Complementary and drug treatments for primary period pain

A woman sits and holds her hands on her lower abdomen to symbolically represent menstrual pain.

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Period pain, also known medically as dysmenorrhea, has a prevalence of 45-97% in different groups of people, according to cross-sectional studies. According to studies, 30-70% of them report having taken pain medication because of it. Now a study analyzed the treatment options by means of drug therapy and complementary medicine methods to create an up-to-date overview of the problem.

A woman sits and holds her hands on her lower abdomen to symbolically represent menstrual pain.

shutterstock.com / GBALLGIGGSPHOTO

Primary Dysmenorrhea:

Dysmenorrhea is defined as uterine stabbing, cramping, throbbing or dull (sometimes persistent) pain around menstruation and is divided into primaryand secondary menstrual pain. Usually these occur one day after the onset of bleeding and disappear after two to three days. Often this pain is accompanied by headache, nausea, constipation or diarrhoea, back pain and frequent urination - vomiting is less common.
Eine primäre Dysmenorrhoe ist eine schmerzhafte Uteruskontraktion verursacht durch eine Verletzung der Gebärmutterschleimhaut.
Sekundäre Regelschmerzen sind durch Veränderung im Beckenbereich gekennzeichnet.
Trotz nicht eindeutiger Ursache für eine primäre Dysmenorrhoe akzeptieren die meisten Forscher die Annahme, dass eine erhöhte Synthese von Prostaglandinen (d.h. Wirken als Gewebshormone und Mediator bei Schmerzvermittlung und Entzündungsprozessen) damit assoziiert werden könnte (besonders E2 und F2α). Dabei werden Arzneimitteltherapien und komplementäre medizinische Ansätze häufig zum Schmerzlindern angewendet, indem sie die Freisetzung und Produktion von diesen Gewebshormonen hemmen können. Dazu werden sogenannte NSARs (d.h. nichtsteroidale Antirheumatika) und orale Kontrazeptiva verwendet, welche jedoch bei längerer Einnahme zu Nebenwirkungen führen können.

Complementary methods use herbs, yoga, relaxation, psychotherapy, massage, hypnosis, vitamins and supplements such as calcium and magnesium, and acupressure and acupuncture to relieve period pain. Limitations are found in all therapeutic methods: while NSAIDs may be contraindicated in patients with digestive problems, certain medicinal plants are not always easy to find. To provide an overview of current advances in the field, researchers in the study, published in 2019, analyzed 17 studies on the topic.

Complementary medicine and drug therapy examined:

From the beginning to March 2018, databases such as Pubmed, Web of Sciences, Scopus, Iran medey, and SID were searched and literature in English and Persian was analyzed. Inclusion criteria for this were:

  • Randomized clinical trials
  • Study subject dysmenorrhea
  • Patients had no infectious diseases like viruses, fungi etc.

Exclusion criteria included the following:

  • Insufficient sample size
  • Limited sample size
  • Infectious diseases

Here, the included information was analyzed and processed by two reviewers.

Results:

Of the total 17 papers, 10 were on complementary medicine, 3 using drug therapies and 4 using acupressure and acupuncture. Each study had between 24 and 303 patients and lasted between 1 and 6 months. The measures used were the visual analogue scale and clinical efficacy of each treatment. Side effects recorded included events such as nausea, vomiting, diarrhoea, abdominal pain and liver or kidney disease. 5 complementary medicine studies used fennel, three used chamomile, and three used the plant species Zataria multiflora. All of these plant species have been researched in the past for their effects on menstrual pain through studies. In drug therapy, one study compared celexcib capsules with paroxene, one study compared vaginal sildenafil citrate with vaginal placebo, and one study compared oral mefenamic acid with placebo capsules with sugar.

Control groups received placebo, placebo vaginal tablets, Fenbid tablets, ibuprofen tablets, vitamin E, mefenamic acid, essential oil, indomethacin, or naproxen. The study groups received oral diclofenac, vaginal sildenafil citrate, oral celecoxib, fennel capsules or drops, chamomile capsules, or Zataria multiflora drops. Also, the 2017 meta-analyses examined found that various acupressure methods, compared to drug treatments, could be an alternative treatment for dysmenorrhea due to no side effects.

Conclusion:

According to the analysis, complementary medicine treatments such as medicinal plants and acupressure, as well as medications, could reduce perceived pain by lowering prostaglandin levels. In addition to this, the research showed that the therapies mediate nitric oxide, increase endorphin levels and improve blood flow in utero. To better describe an effective benefit of these treatments and ensure the absence of unwanted side effects, studies with larger populations, longer observation periods, comparisons with medications, and ideally analysis of molecular mechanisms are needed to more effectively treat this globally significant occurrence in women of different age groups and to transparently continue the scientific discourse.

Sources

Author

Danilo Glisic

Last Update

13.12.2021

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