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  • Title: [Drug therapy of dysmenorrhea].
    Author: Zahradnik HP, Breckwoldt M.
    Journal: Gynakologe; 1988 Mar; 21(1):58-62. PubMed ID: 2897319.
    Abstract:
    Primary dysmenorrhea occurs mostly in young women with a painful bleeding pattern. In a recent study, 72% of 19-year-old women had light, 19% had medium to severe, and 8% had severe symptoms. Secondary dysmenorrhea means pathological organic alterations of the genital tract: uterus myomatosus, endometrial polyps, endometriosis, and retroflexed uterus. IUDs can also generate this condition. A certain imbalance of estradiol and progesterone results in defective prostaglandin formation in the endometrium (too much PGF2alpha and too little PGI2) as well as in abnormal and increased uterine contractility and diminished endometrial, blood supply with concomitant painful ischemia. Increased prostaglandin synthesis leads to inflammatory processes and the traumatization of the endometrium (high PGF2alpha level), but IUDs also often cause secondary dysmenorrhea. Treatment calls for the normalization of prostaglandin formation in the uterus by dietary change by increasing fatty acid intake (fish oils and plant fats), and also by the systematic addition of exogenic gestagens (Duphaston 10 mg/day po. Orgametril 5 mg/day), and by the use of the progesterone-releasing IUDs (Biograviplan and Progestasert) that lessen the contractility of the myometrium by reducing PGF2-alpha synthesis. If pregnancy is to be avoided hormonal ovulation inhibitors as optimal, since their effectiveness is over 90% (Cilest, Femovan, Marvelon, and Ortho-Novum 2 mg). If contraception is not sought, nonsteroidal antiphlogistics are recommended: ibuprofen (400 mg 3-4 times/day), naproxen (250 mg 4-5 times/day), flufenamic acid (200 mg/day tid), mefenamic acid (500 mg 3 tid or 250 mg qid), aspirin (650 mg every 4-6 hours), indomethacin (25 mg tid, although it is relatively toxic). Magnesium is a natural calcium antagonist that can influence the intracellular calcium concentration in the myometrium. THe calcium blocker nifedipin (20-40 mg po) and beta-sympathomimetics (Partusisten) also mitigate uterine contractions, but the latter can produce more side effects as a consequence of interfering in the vegetative nervous system.
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