A comprehensive review and the pharmacologic management of primary dysmenorrhea

Dayong Lee; Seul Ki Kim

doi:10.5124/jkma.2020.63.3.171

J Korean Med Assoc > Volume 63(3); 2020 > Article

Lee and Kim: A comprehensive review and the pharmacologic management of primary dysmenorrhea

Pharmacotherapeutics

J Korean Med Assoc 2020; 63(3): 171-177.

Published online: March 17, 2020

DOI: http://dx.doi.org/10.5124/jkma.2020.63.3.171

A comprehensive review and the pharmacologic management of primary dysmenorrhea

Dayong Lee, MD¹, Seul Ki Kim, MD²

¹Department of Obstetrics and Gynecology, Kyungpook National University Hospital, Daegu, Korea

²Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea

Corresponding author: Seul Ki Kim E-mail: skkim@snubh.org

Revised January 21, 2020 Accepted February 06, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Key words: Dysmenorrhea; Menstruation; Non-steroidal anti-inflammatory agents; Contraceptive agents

Figure 1.

Metabolic pathways of uterine contraction in dysmenorrhea. LT, leukotriene; PGG₂, prostaglandin G₂; PGH₂, prostaglandin H₂; PGF_2α, prostaglandin F_2α; PGE₂, prostaglandin E₂.

Figure 2.

Treatment options for dysmenorrhea. NSAIDs, non-steroidal antiinflammatory drugs.

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

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