Minor ailments

Dysmenorrhea

Clinical basis & sources

Sources used

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Allowable drugs under Schedule 4 (8)

Drugs an Ontario pharmacist may prescribe for Dysmenorrhea under O. Reg. 256/24, Schedule 4. Choice still depends on the assessment, contraindications, allergies, and product availability — this is the eligible list, not a recommendation.

  • Acetylsalicylic acid (ASA)
  • Celecoxib
  • Diclofenac
  • Flurbiprofen
  • Ibuprofen
  • Ketoprofen
  • Mefenamic acid
  • Naproxen

Symptoms this assessment screens

  • Crampy lower abdominal or pelvic pain linked to menses
  • Predictable pattern starting just before or with menstrual flow
  • Pain may radiate to back or thighs
  • Nausea, vomiting, diarrhea, headache, dizziness, or fatigue with menses
  • School, work, sleep, or daily function affected
  • Prior response to NSAIDs, heat, or self-care

Red flags — any positive means refer

  • Pregnancy possible, late or missed period, positive test, or ectopic pregnancy concern
  • Sudden severe pelvic or abdominal pain, syncope, shoulder-tip pain, or unstable patient
  • Fever, abnormal vaginal discharge, pelvic infection concern, or systemic illness
  • Heavy, prolonged, intermenstrual, or postcoital bleeding
  • New or worsening pain after age 25, non-cyclic pain, dyspareunia, infertility, or suspected secondary cause
  • Possible IUD complication, postpartum/recent pelvic procedure, sexual assault, or safety concern
  • NSAID allergy, active ulcer/GI bleed, severe kidney disease, anticoagulation, uncontrolled hypertension, or late pregnancy

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