Dysmenorrhea, characterized by painful menstrual cramps, can be managed with NSAIDs like ibuprofen or naproxen and heat therapy for effective first-line relief. The over-the-counter progesterone-only contraceptive pill, norgestrel (Opill), may also help if not planning pregnancy. Alternatives for those unable to use NSAIDs include acetaminophen or self-acupressure techniques. Severe or persistent symptoms may require prescription treatments, such as combined hormonal contraceptives or GnRH agonists for underlying conditions like endometriosis.
January 10, 2025

Painful Periods (Dysmenorrhea)

Evidence-Based Over-the-Counter Guide

William Shen

William Shen

Co-founder & CPO

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Dysmenorrhea refers to painful menstrual cramps and can be classified as primary dysmenorrhea (without pelvic pathology) or secondary dysmenorrhea (caused by underlying conditions such as endometriosis). Primary dysmenorrhea occurs in up to 90% of women and starts during adolescence. 

Pain that is extreme or persistent despite treatment should be evaluated by a doctor but you do not need to delay self-treatment prior to an appointment.  

First-line recommendations:

Second-line recommendations:

  • Acetaminophen: Alternative for patients who cannot take NSAIDs. Dose: 500-1000 mg orally every 4-6 hours as needed (important to not exceed daily maximum listed on package). Acetaminophen 500mg gelcaps (FDA M013).

  • Oral contraceptives (if not intending to get pregnant): the only over-the-counter birth control pill is a progesterone-only medication called norgesterol (Opill). Dose: 0.075 mg orally once daily within a 3 hour window. Failure rate: perfect use 0.3%, typical use 9%. Norgesterol (Opill) 0.075 mg (FDA NDA 21045/S-011).

  • Self-acupressure: a safe and low-risk intervention, can significantly reduce average menstrual pain intensity, number of days with pain, and use of analgesics, as supported by a clinical trial. Self-acupressure tutorial.

Prescription medications:

  • Combined hormonal contraceptives: Used to suppress ovulation and reduce menstrual flow, thereby reducing or eliminating pain associated with menses.

  • Gonadotropin-releasing hormone (GnRH) agonists: Reserved for secondary dysmenorrhea caused by conditions like endometriosis.

Citations:

McKenna, K. A., & Fogleman, C. D. (2021). Dysmenorrhea. American family physician, 104(2), 164-170.

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