Treatment Of Primary Dysmenorrhea Research Articles

Efficacy of minor analgesics in primary dysmenorrhoea: a systematic review.

To quantify the efficacy and safety of naproxen, ibuprofen, mefenamic acid, aspirin and acetaminophen (paracetamol) in the treatment of primary dysmenorrhoea through a systemic overview of randomised controlled trials. MEDLINE, EMBASE and the Science Citation Index were searched for randomised controlled trials. Efficacy was assessed by measurement of pain relief, requirement for rescue analgesics, restriction of daily life and absence from work or school. The rate ratios of side effects were used to assess safety. Fifty-six trials describing 55 comparisons of analgesics with placebo and 12 direct comparisons with other analgesics met our inclusion criteria. Women taking naproxen were over three times more likely to have at least moderate pain relief than those taking placebo. Ibuprofen, mefenamic acid and aspirin were also superior to placebo but acetaminophen was not. The requirement for rescue analgesics, restriction of daily life and absence from work or school were less frequent with naproxen and ibuprofen than placebo but not with aspirin or acetaminophen. Direct comparisons did not show any difference between naproxen and ibuprofen. Side effects occurred more frequently only with naproxen when compared with placebo. Naproxen, ibuprofen, mefenamic acid and aspirin are all effective in primary dysmenorrhoea. Ibuprofen appears to have the most favourable risk-benefit ratio. Acetaminophen appears to be less effective than nonsteroidal anti-inflammatory drugs, but there was only one trial meeting our inclusion criteria and further studies are required.

Comparison of bromfenac and naproxen sodium in the management of primary dysmenorrhea

Objective: To compare a new analgesic with an established standard and placebo in the treatment of primary dysmenorrhea. Methods: Bromfenac (B) 25 or 50 mg prn, up to 4 doses daily, was compared with naproxen sodium (N) (550/275 mg) and placebo (P) in a double-blind crossover randomized trial where 54 women were treated over 4 menstrual periods. Each treatment lasted up to 3 days. The first-dose analysis was based on a 6-hour observation period. Total pain relief (TOPAR) and summed pain intensity difference (SPID) scores were calculated from hourly collected data as areas under the respective time curves. Results: All 3 active treatments were superior to placebo in all summary variables (SPID and TOPAR for 3 and 6 hours) and corresponding peak pain relief and peak PID, duration of pain half-gone, and global assessment. Both B doses were superior to P in providing significant pain relief between hours 1 and 6, whereas N was superior to P at hours 1, 3, and 4. Good to excellent global rating was achieved by 74% of patients on B 50 mg, 59% on B 25 mg, 57% on N and 33% on P ( P < .001) after the first dose. Patients rated the trial medication superior to their usual treatment as follows: B 50 mg: 65%, B 25 mg: 55%, N: 51%, P: 29% ( P < .001). Adverse events were infrequent and not significantly different among the 4 treatments. Conclusion: Both doses of bromfenac were significantly superior to placebo and at least as efficacious as naproxen sodium in management of primary dysmenorrhea.

Laparoscopic Presacral Neurectomy in the Treatment ofPrimary Dysmenorrhea

Sixty-one laparoscopic presacral neurectomies were performed in Chang Gung Memorial Hospital, Keelung Center over a 1-year period for patients with primary dysmenorrhea who failed to respond to medical management. Eighty-three percent (50) had complete relief of pain, 10% (6) had significant relief, 3.5% (2) had moderate relief, and 3.5% (2) had no relief from their dysmenorrhea at their first menstruation after the procedure. One vascular complication requiring laparotomy occurred. Average total operation time was 24 minutes, and the average hospital stay was 2 days. Six months follow-up was done in 35 patients with complete symptom relief, and all reported continued relief of menstrual pain. The efficacy of laparoscopic presacral neurectomy for the pain relief of primary dysmenorrhea is justified in this report.

Azapropazone: An alternative agent for the treatment of primary dysmenorrhoea

SummaryThe therapeutic response of 33 dysmenorrhoeic women to treatment with azapropazone has been studied. Factors predictive of a favourable response were if a woman had experienced her dysmenorrhoea since her menarche and if she also complained of nausea, vomiting or diarrhoea during her menses. Azapropazone, in contradistinction to other non-steroidal anti-inflammatory agents used in the treatment of dysmenorrhoea is a weak inhibitor of prostaglandin synthetase. The implications of these findings are discussed.

A double‐blind placebo‐controlled crossover study of mebeverine and mefenamic acid in the treatment of primary dysmenorrhoea

International Journal of Clinical PracticeVolume 43, Issue 9 p. 317-321 Clinical Study A double-blind placebo-controlled crossover study of mebeverine and mefenamic acid in the treatment of primary dysmenorrhoea A F Langrick MB, CHB, A F Langrick MB, CHB Senior Lecturer University of Birmingham Health ServiceSearch for more papers by this authorA D G Gunn MRCP, A D G Gunn MRCP Director University of Reading Health ServiceSearch for more papers by this authorH Livesey BSC, RGN, H Livesey BSC, RGN Clinical Research Associate Duphar Laboratories, SouthamptonSearch for more papers by this authorA M Whitehead MB ChB, DIP PHARM MED, Corresponding Author A M Whitehead MB ChB, DIP PHARM MED Medical Director n/[email protected] Duphar Laboratories, SouthamptonAddress correspondence to Dr A M Whitehead, Medical Department. Duphar Laboratories, West End, Southampton S03 3JD.Search for more papers by this author A F Langrick MB, CHB, A F Langrick MB, CHB Senior Lecturer University of Birmingham Health ServiceSearch for more papers by this authorA D G Gunn MRCP, A D G Gunn MRCP Director University of Reading Health ServiceSearch for more papers by this authorH Livesey BSC, RGN, H Livesey BSC, RGN Clinical Research Associate Duphar Laboratories, SouthamptonSearch for more papers by this authorA M Whitehead MB ChB, DIP PHARM MED, Corresponding Author A M Whitehead MB ChB, DIP PHARM MED Medical Director n/[email protected] Duphar Laboratories, SouthamptonAddress correspondence to Dr A M Whitehead, Medical Department. Duphar Laboratories, West End, Southampton S03 3JD.Search for more papers by this author First published: 01 September 1989 https://doi.org/10.1111/j.1742-1241.1989.tb08759.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Volume43, Issue9September 1989Pages 317-321 RelatedInformation

A Double‐Blind Cross‐Over Study Comparing Flurbiprofen With Naproxen‐Sodium For The Treatment Of Primary Dysmenorrhea

The efficacy of flurbiprofen (100 mg, twice daily) and naproxen-sodium (500 mg, twice daily) for the treatment of primary dysmenorrhea was evaluated in a double-blind cross-over study. All the women (n = 57) complained of severe (23%) or very severe (77%) dysmenorrhea which interfered with their daily life. Frequent absenteeism due to dysmenorrhea was reported by 39% of the women. The severity of pain was reduced (p less than 0.001) during treatment with both flurbiprofen and naproxen-sodium compared with the pain severity before the first dose. There was, however, no significant difference in mean pain relief achieved by the two drugs studied. During the study period, absenteeism was reported by only 6 (11%) and 3 (5%) women when treated with flurbiprofen or naproxen-sodium respectively. More than 60% of the women reported no or only mild interference with daily activities during treatment. No serious side effects were reported and none of the patients was obliged to terminate treatment because of side effects. Flurbiprofen and naproxen-sodium, at the dosages indicated, were both shown to be effective in relieving pain in patients suffering from severe primary dysmenorrhea and markedly improved their capacity for normal activities during menstruation.

A Double-Blind Cross-Over Study Comparing Flurbiprofen with Naproxen-Sodium for the Treatment of Primary Dysmenorrhea

The efficacy of flurbiprofen (100 mg, twice daily) and naproxen-sodium (500 mg, twice daily) for the treatment of primary dysmenorrhea was evaluated in a double-blind cross-over study. All the women (n =57) complained of severe (23%) or very severe (77%) dysmenorrhea which interfered with their daily life. Frequent absenteeism due to dysmenorrhea was reported by 39% of the women. The severity of pain was reduced (p < 0.001) during treatment with both flurbiprofen and naproxen-sodium compared with the pain severity before the first dose. There was, however, no significant difference in mean pain relief achieved by the two drugs studied. During the study period, absenteeism was reported by only 6 (11%) and 3 (5%) women when treated with flurbiprofen or naproxen-sodium respectively. More than 60% of the women reported no or only mild interference with daily activities during treatment. No serious side effects were reported and none of the patients was obliged to terminate treatment because of side effects. Flurbiprofen and naproxen-sodium, at the dosages indicated, were both shown to be effective in relieving pain in patients suffering from severe primary dysmenorrhea and markedly improved their capacity for normal activities during menstruation.

Nonsteroidal anti-inflammatory drugs and changing attitudes toward dysmenorrhea

Dysmenorrhea, which may be primary or secondary, is the occurrence of painful uterine cramps during menstruation. Until a decade ago, medical and social attitudes toward dysmenorrhea were shrouded with folklore, psychoanalytical profiles, or psychosomatic bases. In secondary dysmenorrhea, there is a visible pelvic lesion to account for the pain, whereas only a biochemical abnormality is responsible for primary dysmenorrhea. Recent advances in the biochemistry of prostaglandins and their role in the pathophysiology of primary dysmenorrhea and intrauterine device (IUD)-induced dysmenorrhea have now firmly established a rational basis for the disorder. In primary dysmenorrhea, menstrual prostaglandin release is significantly increased but can be readily suppressed to normal levels when nonsteroidal anti-inflammatory drugs (NSAIDs) capable of inhibiting cyclo-oxygenase are given during menstruation. Many clinical trials (controlled and uncontrolled) have demonstrated the efficacy of NSAIDs such as the fenamates, indole-acetic acid derivatives, and arylpropionic acid derivatives in relieving primary dysmenorrhea as well as IUD-induced dysmenorrhea that is also due to elevated prostaglandin levels. With a few of these NSAIDs, it has been shown that the relief of pain is associated with a significant decrease in menstrual fluid prostaglandin levels. Cumulative data of clinical trials indicate that with the effective NSAIDs, 80 percent of patients with significant primary dysmenorrhea can be adequately relieved. Ongoing studies suggest that in some women, endometrial leukotriene, but not PGF 2a production, is increased. With the official approval and availability of several effective NSAIDs for the specific treatment of primary dysmenorrhea in the United States, women who have primary dysmenorrhea have been greatly relieved and their productivity increased. Primary dysmenorrhea affects 50 percent of postpubescent women and absenteeism among the severe dysmenorrheics has been estimated to cause about 600 million lost working hours or 2 billion dollars annually. Thus, an effective, simple, and safe treatment of primary dysmenorrhea for two to three days during menstruation will not only have a positive economic impact but will also enhance the quality of life. The availability of effective dysmenorrhea therapy with NSAIDs has induced greater expectations of relief by the patient, as well as greater willingness to seek medical help, a more rational approach to patient management by physicians, changes in attitude toward women with primary dysmenorrhea, and the debunking of myths about dysmenorrhea that often have been perpetuated as fact. NSAIDs have undoubtedly revolutionized a painful disorder.

Simultaneous objective and subjective evaluation of meclofenamate sodium in the treatment of primary dysmenorrhea

Eighteen patients participated in a double-blind, placebo-controlled, single-dose, crossover study of meclofenamate sodium in women with primary dysmenorrhea. Simultaneous evaluations of pain intensity and pain relief, sampling of continuous intrauterine pressure recording, and monitoring of blood meclofenamate levels were carried out. Improvements in pain intensity and pain relief were observed at 45 minutes and reached statistical significance at and beyond 1 hour 45 minutes after meclofenamate therapy. Ten of 14 uterine pressure parameters showed statistically significant responses after drug therapy and 12 of the 14 parameters showed statistically significant differences in time-response patterns. Statistically significant changes were noted as early as 45 minutes after meclofenamate therapy. Statistically significant correlations were found between and among the parameters of blood drug level and the subjective and objective measures. No drug-related adverse effects were found.

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.

Tiaprofenic acid in the treatment of primary dysmenorrhoea

Thirty-one patients with primary dysmenorrhoea were treated in a double-blind, six-period, cross-over clinical trial with tiaprofenic acid, naproxen sodium and a placebo in randomized order, each for 2 consecutive cycles. Complete disappearance of the symptoms or pronounced therapeutic effects were obtained with tiaprofenic acid, naproxen sodium and the placebo in 74%, 65% and 35% of cases, respectively, while these treatments were ineffective in 3%, 6% and 38% of cases, respectively. Tiaprofenic acid was superior to the placebo for relieving pelvic pain and overall discomfort and for reducing the need for bed-rest. Naproxen sodium compared favourably with the placebo with respect to pelvic pain and overall discomfort. The effects of tiaprofenic acid and naproxen sodium were not significantly different. Tiaprofenic acid had no side-effects, whereas tiredness was experienced in 3 cases of naproxen sodium treatment. The results indicate that tiaprofenic acid is a useful alternative for the treatment of primary dysmenorrhoea.

Flurbiprofen for the treatment of primary dysmenorrhea

Following the demonstration that Increased prostaglandin F 2α production causes pain similar to dysmenorrhea, and the finding that prostaglandin synthetase inhibitors are capable of relieving menstrual pain, the early theory of uterine ischomia has once again gained support as the most likely explanation for this condition. In a double-blind, placebo-controlled, crossover study, 30 of 43 women with moderate to severe dysmenorrhea who completed the trial preferred flurbiprofen (Ansaid, Upjohn), a potent new analgesic/anti-inflammatory agent (50 mg four times daily), to aspirin (650 mg four times daily) and placebo. Flurbiprofen was also rated superior to aspirin and placebo in the degree of pain relief. An algorithm for the diagnosis and treatment of 90 percent of women with primary dysmenorrhea is presented.

The Clinical Pharmacology of Piroxicam

Piroxicam, a potent inhibitor of prostaglandins, is effective and well-tolerated in the treatment of primary dysmenorrhea. A single 40 mg dose has been shown to rapidly reduce the uterine hypercontractility of primary dysmenorrhea. In clinical trials vs placebo, piroxicam in a dose of 40 mg once daily for two days followed by 20 mg once daily thereafter demonstrated superior efficacy. In more than 1,400 piroxicam-treated menstrual cycles and more than 200 placebo-controlled cycles, a similar incidence of side effects-7% and 8.4% respectively-was observed.

Current concepts in the etiology and treatment of primary dysmenorrhea.

Primary dysmenorrhea may affect as many as 40 percent of all adult women, temporarily disabling one-tenth of them. The etiology of this condition may be related to excess production of prostaglandins by the endometrium following decline in progesterone levels consequent to corpus luteum regression. It is proposed that increased prostaglandin levels produce increased myometrial contractility and uterine ischemia and sensitization of pain fibers, resulting in pelvic pain. Administration of nonsteroidal anti-inflammatory agents which block the cyclooxygenase enzyme of the arachidonic acid cascade is an effective treatment for primary dysmenorrhea, as is oral contraceptive therapy. Criteria for an ideal prostaglandin synthetase inhibitor are described.

Ibuprofen and naproxen-sodium in the treatment of primary dysmenorrhea: A double-blind cross-over study

The efficacy of ibuprofen and naproxen-sodium for the treatment of primary dysmenorrhea was evaluated in a double-blind cross-over study in 57 otherwise healthy women. The severity of pain reported by the patients was significantly (P < 0.01) reduced during treatment with both ibuprofen and naproxen-sodium compared to the severity of pain before the first dose. The mean pain relief during treatment with ibuprofen was significantly (P < 0.05) greater than during treatment with naproxen-sodium in the dosages indicated.

Diflunisal compared with naproxen in the treatment of dysmenorrhea

A randomized double-blind cross-over study was carried out in 19 young female undergraduates with severe primary dysmenorrhea to compare the efficacy and tolerance of treatment with diflunisal and naproxen. All patients received both substances twice during four consecutive cycles. The first tablet was taken at the onset of dysmenorrheic symptoms and continued according to the individual need, maximally four tablets daily. The overall relieving effect was good or moderate in 73.7% of the diflunisal cycles and in 92.1% of the naproxen cycles. The difference was not statistically significant. One third of the women estimated decreased menstrual blood loss during treatment with both the drugs. Side effects were mild and did not cause discontinuation of the therapy. Diflunisal seems to be as equally effective in the treatment of primary dysmenorrhea as naproxen, which is a well-documented and widely used prostaglandin synthetase inhibitor.

Efficacy and safety of two dosage regimens of suprofen in the treatment of primary dysmenorrhea

1113 S. 36th St., Philadelphia, PA 19104, USA 2166 E. 5900 South, Salt Lake City, UT 84107, USA 3Dept. of OB/GYN, Vanderbilt School of Medicine, Nashville, TN 37232, USA 4Ortho Pharmaceutical Corporation, Raritan, NJ 08869, USA

Prostaglandin synthetase inhibitors in the treatment of primary dysmenorrhea: Outcome trials reviewed

Clinical trials of prostaglandin synthetase inhibitors (PGSIs) prescribed for the treatment of primary dysmenorrhea were reviewed as to pain relief effectiveness, frequency and nature of side effects, and methodological adequacy. The review investigated 51 PGSI trials for a total of 1,649 women and 682 menstrual cycles and found that, over all, 72% of dysmenorrheic women reported significant pain relief to PGSI, 18% reported minimal or no pain relief, and 15% showed placebo response. Comparisons among the fenamatic compounds, ibuprofen, indomethacin, and naproxen showed the fenamates to be more effective in providing pain relief. PGSI-associated side effects were minimal for all PGSIs with the exception of indomethacin. Results were evaluated with respect to several methodological problems. Conclusions were drawn that despite these shortcomings, PGSIs are undoubtedly effective and safe for the majority of women with primary dysmenorrhea.

The etiology and treatment of primary dysmenorrhea: A review

This paper is a review of the literature regarding the etiology and treatment of primary dysmenorrhea. The review is organized around the four basic theoretical approaches that have guided research in the area: the anatomical approach, the psychological approach, the biochemical approach, and an interactive (psychological and physiological) approach. A critical analysis of the research on both etiology and treatment is presented, and methodological problems and issues in research on dysmenorrhea are examined. Suggestions for future research are also presented

Influence of certain prostaglandin synthetase inhibitors on cytoplasmic estrogen receptors in the uterus

Prostaglandin synthetase inhibitors are widely used in the treatment of primary dysmenorrhea. They are thought to act by inhibiting endometrial synthesis of prostaglandins and subsequently altering endometrial receptor concentration. Since prostaglandins are known to vary with the menstrual cycle in women, implicating an effect associated with sex steroid hormones, we examined the influence of certain prostaglandin synthetase inhibitors on specific estrogen binding capacity of uteri from rats. Ibuprofen (Motrin), 25 mg/kg, indomethacin (Indocin), 15 mg/kg, mefenamic acid (Ponstel), 25 mg/kg, and sulindac (Clinoril), 40 mg/kg, were evaluated at 6 and 24 hours after injection. Specific estrogen-binding capacity was elevated twofold by mefenamic acid; the other agents showed no statistically significant effect. No alteration in the dissociation constant values of the estrogen receptors was observed with these agents. These data suggest that prostaglandin synthetase inhibitors do not influence the estrogen response mechanism in rodents.