Dysmenorrhea treatment

Hendrix SL, Alexander NJ. Primary dysmenorrhea treatment with a desogestrel-containing low-dose oral contraceptive. Contraception 2002 66 393-399. 

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... 

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

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. 

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. 

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. 

Leach CA, Liddle J, Peace S, Philp J, Smith lED, Terrell LR, Zhang J (2006) Preparation of l,6-disubstituted-(3R,6R)-3-(2,3-dihydro-lH-inden-2-yl)-2,5-piperazinedione derivatives as oxytocin receptor antagonists for the treatment of pre-term labor, dysmenorrhea and endometriosis. PCT Int Appl WO 2006067462 Al 20060629... 

The major uses of progestogens are for hormone replacement therapy and for hormonal contraception where they suppress ovulation and make the cervical mucus impenetrable to spermatozoa. Other indications include secondary amenorrhea, dysmenorrhea, infertility and habitual abortion and endometrium suppression in endometriosis. Progestogens are also used for palliation in metastasized endometrial and breast carcinoma. Medrogestone has been used in the treatment of fibroid uterine tumors. 

Aspirin and related salicylates are the primary treatment for mild to moderate pain, such as that associated with headache, joint and muscle pain, and dysmenorrhea. At higher doses aspirin is an effective analgesic in rheumatoid arthritis (see Chapter 36). The analgesic effects of salicylates are thought to be due to the inhibition of prostaglandin synthesis in the periphery and to a less well documented mechanism at cortical areas. 

The arylpropionic acid derivatives are useful for the treatment of rheumatoid arthritis and osteoarthritis, for reduction of mild to moderate pain and fever, and for pain associated with dysmenorrhea. Side effects of the drugs are similar to but less severe than those described for the salicylates. Those who are sensitive to salicylates also may be sensitive to and have adverse reactions when taking ibuprofen and related drugs. Acute hypersensitivity to ibuprofen has been reported in patients with lupus. The hypersensitivity reaction to sulindac can be fatal. The use of sulindac has also been linked to cases of acute pancreatitis. The use of dimethylsulfoxide (DMSO) topically in combination with sulindac has been reported to induce severe neuropathies. The concurrent use of ibuprofen with aspirin reduces the antiinflammatory effects of both drugs. Ibuprofen is contraindicated in patients with aspirin sensitivity leading to bronchiolar constriction and in patients with an-gioedema. As with all NSAIDs, renal and liver function should be normal for adequate clearance of the drugs. 

Celecoxib has been approved for the treatment of osteoarthritis and rheumatoid arthritis, and rofecoxib has been approved for the treatment of osteoarthritis, acute pain and primary dysmenorrhea. Celecoxib and rofecoxib do not appear to differ in efficacy for the treatment of osteoarthritis. However, neither drug has efficacy greater than that of the non-selective NSAIDs. Since the COX-2 enzyme appears to play an important role in colon cancer the COX-2 inhibitors may find future uses in the treatment or prevention of colorectal cancer. 

Rofecoxib is approved for the treatment of osteoarthritis, dysmenorrhea, and acute pain. The most common adverse reactions to rofecoxib are mUd to moderate GI irritation (diarrhea, nausea, vomiting, dyspepsia, abdominal pain). Lower extremity edema and hypertension occur relatively frequently (about 3.5%). It is not metabohzed by CYP2C9, so rofecoxib should not be subject to some of the interactions seen with celecoxib. However, its metabolism is increased by the coadministration of rifampin, which acts as a nonspecific inducer of hepatic metabolism. 

Other clinical uses of estrogens and progestins include the treatment of dysfunctional uterine bleeding, dysmenorrhea, endometriosis, and rarely, metastatic prostate cancer. 

It has become apparent that reduction in the dose of the constituents of oral contraceptives has markedly reduced mild and severe adverse effects, providing a relatively safe and convenient method of contraception for many young women. Treatment with oral contraceptives has also been shown to be associated with many benefits unrelated to contraception. These include a reduced risk of ovarian cysts, ovarian and endometrial cancer, and benign breast disease. There is a lower incidence of ectopic pregnancy. Iron deficiency and rheumatoid arthritis are less common, and premenstrual symptoms, dysmenorrhea, endometriosis, acne, and hirsutism may be ameliorated with their use. 

Dong quai has been used in the treatment of dysmenorrhea, amenorrhea, metorrhagia, menopausal syndromes, anemia, abdominal pain, injuries, migraine headaches, and arthritis. It is believed to ensure healthy pregnancies and easy deliveries. In the U.S., dong quai is recommended primarily to alleviate problems associated with menstruation and menopause. 

Pokeweed has various traditional uses, from medicinal to industrial processes. It is used as a cathartic, emetic, narcotic, and gargle. Additional medicinal uses include treatment of various skin diseases, conjunctivitis, syphilis, cancer, parasitic infestations of the scalp, chronic rheumatism, ringworm, dyspepsia, swollen glands, scabies, ulcers, edema, dysmenorrhea, mumps, and tonsillitis. It is currently popular for its antimicrobial and antineoplastic activity. 

Today, valerian is used for treating insomnia. It is known to have sedative, mild anodyne, hypnotic, antispasmodic, carminative, and hypotensive properties. Traditionally, it has been used for the treatment of fatigue, seizures, hysterical states, excitability, insomnia, hypochondriasis, migraine, cramp, intestinal colic, rheumatic pains, dysmenorrhea, and specifically for conditions producing nervous excitability. 

The menstrual cycle is associated with two potentially incapacitating events dysmenorrhea and the premenstrual syndrome. Substantial evidence indicates that the excessive production of prostaglandin F2a is the major source of painful menstruation. The NSAIDs approved for the treatment of dysmenorrhea are aspirin, ibuprofen, mefenamic acid, and naproxen. 

The effectiveness of ketoprofen at dosages of 100-300 mg/d is equivalent to that of other NSADDs in the treatment of rheumatoid arthritis, osteoarthritis, gout, dysmenorrhea, and other painful conditions. In spite of its dual effect on prostaglandins and leukotrienes, ketoprofen is not superior to other NSAIDs. Its major adverse effects are on the gastrointestinal tract and the central nervous system. 

Rofecoxib is approved for the treatment of acute pain and dysmenorrhea at a dose of 50 mg for up to 5 days. The clinical studies indicate that rofecoxib shows efficacy similar to that produced by the maximum analgesic doses of naproxen and ibuprofen (Ehrich et al., 1999). The pain settings in which rofecoxib has been tested include acute postoperative dental pain, the pain of dysmenorrhea for up to 3 days, and postoperative pain for 5 days following surgical replacement of the knee or hip. In contrast, celecoxib is not approved in the United States for the treatment of acute pain, and it appears to be less effective when given acutely than rofecoxib, ibuprofen, or naproxen. The explanation for the differences between rofecoxib and celecoxib in acute pain is not known. 

Marijuana was first mentioned as a medicine in an American medical text in 1843 and in 1854 was listed in the U.S. Dispensatory. The latter year also marked the first written description by Bayard Taylor in The Atlantic Monthly of cannabis intoxication. In the 1850s, recommended medical uses for marijuana included the treatment of gout, rheumatism, tetanus, opiate and alcohol withdrawal, loss of appetite, dysmenorrhea, convulsions, depression, insanity, and asthma. Although its suggested uses were widespread, marijuana never actually achieved popular use in the medical community. The reasons for this include variations in potency of commercial preparations, variability in patients responses, slow onset of oral action, and lack of solubility preventing administration by injection. However, the drug was included in many patent medicine preparations and was officially recognized as a medicine in the U.S. Pharmacopoeia until 1937. In 1937 there were 28 pharmaceuticals that contained cannabis. 

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