Self-Care Measures for Preventing and Managing Dysmenorrhea

Dysmenorrhea, also known as painful menstruation, is the most commonly reported menstrual symptom among females during the reproductive years.^1-3 Statistics indicate that the prevalence ranges from 50% to 90% of adolescents and adult women of reproductive age, with varying degrees of severity, although some sources suggest that dysmenorrhea is greatest among adolescent girls, affecting an estimated 93%^.1,2

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Dysmenorrhea can be further classified as primary or secondary.^1,2 The American College of Obstetricians and Gynecologists (ACOG) defines these 2 types as follows^1-4:

• Primary dysmenorrhea refers to painful menstruation, characterized by recurrent, crampy lower abdominal pain that occurs during menses in the absence of pelvic pathology, typically starting within 6 to 12 months of menarche.
• Secondary dysmenorrhea refers to painful menstruation caused by pelvic pathology or a diagnosed medical condition, with the most common cause being endometriosis. Other documented causes of secondary dysmenorrhea include fibroids, adenomyosis, infection, myomas, obstructive reproductive tract anomalies, and ovarian cysts

Dysmenorrhea is also one of the leading causes of absenteeism from school and work among females during the reproductive years.^1-3 Literature notes that, left unmanaged, dysmenorrhea can diminish quality of life by adversely affecting day-to-day productivity, limiting social and work activities, and absenteeism.^1-6 Some studies have revealed that dysmenorrhea is associated with high levels of stress and may augment the risk of depression and anxiety in up to 50% of affected patients.^1-6 Data also show that absence from school or work due to dysmenorrhea was reported at least once, and 12% of adolescent girls and young women aged 14 to 20 years lost days of school or work each month because of dysmenorrhea.³ Research has also shown that women with polycystic ovarian syndrome are more likely to experience severe dysmenorrhea.⁷

Findings from a preliminary study from the American Heart Association noted that women with dysmenorrhea were twice as likely to experience ischemic cardiovascular disease (CVD), including angina, myocardial infarction (MI), MI-related complications, and chronic or ongoing ischemic CVD, compared with those without dysmenorrhea.⁷ The authors wrote, “Studying dysmenorrhea is important given that dysmenorrhea stands as the most prevalent menstrual concern. It is associated with heightened stress and disruption of the autonomic nervous system, which influences heart and vessel function and is associated with an increase in certain molecules related to inflammation. Both inflammation and stress are also associated with increased cardiovascular risk, with stress particularly noted for its relevance in heart disease among young women.”⁷ The researchers also noted that more studies are warranted based on their findings.⁷

Clinical Presentation

Dysmenorrhea presents with varying degrees of severity, and pain may occur with menses or 1 to 3 days before menses.⁸ Pain typically peaks 24 hours after the onset of menses and wanes after 2 to 3 days; patients may experience additional symptoms, including headache, nausea, constipation, diarrhea, and lower back pain.⁸

Self-Management of Dysmenorrhea

ACOG notes that when no contraindications are present, most cases of primary dysmenorrhea are managed well with nonsteroidal anti-inflammatory drugs (NSAIDs) or prescription therapy with hormonal suppression, or both, depending upon patient need.³ Some patients may initially present with symptoms that indicate secondary dysmenorrhea, and patients with primary dysmenorrhea who do not attain relief with empirical therapy may require further evaluation and treatment.³ In some cases, treatment of the underlying disorder causing secondary dysmenorrhea may improve or eliminate symptoms.³ Pharmacists can guide patients with dysmenorrhea in the selection and proper use of nonprescription products marketed for dysmenorrhea and provide patients with information about recommended nonpharmacological measures.

Pharmacists are also well positioned to ascertain whether self-treatment is appropriate and can encourage patients with severe cases of primary dysmenorrhea and those with secondary dysmenorrhea, especially when the cause of pain is unknown, to seek further care from their primary health care provider. Pharmacists can also screen for potential drug-drug interactions or contraindications.

In general, treatment of primary dysmenorrhea aims to resolve or provide relief from symptoms and minimize disruption of day-to-day activities. When no contraindications are present, self-treatment of dysmenorrhea is managed with the use of nonprescription products marketed for relief from menstrual discomfort. Selection of an appropriate OTC analgesic should take into consideration various patient factors, including the patient’s overall health status, current medical conditions, and medication profile, as well as patient preferences, which are often influenced by dosage form, required dosing intervals, and cost of OTC medication.³ One study examining adolescents with dysmenorrhea reported that 66% self-treated with analgesics, of which 78% used nonsalicylate NSAIDs, whereas fewer used acetaminophen or aspirin.⁹

ACOG recommends that, when appropriate, medication is most effective when initiated 1 to 2 days before the expected onset of the menstrual cycle and continued through the first 2 to 3 days of menstrual bleeding.³

Nonpharmacological measures that can be employed to treat and prevent dysmenorrhea include topical heat, exercise, and dietary changes tailored to the patient’s needs, with research showing symptom improvement correlated with avoidance of foods high in sodium, sugar, and refined carbohydrates.² Some studies have shown that exercise can reduce the intensity and duration of pain in primary dysmenorrhea.¹⁰ Study results published in Pain Management explored women’s use of nonpharmacological measures for primary dysmenorrhea. Results revealed that many women reported using heat therapy (61.5%), tea (42.4%), and massage (30.9%) to ease dysmenorrhea pain.¹¹

REFERENCES

1. McKenna KA, Fogleman CD. Dysmenorrhea. Am Fam Physician. 2021;104(2):164-170.

2. Lodise N. Dysmenorrhea. In: Krinsky D, Ferreri S, Hemstreet BA, Hume AL, Rollins CJ, Tietze KJ, eds. Handbook of Nonprescription Drugs: An Interactiven Approach for Self-Care. 21st ed. American Pharmaceutical Association; 2025.

3. Dysmenorrhea and endometriosis in the adolescent. American College of Obstetricians and Gynecologists. December 2018. Accessed April 28, 2025. https://www.acog.org/clinical/clinical-guidance/committee-opinion/ articles/2018/12/dysmenorrhea-and-endometriosis-in-the-adolescent

4. Smith RP, Kaunitz AM. Dysmenorrhea in adult females: clinical features and diagnosis. UpToDate. Updated April 10, 2024. Accessed April 28, 2025. https://www.uptodate.com/contents/dysmenorrhea-in-adult-females-clinicalfeatures-and-diagnosis#H3560343747

5. Balik G, Ustüner I, Kağitci M, Sahin FK. Is there a relationship between mood disorders and dysmenorrhea? J Pediatr Adolesc Gynecol. 2014;27(6):371-374.doi:10.1016/j.jpag.2014.01.108

6. Zannoni L, Giorgi M, Spagnolo E, Montanari G, Villa G, Seracchioli R. Dysmenorrhea, absenteeism from school, and symptoms suspicious for endometriosis in adolescents. J Pediatr Adolesc Gynecol. 2014;27(5):258-265.doi:10.1016/j.jpag.2013.11.008

7. Menstrual cycle disorders may be linked to increased cardiovascular disease risk in women. News release. American Heart Association. November 6, 2023. Accessed April 28, 2025. https://newsroom.heart.org/news/menstrualcycle-disorders-may-be-linked-to-increased-cardiovascular-disease-risk-inwomen?preview=c2a1

8. Pinkerton JV. Dysmenorrhea. In: Merck Manual. Professional Version. Merck & Co, Inc; 2025. Updated April 2025. Accessed April 28, 2025. https://www.merckmanuals.com/professional/gynecology-and-obstetrics/menstrualabnormalities/dysmenorrhea

9. Marjoribanks J, Ayeleke RO, Farquhar C, Proctor M. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev.2015;2015(7):CD001751. doi:10.1002/14651858.CD001751.pub3

10. Matthewman G, Lee A, Kaur JG, Daley AJ. Physical activity for primary dysmenorrhea: a systematic review and meta-analysis of randomized controlled trials. Am J Obstet Gynecol. 2018;219(3):255.e1-255.e20. doi:10.1016/j.ajog.2018.04.001

11. Rodrigues JC, de Arruda GT, de Moraes PC, Firão CB, Avila MA, Driusso P. Self-management of primary dysmenorrhea-related pain: cross-sectional study on non-pharmacological interventions. Pain Manag. 2024;14(5-6):265-272. doi:10.1080/17581869.2024.2376519