How is menstrual pain treated?

Patient's question:

Suffered for five years. Lower abdominal pain, feeling nauseous

Doctor's answer:

(1) General Treatment: Engage in physical exercise to enhance physical fitness. Pay attention to a regular lifestyle, balance work and rest, and maintain proper nutrition and adequate sleep. Emphasize the publicity and education of the physiological aspects of menstruation, and alleviate patients' fear, anxiety, and mental burdens through explanation and persuasion. Strengthen menstrual hygiene, avoid strenuous exercise, excessive fatigue, and prevent exposure to cold.
(2) Ovulation Inhibition: If the patient is willing to control fertility, oral contraceptives (combined norethisterone tablets or combined megestrol tablets) are the preferred medication for treating primary dysmenorrhea. The use of oral contraceptives can relieve symptoms in more than 90% of cases, possibly due to the inhibition of endometrial growth, reduced menstrual flow, and a decrease in prostaglandin (PG) levels to normal levels, leading to weakened uterine activity. Treatment can be attempted for 3–4 cycles. If the effect is satisfactory, the medication can be continued; if symptoms do not improve significantly, appropriate additional use of PG synthesis inhibitors may be considered. Since medication needs to be taken throughout the entire menstrual cycle, and the effect occurs only in the last 1–2 days of the cycle, it is generally not well-received by patients unless contraception is also needed.
(3) Prostaglandin Synthesis Inhibitors (PGSI):
1. Fenbid
This class of drugs inhibits prostaglandin synthesis, reducing uterine tension and contractility to achieve the goal of treating dysmenorrhea. Dosage: Generally, take 2–3 days continuously before the onset of menstrual pain, with 1 tablet once daily (qd). For severe pain, 2 tablets can be taken every 12 hours. Since prostaglandins are released most heavily in the first 48 hours of the menstrual cycle, early medication can correct the excessive synthesis and release of prostaglandins during the period. Taking medication during pain may be ineffective, and it takes at least 3 hours to take effect. Indomethacin can also be used.
Side Effects: There may be gastrointestinal reactions and central nervous system symptoms, with rare cases of bronchospasm and temporary renal function impairment.
(4) β-Adrenergic Agonists: By stimulating β receptors on the cell membrane, they activate adenylyl cyclase, thereby increasing intracellular cyclic AMP (cAMP) levels. On one hand, they promote the phosphorylation of sarcoplasmic reticulum proteins, enhancing calcium (Ca2?) binding; on the other hand, they inhibit the activity of myosin light chain kinase, leading to uterine muscle relaxation and rapid relief of dysmenorrhea. However, this also has the side effects of increasing heart rate and elevating blood pressure.