For period pain, take a painkiller such as ibuprofen rather than toughing it out; if the pain keeps you from work or school, or three months of medicine doesn't control it, see a gynecologist

Cost

A box of ibuprofen costs a dozen or so CNY, and you take it only on the days it hurts. If you need to see a gynecologist, registration and an ultrasound cost some money and half a day.

What you get

A Cochrane systematic review pooled 80 randomized controlled trials with 5820 women with primary dysmenorrhea. Primary dysmenorrhea means period pain for which no other disease can be found. Compared with placebo, non-steroidal anti-inflammatory drugs relieved pain more effectively (OR 4.37, 95% CI 3.76–5.09, the plausible range). Converted, 18% of people on placebo got moderate or better relief, against 45% to 53% of those on these drugs. The cost was somewhat more side effects (OR 1.29, 1.11–1.51). 10% of people on placebo had side effects, against 11% to 14% on these drugs. The extra ones were mainly stomach and bowel upset (OR 1.58) and nervous system reactions (OR 2.74). Compared with acetaminophen, these drugs also relieved pain more effectively (OR 1.89, 1.05–3.43), though there were only 3 trials. No difference was found in which of these drugs is best. The UK NICE guideline (updated 2024) lists situations in which endometriosis should be suspected. They are long-term pelvic pain, period pain that affects daily activities and quality of life, and deep pain during or after sex. Also pain with bowel movements during periods, blood in the urine or painful urination during periods, and infertility together with these symptoms. Girls aged 17 and under are included. The guideline advises first trying acetaminophen or these drugs, for example for 3 months. If pain relief is not enough, refer for further tests. A normal gynecological exam and ultrasound do not rule out the disease either. A study surveyed 1418 women having laparoscopy at 16 hospitals in 10 countries. From the start of symptoms to a surgical diagnosis of endometriosis took on average 6.7 years, mostly lost at the primary care stage. Women with a confirmed diagnosis did 10.8 fewer hours of work a week on average, mostly by being at work with reduced efficiency. An online survey in the Netherlands asked 32748 women aged 15 to 45. 13.8% had taken time off because of menstruation, an average of 1.3 days a year. 80.7% were at work during their period with reduced efficiency, equal to 8.9 days a year of lost work.

Notes

People over 60, people who have had stomach bleeding, and people taking anticoagulants or hormones should ask a doctor before using these drugs. For details see §34.3 (painkillers such as ibuprofen). The U.S. ibuprofen label states that it can cause serious allergic reactions, which are more likely in people allergic to aspirin, with signs including asthma attacks. People with asthma should also ask a doctor before using it. If you might be pregnant, ask a doctor first, and after 20 weeks of pregnancy don't take it on your own; see §34.5 (after 20 weeks of pregnancy). People who can't take these drugs can use acetaminophen instead; for the daily limit see §34.1 (acetaminophen). For period pain you take medicine only on the days of your period. The threshold in §34.9 (don't take painkillers more than 15 days a month) is about headaches, and the number of days of medicine for period pain comes nowhere near it. It is graded A because the pain relief comes from a large number of randomized trials. The authors rated the evidence quality of most comparisons as low, mainly because the trial methods were described unclearly, and 59% of the trials were funded by drug companies. The size of the benefit is rated “medium” as a judgment: the review measured only whether it hurts, not fewer days of missed work. In the Dutch survey, the loss from menstruation came to about 10 days a year, which spread over a week is measured in hours. The endometriosis group were women who had already gone for laparoscopy, and do not represent most people with period pain having this disease. The person who benefits is mainly you.

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. 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
2. 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
3. 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
4. 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
5. 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

Translated from the Chinese original. Original book, section 3, tip 25. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer