Pharmacist’s Role in Education About Menstrual Pain Shows Value of Profession in Women’s Health
Pharmacists are on the frontline for patients looking to self-manage their menstrual pain, making their role invaluable in women’s health.
Dysmenorrhea, known as menstrual cramps, are considered throbbing or cramping pains in the lower abdomen, with many women experiencing them just before and during their menstrual periods, according to the Mayo Clinic.1
“The good news about the world we live in today is that women are starting to speak out more and not suffer in silence,” Joanna Lewis, PharmD, MBA, 340B program director at Baptist Health, said in an interview.3 “I think women used to just see menstrual pain as a cross to bear but now they realize that there are remedies available, and even on social media, there are a lot of influencers and just regular people bringing awareness to women and destigmatizing so that we don't suffer alone.”
The estimated prevalence of menstrual pain in 2006 was approximately 17% and 81% of menstruating women. | Image Credit: New Africa - stock.adobe.com
Pharmacists play an essential role in staying up to date on current trends and remedies for menstrual cramps as well as information about women’s health to help best optimize care for patients.
WHAT IS PRIMARY DYSMENORRHEA?
Primary dysmenorrhea occurs as menstrual pain without any pelvic diseases and is categorized as the overproduction of prostaglandins that cause the contraction of the uterine muscles. It is considered the most common gynecological illness in women but is usually underdiagnosed, undertreated, and considered part of the menstrual cycle, according to authors of a European study.2
Primary dysmenorrhea can cause pain that is intense and affects the quality of life for women, with pain usually subsiding in 2 to 3 days after it begins. Although pain can be felt in the abdomen, it can radiate down the lower back and thighs. Besides pain, symptoms can include nausea, loose stools, headache, and dizziness.1
The prevalence of dysmenorrhea is generally underestimated, as a small number of women tend to seek medical treatment for it. The authors of a study note that the estimated prevalence in 2006 was approximately 17% and 81% of menstruating women. However, severe dysmenorrhea was identified in 12% to 14%.2
In another study published in the International Journal of Environmental Research and Public Health, investigators found that primary dysmenorrhea was associated with 8 risk factors: age of 20 years and older, body mass index below 18.5 kg/m2, longer menstrual periods, irregular menstrual cycle, a family history, stress, sleeping less than 7 hours a night, and a bedtime after 11:00 pm.4
TREATMENT OPTIONS FOR MENSTRUAL PAIN
Michelle Palmer, PharmD, FASCP, medication therapy management pharmacist at Consana Health, highlighted nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil) and naproxen (Aleve), as the first-line OTC options that can help most patients. She added that acetaminophen (Tylenol) can also be an option but is generally less effective.5
“These work by blocking prostaglandins, which are the chemicals that trigger uterine contractions and cramping,” Palmer said in an interview.5 “It's really best to start these medications early, ideally a day or 2 before the period begins or at the onset of pain, and there's no single NSAID that's proved superior, so it may take some trial and error.”
Lewis added that acetaminophen can also be used, as it can be used for pain relief from cramps or other symptoms like headaches. She added that aspirin can still be used but is also considered less effective. Combination products, such as Midol Complete and Pamprin multisymptom, can also help cramps or other symptoms, such as fatigue, bloating, and irritability.6
Herbal therapies and supplements are also an option, but Palmer cautions that evidence for these therapies is very limited. Some studies do show benefits for ginger, fish oil, vitamin B1, zinc, and magnesium, but the data are not strong enough to suggest these should be used for first-line treatment. Lewis added that magnesium could be taken to relax contractions and reduce cramp intensity and duration.5,6
Additionally, she added that there has been some evidence for omega-3 fatty acids, which can have anti-inflammatory effects; vitamin B1, which can reduce menstrual cramp pain; and vitamin E, which reduces prostaglandin production. Further, she added that supplements need to be taken daily to have an effect, and it usually takes 1 to 2 cycles before symptom relief can be evident.6
"The most evidence-based combination for supplements is magnesium plus omega-3 plus B vitamins," Lewis said.6 “Then, as always, I would always counsel the patients to remember that supplements are not regulated and to choose one that has been either NSF or USP certified.”
PHARMACIST’S ROLE IN EDUCATION OF MENSTRUAL PAIN TREATMENT
“The first thing a pharmacist needs to do is educate the patient on how to take the medication, and it's best for these NSAIDs to take the medication as soon as you feel the first sign of cramps,” Lewis said.6
Both Palmer and Lewis emphasized how crucial timing is when starting pain relief medications. The general recommendation is to start medication a day or 2 prior to when a patient’s menstrual cycle begins and continue for 2 to 3 days as needed.5,6
“Pharmacists should also discuss [adverse] effects such as stomach upset or kidney issues and screen for any contraindications,” Palmer said.5 “An often-overlooked benefit of NSAIDs...is that these medications can reduce the amount of menstrual blood loss by 10% to 25% [in] women [who] have heavy bleeding by lowering prostaglandin[-mediated] contractions.”
Gastrointestinal (GI) adverse events are typically the most common, both Palmer and Lewis said. This can include stomach upset, nausea, heartburn, and indigestion. However, some patients may experience headache or dizziness. Patients should also use caution and consult with a medical professional if they have current symptoms of GI bleeding, an active ulcer, NSAID-induced asthma, kidney disease, or heart failure.5,6
To avoid as much GI upset as possible, both pharmacists recommend taking an NSAID with food or a small snack, which can include crackers, yogurt, or even some milk, as it can slow the absorption of the medication. Choosing a tablet that is coated or enteric coated can also help with a sensitive stomach. Patients should also avoid lying down immediately after taking these medications, as well as other stomach irritants, including alcohol, caffeine, spicy foods, and acidic foods.5,6
FUTURE OF PHARMACY IN WOMEN’S HEALTH CARE
“This is an exciting time to be a pharmacist because of all the social media content, though sometimes the consumer needs help sifting through the noise,” Lewis said.3 “Pharmacists really need to stay up to date on the current trends and remedies so that we can counsel on what works and what doesn't.”
Palmer added that pharmacists are on the front line for patients who are seeking self-care options. She said that pharmacists can help patients to optimize NSAID use, manage hormonal therapies, integrate nondrug strategies, and, in some states, prescribe oral contraception.7
In addition, Palmer mentioned period tracker apps as a valuable tool for patients to identify any patterns. She said she would suggest it to patients as well because some can also track fertility or ovulation as well as symptoms, severity, moods, and lifestyle. Some period trackers can also be used for educational content.7
"I would just really encourage patients to gather information about themselves and their body and look for an app that's based upon their personal goals and can ensure patient privacy," Palmer said.7 "They might want to look into how data is stored, whether it's shared with any third parties, and if it's encrypted or can use the passcode to protect their data."
Palmer emphasized patient-centered care through a comprehensive assessment. She said that there’s a lot of information, including patterns, treatments tried, dosing, and timing, which can create a clear patient profile. Pharmacists should be looking for contraindications for recommendations, bleeding patterns, pain with intercourse, and family history of endometriosis. Further, she said that goal is to empower patients to talk to the pharmacist or any other health care provider if the pain is impacting their life, which makes the patient feel supported and helps them control their own health.7
“In the future, pharmacists [are] carving out more of a niche role around women's health,” Lewis said.3 “Our jobs are evolving so much, and there may be opportunities for us to be more involved in the public and women's health…so pharmacists can take a very active role in educating their patients and the public about these public health concerns.”
READ MORE: Women's Health Resource Center
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REFERENCES
1. Mayo Clinic. Menstrual cramps. April 30, 2022. Accessed September 25, 2025. https://www.mayoclinic.org/diseases-conditions/menstrual-cramps/symptoms-causes/syc-20374938
2. Guimarães I, Póvoa AM. Primary Dysmenorrhea: Assessment and Treatment. Dismenorreia primária: Avaliação e tratamento. Rev Bras Ginecol Obstet. 2020;42(8):501-507. doi:10.1055/s-0040-1712131
3. Gallagher A, Lewis J. Q&A: pharmacists play essential role in women' health care. Drug Topics. September 17, 2025. Accessed September 25, 2025. https://www.drugtopics.com/view/q-a-pharmacists-play-essential-role-in-women-health-care
4. Mitsuhashi R, Sawai A, Kiyohara K, Shiraki H, Nakata Y. Factors Associated with the Prevalence and Severity of Menstrual-Related Symptoms: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022;20(1):569. Published 2022 Dec 29. doi:10.3390/ijerph20010569
5. Gallagher A, Palmer M. Q&A: dosing timing of NSAIDs is essential for menstrual pain. Drug Topics. August 25, 2025. Accessed September 26, 2025. https://www.drugtopics.com/view/q-a-dosing-timing-of-nsaids-is-essential-for-menstrual-pain
6. Gallagher A, Lewis J. Q&A: pharmacist discusses counseling considerations for menstrual pain. Drug Topics. September 16, 2025. Accessed September 26, 2025. https://www.drugtopics.com/view/q-a-pharmacist-discusses-counseling-considerations-for-menstrual-pain
7. Gallagher A, Palmer M. Q&A: pharmacist urges women to advocate for their menstrual health. Drug Topics. August 26, 2025. Accessed September 26, 2025. https://www.drugtopics.com/view/q-a-pharmacist-urges-women-to-advocate-for-their-menstrual-health
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