# Primary dysmenorrhoea - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ACOG Committee Opinion No. 760 (2018) · Mefenamic Acid 500 mg film-coated Tablets SmPC sections 4.2 and 4.3 (eMC product 12503) · Dysmenorrhea - StatPearls - NCBI Bookshelf - disease-level clinical article (primary-dysmenorrhoea-full.txt) · Microgynon 30 tablets SmPC section 4.2 (eMC product 1130) - Verified date: 2026-08 ## Verified against - Mefenamic Acid 500 mg film-coated Tablets SmPC sections 4.2 and 4.3 (eMC product 12503) - ACOG Committee Opinion No. 760 (2018) - Paracetamol 500mg Tablets SmPC (eMC product 5164) - Dysmenorrhea - StatPearls - NCBI Bookshelf - disease-level clinical article (primary-dysmenorrhoea-full.txt) ## Treatment metadata - Mefenamic acid — 500 mg — oral.solid - Ibuprofen — 400 mg — oral.solid - Paracetamol — oral.solid - Ethinyl estradiol + Levonorgestrel — oral.solid ## Complete treatment card ```text PRIMARY DYSMENORRHOEA Sources: ACOG Committee Opinion No. 760 (2018) · Mefenamic Acid 500 mg film-coated Tablets SmPC sections 4.2 and 4.3 (eMC product 12503) · Dysmenorrhea - StatPearls - NCBI Bookshelf - disease-level clinical article (primary-dysmenorrhoea-full.txt) · Microgynon 30 tablets SmPC section 4.2 (eMC product 1130) Review status: REVIEWED against Mefenamic Acid 500 mg film-coated Tablets SmPC sections 4.2 and 4.3 (eMC product 12503), ACOG Committee Opinion No. 760 (2018), Paracetamol 500mg Tablets SmPC (eMC product 5164), Dysmenorrhea - StatPearls - NCBI Bookshelf - disease-level clinical article (primary-dysmenorrhoea-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (7) - Cramp starts immediately before, or as, the period begins [muscle cramps] - Severity peaks 23 to 48 hours in and is usually over within 72 hours - It appears once ovulatory cycles begin, generally inside two years of the first period - Tiredness, headache, diarrhoea, nausea and vomiting may accompany it [diarrhoea · fatigue · headache · nausea · vomiting] - Pelvic pain sits in the midline and can travel into the lower back or the upper legs [abdominal pain · pelvic pain] - It is crampy and comes in waves, and runs much the same from one cycle to the next - Dizziness and trouble sleeping can come with it as well [dizziness] SIGNS - what you find (9) - Examination is normal in the primary form - Pelvic assessment finds a uterus of usual size, freely mobile and not tender - No abnormal discharge, no adnexal mass and no nodules along the uterosacral ligaments - Starting over the age of 25 points away from the primary form - Whitish grey, mucopurulent or foul-smelling discharge raises pelvic inflammatory disease - A friable cervix raises concern for a sexually transmitted infection - Heavy periods plus a slightly bigger, evenly shaped uterus suggest adenomyosis [abnormal uterine bleeding · heavy periods] - Irregular bleeding with a bulky, lopsided uterus suggests leiomyomas [bleeding] - Pain on passing urine, pain with sex, vaginismus, painful defaecation, infertility, palpable nodularity or adnexal tenderness all argue against the primary form [abdominal pain · infertility · pelvic pain] TESTS (9) - A characteristic story on its own is enough to make the diagnosis - Scanning adds little once the picture is clearly primary - Skip the internal examination in a teenager who is not sexually active and whose history is classic with nothing else added - Do examine internally when the onset and duration of lower abdominal pain hint at a secondary cause, or medical treatment is failing - Where a secondary cause is suspected, the transvaginal scan comes first - Take endocervical or vaginal swabs when infection risk or pelvic inflammatory disease is in question - Cervical cytology or HPV testing if cancer of the cervix is a concern - MRI or Doppler helps when adnexal torsion, adenomyosis or deep pelvic endometriosis is possible, or the scan was equivocal - Laparoscopy is kept for those wanting to conceive in whom endometriosis is the suspected secondary cause IF NOT THIS - what else fits (12) - Endometriosis - Outflow tract obstruction - imperforate hymen, transverse vaginal septum, cervical stenosis - Ovarian cyst, functional or otherwise - Adnexal torsion, which is typically not cyclical with periods - Adenomyosis - Pelvic inflammatory disease or a sexually transmitted infection - Endometrial polyp - Obstructive Müllerian duct anomaly - Leiomyomas - Ectopic pregnancy - Irritable bowel syndrome - Urinary tract infection Source StatPearls "Dysmenorrhea" - disease-level clinical article Status traced to the source above Rx: Main treatment | Combined pill - for the patient who also wants contraception MAIN TREATMENT - choose one 1. MEFENAMIC ACID [1st line] Adult 500 mg TID with meals starting at onset of menses x 2-3 days during menses Peds Over 12 years: 500 mg three times daily (Licensed for dysmenorrhoea in adolescents over 12 years: 500 mg TID) Source Mefenamic Acid 500 mg film-coated Tablets SmPC sections 4.2 and 4.3 (eMC product 12503) Why NSAID with dual action: COX inhibition and prostaglandin receptor antagonism Caution Discontinue immediately if diarrhea develops (unique to mefenamic acid); CONTRAINDICATED in active inflammatory bowel disease. Take with or after food to minimize gastric irritation. CONTRAINDICATED in active peptic ulcer disease or NSAID-induced asthma. Caution in renal impairment or bleeding disorders. CONTRAINDICATED in inflammatory bowel disease, in active or recurrent peptic ulcer or GI haemorrhage, and in severe renal failure. Maximum 1500 mg a day. Opioids and tramadol should not be used routinely for period pain. All NSAIDs carry black box warnings for serious adverse events, which must be heeded whichever agent is chosen. Period pain that does not respond to NSAIDs is a warning sign for endometriosis - up to 35% of NSAID non-responders have it, against up to 29% of women with dysmenorrhoea overall. In primary dysmenorrhoea the pain starts within a few hours of menses and typically resolves within 72 hours; pain lying outside that pattern should raise suspicion of a secondary cause. Onset of menstrual pain in a woman older than 25 points towards a secondary cause rather than primary dysmenorrhoea. Perform a pelvic examination when the history of onset and duration suggests a secondary cause, or when the pain is not responding to medical treatment. A pelvic examination is not required in an adolescent who is not sexually active and has a typical presentation without additional symptoms. If the pain persists despite treatment, investigate for a secondary cause rather than escalating analgesia. Egypt PONAGIC FORTE 500MG 10 F.C. TAB. RAMEDA 3.00 EGP (0.30/unit) MEFRONIL 500 MG 30 TABS. EL NILE. 14.25 EGP (0.47/unit) FAROSTAN FORTE 500MG 10 TAB. PHAROPHARMA 5.00 EGP (0.50/unit) MAFEPAIN 500MG 10 F.C. TAB. SPIMACO > EIMC 6.00 EGP (0.60/unit) MEFENAM 500MG 20 CAPS. JEDCO INT. CO... 14.00 EGP (0.70/unit) PONSTAN FORTE 500MG 20 F.C. TABS. PFIZER 14.00 EGP (0.70/unit) PONOFORTE 500MG 20 CAPS. UNIPHARMA 30.00 EGP (1.50/unit) 2. IBUPROFEN [1st line] Adult 400 mg TID with food starting 1-2 days before or at menses onset x 2-3 days during menses Peds 13 years and over: 200 to 400 mg three times daily with food during menses (Adolescents >12 yrs: 200-400 mg TID with food during menses) Choice Alternatives. Both are NSAIDs for period pain; ibuprofen is the cheaper and the one available without a prescription. Source ACOG Committee Opinion No. 760 (2018) Why Widely available first-line NSAID for dysmenorrhoea relief Caution Take with food or milk. Avoid in active GI ulceration, severe renal impairment, or late pregnancy. May cause dyspepsia or mild fluid retention. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid 3. PARACETAMOL [2nd line] Adult 500-1000 mg (1-2 tablets) every 4-6 hours as required (max 4000 mg/day) Peds Child 1 month and over: 15 mg/kg 3 or 4 times daily (max 60 mg/kg daily). Child under 1 month: 10 mg/kg 3 or 4 times daily (max 40 mg/kg daily). Source Paracetamol 500mg Tablets SmPC (eMC product 5164) Why Non-NSAID analgesic alternative for dysmenorrhea pain when NSAIDs are contraindicated. Caution Do not exceed 4000 mg (8 tablets) in 24 hours to prevent hepatotoxicity. Avoid concurrent use with other paracetamol-containing products. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) PYRAL 500MG 20 TABS. KAHIRA 28.00 EGP (1.40/unit) TEMPORAL 1000 MG 20 TABS. MUP 40.00 EGP (2.00/unit) AUGICETAMIDE 250 MG 20 SACHETS AUG PHARMA 30.00 EGP STOPADOL JOINT 650 MG 30 EXT. REL. TABS. EVA PHARMA 75.00 EGP AUGICETAMIDE 1000 MG 20 SACHETS AUG PHARMA 80.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid COMBINED PILL - FOR THE PATIENT WHO ALSO WANTS CONTRACEPTION 4. ETHINYL ESTRADIOL + LEVONORGESTREL [2nd line] Adult A 21-day pack, one tablet each day at about the same time, begun on day 1 of the period, then 7 days with no tablet before the next pack - Continued cycle after cycle for as long as contraception is wanted; judge the effect on the pain over a few cycles Peds Used from menarche onwards in adolescents who want contraception; the same one-tablet- daily regimen applies, and the contraindications below matter just as much in a teenager as in an older woman. Source Microgynon 30 tablets SmPC section 4.2 (eMC product 1130) - verbatim: "First treatment cycle: 1 tablet daily for 21 days, starting on the first day of the menstrual cycle. Contraceptive protection begins immediately" Why A combined pill thins the endometrium and blocks ovulation, so less prostaglandin is made and the cramps ease. The article limits it to patients who also want contraception, which is the right way to offer it - it is not a painkiller for someone who does not. Caution Do not prescribe it to anyone with a current or past venous thromboembolism, or a known clotting predisposition. Migraine with aura is an absolute contraindication - ask about it directly, because patients volunteer the headache and not the visual symptoms. Avoid it in smokers over 35, in severe hypertension, in diabetes with vascular complications, and in current or past breast cancer or severe liver disease. Vomiting or diarrhoea within a few hours of a tablet, or a tablet more than 12 hours late, means contraceptive cover is lost - additional precautions are needed for the next 7 days. If the pain does not settle over a few cycles, look again for a secondary cause such as endometriosis or adenomyosis rather than escalating the hormone. Egypt MICROCEPT 21 TAB. CID 0.76 EGP (0.04/unit) MICRODETTE 3* 21 TAB. EL NILE. 7.50 EGP (0.36/unit) NORDETTE 5*21 TAB. EL NILE. > PF... 15.00 EGP (0.71/unit) MICROGENEST 30/150 MCG 21 TABS. ACDIMA INTERN... 23.00 EGP (1.10/unit) TRIOCEPT 21 TAB. X 6 STRIP (TRIPHASIC) CID 120.00 EGP (5.71/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)