Dysmenorrhea Medication

Updated: Oct 27, 2016
  • Author: Karim Anton Calis, PharmD, MPH, FASHP, FCCP; Chief Editor: Michel E Rivlin, MD  more...
  • Print
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.

Next:

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

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)

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)

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)

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

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)

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.

Previous
Next:

Opioid Analgesics

Class Summary

These medications provide control of moderate to severe pain.

Hydrocodone and acetaminophen (Vicodin, Lorcet Plus, Lortab)

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

Previous
Next:

Oral Contraceptives

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)

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

Levonorgestrel-releasing intrauterine device (Mirena)

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)

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)

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)

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)

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)

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)

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

Previous