Nonsteroidal anti-inflammatory drug resistance in dysmenorrhea: a study of prevalence, predictors, and alternative pain management among Nigerian female students.

Abstract

Background: Dysmenorrhea is a common gynaecological condition among young women, with non-steroidal anti-inflammatory drugs (NSAIDs) recommended as first-line therapy. However, a substantial proportion of women experience inadequate pain relief despite NSAID use. This study aimed to determine the prevalence of NSAID-resistant dysmenorrhea and to identify predictors as well as alternative pain management strategies among female undergraduate students at Afe Babalola University, Ado-Ekiti, Nigeria (ABUAD).

Methods: A descriptive cross-sectional study was conducted among 271 female undergraduate students of ABUAD. Data were collected using a structured, self-administered electronic questionnaire that assessed socio-demographic characteristics, menstrual history, dysmenorrhea severity, NSAID use, perceived effectiveness, and alternative pain management strategies. NSAID-resistant dysmenorrhea was operationally defined as persistent menstrual pain despite reported use of recommended NSAID dosages. Descriptive statistics were used to summarize data. Bivariate analyses were conducted using Chi-square, Fisher's exact, and Mann-Whitney U tests, as appropriate. Multivariate logistic regression was performed to identify independent predictors of NSAID resistance. Statistical significance was set at p ≤ 0.05.

Results: The prevalence of dysmenorrhea among participants was 70.8% (192/271). Of those with dysmenorrhea, 62.5% (120/192) reported NSAID use for pain management. Among NSAID users, 63 students were classified as having NSAID-resistant dysmenorrhea, representing 52.5% of NSAID users and 32.8% of all students with dysmenorrhea. Perceived delayed onset of NSAID action (adjusted odds ratio [AOR] = 16.91; 95% CI: 2.00-141.60; p = 0.009) and lower NSAID effectiveness scores (AOR = 0.72; 95% CI: 0.57-0.90; p = 0.004) were significant predictors of NSAID resistance. Common coping strategies among NSAID-resistant students included activities such as use of alternative medications (25.4%), NSAID dose escalation (23.8%), rest or sleep (6.3%), as well as medications including antispasmodics (31.7%), and herbal remedies (11.2%).

Conclusion: NSAID-resistant dysmenorrhea is common among undergraduate students. Perceived delayed onset and reduced effectiveness of NSAIDs are key predictors of resistance and contribute to reliance on alternative and potentially unsafe coping strategies. These findings highlight the need for improved education on appropriate dysmenorrhea management, early identification of NSAID non-responders, and access to evidence-based alternative treatment options.