Team Training: Management and Treatment of Menstrual Pain
Source: Irish Pharmacy News, January 2026, page 54.
Menstrual pain (dysmenorrhoea) is one of the most common gynaecological complaints, affecting up to 80% of menstruating people at some point. For many, community pharmacy is the first – and often only – point of contact for advice and treatment. Pharmacy teams therefore play a vital role in improving quality of life, reducing unnecessary GP visits, and identifying red flags that require referral.
Understanding Menstrual Pain
Menstrual pain is typically categorised as:
Primary dysmenorrhoea – pain without underlying pelvic pathology, usually starting within a few years of menarche and linked to prostaglandin release.
Secondary dysmenorrhoea – pain caused by an underlying condition such as endometriosis, fibroids, adenomyosis, or pelvic inflammatory disease.
Primary dysmenorrhoea is far more common in younger patients and is usually responsive to OTC treatments.
Typical Symptoms
- Cramping lower abdominal pain
- Pain radiating to the back or thighs
- Nausea, vomiting or diarrhoea
- Headache, fatigue
- Pain beginning 1-2 days before or at onset of menstruation
Pharmacy Consultation: Key Questions
A structured but sensitive consultation is essential. Ensure privacy and use inclusive, non-judgemental language.
Ask about:
- Age and time since menarche
- Onset and duration of pain
- Severity (e.g. does it interfere with work, school, or sleep?)
- Cycle regularity
- Current medicines (including hormonal contraception)
- Response to previous treatments
- Associated symptoms (heavy bleeding, intermenstrual bleeding, pelvic pain outside periods)
This helps differentiate between primary and secondary dysmenorrhoea and guides treatment choice.
Pharmacological Management
NSAIDs – First-Line Treatment
Non-steroidal anti-inflammatory drugs (NSAIDs) are the treatment of choice for primary dysmenorrhoea due to their prostaglandin-inhibiting effect.
Common options include:
- Ibuprofen
- Naproxen
- Mefenamic acid (where appropriate)
Counselling points:
- Start at onset of pain or up to 24 hours before menstruation if cycles are predictable
- Take regularly for the first 48-72 hours
- Take with food
- Avoid in patients with contraindications (e.g. NSAID-sensitive asthma, peptic ulcer disease, renal impairment)
Paracetamol
Paracetamol is suitable where NSAIDs are contraindicated or not tolerated. While less effective alone, it can be useful in combination with an NSAID.
Combination Analgesia
Combination products containing paracetamol and ibuprofen may be an appropriate option for some patients. This approach offers dual mechanisms of action – central analgesia from paracetamol and peripheral anti-inflammatory effects from ibuprofen – without increasing the dose of either component beyond standard OTC strengths.
Hormonal Management – Awareness and Signposting
Hormonal contraception can reduce menstrual pain by suppressing ovulation and reducing prostaglandin production.
Pharmacy teams should:
- Be aware of the role of combined and progestogen-only contraception in dysmenorrhoea
- Support patients accessing contraception services
- Encourage follow-up if pain persists despite hormonal treatment
Non-Pharmacological Advice
Alongside pharmacological treatment, non-pharmacological measures can play a valuable supportive role in the management of menstrual pain. The application of local heat, such as a hot water bottle or heat patch, can help relax uterine muscles and reduce cramping. Gentle physical activity, including walking or stretching, may also alleviate symptoms by improving blood flow and releasing endorphins. Relaxation techniques and stress reduction strategies, such as breathing exercises or mindfulness, can further support pain management, particularly for individuals who experience heightened discomfort during periods of stress. Adequate sleep is equally important, as fatigue can lower pain tolerance and exacerbate symptoms. These approaches should be recommended as complementary measures, used alongside appropriate analgesia rather than as substitutes for effective pain relief.
Consider
- Are I/my team confident in identifying menstrual pain that can be managed in the pharmacy versus symptoms that require referral, and are we up to date with guidance on appropriate OTC treatment choices?
- How can this knowledge help us improve conversations with patients, particularly around validating pain, setting realistic expectations for relief, and encouraging timely follow-up if symptoms persist?
- What practical steps can we implement immediately in the pharmacy, such as proactive questioning, consistent advice on medicine use and non-pharmacological options, and clear signposting to GP or specialist care where appropriate?
Key Points
- Reinforce that period pain is common but not “something to suffer through” and that effective treatment options are available in the pharmacy.
- Ensure the team can confidently recommend appropriate OTC analgesia, including NSAIDs and paracetamol, tailored to pain severity, medical history and patient preference.
- Promote awareness of red flags and referral criteria, particularly severe or worsening pain, poor response to treatment, heavy bleeding or symptoms suggestive of secondary causes such as endometriosis.
- Encourage supportive advice alongside medicines, including heat therapy, gentle activity and reassurance, while using empathetic, inclusive language to validate the patient’s experience.
Actions
- Ensure support staff understand the following key points:
- The typical features of primary menstrual pain, including cramping lower abdominal pain, back pain and associated symptoms such as nausea or headache, and how these differ from symptoms that may indicate an underlying condition.
- How to recommend appropriate OTC treatment options for menstrual pain, including the correct use of NSAIDs and paracetamol, and when combination therapy may be appropriate.
- How to recognise when referral is required, including poor response to treatment, severe or worsening pain, heavy or irregular bleeding, or symptoms suggestive of secondary dysmenorrhoea.
- The role of non-pharmacological measures, such as heat therapy, gentle activity and reassurance, and the importance of using empathetic, non-judgemental language when supporting patients.
