A 13-year-old girl presents with primary dysmenorrhea. She attained menarche 8 months ago and has had increasingly painful menses with each cycle. Pain is crampy, suprapubic, and radiates to the lower back. Pelvic examination is not performed as she is not sexually active. Which of the following is the most appropriate first-line treatment?
- A Combined oral contraceptive pill
- B NSAIDs (e.g., mefenamic acid or ibuprofen) ✓
- C Laparoscopic evaluation
- D Acetaminophen
Correct answer: B. NSAIDs (e.g., mefenamic acid or ibuprofen)
Explanation
Primary dysmenorrhea results from excess prostaglandin production in the endometrium during ovulatory cycles. NSAIDs, which inhibit cyclooxygenase and reduce prostaglandin synthesis, are the first-line treatment per ACOG and Indian pediatric guidelines. Combined oral contraceptives are second-line for cases refractory to NSAIDs or when contraception is also desired. Laparoscopy is reserved for suspected secondary dysmenorrhea. Acetaminophen lacks anti-prostaglandin activity and is less effective.
Reference: Williams Gynecology, 4th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.