NSAID — Gynaecological Pain Pregnancy: Contraindicated in pregnancy — particularly third trimester

Diclofenac (Dysmenorrhoea / Post-gynaecological Procedure)

Brand names: Voltarol

Adult dose

Dose: 50 mg oral three times daily; 100 mg PR (suppository)

Route: Oral / Rectal

Frequency: Two to three times daily with food

Max: 150 mg/day

Primary dysmenorrhoea: 50-100 mg at onset of pain, continued for 2-3 days. Post-procedure analgesia (colposcopy, LLETZ, hysteroscopy): 75 mg IM pre-procedure or 100 mg PR post-procedure

Paediatric dose

Dose: 1-3 mg/kg/day in divided doses mg/day/kg

Route: Oral

Frequency: Two to three times daily

Max: 3 mg/kg/day

Adolescent dysmenorrhoea: 50 mg oral two to three times daily as needed

Dose adjustments

Renal

Avoid if eGFR under 30

Hepatic

Avoid in severe hepatic impairment

Paediatric weight-based calculator

Patient weight (kg)

Adolescent dysmenorrhoea: 50 mg oral two to three times daily as needed

Clinical pearls

Primary dysmenorrhoea: NSAIDs are more effective than paracetamol — prostaglandin-mediated uterine cramping is the mechanism; start at or just before onset of menstruation for best effect
CONTRAINDICATED in pregnancy — particularly third trimester (premature closure of ductus arteriosus, neonatal pulmonary hypertension, oligohydramnios); also avoid in first trimester if possible
Post-gynaecological procedure: PR diclofenac 100 mg significantly reduces pain after outpatient hysteroscopy and LLETZ — RCOG endorses routine use
MHRA 2013: Diclofenac has equivalent cardiovascular risk to COX-2 inhibitors — avoid in women with cardiovascular risk factors for long-term use
Endometriosis: NSAIDs provide useful symptom relief but do not modify disease — hormonal treatment (progestogens, GnRH agonists, combined pill) is the mainstay of management

Contraindications

Pregnancy (third trimester absolute; avoid in first and second trimesters)
Active GI ulceration
Cardiovascular disease (MHRA 2013)
Aspirin-sensitive asthma

Side effects

GI upset and bleeding
Renal impairment
Cardiovascular events
Hepatotoxicity

Interactions

Anticoagulants (increased bleeding)
ACEi + diuretics (AKI triple whammy)
Lithium and methotrexate (increased levels)

Monitoring

Renal function
Blood pressure
GI symptoms

Reference: BNFc; BNF 90; RCOG Green-top (Hysteroscopy); NICE NG73 (Endometriosis); MHRA 2013. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators