{"paper_id":"62971906-d344-4f87-849c-be104d5318fb","body_text":"Summary\nPrimary 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.\nRecent 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.\nIn 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.\nSimilar content being viewed by others\nReferences\nAnderson, A.B.M.; Gillebaud, J.; Haynes, P.J. and Turnbull, A.C.: Reduction of menstrual blood-loss by prostaglandin synthetase inhibitors. Lancet 1: 774 (1976).\nAnderson, A.B.M.; Haynes, P.J.; Fraser, I.S. and Turnbull, A.C.: Trial of prostaglandin-synthetase inhibitors in primary dysmenorrhoea. Lancet 1: 345 (1978).\nBudoff, P.W.: Use of mefanamic acid in the treatment of primary dysmenorrhea. 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American Journal of Obstetrics and Gynecology 121: 1003 (1975).\nWilliam, E.A.; Collins, W.P. and Clayton, S.G.: Studies in the involvement of prostaglandins in uterine symptomatology and pathology. British Journal of Obstetrics and Gynaecology 83: 337 (1976).\nYlikorkala, O. and Dawood, M.Y.: New concepts in dysmenorrhea. American Journal of Obstetrics and Gynecology 130: 833 (1978)\nAuthor information\nAuthors and Affiliations\nRights and permissions\nAbout this article\nCite this article\nDawood, M.Y. Dysmenorrhoea and Prostaglandins: Pharmacological and Therapeutic Considerations. Drugs 22, 42–56 (1981). https://doi.org/10.2165/00003495-198122010-00003\nPublished:\nIssue date:\nDOI: https://doi.org/10.2165/00003495-198122010-00003","source_license":"CC0","license_restricted":false}