Page 147 - Community pharmcy practice E-book 2025

02/11/2025, 00:29

• If patient is on anticoagulants or other medications that may complicate bleeding/pain.
• If pregnancy suspected or irregular cycles in adolescent undergoing menarche or
menopausal woman.

Non-Pharmacological Treatment
• Encourage regular exercise (aerobic, stretching), as evidence shows exercise reduces
severity of cramps. ( )
• Use of heat therapy (hot water bottle, heating pad) on lower abdomen/back; helps relieve
muscle cramps. ( )
• Dietary modifications: reduce caffeine, alcohol, salt; increase water, magnesium-rich
foods, anti-inflammatory diet (fruits/vegetables, whole grains).
• Adequate sleep/rest, stress-reduction, yoga/stretching (for example child’s pose, cobra,
cat-cow) for pelvic pain relief.
• Use of period-tracker apps to monitor cycle, pain patterns, triggers.
• Pharmacist role: counsel on these non-drug options and integrate into plan for pain relief
and prevention.

Pharmacological Treatment
• First‐line: NSAIDs (ibuprofen, naproxen, mefenamic acid) taken at the start of menses (or
even just before onset of flow/cramps) and continued for 1-2 days.
• Alternative: Acetaminophen if NSAIDs contraindicated, though may be less effective.
• Hormonal contraceptives (combined oral contraceptive pills or progestin-only options)
may be used when indicated (reduces prostaglandins, uterine contractions) — though pharmacist
may counsel but physician prescription required.
• Ensure safe use: check for contraindications (NSAIDs in gastric ulcer/renal impairment;
hormonal contraception in smokers >35 years, etc).
• Pharmacist role: review OTC use, assess contraindications, educate on dosing timing (e.g.,
start NSAIDs at onset or just before menses for optimal effect) and reinforce adherence.

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