Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may be more effective for relieving period pain than paracetamol, according to the update of a Cochrane Review. However, it remains unclear whether any one NSAID is safer or more effective than others.
Period pain affects a high proportion of women: up to 72% in a recent Australian survey of 16-49 year olds. It is thought to be caused by an excess or imbalance of certain hormones released by the body during menstrual periods, including one called prostaglandin. NSAIDs such as ibuprofen, aspirin, and naproxen are commonly used for period pain.
The updated review includes data from 73 trials carried out in 18 different countries and involving a total of 5,156 women. The trials compared NSAIDs with placebo, with each other, and with paracetamol. The review shows that NSAIDs are very effective for treating period pain compared with placebo. This applied to all NSAIDs tested except aspirin, for which there was only limited evidence of effectiveness. Due to the large number of different NSAIDs tested in the trials, no one drug emerged as more safe or effective than the rest.
The review also provides some evidence that NSAIDs are significantly more effective than paracetamol, though there were only three relevant studies. Until now there has been no evidence that NSAIDs work any better than paracetamol, and a previous Cochrane Review published in 2003 concluded that there was no evidence of any difference.
Overall, NSAIDs were shown to carry a significantly increased risk of adverse effects compared to placebo. Adverse effects can include indigestion, headaches, and drowsiness. "Women using these drugs need to be aware of the side effects," said lead author Jane Marjoribanks, who works with the Cochrane Menstrual Disorders and Subfertility Group in Auckland, New Zealand . "It would be interesting to see whether these could be reduced, without loss of effectiveness, by combining lower doses with other drugs such as paracetamol, or with other therapies such as transcutaneous electrical nerve stimulation."