Most patients with primary dysmenorrhea show subjective improvement with NSAID treatment. Various studies report successful pain relief in 64 to 100 percent of subjects. Oral contraceptives provide another effective and well-studied choice for therapy, especially in women desiring birth control. Oral contraceptives are effective in about 90 percent of patients with primary dysmenorrhea.
For the approximately 10 percent who do not respond to these options, a host of alternatives exists, ranging from laparoscopic surgery to acupuncture, although with much less evidence to support their use. Lack of pain relief should increase suspicion of a secondary cause of dysmenorrhea
Nonsteroidal Anti-inflammatory Drugs:
The most appropriate first-line choice of therapy in most women with primary dysmenorrhea is an NSAID. These medications work through the inhibition of the production and release of prostaglandins. The choices of specific agents are numerous, and no particular NSAID has been reliably shown to be more effective than others for this condition. Aspirin must not used for the treatment of dysmenorrhea. It is not potent enough in the usual dosage. Response to NSAIDs usually occurs within 30 to 60 minutes. Since individual response may vary, it may be prudent to try a second agent of a different class if the pain is not relieved with the first agent after one or two menstrual cycles.
NSAIDs are the drug of choice
Aspirin must not be used
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