Primary and secondary dysmenorrhea: medical therapy
The main purpose of treating primary and secondary dysmenorrhea is pain relief.
Non-steroidal anti-inflammatory drugs: NSAIDs are usually the first-line therapy for dysmenorrhea and should be prescribed for at least three months. If NSAIDs alone are not enough, hormonal contraceptives can be combined with it. NSAIDs are drugs that work by blocking the production of prostaglandins through the inhibition of cyclooxygenase, an enzyme responsible for the formation of prostaglandins. NSAIDs (aspirin, naproxen and ibuprofen) are very effective in decreasing menstrual pain. They reduce menstrual cramps and can prevent other symptoms such as nausea and diarrhoea. NSAIDs reduce severe pain in women with primary dysmenorrhea. With the widespread availability of NSAIDs, the management of dysmenorrhea has significantly improved.
Oral contraceptives: Hormonal contraceptives (OC) act by suppressing ovulation and inhibiting endometrial proliferation. OCs lead almost immediately to relief from symptoms associated with menstruation: heavy and painful periods, and irregular bleeding. Additionally, OCs are often used as therapeutic drugs for women with symptomatic menorrhagia or endometriosis. The effectiveness of OC therapy has been demonstrated by numerous studies in the literature for the treatment of dysmenorrhea, regardless of the route of administration (oral, transdermal, intravaginal or intrauterine). The use of continuous OCs can be considered to treat primary dysmenorrhea, with two main advantages: the reduction of menstrual disorders and the improvement of pain relief for women. The choice between the use of combined OCs and progesterone must be guided by the patient’s pain relief, tolerance of possible negative effects, in particular related to the frequency of bleeding and weight gain, and the baseline risk of venous thromboembolism.
Progestin: Hormone treatment with progestin alone produces a benefit on menstrual pain, causing endometrial atrophy and inhibiting ovulation. Several long-acting progestogen-containing contraceptives are used as effective treatments for primary dysmenorrhea. These include 52 mg. (20 μg./day) of levonorgestrel releasing intrauterine system, and the subcutaneous implant releasing etonogestrel.
Primary and secondary dysmenorrhea are therefore never to be ignored and even less to be considered as a physiological characteristic to be accepted. It is advisable to consult a gynaecologist, carry out the necessary checks and set up an adequate therapy, as often the pain itself can cause chronic stress and cause a series of disorders that can affect both the psychological and physical well-being of the woman.
The therapeutic possibilities derive from the different actions on the pathophysiological mechanisms; only symptomatic targeting methods can be proposed. The initial choice of therapy is based on the intensity of pain, the desire or not for contraception and the impact of pain on the patient’s quality of life.
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-Harada T, Momoeda M: Evaluation of an ultra-low-dose oral contraceptive for dysmenorrhea: a placebo-controlled, double-blind, randomised trial. Fertil Steril. 2016; 106: 1807–14.
-Ryan SA: The Treatment of Dysmenorrhea. Pediatr Clin North Am. 2017; 64: 331–42.
Prof Stefano Luisi, MD, PhD
Associate Professor of Obstetrics & Gynaecology
Department of Molecular and Developmental Medicine
University of Siena