Anti-inflammatory Drugs Offer Better OTC Relief for Menstrual Pain

A recent review of studies indicates that anti-inflammatory drugs such as NSAIDs are most effective in providing relief from menstrual cramps, also known as period pain and dysmenorrhea. For some women, menstrual cramps can be so intense that it prevents them from engaging in daily activities, and they may ask pharmacists for advice what to take for the pain.

Anti-inflammatory drugs such as diclofenac, ibuprofen, and naproxen work by suppressing the production of prostaglandin which promotes uterine contractions.  “The cause is usually having too many prostaglandins, made by

Heather Free, PharmDthe uterus,” said Heather Free, PharmD, AAHIVP, a pharmacist in Washington DC and spokesperson for APhA. “These chemicals make the muscles of the uterus tighten and relax, and this causes the cramps. The pain can start a day or two before the cycle. It normally lasts for a few days, though in some women it can last longer.”

Severe and long-lasting period pain can also be caused by uterine fibroids or endometriosis. With these conditions, the pain often gets worse over time.

 Researchers at the Cochrane Collaboration reviewed published studies to determine if NSAIDs were really the best option for menstrual pain relief, both in terms of efficacy and toleration. “Period pains: can anti-inflammatory drugs help?” examined 80 studies that followed 5,800 girls and women between the ages of 12 and 46, including women who had endometriosis and those who did not. Studies included comparisons of NSAIDs to placebos and to other medications.

The review suggested that NSAIDs were more effective than placebos at relieving pain, since 82% of the women and girls who didn’t take NSAIDs still had severe pain after a few hours but only 51% of those who took NSAIDs still had severe pain.

There was not enough evidence from the studies to determine if any one NSAID was better than any other. Studies that compared NSAIDs to acetaminophen found that they were a little more effective

When recommending NSAIDs for menstrual pain, pharmacists may want to caution patients about potential side effects, which can include an increased risk for cardiovascular or renal complications, as well as digestive problems. Since prostaglandin also serves to protect the digestive tract, suppressing production results in digestive problems for some women. According to the Cochrane review, 2% to 3%girls and women experienced stomach problems, nausea, headaches, or drowsiness after taking NSAIDs to treat period pain.

“Gastric ulceration from NSAIDs is common and often silent,” Free told Drug Topics.

Pharmacists should caution patients not to take more than the recommended dose and not to combine NSAIDs with other pain medication or acid reflux medications. Women should be told to contact their doctor if NSAIDs don’t help, cramps get worse, or a fever is present.