Dysmenorrhea: Difference between revisions
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Oral intake of [[Magnesium in biology|magnesium]] has also been indicated in providing relief: two [[double-blind]], [[placebo]]-controlled studies demonstrated a positive therapeutic effect of magnesium on dysmenorrhea.<ref>{{cite journal |author=Seifert B, Wagler P, Dartsch S, Schmidt U, Nieder J |title=[Magnesium--a new therapeutic alternative in primary dysmenorrhea] |language=German |journal=Zentralbl Gynakol |volume=111 |issue=11 |pages=755–60 |year=1989 |pmid=2675496 |doi= |url=}}</ref> |
Oral intake of [[Magnesium in biology|magnesium]] has also been indicated in providing relief: two [[double-blind]], [[placebo]]-controlled studies demonstrated a positive therapeutic effect of magnesium on dysmenorrhea.<ref>{{cite journal |author=Seifert B, Wagler P, Dartsch S, Schmidt U, Nieder J |title=[Magnesium--a new therapeutic alternative in primary dysmenorrhea] |language=German |journal=Zentralbl Gynakol |volume=111 |issue=11 |pages=755–60 |year=1989 |pmid=2675496 |doi= |url=}}</ref> |
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<ref>{{cite journal |author=Fontana-Klaiber H, Hogg B |title=[Therapeutic effects of magnesium in dysmenorrhea] |language=German |journal=Schweiz. Rundsch. Med. Prax. |volume=79 |issue=16 |pages=491–4 |year=1990 |pmid=2349410 |doi= |url=}}</ref> A randomized, double-blind, controlled trial demonstrated that oral intake of vitamin E relieves the pain of primary dysmenorrhea and reduces blood loss.<ref>{{cite journal |author=Ziaei S, Zakeri M, Kazemnejad A |title=A randomised controlled trial of vitamin E in the treatment of primary dysmenorrhoea |journal=BJOG |volume=112 |issue=4 |pages=466–9 |year=2005 |pmid=15777446 |doi=10.1111/j.1471-0528.2004.00495.x |url=}}</ref> 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.<ref name="pmid17289285">{{cite journal |author=Eby GA |title=Zinc treatment prevents dysmenorrhea |journal=Med. Hypotheses |volume=69 |issue=2 |pages=297–301 |year=2007 |pmid=17289285 |doi=10.1016/j.mehy.2006.12.009}}</ref> Intake of thiamine (vitamin B<sub>1</sub>) was demonstrated to provide "curative" relief in 87% of females experiencing dysmenorrhea, in a controlled study.<ref>{{cite journal |author=Proctor M, Farquhar C |title=Diagnosis and management of dysmenorrhoea |journal=BMJ |volume=332 |issue=7550 |pages=1134–8 |year=2006 |pmid=16690671 |pmc=1459624 |doi=10.1136/bmj.332.7550.1134 |url=http://www.bmj.com/cgi/content/full/332/7550/1134}}</ref> |
<ref>{{cite journal |author=Fontana-Klaiber H, Hogg B |title=[Therapeutic effects of magnesium in dysmenorrhea] |language=German |journal=Schweiz. Rundsch. Med. Prax. |volume=79 |issue=16 |pages=491–4 |year=1990 |pmid=2349410 |doi= |url=}}</ref> A randomized, double-blind, controlled trial demonstrated that oral intake of vitamin E relieves the pain of primary dysmenorrhea and reduces blood loss.<ref>{{cite journal |author=Ziaei S, Zakeri M, Kazemnejad A |title=A randomised controlled trial of vitamin E in the treatment of primary dysmenorrhoea |journal=BJOG |volume=112 |issue=4 |pages=466–9 |year=2005 |pmid=15777446 |doi=10.1111/j.1471-0528.2004.00495.x |url=}}</ref> 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.<ref name="pmid17289285">{{cite journal |author=Eby GA |title=Zinc treatment prevents dysmenorrhea |journal=Med. Hypotheses |volume=69 |issue=2 |pages=297–301 |year=2007 |pmid=17289285 |doi=10.1016/j.mehy.2006.12.009}}</ref> Intake of thiamine (vitamin B<sub>1</sub>) was demonstrated to provide "curative" relief in 87% of females experiencing dysmenorrhea, in a controlled study.<ref>{{cite journal |author=Proctor M, Farquhar C |title=Diagnosis and management of dysmenorrhoea |journal=BMJ |volume=332 |issue=7550 |pages=1134–8 |year=2006 |pmid=16690671 |pmc=1459624 |doi=10.1136/bmj.332.7550.1134 |url=http://www.bmj.com/cgi/content/full/332/7550/1134}}</ref> |
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A switch from acidic foods such as orange juice, lemonade, meals high in tomato products such as spagetti and pizza, also have a positive affect on those with nausea and vomiting. Acid-reflux and dysmenorrhea often are linked conditions. Most nutritionists recommend that women with dysmenorrhea switch their diets to containing over 75% foods of a pH of 7 or greater. Light meals of spinach, dairy, soy protein products such as tofu, lettuce all help the stomach to remain less acidic during hormonal change and through out the month. Women with dysmennorrhea and associated acid reflux and vomiting can use Tums lightly during their period to reduce acidic mouth. |
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Dentists can also prescribe an alkaline toothpaste which reduces acid in the mouth. This is especially important because the vomiting and acid spewing can damage tooth enamel, if the mouth is not properly neutralized. |
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The vagina is also naturally acidic, yet women with dysmennorrhea may have increased symptoms of feeling as though their vagina is 'on fire' during menstration. This is because women with dysmenorrhea have extra acid in their systems blood stream then the typical woman. Blood is suppose to have a neutral pH, yet the dymenorrheic woman's body overall has a very painfully low acidic pH, as the neutral blood leaves her body. Typicaly a vagina has a pH of around 4 until menopause when it neutralizes to a pH of about 6-7. |
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====NSAIDs==== |
====NSAIDs==== |
Revision as of 12:39, 9 May 2010
Dysmenorrhea | |
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Specialty | Family medicine ![]() |
Dysmenorrhea (or dysmenorrhoea) is a gynaecological medical condition characterized by severe uterine pain during menstruation. While most women 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 is detected.
Primary dysmenorrhea
Pathophysiology
During a woman's menstrual cycle, the endometrium thickens in preparation for potential pregnancy. After ovulation, if the ovum is not fertilized and there is no pregnancy, the built-up uterine tissue is not needed and thus shed.
Molecular compounds called prostaglandins are released during menstruation, due to the destruction of the endometrial cells, and the resultant release of their contents.[1] Release of prostaglandins and other inflammatory mediators in the uterus cause the uterus to contract. These substances are thought to be a major factor in primary dysmenorrhea.[2] When the uterine muscles contract, they constrict the blood supply to the tissue of the endometrium, which, in turn, breaks down and dies. These uterine contractions continue as they squeeze the old, dead endometrial tissue through the cervix and out of the body through the vagina. These contractions, and the resulting temporary oxygen deprivation to nearby tissues, are responsible for the pain or "cramps" experienced during menstruation.
Compared with other women, females with primary dysmenorrhea have increased activity of the uterine muscle with increased contractility and increased frequency of contractions.[3]
Signs and symptoms
The main symptom of dysmenorrhea is pain concentrated in the lower abdomen, in the umbilical region or the suprapubic region of the abdomen. It is also commonly felt in the right or left abdomen. It may radiate to the thighs and lower back. Other symptoms may include nausea and vomiting, diarrhea or constipation, headache, dizziness, disorientation, hypersensitivity to sound, light, smell and touch, fainting, and fatigue. Symptoms of dysmenorrhea often begin immediately following ovulation and can last until the end of menstruation. This is because dysmenorrhea is often associated with changes in hormonal levels in the body that occur with ovulation. The use of certain types of birth control pills can prevent the symptoms of dysmenorrhea, because the birth control pills stop ovulation from occurring.
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.[4]
Treatments
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 anti-inflammatory, vasodilator eicosanoids derived from omega-3 fatty acids, and proinflammatory, vasoconstrictor eicosanoids derived from omega-6 fatty acids.[5] 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.[6] [7][8] The richest dietary source of omega-3 fatty acids is found in flax oil.[9]
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.[10] [11] A randomized, double-blind, controlled trial demonstrated that oral intake of vitamin E relieves the pain of primary dysmenorrhea and reduces blood loss.[12] 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.[13] Intake of thiamine (vitamin B1) was demonstrated to provide "curative" relief in 87% of females experiencing dysmenorrhea, in a controlled study.[14]
NSAIDs
Non-steroidal anti-inflammatory drugs (NSAIDs) are effective in relieving the pain of primary dysmenorrhea.[15] NSAIDs can have side effects of nausea, dyspepsia, peptic ulcer, and diarrhea.[16] Patients who cannot take the more common NSAIDs, or for whom they are not effective, may be prescribed a COX-2 inhibitor.[17] One study indicated that conventional therapy with NSAIDs "provides symptomatic relief but has increasing adverse effects with long-term use",[18] another indicated that long-term use of NSAIDs has "severe adverse effects".[19]
Hormonal contraceptives
Although use of hormonal contraception can improve or relieve symptoms of primary dysmenorrhea,[20][21] a 2001 systematic review found that no conclusions can be made about the efficacy of commonly used modern lower dose combined oral contraceptive pills for primary dysmenorrhea.[22] 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 studied, including behavioral, acupuncture, acupressure, chiropractic care, and the use of a TENS unit.
Behavioral therapies assume that the physiological process underlying dysmenorrhea is influenced by environmental and psychological factors, and that dysmenorrhea can be effectively treated by physical and cognitive procedures that focus on coping strategies for the symptoms rather than on changes to the underlying processes. A 2007 systematic review found some scientific evidence that behavioral interventions may be effective, but that the results should be viewed with caution due to poor quality of the data.[27]
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.[28] This review stated that the treatments appear "promising" for dysmenorrhea, and that the researchers considered further studies to be justified. Another study indicated that acupuncture "reduced the subjective perception of dysmenorrhea",[29] still another indicated that adding acupuncture in patients with dysmenorrhea was associated with improvements in pain and quality of life.[30]
Although claims have been made for chiropractic care, under the theory that treating subluxations in the spine may decrease symptoms,[31] a 2006 systematic review found that overall no evidence suggests that spinal manipulation is effective for treatment of primary and secondary dysmenorrhea.[32]
Treatment with a transcutaneous electrical nerve stimulation (TENS) unit, often used for chronic pain, was indicated as effective in several studies.[33] [34] [35][36] 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".[37] A study led by the same researchers reported proof of TENS' effectiveness.[38] An alternative to this is a hot water bottle on the effected area. The heat relaxes the muscles in the area and provides a temporary relief to the pain experienced.
Other medications and herbal therapies
Other medications and herbal therapies have been studied in the treatment of dysmenorrhea. A 2008 systematic review found promising evidence for Chinese herbal medicine for primary dysmenorrhea, but that the evidence was limited by its poor methodological quality.[39] One study indicated that two Japanese herbal medicines provided all of the study participants with complete relief.[40] A review indicated the effectiveness of use of transdermal nitroglycerin.[41] A double-blind, controlled study indicated that treatment with an extract of guava leaf resulted in significant reduction of symptoms.[42] In a small double-blind, placebo-controlled study, guaifenesin reduced primary dysmenorrhea, but the effect was not significant.[43]
Hormonal treatments
One study suggested that vasopressin antagonists with V1(a) selectivity might be useful in treating a variety of disorders, including dysmenorrhea.[44]
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.[45] Among adolescent girls, dysmenorrhea is the leading cause of recurrent short-term school absence in this group.[46]
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.[47] A study of Hispanic adolescent females indicated a high prevalence and impact in this group.[48] Another study indicated that dysmenorrhea was present in 36.4% of participants, and was significantly associated with lower age and lower parity.[49] Childbearing is said to relieve dysmenorrhea, but this does not always occur. One study indicated that in nulliparous women with primary dysmenorrhea, the severity of menstrual pain decreased significantly after age 40.[50] A questionnaire concluded that menstrual problems, including dysmenorrhea, were more common in females who had been sexually abused.[51]
Secondary dysmenorrhea
![]() | This section needs expansion. You can help by adding to it. (June 2008) |
Secondary dysmenorrhea is dysmenorrhea which is associated with an existing condition. The most common cause of secondary dysmenorrhea is endometriosis.[46] Other causes include leiomyoma,[52] adenomyosis,[53] ovarian cysts, and pelvic congestions.[54] The presence of a copper IUD can also cause dysmenorrhea.[55][56] In patients with adenomyosis, the levonorgestrel intrauterine system (Mirena) was observed to provide relief.[57]
References
- ^ 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) - ^ Wright, Jason and Solange Wyatt. The Washington Manual Obstetrics and Gynecology Survival Guide. Lippincott Williams and Wilkins, 2003. ISBN 0-7817-4363-X
- ^ Rosenwaks Z, Seegar-Jones G (1980). "Menstrual pain: its origin and pathogenesis". J Reprod Med. 25 (4 Suppl): 207–12. PMID 7001019.
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: Unknown parameter|month=
ignored (help) - ^
Kataoka M, Togashi K, Kido A; et al. (2005). "Dysmenorrhea: evaluation with cine-mode-display MR imaging--initial experience". Radiology. 235 (1): 124–31. doi:10.1148/radiol.2351031283. PMID 15731368.
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(help)CS1 maint: multiple names: authors list (link) - ^ Deutch B (1996). "[Painful menstruation and low intake of n-3 fatty acids]". Ugeskr. Laeg. (in Danish). 158 (29): 4195–8. PMID 8701537.
- ^ Harel Z, Biro FM, Kottenhahn RK, Rosenthal SL (1996). "Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents". Am. J. Obstet. Gynecol. 174 (4): 1335–8. doi:10.1016/S0002-9378(96)70681-6. PMID 8623866.
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: CS1 maint: multiple names: authors list (link) - ^ Menstrual discomfort in Danish women reduced by dietary supplements of omega-3 PUFA and B12 (fish oil or seal oil capsules), ScienceDirect
- ^ Prasad K (1997). "Dietary flax seed in prevention of hypercholesterolemic atherosclerosis". Atherosclerosis. 132 (1): 69–76. doi:10.1016/S0021-9150(97)06110-8. PMID 9247361. "Flax seed is the richest source of omega-3 fatty acid and lignans."
- ^ Seifert B, Wagler P, Dartsch S, Schmidt U, Nieder J (1989). "[Magnesium--a new therapeutic alternative in primary dysmenorrhea]". Zentralbl Gynakol (in German). 111 (11): 755–60. PMID 2675496.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Fontana-Klaiber H, Hogg B (1990). "[Therapeutic effects of magnesium in dysmenorrhea]". Schweiz. Rundsch. Med. Prax. (in German). 79 (16): 491–4. PMID 2349410.
- ^ Ziaei S, Zakeri M, Kazemnejad A (2005). "A randomised controlled trial of vitamin E in the treatment of primary dysmenorrhoea". BJOG. 112 (4): 466–9. doi:10.1111/j.1471-0528.2004.00495.x. PMID 15777446.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Eby GA (2007). "Zinc treatment prevents dysmenorrhea". Med. Hypotheses. 69 (2): 297–301. doi:10.1016/j.mehy.2006.12.009. PMID 17289285.
- ^ Proctor M, Farquhar C (2006). "Diagnosis and management of dysmenorrhoea". BMJ. 332 (7550): 1134–8. doi:10.1136/bmj.332.7550.1134. PMC 1459624. PMID 16690671.
- ^ 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
- ^ Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006. ISBN 0-9757919-2-3
- ^ Chantler I, Mitchell D, Fuller A (2008). "The effect of three cyclo-oxygenase inhibitors on intensity of primary dysmenorrheic pain". Clin J Pain. 24 (1): 39–44. doi:10.1097/AJP.0b013e318156dafc. PMID 18180635.
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: CS1 maint: multiple names: authors list (link) - ^ Jia W, Wang X, Xu D, Zhao A, Zhang Y (2006). "Common traditional Chinese medicinal herbs for dysmenorrhea". Phytother Res. 20 (10): 819–24. doi:10.1002/ptr.1905. PMID 16835873.
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: CS1 maint: multiple names: authors list (link) - ^ Ostad SN, Soodi M, Shariffzadeh M, Khorshidi N, Marzban H (2001). "The effect of fennel essential oil on uterine contraction as a model for dysmenorrhea, pharmacology and toxicology study". J Ethnopharmacol. 76 (3): 299–304. doi:10.1016/S0378-8741(01)00249-5. PMID 11448553.
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: CS1 maint: multiple names: authors list (link) - ^ 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.
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ignored (help) - ^ 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.
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: Unknown parameter|month=
ignored (help) - ^ Proctor ML, Roberts H, Farquhar CM (2001). "Combined oral contraceptive pill (OCP) as treatment for primary dysmenorrhoea". Cochrane Database Syst Rev (4): CD002120. doi:10.1002/14651858.CD002120. PMID 11687142.
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: CS1 maint: multiple names: authors list (link) - ^ 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.
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- ^ "Mozon: Sykemelder seg på grunn av menssmerter". Mozon. 2004-10-25. Retrieved 2007-02-02.
- ^ a b French L (2008). "Dysmenorrhea in adolescents: diagnosis and treatment". Paediatr Drugs. 10 (1): 1–7. PMID 18162003.
- ^ Sharma P, Malhotra C, Taneja DK, Saha R (2008). "Problems related to menstruation amongst adolescent girls". Indian J Pediatr. 75 (2): 125–9. doi:10.1007/s12098-008-0018-5. PMID 18334791.
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: CS1 maint: multiple names: authors list (link) - ^ Banikarim C, Chacko MR, Kelder SH (2000). "Prevalence and impact of dysmenorrhea on Hispanic female adolescents". Arch Pediatr Adolesc Med. 154 (12): 1226–9. PMID 11115307.
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