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Medicine 1: NSAIDs

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Medicine 1: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

What is it?

Non-steroidal anti-inflammatory drugs (NSAIDs) are medicines that are widely used to relieve pain, reduce inflammation, and bring down a high temperature.

NSAIDs are available as tablets, capsules, suppositories (capsules inserted into the bottom), creams, gels, and injections. Some can be bought over the counter from pharmacies, while others need a prescription.

The main types of NSAIDs include:

  • Ibuprofen

  • Naproxen

  • Diclofenac

  • Mefenamic acid (Read more here)

  • Etoricoxib

  • Indomethacin

  • Aspirin 1

How does it work?

Cyclooxygenase (COX) is the enzyme that mediates the bioconversion of arachidonic acid to inflammatory prostaglandins (PGs).

NSAIDs are competitive inhibitors of COX, thus decreasing the production of prostaglandins, which results in decreased menstrual pain.2

What is the efficacy?

80 randomized controlled trials were included (5820 women). They compared 20 different NSAIDs (18 non-selective and two COX-2-specific) versus placebo, paracetamol, or each other. NSAIDs versus placebo among women with primary dysmenorrhea, NSAIDs were more effective for pain relief than placebo.

Conclusion: NSAIDs appear to be a very effective treatment for dysmenorrhea, though women using them need to be aware of the substantial risk of adverse effects. There is insufficient evidence to determine which (if any) individual NSAID is the safest and most effective for the treatment of dysmenorrhea.3

Side-effects:

Short-term effects: Nausea, diarrhea.

Long-term effects: Myocardial Infarction, thromboembolic events, and atrial fibrillation.2

References

  1. Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. BMJ. 2006 May 13;332(7550):1134–8.

  2. Patel RM, Patel MM. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) [Internet]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Jan– [cited 2025 May 16]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547742/

  3. Marjoribanks J, Ayeleke RO, Farquhar C, Proctor M. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev. 2015 Jul 30;2015(7):CD001751. doi:10.1002/14651858.CD001751.pub3.

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