How to treat dysmenorrhea?
BR is a 32-year-old woman who inquires about treatment options for menstrual cramp pain relief. Recently, she reports experiencing new-onset lower abdominal pain that worsens with the onset of menstruation. She has a history of uterine fibroids and reports experiencing particularly heavy and prolonged menstrual bleeding. BR reports no known medication allergies and reports taking only an iron supplement every day to prevent anemia. Is she a candidate for OTC treatment? What would you recommend?
@falguni BR’s lower abdominal pain requires evaluation by a primary care provider. Her symptoms are consistent with secondary causes of dysmenorrhea (eg, age at onset older than 25 years, continuous pain or pain at times other than menses, heavy and prolonged menses) that are associated with a pelvic pathology, notably her history of uterine fibroids. She should not consider using OTC remedies for cramp relief, as these agents may mask the underlying problem and delay medical evaluation. Further, nonsteroidal anti-inflammatory drugs—the treatment of choice for primary dysmenorrhea symptoms—may exacerbate BR’s anemia and increase her risk of bleeding.