Important Note: The following information is provided for your education. It should not be relied upon for personal diagnosis or treatment. If you believe that a particular therapy applies to you or someone you care about, be sure to consult a doctor before trying it.
   

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Previous Menstrual Cramps Research:
2002-2006   
The Menstrual Cramps File also contains summaries of past research that has shown promise and may still be standard practice among many physicians. To download earlier research findings on Menstrual Cramps, click HERE.

Latest Research on
Menstrual Cramps
     
Clin Obstet Gynecol. 2008 Jun;51(2):257-67.
Evaluation and management of dysmenorrhea in adolescents.
Sanfilippo J, Erb T.
The University of Pittsburgh School of Medicine, Magee Women's Hospital, Pittsburgh, Pennsylvania, USA. jsanfilippo@mail.magee.edu

Chronic pelvic pain is defined by the American College of Obstetricians and Gynecologists (ACOG) as noncyclic pelvic pain of at least 3 months duration or cyclic pain of 6-month duration, either of which interferes with one's normal activities of daily living. Dysmenorrhea, or painful menses, is the most common gynecologic complaint among adolescent and young adult females and is the leading cause of recurrent short-term school or work absenteeism. This chapter reviews the assessment, diagnosis, and treatment of some of the most common causes of pelvic pain in adolescents.

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Zhongguo Zhen Jiu. 2008 May;28(5):349-52.
[Comparison between western trigger point of acupuncture and traditional acupoints]
[Article in Chinese]
Peng ZF.
Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China. peng.zengfu@gmail.com

Trigger point theory as the soul of western acupuncture is very similar to acupoint theory of traditional acupuncture and moxibustion science. After comparison, it is found that over 92% of trigger points (235/255) is corresponding to acupoints in anatomy, and the local pain treated by 79.5% acupoints are similar to corresponding myofascial trigger point. Both of them can induce similar linear propagation of needling response, with complete uniform or basically complete uniform of 76%, and a part uniform of 14%; next, both of them can treat symptoms of internal organs such as diarrhea, constipation, dysmenorrhea, etc. Therefore, they are very similar in anatomic location, clinical indications, and the linear propagation of needling response induced by acupuncture.

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Cochrane Database Syst Rev. 2008 Apr 16;(2):CD005288. Update of: Cochrane Database Syst Rev. 2007;(4):CD005288.
Chinese herbal medicine for primary dysmenorrhoea.
Zhu X, Proctor M, Bensoussan A, Wu E, Smith CA.
Chinese Medicine Program, University of Western Sydney, Center for Complementary Medicine Research, Bldg 3, Bankstown Campus, Locked Bag 1797, Penrith South DC, Sydney, New South Wales, Australia, 2750. x.zhu@uws.edu.au

BACKGROUND: Conventional treatment for primary dysmenorrhoea has a failure rate of 20% to 25% and may be contraindicated or not tolerated by some women. Chinese herbal medicine may be a suitable alternative. OBJECTIVES: To determine the efficacy and safety of Chinese herbal medicine for primary dysmenorrhoea when compared with placebo, no treatment, and other treatment. SEARCH STRATEGY: The Cochrane Menstrual Disorders and Subfertility Group Trials Register (to 2006), MEDLINE (1950 to January 2007), EMBASE (1980 to January 2007), CINAHL (1982 to January 2007), AMED (1985 to January 2007), CENTRAL (The Cochrane Library issue 4, 2006), China National Knowledge Infrastructure (CNKI, 1990 to January 2007), Traditional Chinese Medicine Database System (TCMDS, 1990 to December 2006), and the Chinese BioMedicine Database (CBM, 1990 to December 2006) were searched. Citation lists of included trials were also reviewed. SELECTION CRITERIA: Any randomised controlled trials involving Chinese herbal medicine versus placebo, no treatment, conventional therapy, heat compression, another type of Chinese herbal medicine, acupuncture or massage. Exclusion criteria were identifiable pelvic pathology and dysmenorrhoea resulting from the use of an intra-uterine contraceptive device. DATA COLLECTION AND ANALYSIS: Quality assessment, data extraction and data translation were performed independently by two review authors. Attempts were made to contact study authors for additional information and data. Data were combined for meta-analysis using either Peto odds ratios or relative risk (RR) for dichotomous data or weighted mean difference for continuous data. A fixed-effect statistical model was used, where suitable. If data were not suitable for meta-analysis, any available data from the trial were extracted and presented as descriptive data. MAIN RESULTS: Thirty-nine randomised controlled trials involving a total of 3475 women were included in the review. A number of the trials were of small sample size and poor methodological quality. Results for Chinese herbal medicine compared to placebo were unclear as data could not be combined (3 RCTs). Chinese herbal medicine resulted in significant improvements in pain relief (14 RCTs; RR 1.99, 95% CI 1.52 to 2.60), overall symptoms (6 RCTs; RR 2.17, 95% CI 1.73 to 2.73) and use of additional medication (2 RCTs; RR 1.58, 95% CI 1.30 to 1.93) when compared to use of pharmaceutical drugs. Self-designed Chinese herbal formulae resulted in significant improvements in pain relief (18 RCTs; RR 2.06, 95% CI 1.80 to 2.36), overall symptoms (14 RCTs; RR 1.99, 95% CI 1.65 to 2.40) and use of additional medication (5 RCTs; RR 1.58, 95% CI 1.34 to 1.87) after up to three months of follow-up when compared to commonly used Chinese herbal health products. Chinese herbal medicine also resulted in better pain relief than acupuncture (2 RCTs; RR 1.75, 95% CI 1.09 to 2.82) and heat compression (1 RCT; RR 2.08, 95% CI 2.06 to 499.18). AUTHORS' CONCLUSIONS: The review found promising evidence supporting the use of Chinese herbal medicine for primary dysmenorrhoea; however, results are limited by the poor methodological quality of the included trials.

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J Womens Health (Larchmt). 2008 Apr;17(3):423-37.
Efficacy and tolerability of lumiracoxib 200 mg once daily for treatment of primary dysmenorrhea: results from two randomized controlled trials.
Daniels S, Gitton X, Zhou W, Stricker K, Barton S.
Scirex Clinical Research Centers, Austin, TX 78705, USA. Stephen.Daniels@premier-research.com

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are established as treatment for managing pain associated with primary dysmenorrhea. However, the efficacy and tolerability of lumiracoxib 200 mg once daily (q.d.) has not previously been examined in primary dysmenorrhea. METHODS: Two randomized, multicenter, double-blind, placebo-controlled, crossover studies of similar design have assessed the efficacy and tolerability of two regimens of lumiracoxib compared with placebo (Study 1) or naproxen and placebo (Study 2) in women (aged 18-45 years) with moderate to severe primary dysmenorrhea. In Study 1 (n = 132), patients received lumiracoxib 200 mg q.d., lumiracoxib 200 mg with a 200 mg redose (p.r.n.) on day 1, or placebo. In Study 2 (n = 144), patients received lumiracoxib 200 mg q.d., lumiracoxib 200 mg with a 200 mg redose p.r.n. on day 1, naproxen 500 mg twice daily (b.i.d.), or placebo. Patients recorded study medication use, efficacy assessments, and rescue medication use. RESULTS: The primary efficacy variable, summed (time-weighted) pain intensity difference (categorical scale) over the first 8 hours (SPID-8), was similar between all active treatments (e.g., p = 0.939 for naproxen 500 mg b.i.d. vs. lumiracoxib 200 mg q.d. in Study 2), and all active treatments were superior to placebo (p < 0.001). Median time-to-onset of analgesia was similar between lumiracoxib 200 mg q.d. and naproxen 500 mg b.i.d. Similar trends were observed for all other secondary efficacy variables. All treatments were well tolerated. CONCLUSIONS: Short-term administration of lumiracoxib 200 mg q.d. is effective and well tolerated and provides an alternative treatment option for the management of moderate to severe pain associated with primary dysmenorrhea.

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J Manipulative Physiol Ther. 2008 Mar;31(3):237-46.
Prospective case series on the effects of lumbosacral manipulation on dysmenorrhea.
Holtzman DA, Petrocco-Napuli KL, Burke JR.
Clinical Sciences Department, New York Chiropractic College, Seneca Falls, NY 13148, USA. dholtzman@nycc.edu

OBJECTIVE: The objective of this prospective case series was to collect preliminary data as to the effectiveness of a specific chiropractic technique, drop table method, in the treatment of primary dysmenorrhea. METHODS: Over a 4-week period, 16 females were screened for symptoms of primary dysmenorrhea and motion restrictions of the lumbosacral spine. Thirteen subjects were enrolled into the study. Bilateral and unilateral lumbosacral flexion and extension restrictions were treated using drop table manipulations 3 times during each of the 2 consecutive menstrual cycles. Before entering the study and at the end of each menstrual cycle, the subjects self-reported ratings of menstrual pain (abdominal, pelvic, and low back pain) and associated symptoms of primary dysmenorrhea using Numeric Pain Scale. Numeric Pain Scale ratings for menstrual pain were the primary outcome measures. RESULTS: The median age was 26 years, and the median self-reported duration of the symptoms was 12 years. At baseline, all subjects reported pain severity scores of 5 or higher for at least 2 of 3 anatomical sites: lower or general abdominal pain and/or lower back pain. Using the 95% confidence interval (CI) as an estimate, clinically meaningful changes (<5) in general abdominal pain and lower back pain were evident for most patients during the treatment phase, whereas for lower abdominal pain, the improvements were subject and cycle dependent. CONCLUSIONS: Menstrual pain associated with primary dysmenorrhea may be alleviated with treatment of motion segment restrictions of the lumbosacral spine with drop table technique.

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Zhongguo Zhen Jiu. 2008 Mar;28(3):187-90.
[Acupuncture at Siguan points for treatment of primary dysmenorrhea]
[Article in Chinese]
Li CH, Wang YZ, Guo XY.
Luohe High Medical Training School, Henan, China. lhwxlchong@126.com

OBJECTIVE: To observe the therapeutic effect of acupuncture at Siguan points with Qinglong Baizei method on primary dysmenorrhea (PD) and to study the mechanism. METHODS: One hundred and eighty cases of PD were zandomly divided into group A, group B and group C, 60 cases in each group. Group A were treated by acupuncture at Hegu (LI 4) and Taichong (LR 3) with Qinglong Baiwei method; group B were treated by routine acupuncture with Sanyinjiao (SP 6), Ciliao (BL 32) selected as main points; and group C were treated by oral administration of Yueyueshu Decoction. After treatment of 3 months, the therapeutic effects were analyzed, and changes of hemorrheological indexes and prostaglandin level were observed. RESULTS: The cured rate and the total effective rate were 75.0% and 100.0% in group A, 60.0% and 95.0% in group B, and 25.0% and 90.0% in group C, respec tively, group A and B being significantly better than group C (P < 0.01). And the analgesic effects within 30 min of treatment in both group A and group B were significantly better than that in group C (P < 0.01), and that in group A was significantly better than that in group B (P < 0.01). CONCLUSION: Acupuncture at Siguan points with Qinglong Baiwei method has a significant therapeutic effect on primary dysmenorrhea. The possible mechanism is to relieve pain by improving blood circulation and inhibiting production of prostaglandin.

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Paediatr Drugs. 2008;10(1):1-7.
Dysmenorrhea in adolescents: diagnosis and treatment.
French L.
Department of Family Medicine, University of Toledo, College of Medicine, Toledo, Ohio, USA.

Dysmenorrhea occurs in the majority of adolescent girls and is the leading cause of recurrent short-term school absence in this group. In the vast majority of cases, a presumptive diagnosis of primary dysmenorrhea can be made based on a typical history of low anterior pelvic pain coinciding with the onset of menses and lasting 1-3 days with a negative physical examination. Risk factors for primary dysmenorrhea include nulliparity, heavy menstrual flow, and smoking. Poor mental health and social supports are other associations. Empiric therapy for primary dysmenorrhea can be initiated without diagnostic testing. Effective therapies include NSAIDs, oral contraceptives, and pharmacologic suppression of menstrual cycles. In atypical, severe, or refractory cases, imaging and/or laparoscopy should be performed to investigate secondary causes of dysmenorrhea. The most common cause of secondary dysmenorrhea is endometriosis, the treatment of which may include medical and surgical approaches. Pharmacologic treatment of young women with pain related to endometriosis is similar to treatment of primary dysmenorrhea but may infrequently include gonadotropin-releasing hormone agonists in severe refractory cases.

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Am J Obstet Gynecol. 2008 Feb;198(2):166.e1-8.
Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care.
Witt CM, Reinhold T, Brinkhaus B, Roll S, Jena S, Willich SN.
Institute for Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany. claudia.witt@charite.de

OBJECTIVE: To investigate the clinical effectiveness and cost-effectiveness of acupuncture in patients with dysmenorrhea. STUDY DESIGN: In a randomized controlled trial plus non-randomized cohort, patients with dysmenorrhea were randomized to acupuncture (15 sessions over three months) or to a control group (no acupuncture). Patients who declined randomization received acupuncture treatment. All subjects were allowed to receive usual medical care. RESULTS: Of 649 women (mean age 36.1 +/- 7.1 years), 201 were randomized. After three months, the average pain intensity (NRS 0-10) was lower in the acupuncture compared to the control group: 3.1 (95% CI 2.7; 3.6) vs. 5.4 (4.9; 5.9), difference -2.3 (-2.9; -1.6); P<.001. The acupuncture group had better quality of life and higher costs. (overall ICER 3,011 euros per QALY). CONCLUSION: Additional acupuncture in patients with dysmenorrhea was associated with improvements in pain and quality of life as compared to treatment with usual
care alone and was cost-effective within usual thresholds.

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J Psychiatr Pract. 2008 Jan;14(1):13-21.
Symptoms related to the menstrual cycle: diagnosis, prevalence, and treatment.
Clayton AH.
Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, Charlottesville, VA 22908, USA. ahc8v@virginia.edu

Menstrual cycle-related symptoms are associated with the intrinsic hormonal fluctuations of the menstrual cycle. These symptoms can be physical, behavioral, or emotional and include problems such as dysmenorrhea, premenstrual syndrome (PMS), and premenstrual dysphoric disorder (PMDD). Because of the emotional and behavioral aspects of menstrual cycle-related symptoms, it is likely that clinical psychiatrists will encounter these symptoms in their daily practice and should therefore be familiar with their diagnosis, prevalence, etiology, and treatment. As many as 2.5 million women are affected by menstrual disorders each year, which can have a profound impact on their quality of life. Although a definitive etiology has yet to be established, fluctuations in estrogen and progesterone as well as genetic factors are thought to contribute to the occurrence of menstrual disorders. Current treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs) (for dysmenorrhea), lifestyle changes, selective serotonin reuptake inhibitors (SSRIs), and ovulation suppression (e.g., with oral contraceptives). Treatment with oral contraceptives (OCs), particularly extended or continuous use, may significantly reduce the incidence of menstrual cycle-related symptoms.

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Drugs. 2007;67(16):2433-72.
Celecoxib: a review of its use in the management of arthritis and acute pain.
Frampton JE, Keating GM.
Wolters Kluwer Health | Adis, Auckland, New Zealand. demail@adis.co.nz

Celecoxib (Celebrex), the first cyclo-oxygenase (COX) 2-selective inhibitor (coxib) to be introduced into clinical practice, has been available for almost a decade. It is approved in one or more countries worldwide for the relief of the signs and symptoms of osteoarthritis (OA), rheumatoid arthritis (RA), juvenile rheumatoid arthritis (in patients aged > or =2 years) and ankylosing spondylitis (AS), the management of acute pain in adults, the treatment of primary dysmenorrhoea and the reduction in the number of adenomatous colorectal polyps in familial adenomatous polyposis.Celecoxib remains an effective and useful altenative to nonselective NSAIDs in the treatment of acute or chronic musculoskeletal pain. In the latter setting, it offers the prospect of improved gastrointestinal (GI) tolerability and, in patients not taking aspirin for cardioprophylaxis, a GI safety advantage. Currently available evidence of an increase in cardiovascular (CV) risk with celecoxib is inconsistent; any increase in risk is likely to be small and similar to that with nonselective NSAIDs. As with all NSAIDs, the potential GI, CV and renal risks of celecoxib must be weighed against the potential benefits in each individual; it is a rational choice for patients at low CV risk who require NSAID therapy, especially those at increased risk of NSAID-induced GI toxicity, but also those unresponsive to, or intolerant of, other NSAIDs. If selected, celecoxib, like all NSAIDs, should be used at the lowest effective dose for the shortest possible duration.

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Clin Obstet Gynecol. 2007 Dec;50(4):907-917.
The Contraceptive Implant.
Hohmann H, Creinin MD.
*Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine †Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.

Contraceptive implants provide long-acting, highly effective reversible contraception. Currently, the only subdermal implant available to women in the United States is the single rod etonogestrel implant, Implanon (N.V. Organon, Oss, the Netherlands) approved by the Food and Drug Administration in July 2006. Implanon is currently approved for 3 years of use, provides excellent efficacy throughout its use, and is easy to insert and remove. Similar to other progestin-only contraceptives, Implanon can cause irregular vaginal bleeding. Implanon has been shown to be safe to use during lactation, may improve dysmenorrhea, and does not significantly affect bone mineral density, lipid profile, or liver enzymes.

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J Obstet Gynaecol. 2007 Oct;27(7):726-8.
Treatment of dysmenorrhoea with a new TENS device (OVA).
Schiøtz HA, Jettestad M, Al-Heeti D.
Department of Obstetrics and Gynaecology, Hospital of Vestfold, Tønsberg, Norway.

Transcutaneous electrical nerve stimulation (TENS) is an established method for pain relief in dysmenorrhoea, which does not involve the use of medication. This prospective study evaluated the clinical utility of a new, very small and light, high frequency TENS device in 21 menstruating women during four menstrual cycles. The efficacy measures were pain relief evaluated on a VAS scale and reduction in use of analgesic tablets. All the participants subjectively found the device useful. There was a statistically significant drop in mean pain score from 6.73 to 5.18 points (p = 0.0009). Concurrent use of analgesic tablets was also significantly reduced (p = 0.03) and seven women stopped taking analgesics while using the device (p = 0.02). There were no adverse events. On follow-up 6 - 8 months post study, 14 of the women were still using the device regularly. This TENS device appears to be a useful treatment alternative for dysmenorrhoea.

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Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005288.
Chinese herbal medicine for primary dysmenorrhoea.
Zhu X, Proctor M, Bensoussan A, Smith CA, Wu E.
Chinese Medicine Program, University of Western Sydney, Center for Complementary Medicine Research, Bldg 3, Bankstown Campus, Locked Bag 1797, Penrith South DC, Sydney, New South Wales, Australia, 2750. x.zhu@uws.edu.au

BACKGROUND: Conventional treatment for primary dysmenorrhoea (PD) has a failure rate of 20% to 25% and may be contraindicated or not tolerated by some women. Chinese herbal medicine (CHM) may be a suitable alternative. OBJECTIVES: To determine the efficacy and safety of CHM for PD when compared with placebo, no treatment, and other treatment. SEARCH STRATEGY: The Cochrane Menstrual Disorders and Subfertility Group Trials Register (to 2006), MEDLINE (1950 to January 2007), EMBASE (1980 to January 2007), CINAHL (1982 to January 2007), AMED (1985 to January 2007), CENTRAL (The Cochrane Library issue 4, 2006), China National Knowledge Infrastructure (CNKI, 1990 to January 2007), Traditional Chinese Medicine Database System (TCMDS, 1990 to Dec 2006), and the Chinese BioMedicine Database (CBM, 1990 to Dec 2006) were searched. Citation lists of included trials were also reviewed. SELECTION CRITERIA: Any randomised controlled trials (RCTs) involving CHM versus placebo, no treatment, conventional therapy, heat compression, another type of CHM, acupuncture or massage. Exclusion criteria were identifiable pelvic pathology and dysmenorrhoea resulting from the use of an intra-uterine contraceptive device (IUD). DATA COLLECTION AND ANALYSIS: Quality assessment, data extraction and data translation were performed independently by two review authors. Attempts were made to contact study authors for additional information and data. Data were combined for meta-analysis using either Peto odds ratios or relative risk (RR) for dichotomous data or weighted mean difference for continuous data. A fixed-effect statistical model was used, where suitable. If data were not suitable for meta-analysis, any available data from the trial were extracted and presented as descriptive data. MAIN RESULTS: Thirty-nine RCTs involving a total of 3475 women were included in the review. A number of the trials were of small sample size and poor methodological quality. Results for CHM compared to placebo were unclear as data could not be combined (3 RCTs). CHM resulted in significant improvements in pain relief (14 RCTs; RR 1.99, 95% CI 1.52 to 2.60), overall symptoms (6 RCTs; RR 2.17, 95% CI 1.73 to 2.73) and use of additional medication (2 RCTs; RR 1.58, 95% CI 1.30 to 1.93) when compared to use of pharmaceutical drugs. Self-designed CHM resulted in significant improvements in pain relief (18 RCTs; RR 2.06, 95% CI 1.80 to 2.36), overall symptoms (14 RCTs; RR 1.99, 95% CI 1.65 to 2.40) and use of additional medication (5 RCTs; RR 1.58, 95% CI 1.34 to 1.87) after up to three months follow up when compared to commonly used Chinese herbal health products. CHM also resulted in better pain relief than acupuncture (2 RCTs; RR 1.75, 95% CI 1.09 to 2.82) and heat compression (1 RCT; RR 2.08, 95% CI 2.06 to 499.18). AUTHORS' CONCLUSIONS: The review found promising evidence supporting the use of CHM for primary dysmenorrhoea; however, results are limited by the poor methodological quality of the included trials.

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Cochrane Database Syst Rev. 2007 Oct 17;(4):CD000400.
Nonsteroidal anti-inflammatory drugs for heavy menstrual bleeding.
Lethaby A, Augood C, Duckitt K, Farquhar C.
University of Auckland, O&G FMHS, Grafton Rd, Private Bag 92019, Auckland, New Zealand, 1142. a.lethaby@auckland.ac.nz

BACKGROUND: Heavy menstrual bleeding (HMB) is an important cause of ill health in premenopausal women. Although surgery is often used as a treatment, a range of medical therapies are also available. Nonsteroidal anti-inflammatory drugs reduce prostaglandin levels which are elevated in women with excessive menstrual bleeding and also may have a beneficial effect on dysmenorrhoea. OBJECTIVES: The primary objective of this review was to investigate the effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs) in achieving a reduction in menstrual blood loss in women of reproductive years HMB. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders & Subfertility Group trials register (searched April 2007), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2007), MEDLINE (1966 to April 2007), EMBASE (1985 to April 2007), CINAHL (1982 to April 2007), Current Contents (1993 to April 2007) and reference lists of articles. We also contacted manufacturers and researchers in the field. SELECTION CRITERIA: The inclusion criteria were randomised comparisons of individual NSAIDs with either each other, placebo or other medical treatments in women with regular heavy periods measured either objectively or subjectively and with no pathological or iatrogenic (treatment induced) causes for their heavy menstrual blood loss. DATA COLLECTION AND ANALYSIS: Seventeen RCTs were identified that fulfilled the inclusion criteria for this review and data were extracted independently. Odds ratios for dichotomous outcomes and weighted mean differences for continuous outcomes were estimated from the data of nine trials. The results of the remaining seven crossover trials with data unsuitable for pooling and one trial with skewed data were described in the Other Data section. MAIN RESULTS: As a group, NSAIDs were more effective than placebo at reducing heavy menstrual bleeding but less effective than either tranexamic acid, danazol or the levonorgestrel releasing intrauterine system (LNG IUS). Treatment with danazol caused a shorter duration of menstruation and more adverse events than NSAIDs but this did not appear to affect the acceptability of treatment. There were no statistically significant differences between NSAIDs and the other treatments (oral luteal progestogen, ethamsylate, an older progesterone releasing intra-uterine system (Progestasert), oral contraceptive pill (OCC)) but most studies were underpowered. There was no evidence of a difference between the individual NSAIDs (naproxen and mefenamic acid) in reducing HMB. AUTHORS' CONCLUSIONS: NSAIDs reduce HMB when compared with placebo but are less effective than either tranexamic acid, danazol or LNG IUS. However, adverse events are more severe with danazol therapy. In the limited number of small studies suitable for evaluation, no significant difference in efficacy was demonstrated between NSAIDs and other medical treatments such as oral luteal progestogen, ethamsylate, OCC or another type of IUS, Progestasert.

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Eur J Contracept Reprod Health Care. 2007 Sep;12(3):240-7.
Clinical experience with NuvaRing in daily practice in Switzerland: cycle control and acceptability among women of all reproductive ages.
Merki-Feld GS, Hund M.
Clinic for Reproductive Endocrinology, Department of Gynaecology and Obstetrics, University Hospital, Zurich, Switzerland.

OBJECTIVES: To assess clinical experience with NuvaRing in daily practice in Switzerland, including a large subgroup of young women (aged < or = 22 years). METHODS: Open, prospective, multicentre, observational clinical experience study to investigate cycle control, acceptability and usage of NuvaRing. RESULTS: Altogether, 2642 women participated in the programme and were included in the analysis, of which 658 were aged < or = 22 years (25% of the total group). A total of 744 women (28% of the total group) discontinued NuvaRing use; the main reason was adverse events (11% of all users). In younger women, there was a shift from moderate (-18%) and heavy (-45%) bleeding to mild bleeding (+71%) and dysmenorrhoea decreased by 60%, despite previous hormonal contraception use by 83% of women. Most women found ring insertion and removal to be straightforward (>95%), and were satisfied with its use (85%), primarily for the ring's once-a-month application (81%). Data were very similar for the total group. Cycle control and satisfaction were further improved with duration of treatment. CONCLUSIONS: In daily practice, NuvaRing improved cycle control and was highly acceptable to women, including young women. Switchers from other hormonal methods also showed improved cycle control and high satisfaction.

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Eur J Contracept Reprod Health Care. 2007 Aug 28;:1-8 [Epub ahead of print]
Cycle control, tolerability, efficacy and acceptability of the vaginal contraceptive ring, NuvaRing(R): Results of clinical experience in Germany.
Brucker C, Karck U, Merkle E.
Department of Obstetrics and Gynaecology, Nuernberg Hospital, Nuernberg.

Objectives To investigate the real-life clinical experience of NuvaRing(R) users in Germany. Methods An open-label, prospective, uncontrolled, non-randomized, multicentre post-marketing surveillance study was conducted by 1204 gynaecologists amongst 5823 women requesting contraception. The women underwent routine examinations and contraceptive counselling, and were assessed after three and six cycles of NuvaRing(R) use. Results: Good cycle control was observed and there was a reduction in cycle irregularity and inter-menstrual bleeding, bleeding duration and intensity, and dysmenorrhoea. NuvaRing(R) was well tolerated, and had no significant effect on body weight or blood pressure. Nine women became pregnant unintentionally (two had conceived before they started to use NuvaRing(R), three due to non-compliance, one because of repeated ring expulsion/loss and three during treatment in spite of having applied this latter as instructed). Most women expressed their satisfaction with NuvaRing(R); 82% were 'very satisfied/satisfied', 72% planned to continue using it and 82% would recommend it to others. More than 90% of women found NuvaRing(R)'without problems/easy' to insert and to remove, and more than 80% of the women and their partners were not disturbed by its presence during intercourse. Conclusion: NuvaRing(R) is a highly effective and acceptable method of once-monthly contraception that is safe and well tolerated.

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Eur J Contracept Reprod Health Care. 2007 Aug 16;:1-8 [Epub ahead of print]
The effects of an oestrogen-free, desogestrel-containing oral contraceptive in women with cyclical symptoms: Results from two studies on oestrogen-related symptoms and dysmenorrhoea.
Ahrendt HJ, Karck U, Pichl T, Mueller T, Ernst U.
Private Practice, Magdeburg.

Objectives To evaluate the effects of an oestrogen-free oral contraceptive (Cerazette(R); 75 mcg/day desogestrel) in women with oestrogen-related symptoms during previous combined oral contraceptive (COC) use (ERS study) and in women with dysmenorrhoea (DYS study). Methods Two similarly designed prospective, non-comparative multicentre observational studies were carried out in Germany. Altogether, 403 women with oestrogen-related symptoms during previous COC use and 406 women with dysmenorrhoea took Cerazette(R) continuously. Symptom-related assessments were made at baseline and after 3-4 months, along with bleeding pattern and treatment satisfaction. Results In the ERS study, the four oestrogen-related symptoms studied resolved or improved in over 70% of women. Nausea improved/resolved most (92% of women), followed by breast tenderness (90%), oestrogen-related headache (84%) and oedema (74%). In the DYS study, dysmenorrhoea resolved or considerably improved in 93% of the study population. Correspondingly, use of analgesics dropped from 70% of women at baseline to 8% at study end. Adverse events were reported by 7-8% of both study populations and were mainly bleeding irregularities. Most women in both studies were satisfied with treatment ( approximately 90%) and wished to continue treatment after study completion ( approximately 85%). Conclusions Cerazette(R) in this study set-up improved oestrogen-related symptoms and dysmenorrhoea in women affected and treatment was well accepted.

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Cochrane Database Syst Rev. 2007 Jul 18;(3):CD002248.
Behavioural interventions for primary and secondary dysmenorrhoea.
Proctor M, Murphy P, Pattison H, Suckling J, Farquhar C.

BACKGROUND: Dysmenorrhoea refers to the occurrence of painful menstrual cramps of uterine origin and is a common gynaecological condition with considerable morbidity. The behavioural approach assumes that psychological and environmental factors interact with, and influence, physiological processes. Behavioural interventions for dysmenorrhoea may include both physical and cognitive procedures and focus on both physical and psychological coping strategies for dysmenorrhoeic symptoms rather than modification of any underlying organic pathology. OBJECTIVES: To determine the effectiveness of any behavioural interventions for the treatment of primary or secondary dysmenorrhoea when compared to each other, placebo, no treatment, or conventional medical treatments for example non-steroidal anti-inflammatory drugs (NSAIDs). SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (searched April 2005), Cochrane Central Register of Controlled Trials (CENTRAL on The Cochrane Library, Issue 2, 2005), MEDLINE (1966 to April 2005), EMBASE (1980 to April 2005), Social Sciences Index (1980 to April 2005), PsycINFO (1972 to April 2005) and CINAHL (1982 to April 2005) and reference lists of articles. SELECTION CRITERIA: Randomised controlled trials comparing behavioural interventions with placebo or other interventions in women with dysmenorrhoea. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. MAIN RESULTS: Five trials involving 213 women were included.Behavioural intervention vs control: One trial of pain management training reported reduction in pain and symptoms compared to a control. Three trials of relaxation compared to control reported varied results, two trials showed no difference in symptom severity scores however one trial reported relaxation was effective for reducing symptoms in menstrual sufferers with spasmodic symptoms. Two trials reported less restriction in daily activities following treatment with either relaxation of pain management training compared to a control. One trial also reported less time absent from school following treatment wit pain management training compared to a control.Behavioural intervention vs other behavioural interventions: Three trials showed no difference between behavioural interventions for the outcome of improvement in symptoms. One trial showed that relaxation resulted in a decrease in the need for resting time compared to the relaxation and imagery. AUTHORS' CONCLUSIONS: There is some evidence from five RCTs that behavioural interventions may be effective for dysmenorrhoea however results should be viewed with caution as they varied greatly between trials due to inconsistency in the reporting of data, small trial size, poor methodological quality and age of the trials.

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Drugs Today (Barc). 2007 Mar;43(3):137-47.
Lumiracoxib.
Buvanendran A, Barkin R.
Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois 60612, USA. Asokumar@aol.com

Lumiracoxib is a selective cyclooxygenase (COX)-2 inhibitor that possesses a carboxylic acid group that makes it weakly acidic. It has good oral bioavailability; maximum plasma concentrations are reached two hours after oral administration. Despite its short elimination half-life of four hours from the plasma, the drug is distributed to inflamed tissues and is retained for up to 24 hours. This unique property suggests that lumiracoxib, while having reduced systemic exposure, can still reach sites where COX-2 inhibition is required for pain relief. Lumiracoxib is metabolized extensively with only a small amount excreted in the urine. Selectivity for COX-2 is high compared to all other similar agents. It is indicated for the relief of pain in osteoarthritis, rheumatoid arthritis, acute pain and primary dysmenorrhea. Lumiracoxib has been found to be effective at doses of 100-400 mg once a day for chronic pain and 400 mg/day for acute pain. Large clinical trials where lumiracoxib was administered to patients with osteoarthritis have demonstrated that this drug is equally effective as other COX-2 inhibitors and nonsteroidal anti-inflammatory drugs (NSAIDs). In comparison to NSAIDs, patients taking lumiracoxib experience significantly fewer adverse events and greater tolerability. It has also been shown to be effective in acute pain states, like the dental pain model and postoperative pain after orthopedic surgery. A large clinical study (TARGET) has demonstrated the gastrointestinal safety of lumiracoxib over one year. The study also showed that there was no increase in cardiovascular events in non-high-risk patients. However, a black box warning similar to those accompanying other COX-2 inhibitors has been placed by regulatory agencies that have approved this drug for clinical use. When lumiracoxib is coadministered with warfarin or aspirin, no dosage adjustment is required. (c) 2007 Prous Science.

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Curr Med Res Opin. 2007 Apr;23(4):841-51.
Efficacy of a paracetamol and caffeine combination in the treatment of the key symptoms of primary dysmenorrhoea.
Ali Z, Burnett I, Eccles R, North M, Jawad M, Jawad S, Clarke G, Milsom I.
GlaxoSmithKline Consumer Healthcare, St George's Avenue, Weybridge, Surrey, UK. ali@gsk.com <ali@gsk.com>

OBJECTIVE: Primary dysmenorrhoea is characterised by pain, cramping and backache at the time of menses. Despite the high prevalence of dysmenorrhoea, few sufficiently powered, placebo-controlled studies have examined the efficacy of over the counter analgesics in this condition. Furthermore, even fewer studies have directly examined the efficacy of analgesics on specific dysmenorrhoea symptoms. Research design and main outcome measures: This was a single-dose, placebo-controlled, double blind, crossover study carried out in 320 women with moderate-to-severe dysmenorrhoea pain. At 2 h following dosing, 1 g paracetamol plus 130 mg caffeine led to significantly greater pain relief compared to 1 g paracetamol alone (p < 0.05), 130 mg caffeine alone (p < 0.01) or placebo (p < 0.01). The combination was also significantly more effective in relieving abdominal cramping and backache compared to the other treatment arms. No major treatment related adverse events were reported during this study. CONCLUSIONS: When taken at recommended doses, both paracetamol and the combination of paracetamol and caffeine are safe and effective treatments for primary dysmenorrhoea. Consistent with results from other acute pain states, caffeine acts as an analgesic adjuvant and enhances the efficacy of paracetamol.

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Med Hypotheses. 2007;69(2):297-301. Epub 2007 Feb 7.
Zinc treatment prevents dysmenorrhea.
Eby GA.
George Eby Research, 14909-C Fitzhugh Road, Austin, TX 78736, United States.

Primary dysmenorrhea, menstrual cramps in otherwise well women, produces mild to debilitating cramping of the uterus. More than half, and by some estimates 90% of all American women experience menstrual cramps during the first several days of menstruation. About one in ten women are unable to perform their normal routine for one to three days each menstrual cycle due to severe uterine cramping. Although the uterus contracts and relaxes routinely, during menstruation the contractions are much stronger producing pain and "cramps". Women with dysmenorrhea have high levels of prostaglandins, hormones believed to cause menstrual cramping. Prostaglandins are believed to temporarily reduce or stop blood supply to the uterus, thus depriving the uterus of oxygen resulting in contractions and pain. One would expect zinc, like the non-steroidal anti-inflammatory drugs used to treat cramping, to reduce the production of prostaglandins. Zinc inhibits the metabolism of prostaglandins ruling out this mechanism of action, suggesting erroneously that zinc deficiency would prevent cramping. However, it is shown by case histories that zinc, in 1-3 30-mg doses given daily for one to four days prior to onset of menses, prevents essentially all to all warning of menses and all menstrual cramping. One hypothesis for a mechanism of action is that a precursor (COX-2) or metabolite of prostaglandins causes menstrual cramping and not prostaglandins themselves. Another hypothesis is that zinc has antioxidant and anti-inflammatory actions in the uterus. Improvement in micro-vessel circulation by zinc may help prevent cramping and pain. In patients consuming 31 mg of zinc per day, premenstrual tension (PMT) symptoms did not occur, while in patients consuming 15 mg of zinc, PMT symptoms did occur (P<0.001). Protocols using 30 mg of zinc once to three times a day for one to four days immediately prior to menses to prevent dysmenorrhea are described and they are recommended for additional study. The side effect from the absence of all warning of pending menses due to zinc treatment was concern of possible pregnancy. The United States RDA for zinc appears to be too low to optimize women's health and prevent menstrual cramps.

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Med Hypotheses. 2007 Feb 6; [Epub ahead of print]
Zinc treatment prevents dysmenorrhea.
Eby GA.
George Eby Research, 14909-C Fitzhugh Road, Austin, TX 78736, United States.

Primary dysmenorrhea, menstrual cramps in otherwise well women, produces mild to debilitating cramping of the uterus. More than half, and by some estimates 90% of all American women experience menstrual cramps during the first several days of menstruation. About one in ten women are unable to perform their normal routine for one to three days each menstrual cycle due to severe uterine cramping. Although the uterus contracts and relaxes routinely, during menstruation the contractions are much stronger producing pain and "cramps". Women with dysmenorrhea have high levels of prostaglandins, hormones believed to cause menstrual cramping. Prostaglandins are believed to temporarily reduce or stop blood supply to the uterus, thus depriving the uterus of oxygen resulting in contractions and pain. One would expect zinc, like the non-steroidal anti-inflammatory drugs used to treat cramping, to reduce the production of prostaglandins. Zinc inhibits the metabolism of prostaglandins ruling out this mechanism of action, suggesting erroneously that zinc deficiency would prevent cramping. However, it is shown by case histories that zinc, in 1-3 30-mg doses given daily for one to four days prior to onset of menses, prevents essentially all to all warning of menses and all menstrual cramping. One hypothesis for a mechanism of action is that a precursor (COX-2) or metabolite of prostaglandins causes menstrual cramping and not prostaglandins themselves. Another hypothesis is that zinc has antioxidant and anti-inflammatory actions in the uterus. Improvement in micro-vessel circulation by zinc may help prevent cramping and pain. In patients consuming 31mg of zinc per day, premenstrual tension (PMT) symptoms did not occur, while in patients consuming 15mg of zinc, PMT symptoms did occur (P<0.001). Protocols using 30mg of zinc once to three times a day for one to four days immediately prior to menses to prevent dysmenorrhea are described and they are recommended for additional study. The side effect from the absence of all warning of pending menses due to zinc treatment was concern of possible pregnancy. The United States RDA for zinc appears to be too low to optimize women's health and prevent menstrual cramps.

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Acta Obstet Gynecol Scand. 2007;86(1):4-15.
Surgical interruption of pelvic nerve pathways in dysmenorrhea: a systematic review of effectiveness.
Latthe PM, Proctor ML, Farquhar CM, Johnson N, Khan KS.
Academic Department of Obstetrics & Gynaecology, University of Birmingham, Birmingham, UK. pallavi@doctors.org

OBJECTIVES: To assess the effectiveness of surgical interruption of pelvic nerve pathways in primary and secondary dysmenorrhea. Data sources. The Cochrane Menstrual Disorders and Subfertility Group Trials Register (9 June 2004), CENTRAL (The Cochrane Library, Issue 2, 2004), MEDLINE (1966 to Nov. 2003), EMBASE (1980 to Nov. 2003), CINAHL (1982 to Oct. 2003), MetaRegister of Controlled Trials, the citation lists of review articles and included trials, and contact with the corresponding author of each included trial. REVIEW METHODS: The inclusion criteria were randomized controlled trials of uterosacral nerve ablation or presacral neurectomy (both open and laparoscopic procedures) for the treatment of dysmenorrhea. The main outcome measures were pain relief and adverse effects. Two reviewers extracted data on characteristics of the study quality and the population, intervention, and outcome independently. RESULTS: Nine randomized controlled trials were included in the systematic review. There were two trials with open presacral neurectomy; all other trials used laparoscopic techniques. For the treatment of primary dysmenorrhea, laparoscopic uterosacral nerve ablation at 12 months was better when compared to a control or no treatment (OR 6.12; 95% CI 1.78-21.03). The comparison of laparoscopic uterosacral nerve ablation with presacral neurectomy for primary dysmenorrhea showed that at 12 months follow-up, presacral neurectomy was more effective (OR 0.10; 95% CI 0.03-0.32). In secondary dysmenorrhea, along with laparoscopic surgical treatment of endometriosis, the addition of laparoscopic uterosacral nerve ablation did not improve the pain relief (OR 0.77; 95% CI 0.43-1.39), while presacral neurectomy did (OR 3.14; 95% CI 1.59-6.21). Adverse events were more common for presacral neurectomy than procedures without presacral neurectomy (OR 14.6; 95% CI 5-42.5). CONCLUSION: The evidence for nerve interruption in the management of dysmenorrhea is limited. Methodologically sound and sufficiently powered randomized controlled trials are needed.

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Eur J Obstet Gynecol Reprod Biol. 2007 Jan 6; [Epub ahead of print]
Endometriosis, dysmenorrhea and diet—What is the evidence?
Fjerbaek A, Knudsen UB.
Department of Gynecology and Obstetrics, Odense University Hospital, University of Southern Denmark, DK-5000 Odense C, Denmark.

The objective of this study is to assess the literature concerning the effect of diet on endometriosis and dysmenorrhea and to elucidate evidential support, to give dietary recommendations to women suffering from these conditions. A systematic search in electronic databases on a relationship between diet and endometriosis/dysmenorrhea was performed. Data on diet and endometriosis were limited to four trials of which two were animal studies. The articles concerning human consumption found some relation between disease and low intake of vegetable and fruit and high intake of vegetarian polyunsaturated fat, ham, beef and other red meat. Results concerning fish intake were not consistent. Eight trials of different design, with a total of 1097 women, investigated the relationship between diet and dysmenorrhea. Intake of fish oil seemed to have a positive effect on pain symptoms. This study concludes that literature on diet and endometriosis is sparse, whereas eight studies have looked at diet and dysmenorrhea. No clear recommendations on what diet to eat or refrain from to reduce the symptoms of endometriosis can be given, while a few studies indicate that fish oil can reduce dysmenorrhea. Further research is recommended on both subjects.

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J Pediatr Adolesc Gynecol. 2006 Dec;19(6):363-71.
Dysmenorrhea in adolescents and young adults: etiology and management.
Harel Z.
Associate Professor of Pediatrics, Division of Adolescent Medicine/Hasbro Children's Hospital and Department of Pediatrics, Brown University, Providence, Rhode Island 02903, USA. Zharel@Lifespan.org

Dysmenorrhea is the most common gynecologic complaint among adolescent and young adult females. Dysmenorrhea in adolescents and young adults is usually primary (functional), and is associated with normal ovulatory cycles and with no pelvic pathology. In approximately 10% of adolescents and young adults with severe dysmenorrhea symptoms, pelvic abnormalities such as endometriosis or uterine anomalies may be found. Potent prostaglandins and potent leukotrienes play an important role in generating dysmenorrhea symptoms. Nonsteroidal anti-inflammatory drugs (NSAID) are the most common pharmacologic treatment for dysmenorrhea. Adolescents and young adults with symptoms that do not respond to treatment with NSAIDs for 3 menstrual periods should be offered combined estrogen/progestin oral contraceptive pills for 3 menstrual cycles. Adolescents and young adults with dysmenorrhea who do not respond to this treatment should be evaluated for secondary causes of dysmenorrhea. The care provider's role is to explain about pathophysiology of dysmenorrhea to every adolescent and young adult female, address any concern that the patient has about her menstrual period, and review effective treatment options for dysmenorrhea with the patient.
  
Previous Menstrual Cramps Research:
2002-2006   
The Menstrual Cramps File also contains summaries of past research that has shown promise and may still be standard practice among many physicians. To download earlier research findings on Menstrual Cramps, click HERE.
 

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