My New Medication for Period Pain

Editors Note: Always talk to your doctor if you have any questions about making a change in your medications.

I've never been able to have a medication-free period. Well, not without blurry vision, vomiting, and lots of tears.

My go-to period painkiller has always been ibuprofen. It usually takes the edge off my worst cramps.

But lately, I've had to up my dose with each period without much relief, so I asked my general doctor if I could try something different.

Luckily, I have a really good relationship with my current doctor. Unlike my OB/GYN, who I fired, my GP values my perspective.

She's always willing to work with me on a pain management plan. I told her I'd read some research that a Cox-2 inhibitor could help with period pain related to endometriosis and adenomyosis, and I wondered if she thought I should give it a shot^1,2.

She sent in the prescription right away, and I started my new meds three menstrual cycles ago.

What is a COX-2 inhibitor? 

It's a selective non-steroidal anti-inflammatory drug (NSAID). It targets COX-2, a pro-inflammatory enzyme. Cox-2 is linked to certain kinds of prostaglandins. Those are chemicals that help your uterus contract — like during your period — but they can also cause pain¹.

Non-selective NSAIDs include drugs like ibuprofen and naproxen, which block COX-1 and COX-2 enzymes.

You've got a lot of COX-1 in non-period places like your digestive tract and kidneys. That's why chronic use with non-selective NSAIDs raises your risk of stomach ulcers and kidney problems³.

What effect does COX-2 have on endometriosis?

People with endometriosis and adenomyosis tend to have higher levels of COX-2 and COX-2-related prostaglandins in their endometrium, when compared to people without either condition. And high levels of COX-2 are linked to endometriosis-related pain and infertility^1,2.

Anecdotally, I've heard a lot about prostaglandins in previous interviews with endometriosis specialists. Experts are always talking about how these inflammatory chemicals can get into the bloodstream and stir up trouble, including pain and bloating.

And some researchers think the COX-2/prostaglandin pathway may be directly linked to the biology behind endo. We need more research on that¹.

What happens when I use a COX-2 inhibitor?

My doctor prescribed 200 milligrams of celecoxib (Celebrex) twice a day for up to five days. I'm supposed to start a couple of days before my period starts to get ahead of the pain.

But my cycle isn't that predictable, so it doesn't always work out that way.

I can definitively say that, so far, celecoxib works better for my period pain than anything I've ever taken, including other prescription painkillers.

It even calms my cramps and related symptoms when taken the day my period starts. That's when pain, backaches, and nausea tend to hit me like a truck.

I also don't have to take tons of it. I take one pill twice a day. That’s two pills, or 400 milligrams a day, for the first two or three days of my period.

With ibuprofen, I was taking 400 milligrams every four hours for the same time period.  And I got less relief, though, I still use ibuprofen for other kinds of inflammatory non-period pain.

Why don't more doctors prescribe a COX-2 inhibitor for period pain? 

I'm not a doctor, so I can't really answer that. But I know celecoxib is a lot more expensive than over-the-counter NSAIDs.

I had to pay a little over $30 for a bottle of 30 pills, even with health insurance. That's about $1 a pill. Compare that to $4 for 200 OTC ibuprofen.

I've also read that other COX-2 inhibitors were taken off the market because of their risk for health issues like cardiovascular events. A 2016 study found that low-dose celecoxib was just as safe as ibuprofen or naproxen⁴.

All I know is this medication seems to help my period pain. Yet, no doctor ever mentioned it.

I had to bring it up on my own. If you'd like to know more, don't be shy about asking a trusted health professional about trying it. If you do, let us know how it goes!