Dysmenorrhea



Fig. 21.1
Primary vs. secondary dysmenorrhea flow diagram. [3]





21.7 Introduction to Treatment


Increased levels of circulating PGF2α and PGE2 lead to increased myometrial contraction, vasoconstriction, and hypersensitization of pain fibers [3]. On account of the PG-based etiology of primary dysmenorrhea, the current most common pharmacologic treatment for dysmenorrhea is nonsteroidal anti-inflammatory drugs (NSAIDS) [9].


21.8 Pharmacologic Treatment



21.8.1 NSAIDS: First-Line Therapy


The various formulations of NSAIDS have comparable efficacy for dysmenorrhea, and pain relief is successfully achieved in 64–100 % on women [3]. First-line therapy:
















Nonsteroidal anti-inflammatory drugs (NSAIDS)

Naproxen

Ibuprofen

Mefenamic acid

Diclofenac


Pitfalls




  1. 1.


    May increase risk of cardiovascular thrombotic events

     

  2. 2.


    May increase risk of stroke

     

  3. 3.


    May increase risk of gastric ulcer/bleeding and intestine perforation

     

  4. 4.


    Caution if asthmatic

     

  5. 5.


    Caution if dehydrated

     


21.8.2 Hormonal Contraceptives: Second-Line Therapy


Suppress ovulation and reduce thickness of the endometrial lining of the uterus, thereby reducing the volume of menstrual fluid [8]. This form of therapy includes hormonal intrauterine devices (IUDs) [3].


Pitfalls




  1. 1.


    Increase risk of thrombotic event

     

  2. 2.


    Increase risk of cardiovascular side effects with cigarette smoking

     

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Nov 20, 2017 | Posted by in Uncategorized | Comments Off on Dysmenorrhea
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