Treatment
-NSAIDs are 1st-line. Start NSAID at the onset of menstruation and continue for the first 2-3 days of the menstrual cycle. Alternatively, start 1-2 days before the expected onset of menstrual period and continue on a fixed schedule for 2-3 days. Eg. Naproxen 375mg or 500mg po BID; Ibuprofen 400mg po q6-8h. All NSAIDs are equally effective. None has been shown to be better. The choice depends on patient preference.
-Oral contraceptive (OC) if contraception is desired.
-Combine both NSAID and OC if a single agent doesn’t provide adequate relief.
-Consider laparoscopy if medical therapy fails.
Background
Primary dysmenorrhea = Painful menses without apparent pathology; increased PGF2 alpha in the menstrual fluid may contribute to dysmenorrhea. Primary dysmenorrhea is common in the first 3 years after menarche. It improves after a full-term pregnancy. It’s difficult to distinguish primary dysmenorrhea from endometriosis based on the symptoms alone.