What is the first-line treatment for dysmenorrhea?

• A. Nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptives.
• B. Antibiotics.
• C. Surgery.
• D. Only rest.

Answer: (A)

Painful periods mainly come from prostaglandin-driven uterine contractions. The best first-line approach targets those mechanisms: NSAIDs block COX enzymes and reduce prostaglandin synthesis, which directly lowers cramps and pain. Hormonal contraceptives suppress ovulation and thin the endometrium, which decreases prostaglandin release and reduces menstrual flow, providing longer-term relief and contraception if needed. Together, they address both immediate symptoms and the underlying cycle-related factors. Antibiotics address infections, not the cause of primary dysmenorrhea, and surgery is reserved for other problems or refractory cases. Rest alone doesn’t treat the underlying process.