NSAIDs are the most common pharmacologic treatment for dysmenorrhea: NSAIDs, which are able to inhibit prostaglandin synthetase, have significantly alleviated symptoms of dysmenorrhea in 75% of adolescents.
Propionates such as ibuprofen (400 mg/4 h), naproxen (500 mg: half a pill every 6 h) are usually prescribed the day before menstruation and during the acute pain. Funamates, also potent inhibitors of PG synthetase, are better tolerated.
Progestagen (dydrogesterone) has also been proved helpful in relieving the symptoms of dysmenorrhea.
One small randomized controlled trial including adolescents demonstrated an improvement in dysmenorrhea with high-dose combined oral contraceptive treatment (COC) compared to placebo. The efficacy of low-dose COC in the treatment of adolescent dysmenorrhea has yet to be determined. If effective, well-established safety and non-contraceptive health benefits may make COC an ideal treatment for dysmenorrhea in adolescent girls, according to these authors. In our opinion, COC should be reserved for older adolescents who need a contraceptive method, also, it lessens dysmenorrhea by reducing endometrial development.
Recently, Ziaei et al. reported the effectiveness of vitamin E (500 IU/day) in adolescent dysmenorrhea, and Brouard et al. showed for the first time a therapeutic effect of an orally active vasopressin V1a receptor antagonist in the prevention of dysmenorrhea in young women. A low-fat vegetarian diet was associated with reduction in body weight, dysmenorrhea duration and intensity. However, as pointed out by some groups, 29% of the prescription drug users may not be using medications effectively.
Revision date: July 7, 2011
Last revised: by Jorge P. Ribeiro, MD