Dysmenorrhea Medication: Nonsteroidal Anti-inflammatory Drugs (NSAIDs), Opioid Analgesics, Oral Contraceptives

Sections

Dysmenorrhea

Medication

Medication Summary

Treatment of primary dysmenorrhea is directed at providing relief from the cramping pelvic pain and associated symptoms that typically accompany or immediately precede the onset of menstrual flow. To date, pharmacotherapy has been the most reliable and effective treatment for relieving dysmenorrhea. Nonsteroidal anti-inflammatory drugs (NSAIDs) and combination oral contraceptives (OCs) are the most commonly used therapeutic modalities for the management of primary dysmenorrhea.

Treatment of secondary dysmenorrhea involves correction of the underlying organic cause. Specific measures (medical or surgical) may be required to treat pelvic pathology (eg, endometriosis) and to ameliorate the associated dysmenorrhea. Periodic use of analgesic agents as adjunctive therapy may be beneficial.

Class Summary

NSAIDs are highly effective in treating dysmenorrhea, especially when they are started before the onset of menses and continued through day 2. They are readily available, relatively inexpensive, and have a low side effect profile when used cautiously and in those who have no contraindications. Diclofenac, ibuprofen, ketoprofen, meclofenamate, mefenamic acid, and naproxen are the NSAIDs specifically approved by the US Food and Drug Administration (FDA) for treatment of dysmenorrhea.

Naproxen (Naprosyn, Aleve, Anaprox)

View full drug information

Naproxen is available in both prescription and nonprescription doses. It inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, thereby decreasing prostaglandin synthesis. The daily cost is approximately $3.00, compared with $0.14 for generic ibuprofen.

Ibuprofen (Advil, Motrin, NeoProfen)

View full drug information

Ibuprofen is available in both prescription and nonprescription doses. It inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, thereby decreasing prostaglandin synthesis. If not contraindicated, it is the drug of choice for treatment of mild to moderate pain.

Diclofenac (Cataflam, Voltaren XR, Cambia, Zipsor)

View full drug information

Diclofenac is one of a series of phenylacetic acids that have demonstrated anti-inflammatory and analgesic properties in pharmacologic studies. It inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, thereby decreasing prostaglandin synthesis.

Because diclofenac can cause hepatotoxicity, liver enzymes should be monitored in the first 8 weeks of treatment. Diclofenac is rapidly absorbed; metabolism occurs in the liver via demethylation, deacetylation, and glucuronide conjugation. The delayed-release, enteric-coated form is diclofenac sodium, and the immediate-release form is diclofenac potassium. Diclofenac carries a relatively low risk of bleeding gastrointestinal (GI) ulcers.

Ketoprofen

View full drug information

Ketoprofen inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, thereby decreasing prostaglandin synthesis. Smaller initial dosages are particularly indicated in the elderly and in those with renal or liver dysfunction. Doses higher than 75 mg do not improve therapeutic response and may be associated with a higher incidence of adverse effects.

Meclofenamate

Meclofenamate inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, thereby decreasing prostaglandin synthesis. Compared with other NSAIDs, it is associated with a higher incidence of diarrhea.

Mefenamic acid (Ponstel)

View full drug information

Mefenamic acid inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, thereby decreasing prostaglandin synthesis. Compared with other NSAIDs, it is associated with a higher incidence of diarrhea.

Class Summary

These medications provide control of moderate to severe pain.

Hydrocodone and acetaminophen (Vicodin, Lorcet Plus, Lortab)

View full drug information

Hydrocodone plus acetaminophen is a drug combination indicated for moderate to severe pain.

Class Summary

In some patients, OCs can prevent dysmenorrhea altogether, though these agents are not approved by the FDA for this indication. OCs may be an appropriate treatment choice in patients who do not wish to conceive. Use of OCs in a manner that reduces the number of menstrual cycles may be beneficial for some patients. Combination OCs, the levonorgestrel intrauterine device, and depot medroxyprogesterone acetate provide effective pain relief and are associated with a reduced menstrual flow.

Medroxyprogesterone (Provera, Depo Provera)

View full drug information

Medroxyprogesterone inhibits secretion of gonadotropins, thereby inhibiting ovulation and decreasing the thickness of the endometrium.

Levonorgestrel-releasing intrauterine device (Mirena)

View full drug information

The levonorgestrel-releasing intrauterine device inhibits secretion of gonadotropins, thereby inhibiting ovulation and decreasing the thickness of the endometrium.

Ethinyl estradiol and norgestimate (Ortho Tri-Cyclen, MonoNessa, Previfem, TriNessa)

View full drug information

This drug combination reduces secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary by decreasing the amount of gonadotropin-releasing hormones.

Ethinyl estradiol and norgestrel (Lo/Ovral 28, Ogestrel, Low-Ogestrel)

View full drug information

This drug combination reduces secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary by decreasing the amount of gonadotropin-releasing hormones.

Ethinyl estradiol and levonorgestrel (Levora, Lybrel, Altavera)

View full drug information

This drug combination reduces secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary by decreasing the amount of gonadotropin-releasing hormones.

Ethinyl estradiol and Norethindrone (Cyclofem, Nortrel 1/35, Ortho-Novum)

View full drug information

This drug combination reduces secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary by decreasing the amount of gonadotropin-releasing hormones.

Ethinyl estradiol and Ethynodiol diacetate (Kelnor, Zovia)

View full drug information

This drug combination reduces secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary by decreasing the amount of gonadotropin-releasing hormones.

Drosperinone/ethinyl estradiol (Yasmin, Yaz)

View full drug information

Reduces secretion of LH and FSH from pituitary by decreasing amount of gonadotropin-releasing hormones.

Questions

Smith RP. Cyclic pelvic pain and dysmenorrhea. Obstet Gynecol Clin North Am. 1993 Dec. 20(4):753-64. [Medline].
Smith RP. Gynecology in Primary Care. Baltimore: Williams & Wilkins; 1997. 389-404.
Ryan SA. The Treatment of Dysmenorrhea. Pediatr Clin North Am. 2017 Apr. 64 (2):331-342. [Medline].
Jamieson DJ, Steege JF. The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices. Obstet Gynecol. 1996 Jan. 87(1):55-8. [Medline].
Dawood MY. Dysmenorrhea. J Reprod Med. 1985 Mar. 30(3):154-67. [Medline].
Koltz MM. Dysmenorrhea, endometriosis and pelvic pain. Lemeke DP, Pattison J, Marshall LA, Cowley DS, eds. Primary Care of Women. Norwalk Conn: Appleton & Lange; 1992. 420-32.
Dawood MY. Nonsteroidal anti-inflammatory drugs and changing attitudes toward dysmenorrhea. Am J Med. 1988 May 20. 84(5A):23-9. [Medline].
Dawood MY. Dysmenorrhea. Clin Obstet Gynecol. 1990 Mar. 33(1):168-78. [Medline].
Harlow SD, Park M. A longitudinal study of risk factors for the occurrence, duration and severity of menstrual cramps in a cohort of college women. Br J Obstet Gynaecol. 1996 Nov. 103(11):1134-42. [Medline].
Andersch B, Milsom I. An epidemiologic study of young women with dysmenorrhea. Am J Obstet Gynecol. 1982 Nov 15. 144(6):655-60. [Medline].
Sundell G, Milsom I, Andersch B. Factors influencing the prevalence and severity of dysmenorrhoea in young women. Br J Obstet Gynaecol. 1990 Jul. 97(7):588-94. [Medline].
Parazzini F, Tozzi L, Mezzopane R, Luchini L, Marchini M, Fedele L. Cigarette smoking, alcohol consumption, and risk of primary dysmenorrhea. Epidemiology. 1994 Jul. 5(4):469-72. [Medline].
Durain D. Primary dysmenorrhea: assessment and management update. J Midwifery Womens Health. 2004 Nov-Dec. 49(6):520-8. [Medline].
Proctor ML, Murphy PA, Pattison HM, Suckling J, Farquhar CM. Behavioural interventions for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev. 2007 Jul 18. CD002248. [Medline].
Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update. 2015 Nov. 21 (6):762-78. [Medline].
Willman EA, Collins WP, Clayton SG. Studies in the involvement of prostaglandins in uterine symptomatology and pathology. Br J Obstet Gynaecol. 1976 May. 83(5):337-41. [Medline].
Eden JA. Dysmenorrhea and premenstrual syndrome. NF Hacker, JG Moore, eds. Essentials of Obstetrics and Gynecology. 3rd ed. Philadelphia: WB Saunders; 1998. 386-92.
Speroff L. Postmenopausal hormone therapy into the 21st century. Int J Gynaecol Obstet. 1997 Oct. 59 Suppl 1:S3-10. [Medline].
Demers LM, Hahn DW, McGuire JL. Newer concepts in dysmenorrhea research: leukotrienes and calcium channel blockers. Dawood MY, McGuire JL, Demers LM, eds. Premenstrual Syndrome and Dysmenorrhea. London: Pitman; 1984. 205-13.
Chegini N, Rao CV. The presence of leukotriene C4- and prostacyclin-binding sites in nonpregnant human uterine tissue. J Clin Endocrinol Metab. 1988 Jan. 66(1):76-87. [Medline].
Nigam S, Benedetto C, Zonca M, Leo-Rossberg I, Lubbert H, Hammerstein J. Increased concentrations of eicosanoids and platelet-activating factor in menstrual blood from women with primary dysmenorrhea. Eicosanoids. 1991. 4(3):137-41. [Medline].
Rees MC, DiMarzo V, Tippins JR, Morris HR, Turnbull AC. Leukotriene release by endometrium and myometrium throughout the menstrual cycle in dysmenorrhoea and menorrhagia. J Endocrinol. 1987 May. 113(2):291-5. [Medline].
Akerlund M, Stromberg P, Forsling ML. Primary dysmenorrhoea and vasopressin. Br J Obstet Gynaecol. 1979 Jun. 86(6):484-7. [Medline].
Akerlund M. Pathophysiology of dysmenorrhea. Acta Obstet Gynecol Scand Suppl. 1979. 87:27-32. [Medline].
French L. Dysmenorrhea. Am Fam Physician. 2005 Jan 15. 71(2):285-91. [Medline].
Liu P, Yang J, Wang G, Liu Y, Liu X, Jin L, et al. Altered regional cortical thickness and subcortical volume in women with primary dysmenorrhoea. Eur J Pain. 2016 Apr. 20 (4):512-20. [Medline].
Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. BMJ. 2006 May 13. 332(7550):1134-8. [Medline]. [Full Text].
Baines PA, Allen GM. Pelvic pain and menstrual related illnesses. Emerg Med Clin North Am. 2001 Aug. 19(3):763-80. [Medline].
Kalish GM, Patel MD, Gunn ML, Dubinsky TJ. Computed tomographic and magnetic resonance features of gynecologic abnormalities in women presenting with acute or chronic abdominal pain. Ultrasound Q. 2007 Sep. 23(3):167-75. [Medline].
Kamaya A, Shin L, Chen B, Desser TS. Emergency gynecologic imaging. Semin Ultrasound CT MR. 2008 Oct. 29(5):353-68. [Medline].
Walker CK, Wiesenfeld HC. Antibiotic therapy for acute pelvic inflammatory disease: the 2006 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis. 2007 Apr 1. 44 Suppl 3:S111-22. [Medline].
Houry D, Abbott JT. Ovarian torsion: a fifteen-year review. Ann Emerg Med. 2001 Aug. 38(2):156-9. [Medline].
Levy BS, Apgar BS, Surrey ES, Wysocki S. Endometriosis and chronic pain: a multispecialty roundtable discussion. J Fam Pract. 2007 Mar. 56(3 Suppl Diagnosis):S3-13. [Medline].
Parker JD, Leondires M, Sinaii N, Premkumar A, Nieman LK, Stratton P. Persistence of dysmenorrhea and nonmenstrual pain after optimal endometriosis surgery may indicate adenomyosis. Fertil Steril. 2006 Sep. 86(3):711-5. [Medline].
Sobczyk R, Braunstein ML, Solberg L, Schuman SH. A case control survey and dysmenorrhea in a family practice population: a proposed disability index. J Fam Pract. 1978 Aug. 7(2):285-90. [Medline].
Fraser IS. Prostaglandins, prostaglandin inhibitors and their roles in gynaecological disorders. Baillieres Clin Obstet Gynaecol. 1992 Dec. 6(4):829-57. [Medline].
Osuga Y, Hayashi K, Kobayashi Y, et al. Dysmenorrhea in Japanese women. Int J Gynaecol Obstet. 2005 Jan. 88(1):82-3. [Medline].
Latthe P, Mignini L, Gray R, Hills R, Khan K. Factors predisposing women to chronic pelvic pain: systematic review. BMJ. 2006 Apr 1. 332(7544):749-55. [Medline]. [Full Text].
Klein JR, Litt IF. Epidemiology of adolescent dysmenorrhea. Pediatrics. 1981 Nov. 68(5):661-4. [Medline].
Ohde S, Tokuda Y, Takahashi O, Yanai H, Hinohara S, Fukui T. Dysmenorrhea among Japanese women. Int J Gynaecol Obstet. 2008 Jan. 100(1):13-7. [Medline].
Sharma P, Malhotra C, Taneja DK, Saha R. Problems related to menstruation amongst adolescent girls. Indian J Pediatr. 2008 Feb. 75(2):125-9. [Medline].
Lee LK, Chen PC, Lee KK, Kaur J. Menstruation among adolescent girls in Malaysia: a cross-sectional school survey. Singapore Med J. 2006 Oct. 47(10):869-74. [Medline].
El-Gilany AH, Badawi K, El-Fedawy S. Epidemiology of dysmenorrhoea among adolescent students in Mansoura, Egypt. East Mediterr Health J. 2005 Jan-Mar. 11(1-2):155-63. [Medline].
Cakir M, Mungan I, Karakas T, Girisken I, Okten A. Menstrual pattern and common menstrual disorders among university students in Turkey. Pediatr Int. 2007 Dec. 49(6):938-42. [Medline].
Burnett MA, Antao V, Black A, et al. Prevalence of primary dysmenorrhea in Canada. J Obstet Gynaecol Can. 2005 Aug. 27(8):765-70. [Medline].
Grandi G, Ferrari S, Xholli A, et al. Prevalence of menstrual pain in young women: what is dysmenorrhea?. J Pain Res. 2012. 5:169-74. [Medline]. [Full Text].
Swift D. Smoking may increase risk for dysmenorrhea. Medscape Medical News from WebMD. 2014 Nov 18. Available at http://www.medscape.com/viewarticle/835082. Accessed: November 29, 2014.
Ju H, Jones M, Mishra GD. Smoking and trajectories of dysmenorrhoea among young Australian women. Tob Control. 2014 Nov 17. [Medline].
Habibi N, Huang MS, Gan WY, Zulida R, Safavi SM. Prevalence of primary dysmenorrhea and factors associated with its intensity among undergraduate students: a cross-sectional study. Pain Manag Nurs. 2015 Aug 29. [Medline].
Dawood MY. Ibuprofen and dysmenorrhea. Am J Med. 1984 Jul 13. 77(1A):87-94. [Medline].
Bahrami A, Sadeghnia H, Avan A, Mirmousavi SJ, Moslem A, Eslami S, et al. Neuropsychological function in relation to dysmenorrhea in adolescents. Eur J Obstet Gynecol Reprod Biol. 2017 Aug. 215:224-229. [Medline].
Simpson JL, Elias S, Malinak LR, Buttram VC Jr. Heritable aspects of endometriosis. I. Genetic studies. Am J Obstet Gynecol. 1980 Jun 1. 137(3):327-31. [Medline].
Jamieson DJ, Steege JF. The association of sexual abuse with pelvic pain complaints in a primary care population. Am J Obstet Gynecol. 1997 Dec. 177(6):1408-12. [Medline].
Propst AM, Storti K, Barbieri RL. Lateral cervical displacement is associated with endometriosis. Fertil Steril. 1998 Sep. 70(3):568-70. [Medline].
Barbieri RL, Propst AM. Physical examination findings in women with endometriosis: uterosacral ligament abnormalities, lateral cervical displacement and cervical stenosis. J Gynecol Tech. 1999. 135:102.
Milsom I, Andersch B, Sundell G. The effect of flurbiprofen and naproxen sodium on intra-uterine pressure and menstrual pain in patients with primary dysmenorrhea. Acta Obstet Gynecol Scand. 1988. 67(8):711-6. [Medline].
Chan WY, Fuchs F, Powell AM. Effects of naproxen sodium on menstrual prostaglandins and primary dysmenorrhea. Obstet Gynecol. 1983 Mar. 61(3):285-91. [Medline].
Dawood MY, Khan-Dawood FS. Clinical efficacy and differential inhibition of menstrual fluid prostaglandin F2alpha in a randomized, double-blind, crossover treatment with placebo, acetaminophen, and ibuprofen in primary dysmenorrhea. Am J Obstet Gynecol. 2007 Jan. 196(1):35.e1-5. [Medline].
Zhang WY, Li Wan Po A. Efficacy of minor analgesics in primary dysmenorrhoea: a systematic review. Br J Obstet Gynaecol. 1998 Jul. 105(7):780-9. [Medline].
Rosenwaks Z, Jones GS, Henzl MR, Dubin NH, Ghodgaonkar RB, Hoffman S. Naproxen sodium, aspirin, and placebo in primary dysmenorrhea. Reduction of pain and blood levels of prostaglandin F2-alpha metabolite. Am J Obstet Gynecol. 1981 Jul 1. 140(5):592-8. [Medline].
Daniels SE, Torri S, Desjardins PJ. Valdecoxib for treatment of primary dysmenorrhea. A randomized, double-blind comparison with placebo and naproxen. J Gen Intern Med. 2005 Jan. 20(1):62-7. [Medline].
Morrison BW, Daniels SE, Kotey P, Cantu N, Seidenberg B. Rofecoxib, a specific cyclooxygenase-2 inhibitor, in primary dysmenorrhea: a randomized controlled trial. Obstet Gynecol. 1999 Oct. 94(4):504-8. [Medline].
Fujiwara H, Konno R, Netsu S, et al. Efficacy of montelukast, a leukotriene receptor antagonist, for the treatment of dysmenorrhea: a prospective, double-blind, randomized, placebo-controlled study. Eur J Obstet Gynecol Reprod Biol. 2010 Feb. 148(2):195-8. [Medline].
Wong CL, Farquhar C, Roberts H, Proctor M. Oral contraceptive pill as treatment for primary dysmenorrhoea. Cochrane Database Syst Rev. 2009 Apr 15. CD002120. [Medline].
Sillem M, Schneidereit R, Heithecker R, Mueck AO. Use of an oral contraceptive containing drospirenone in an extended regimen. Eur J Contracept Reprod Health Care. 2003 Sep. 8(3):162-9. [Medline].
Vercellini P, Frontino G, De Giorgi O, Pietropaolo G, Pasin R, Crosignani PG. Continuous use of an oral contraceptive for endometriosis-associated recurrent dysmenorrhea that does not respond to a cyclic pill regimen. Fertil Steril. 2003 Sep. 80(3):560-3. [Medline].
Cheewadhanaraks S, Choksuchat C, Dhanaworavibul K, Liabsuetrakul T. Postoperative depot medroxyprogesterone acetate versus continuous oral contraceptive pills in the treatment of endometriosis-associated pain: a randomized comparative trial. Gynecol Obstet Invest. 2012. 74(2):151-6. [Medline].
Petraglia F, Parke S, Serrani M, et al. Estradiol valerate plus dienogest versus ethinylestradiol plus levonorgestrel for the treatment of primary dysmenorrhea. Int J Gynaecol Obstet. 2014 Jun. 125(3):270-4. [Medline].
Barnard ND, Scialli AR, Hurlock D, Bertron P. Diet and sex-hormone binding globulin, dysmenorrhea, and premenstrual symptoms. Obstet Gynecol. 2000 Feb. 95(2):245-50. [Medline].
Harel Z, Biro FM, Kottenhahn RK, Rosenthal SL. Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents. Am J Obstet Gynecol. 1996 Apr. 174(4):1335-8. [Medline].
Ziaei S, Zakeri M, Kazemnejad A. A randomised controlled trial of vitamin E in the treatment of primary dysmenorrhoea. BJOG. 2005 Apr. 112(4):466-9. [Medline].
Smith CA, Armour M, Zhu X, Li X, Lu ZY, Song J. Acupuncture for dysmenorrhoea. Cochrane Database Syst Rev. 2016 Apr 18. 4:CD007854. [Medline].
Witt CM, Reinhold T, Brinkhaus B, Roll S, Jena S, Willich SN. Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care. Am J Obstet Gynecol. 2008 Feb. 198(2):166.e1-8. [Medline].
Ma YX, Ye XN, Liu CZ, et al. A clinical trial of acupuncture about time-varying treatment and points selection in primary dysmenorrhea. J Ethnopharmacol. 2013 Jul 9. 148(2):498-504. [Medline].
Abaraogu UO, Tabansi-Ochuogu CS. As acupressure decreases pain, acupuncture may improve some aspects of quality of life for women with primary dysmenorrhea: a systematic review with meta-analysis. J Acupunct Meridian Stud. 2015 Oct. 8 (5):220-8. [Medline].
Wade C, Wang L, Zhao WJ, Cardini F, Kronenberg F, Gui SQ, et al. Acupuncture point injection treatment of primary dysmenorrhoea: a randomised, double blind, controlled study. BMJ Open. 2016 Jan 5. 6 (1):e008166. [Medline].
Chen MN, Chien LW, Liu CF. Acupuncture or acupressure at the Sanyinjiao (SP6) acupoint for the treatment of primary dysmenorrhea: a meta-analysis. Evid Based Complement Alternat Med. 2013. 2013:493038. [Medline]. [Full Text].
Direkvand-Moghadam A, Khosravi A. The impact of a novel herbal Shirazi Thymus Vulgaris on primary dysmenorrhea in comparison to the classical chemical Ibuprofen. J Res Med Sci. 2012 Jul. 17(7):668-70. [Medline]. [Full Text].
Pattanittum P, Kunyanone N, Brown J, Sangkomkamhang US, Barnes J, Seyfoddin V, et al. Dietary supplements for dysmenorrhoea. Cochrane Database Syst Rev. 2016 Mar 22. 3:CD002124. [Medline].
Azima S, Bakhshayesh HR, Kaviani M, Abbasnia K, Sayadi M. Comparison of the effect of massage therapy and isometric exercises on primary dysmenorrhea: a randomized controlled clinical trial. J Pediatr Adolesc Gynecol. 2015 Dec. 28 (6):486-91. [Medline].
Akin M, Price W, Rodriguez G Jr, Erasala G, Hurley G, Smith RP. Continuous, low-level, topical heat wrap therapy as compared to acetaminophen for primary dysmenorrhea. J Reprod Med. 2004 Sep. 49(9):739-45. [Medline].
Akin MD, Weingand KW, Hengehold DA, Goodale MB, Hinkle RT, Smith RP. Continuous low-level topical heat in the treatment of dysmenorrhea. Obstet Gynecol. 2001 Mar. 97(3):343-9. [Medline].
Gurgan T, Urman B, Aksu T, Develioglu O, Zeyneloglu H, Kisnisci HA. Laparoscopic CO2 laser uterine nerve ablation for treatment of drug resistant primary dysmenorrhea. Fertil Steril. 1992 Aug. 58(2):422-4. [Medline].
Chen FP, Chang SD, Chu KK, Soong YK. Comparison of laparoscopic presacral neurectomy and laparoscopic uterine nerve ablation for primary dysmenorrhea. J Reprod Med. 1996 Jul. 41(7):463-6. [Medline].
Latthe PM, Proctor ML, Farquhar CM, Johnson N, Khan KS. Surgical interruption of pelvic nerve pathways in dysmenorrhea: a systematic review of effectiveness. Acta Obstet Gynecol Scand. 2007. 86(1):4-15. [Medline].
Matthewman G, Lee A, Kaur JG, Daley AJ. Physical activity for primary dysmenorrhea: a systematic review and meta-analysis of randomized controlled trials. Am J Obstet Gynecol. 2018 Sep. 219 (3):255.e1-255.e20. [Medline].
Song JA, Lee MK, Min E, Kim ME, Fike G, Hur MH. Effects of aromatherapy on dysmenorrhea: A systematic review and meta-analysis. Int J Nurs Stud. 2018 Aug. 84:1-11. [Medline].

Media Gallery

of 0

Author

Karim Anton Calis, PharmD, MPH, FASHP, FCCP Clinical Professor, Medical College of Virginia, Virginia Commonwealth University School of Pharmacy; Clinical Professor, University of Maryland School of Pharmacy; Director of Clinical Research and Compliance, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health

Karim Anton Calis, PharmD, MPH, FASHP, FCCP is a member of the following medical societies: American College of Clinical Pharmacy, American Society of Health-System Pharmacists, Endocrine Society

Disclosure: Nothing to disclose.

Coauthor(s)

Devra K Dang, PharmD, BCPS (AQ-ID), CDE Associate Clinical Professor, University of Connecticut School of Pharmacy

Disclosure: Nothing to disclose.

Sophia N Kalantaridou, MD Professor, Department of Obstetrics and Gynecology, University of Ioannina Medical School, Greece

Disclosure: Nothing to disclose.

Mert Erogul, MD Assistant Professor of Emergency Medicine, University Hospital of Brooklyn; Consulting Staff, Department of Emergency Medicine, Kings County Hospital

Mert Erogul, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Frances E Casey, MD, MPH Director of Family Planning Services, Department of Obstetrics and Gynecology, VCU Medical Center

Frances E Casey, MD, MPH is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Reproductive Health Professionals, National Abortion Federation, Physicians for Reproductive Health, Society of Family Planning

Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD Former Professor, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine

Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, Royal College of Surgeons of Edinburgh, Royal College of Obstetricians and Gynaecologists

Disclosure: Nothing to disclose.

Additional Contributors

Vaishali Popat, MD, MPH Clinical Investigator, Intramural Research Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health

Vaishali Popat, MD, MPH is a member of the following medical societies: American College of Physicians, Endocrine Society

Disclosure: Nothing to disclose.

Acknowledgements

Nahrain Alzubaidi, MD Georgetown University Hospital