Treatment of primary dysmenorrhea in adult women

INTRODUCTION

Primary dysmenorrhea (PD) refers to the presence of recurrent, crampy, lower abdominal pain that occurs during menses in the absence of demonstrable pelvic disease. The management of women with PD will be reviewed here. The pathogenesis, clinical manifestations, and diagnosis of PD are discussed separately. (See "Pathogenesis, clinical manifestations, and diagnosis of primary dysmenorrhea in adult women".)

GENERAL APPROACH

Grading dysmenorrhea according to the severity of pain and limitation of daily activities may help guide treatment decisions (table 1). General measures for therapy include patient reassurance and education. In most women with PD, therapy can be initiated empirically.

Nonpharmacological interventions

Heat — Application of heat to the lower abdomen appears to be as effective as oral analgesics for relief of dysmenorrhea.

• One trial randomly assigned women to receive a heated patch plus placebo tablet, an unheated patch plus ibuprofen (400 mg), a heated patch plus ibuprofen, or an unheated patch and placebo tablet [1]. Women assigned a heated abdominal patch or ibuprofen achieved comparable pain relief and significantly greater pain relief than those assigned an unheated patch and placebo tablet. The combination of a heated abdominal patch plus ibuprofen did not provide greater total pain relief than an unheated abdominal patch plus ibuprofen. However, the combination of a heated abdominal patch plus ibuprofen reduced the time to noticeable pain relief compared to an unheated abdominal patch plus ibuprofen.
• A second trial by the same group randomly assigned women with dysmenorrhea to an abdominal heat wrap (40 degrees Celsius) which was worn for eight hours, a placebo wrap, acetaminophen (1000 mg every five hours, four times per day for one day), or placebo pills [2]. The heat wrap provided better pain relief than acetaminophen and was well tolerated.

Dietary, vitamin, and herbal treatments — A variety of dietary and vitamin therapies may reduce the severity of menstrual pain, but data are limited to a few small studies. Although the limited available data appear promising, we do not suggest these interventions for our patients at this time.