Primer Dismenore Tedavisinde Vitamin D ile Randomize Kontrollü Bir Çalışma

Yıl 2019, Cilt: 21 Sayı: 1, 32 - 36, 30.04.2019

Ayşegül Özel Seda Ateş Osman Şevket Mucize Özdemir Gülşah İlhan Ebru Davutoğlu

https://doi.org/10.18678/dtfd.480596

Cited By: 3

Öz

Amaç: Bu çalışmanın amacı primer dismenore tedavisinde D vitamininin etkinliğini değerlendirmektir.

Gereç ve Yöntemler: Bir üniversite hastanesine başvurmuş ve primer dismenore tanısı alan 16-35 yaş arası 142 hasta randomize kontrollü bir şekilde çalışmaya dahil edilmiştir. Olgular günde bir kez 667 IU D vitamini, günde bir kez 200 IU E vitamini ve günde iki kez 400 mg İbuprofen alacak şekilde üç gruba randomize edildi. Beklenen adet tarihinden iki gün önce ve adetin ilk üç gününde tedavi verildi. Ardışık iki siklüsde tedaviye devam edildi. Birincil sonuç olarak Vizüel Analog Skala (VAS) ile menstrüel ağrının şiddeti değerlendirildi. İkincil sonuç olarak ise iki aylık araştırma süresince Nonsteroidal anti-inflamatuar ilaç (NSAIDs) kullanma ihtiyacı değerlendirildi.

Bulgular: Gruplar arasında yaş, beden kitle indeksi ve bazal VAS skorları açısından anlamlı bir farklılık saptanmadı. Vitamin D grubunda tedavi sonrası ağrı şiddeti, İbuprofen grubundaki kadar düşük bulundu. Tedavi sonrası median VAS skoru D vitamini grubunda 5 (1-10), E vitamini grubunda 7 (1-10) ve ibuprofen grubunda ise 7 (2-10) olarak saptandı (p<0,001). NSAIDs kullanma gereksinimi ise D vitamini grubunda, E vitamini grubuna kıyasla anlamlı şekilde daha düşük olarak saptandı (%27,3 vs %65,9, p<0,001). Grupların hiç birisinde yan etkiye rastlanmadı.

Sonuç: Primer dismenorede ağrı kontrolünde hem D vitamini hem de E vitamini etkili bulunmuştur, bununla birlikte D vitaminin etkinliği daha açık görülmektedir.

Anahtar Kelimeler

Primer dismenore, D vitamini, menstrüel ağrı

A Randomized Controlled Study of Vitamin D in the Treatment of Primary Dysmenorrhea

Öz

Aim: The aim of this study was evaluating the effectiveness of vitamin D in the treatment of primary dysmenorrhea.

Material and Methods: A total of 142 patients between 16 and 35 years of age who were admitted to a university hospital and diagnosed with primary dysmenorrhea were included in the study in a randomized controlled manner. Cases were randomized into three groups of 667 IU vitamin D once a day, 200 IU vitamin E once a day and 400 mg ibuprofen twice a day. The treatment was given two days before the expected date of menstruation and the first three days of menstruation. Treatment was continued in two consecutive cycles. Severity of menstrual pain was measured with Visual Analogue Scale (VAS), as the primary outcome. Need for using nonsteroidal anti-inflammatory drugs (NSAIDs) during two-month study period was evaluated as the secondary outcome.

Results: There were no significant difference in age, body mass index and baseline VAS scores between groups. Pain severity of vitamin D group after treatment was found as low as in the ibuprofen group. Median VAS scores of vitamin D, vitamin E and ibuprofen groups were 5 (1-10), 7 (1-10) and 7 (2-10), respectively after treatment (p<0.001). Requirement of NSAIDs was significantly less in vitamin D group than the vitamin E group (27.3% vs 65.9%, p<0.001). There were no side effects in groups.

Conclusion: Both vitamin D and E are effective in alleviation the pain of primary dysmenorrhea, however the effect of vitamin D is clearer.

Anahtar Kelimeler

Primary dysmenorrhoea, vitamin D, menstrual pain

Kaynakça

• Proctor ML, Smith CA, Farquhar CM, Stones RW. Transcutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea. Cochrane Database Syst Rev. 2002;(1):CD002123.
• Ruoff G, Lema M. Strategies in pain management: new and potential indications for COX-2 specific inhibitors. J Pain Symptom Manage. 2003;25( Suppl 2):21-31.
• Harlow SD, Park M. A longitudinal study of risk factors fort the occurance, duration and severity of menstrual cramps in a cohort of college women. Br J Obstet Gynaecol. 1996;103(11):1134-42.
• Robinson JC, Plichta S, Weisman CS, Nathanson CA, Ensminger M. Dysmenorrhoea and the use of oral contraceptives in adolescent women attending a family planning clinic. Am J Obstet Gynecol. 1992;166(2):578-83.
• Patel V, Tanksale V, Sahasrabhojanee M, Gupte S, Nevrekar P. The burden and determinants of dysmenorrhoea: A population-based survey of 2262 women in Goa, India. BJOG. 2006;113(4):453-63.
• Bernard K, Frayne SM, Skinner KM, Sullivan LM. Health status among women with menstrual symptoms. J Womens Health (Larchmt). 2003;12(9):911-9.
• Koike H, Egawa H, Ohtsuka T, Yamaguchi M, Ikenoue T, Mori N. Correlation between dysmenorrhoeic severity and prostaglandin production in women with endometriosis. Prostglandins Leukot Essent Fatty Acids. 1992;46(2):133-7.
• Morrison BW, Daniels SE, Kotey P, Cantu N, Seidenberg B. Rofecoxib, a specific cyclooxygenase-2 inhibitor, in primary dysmenorrhoea: a randomised controlled trial. Obstet Gynecol. 1999;94(4):504-8.
• Hayes EC, Rock JA. Cox-2 inhibitors and their role in gynecology. Obstet Gynecol Surv. 2002;57(11):768-80.
• Dawood MY. Primary dysmenorrhea: advances in pathogenesis and management. Obstet Gynecol. 2006;108(2):428-41.
• Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. BMJ. 2006;332(7550):1134-8.
• Vigano P, Lattuada D, Mangioni S, Ermellino L, Vignali M, Caporizzo E, et al. Cycling and early pregnant endometrium as a site of regulated expression of the vitamin D system. J Mol Endocrinol. 2006;36(3):415-24.
• Zehnder D, Bland R, Williams MC, McNinch RW, Howie AJ, Stewart PM, et al. Extrarenal expression of 25-hydroxyvitamin d (3)-1 α-hydroxylase. J Clin Endocrinol Metab. 2001;86(2):888-94.
• Helde-Frankling M, Björkhem-Bergman L. Vitamin D in pain management. Int J Mol Sci. 2017;18(10):E2170.
• Wu D, Mura C, Beharka AA, Han SN, Paulson KE, Hwang D, et al. Age-associated increase in PGE2 synthesis and COX activity in murine macrophages is reversed by vitamin E. Am Physiol. 1998;275(3):C661-8.
• El Attar TMA, Lin HS. Effect of vitamin C and vitamin E on prostaglandin synthesis by fibroblasts and squamous carcinoma cells. Prostaglandins Leukot Essent Fatty Acids. 1992;47(4):253-7.
• Lasco A, Catalano A, Benvenga S. Improvement of primary dysmenorrhoea caused by a single oral dose of vitamin D: results of a randomized, double-blind, placebo-controlled study. Arch Intern Med. 2012;172(4):366-7.
• Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimeters? Pain. 1997;72(1-2):95-7.
• Bertone-Johnson ER, Manson JE. Vitamin d for menstrual and pain-related disorders in women: comment on "improvement of primary dysmenorrhea caused by a single oral dose of vitamin d" Arch Intern Med. 2012;172(4):367-9.
• Harris HR, Chavarro JE, Malspeis S, Willet WC, Missmer SA. Dairy-food, calcium, magnesium, and vitamin D intake and endometriosis: a prospective cohort study. Am J Epidemiol. 2013;177(5):420-30.
• Kinuta K, Tanaka H, Moriwake T, Aya K, Kato S, Seino Y. Vitamin D is an important factor in estrogen biosynthesis of both female and male gonads. Endocrinology. 2000;141(4):1317-24.
• Sayegh L, Fuleihan Gel-H, Nassar AH. Vitamin D in endometriosis: A causative or confounding factor? Metabolism. 2014;63(1):32-41.
• Bertone-Johnson ER, Hankinson SE, Bendich A, Johnson SR, Willet WC, Manson JE. Calcium and vitamin D intake and risk of incident premenstrual syndrome. Arch Intern Med. 2005;165(11):1246-52.
• Anastasi E, Fuggetta E, De Vito C, Migliara G, Viggiani V, Manganoro L, et al. Low levels of 25-OH vitamin D in women with endometriosis and associated pelvic pain. Clin Chem Lab Med. 2017;55(12):e282-4.
• Bahrami A, Avan A, Sadeghnia HR, Esmaeili H, Tayefi M, Ghasemi F, et al. High dose vitamin D supplementation can improve menstrual problems, dysmenorrhea, and premenstrual syndrome in adolescents. Gynecol Endocrinol. 2018;34(8):659-63.
• Karacin O, Mutlu I, Kose M , Celik F, Kanat-Pektas M, Yilmazer M. Serum vitamin D concentrations in young Turkish women with primary dysmenorrhea: A randomized controlled study. Taiwan J Obstet Gynecol. 2018;57(1):58-63.
• Ziaei S, Faghihzadeh S, Sohrabvand F, Lamyian M, Emamgholy T. A randomised placebo-controlled trial to determine the effect of vitamin E in treatment of primary dysmenorrhoea. BJOG. 2001;108(11):1181-3.
• Ziaei S, Zakeri M, Kazemnejad A. A randomised controlled trial of vitamin E in the treatment of primary dysmenorrhoea. BJOG. 2005;112(4):466-9.