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.
May increase risk of cardiovascular thrombotic events
- 2.
May increase risk of stroke
- 3.
May increase risk of gastric ulcer/bleeding and intestine perforation
- 4.
Caution if asthmatic
- 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.
Increase risk of thrombotic event
- 2.
Increase risk of cardiovascular side effects with cigarette smoking
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