Understanding Menstrual Pain and PMS Choosing Pain Relievers and Management

Many people simply endure monthly menstrual pain or reach for their usual medication. In the clinic, it's rare to find those who understand which medication works, why it works, or when to take it to alleviate pain more effectively. It's also not widely known that common over-the-counter pain relievers like Tylenol may not be the optimal choice for menstrual pain. This article will cover everything from the principles of menstrual pain to tips for choosing and taking painkillers, and even premenstrual syndrome (PMS).

Menstrual pain is broadly categorized into primary and secondary. Their causes differ, and so do their management strategies.

• Primary Dysmenorrhea: Pain that occurs without any specific underlying disease, typically affecting the lower abdomen and lower back around the start of menstruation. This is a common form that many people have experienced at some point.
• Secondary Dysmenorrhea: Pain caused by an actual disease within the pelvis. Common causes include uterine fibroids, adenomyosis, and endometriomas.

Primary dysmenorrhea may rarely be accompanied by nausea, but the main symptoms are abdominal pain and lower back pain. In severe cases, some individuals may visit the emergency room due to chills, vomiting, diarrhea, or a feverish sensation.

The core cause of primary dysmenorrhea is prostaglandins. When the uterine lining breaks down, arachidonic acid is converted into prostaglandins via an enzyme called COX, and this substance causes pain.

Prostaglandins create pain in several ways. They strongly contract the uterus, causing abdominal pain, and constrict uterine blood vessels, reducing blood flow and oxygen supply, which intensifies the pain. They also sensitize pain receptors and can even overstimulate bowel movements, leading to diarrhea.

Pain relievers generally fall into two main categories. Understanding the difference clarifies the criteria for choosing medication.

NSAIDs block the process of prostaglandin production itself. Figuratively speaking, it's like stopping the factory that produces pain, which helps not only in pain relief but also in alleviating accompanying symptoms like reduced menstrual flow and diarrhea. Tylenol, on the other hand, only slightly reduces the "noise" while leaving the "factory" intact, so it doesn't address the root cause. However, if your stomach is sensitive and you find it difficult to take NSAIDs on an empty stomach, Tylenol can be used as a temporary measure.

If you experience recurring menstrual pain and are always concerned about medication choices, we recommend reviewing Guidance on Menstrual Pain and Irregularity to understand when medical consultation is necessary.

Even with the same medication, the timing of administration significantly affects its efficacy. It usually takes two to three hours for NSAIDs to be absorbed and take effect. Therefore, it is much more comfortable to take them when menstruation slightly begins or just before it starts, rather than after the pain has already set in. This single timing can make a difference in your day.

Beyond painkillers, there are also methods to regulate menstruation itself. Oral contraceptives or intrauterine devices suppress ovulation or keep the uterine lining thin, thereby reducing prostaglandin secretion. However, there may be side effects such as irregular bleeding or breast tenderness, and for women over 35 who smoke, it may not be recommended due to the risk of blood clots, so consultation with an obstetrician-gynecologist is advisable. Hot packs are helpful in the same context; warm stimulation is reported to relax blood flow and alleviate pain.

If the pain does not subside even after taking painkillers properly, secondary dysmenorrhea should be suspected. The three common causes are summarized as follows:

• Uterine Fibroids: A condition where benign growths develop in the uterine muscle.
• Adenomyosis: A condition where endometrial tissue grows into the muscular wall of the uterus, causing the uterus to enlarge and menstrual bleeding to increase.
• Endometrioma: A condition where endometrial tissue grows outside the uterus (e.g., ovaries, pelvis), causing inflammation with each menstrual period.

In such cases, the pain may not be resolved by painkillers alone and can worsen over time. Especially if menstrual pain suddenly appeared after becoming an adult, there might be changes within the pelvis, making it important to confirm the cause with an ultrasound at an obstetrician-gynecologist. The feeling that the pain is getting progressively worse or is different from before is a signal to seek medical attention.

Premenstrual Syndrome (PMS) is another condition that troubles many people as much as menstrual pain. It is characterized by emotional and physical symptoms that recur for about one to two weeks after ovulation and subside once menstruation begins. A significant number of menstruating women experience it, and some find it difficult enough to disrupt their daily lives.

Symptoms vary widely, from mood swings, irritability, depression, anxiety, and reduced concentration to intense cravings for sweets and carbohydrates, breast tenderness, abdominal bloating, and headaches. The key is that this is not a matter of personality or willpower, but rather changes in hormones and neurotransmitters. When serotonin in the brain becomes insufficient during the fluctuating levels of progesterone, it becomes difficult to regulate emotions, sleep, and appetite. The craving for sweets is also explained by carbohydrates helping serotonin synthesis.

When symptoms are much more severe, with prominent depression, anxiety, and mood instability affecting interpersonal relationships and work, it is called Premenstrual Dysphoric Disorder (PMDD). In such cases, active treatment is needed rather than simply enduring it. If you feel overwhelmed by PMS management, also refer to PMS Symptom Relief and Management.

Management depends on how much the symptoms affect daily life. First, non-pharmacological methods such as regular exercise, reducing sodium and caffeine intake, regular sleep, and cognitive behavioral therapy are recommended. If symptoms are severe, medication may be considered at an obstetrician-gynecologist or a psychiatrist.

Typically, SSRIs are an officially used option for PMS, helping to maintain serotonin at a consistent level to alleviate depression, anxiety, and irritability. They may be taken only during the luteal phase or continuously in severe cases. Oral contraceptives containing drospirenone, such as Yaz, can help with edema or abdominal bloating and may also reduce PMS itself by suppressing ovulation. However, these may not be suitable for everyone, so it is best to check the detailed information in Guidance on Yaz for PMS and PMDD Treatment and find a method suitable for you through medical consultation.

For reference, many people endure pain, believing that frequent use of painkillers leads to tolerance. However, NSAIDs used for menstrual pain are not narcotics, so taking them for a few days a month does not cause tolerance. It is better to manage the pain according to its cause rather than simply enduring it.

The cause of primary dysmenorrhea is prostaglandins, and taking NSAIDs proactively before the pain intensifies is key. If the pain still doesn't improve, secondary causes should be considered. PMS and PMDD may be issues related to neurotransmitters rather than personality, and can be alleviated through lifestyle modifications and, if necessary, treatment. If you experience monthly pain or your daily life is disrupted, we recommend not enduring it and seeking medical consultation.

Author: Lee Dong-hee Chief Director · Obstetrician-Gynecologist · View Medical Staff Profile

This article is based on the content of a YouTube video · First published March 23, 2026 · Last reviewed May 30, 2026

This article provides general health information and is not a substitute for individual diagnosis or treatment. If you have symptoms, please consult a doctor through a medical examination.