Spasmodic Dysmenorrhea Research Articles

Causes of abnormal uterine bleeding in women of 20–60 years of age based on polyp, adenomyosis, leiomyoma, malignancy, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not-yet-classified at a tertiary care hospital: A cross-sectional study

Abstract Background: Approximately 10%–25% of women are affected with abnormal uterine bleeding (AUB). It is essential to have a thorough understanding and knowledge about the disease, causative factors, pathophysiology, incidence and prevalence of various causative factors, clinical presentations, and diagnostic aids for an early prediction and diagnosis of disease to treat the condition at the earliest possible phase and with minimum morbidity and costs. Objective: The objective of this study was to study the causes of AUB women of 20–60 years of age based on polyp, adenomyosis, leiomyoma, malignancy, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not-yet-classified (PALM COEIN). Materials and Methods: It was a hospital-based prospective study among 136 patients with AUB aged 20–60 years. History, general and gynecological examination, and routine gynecological examination were done using speculum examination of the vagina and the cervix and a bimanual examination. Routine investigations and an ultrasonography were done. Some were subjected to PAP smear as a routine procedure. Results: Women aged 31–50 years and multiparous were most affected with AUB in 84.6% and 88.9% of cases, respectively. According to the International Federation of Gynecology and Obstetrics type classification, the most common type of presentation was heavy menstrual bleeding in 54% of cases. The most common presenting symptom was pain in the abdomen in 4.4%. The most common-related symptom was spasmodic dysmenorrhea in 36%. The most common clinical sign was pallor in 25%. The most common associated comorbidity was anemia in 49%. Leiomyoma was the most common ultrasound diagnosis of underlying pathology in 52.2%. The most common cause of AUB as per PALM COEIN was AUB leiomyoma in 52.2%. Conclusion: Our study shows that the causation of AUB was multifactorial (though in some cases, solitary lesions were found) involving the entire female reproductive system resulting in a single common presentation as AUB.

An approach towards Pain Management w.s.r. to Udavartini Yonivyapat

In Ayurveda, diseases related to the female reproductive system i.e., gynaecological disorders are described under the caption of Yoni Vyapada. Women have been placed on an extreme worshiping place due to their power of ‘Janani’- creation. it is needed to give proper care and respect to women. God has blessed the female with the most valuable gift of motherhood.[1] The preparation of motherhood starts with puberty when Rajah-Pravriti i.e., menstruation begins.[2] and by the age of 16 it is fully completed after which she is capable of childbearing.[3] Udavarta Yonivyapada or painful menstruation is a common problem of the females in the reproductive age group & has got a detailed patho-physiology and treatment in the classical literature of Ayurveda.[4] “Arthave Sa Vimukthe Tu Tat Kshanam Labhate Sukham” mentioned by Acharya Charaka substantiate the close similarity of Udavarta with spasmodic dysmenorrhoea. Vegodavarthana leading to Pratiloma Gati of Apana Vata and Rajas is the pathology behind Udavartha Yonivyapath. So, treatment should aim at the relief of pain by normalising the direction of menstrual flow which in turn is by normalising the vitiated Apana Vayu. The present paper is aimed at incorporating all the references regarding Udavartha including Nidana Panchakas from Ayurvedic classics and to show the significance of Basti in normalizing the Apana Vata.

An Open-Labelled Randomized Comparative Efficacy Study of Unani Formulations and Hijama Bila Shart in Tashanuji Usr al-Tamth (Spasmodic Dysmenorrhea)

An Open-Labelled Randomized Comparative Efficacy Study of Unani Formulations and Hijama Bila Shart in Tashanuji Usr al-Tamth (Spasmodic Dysmenorrhea)

Yogasanas in Spasmodic Dysmenorrhoea w.s.r to Udavartha Yonivyapath

Many women are familiar with the experience of spasmodic dysmenorrhoea, one of the commonest gynaecological conditions that affects the quality of life of many in their reproductive years. This condition manifested as painful menstruation, is the most frequently encountered gynaecological complaint and it can be included under Udavartha yonivyapat, caused by Apanavata vaigunya described in Ayurvedic classics. This situation not only has a significant effect on quality of life and personal health but also resulting in loss of work hours and depression. Scholastic backwardness and work absenteeism as a result of dysmenorrhoea is common nowadays. Most of the medical therapies for painful periods like analgesics, antispasmodics, NSAID, and anti-prostaglandins are having many side effects. Hormonal and surgical therapies are also not advisable to all type of patients, especially teenagers as it may harm their future reproductive capacity. Here comes the importance of Yoga, which provides good approach to treat primary dysmenorrhea. Yoga asanas helps in stretching muscles of pelvic cavity and increases the blood circulation to the pelvic organs and also helps to neutralize Apana vayu, which help in normal menstrual flow. The practice of Asanas has a beneficial impact on the whole body systems and helps in relaxation of both body and mind. This study is undertaken to find out the Yogasanas having pain relieving capacity in spasmodic dysmenorrhoea as it doesn’t cause any side effects but improve the quality of life. A thorough literary survey was done in Yogic classics especially Asanas for women’s health, Asanas for reproductive health and tried to compile the Asanas together having the pain relieving capacity in primary dysmenorrhoea.

Efficacy of magnesium phosphoricum 30c in the treatment of spasmodic dysmenorrhoea

Spasmodic dysmenorrhea is a recurring condition which disturbs the daily routine of females in abundance. It is a commonest gynaecological condition which affects many women regardless of age, race and region. It is one of the leading cause of absenteeism in adult women with substantial economic loss, disrupt in personal life and a significant public health problem as well. Also responsible for poor academic and work performance. Mild pain is common with menstruation but moderate and severe pains require medications.The available modes of dysmenorrhea treatments are relieving the pain momentarily and let the woman suffer for many months and years. Homoeopathic medicines offers a viable solution with less or zero side effects in cases of spasmodic dysmenorrhea.

Current research opportunities for potential phytotherapeutic agents for the treatment of pathologies of the female reproductive system

Introduction and aim. Herbal medicine is prescribed for various disorders of the menstrual cycle (uterine bleeding, dysmenorrhea), for the treatment of premenstrual and climacteric syndromes, inflammatory diseases of the genital organs, mastopathy and mastalgia and other pathological conditions. The aim of the study is to analysis and generalization of data from professional literature and own experience in the treatment of patients with pathologies of the female reproductive system by phytotherapeutic methods, taking into account the influence of medicinal plants on various links in the pathogenesis of the disease, as well as making recommendations for improvement and prospects for the use of phytotherapy in the treatment of this pathology. Material and methods. To make an analysis of literary sources of domestic and foreign authors about usage of medicinal plants for the treatment of pathologies of the female reproductive system. Analysis of the literature. In the treatment of primary (spasmodic) dysmenorrhea, herbal remedies with an antispasmodic, analgesic, hormone-mimetic effects are prescribed. It can be Chamomile (Matricaria chamomilla L.), Achillea millefolium, commonly known as yarrow, Viburnum, Shepherd’s purse (Capsella bursa-pastoris), Greater celandine, Atropa belladonna, Hyoscyamus niger, commonly known as henbane, black henbane, or stinking nightshade and Abraham’s tree. Many plants have bactericidal activity, and this property is used in the treatment of inflammatory diseases of the mucous membranes and skin. Such properties are possessed by flowers of Chamomile (Matricaria chamomilla L.), Calendula officinalis, infusion of Medicinal sage (Salvia officinalis L.). For the treatment of functional hyperprolactinemia phytopreparations are also successfully used. It is known that the medicinal plant Vitex agnus castus has dopaminergic properties, selectively blocking prolactin synthesis, and reduces follicle stimulating hormone levels. Strychnos ignatia, Caulophyllum thalictroides, European cyclamen, Lilium tigrinum, Iris versicolor provide a complex effect on the female body, effectively reduces the level of prolactin and the severity of mastalgia, which is confirmed not only by clinical data, but also by mammography data in fibrocystic breast disease. For the treatment of climacteric syndrome, a large number of medicinal plants are used, in particular, the most popular is the Cimicifuga racemose. Conclusion. The effectiveness of phytotherapeutic drugs has been verified by many clinical trials. Modern phytotherapy is becoming more widespread in clinical practice, as an alternative to drug treatment.

COMPARATIVE CLINICAL STUDY OF KUMARIKA VATI AND MEFENAMIC ACID IN UDAVARTINI YONIVYAPAD (SPASMODIC DYSMENORRHEA)

Menstruation is a normal physiological process when it is accompanied by pain is called Dysmenorrhea. It is one of the commonest gynaecological complaints. Dysmenorrhea is painful menstruation, which is the pratyatma lax- ana of Udavartini yoni vyapad i.e., spasmodic dysmenorrhea. It is a common cause of distress in women. Here the main reason for pain is the vitiation of vata dosha (apana vata), viloma/pratiloma gati leading to vedna yukta artava munchan and to manage this pratiloma vata, one needs to use drugs that have anulomana properties and vedna samak. Kumarika vati is used as vedana shamaka aushadha to give symptomatic relief. Hence the topic was selected for the study. Objectives: To compare the effect of Kumarika Vati with Mefenamic Acid in the man- agement of Udavartini Yonivyapad (Spasmodic Dysmenorrhea). Materials & Methods: 20 patients of Group A were treated with Kumarika Vati, a dose of 250mg BD 5 days before menstruation & 5 days during menstruation. 20 patients of Group B were treated with a Mefenamic Acid dose of 250mg BD for 3 days during menstruation. Result: The data of both groups were collected according to the objective and subjective parameters and analyzed using the most appropriate statistical test (repeated measures of ANOVA test and Mann –Whitney U test). The efficacy is statically significant within the group at P<0.001 and statistically insignificant between the group at P>0.05 among all the parameters. Interpretation and Conclusion: On comparison of Kumarika Vati with Mefenamic acid both have equal effectiveness in relieving the pain intensity, pain duration, site of pain, nature of pain and associated complaints. Keywords: Udavartini Yoni Vyapad, Dysmenorrhea, Kumarika Vati, Mefenamic Acid.

LEIOMYOMA TYPES, INCIDENCE AND CLINICAL PRESENTATION - A STUDY AT A TERTIARY CARE HOSPITAL

A cross sectional studywas conducted over a period of 15 months from 1st Jan 2020 to 31st March 2021 at Malla Reddy Hospital,a tertiary care hospital. To study the incidence of fibroids according to FIGO categorization and their clinical presentation. 38 confirmed cases of fibroid uterus in the age group 20 – 60 attending gynecology OPD were interviewed and subjected to regular gynecological examination, PAP smear, dilatation and curettage procedures. Based on the studies, 60% of these patients were subjected to total abdominal hysterectomy as a part of treatment and the intra operative findings of the specimens were noted. The leiomyomas were classified according to the histopathological and ultrasonographic findings based on FIGO categorization. Highest incidence was seen 41 to 45 years age (52.6%). Incidence of Leiomyoma types according to FIGO subclassification system were found to be Type0=5%, Type1=5%, Type2=5%, Type3=13%, Type4=30%, Type5=13%, Type6=18.6%, Type7=3.3% and Type8=5%. Multiple fibroids were more common than single fibroids. Posterior location fibroids were more common than anterior. Most common symptom was menorrhagia (73.6%) followed by spasmodic dysmenorrhea (47.3%) and metrorrhagia (26.3%), infertility and symptoms of anemia. Most common sign was pallor (58%) followed by mass per abdomen (18.4%). Incidence of associated pathology of adenomyosis (18%) ovarian cysts (8%), endometrial polyps (8%), myxoid degeneration (2.6%). The results of our study matched the existing studies.

Thin Layer Chromatographic Detection of Dicyclomine Hydrochloride Extracted from Whole Blood

Dicyclomine Hydrochloride belongs to a class of synthetic anticholinergics. It is regularly used for the treatment of spasmodic pain, spasmodic dysmenorrhea, and renal, ureteric and biliary colic. This drug is easily available in the market and can be abused for suicidal purposes. Its unsupervised use can lead to abuse, accidental poisoning along with the occasional report of intentional suicidal poisoning. Hence its analysis is very important for medicolegal purposes.Biological samples of choice for routine qualitative analysis of drug is liver, stomach content, whole blood, and urine. Routine toxicological procedures employ highly sophisticated state of the art instruments like High Performance Liquid Chromatography (HPLC), Gas Liquid Chromatography (GLC) and Liquid ChromatographyMass Spectrophotometer (LC-MS) for the estimation of drug from biological and non-biological matrices but the present paper deals with an attempt to analyse the drug extracted from the biological sample of interest using a simple, feasible and optimal method with the help of Thin Layer Chromatography (TLC). The study involves the extraction of the drug from matrix (blood), using Liquid-Liquid Extraction method of alkaline plasma followed by its separation and identification by Thin Layer Chromatography. The present paper describes a simple, economical, reproducible sample extraction, clean-up and detection method that can be easily attempted in a laboratory. Keywords: Whole blood; Dicyclomine; Extraction; Analysis; Drug.

A CLINICAL COMPARATIVE STUDY TO EVALUATE THE EFFECTIVENESS OF RASNA SWADAMSTRADI KSHEERAPAKA WITH SUKUMARAM KASHAYAM IN SPASMODIC DYSMENORRHOEA

Many women are familiar with the experience of spasmodic dysmenorrhoea, one of the commonest gynaecological conditions that affects the quality of life of many in their reproductive years. This condition manifested as painful menstruation, is the most frequently encountered gynaecological complaint and it can be included under Udavartha yonivyapat, caused by Apana vata vaigunya described in Ayurvedic classics. As the condition has significant effect on quality of life, personal health, and working hours and there are several limitations and adverse effects in modern medicine, its Ayurvedic management is of great importance. Randomized clinical study was conducted in Govt. Ayurveda College Hospital for Women and Children, Poojappura to evaluate the effectiveness of Rasna swadamstraadi ksheerapaaka in spasmodic dysmenorrhoea and to compare its result with that of Sukumaram kashayam. Total 30 patients between the age group 15-35 yrs were taken in to the study who had complaints of severe or moderate lower abdominal pain and associated complaints such as low back ache, nausea, vomiting, diarrhoea, and allocated them into two groups. Study group were treated with Rasna swadamstraadi ksheerapaaka and control group with Sukumaram kashayam. Administration of drug started10 days before menstruation and continued till 4th day of menstruation for 3 consecutive cycles for study group and control group. Follow up without medicine was done for next 3 consecutive cycles for both the groups. Results were analyzed and compared statistically. The research drug Rasna swadamstraadi ksheerapaaka had shown effectiveness in controlling pain in spasmodic dysmenorrhoea and associated symptoms like low back ache and nausea, but in the case of vomiting, and diarrhoea it showed less sustained action in follow up period. The control drug Sukumaram kashayam had also shown effectiveness in controlling pain in spasmodic dysmenorrhoea and associated complaints nausea and low back ache. But in the case of vomiting, and diarrhoea this medicine also showed less sustained action in follow up period. On conclusion the study revealed that the research drug Rasna swadamstraadi ksheerapaaka and control drug Sukumaram kashayam are equally effective in treating spasmodic dysmenorrhoea, without any side effects.

CONCEPT OF UDAVARTA (PRIMARY/SPASMODIC DYSMENORRHOEA) – AN AYURVEDIC PERSPECTIVE

Many women are familiar with the experience of spasmodic dysmenorrhoea, one of the commonest gynaecological conditions that affects the quality of life of many in their reproductive years.This condition manifested as painful menstruation, is the most frequently encountered gynaecological complaint and it can be included under Udavartha yonivyapat, caused by Apana vata vaigunya described in Ayurvedic classics. Nidana samprapthi and Rupa of Udavartha yonivyapat can well explain the etiopathogenesis and clinical features of Spasmodic dysmenorrhoea. “Arthave sa vimukthe tu tat kshanam labhate sukham” mentioned by Acharya Charaka substantiate the close similarity of Udavarta with Spasmodic dysmenorrhoea. Vegodavarthana leading to Pratiloma gati of Apana vata and rajas is the pathology behind Udavartha yonivyapath. So treatment should aim at the relief of pain by normalising the direction of menstrual flow which in turn is by normalising the vitiated Apana vayu. The present paper is aimed at incorporating all the references regarding Udavartha including Nidana panchakas from Ayurvedic classics and tried to give an Ayurvedic view to the concept and postulated theories on spasmodic dysmenorrhoea.

Preemptive analgesia for primary dysmenorrhea : A randomized controlled clinical trial

Background: Spasmodic dysmenorrhea is one of the commonest painful attacks that affects young ladies. Non steroidalanti-inflammatory (NSAID) drugs are considered as one of the main treatment options. Different pain management modalities concern with pretreatment with analgesia before the painful stimuli that defined as preemptive analgesia.Aim: This study aimed to evaluate the possible effect of administration of NSAIDs before the onset of pain in the anticipating menstrual cycle. Materials and Methods: One hundered young ladies ranged from 15-25 years old were randomly divided into two groups. Group 1 received mefinamic acid 2 days before the anticipating date of menstruation and continued throughout the first 2 days of menstruation and group 2 received the same medication however started with the onset of symptoms only. Results: Both groups were comparable regarding age, education and menstrual characters. The average pain score was nearly the same in both groups (8.78 ± 1.07 and 8.66 ± 1.04) and it was significantly decrease after intervention in both groups. The decrease in pain score was more in the girls treated before menstruation (4.24 ± 1.57) compared to (7.20 ± 1.77) in the girls treated after onset of menstruation and the difference was statistically significant. The percentage decrease in pain score among the girls of premenstrual treatment ranged from 14.28% to 80.0% with median decrease 55.56%, compared to 0.0% to 62.5% with median decrease 10.56% in the group treated at onset of menstruation. The difference was also statistically significant (P <0.001). Conclusion: NSAIDS can be used effectively to prevent and control primary dysmenorrhea associated symtoms if used before the appearance of symptoms, and targeted groups are in great chance to practice an easier life throughout the entiremenstrual cycle.

Pain coping, pain acceptance and analgesic use as predictors of health-related quality of life among women with primary dysmenorrhea

ObjectivesPrimary dysmenorrhea causes menstrual pain that affects women’s quality of life (QoL) and analgesics are only moderately effective. Pain coping and pain acceptance influence QoL among people affected by other chronic pain conditions, so we examined pain coping, pain acceptance and analgesic use as predictors of QoL among women with primary dysmenorrhea. Study design145 women with primary dysmenorrhea completed an online survey including the Menstrual Symptoms Questionnaire (MSQ), the Coping Strategies Questionnaire (CSQ), the Chronic Pain Acceptance Questionnaire (CPAQ-8), questions about analgesic use, and the Short Form-12 (SF-12), a measure of physical and mental health-related QoL. ResultsIn multiple regression, pain acceptance predicted better physical and mental QoL, whereas pain coping did not predict mental or physical quality of life. Being married or cohabiting and menstrual pain that was less severe and shorter in duration predicted better physical QoL, and those effects were mediated by pain acceptance. Being older at the onset of painful periods predicted better mental QoL and that effect was also mediated by pain acceptance. More severe menstrual pain and congestive rather than spasmodic dysmenorrhea predicted worse mental QoL but those effects were not mediated by other factors. Analgesic use did not predict physical or mental QoL. ConclusionsThe results show the impact that menstrual pain has on women’s quality of life, and suggest that initiatives to increase pain acceptance among women with menstrual pain are worthwhile. More research is needed to understand more fully the factors that influence health-related quality of life among women with menstrual pain.

Uterine Didelphys Associated With Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) Syndrome: a Case Report

A 30 year old nulligravida female reported to the fertility centre of AHD with the complaints of primary infertility for three and half years and spasmodic dysmenorrhoea. There is also history of progressively increasing right lower abdominal pain as well as discomfort which was cyclically associated with the onset of menses. Transabdominal sonography showed-‘Endometrial splitting into two at the fundus–suggesting bicornuate uterus. Echogenic soft tissue in the cervical canal due to blood clots. Non visualized right kidney. Mildly enlarged left kidney’. HSG done outside AHD suggestive of unicornuate uterus with single fallopian tube. IVU showed non visualized right kidney. Normally excreting left kidney. TVS showed normal sized septated nulliparus uterus with homogeneous myometrium and thick endometrium with proliferative phase echo. Mildly enlarged right ovary with mildly distended right tube. Mild collection adjacent to the vagina. Then the patient came to the gynaecology dept of AHD from where she was sent to our Radiology department to undergo MRI of pelvis. The MRI showed uterine didelphys. Obstructed hemivagina (right) with hematocolpos extended upto pelvic brim along right and posterior aspect of uterus through anomalous dilated remnant of right lower ureter with ipsilateral renal agenesis. Patient was diagnosed as OHVIRA syndrome radiologically. DOI: http://dx.doi.org/10.3329/pulse.v6i1-2.20358 Pulse Vol.6 January-December 2013 p.66-69

Ibuprofen is a Useful Treatment for Primary Dysmenorrhoea

A double-blind crossover placebo-controlled trial over 6 cycles in 38 Australian women has confirmed that ibuprofen is a valuable drug for the treatment of primary spasmodic dysmenorrhoea. This drug was highly effective when given in a dosage of one 400mg tablet at the first sign of pain or bleeding followed by further 400mg tablets every 4 to 6 hours for the duration of expected symptoms. Side-effects were mild and noted with equal low frequency during placebo treatment.

Psychological treatments of dysmenorrhea: Differential effectiveness for spasmodics and congestives

Two studies are reported, examining the effectiveness of psychological treatments for dysmenorrhea. In Experiment 1, 33 women with spasmodic dysmenorrhea were treated with relaxation alone, or relaxation plus imagery, or assigned to a waiting-list control condition; and 29 women with congestive dysmenorrhea were treated with relaxation alone, or assigned to a waiting-list control condition. In Experiment 2, 18 additional congestives were treated with a coping skills package, or this package plus relaxation; these two groups were compared with the two congestive groups from Experiment 1. The dependent measures were reports of symptom severity, general discomfort, resting time, and medication use. Consistent with the literature, the main findings of the present studies are: (a) relaxation training (alone or with imagery) effectively reduces resting time for spasmodics; and (b) none of the treatments was shown to be effective for congestive sufferers.

Differential response by adolescents to naproxen sodium therapy for spasmodic and congestive dysmenorrhea

The purpose of this study was to determine whether adolescents with "spasmodic" dysmenorrhea (SD) versus "congestive" dysmenorrhea (CD) respond differently to naproxen sodium therapy. Forty-five females ages 12-18 years were pretested and randomly assigned in a double-blind fashion to one of five treatment regimens of various dosages of naproxen sodium and placebo. Subjects were posttested at one, two, and three months. Subjects with initial Menstrual Symptom Questionnaire (MSQ) scores of greater than or equal to 76 were classified as SD (n = 28) and those with scores of less than or equal to 75 were classified as CD (n = 17). Subjects with SD had a significant (p less than or equal to 0.05) reduction in MSQ scores after the first month of naproxen sodium therapy. By the second month, the degree of reduction was associated with a loading dose of 550 mg of naproxen sodium. Subjects with CD had a dose-related (p less than or equal to 0.05) response to naproxen sodium therapy that appeared to be influenced by other factors. At the first month follow-up, greater post menarchal age and parents' education were associated with increased symptom relief following naproxen sodium therapy (p less than or equal to 0.05). At the second month, CD subjects with increased life crisis events and lower self-concepts had more severe symptoms following naproxen sodium therapy (p less than 0.05). Our subjects with SD symptoms had a greater response to naproxen sodium therapy than those with CD symptoms.

Life stress in spasmodic and congestive dysmenorrhea.

145 college-aged women completed The Menstrual Symptom Questionnaire dealing with menstrual subtype (congestive or spasmodic), life stress, age, and menstrual severity. Spasmodic-typed women seemed to report significantly greater severity following recent (within one month) life stress but the expected dichotomous split between congestive and spasmodic dysmenorrhea was not noted. It appears that women scoring clearly spasmodic respond differentially to recent life stress. Psychological stress may trigger prostaglandin production in spasmodic women or stress may contribute to uterine muscular tension.

Menstrual stress

AbstractMenstruation and stress are closely related. Stress can cause alterations of menstruation, while alterations of menstruation can result in stress. The normal menstrual pattern shows wide variations in cycle length from 21 to 36 days and the duration of menstrual flow may last from two to eight days, and there are variations both within and between individuals. The effect of the same stress on the menstrual pattern may be different and opposite in individuals, but the same response tends to continue throughout the menstrual lifespan. Menstrual synchrony can occur among those living closely together, while the male may influence the length of the woman's menstrual cycle depending on the frequency of contact.Formerly, many menstrual disorders for which no structural abnormality could be detected were regarded as being of psychological origin. With increasing knowledge of hormonal interactions, neurohormones, receptors and binding mechanisms, and with improved investigative techniques, such as radioimmunoassays, ultrasonic pelvic scan and laparoscopy, today many hormone abnormalities have been uncovered to account for menstrual disorders. Thus premenstrual syndrome is now known to be caused by a deficiency of progesterone, spasmodic dysmenorrhoea by an excess of prostaglandin F2 alpha and menopausal symptoms by oestrogen deficiency. These hormonal abnormalities can be corrected by appropriate therapy and should therefore now be recognized as coming within the ambiance of gynaecological endocrinologists.

Use of Mefenamic Acid in the Treatment of Primary Dysmenorrhea

Mefenamic acid (Ponstel), 250 mg four times a day, and placebo were compared in a double-blind, crossover study conducted in 46 women with primary spasmodic dysmenorrhea. When compared with placebo, treatment with mefenamic acid resulted in significant decreases in the frequency and severity of the symptoms, and significantly reduced the need for additional analgesic medication. Mefenamic acid was well tolerated. No changes in clinical laboratory values were associated with its use. ( JAMA 241:2713-2716, 1979)