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Am J Med. 1988 May 20;84(5A):23-9.

Nonsteroidal anti-inflammatory drugs and changing attitudes toward dysmenorrhea.

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Department of Obstetrics and Gynecology, University of Illinois College of Medicine, Chicago 60612.


Dysmenorrhea, which may be primary or secondary, is the occurrence of painful uterine cramps during menstruation. Until a decade ago, medical and social attitudes toward dysmenorrhea were shrouded with folklore, psychoanalytical profiles, or psychosomatic bases. In secondary dysmenorrhea, there is a visible pelvic lesion to account for the pain, whereas only a biochemical abnormality is responsible for primary dysmenorrhea. Recent advances in the biochemistry of prostaglandins and their role in the pathophysiology of primary dysmenorrhea and intrauterine device (IUD)-induced dysmenorrhea have now firmly established a rational basis for the disorder. In primary dysmenorrhea, menstrual prostaglandin release is significantly increased but can be readily suppressed to normal levels when nonsteroidal anti-inflammatory drugs (NSAIDs) capable of inhibiting cyclo-oxygenase are given during menstruation. Many clinical trials (controlled and uncontrolled) have demonstrated the efficacy of NSAIDs such as the fenamates, indole-acetic acid derivatives, and arylpropionic acid derivatives in relieving primary dysmenorrhea as well as IUD-induced dysmenorrhea that is also due to elevated prostaglandin levels. With a few of these NSAIDs, it has been shown that the relief of pain is associated with a significant decrease in menstrual fluid prostaglandin levels. Cumulative data of clinical trials indicate that with the effective NSAIDs, 80 percent of patients with significant primary dysmenorrhea can be adequately relieved. Ongoing studies suggest that in some women, endometrial leukotriene, but not PGF2a production, is increased. With the official approval and availability of several effective NSAIDs for the specific treatment of primary dysmenorrhea in the United States, women who have primary dysmenorrhea have been greatly relieved and their productivity increased. Primary dysmenorrhea affects 50 percent of postpubescent women and absenteeism among the severe dysmenorrheics has been estimated to cause about 600 million lost working hours or 2 billion dollars annually. Thus, an effective, simple, and safe treatment of primary dysmenorrhea for two to three days during menstruation will not only have a positive economic impact but will also enhance the quality of life. The availability of effective dysmenorrhea therapy with NSAIDs has induced greater expectations of relief by the patient, as well as greater willingness to seek medical help, a more rational approach to patient management by physicians, changes in attitude toward women with primary dysmenorrhea, and the debunking of myths about dysmenorrhea that often have been perpetuated as fact.(ABSTRACT TRUNCATED AT 400 WORDS).


The availability of effective dysmenorrhea therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) has been accompanied by greater expectations of relief on the part of the patient, increased willingness to seek medical help, a more rational approach to patient management by physicians, changes in attitude toward women with primary dysmenorrhea, and a debunking of the myths associated with dysmenorrhea. Following a review of the prevalence, social and economic impact, and the nonmedical myths surrounding dysmenorrhea, attention focuses on the cause and clinical diagnosis of dysmenorrhea and the therapeutic use of NSAIDS. NSAIDs Relief can be obtained in 80-85% of patients studied, with NSAIDs shown to be clinically effective against primary dysmenorrhea. Several NSAIDs have been shown to relieve primary dysmenorrhea through the suppression of menstrual fluid prostaglandins. Primary dysmenorrhea now is more often diagnosed on the basis of its positive features rather than by the exclusion of other disorders as was previously the case. As yet, it is unclear as to why 15-20% of patients fail to have an adequate response to NSAIDs. As patients can obtain effective relief from primary dysmenorrhea from treatment with the appropriate NSAID, there is a significant impact on work productivity, absenteeism, economic loss, social adjustment, and patient attitude toward menstruation and medical help.

[Indexed for MEDLINE]

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