A 19-year-old woman presents with severe dysmenorrhea since menarche. Pain begins 1-2 days before menses and lasts 3 days, radiating to the thighs with associated nausea and diarrhea. Pelvic examination and transvaginal ultrasound are normal. What is the first-line pharmacological treatment?
- A Combined oral contraceptive pill
- B Laparoscopic presacral neurectomy
- C NSAIDs (mefenamic acid or ibuprofen) ✓
- D Levonorgestrel-releasing intrauterine system
Correct answer: C. NSAIDs (mefenamic acid or ibuprofen)
Explanation
Primary dysmenorrhea results from excess prostaglandin production in the endometrium causing uterine hypercontractility and ischemia. NSAIDs are first-line as they inhibit cyclooxygenase and reduce prostaglandin synthesis. Combined oral contraceptives are second-line or used when contraception is also desired. Presacral neurectomy is reserved for refractory cases. LNG-IUS is more commonly used for secondary dysmenorrhea or heavy menstrual bleeding. Normal examination and imaging confirm primary (not secondary) dysmenorrhea. (Williams Gynecology; ACOG Committee Opinion on Dysmenorrhea).
Reference: Williams Gynecology, 4th ed.
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