chronic

Primary dysmenorrhoea

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

ACOG Committee Opinion No. 760 (2018) · Mefenamic Acid 500 mg film-coated Tablets SmPC sections 4.2 and 4.3 (eMC product 12503) · Dysmenorrhea - StatPearls - NCBI Bookshelf - disease-level clinical article (primary-dysmenorrhoea-full.txt) · Microgynon 30 tablets SmPC section 4.2 (eMC product 1130)

Verified against4 documents

Mefenamic Acid 500 mg film-coated Tablets SmPC sections 4.2 and 4.3 (eMC product 12503)
ACOG Committee Opinion No. 760 (2018)
Paracetamol 500mg Tablets SmPC (eMC product 5164)
Dysmenorrhea - StatPearls - NCBI Bookshelf - disease-level clinical article (primary-dysmenorrhoea-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (7)

Cramp starts immediately before, or as, the period begins [muscle cramps]
Severity peaks 23 to 48 hours in and is usually over within 72 hours
It appears once ovulatory cycles begin, generally inside two years of the first period
Tiredness, headache, diarrhoea, nausea and vomiting may accompany it [diarrhoea · fatigue · headache · nausea · vomiting]
Pelvic pain sits in the midline and can travel into the lower back or the upper legs [abdominal pain · pelvic pain]
It is crampy and comes in waves, and runs much the same from one cycle to the next
Dizziness and trouble sleeping can come with it as well [dizziness]

Signs — what you find (9)

Examination is normal in the primary form
Pelvic assessment finds a uterus of usual size, freely mobile and not tender
No abnormal discharge, no adnexal mass and no nodules along the uterosacral ligaments
Starting over the age of 25 points away from the primary form
Whitish grey, mucopurulent or foul-smelling discharge raises pelvic inflammatory disease
A friable cervix raises concern for a sexually transmitted infection
Heavy periods plus a slightly bigger, evenly shaped uterus suggest adenomyosis [abnormal uterine bleeding · heavy periods]
Irregular bleeding with a bulky, lopsided uterus suggests leiomyomas [bleeding]
Pain on passing urine, pain with sex, vaginismus, painful defaecation, infertility, palpable nodularity or adnexal tenderness all argue against the primary form [abdominal pain · infertility · pelvic pain]

Tests (9)

A characteristic story on its own is enough to make the diagnosis
Scanning adds little once the picture is clearly primary
Skip the internal examination in a teenager who is not sexually active and whose history is classic with nothing else added
Do examine internally when the onset and duration of lower abdominal pain hint at a secondary cause, or medical treatment is failing
Where a secondary cause is suspected, the transvaginal scan comes first
Take endocervical or vaginal swabs when infection risk or pelvic inflammatory disease is in question
Cervical cytology or HPV testing if cancer of the cervix is a concern
MRI or Doppler helps when adnexal torsion, adenomyosis or deep pelvic endometriosis is possible, or the scan was equivocal
Laparoscopy is kept for those wanting to conceive in whom endometriosis is the suspected secondary cause

If not this — what else fits (12)

Endometriosis
Outflow tract obstruction - imperforate hymen, transverse vaginal septum, cervical stenosis
Ovarian cyst, functional or otherwise
Adnexal torsion, which is typically not cyclical with periods
Adenomyosis
Pelvic inflammatory disease or a sexually transmitted infection
Endometrial polyp
Obstructive Müllerian duct anomaly
Leiomyomas
Ectopic pregnancy
Irritable bowel syndrome
Urinary tract infection

SourceStatPearls "Dysmenorrhea" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Combined pill - for the patient who also wants contraception

MAIN TREATMENT - choose one

MEFENAMIC ACID

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg TID with meals starting at onset of menses x 2-3 days during menses

Paediatric dose

(Licensed for dysmenorrhoea in adolescents over 12 years: 500 mg TID)

Dose by age
Over 12 years:	500 mg three times daily

Dose source

Mefenamic Acid 500 mg film-coated Tablets SmPC sections 4.2 and 4.3 (eMC product 12503)

Why

NSAID with dual action: COX inhibition and prostaglandin receptor antagonism

Cautions

Discontinue immediately if diarrhea develops (unique to mefenamic acid); CONTRAINDICATED in active inflammatory bowel disease.
Take with or after food to minimize gastric irritation.
CONTRAINDICATED in active peptic ulcer disease or NSAID-induced asthma.
Caution in renal impairment or bleeding disorders.
CONTRAINDICATED in inflammatory bowel disease, in active or recurrent peptic ulcer or GI haemorrhage, and in severe renal failure. Maximum 1500 mg a day.
Opioids and tramadol should not be used routinely for period pain.
All NSAIDs carry black box warnings for serious adverse events, which must be heeded whichever agent is chosen.
Period pain that does not respond to NSAIDs is a warning sign for endometriosis - up to 35% of NSAID non-responders have it, against up to 29% of women with dysmenorrhoea overall.
In primary dysmenorrhoea the pain starts within a few hours of menses and typically resolves within 72 hours; pain lying outside that pattern should raise suspicion of a secondary cause.
Onset of menstrual pain in a woman older than 25 points towards a secondary cause rather than primary dysmenorrhoea.
Perform a pelvic examination when the history of onset and duration suggests a secondary cause, or when the pain is not responding to medical treatment.
A pelvic examination is not required in an adolescent who is not sexually active and has a typical presentation without additional symptoms.
If the pain persists despite treatment, investigate for a secondary cause rather than escalating analgesia.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
PONAGIC FORTE 500MG 10 F.C. TAB.	RAMEDA	3.00 EGP (0.30/unit)
MEFRONIL 500 MG 30 TABS.	EL NILE.	14.25 EGP (0.47/unit)
FAROSTAN FORTE 500MG 10 TAB.	PHAROPHARMA	5.00 EGP (0.50/unit)
MAFEPAIN 500MG 10 F.C. TAB.	SPIMACO > EIMC	6.00 EGP (0.60/unit)
MEFENAM 500MG 20 CAPS.	JEDCO INT. CO. FOR PHARMACEUTICALS	14.00 EGP (0.70/unit)
PONSTAN FORTE 500MG 20 F.C. TABS.	PFIZER	14.00 EGP (0.70/unit)
PONOFORTE 500MG 20 CAPS.	UNIPHARMA	30.00 EGP (1.50/unit)

IBUPROFEN

1st line

Strength400 mg

Formoral.solid

Adult dose and duration

400 mg TID with food starting 1-2 days before or at menses onset x 2-3 days during menses

Paediatric dose

(Adolescents >12 yrs: 200-400 mg TID with food during menses)

Dose by age
13 years and over:	200 to 400 mg three times daily with food during menses

Choice

Alternatives. Both are NSAIDs for period pain; ibuprofen is the cheaper and the one available without a prescription.

Dose source

ACOG Committee Opinion No. 760 (2018)

Why

Widely available first-line NSAID for dysmenorrhoea relief

Cautions

Take with food or milk.
Avoid in active GI ulceration, severe renal impairment, or late pregnancy.
May cause dyspepsia or mild fluid retention.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
DAJUANOFEN 400 MG 20 F.C. TABS.	COPAD PHARMA	5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.	DELTA PHARMA	3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETS	SANOFI	12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.	SEDICO	6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABS	EIPICO	42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.	KAHIRA > ABBOTT LABORATORIES	78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.	EUROPEAN EGYPTIAN PHARM. IND.	31.00 EGP
ANALGIPROF 400 MG 25 SACHETS	EVA PHARMA	37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solid	SANOFI	2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solid	ARAB DRUG COMPANY (ADCO)	4.50 EGP

PARACETAMOL

2nd line

Formoral.solid

Adult dose and duration

500-1000 mg (1-2 tablets) every 4-6 hours as required (max 4000 mg/day)

Paediatric dose

Dose by age
Child 1 month and over:	15 mg/kg 3 or 4 times daily (max 60 mg/kg daily). Child under 1 month: 10 mg/kg 3 or 4 times daily (max 40 mg/kg daily).

Dose source

Paracetamol 500mg Tablets SmPC (eMC product 5164)

Why

Non-NSAID analgesic alternative for dysmenorrhea pain when NSAIDs are contraindicated.

Cautions

Do not exceed 4000 mg (8 tablets) in 24 hours to prevent hepatotoxicity.
Avoid concurrent use with other paracetamol-containing products.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
FEBRIMOL 500 MG 20 TAB.	PHARCO	3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.	MEMPHIS	8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.	MUP	13.00 EGP (0.65/unit)
PYRAL 500MG 20 TABS.	KAHIRA	28.00 EGP (1.40/unit)
TEMPORAL 1000 MG 20 TABS.	MUP	40.00 EGP (2.00/unit)
AUGICETAMIDE 250 MG 20 SACHETS	AUG PHARMA	30.00 EGP
STOPADOL JOINT 650 MG 30 EXT. REL. TABS.	EVA PHARMA	75.00 EGP
AUGICETAMIDE 1000 MG 20 SACHETS	AUG PHARMA	80.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solid	PHARCO	4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solid	PHAROPHARMA	5.00 EGP

COMBINED PILL - FOR THE PATIENT WHO ALSO WANTS CONTRACEPTION

ETHINYL ESTRADIOL + LEVONORGESTREL

Combined pill - for the patient who also wants contraception

2nd line

Formoral.solid

Adult dose and duration

A 21-day pack, one tablet each day at about the same time, begun on day 1 of the period, then 7 days with no tablet before the next pack - Continued cycle after cycle for as long as contraception is wanted; judge the effect on the pain over a few cycles

Paediatric dose

Used from menarche onwards in adolescents who want contraception; the same one-tablet-daily regimen applies, and the contraindications below matter just as much in a teenager as in an older woman.

Dose source

Microgynon 30 tablets SmPC section 4.2 (eMC product 1130) - verbatim: "First treatment cycle: 1 tablet daily for 21 days, starting on the first day of the menstrual cycle. Contraceptive protection begins immediately"

Why

A combined pill thins the endometrium and blocks ovulation, so less prostaglandin is made and the cramps ease. The article limits it to patients who also want contraception, which is the right way to offer it - it is not a painkiller for someone who does not.

Cautions

Do not prescribe it to anyone with a current or past venous thromboembolism, or a known clotting predisposition.
Migraine with aura is an absolute contraindication - ask about it directly, because patients volunteer the headache and not the visual symptoms.
Avoid it in smokers over 35, in severe hypertension, in diabetes with vascular complications, and in current or past breast cancer or severe liver disease.
Vomiting or diarrhoea within a few hours of a tablet, or a tablet more than 12 hours late, means contraceptive cover is lost - additional precautions are needed for the next 7 days.
If the pain does not settle over a few cycles, look again for a secondary cause such as endometriosis or adenomyosis rather than escalating the hormone.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
MICROCEPT 21 TAB.	CID	0.76 EGP (0.04/unit)
MICRODETTE 3* 21 TAB.	EL NILE.	7.50 EGP (0.36/unit)
NORDETTE 5*21 TAB.	EL NILE. > PFIZER	15.00 EGP (0.71/unit)
MICROGENEST 30/150 MCG 21 TABS.	ACDIMA INTERNATIONAL TRADING	23.00 EGP (1.10/unit)
TRIOCEPT 21 TAB. X 6 STRIP (TRIPHASIC)	CID	120.00 EGP (5.71/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.