What are the treatment options for primary dysmenorrhoea?

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Most women with painful periods have mild pain that they can treat
themselves at home. However, if your pain becomes more severe and is
interfering with your usual activities, you should see your doctor.

There are a number of treatments that may help if you have primary dysmenorrhoea.

Warmth: you may find it soothing to hold a hot water
bottle against your lower abdomen, or to have a hot bath. The pain
often does not last long, and this may be all that you need. (Be
careful not to burn yourself with a hot water bottle which is too hot.)
A warm bath or shower may also help.
Non-steroidal anti-inflammatory painkillers:
these can greatly ease the pain in about 8 in 10 cases. They work by
blocking the effect of the prostaglandin chemicals that are thought to
cause the pain. Also, non-steroidal anti-inflammatories usually reduce
the amount of bleeding. There are several types and brands, and most
need a prescription. However, you can buy one type (ibuprofen) at
pharmacies. Some tips when using an anti-inflammatory include the
following:
- Take the first dose as soon as your pain begins, or
  as soon as the bleeding starts, whichever comes first. Some doctors
  advise to start taking the tablets the day before your period is due.
  This may prevent the pain from building up.
- Take the tablets regularly, for 2-3 days each period, rather than 'now and then' when pain builds up.
- Take a strong enough dose. If your pains are not eased, ask your
  doctor or pharmacist if the dose that you are taking is the maximum
  allowed. An increase in dose may be all that you need.
- Some people cannot take non-steroidal anti-inflammatory
  painkillers. For example, people with a duodenal ulcer, and some people
  with asthma.
- Side-effects are uncommon if you take a non-steroidal
  anti-inflammatory for just a few days at a time, during each period.
  Read the leaflet that comes with the tablets for a full list of
  possible side-effects and cautions.
Paracetamol: this is an alternative painkiller
that you can try if you cannot take non-steroidal anti-inflammatory
painkillers. Also, paracetamol can be used in combination with a
non-steroidal anti-inflammatory painkiller if the anti-inflammatory
alone is not enough. Sometimes painkillers containing a combination of
codeine and paracetamol may be helpful if paracetamol alone is not
enough. Always read the details on the packet so that you do not exceed
the maximum daily dose of either painkiller.
The combined oral contraceptive pill ('the pill'):
this is an option if you also need contraception. Painful or heavy
periods are much less likely if you take 'the pill'. This is because
the pill causes the lining of the uterus to become thin, and the amount
of prostaglandin is much reduced. See separate leaflet called 'Combined Oral Contraceptive Pill' for more detail.
The intra-uterine system (IUS):
a special intra-uterine contraceptive device called the IUS is an
option if you also need long-term contraception. This device slowly
releases a progestogen hormone called levonorgestrel. This 'thins' the
lining of the uterus. It is a good contraceptive, but also reduces the
amount of pain and bleeding during periods. See separate leaflet called
'Intrauterine System' which describes the IUS in more detail.
Other progestogen contraceptives:
another option if you also need contraception is to try another type of
contraception that contains progestogen. Options include Cerazette®
contraceptive pill or an injectable progestogen contraceptive such as
Depo-Provera®. See separate leaflets called 'Progestogen Only Pill' and 'Contraceptive Injection' which describe these options in more detail.
A transcutaneous electrical nerve stimulation (TENS) machine:
this can be an option for women who prefer not to use medication. These
machines give out a small electrical current. They seem to work by
interfering with pain signals which are sent to the brain from the
nerves. However, you would normally have to buy a TENS machine, as they
are not usually available on the NHS for the treatment of period pain.
Other medicines:
if all other treatments have failed, then various other medicines are
sometimes tried. For example, medicines that prevent ovulation are
sometimes used. These are not routine treatments as side-effects can be
a problem, and the research evidence to support their use is limited.
Alternative medicine treatments:
there is not enough evidence so far to support the use of other
treatments for painful periods. For example, herbal and dietary
supplements, acupuncture, exercise and spinal manipulation. Some small
studies have shown that some of these treatments may help but overall,
the effectiveness of these treatments is not clear. More studies are
needed to help decide if these treatments are helpful or not for
painful periods.