormonal therapy as highly effective, making opioids unnecessary and potentially harmful. 2, 4
Approximately 10% of women do not respond to NSAIDs and hormonal therapy—these patients require evaluation for secondary dysmenorrhea (endometriosis, fibroids, adenomyosis). 4, 8
- Consider pelvic examination, ultrasound, and gynecology referral if pain persists despite 3 months of appropriate first-line treatment. 8, 7
- Endometriosis should be strongly suspected in adolescents and young women with severe dysmenorrhea refractory to NSAIDs and hormonal contraception. 8
Alternative Therapies (Adjunctive Only)
Ginger, cinnamon, and peppermint supplements may provide modest additional benefit but should not replace NSAIDs. 8, 7
Acupuncture and transcutaneous electrical nerve stimulation (TENS) have limited evidence and should only be considered as adjuncts after first-line therapy. 7