Journal List > J Korean Med Assoc > v.63(3) > 1143898

Lee and Kim: A comprehensive review and the pharmacologic management of primary dysmenorrhea


Dysmenorrhea is the most common gynecologic condition in women during the reproductive period. Severe dysmenorrhea pain affects their social activities, sleep, and quality of life. Nevertheless, the proportion of women with dysmenorrhea do not receive adequate medical counseling or pharmacological treatments. Primary dysmenorrhea is diagnosed clinically, and the secondary causes that can cause pelvic pain should be identified. The treatment of choice for primary dysmenorrhea is non-steroidal anti-inflammatory drugs (NSAIDs). In order to maximize the therapeutic effect, it is necessary to ensure that the appropriate medication is administered in a proper way. NSAIDs can cause adverse effects, including gastrointestinal disorders. If side effects occur or are anticipated with NSAIDs, the use of hormonal contraceptives may be recommended when contraception is considered. In addition to these pharmacological treatments, heat, dietary, and behavioral therapies have been tried and reported to have some effects. However, further research is required for robust conclusions.


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Figure 1.
Metabolic pathways of uterine contraction in dysmenorrhea. LT, leukotriene; PGG2, prostaglandin G2; PGH2, prostaglandin H2; PGF, prostaglandin F; PGE2, prostaglandin E2.
Figure 2.
Treatment options for dysmenorrhea. NSAIDs, non-steroidal antiinflammatory drugs.
Table 1.
Charact teristics of primary and secondary dysmenorrhea
Characteristics Primary dysmenorrhea Secondary dysmenorrhea
Onset Within 3 years from menarche After 5 years from menarche
Age (yr) About 15-25 Over 30-35
Prognosis Gradually improve Become worse
Postpartum Improve No change
Pelvic examination Normal Features of endometriosis, adenomyosis, leiomyoma, pelvic inflammatory disease, etc.
Timing Menstruation Menstruation or other time
Duration 4-72 hours during menses Prior to onset of menses and throughout menstrual cycle
Table 2.
Non-steroidal anti-inflammatory agents to treat dysmenorrhea
Drug Initial dose (mg) Maintenance dose (mg)
Naproxen 500 250 per 6-8 hours
Ibuprofen 200-600 200-600 per 6 hours
Ketoprofen 75 75 per 8 hours
Mefenamic acid 500 250 per 4 hours
Tolfenamic acid 200 200 per 8 hours
Flufenamic acid 200 200 per 8 hours
Meclofenamate 100 50-100 per 6 hours
Celecoxib 400 200 per 12 hours
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