Patient's question:
Hello! I am a 19-year-old girl. Every time during my period, the first two days are extremely painful, making it impossible for me to attend classes. I have taken many medications, such as Wuji Baifeng Pill, Xiaoyao Pill, and Fenbid, among others, but they only provide temporary relief and have no long-term effect. Could you please recommend any medications for treatment?Doctor's answer:
Hello, Primary Dysmenorrhea:(1) General Treatment: Engage in physical exercise to strengthen the body. Maintain a regular lifestyle, balance work and rest, and ensure adequate nutrition and sufficient sleep. Emphasize education about the physiological aspects of menstruation, explaining and persuading to alleviate patients' fear, anxiety, and mental burden. Strengthen menstrual hygiene, avoiding strenuous exercise, excessive fatigue, and preventing exposure to cold.
(2) Ovulation Suppression: If the patient wishes to control fertility, oral contraceptives (combined norethisterone tablets or combined medroxyprogesterone tablets) are the first-line medication for treating primary dysmenorrhea. The use of oral contraceptives can relieve symptoms in over 90% of cases, possibly due to the inhibition of endometrial growth, reduced menstrual flow, and a decrease in prostaglandin (PG) levels to below normal, leading to weakened uterine activity. Treatment can begin with 3–4 cycles. If the effect is satisfactory, the patient can continue; if symptoms do not improve significantly, appropriate additional PG synthesis inhibitors can be added. Since medication must be taken throughout the entire menstrual cycle, with effects only occurring on the last 1–2 days, it is generally unpopular with patients unless contraception is also needed.
(3) Prostaglandin Synthesis Inhibitors (PGSIs): For patients unwilling to use contraception, PGSIs are a suitable choice. They inhibit the synthesis of PGs in the endometrium, significantly reducing the amplitude and frequency of uterine contractions, without affecting the hypothalamic-pituitary-ovarian axis function or causing metabolic side effects like those of oral contraceptives. The main advantage is that they can be taken starting before pain onset and continued for 2–3 days. However, it is necessary to try different medications and dosages for a period to determine the most effective and suitable options for each individual. This trial and adjustment phase can sometimes last up to half a year.