Dysmenorrhea
Cyclic lower abdominal pain during menstruation. First-line treatment is NSAIDs. Antispasmodics are used as adjunctive therapy.
ICD-10 N94.43 drugs
Also known as: Painful periods, Menstrual cramps
Drugs used for this condition
- AKetoprofenFirst line · Non-steroidal anti-inflammatory drug, propionic acid derivativePrimary dysmenorrhoea is named directly in the AEMPS Fastum label, and the mechanism fits best here: endometrial prostaglandins produce the pain, and ketoprofen blocks their synthesis. The practical point is timing: the drug starts within the first hours of pain or at the onset of menstruation, not after cramping has unfolded. The course is short, covering the first day or two of the cycle, and that is usually enough. Limits are those of any NSAID: active ulcer, severe cardiac, hepatic or renal impairment, aspirin-induced asthma. If the pain needs ever larger doses each month or fails to answer NSAIDs, the question is no longer analgesia but the cause, endometriosis included.
- DDrotaverineSecond line · Myotropic antispasmodicsAdjunct for dysmenorrhea. First-line is NSAIDs (ibuprofen, naproxen), which suppress prostaglandin synthesis. Drotaverine relieves uterine spasm but does not affect inflammation. A few small RCTs showed pain relief, but their quality is low. International guidelines do not list drotaverine for dysmenorrhea; it is popular in Russia and several regions.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit