Study of the recommended dosage of the N-Acetyl Cysteine, Alpha Lipoic Acid, Bromelain and Zinc preparation as a treatment for dysmenorrhea

Zuramis Estrada, Francisco Carmona
In: medRxiv · 2022 · doi:10.1101/2022.08.08.22278399 · W4291016456
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

A survey of gynecologists revealed their recommended dosage regimens for a N-acetyl cysteine, alpha lipoic acid, bromelain, and zinc preparation to treat dysmenorrhea based on pain severity and type.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This study surveyed 73 experienced Spanish gynecologists (97% response rate) to determine how they recommend a compounded supplement containing N-acetyl cysteine, alpha lipoic acid, bromelain, and zinc (NAC/LA/Br/Zn) for dysmenorrhea in daily clinical practice, including differences between primary and secondary dysmenorrhea and adjustments based on pain severity. Most specialists reported starting continuous administration for 90 days with 10-day breaks (with a smaller proportion using continuous 90-day administration without breaks) and adapting discontinuous versus continuous patterns according to whether pain was mild, moderate, or severe; they also generally did not change the regimen when patients used other drugs like NSAIDs or hormonal contraception. A stated limitation is that the work is based on survey responses rather than direct clinical efficacy testing. Relevance to endometriosis: the paper explicitly describes secondary dysmenorrhea as commonly associated with endometriosis and uses referenced prior data on dosing in patients with endometriosis to develop the survey, though its main focus is gynecologists’ real-world dosing recommendations for dysmenorrhea.

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Abstract

1. Abstract AIM Dysmenorrhea, defined as pain during menstruation, is the most common gynecological condition, affecting a large percentage of women with varying degrees of pain. In recent years, the management of dysmenorrhea has become increasingly important because of the emotional, health and economic burden it entails and because of the need for new studies and research for effective treatments to alleviate its symptoms. The most common treatments for dysmenorrhea are NSAIDs or oral contraceptives, although gynecologists also recommend the preparation composed of N-acetyl cysteine (NAC), alpha lipoic acid (LA), bromelain (Br) and Zinc (Zn), (NAC/LA/Br/Zn) due to its anti-inflammatory and anti-oxidative properties and efficacy in reducing pain. However, there is no data on what dosage of the preparation should be recommended for patients with dysmenorrhea. Therefore, the aim of this study is to determine how the NAC/LA/Br/Zn preparation is recommended for the treatment of dysmenorrhea in daily clinical practice and what specialists base their decision on. Methods and Results A survey was conducted among gynecologists with extensive experience recommending the preparation, with a participation rate of 97% (N=73). The most frequently recommended regimen is to begin with continuous administration for 90 days with 10-day breaks (69%) or without breaks (31%). Specialists recommend the preparation for any type of pain and may recommend discontinuous administration (in the days around menstruation) when the pain is moderate or mild. In patients with primary dysmenorrhea with mild pain, the most recommended approach is discontinuous therapy in the days around menstruation (50.7%) followed by continuous administration for 90 days with 10-day breaks (24.7%). When pain is moderate or severe, the most recommended approach is 90-day continuous therapy with 10-day breaks (47.9% and 71.2%, respectively). In the case of secondary dysmenorrhea, the most recommended approach is 90-day continuous therapy with 10-day breaks for any degree of pain (41.1%, 57.5% and 76.7% for mild, moderate and severe pain, respectively). Most gynecologists (79%) adapt the regimen after clinical assessment of the degree of pain towards discontinuous administration patterns, on the days around menstruation. Most of the specialists consulted do not modify the recommended regimen if the patient is being treated with other drugs such as NSAIDs, hormonal contraception or a combination of progestogens (78%, 59% and 58%, respectively). The preparation is recommended in conjunction with hygienic-dietary measures without modification of the dosage (90%). Conclusion This is the first study that addresses how specialists recommend the NAC/LA/Br/Zn preparation to patients with dysmenorrhea. The most common regimen for dysmenorrhea is to start treatment with continuous administration of the preparation for 90 days with 10 days of break, continuing the regimen or adapting it according to the degree of pain reported by the patient during treatment.

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dysmenorrhea

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