Consider suitable pain relief for period pain and seek assessment when symptoms disrupt life or persist

Cost: The source describes a box of ibuprofen costing tens of yuan, used during painful menstrual days. A gynaecology visit and ultrasound take additional money and time. Suitability and use should follow the product instructions and clinician's advice; no dose is specified here.

In plain language: In the cited review of primary dysmenorrhoea, NSAIDs such as ibuprofen improved pain relief compared with placebo and, in fewer studies, paracetamol, with somewhat more side effects. Period pain interfering with school or work, deep pain during sex, or inadequate relief despite an initial treatment trial can warrant assessment for endometriosis. An average diagnostic delay from a selected study is not a prediction for every person.

Findings reported by the source: A Cochrane review included 80 randomized trials and 5,820 women with primary dysmenorrhoea, meaning no other identified disease causing the pain. NSAIDs versus placebo had OR 4.37 (95% CI 3.76–5.09) for pain relief. With 18% obtaining moderate or better relief on placebo, the corresponding NSAID estimate was 45–53%. Side effects had OR 1.29 (1.11–1.51), corresponding to 11–14% versus a 10% placebo rate; gastrointestinal and neurological effects had ORs 1.58 and 2.74. Against paracetamol, pain relief had OR 1.89 (1.05–3.43), based on only three trials. No NSAID was clearly established as best.

Assessment guidance described by the source: NICE's 2024-updated endometriosis guidance includes chronic pelvic pain, period pain affecting daily activities or quality of life, deep pain during or after sex, cyclical painful bowel movements, cyclical painful urination or blood in urine, and infertility with these symptoms. Girls aged 17 or younger are also included. It describes an initial trial of paracetamol or an NSAID, for example three months, followed by further assessment when relief is insufficient. Normal examination or ultrasound does not exclude endometriosis.

Other studies reported by the source: Among 1,418 women undergoing laparoscopy at 16 hospitals in ten countries, mean time from symptom onset to surgical diagnosis was 6.7 years, with much delay in primary care. Diagnosed participants lost around 10.8 productive hours weekly, mostly reduced effectiveness while at work. A Dutch online survey of 32,748 women aged 15–45 found 13.8% reporting menstruation-related absence, averaging 1.3 days yearly; 80.7% reported lower effectiveness while present, equivalent to 8.9 days yearly.

Source author's evidence grade: A; not site verification or professional approval.

Notes: The source advises consulting a clinician before NSAIDs for older adults, previous gastrointestinal bleeding, anticoagulant or steroid use, asthma or possible pregnancy. The cited ibuprofen label warns about serious allergic reactions, including asthma attacks, particularly with aspirin allergy. Do not self-use after 20 weeks of pregnancy; see chapter 34, entries 3 and 5. People unable to use NSAIDs should discuss alternatives such as paracetamol; see entry 1 for its limits. This entry concerns medication during painful menstrual days; the source's separate monthly medication-use threshold in entry 9 concerns headache. Most comparisons in the review were low-quality, partly from unclear methods; 59% of trials had pharmaceutical sponsorship. The medium-benefit label is judgment-based: trials measured pain relief, not days of absence avoided. The selected laparoscopy population does not mean most people with period pain have endometriosis.

Original source bibliography (titles retained as supplied): Marjoribanks J, Ayeleke RO, Farquhar C, Proctor M (2015). Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database of Systematic Reviews, (7):CD001751. https://doi.org/10.1002/14651858.CD001751.pub3；National Institute for Health and Care Excellence (2017, updated 2024). Endometriosis: diagnosis and management (NG73), recommendations 1.3.1, 1.4.2, 1.4.3, 1.5.4. https://www.nice.org.uk/guidance/ng73/chapter/Recommendations；Nnoaham KE, Hummelshoj L, Webster P, et al.; World Endometriosis Research Foundation Global Study of Women's Health consortium (2011). Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertility and Sterility, 96(2):366-373.e8. https://doi.org/10.1016/j.fertnstert.2011.05.090；Schoep ME, Adang EMM, Maas JWM, De Bie B, Aarts JWM, Nieboer TE (2019). Productivity loss due to menstruation-related symptoms: a nationwide cross-sectional survey among 32 748 women. BMJ Open, 9(6):e026186. https://doi.org/10.1136/bmjopen-2018-026186；Haleon (2026). Advil (ibuprofen capsule, liquid filled), OTC drug label: Warnings. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1f01c10a-9434-91a4-2ee4-352315a6b610