American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first line treatment for primary dysmenorrhea?

1. Acupuncture and massage therapy

2. Heat application and herbal remedies

3. NSAIDs and cyclooxygenase-2 inhibitors

4. Injectable corticosteroids

The correct answer is: NSAIDs and cyclooxygenase-2 inhibitors

The first line treatment for primary dysmenorrhea involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors. Primary dysmenorrhea is characterized by menstrual pain due to uterine contractions that occurs in the absence of pelvic pathology. The pain is mediated by the release of prostaglandins, which NSAIDs effectively reduce by inhibiting their synthesis. NSAIDs help alleviate the pain by providing anti-inflammatory effects and reducing uterine contractility. COX-2 inhibitors are particularly advantageous because they target the enzyme more specifically involved in inflammation and pain associated with menstrual cramps, which can result in fewer gastrointestinal side effects compared to traditional NSAIDs. Other treatments, such as acupuncture, massage therapy, and herbal remedies, while they may provide some relief for some individuals, lack the robust evidence of efficacy that NSAIDs and COX-2 inhibitors possess. Similarly, injectable corticosteroids are generally used for more serious inflammatory conditions or those associated with pelvic disorders but are not recommended as a first-line treatment for primary dysmenorrhea. Therefore, NSAIDs and COX-2 inhibitors are preferred and supported by clinical guidelines as the initial approach to effectively manage primary dysmen