Fig. 21.1
Primary vs. secondary dysmenorrhea flow diagram. [3]

21.7 Introduction to Treatment

Increased levels of circulating PGF2α and PGE2 lead to increased myometrial contraction, vasoconstriction, and hypersensitization of pain fibers [3]. On account of the PG-based etiology of primary dysmenorrhea, the current most common pharmacologic treatment for dysmenorrhea is nonsteroidal anti-inflammatory drugs (NSAIDS) [9].

21.8 Pharmacologic Treatment

21.8.1 NSAIDS: First-Line Therapy

The various formulations of NSAIDS have comparable efficacy for dysmenorrhea, and pain relief is successfully achieved in 64–100 % on women [3]. First-line therapy:

Nonsteroidal anti-inflammatory drugs (NSAIDS)



Mefenamic acid



  1. 1.

    May increase risk of cardiovascular thrombotic events


  2. 2.

    May increase risk of stroke


  3. 3.

    May increase risk of gastric ulcer/bleeding and intestine perforation


  4. 4.

    Caution if asthmatic


  5. 5.

    Caution if dehydrated


21.8.2 Hormonal Contraceptives: Second-Line Therapy

Suppress ovulation and reduce thickness of the endometrial lining of the uterus, thereby reducing the volume of menstrual fluid [8]. This form of therapy includes hormonal intrauterine devices (IUDs) [3].


  1. 1.

    Increase risk of thrombotic event


  2. 2.

    Increase risk of cardiovascular side effects with cigarette smoking


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Nov 20, 2017 | Posted by in Uncategorized | Comments Off on Dysmenorrhea
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