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Dysmenorrhoea - Management
How do I manage primary dysmenorrhoea?

  • Offer a nonsteroidal anti-inflammatory drug (NSAID) first line unless NSAIDs are contraindicated.
    • Ibuprofen, naproxen, and mefenamic acid are the NSAIDs of choice.
    • See the CKS topic on NSAIDs - prescribing issues for further information.
  • Offer paracetamol first line if NSAIDs are contraindicated or not tolerated, or in addition to an NSAID if the response is insufficient.
  • Codeine may be added to paracetamol or an NSAID if the response is insufficient.
  • If the woman does not wish to conceive, consider hormonal contraception as alternative first-line treatment.
    • Monophasic combined oral contraceptive (COC) preparations containing 30–35 micrograms of ethinylestradiol, and norethisterone, norgestimate, or levonorgestrel, are usually first choice.
    • Oral (Cerazette®), parenteral (Depo-Provera®, Nexplanon® [formerly Implanon®]), and intrauterine progestogen-only (Mirena®) contraceptives may also be considered, after a full discussion of the advantages and disadvantages.
    • See the CKS topic on Contraception for detailed information on prescribing hormonal contraceptives.
  • Combination of an NSAID (or paracetamol, with or without codeine) and hormonal contraception is an option for women who do not respond to a single treatment.
  • Refer the woman if her symptoms are severe and not responding to initial treatment, or if there is doubt about the diagnosis.
  • Non-drug measures that may help to reduce pain include:
    • Local application of heat (e.g. a hot water bottle or heat patch).
    • Transcutaneous electrical nerve stimulation (TENS).
  • There is insufficient evidence available to recommend herbal and dietary supplements, acupuncture, exercise, spinal manipulation, or behavioural interventions for the treatment of primary dysmenorrhoea.

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