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====Hormonal contraceptives====
====Hormonal contraceptives====
[[Oral contraceptive]]s can improve or relieve symptoms of primary dysmenorrhea.{{Fact|date=March 2008}} The mechanism of action involves reducing menstrual blood volume, and suppressing [[ovulation]].{{Fact|date=March 2008}} It may take up to three months of treatment to experience relief.{{Fact|date=March 2008}} [[Norplant]] and [[Depo-provera]] are also effective, since these methods often induce [[amenorrhea]].{{Fact|date=March 2008}} The [[IntraUterine System]] (Mirena IUD) has been cited as useful in reducing symptoms of dysmenorrhea.<ref name="gupta">[http://www.ncbi.nlm.nih.gov/pubmed/18178990?ordinalpos=18&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Laevonorgestrel intra-uterine system--a revolutionary intra-uterine device.]</ref>
[[Oral contraceptive]]s can improve or relieve symptoms of primary dysmenorrhea<ref name="Archer 2006">{{cite journal |author=Archer DF |title=Menstrual-cycle-related symptoms: a review of the rationale for continuous use of oral contraceptives |journal=Contraception |volume=74 |issue=5 |pages=359–66 |year=2006 |month=November |pmid=17046376 |doi=10.1016/j.contraception.2006.06.003 |url=}}</ref><ref name="Harel 2006">{{cite journal |author=Harel Z |title=Dysmenorrhea in adolescents and young adults: etiology and management |journal=J Pediatr Adolesc Gynecol |volume=19 |issue=6 |pages=363–71 |year=2006 |month=December |pmid=17174824 |doi=10.1016/j.jpag.2006.09.001 |url=}}</ref>. The mechanism of action involves reducing menstrual blood volume, and suppressing [[ovulation]].{{Fact|date=March 2008}} It may take up to three months of treatment to experience relief.{{Fact|date=March 2008}} [[Norplant]]<ref>{{cite journal |author=Power J, French R, Cowan F |title=Subdermal implantable contraceptives versus other forms of reversible contraceptives or other implants as effective methods of preventing pregnancy |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD001326 |year=2007 |pmid=17636668 |doi=10.1002/14651858.CD001326.pub2 |url=}}</ref> and [[Depo-provera]]<ref name="glasier">{{cite book |last=Glasier |first=Anna |editor=DeGroot, Leslie J.; Jameson, J. Larry (eds.) |title=Endocrinology |edition=5th edition |year=2006 |publisher=Elsevier Saunders |location=Philadelphia |id=ISBN 0-7216-0376-9 |pages=pp. 2993-3003 |chapter=Contraception}}</ref><ref name="loose">{{cite book |author=Loose, Davis S.; Stancel, George M. |editor=Brunton, Laurence L.; Lazo, John S.; Parker, Keith L. (eds.) |year=2006 |chapter=Estrogens and Progestins |title=Goodman & Gilman's The Pharmacological Basis of Therapeutics |edition=11th ed. |pages=pp. 1541-1571 |location=New York |publisher=McGraw-Hill |id=ISBN 0-07-142280-3}}</ref> are also effective, since these methods often induce [[amenorrhea]]. The [[IntraUterine System]] (Mirena IUD) has been cited as useful in reducing symptoms of dysmenorrhea.<ref name="gupta">[http://www.ncbi.nlm.nih.gov/pubmed/18178990?ordinalpos=18&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Laevonorgestrel intra-uterine system--a revolutionary intra-uterine device.]</ref>


====Non-drug therapies====
====Non-drug therapies====

Revision as of 10:04, 24 April 2008

Dysmenorrhea
SpecialtyFamily medicine Edit this on Wikidata

Dysmenorrhea (or dysmenorrhoea) is a medical condition characterized by severe uterine pain during menstruation. While many individuals experience minor pain during menstruation, dysmenorrhea is diagnosed when the pain is so severe as to limit normal activities, or require medication.

Dysmenorrhea can feature different kinds of pain, including sharp, throbbing, dull, nauseating, burning, or shooting pain. Dysmenorrhea may precede menstruation by several days or may accompany it, and it usually subsides as menstruation tapers off. Dysmenorrhea may coexist with excessively heavy blood loss, known as menorrhagia.

Secondary dysmenorrhea is diagnosed when symptoms are attributable to an underlying disease, disorder, or structural abnormality either within or outside the uterus. Primary dysmenorrhea is diagnosed when none of these are detected.

Primary dysmenorrhea

Signs and symptoms

The main symptom of dysmenorrhea is pain centering in the lower abdomen, which may radiate to the thighs and lower back. Other symptoms may include nausea and vomiting, diarrhea, headache, and fatigue. Symptoms of dysmenorrhea usually begin a few hours before the start of menstruation, and may continue for a few days.

Etiology

In a systematic review, an age of less than 30 years, a low body mass index, smoking, earlier menarche (< 12 years), longer menstrual cycles, heavy menstrual flow, nulliparity, premenstrual syndrome, sterilisation, clinically suspected pelvic inflammatory disease, sexual abuse, and psychological symptoms were associated with dysmenorrhoea.[1]

Pathophysiology

Prostaglandins are released during menstruation, due to the destruction of the endometrial cells, and the resultant release of their contents[2]. Release of prostaglandins and other inflammatory mediators in the uterus is thought to be a major factor in primary dysmenorrhea.[3] Prostaglandin levels have been found to be much higher in females with severe menstrual pain than in females who experience mild or no menstrual pain.[citation needed] Females with primary dysmenorrhea have increased activity of the uterine muscle with increased contractility and increased frequency of contractions[4].

Diagnosis

In one research study using MRI, visible features of the uterus were compared in dysmenorrheic and eumenorrheic (normal) participants. The study concluded that in dysmenorrheic patients, visible features on cycle days 1-3 correlated with the degree of pain, and differed significantly from the control group.[5]

Treatment

Nutritional

Several nutritional supplements have been indicated as effective in treating dysmenorrhea, including omega-3 fatty acids, magnesium, vitamin E, zinc, and thiamine (vitamin B1).

Research indicates that one mechanism underlying dysmenorrhea is a disturbed balance between antiinflammatory, vasodilator eicosanoids derived from omega-3 fatty acids, and proinflammatory, vasoconstrictor eicosanoids derived from omega-6 fatty acids.[6] Several studies have indicated that intake of omega-3 fatty acids can reverse the symptoms of dysmenorrhea, by decreasing the amount of omega-6 FA in cell membranes.[7][8][9] The richest dietary source of omega-3 fatty acids is found in flax oil.[10]

Oral intake of magnesium has also been indicated in providing relief: two double-blind, placebo-controlled studies demonstrated a positive therapeutic effect of magnesium on dysmenorrhea.[11][12] A randomized, double-blind, controlled trial demonstrated that oral intake of vitamin E relieves the pain of primary dysmenorrhea and reduces blood loss.[13] A review of case histories indicated that zinc, in 1 to 3 30-milligram doses given daily for one to four days prior to onset of menses, prevents essentially all to all warning of menses and all menstrual cramping.[14] Intake of thiamine (vitamin B1) was demonstrated to provide "curative" relief in 87% of females experiencing dysmenorrhea, in a controlled study.[15]

NSAIDs

Drugs which inhibit the production of prostaglandins, such as the non-steroidal anti-inflammatory drugs (NSAIDs) naproxen, ibuprofen and mefenamic acid can provide relief for the pain associated with high prostaglandin release.[citation needed] NSAIDs are effective in relieving the pain of primary dysmenorrhea.[16] NSAIDs can have side effects of nausea, dyspepsia, peptic ulcer, and diarrhea.[17] Patients who cannot take the more common NSAIDs, or for whom they are not effective, may be prescribed a COX-2 inhibitor.[18] One study indicated that conventional therapy with NSAIDs "provides symptomatic relief but has increasing adverse effects with long-term use",[19] another indicated that long-term use of NSAIDs has "severe adverse effects".[20]

Hormonal contraceptives

Oral contraceptives can improve or relieve symptoms of primary dysmenorrhea[21][22]. The mechanism of action involves reducing menstrual blood volume, and suppressing ovulation.[citation needed] It may take up to three months of treatment to experience relief.[citation needed] Norplant[23] and Depo-provera[24][25] are also effective, since these methods often induce amenorrhea. The IntraUterine System (Mirena IUD) has been cited as useful in reducing symptoms of dysmenorrhea.[26]

Non-drug therapies

Several non-drug therapies for dysmenorrhea have been indicated in studies, including acupuncture, acupressure, chiropractic care, and the use of a TENS unit.

Acupuncture and acupressure are used to treat dysmenorrhea. A review cited four studies, two of which were patient-blind, indicating that acupuncture and acupressure were effective.[27] This review stated that the treatments appear "promising" for dysmenorrhoea, and that the researchers considered further studies to be justified. Another study indicated that acupuncture "reduced the subjective perception of dysmenorrhea",[28] still another indicated that adding acupuncture in patients with dysmenorrhea was associated with improvements in pain and quality of life.[29]

Chiropractic care is disputed in its effectiveness. Some studies indicate its effectiveness, and claim that treating subluxations in the spine may cause the nerves leaving the spine to be less aggravated and so decrease symptoms, as well as other symptoms such as chronic stomach aches and headaches.[30] Other research concluded that spinal manipulation is not an effective treatment.[31]

Treatment with a transcutaneous electrical nerve stimulation (TENS) unit, often used for chronic pain, was indicated as effective in several studies.[32][33][34][35] One study encouraged providers to try the TENS unit with patients, on the grounds that they found it to be "non-invasive, efficient, and easy to use".[36] A study led by the same researchers reported proof of TENS' effectiveness.[37]

Other medications and herbal therapies

Other medications and herbal therapies have been studied in the treatment of dysmenorrhea. One study indicated that two Japanese herbal medicines provided all of the study participants with complete relief.[38] A review indicated the effectiveness of use of transdermal nitroglycerin.[39] A double-blind, controlled study indicated that treatment with an extract of guava leaf resulted in significant reduction of symptoms.[40] In a small double-blind, placebo-controlled study, guaifenesin reduced primary dysmenorrhea, but the effect was not significant.[41]

Hormonal treatments

Hormonal treatments such as danazol, progestational agents, GnRH agonists, and progestins may be used.[citation needed] One study suggested that vasopressin antagonists with V1(a) selectivity might be useful in treating a variety of disorders, including dysmenorrhoea.[42]

Surgical treatments

In severe cases, interruption of uterine nerves by presacral neurectomy and division of the sacrouterine ligaments may be used when other treatment options fail.[citation needed]

Prognosis

A survey in Norway showed that 14 percent of females between the ages of 20 to 35 experience symptoms so severe that they stay home from school or work.[43] Among adolescent girls, dysmenorrhea is the leading cause of recurrent short-term school absence in this group.[44]

Epidemiology

Reports of dysmenorrhea are greatest among individuals in their late teens and 20s, with reports usually declining with age. One study indicated that 67.2% of adolescent females experienced dysmenorrhea.[45] A study of Hispanic adolescent females indicated a high prevalence and impact in this group.[46] Another study indicated that dysmenorrhoea was present in 36.4% of participants, and was significantly associated with lower age and lower parity.[47] Childbearing can relieve dysmenorrhea.[48] One study indicated that in nulliparous women with primary dysmenorrhea, the severity of menstrual pain decreased significantly after age 40.[48] A questionnaire concluded that menstrual problems, including dysmenorrhea, were more common in females who had been sexually abused.[49]

Secondary dysmenorrhea

Signs and symptoms

The symptoms of secondary dysmenorrhea vary with the underlying cause, but are similar to those of primary dysmenorrhea. While the symptoms of primary dysmenorrhea are generally limited to the time around menses, in secondary dysmenorrhea, they may extend further through the menstrual cycle.

Etiology

The most common cause of secondary dysmenorrhea is endometriosis.[44] Approximately 24% of females who report pelvic pain are subsequently found to have endometriosis. Other causes include pelvic inflammatory disease, leiomyoma,[50] adenomyosis,[51] ovarian cysts, and pelvic congestions.[52] The presence of a copper IUD can also cause dysmenorrhea.[53][54] Some find that use of internally-worn menstrual products (such as tampons and menstrual cups) exacerbate dysmenorrhea.

Pathophysiology

The mechanisms causing the pain of secondary dysmenorrhea are varied, and may or may not involve prostaglandins. Secondary dysmenorrhea is less related to the onset of bleeding in menstruation, is seen in older females, and is sometimes associated with other conditions, such as infertility.

Treatment

Of underlying causes

The most effective treatment of secondary dysmenorrhea is the identification and treatment of the underlying cause of the pain. The first line of treatment is medical; if possible, the underlying medical disorder or anatomic abnormality is corrected. Dilation of a narrow cervical os may give 3 to 6 months of relief, and allows diagnostic curettage if needed. Myomectomy, polypectomy, or dilation and curettage may be needed. In patients with adenomyosis, the levonorgestrel intrauterine system (Mirena) was observed to provide relief.[55]

Pain relief

The medical options used for relieving pain in secondary dysmenorrhea are similar to those used in primary dysmenorrhea.

References

  1. ^ Latthe, P (April 1, 2006). "Factors predisposing women to chronic pelvic pain: systematic review". British Medical Journal. 332 (7544). Academic Department of Obstetrics and Gynaecology, University of Birmingham, Birmingham B15 2TG.: 749–55. Retrieved 2008-03-21. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)CS1 maint: location (link)
  2. ^ Lethaby A, Augood C, Duckitt K, Farquhar C (2007). "Nonsteroidal anti-inflammatory drugs for heavy menstrual bleeding". Cochrane Database Syst Rev (4): CD000400. doi:10.1002/14651858.CD000400.pub2. PMID 17943741.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. ^ Wright, Jason and Solange Wyatt. The Washington Manual Obstetrics and Gynecology Survival Guide. Lippincott Williams and Wilkins, 2003. ISBN 0-7817-4363-X
  4. ^ Rosenwaks Z, Seegar-Jones G (1980). "Menstrual pain: its origin and pathogenesis". J Reprod Med. 25 (4 Suppl): 207–12. PMID 7001019. {{cite journal}}: Unknown parameter |month= ignored (help)
  5. ^ Kataoka, M (April, 2005). "Dysmenorrhea: evaluation with cine-mode-display MR imaging--initial experience". Radiology. 235 (1): 124–31. Retrieved 2008-03-21. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  6. ^ Xu L, Liu SL, Zhang JT (2005). "(-)-Clausenamide potentiates synaptic transmission in the dentate gyrus of rats". Chirality. 17 (5): 239–44. doi:10.1002/chir.20150. PMID 15841477. Retrieved 2008-03-23.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  7. ^ Painful menstruation and low intake of n-3 fatty acids, PubMed
  8. ^ Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents., PubMed
  9. ^ Menstrual discomfort in Danish women reduced by dietary supplements of omega-3 PUFA and B12 (fish oil or seal oil capsules), ScienceDirect
  10. ^ Dietary flax seed in prevention of hypercholesterolemic atherosclerosis., "Flax seed is the richest source of omega-3 fatty acid and lignans."
  11. ^ Magnesium--a new therapeutic alternative in primary dysmenorrhea
  12. ^ Therapeutic effects of magnesium in dysmenorrhea
  13. ^ A randomised controlled trial of vitamin E in the treatment of primary dysmenorrhoea.
  14. ^ Eby GA (2007). "Zinc treatment prevents dysmenorrhea". Med. Hypotheses. 69 (2): 297–301. doi:10.1016/j.mehy.2006.12.009. PMID 17289285.
  15. ^ Diagnosis and management of dysmenorrhoea
  16. ^ Andreoli, Thomas E., Charles C. J. Carpenter, Robert C. Griggs, and Joseph Loscalzo. CECIL Essentials of Medicine, 6th ed. Saunders, 2004. ISBN 0-7216-0147-2
  17. ^ Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006. ISBN 0-9757919-2-3
  18. ^ The effect of three cyclo-oxygenase inhibitors on intensity of primary dysmenorrheic pain.
  19. ^ Common traditional Chinese medicinal herbs for dysmenorrhea.
  20. ^ The effect of fennel essential oil on uterine contraction as a model for dysmenorrhea, pharmacology and toxicology study.
  21. ^ Archer DF (2006). "Menstrual-cycle-related symptoms: a review of the rationale for continuous use of oral contraceptives". Contraception. 74 (5): 359–66. doi:10.1016/j.contraception.2006.06.003. PMID 17046376. {{cite journal}}: Unknown parameter |month= ignored (help)
  22. ^ Harel Z (2006). "Dysmenorrhea in adolescents and young adults: etiology and management". J Pediatr Adolesc Gynecol. 19 (6): 363–71. doi:10.1016/j.jpag.2006.09.001. PMID 17174824. {{cite journal}}: Unknown parameter |month= ignored (help)
  23. ^ Power J, French R, Cowan F (2007). "Subdermal implantable contraceptives versus other forms of reversible contraceptives or other implants as effective methods of preventing pregnancy". Cochrane Database Syst Rev (3): CD001326. doi:10.1002/14651858.CD001326.pub2. PMID 17636668.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  24. ^ Glasier, Anna (2006). "Contraception". In DeGroot, Leslie J.; Jameson, J. Larry (eds.) (ed.). Endocrinology (5th edition ed.). Philadelphia: Elsevier Saunders. pp. pp. 2993-3003. ISBN 0-7216-0376-9. {{cite book}}: |edition= has extra text (help); |editor= has generic name (help); |pages= has extra text (help)CS1 maint: multiple names: editors list (link)
  25. ^ Loose, Davis S.; Stancel, George M. (2006). "Estrogens and Progestins". In Brunton, Laurence L.; Lazo, John S.; Parker, Keith L. (eds.) (ed.). Goodman & Gilman's The Pharmacological Basis of Therapeutics (11th ed. ed.). New York: McGraw-Hill. pp. pp. 1541-1571. ISBN 0-07-142280-3. {{cite book}}: |edition= has extra text (help); |editor= has generic name (help); |pages= has extra text (help)CS1 maint: multiple names: authors list (link)
  26. ^ Laevonorgestrel intra-uterine system--a revolutionary intra-uterine device.
  27. ^ White A (2003). "A review of controlled trials of acupuncture for women's reproductive health care". J Fam Plann Reprod Health Care. 29 (4): 233–6. PMID 14662058.
  28. ^ Jun E (2004). "[Effects of SP-6 acupressure on dysmenorrhea, skin temperature of CV2 acupoint and temperature, in the college students]". Taehan Kanho Hakhoe Chi. 34 (7): 1343–50. PMID 15687775.
  29. ^ Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care.
  30. ^ Chapman-Smith, David A. "The Chiropractic Profession." NCMIC Group Inc., 2000. ISBN 1-892734-02-8
  31. ^ Proctor ML, Hing W, Johnson TC, Murphy PA. Spinal manipulation for primary and secondary dysmenorrhoea. Art. No.: CD002119. DOI: 10.1002/14651858.CD002119.pub3.
  32. ^ Effectiveness of transcutaneous electrical nerve stimulation and interferential current in primary dysmenorrhea.
  33. ^ Treatment of dysmenorrhoea with a new TENS device (OVA).
  34. ^ Transcutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea.
  35. ^ TENS is effective in painful menstruation
  36. ^ Transcutaneous electrical nerve stimulation (TENS) as a pain-relief device in obstetrics and gynecology.
  37. ^ Clinical evaluation of a new model of a transcutaneous electrical nerve stimulation device for the management of primary dysmenorrhea.
  38. ^ A novel anti-dysmenorrhea therapy with cyclic administration of two Japanese herbal medicines.
  39. ^ Nitroglycerin as a uterine relaxant: a systematic review.
  40. ^ Effect of a Psidii guajavae folium extract in the treatment of primary dysmenorrhea: a randomized clinical trial.
  41. ^ Marsden JS, Strickland CD, Clements TL (2004). "Guaifenesin as a treatment for primary dysmenorrhea". J Am Board Fam Pract. 17 (4): 240–6. PMID 15243011.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  42. ^ Pharmacology and clinical relevance of vasopressin antagonists.
  43. ^ "Mozon: Sykemelder seg på grunn av menssmerter". 2004-10-25. Retrieved 2007-02-02. {{cite web}}: Text "publisher: Mozon" ignored (help)
  44. ^ a b Dysmenorrhea in adolescents: diagnosis and treatment.
  45. ^ Problems related to menstruation amongst adolescent girls.
  46. ^ Prevalence and impact of dysmenorrhea on Hispanic female adolescents.
  47. ^ Premenstrual symptoms and dysmenorrhoea among Muslim women in Zaria, Nigeria.
  48. ^ a b Natural progression of menstrual pain in nulliparous women at reproductive age: an observational study.
  49. ^ Menstruation disorders more frequent in women with a history of sexual abuse
  50. ^ Action of aromatase inhibitor for treatment of uterine leiomyoma in perimenopausal patients.
  51. ^ Successful total laparoscopic cystic adenomyomectomy after unsuccessful open surgery using transtrocar ultrasonographic guiding.
  52. ^ Hacker, Neville F., J. George Moore, and Joseph C. Gambone. Essentials of Obstetrics and Gynecology, 4th ed. Elsevier Saunders, 2004. ISBN 0-7216-0179-0
  53. ^ Preventing copper intrauterine device removals due to side effects among first-time users: randomized trial to study the effect of prophylactic ibuprofen.
  54. ^ Insertion and removal of intrauterine devices.
  55. ^ Clinical effects of the levonorgestrel-releasing intrauterine device in patients with adenomyosis.

External links

Dysmenorrhea at Curlie

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