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Although nonsteroidal antiinflammatory drugs can alleviate menstrual pain, about 18% of women with dysmenorrhea are unresponsive, leaving them and their physicians to pursue less well-studied strategies. The goal of this review is to provide a background for treating menstrual pain when first-line options fail. Research on menstrual pain and failure of similar drugs in the antiplatelet category suggested potential mechanisms underlying nonsteroidal antiinflammatory drug resistance. Based on these mechanisms, alternative options may be helpful for refractory cases. This review also identifies key pathways in need of further study to optimize menstrual pain treatment., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: This guideline reviews the investigation and treatment of primary dysmenorrhea., Intended Users: Health care providers., Target Population: Women and adolescents experiencing menstrual pain for which no underlying cause has been identified., Evidence: Published clinical trials, population studies, and review articles cited in PubMed or the Cochrane database from January 2005 to March 2016., Validation Methods: Seven clinical questions were generated by the authors and reviewed by the SOGC Clinical Practice-Gynaecology Committee. The available literature was searched. Guideline No. 169 was reviewed and rewritten in order to incorporate current evidence. Recommendations addressing the identified clinical questions were formulated and evaluated using the ranking of the Canadian Task Force on Preventive Health Care., Benefits, Harms, and Costs: Primary dysmenorrhea is common and frequently undertreated. Effective therapy is widely available at minimal cost. Treatment has the potential to improve quality of life and to decrease time lost from school or work., Guideline Update: This guideline is a revision and update of No. 169, December 2005., Sponsors: SOGC., Summary Statements: RECOMMENDATIONS., (Copyright © 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.)