Primary Dysmnorhea In Adolescents and Therapeutic Approaches

Year 2019, Volume: 16 Issue: 3, 160 - 166, 01.07.2019

Huri Güvey

Abstract

Dysmenorrhea is one of the most common gynecologic problems among adolescent and young adult females. Usually ıt ıs categorised into two types as primary and secondary dysmenorrhea. Primary dysmenorrhea is defined as recurrent, crampy pain occurring with menses in the absence of identifiable pelvic pathology. The prevalence of primary dysmenorrhea varies between 16% and 93%. Several studies suggest that severe menstrual pain is associated with absentenism from school or work and limitation of other daily activities. Studies indicate that increase in the activity of leukotriene and prostaglandin pathways in endometrium and uterin contractility contributes to the pathphysiology. Early menarch, long menstrual periods, heavy menstruation, smoking and family history are among the risk factors. Multidimensional pain scoring system and visual analog scale are used for grading the severity of the pain related with dismenorrhea. But these relies on the patient’s self reporting. Parity and advanced age are related with reduction of the prevalence of dismenorrhea. Nonsteroidal antiinflammatory drugs and hormonal contraceptives take place in medical treatment. Majority of the patiens response to these therapies. There are several options for nonsteroidal antiinflammatory drugs and there is no evidence that one is better than others. For hormonal contraception, oral contraceptive pills, contraceptive patchs, rings and intrauterine systems could be options. Hence, patients should be warned about advers effects of medical treatment. Complementary and alternative thereapies might be advised for the patients who don’t want medical treatment or couldn’t tolerate the advers effects of medical treatment. It was shown that alternative therapies such as heat therapy, exercise, transcutaneus electrical nerve stimulation, vitamine B1, B6, D, E, omega 3 and magnesium replacement are effective in dismenorrhea. Acupuncture, as a traditional treatment method from the past, also took place in treatment of primary dismenorrhea. But further studies are needed about effectiveness of complementary and alternative medicine.

Keywords

Adolescent, primary dismenorrhea, complementary and alternative treatment

Adölesanlarda Primer Dismenore Ve Tedavi Yaklaşımları

Abstract

Dismenore adölesanlarda ve genç kadınlarda en sık görülen jinekolojik problemlerden biridir. Genellikle primer ve sekonder olmak üzere iki tipte kategorize edilir. Primer dismenore mens döneminde ortaya çıkan tanımlanabilen herhangi bir pelvik patoloji olmadan rekürren, kramp şeklinde ortaya çıkan karın ağrılarıdır. Prevalansı %8,8 den %94 e kadar değişkenlik göstermektedir. Birçok çalışma şiddetli menstüel ağrının iş veya okuldan uzak kalmaya ve günlük aktivitelerde kısıtlanmaya yol açtığını göstermektedir. Patofizyolojiye endometriumdaki prostaglandin ve lökotrien yolaklarındaki aktivite ve uterin kontraksiyonlardaki artışın katkıda bulunduğu çalışmalarda belirtilmektedir. Erken menarş, uzun menstrüel periyotlar, yoğun menstrüel kanama, sigara kullanma ve aile öyküsü primer dismenorenin risk faktörleri arasında bulunmaktadır. Dismenoreyle ilişkili ağrını şiddetini derecelendirmede çok boyutlu ağrı skorlama sistemi ve görsel analog skala kullanılmaktadır. Ancak bunlar hastanın kendi ifadesine dayanmaktadır. Parite ve yaşın ilerlemesi dismenore sıklığında azalma ile ilişkilendirilmiştir. Medikal tedavide nonsteroidal anitiinflamatuar ilaçlar ve hormonal kontraseptifler yer almaktadır. Hastaların birçoğu bu tedavilere yanıt vermektedir. Primer dismenore tedavisi için birçok nonsteroidal anitiinflamatuar ilaç seçeneği vardır ve bunların birbirinden daha iyi olduğunu gösteren bir kanıt yoktur. Hormonal kontrasepsiyon için oral kontraseptifler, kontraseprif yamalar, halkalar ve rahim içi sistemler seçenek olabilir. Ancak hastalar medikal tedavilerin yan etkileri konusunda uyarılmalıdır. Medikal tedaviyi istemeyen veya yan etkilerinden dolayı tolere edemeyen hastalar için tamamlayıcı ve alternatif tedaviler önerilebilir. Sıcak tedavisi, egzersiz, transkutanöz elektrikli sinir uyarımı, B1, B6, D, E, vitaminleri omega 3 ve magnezyum replasmanı gibi alternatiflerin dismenorede etkili olduğu gösterilmiştir. Eskiden beri geleneksel tedavi yöntemi olarak birçok alanda kullanılan akupunktur kendine primer dismenore tedavisinde de yer bulmuştur. Ancak tamamalyıcı ve alternatif tedavilerin etkinliği konusunda daha fazla çalışmaya ihtiyaç vardır.

Keywords

Adölesan, primer dismenore, tamamlayıcı ve alternatif tedaviler

References

• Allen LM, Lam AC. Premenstrual syndrome and dysmenor-rhea in ado- lescents. Adolesc Med State Art Rev 2012; 23: 139-163.
• Harlow SD, Park M. A longitudinal study of risk factors for the occur- rence, duration and severity of menstrual cramps in a cohort of college women. Br J Obstet Gynaecol 1996; 103: 1134-1142.
• Gordley LB, Lemasters G, Simpson SR, Yiin JH. Menstrual disorders and occupational, stress, and racial factors among military personnel. J Occup Environ Med 2000; 42: 871-881.
• Subasinghe K A, Happo L, Jayasinghe Y L. Prevalence and severity of dysmenorrhoea, and management options reported by young Australian women. The Royal Australian College of General Practitioners. 2016;45: 829-834.
• Kazama M, Maruyama K, Nakamura K. Prevalence of dysmenorrhea and its correlating lifestyle factors in Japanese female junior high school stu- dents. Tohoku J Exp Med 2015;236:107-113.
• Ohde S, Tokuda Y, Takahashi O, Yanai H, Hinohara S, Fukui T. Dysmenor- rhea among Japanese women. Int J Gynaecol Obstet 2008;100:13–17.
• Parker MA, Sneddon AE, Arbon P. The menstrual disorder of teenagers (MDOT) study: determining typical menstrual patterns and menstrual disturbance in a large population based study of Australian teenagers. BJOG 2010;117:185–192.
• Balbi C, Musone R, Menditto A, et al: Influence of menstrual factors and dietary habits on menstrual pain in adolescence age. Eur J Obstet Gynecol Reprod Biol 2000; 91: 143.
• Hornsby PP, Wilcox AJ, Weinber CR: Cigarette smoking and disturbance of menstrual function. Epidemiology 1998; 9:193.
• Alvin PE, Litt IF: Current status of etiology and management of dysme- norrhea in adolescents. Pediatrics 1982; 70:516.
• Simopoulos AP: Omega-3 fatty acids in health and disease and in growth and development. Am J Clin Nutr 1991; 54:438.
• Chan WY, Hill JC: Determination of menstrual prostaglandin levels in nondysmenorrheic and dysmenorrheic subjects. Prostaglandins 1978; 15:365.
• Rees MCP, Di Marzo V, Tippins JR, et al: Leukotriene release by endo- metrium and myometrium throughout the menstrual cycle in dysmenor- rhea and menorrhagia. J Endocrinol 1987; 113:291.
• Levinson SL: Peptidoleukotriene binding in guinea pig uterine membrane preparations. Prostaglandins 1984; 28: 229.
• Harel Z, Lilly C, Riggs S, et al: Urinary leukotriene (LT)-E4 in adolescents with dysmenorrhea. J Adolesc Health 2000; 27:151.
• Ma H, Hong M, Duan J, Liu P, Fan X, Shang E, Su S, Guo J, Qian D, Tang Y. Altered cytokine gene expression in peripheral blood monocytes across the menstrual cycle in primary dysmenorrhea: a case-control study. PLoS One. 2013;8(2):e55200 doi: 10.1371
• Akerlund M, Stromberg P, Forsling ML. Primary dysmenorrhoea and va- sopressin. Br J Obstet 1979;86:484–487.
• Davis KD, Moayedi M. Central mechanisms of pain revealed through functional and structural MRI. J Neuroimmune Pharmacol 2013;8:518– 534.
• Tu CH, Niddam DM, Yeh TC, Lirng JF, Cheng CM, Chou CC, Chao HT, Hsieh JC. Menstrual pain is associated with rapid structural alterations in the brain. Pain 2013; Epub May 18
• Liu P, Yang J, Wang G, Liu Y, Liu X, Jin L, Liang F, Qin W, Calhoun VD. Altered regional cortical thickness and subcortical volume in women with primary dysmenorrhoea. Eur J Pain 2015 doi 10.1002
• Sundell G, Milsom I, Andersch B. Factors influencing the prevalence and severity of dysmenorrhoea in young women. Br J Obstet Gynaecol 1990;97:588–594.
• Weissman AM, Hartz AJ, Hansen MD, Johnson SR. The natural history of primary dysmenorrhoea: a longitudinal study. Br J Obstet Gynaecol 2004;111:345–352.
• Seven M et al. Evaluating dysmenorrhea in a sample of Turkish nursing students. Pain Manag Nurs. 2014;15:664-71.
• Boctor AM, Eickolt M, Pugsley TA: Meclofenamate sodium is an inhibitor of both the 5- lipoxygenase and cycloxygenase pathways of the arachi- donic acid cascade in vitro. Prostaglandins Leukot Med 1986; 23:229
• Marjoribanks J, Proctor M, Farquhar C, Derks RS. Nonsteroidal anti-inf- lammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev. 2010;(1):CD001751.
• Umland EM, Weinstein LC, Buchanan EM. Menstruation-related disor- ders. In: DiPiro J, Talbert RL, Yee GC, et al, eds. Pharmacotherapy: A Pathophysiologic Approach. Based on: DiPiro JT, Talbert RL, Yee GC, et al, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York, NY: McGraw-Hill; 2011.
• Marjoribanks J, Proctor M, Farquhar C, Derks RS. Nonsteroidal anti-inf- lammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev. 2010;(1):CD001751.
• Lefebvre G, Pinsonneault O, Antao V, et al. Primary dysmenorrhea con- sensus guideline. J Obstet Gynaecol Can. 2005;27:1117-1146.
• Wong CL, Farquhar C, Roberts H, Proctor M. Oral contracepti- ve pill for primary dysmenorrhoea. Cochrane Database Syst Rev. 2009;(4):CD002120.
• Dmitrovic R, Kunselman AR, Legro RS. Continuous compared with cyc- lic oral contraceptives for the treatment of primary dysmenorrhea: a ran- domized controlled trial. Obstet Gynecol. 2012;119:1143-1150.
• Akin MD, Weingand KW, Hengehold DA, et al. Continuous low-le- vel topical heat in the treatment of dysmenorrhea. Obstet Gynecol. 2001;97:343-349.
• Akin M, Price W, Rodriguez G Jr, et al. Continuous, low-level, topical heat wrap therapy as compared to acetaminophen for primary dysmenorr- hea. J Reprod Med. 2004;49:739-745.
• Lloyd KB, Hornsby LB. Complementary and alternative medications for women’s health issues. Nutr Clin Pract. 2009;24:589-608.
• Ziaei S, Faghihzadeh S, Sohrabvand F, et al. A randomised placebo-cont- rolled trial to determine the effect of vitamin E in treatment of primary dysmenorrhoea. BJOG. 2001;108:1181-1183.
• Lasco A, Catalano A, Benvenga S. Improvement of primary dysmenorr- hea caused by a single oral dose of vitamin D: results of a randomized, double-blind, placebo-controlled study. Arch Intern Med. 2012;172:366- 367.
• Latthe P, Mignini L, Gray R, et al. Factors predisposing women to chronic pelvic pain: systematic review. BMJ. 2006;332:749-755.
• Azima S, Bakhshayesh H R, Kaviani M. Comparison of the Effect of Mas- sage Therapy and Isometric Exercises on Primary Dysmenorrhea: A Randomized Controlled Clinical Trial. Journal of pediatric and adolescent gynecology. 2015 ;https://doi.org/10.1016/j.jpag.2015.02.003
• National Center for Complementary and Alternative Medicine. Acupun- cture: an introduction.
• Armour M, Dahlen H G, Zhu X. The role of treatment timing and mode of stimulation in the treatment of primary dysmenorrhea with acupunc- ture: An exploratory randomised controlled trial. Plos One. 2017;12(7): e0180177. https://doi.org/10.1371/journal.
• Witt CM, Reinhold T, Brinkhaus B, et al. Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care. Am J Obstet Gynecol. 2008;198:166.
• Parsa P, Bashırıan S. Effect of Transcutaneous Electrical Nerve Stimu- lation (TENS) on primary dysmenorrhea in adolescent girls. Journal of Postgraduate Medical Institute (Peshawar - Pakistan), North America, 27, Jun. 2013 available at :www.jpmi.org.pk date accessed 30 Nov