Effects of Some Non Steroidal Anti-inflammatory Drugs on Ovulation in Women with Mild Musculoskeletal Pain (A Clinical Study)

Abstract

NSAIDs are popular drugs used for variable conditions, being analgesics, antipyretics and anti- inflammatory agents for more than a century. They are sold without a prescription and taken by millions of patients every day all over the world. Since they are used on a large scale as an anti-inflammatory agents & are given in doses that are consider high as compared to doses used in conditions other than inflammation and because many of NSAIDs users are females at child bearing age, so the present study was conducted to investigate the effects of diclofenac, naproxen & etoricoxib on ovulation & progesterone level in women. Adults women (39 females at fertile age ) were chosen as volunteers to take part in this study. They were visited the Rheumatology consultation clinic in Baghdad Hospital, suffering from minor aches & were diagnosed & received one of the three test drugs included in this study ( diclofenac 100mg once daily, naproxen500mg twice daily & etoricoxib 90mg once daily). Treatment with the above drugs was lasted for ten days starting at day ten after the onset of the period, a blood sample was taken from each patients for hormonal analysis( progesterone level) together with an ultra sonsography(U/S) to assess the mean diameter of the dominant follicle. At day twenty the patient came back for another ultra sonography & to give a blood sample for another check for progesterone level. A fourth group served as controls, who received no treatment ( volunteers ). The present study presents several new findings: 1. A significant inhibition of ovulation have been observed in patients teated with diclofenac , naproxen & etoricoxib. 2. Diclofenac was the highest inhibitor of ovulation compared to the other two drugs ( naproxen & etoricoxib ). 3. A significant decrease in progesterone level in all three groups in compared to the control group. 4. Functional cysts have been observed in one third of patients by the end of the treatment period with diclofenac, naproxen & etoricoxib due to unruptured follicles ( disappeared at the next cycle ). The above new findings have a direct implication & importance in relation to conditions where NSAIDs ( diclofenac, naproxen & eroricoxib ) used and may serve as an alarm of the harmful effects of these drugs on female fertility & these effects should be taken into consideration in females planning to have a child. In the other hand, the above results may open the door for looking for an emergency contraceptive tablet safer than those at use nowadays.