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 do not offer a permanent solution. 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 patients to alleviate their 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 treatment for primary dysmenorrhea. The use of oral contraceptives can alleviate 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 be started with 3–4 cycles. If the effect is satisfactory, the medication can be continued. If symptoms do not improve significantly, appropriate additional PGs synthesis inhibitors can be added. Since medication must be taken throughout the entire menstrual cycle, while the effect occurs only on the last 1–2 days, it is generally unpopular with patients unless contraception is also needed.
(3) Prostaglandin Synthesis Inhibitors (PGSI): For patients unwilling to use contraception, PGSI is a suitable choice. It inhibits 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 it can be taken starting before pain onset and continued for 2–3 days. However, it is necessary to try different medications for a period to determine the most effective drug type and the most suitable dosage for each individual. The trial and adjustment phase may sometimes last up to half a year.