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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Primary dysmenorrhea is a familiar complaint to medical practitioners. Recently, behavior therapy has been shown to be an effective treatment for the symptoms of dysmenorrhea. The present case study offers biofeedback-assisted relaxation treatment as an effective alternative treatment. The Menstrual Symptom Questionnaire was used to classify dysmenorrhea as spasmodic or congestive. This classification provides homogeneous groups of patients. The patient in this study had an 18-year history of primary dysmenorrhea that was resistant to hormonal and analgesic treatment. After two months of baseline observation, she was given eight sessions of skin-temperature biofeedback and autogenic training. She reported significant reduction of pain and discomfort with the use of biofeedback-assisted relaxation. Desensitization using visual imagery, an important component of previous therapies, was not used. Further examination of the efficacy of biofeedback-assisted relaxation training for the treatment of both congestive and spasmodic dysmenorrhea is suggested.
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PMID:Biofeedback-assisted relaxation training for primary dysmenorrhea: a case study. 36 50

Primary dysmenorrhea is a difficult entity to treat, and therapy is usually directed at relieving symptoms. There is some indication that this disorder is caused by an increase in prostaglandin F2alpha. Therefore, logically the treatment may include antiprostaglandin agents. We have studied 32 women with the diagnosis of primary dysmenorrhea in a randomized double-blind fashion using a placebo and indomethacin. Both agents were taken three times a day over four cycles, and therapy was begun two days before the usual onset of pelvic pain. Only two of 16 patients in the placebo group were significantly improved in the four-month treatment cycles while all 16 in the treatment group showed some improvement, 11 having cessation of pain. In the six months following the study period, all patients were given indomethacin. The original treatment group did not change significantly. However, all in the placebo group when switched to indomethacin had some relief, 12 of the 16 showing complete cessation of pain. Gastric irritation was the main side effect and was present in 18% of the treatment group and 12% in the placebo group. Indomethacin appears to effectively relieve primary dysmenorrhea and does not appear to be associated with a high incidence of side effects.
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PMID:Primary dysmenorrhea treated with indomethacin. 37 24

A review of the clinical features, diagnosis and management of primary and secondary dysmenorrhea updates some old views. Dysmenorrhea is painful menstruation, either cramps with no visible cause, primary dysmenorrhea, or secondary to specific pelvic pathology. Primary dysmenorrhea occurs in as many as 50% of young women, only in ovulatory cycles, and usually limited to the first 48 or 72 hours of menstruation. Secondary dysmenorrhea can be caused by any of a dozen or so disorders such as endometriosis, pelvic inflammatory disease, IUDs, irregular cycles or infertility problems, ovarian cysts, adenomyosis, uterine myomas or polyps, intrauterine adhesions or cervical stenosis. Psychological factors are now known not to cause dysmenorrhea, only to add to the reactive component of the pain. The pain is due to uterine cramps, hypoxia or ischemia, due to overproduction of prostaglandins, leukotrienes or vasopressin. Thus, primary dysmenorrhea can be treated with oral contraceptives if the women wishes to take pills for contraception and they are not contraindicated, or with non-steroidal antiinflammatory agents for the full 72 hours after pain begins. Calcium channel-blockers are also used on a research basis; transcutaneous electrical nerve stimulation is sometimes effective. If these treatments are not effective, investigation for causes of secondary dysmenorrhea is indicated, preferably for laparoscopy.
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PMID:Dysmenorrhea. 217 34

Dysmenorrhea is one of the most common gynecologic complaints of young women, affecting approximately half of menstruating females. Although most patients have primary dysmenorrhea, which although creating much discomfort does not lead to significant physical problems, it is very important to rule out secondary dysmenorrhea to prevent problems with health and fertility. Primary dysmenorrhea is seen only in ovulatory cycles, usually developing within 6 to 12 months of menarche and is characterized by lower midabdominal colicky pain that may radiate to the back and upper thighs. The pain of primary dysmenorrhea starts with the onset of menstrual flow or a few hours following onset and may last for a few hours up to 2 days. The pain of secondary dysmenorrhea usually begins several days before the start of menstrual flow and may be present during much of the menstrual cycle. Pain that occurs with the first menses or after the age of 25 or is associated with anovulatory cycles is more likely to be secondary dysmenorrhea. The causes of secondary dysmenorrhea, such as endometriosis, adenomyosis, complications of intrauterine devices, and congenital abnormalities, will often be associated with abnormalities noted on pelvic examination, and whenever dysmenorrheic patients have any abnormalities, further evaluation is necessary.
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PMID:Dysmenorrhea. 305 62

Primary dysmenorrhea may affect as many as 40 percent of all adult women, temporarily disabling one-tenth of them. The etiology of this condition may be related to excess production of prostaglandins by the endometrium following decline in progesterone levels consequent to corpus luteum regression. It is proposed that increased prostaglandin levels produce increased myometrial contractility and uterine ischemia and sensitization of pain fibers, resulting in pelvic pain. Administration of nonsteroidal anti-inflammatory agents which block the cyclooxygenase enzyme of the arachidonic acid cascade is an effective treatment for primary dysmenorrhea, as is oral contraceptive therapy. Criteria for an ideal prostaglandin synthetase inhibitor are described.
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PMID:Current concepts in the etiology and treatment of primary dysmenorrhea. 354 8

Primary dysmenorrhea is a common gynecologic disorder. Dysmenorrheic pain normally has an onset of from 2-12 hours before the start of menses and tapers over the next one to two days. Although the exact etiology is unknown, this condition is associated with an increase in prostaglandin F2 alpha. In the past, nonspecific treatments such as heat and exercise were tried, with poor results. Little relief was offered by antispasmodics or low-dose aspirin. Currently, effective therapy for primary dysmenorrhea includes oral contraceptives and prostaglandin synthetase inhibitors. Oral contraceptives should be prescribed only for women who desire contraception and who are candidates for this type of therapy. Prostaglandin synthetase inhibitors can be given to women who do not desire oral contraceptives or those who do not respond to hormonal therapy. Secondary dysmenorrhea should be suspected in women who do not respond to either treatment modality.
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PMID:Therapeutic management of primary dysmenorrhea. 642 Jan 34

Dysmenorrhea means not only uterine pain in the lower abdomen and back, but in many cases headaches, depression, perspiration, nausea, vomiting, and diarrhea, mostly during the first 12-48 hours of menstruation. Primary dysmenorrhea begins at a young age, and some investigators have stated that 50% all of women suffer from dysmenorrhea. No gynecological cure has been found. The socioeconomic consequences are substantial due to absences from school and work. It was previously believed that dysmenorrhea was caused by hormonal imbalance, but there is now evidence that it could be caused by prostaglandins in the menstrual blood. When prostaglandins are administered, the aforementioned side effects of dysmenorrhea are experienced. Since the 1960s, oral contraceptives (OCs) have been administered with success. If for some reason OCs are not advisable, there are very few effective alternatives. Dydrogesterone, a retroprogesterone derivative, does not slow down ovulation, but has to be taken for several weeks of the month just like the pill. Several inhibitors of prostaglandin synthesis are available, but naproxene is the best. It is the longest acting, requiring administration only 2 times/day. It works immediately and can be taken when needed. Because it is used only when needed, there is a minimm of side effects from long-term use. It should not be used by women under 16 years of age. Side effects of all prostaglandin synthesis inhibitors are nausea, vomiting, abdominal pain, and diarrhea. The use of calcium is also advised and warrants further study.
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PMID:[Primary dysmenorrhea: current insights in etiology and treatment]. 642 13

Primary dysmenorrhoea is characterised by painful menstrual cramps which appear to have no macroscopically identifiable pelvic pathology. 50% of postpubescent females suffer from dysmenorrhoea, and 10% are incapacitated for 1 to 3 days each month. Many of these patients have an increased synthesis of prostaglandins in their endometrial tissue with increased prostaglandin release in the menstrual fluid. The increased amount of prostaglandins induces incoordinate hyperactivity of the uterine muscle resulting in uterine ischaemia and pain. Recent clinical and laboratory studies have shown that many of the non-steroidal anti-inflammatory drugs such as ibuprofen, naproxen, flufenamic acid, mefenamic acid and indomethacin are capable of relieving primary dysmenorrhoea. These drugs are inhibitors of the prostaglandin synthetase enzymes which are necessary for prostaglandin biosynthesis. Thus, with ibuprofen it has been shown that clinical relief of the dysmenorrhoeic symptoms accompanies the reduction of menstrual fluid prostaglandins. With the oral contraceptive pill there is good relief of primary dysmenorrhoea, significant decrease in menstrual fluid prostaglandins, but no reduction in menstrual fluid volume; this suggests that the reduction in prostaglandins is secondary to the inhibition of endometrial growth and development. In some forms of secondary dysmenorrhoea elevated prostaglandin levels have been implicated. However, the evidence is less conclusive for dysmenorrhoea secondary to endometriosis and uterine myomas than for dysmenorrhoea associated with intrauterine devices. With the intrauterine device, prostaglandin synthetase inhibitors such as flufenamic acid, ibuprofen and naproxen are able not only to relieve dysmenorrhoea but also to reduce menstrual blood loss to normal levels. Thus, the use of appropriately selected prostaglandin synthetase inhibitors can offer effective relief from the miseries of some types of dysmenorrhoea with subsequent restoration of normal daily activities.
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PMID:Dysmenorrhoea and prostaglandins: pharmacological and therapeutic considerations. 679 Feb 61

Current theories concerning the etiology of dysmenorrhea are reviewed, and the use of the combined oral contraceptive pill solely for dysmenorrhea is evaluated in light of the recent approval of antiprostaglandin agents for therapeutic use in relieving menstrual pain. Primary dysmenorrhea refers to menstrual cramping and discomfort in women free from underlying pathology and does not encompass symptoms occurring prior to the menses. There are many theories explaining the 2 types of dysmenorrhea, but none seems to offer a complete rationale. Current research appears to point toward a complex interaction of steroid hermones and prostaglandins. It is now accepted that although psychosocial factors are active in a woman's response to menstrual pain, they are not the cause. Oral contraceptives cannot be considered innocuous but have the potential for serious harm if casually prescribed and used. If a woman wants contraception concomitantly with seeking relief from severe dysmenorrhea, and if following a history and a physical she is found to be free of any pelvic pathology or contraindications for the oral contraceptive (OC), then OCs may be regarded as appropriate. There is now another choice of treatment available for dysmenorrhea -- ibuprofen -- if a woman does not need contraception or does not choose to use OC. The overall approach to care of a woman presenting with dysmenorrhea needs to be holistic. Now that there is an effective alternative in ibuprofen, continuous OC use solely for dysmenorrhea needs to be seriously questioned.
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PMID:Are combined oral contraceptives appropriate therapy for primary dysmenorrhea? 689 47

Primary dysmenorrhea is menstrual pain that is not associated with pelvis pathology. It usually begins with the onset of ovulatory cycles, characteristically appearing in the year after menarche and increasing with time. The pain is associated with increased myometrial activity. Oral contraceptives and prostaglandin synthetase inhibitors are effective in alleviating symptoms. Causes of secondary dysmenorrhea, such as pelvic inflammatory disease, endometriosis and uterine myomas, must be excluded before treatment is given.
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PMID:Primary dysmenorrhea: current concepts. 719 60


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