Diagnosis and management of dysmenorrhoea
BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7550.1134 (Published 11 May 2006) Cite this as: BMJ 2006;332:1134
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Proctor and Farrell list magnesium and fish oil supplements for
dysmenorrhoea as herbal or alternative treatments but these are often
needed for repletion of very common essential nutrient deficiencies.
Erythrocyte analyses can acurately diagnose magnesium and omega-3 (and
often omega-6) polyunsaturated fatty acid (PUFA) deficiencies in women
with dysmenorrhoea. Repletion is therefore indicated to prevent a plethora
of well established impairments in cell functions. Trials of essential
nutrient repletion, without biochemical analyses confirming successful
repletion, are seldom satisfactory. Also many essential nutrients,
including zinc, copper, selenium and chromium, B vitamins and PUFAs, are
often deficient in patients with gynaecological or neurological symptoms.
Cochrane evidence seems to concentrate on drug testing-type randomised
double blind placebo controlled trials rather than on basic clinical
investigations of causes in individual patients.
Large international trials of use of progestogens and oestrogens have
been terminated prematurely because of increases in breast cancer,
thrombosis, strokes and heart attacks. It is therefore unwise to give
contraceptive progestogens and oestrogens to women with dysmenorrhoea to
block ovulation but cause more undiagnosed underlying biochemical
abnormalities.
Competing interests:
None declared
Competing interests: No competing interests
M Proctor & C Farquhar's review of the diagnosis and treatment of
dysmenorrhoea whilst helpful and thorough did not include several points,
that as a GP, I feel are very relevant,particually to school-age girls
with painful periods.
One of the main barriers to effective management of dysmenorrhoea is
that many girls do not use school toilets and so spend their day with
either a full bladder or one with very concentrated urine in it.They do
not drink clear fluids (for several reasons)and often have a diet low in
fibre and so are prone to constipation as well.
These two reasons alone will mean that when they are menstruating their
pain is exacerbated by a full bladder and often a full rectum and
therefore analgesia is often ineffective.
The average age of the menarche has dropped by two years since most
of our secondary schools were built.In my opinion they do not provide the
facilities which these young women need ,let alone those any work place
would be expected to provide for it's employees.
It is therefore at worst bad practice, and at the least ineffective,
to "put these girls on the pill" when some simple changes in their schools
and diet might make all the difference.
Competing interests:
Mother of 2 girls one of whom attends a secondary school
Competing interests: No competing interests
I read the article about the diagnosis and management of
dysmenorrhoea with interest as it is a very common problem in general
practice. However, I was concerned that it suggested that simple
analgesics such as ASPIRIN and paracetamol may be useful as a starting
point especially when NSAIDs (non-steroidal anti-inflammatory drugs) are
contraindicated as aspirin is a member of the family of NSAIDs and so
should also be contraindicated.
Competing interests:
None declared
Competing interests: No competing interests
Non-Medicinal Pain Control Option for Dysmenorrhea
Another option is the use of a transcutaneous electrical nerve
stimulation (TENS) unit. A small battery operated and user controlled
device with surface electrodes has shown efficacy as a non-medicinal
alternative for the control of dysmenorrhea.
I completed a study on this that was published in the Clinical
Journal of Pain and to my knowledge was not included in the Cochrane
Database.
Mannheimer, JS & Whalen E. The efficacy of transcutaneous
electrical nerve stimulation in dysmenorrhea. Clinical Journal of Pain,
1(2): 75-83, 1985.
Additional publications which have also shown efficacy:
Benassi, et al. Efficacy of mini-TENS in the treatment of primary
dysmenorrhea. Ann Oset Ginecol Med Perint, 113(4); 207-214, 1992.
Kaplan, et al. Clinical evaluation of a new model of a transcutaneous
electrical nerve stimulation device for the management of primary
dysmenorrhea. Gynecol Obstet Invest 44(4): 255-259, 1997.
Competing interests:
None declared
Competing interests: No competing interests