The Doctor's Notes: Dysmenorrhea: How is it Treated?
by Dr. Robert C. Lawler, M.D.
The majority of patients who are diagnosed with primary dysmenorrhea can be effectively treated with a class of drugs know as nonsteroidal antiinflammatory drugs or (NSAIDs). These medications act primarily by blocking prostaglandin production at the uterine lining also known as the endometrium. Many of these medications are available without a prescription, and typically can be taken at the onset of menstruation. In some patients with severe cramping these medications can be started a couple days prior to onset of bleeding. If the desired effect is not achieved with an initial OTC medication, than it is appropriate to switch to a different class of drug. The Fenemates such as Mefenamic acid (ponstel) have been shown to be particularly effective as they have a duel action of suppressing prostaglandin release and also blocking prostaglandin receptor sites.
Other treatment modalities that have shown benefit include local heat applied during the symptomatic period. Also (TENS) transcutaneous electrical nerve stimulation has been used successfully to treat dysmenorrhea. Many physicians will place patients on oral contraception, however this treatment has not been shown to be more effective than NSAID therapy, and may indeed lead to a delay in diagnosis by suppressing symptoms but not treating.
In the patient who has failed an adequate trail various NSAID's: Then secondary causes of dysmenorrhea must be considered. In many patients a diagnostic laparoscopy will detect the presence of endometriosis, which in most cases can be effectively treated as an out patient surgery, sometimes it can be treated at the time of the diagnostic laparocopy. If intrauterine pathology is detected then operative hysteroscopy can be performed to correct this pathology, this too is an outpatient procedure. If no discernable gynecologic reason can be found than appropriate consultation with gastroenterology should be considered. If still no pathology is evident, there may be a psychogenic component that needs to be addressed.
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