What medications are effective for managing period cramps?

Medications for Period Cramps (Dysmenorrhea)

NSAIDs are the first-line treatment for menstrual cramps, with naproxen 440-550 mg every 12 hours or ibuprofen 600-800 mg every 6-8 hours being the most effective options, taken with food for 5-7 days during menstruation. 1, 2

First-Line Pharmacological Treatment: NSAIDs

NSAIDs work by blocking prostaglandin synthesis, which is the primary cause of menstrual cramping pain. 3, 4 The endometrium in women with dysmenorrhea produces excessive prostaglandins, leading to uterine hypercontractility, ischemia, and pain. 3, 5

Recommended NSAID Regimens:

• Naproxen sodium 440-550 mg every 12 hours, taken with food 1, 2
• Ibuprofen 600-800 mg every 6-8 hours, taken with food 1
• Mefenamic acid for 5-7 day treatment courses 1
• Diclofenac potassium 50 mg three times daily provides effective 24-hour pain relief 6

Optimal Timing Strategy:

• Start NSAIDs 2 days before expected menstruation for perimenstrual prophylaxis, continuing for 5 days total 2
• This prophylactic approach is particularly effective for severe, disabling dysmenorrhea 7
• Treatment duration should be short-term (5-7 days) during days of bleeding only 1, 2

Critical Safety Considerations:

• Use the lowest effective dose for the shortest duration 2
• Contraindications include: active peptic ulcer disease, cardiovascular disease, renal insufficiency, history of GI bleeding 2, 8
• Exercise caution in patients at risk for bleeding or with renal impairment 2
• NSAIDs should never be used right before or after coronary artery bypass graft (CABG) surgery 8
• High-risk patients (older adults, those with cardiovascular or GI comorbidities) require counseling about gastrointestinal protection 2

Second-Line Treatment: Hormonal Contraceptives

If NSAIDs fail after 2-3 menstrual cycles, combined oral contraceptives (COCs) with 30-35 μg ethinyl estradiol plus levonorgestrel or norgestimate should be initiated. 1

• COCs reduce menstrual fluid prostaglandins by inhibiting endometrial growth 3
• Extended or continuous cycle COCs are particularly appropriate for severe dysmenorrhea, as they minimize hormone-free intervals and optimize ovarian suppression 1
• Monophasic formulations are recommended for simplicity 1
• COCs are completely reversible with no negative effect on long-term fertility 1

Complementary Non-Pharmacological Measures

These adjunctive treatments can enhance pain relief:

• Heat therapy applied to the abdomen or back reduces cramping pain 1, 2
• Acupressure on specific points:
  • Large Intestine-4 (LI4) point on the dorsum of the hand 1, 2
  • Spleen-6 (SP6) point located approximately 4 fingers above the medial malleolus 1, 2
• Peppermint essential oil has been shown to decrease dysmenorrhea symptoms 1

When Treatment Fails

Approximately 18% of women with dysmenorrhea are unresponsive to NSAIDs. 1 In these cases:

• Verify the diagnosis and rule out secondary dysmenorrhea from underlying pelvic pathology 2
• Rule out: pregnancy, sexually transmitted diseases, structural abnormalities (fibroids, polyps, endometriosis) 1
• Refer for hormonal contraceptive options or further gynecologic evaluation 2
• Consider medical management with progestins, danazol, oral contraceptives, or GnRH agonists if endometriosis is suspected 1

Critical Pitfall to Avoid

Never prescribe opioids for dysmenorrhea - they are not more effective than NSAIDs and carry significant risks of dependence, adverse effects, and long-term use without improving outcomes. 2