For period pain, take an ibuprofen-type painkiller instead of toughing it out; if pain keeps you from work or school, or three months of medication still does not control it, see a gynecologist

For period pain, ibuprofen-type drugs raise the share with clearly less pain from under two in ten to about half. They work better than acetaminophen, with a bit more side effects. If pain keeps you from work or school, hurts deep during sex, or three months of medication still does not control it, see a gynecologist and check for endometriosis. In one ten-country study, average time from first symptoms to diagnosis was 6.7 years.

Cost

A box of ibuprofen costs a dozen or so yuan; take it only on the days it hurts. If you need gynecology, registration and ultrasound cost some money and half a day.

Benefit

A Cochrane systematic review pooled 80 randomized controlled trials and 5820 women with primary dysmenorrhea. Primary dysmenorrhea means period pain with no other disease found. Versus placebo, nonsteroidal anti-inflammatory drugs relieved pain better (OR 4.37, 95% CI 3.76–5.09). Converted, 18% of people on placebo got moderate or better relief, versus 45% to 53% on these drugs. The tradeoff is more side effects (OR 1.29, 1.11–1.51). 10% of people on placebo had side effects, versus 11% to 14% on these drugs. The extras were mainly stomach upset (OR 1.58) and nervous-system reactions (OR 2.74). Versus acetaminophen, these drugs also relieved pain better (OR 1.89, 1.05–3.43), though only 3 trials. Which of these drugs is best showed no difference. The UK NICE guideline (updated 2024) lists situations that should raise suspicion of endometriosis. They are long-term pelvic pain, period pain that affects daily activity and quality of life, and deep pain during or after sex. Also pain on bowel movements during periods, blood in urine or painful urination during periods, and infertility with these symptoms. Girls aged 17 and under are included. The guideline advises a trial of acetaminophen or one of these drugs first, for example 3 months. If pain relief is not enough, refer for further checks. A normal pelvic exam and ultrasound do not rule the disease out. One study surveyed 1418 women who had laparoscopy at 16 hospitals in 10 countries. From first symptoms to surgical diagnosis of endometriosis averaged 6.7 years, mostly lost at the primary-care stage. Women with a diagnosis lost an average of 10.8 hours of work a week, mostly presenteeism with lower efficiency. A Dutch online survey asked 32748 women aged 15 to 45. 13.8% had taken leave for menstruation, averaging 1.3 days a year. 80.7% were at work during periods with lower efficiency, equal to 8.9 days of lost work a year.

Notes

If you are over 60, have had stomach bleeding, or take anticoagulants or hormones, ask a doctor before using these drugs. Details are in Section 34, Item 3 (ibuprofen-type painkillers). The US ibuprofen label states it can cause serious allergic reactions, more often in people allergic to aspirin, including asthma attacks. If you have asthma, ask a doctor before use. If you might be pregnant, ask a doctor first; after 20 weeks of pregnancy do not take it on your own; see Section 34, Item 5 (after 20 weeks of pregnancy). If you cannot take these drugs, switch to acetaminophen; daily ceiling is in Section 34, Item 1 (acetaminophen). For period pain, take the drug only on period days. The threshold in Section 34, Item 9 (do not take painkillers more than 15 days a month) is about headaches; period-pain days never come close. Grade A because pain relief comes from many randomized trials. The authors rated evidence quality for most comparisons as low, mainly because methods were unclearly reported and 59% of trials were drug-company funded. Benefit set to “medium” is a judgment: the review measured only pain, not fewer days off. In the Dutch survey, loss from menstruation came to about 10 days a year, hours when spread over each week. The endometriosis group were women already going to laparoscopy; that does not mean most people with period pain have this disease. The main beneficiary is you.

Sources · 5

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