Management

Women will usually seek medical advice when self-help measures such as heat and over the counter NSAIDs have failed [41]. The mainstays of treatment are NSAIDs and the combined oral contraceptive pill, the latter especially when fertility control is required.

NON-STEROIDAL ANTI-INFLAMMATORY DRUGS

Meta-analysis shows that COX-1 inhibitors such as mefe-namic acid, naproxen, ibuprofen and aspirin are all effective [20,21,42,43]. Ibuprofen is the preferred analgesic because of its favourable efficacy and safety profiles [20,42,44]. Commencing treatment before the onset of menstruation appears to have no demonstrable advantage over starting treatment when bleeding starts. This observation is compatible with the short plasma half-life of NSAIDs. The advantage of starting treatment at the onset of menstruation is that it prevents the patient treating herself when she is unknowingly pregnant which would only become apparent when a period is missed.

It is interesting to note that traditional healers have used plants with significant COX-inhibitory activity to treat menstrual pain [45].

THE COMBINED ORAL CONTRACEPTIVE PILL

Although commonly used, clinical trial evidence supporting the efficacy of combined oral contraceptives in primary dysmenorrhoea is limited. They are thought to act by inhibiting ovulation and decreasing endometrial production of prostaglandins and leukotrienes by inducing endometrial atrophy and therefore reducing the amount of endometrial tissue available to produce these mediators [23,46,47]. However, most of the clinical trials were undertaken with contraceptives with higher doses of hormones than those currently used [23,46].

OTHER HORMONAL METHODS

Although primarily designed for parous women, the LNG-IUS may be an effective treatment for nulliparous women who have a contraindication to either NSAIDs or the combined oral contraceptive. In women aged 2547 years, the frequency of menstrual pain decreased from

60 to 29% after 36 months use of the device [48]. Other alternatives include depot progestogens used for contraception. Clinically they are effective since they render most women amenorrhoeic, but clinical trial data are scant. Of some of the new progestogen only contraceptive pills (e.g. 75 mcg desogestrel) effectively inhibit ovulation and thus probably relieve symptoms of dysmenorrhoea.

OTHER METHODS

A number of other pharmaceutical agents exist that alleviate the symptoms of dysmenorrhoea. An orally active vasopressin receptor antagonist has been shown to be effective [49].

Beta-adrenergic agonists and calcium channel blockers can reduce uterine contractility and thus are potentially effective but clinical trials have not been undertaken [50,51]. Transdermal glyceryl trinitrate has also been evaluated [52]. A placebo-controlled trial found both placebo and vitamin E are effective in relieving symptoms due to primary dysmenorrhoea, but the effects of vitamin E are more marked [53]. A randomized control study found supplementation with omega-3 polyunsaturated fatty acids beneficial in the management of dysmenorrhoea in adolescents [54]. The mode of action is presumed to involve altered prostaglandin biosynthesis.

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Pregnancy Diet Plan

Pregnancy Diet Plan

The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.

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