Conventional Treatment Options for Primary Dysmenorrhea
PG synthetase inhibitors (non-steroidal anti-inflammatory drugs), such as ibuprofen, mefanamic acid, naproxen, and indomethacin, have been used as analgesic treatment for dysmenorrhea since the early 1970s.1,19 Prior to their discovery, women who had dysmenorrhea were dependent largely on narcotics or oral contraceptives for pain relief.8 PG inhibitors block PG synthesis early in the inflammatory reaction by inhibiting the cyclooxygenase pathway. Once pain has become severe, relief is unlikely. However, these drugs should not be used prior to the onset of menses because of their teratogenic potential.
In a comprehensive review of clinical trials of PG inhibitors in the treatment of primary dysmenorrhea, it was found that significant pain relief was reported for each of the PG inhibitors for the majority of women.1 However, the authors concluded that 9% to 22% of dysmenorrheic women will not benefit from PG inhibitor treatment, possibly because some of these women may have secondary dysmenorrhea. While PG inhibitors are generally recognized as effective against pain, there are drawbacks. These drugs are not selective in their inhibition of PGs, translating to a reduction of all PGs, good or bad. In addition, possible side effects include dizziness, headache, nausea, vomiting, heartburn, and diarrhea, as well as GI damage with protracted use.
Cyclic administration of oral contraceptives, usually in the lowest dosage but occasionally with increased estrogen, is also used to alleviate pain. The mechanism of pain relief may be related to absence of ovulation or to altered endometrium resulting in decreased prostaglandin production during the luteal phase. Surgery is a rare form of intervention used in women who do not respond to medication.
In a comprehensive review of clinical trials of PG inhibitors in the treatment of primary dysmenorrhea, it was found that significant pain relief was reported for each of the PG inhibitors for the majority of women.1 However, the authors concluded that 9% to 22% of dysmenorrheic women will not benefit from PG inhibitor treatment, possibly because some of these women may have secondary dysmenorrhea. While PG inhibitors are generally recognized as effective against pain, there are drawbacks. These drugs are not selective in their inhibition of PGs, translating to a reduction of all PGs, good or bad. In addition, possible side effects include dizziness, headache, nausea, vomiting, heartburn, and diarrhea, as well as GI damage with protracted use.
Cyclic administration of oral contraceptives, usually in the lowest dosage but occasionally with increased estrogen, is also used to alleviate pain. The mechanism of pain relief may be related to absence of ovulation or to altered endometrium resulting in decreased prostaglandin production during the luteal phase. Surgery is a rare form of intervention used in women who do not respond to medication.
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