Many people living with period pain are not using the most effective medications available. New research based on supermarket purchases from more than 3 million shoppers found that paracetamol is the painkiller most commonly purchased for menstrual cramps, even though ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) generally provide better relief.
This gap between purchasing habits and medical evidence suggests that menstrual pain remains both under-treated and poorly understood. Dysmenorrhea, the medical term for period pain, affects a large proportion of people who menstruate and is one of the leading causes of missed school and work worldwide.
How Period Pain Develops
Menstrual cramps are primarily caused by hormone-like substances called prostaglandins, which are released from the uterine lining as it sheds each month. These compounds trigger powerful uterine contractions that help expel the lining but also reduce blood flow to the uterus, causing cramping pain in the lower abdomen and back.
High prostaglandin levels are also associated with nausea, diarrhea, headaches, and other symptoms that often accompany menstruation. While some people experience only mild discomfort, others develop pain severe enough to interfere with normal daily activities.
Why Ibuprofen Usually Works Better Than Paracetamol
Ibuprofen belongs to a class of medications known as non-steroidal anti-inflammatory drugs (NSAIDs). These medications block cyclooxygenase enzymes that are required for prostaglandin production, targeting the underlying biological cause of menstrual cramps rather than simply reducing the perception of pain.
Paracetamol, in contrast, has only limited effects on prostaglandin production outside the central nervous system. It acts mainly within the brain and spinal cord to reduce pain perception, making it effective for headaches and fever but generally less effective for inflammatory pain such as menstrual cramps.
A large review of approximately 80 clinical trials involving more than 5,800 women found that NSAIDs were significantly more effective than paracetamol for relieving dysmenorrhea. Despite this evidence, paracetamol remains the preferred choice for many consumers, likely because it is widely available, heavily marketed, and commonly perceived as gentler on the stomach.
Other NSAIDs and the Importance of Timing
Ibuprofen is not the only NSAID used to treat menstrual pain. Naproxen and mefenamic acid are also effective treatment options. Aspirin is used less frequently because it may increase menstrual bleeding by thinning the blood and is not recommended for people under 16 years of age due to the risk of Reye’s syndrome.
Current evidence does not show that any single NSAID consistently outperforms the others in terms of effectiveness or side effects. If one medication is ineffective or causes unwanted effects, another NSAID may provide better relief. Mefenamic acid, which is often prescribed rather than purchased over the counter, may also help reduce heavy menstrual bleeding.
Timing is equally important. Although NSAIDs can relieve pain when started after symptoms appear, they are generally most effective when taken one to two days before menstruation begins and continued during the first few days of the period. Starting treatment early helps suppress the prostaglandin surge before severe cramps develop.
Potential Risks of NSAIDs
For most healthy individuals, short-term NSAID use is considered safe. However, these medications can irritate the stomach lining and may increase the risk of ulcers or gastrointestinal bleeding. They can also affect kidney function and, with prolonged or excessive use, may increase cardiovascular risk.
People with asthma, kidney disease, heart disease, or a history of stomach ulcers should consult a healthcare professional before taking NSAIDs. These medications may also interact with blood thinners, certain antidepressants, some blood pressure medications, and corticosteroids, making professional advice particularly important.
Even when used correctly, NSAIDs do not work for everyone. Research suggests that approximately 18% of people with dysmenorrhea do not achieve adequate pain relief with NSAIDs alone, highlighting the need for additional treatment options.
Alternative Treatments and Hormonal Contraception
For individuals who cannot take NSAIDs, hyoscine butylbromide may offer an alternative. This antispasmodic medication is more commonly used for abdominal cramps and works by relaxing smooth muscle in the digestive tract and uterus rather than reducing prostaglandin production.
Although hyoscine butylbromide is generally less effective than NSAIDs for menstrual pain, it may provide partial relief or be combined with paracetamol. A small study suggested that this combination was more effective than placebo, although larger, high-quality clinical trials are still needed to compare it directly with NSAIDs.
Hormonal contraception, particularly the combined oral contraceptive pill, is another well-established treatment for dysmenorrhea. By suppressing ovulation and thinning the uterine lining, hormonal contraceptives reduce prostaglandin production, often resulting in lighter, more predictable, and less painful periods.
Like all medications, hormonal contraceptives may cause side effects, including nausea, breast tenderness, breakthrough bleeding, and mood changes. The decision to use hormonal therapy should be based on an individual discussion with a healthcare professional that considers both potential benefits and risks.
Non-Drug Approaches and When to Seek Medical Advice
Non-pharmacological strategies can complement medication and provide additional symptom relief. Applying heat to the lower abdomen with a heating pad or hot water bottle can help relax muscles and reduce cramping. Many people also benefit from gentle physical activity, stretching exercises, and relaxation techniques.
Transcutaneous electrical nerve stimulation (TENS) is another treatment option. These small devices deliver mild electrical impulses through adhesive pads placed on the skin, helping to interrupt pain signals while stimulating the release of the body’s natural pain-relieving chemicals. High-frequency TENS has been shown to reduce menstrual pain in some users.
TENS is generally considered safe when used as directed. However, it should be avoided during pregnancy and by individuals with epilepsy or implanted cardiac pacemakers unless recommended by a healthcare professional. As with medications, treatment response varies, and some people may need to try several approaches before finding consistent relief.
Severe, worsening, or newly developed menstrual pain should never be ignored. Persistent symptoms that interfere with work, school, or daily life may indicate underlying conditions such as endometriosis, adenomyosis, or uterine fibroids. Early medical evaluation can help reduce the prolonged delays in diagnosis that many patients with these conditions currently experience.
The new purchasing data highlight a broader need for improved public education about menstrual health. Helping people understand which treatments are most effective, how to use them correctly, and when to seek medical advice could reduce unnecessary suffering and improve quality of life for millions.
