J Korean Med Assoc Search

CLOSE


J Korean Med Assoc > Volume 63(3); 2020 > Article
Lee and Kim: A comprehensive review and the pharmacologic management of primary dysmenorrhea

Abstract

Dysmenorrhea is the most common gynecologic condition in women during the reproductive period. Severe dysmenorrhea pain affects their social activities, sleep, and quality of life. Nevertheless, the proportion of women with dysmenorrhea do not receive adequate medical counseling or pharmacological treatments. Primary dysmenorrhea is diagnosed clinically, and the secondary causes that can cause pelvic pain should be identified. The treatment of choice for primary dysmenorrhea is non-steroidal anti-inflammatory drugs (NSAIDs). In order to maximize the therapeutic effect, it is necessary to ensure that the appropriate medication is administered in a proper way. NSAIDs can cause adverse effects, including gastrointestinal disorders. If side effects occur or are anticipated with NSAIDs, the use of hormonal contraceptives may be recommended when contraception is considered. In addition to these pharmacological treatments, heat, dietary, and behavioral therapies have been tried and reported to have some effects. However, further research is required for robust conclusions.

Figure 1.
Metabolic pathways of uterine contraction in dysmenorrhea. LT, leukotriene; PGG2, prostaglandin G2; PGH2, prostaglandin H2; PGF, prostaglandin F; PGE2, prostaglandin E2.
jkma-63-171f1.jpg
Figure 2.
Treatment options for dysmenorrhea. NSAIDs, non-steroidal antiinflammatory drugs.
jkma-63-171f2.jpg
Table 1.
Charact teristics of primary and secondary dysmenorrhea
Characteristics Primary dysmenorrhea Secondary dysmenorrhea
Onset Within 3 years from menarche After 5 years from menarche
Age (yr) About 15-25 Over 30-35
Prognosis Gradually improve Become worse
Postpartum Improve No change
Pelvic examination Normal Features of endometriosis, adenomyosis, leiomyoma, pelvic inflammatory disease, etc.
Timing Menstruation Menstruation or other time
Duration 4-72 hours during menses Prior to onset of menses and throughout menstrual cycle
Table 2.
Non-steroidal anti-inflammatory agents to treat dysmenorrhea
Drug Initial dose (mg) Maintenance dose (mg)
Naproxen 500 250 per 6-8 hours
Ibuprofen 200-600 200-600 per 6 hours
Ketoprofen 75 75 per 8 hours
Mefenamic acid 500 250 per 4 hours
Tolfenamic acid 200 200 per 8 hours
Flufenamic acid 200 200 per 8 hours
Meclofenamate 100 50-100 per 6 hours
Celecoxib 400 200 per 12 hours

REFERENCES

1. Campbell MA, McGrath PJ. Use of medication by adolescents for the management of menstrual discomfort. Arch Pediatr Adolesc Med 1997;151:905-913.
crossref pmid
2. Latthe P, Latthe M, Say L, Gulmezoglu M, Khan KS. WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health 2006;6:177.
crossref pmid pmc pdf
3. Burnett MA, Antao V, Black A, Feldman K, Grenville A, Lea R, Lefebvre G, Pinsonneault O, Robert M. Prevalence of primary dysmenorrhea in Canada. J Obstet Gynaecol Can 2005;27:765-770.
crossref pmid
4. Sundell G, Milsom I, Andersch B. Factors influencing the prevalence and severity of dysmenorrhoea in young women. Br J Obstet Gynaecol 1990;97:588-594.
crossref pmid
5. Baker FC, Driver HS, Rogers GG, Paiker J, Mitchell D. High nocturnal body temperatures and disturbed sleep in women with primary dysmenorrhea. Am J Physiol 1999;277:E1013-E1021.
crossref pmid
6. Klein JR, Litt IF. Epidemiology of adolescent dysmenorrhea. Pediatrics 1981;68:661-664.
crossref pmid pdf
7. Lee EH, Kim JI, Kim HW, Lee HK, Lee SH, Kang NM, Hur MH. Dysmenorrhea and menstrual attitudes in adult women. Korean J Women Health Nurs 2003;9:105-112.
crossref pdf
8. Latthe P, Mignini L, Gray R, Hills R, Khan K. Factors predisposing women to chronic pelvic pain: systematic review. BMJ 2006;332:749-755.
crossref pmid pmc
9. Altunyurt S, Gol M, Altunyurt S, Sezer O, Demir N. Primary dysmenorrhea and uterine blood flow: a color Doppler study. J Reprod Med 2005;50:251-255.
pmid
10. Ylikorkala O, Dawood MY. New concepts in dysmenorrhea. Am J Obstet Gynecol 1978;130:833-847.
crossref pmid
11. Chan WY, Dawood MY, Fuchs F. Relief of dysmenorrhea with the prostaglandin synthetase inhibitor ibuprofen: effect on prostaglandin levels in menstrual fluid. Am J Obstet Gynecol 1979;135:102-108.
crossref pmid
12. Dawood MY. Primary dysmenorrhea: advances in pathogenesis and management. Obstet Gynecol 2006;108:428-441.
pmid
13. Nigam S, Benedetto C, Zonca M, Leo-Rossberg I, Lubbert H, Hammerstein J. Increased concentrations of eicosanoids and platelet-activating factor in menstrual blood from women with primary dysmenorrhea. Eicosanoids 1991;4:137-141.
pmid
14. Buhimschi I, Yallampalli C, Dong YL, Garfield RE. Involvement of a nitric oxide-cyclic guanosine monophosphate pathway in control of human uterine contractility during pregnancy. Am J Obstet Gynecol 1995;172:1577-1584.
crossref pmid
15. Moya RA, Moisa CF, Morales F, Wynter H, Ali A, Narancio E. Transdermal glyceryl trinitrate in the management of primary dysmenorrhea. Int J Gynaecol Obstet 2000;69:113-118.
crossref pmid pdf
16. Pittrof R, Lees C, Thompson C, Pickles A, Martin JF, Campbell S. Crossover study of glyceryl trinitrate patches for controlling pain in women with severe dysmenorrhoea. BMJ 1996;312:884.
crossref pmid pmc
17. Kang AR, Hur JY. Medical therapy of endometriosis. J Korean Med Assoc 2010;53:424-429.
crossref
18. Kim H, Cho S. Diagnosis and treatment of endometriosis. J Korean Med Assoc 2019;62:513-518.
crossref pdf
19. French L. Dysmenorrhea. Am Fam Physician 2005;71:285-291.
pmid
20. Marjoribanks J, Proctor ML, Farquhar C. Nonsteroidal antiinflammatory drugs for primary dysmenorrhoea. Cochrane Database Syst Rev 2003;4:CD001751.
crossref
21. Oh ST. The management of chronic pelvic pain. J Korean Med Assoc 2008;51:53-64.
crossref
22. Smith RP. Cyclic pelvic pain and dysmenorrhea. Obstet Gynecol Clin North Am 1993;20:753-764.
crossref pmid
23. Budoff PW. Use of mefenamic acid in the treatment of primary dysmenorrhea. JAMA 1979;241:2713-2716.
crossref pmid
24. Athanasiou S, Bourne TH, Khalid A, Okokon EV, Crayford TJ, Hagstrom HG, Campbell S, Collins WP. Effects of indomethacin on follicular structure, vascularity, and function over the periovulatory period in women. Fertil Steril 1996;65:556-560.
crossref pmid
25. Norman RJ, Wu R. The potential danger of COX-2 inhibitors. Fertil Steril 2004;81:493-494.
crossref pmid
26. Wong CL, Farquhar C, Roberts H, Proctor M. Oral contraceptive pill as treatment for primary dysmenorrhoea. Cochrane Database Syst Rev 2009;2:CD002120.
crossref
27. Davis AR, Westhoff C, O'Connell K, Gallagher N. Oral contraceptives for dysmenorrhea in adolescent girls: a randomized trial. Obstet Gynecol 2005;106:97-104.
pmid
28. Proctor ML, Roberts H, Farquhar CM. Combined oral contraceptive pill (OCP) as treatment for primary dysmenorrhoea. Cochrane Database Syst Rev 2001;4:CD002120.

29. Zahradnik HP, Goldberg J, Andreas JO. Efficacy and safety of the new antiandrogenic oral contraceptive Belara. Contraception 1998;57:103-109.
crossref pmid
30. Morrow C, Naumburg EH. Dysmenorrhea. Prim Care 2009;36:19-32.
crossref pmid
31. Anderson FD, Gibbons W, Portman D. Safety and efficacy of an extended-regimen oral contraceptive utilizing continuous low-dose ethinyl estradiol. Contraception 2006;73:229-234.
crossref pmid
32. Yucel N, Baskent E, Karamustafaoglu Balci B, Goynumer G. The levonorgestrel-releasing intrauterine system is associated with a reduction in dysmenorrhoea and dyspareunia, a decrease in CA 125 levels, and an increase in quality of life in women with suspected endometriosis. Aust N Z J Obstet Gynaecol 2018;58:560-563.
crossref pmid pdf
33. Lee JY. Therapeutic efficacy of Mirena in gynecologic. J Korean Med Assoc 2019;62:459-465.
crossref pdf
34. Croxatto HB. Clinical profile of Implanon: a single-rod etonogestrel contraceptive implant. Eur J Contracept Reprod Health Care 2000;5((Suppl 2):21-28.
crossref pmid
35. Roumen FJ. The contraceptive vaginal ring compared with the combined oral contraceptive pill: a comprehensive review of randomized controlled trials. Contraception 2007;75:420-429.
crossref pmid
36. Harel Z, Biro FM, Kollar LM. Depo-Provera in adolescents: effects of early second injection or prior oral contraception. J Adolesc Health 1995;16:379-384.
crossref pmid
37. Ling FW. Pelvic Pain Study Group. Randomized controlled trial of depot leuprolide in patients with chronic pelvic pain and clinically suspected endometriosis. Obstet Gynecol 1999;93:51-58.
crossref pmid
38. Akin M, Price W, Rodriguez G Jr, Erasala G, Hurley G, Smith RP. Continuous, low-level, topical heat wrap therapy as compared to acetaminophen for primary dysmenorrhea. J Reprod Med 2004;49:739-745.
pmid
39. Akin MD, Weingand KW, Hengehold DA, Goodale MB, Hinkle RT, Smith RP. Continuous low-level topical heat in the treatment of dysmenorrhea. Obstet Gynecol 2001;97:343-349.
crossref pmid
40. Wilson ML, Murphy PA. Herbal and dietary therapies for primary and secondary dysmenorrhoea. Nurs Times 2001;97:44.

41. Zhu X, Proctor M, Bensoussan A, Wu E, Smith CA. Chinese herbal medicine for primary dysmenorrhoea. Cochrane Database Syst Rev 2008;2:CD005288.
crossref
42. Pakniat H, Chegini V, Ranjkesh F, Hosseini MA. Comparison of the effect of vitamin E, vitamin D and ginger on the severity of primary dysmenorrhea: a single-blind clinical trial. Obstet Gynecol Sci 2019;62:462-468.
crossref pmid pmc pdf
43. Jenabi E, Fereidooni B, Karami M, Masoumi SZ, Safari M, Khazaei S. The effect of bee propolis on primary dysmenorrhea: a randomized clinical trial. Obstet Gynecol Sci 2019;62:352-356.
crossref pmid pmc pdf
44. Golomb LM, Solidum AA, Warren MP. Primary dysmenorrhea and physical activity. Med Sci Sports Exerc 1998;30:906-909.
crossref pmid
45. Metheny WP, Smith RP. The relationship among exercise, stress, and primary dysmenorrhea. J Behav Med 1989;12:569-586.
crossref pmid pdf
46. Proctor ML, Murphy PA, Pattison HM, Suckling J, Farquhar CM. Behavioural interventions for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev 2007;3:CD002248.
crossref


ABOUT
ARTICLE CATEGORY

Browse all articles >

ARCHIVES
FOR CONTRIBUTORS
Editorial Office
37 Ichon-ro 46-gil, Yongsan-gu, Seoul
Tel: +82-2-6350-6562    Fax: +82-2-792-5208    E-mail: jkmamaster@gmail.com                

Copyright © 2024 by Korean Medical Association.

Developed in M2PI

Close layer
prev next