Dysmenorrhea

Relcovaptan (SR-49059) is a selective, orally active V1aR antagonist that prevents pain of primary dysmenorrhea and inhibits preterm labour and could be useful in the treatment of Raynaud s phenomenon. The selective ViBR antagonist SSR149415 showed beneficial effects in the treatment of depression and anxiety in several animal models. 

Management of inflammatory disorders including rheumatoid arthritis and osteoarthritis, management of mild to moderate pain, treatment of dysmenorrhea Rheumatoid arthritis and osteoarthritis... 

Mild to moderate pain, rheumatoid arthritis and osteoarthritis Sgns and symptoms of osteoarthritis, management of acute pain, primary dysmenorrhea... 

Pain, primary dysmenorrhea 500 mg initially then 250 mg q6-8h arthritic disorders 250-500 mg PO BID... 

Dysmenorrhea and acute pain 50 mg PO QD for no more than 5 days... 

Taking the contraceptive hormones provides health benefits not related to contraception, such as regulating the menstrual cycle and decreased blood loss, and incidence of iron deficiency anemia, and dysmenorrhea Health benefits related to the inhibition of ovulation include a decrease in ovarian cysts and ectopic pregnancies. hi addition, there is a decrease in fibrocyctic breast disease, acute pelvic inflammatory disease endometrial cancer, ovarian cancer, maintenance of bone density, and symptoms related to endometriosis in women taking contraceptive hormones. Newer combination contraceptives such as norgestimate and ethinyl estradiol... 

Women who take oral contraceptives typically experience more regular menstrual cycles. In general, oral contraceptive use is associated with less cramping and dysmenorrhea.1,8 Also, women who take oral contraceptives experience fewer days of menstruation each month and as a result experience less blood loss with each menstrual period.1,13 Some studies suggest that oral contraceptive use decreases overall monthly menstrual flow by 60% or more, which may be particularly beneficial in women who are anemic.1... 

Describe the underlying etiology and pathophysiology of amenorrhea, menorrhagia, anovulatory bleeding, and dysmenorrhea and how they relate to selection of effective treatment modalities. 

Recommend appropriate lifestyle and dietary modifications and pharmacotherapeutic interventions for patients with amenorrhea, menorrhagia, anovulatory bleeding, dysmenorrhea, premenstrual symptoms, and premenstrual dysphoric disorder. 

Complaints of heavy/prolonged menstrual flow and fatigue and light-headedness in the case of severe blood loss. These symptoms may or may not occur with dysmenorrhea. 

Dysmenorrhea is commonly defined as crampy pelvic pain occurring with or just prior to menses. Primary dysmenorrhea implies pain in the setting of normal pelvic anatomy and physiology, whereas secondary dysmenorrhea is associated with underlying pelvic pathology.17... 

Rates of dysmenorrhea range from 20% to 90%.17-19 Dysmenorrhea can be associated with significant interference in attendance at work and school. Risk factors for dysmenorrhea include young age, heavy menses, and nulliparity.17... 

The most significant mechanism for primary dysmenorrhea is the release of prostaglandins in the menstrual fluid and possibly vasopressin-mediated vasoconstriction.5,17 Causes of secondary dysmenorrhea may include cervical stenosis, endometriosis, pelvic infections, pelvic congestion syndrome, uterine or cervical polyps, and uterine fibroids.20... 

Dysmenorrhea Combination OC Less than 35 meg formulations + norgestrel or levonorgestrel28 use of extended-cycle formulations are beneficial for this indication As noted above for CEE, ethinyl estradiol, and combination OC (progesterone side effects with the OC depend on agent chosen)... 

The medical management of dysmenorrhea should relieve the related pelvic pain. Effective management of dysmenorrhea also results in a reduction in lost school and work days. Table 46-2 identifies the agents used in the management of dysmenorrhea, their recommended doses, and their common side effects. Figure 46-5 is a treatment algorithm for the management of dysmenorrhea. 

Several nonpharmacologic interventions exist for the management of dysmenorrhea. Among these, topical heat therapy,... 

I exercise, and following a low-fat vegetarian diet all have been shown to reduce the intensity of the dysmenorrhea.17,28 Dietary changes also may shorten the duration of dysmenorrhea. These interventions require little time and minimal cost and are associated with little risk. Other nonpharmacologic options that may be considered before or, in most cases, after a trial of pharmacologic interventions include the use of transcutaneous electric nerve stimulation (TENS), acupressure, and acupuncture.17... 

Given the role of prostaglandins in the pathophysiology of I dysmenorrhea, NSAIDs are the treatment of choice. There does not appear to be a difference between agents in efficacy. Choice of one agent over another may be based on cost, convenience, and patient preference.17 The most commonly used agents are naproxen and ibuprofen. 

The benefit of depo-medroxyprogesterone acetate in dysmenorrhea is related to its ability to render most patients amen-orrheic within 1 year of use.17 This is an expected side effect. Since the pelvic pain of dysmenorrhea is related to the prostaglandins released during menses, in the setting of amenorrhea, the underlying cause of dysmenorrhea is removed. 

Observational data illustrate a reduction in dysmenorrhea from 60% to 29% with the levonorgestrel-releasing IUD after 3 years.17 As observed with depo-medroxyprogesterone acetate, this reduction is likely secondary to the increasing incidence of amenorrhea in users of this contraceptive device. 

Dysmenorrhea is very common in adolescent females. Any of the treatment measures discussed earlier for other patients... 

Measure the treatment success for the various menstruation-related disorders by the degree to which the care plan (1) relieves or reverses symptoms of the disorder, (2) prevents or reverses the complications of the disorder (e.g., osteoporosis, anemia, and infertility), and (3) minimizes side effects. The return of a regular menstrual cycle with minimal premenstrual symptoms or symptoms of dysmenorrhea should occur. Depending on the desire for conception and subsequent therapy, this cycle may be ovulatory or anovulatory. 

Assess symptoms to determine if patient-directed therapy is appropriate (e.g., NSAIDs for dysmenorrhea) or whether the patient should be evaluated by a physician (e.g., amenorrhea, menorrhagia, anovulatory bleeding, or PMDD). Does the patient have any related complications, such as symptoms of anemia in patients presenting with menorrhagia or complaints of difficulty conceiving in women with amenorrhea or anovulatory bleeding. 

Stenchever MA, Droegemueller W, Herbst AL, Mishell DR. Primary and secondary dysmenorrhea and premenstrual syndrome Etiology, diagnosis, and management. In Stenchever MA, ed. Comprehensive Gynecolgy. 4th ed. St. Louis Mosby 2001 1065-1078. 

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