PRIMARY DYSMENORRHEA

Primary dysmenorrhea is the more common type of dysmenorrhea and is due to the production of prostaglandins. These are natural substances made by cells in the inner lining of the uterus and other parts of the body. The prostaglandins made in the uterus make the uterine muscles contract and help the uterus to shed the lining that has built up during the menstrual cycle. If excessive prostaglandins are produced, the woman may have excessive pain or dysmenorrhea with her menstrual cycle. Prostaglandins can also cause headaches, nausea, vomiting and diarrhea.

Therapies for primary dysmenorrhea include rest, heating pad to the lower abdomen or back, nutrition, aerobic exercise and medication. Nutrition. therapy includes a well-balanced diet with an adequate intake of calcium (1000 mg. per day) and a fluid intake of two quarts of water each day. Vitamin B6 , 50 to 100 mg. each day, may occasionally be helpful.

Medication for dysmenorrhea may involve two complementary strategies: decreasing prostaglandin production and hormonal alteration.

Prostaglandin production can be decreased with over-the-counter, non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen or naproxen sodium, or similar drugs that are stronger and available only by prescription. These drugs are generally well tolerated, although they can upset the stomach and are best taken with a small amount of food. Contraindications to the use of NSAIDs include pregnancy, ulcers, asthma and known allergy to this type of drug. NSAIDs are usually started with the onset of menstruation, although some women respond better if the medication is started 1-3 days prior to the onset of menstruation. It is sometimes necessary to take one of several NSAIDs until the one with the maximum efficacy for an individual woman is found.

Hormonal alteration of the menstrual cycle is usually accomplished by taking oral contraceptives (OC). OC's prevent ovulation, decrease the thickness of the uterine lining (endometrium) and as a result, fewer prostaglandins are made. The birth control shot, Depo-Provera®, 150 mg. every 10-12 weeks, can also be used to accomplish the same purpose. If Depo-Provera® is used to alter the hormones, it is extremely important that the woman obtain an adequate daily intake of calcium (1000 mg.).