NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are effective in relieving the pain of primary dysmenorrhea. They can have side effects of nausea, dyspepsia, peptic ulcer and diarrhea.

Hormonal birth control

Use of hormonal birth control may improve symptoms of primary dysmenorrhea.

A 2009 systematic review found limited evidence that the low or medium doses of estrogen contained in the birth control pill reduces pain associated with dysmenorrhea. In addition, no differences between different birth control pill preparations were found.

Norplant and Depo-provera are also effective, since these methods often induce amenorrhea. The intrauterine system (Mirena IUD) may be useful in reducing symptoms.

Other

A review indicated the effectiveness of transdermal nitroglycerin. Reviews indicated the effectiveness of magnesium supplementation.

A review indicated the usefulness of using calcium channel blockers.

Heat is effective compared to NSAIDs and is a preferred option by many patients, as it is easy to access and has no known side effects.

Tamoxifen has been used effectively to reduce uterine contractility and pain in dysmenorrhea patients.

Alternative medicine

There is insufficient evidence to recommend the use of many herbal or dietary supplements for treating dysmenorrhea, including melatonin, vitamin E, fennel, dill, chamomile, cinnamon, damask rose, rhubarb, guava, and uzara. Further research is recommended to follow up on weak evidence of benefit for: fenugreek, ginger, valerian, zataria, zinc sulphate, fish oil, and vitamin B1.

A 2016 review found that evidence of safety is insufficient for most dietary supplements. There is some evidence for the use of fenugreek.

One review found thiamine and vitamin E to be likely effective. It found the effects of fish oil and vitamin B12 to be unknown.

Reviews found tentative evidence that ginger powder may be effective for primary dysmenorrhea. Reviews have found promising evidence for Chinese herbal medicine for primary dysmenorrhea, but that the evidence was limited by its poor methodological quality.

A 2016 Cochrane review of acupuncture for dysmenorrhea concluded that it is unknown if acupuncture or acupressure is effective. There were also concerns of bias in study design and in publication, insufficient reporting (few looked at adverse effects), and that they were inconsistent. There are conflicting reports in the literature, including one review which found that acupressure, topical heat, and behavioral interventions are likely effective. It found the effect of acupuncture and magnets to be unknown.

A 2007 systematic review found some scientific evidence that behavioral interventions may be effective, but that the results should be viewed with caution due to poor quality of the data.

Spinal manipulation does not appear to be helpful.

Although claims have been made for chiropractic care, under the theory that treating subluxations in the spine may decrease symptoms, a 2006 systematic review found that overall no evidence suggests that spinal manipulation is effective for treatment of primary and secondary dysmenorrhea.

Valerian, Humulus lupulus and Passiflora incarnata may be safe and effective in the treatment of dysmenorrhea.

Holistic Approach

Many ancient cultures revered a women’s bleeding time as sacred. Traditionally women would spend time in a red tent to honor the rest phase of their cycles. Cultural pace may have shifted since such times, however simply slowing down, taking time to rest, eating warm and cooked foods, and drinking nourishing, mineral rich teas such as raspberry leaf, nettles, and hibiscus can help soothe the effects of blood loss and hormonal imbalance during menstruation. Honouring menstruation as worthwhile and even sacred can help mitigate any cultural, conditioned shame that may contribute to pain in a women’s uterus during this time.

TENS

A 2011 review stated that high-frequency transcutaneous electrical nerve stimulation may reduce pain compared with sham TENS, but seems to be less effective than ibuprofen.

Surgery

One treatment of last resort is presacral neurectomy.

Cramps

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