Pharmacologic management of dysmenorrhea typically includes

• A. Antibiotics
• B. Proton pump inhibitors
• C. NSAIDs and hormonal contraceptives
• D. Surgical removal of uterus

Answer: (C)

Painful menstrual cramps are mainly driven by prostaglandin-mediated uterine contractions, so effective pharmacologic management targets both inflammation and hormonal regulation. Nonsteroidal anti-inflammatory drugs block COX enzymes, lowering prostaglandin production and reducing menstrual cramp intensity and overall pain; this makes them the first-line treatment for primary dysmenorrhea. Hormonal contraceptives work by suppressing ovulation and stabilizing or thinning the endometrium, which decreases menstrual bleeding and prostaglandin activity, often providing substantial relief and sometimes allowing continuous dosing to prevent monthly cramps. Antibiotics or proton pump inhibitors don’t address the underlying mechanisms of dysmenorrhea and aren’t used for this condition unless there’s an unrelated infection or GI issue. Surgical removal of the uterus is a drastic, nonpharmacologic option reserved for extreme or unrelated pelvic disease, not first-line management. Thus, combining NSAIDs with hormonal contraceptives reflects the standard pharmacologic approach to dysmenorrhea.