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)