Curative treatment of primary (spasmodic) dysmenorrhoea. [Magnesium--a new therapeutic alternative in primary dysmenorrhea]. [Therapeutic effects of magnesium in dysmenorrhea]. Flufenamic acid in treatment of primary spasmodic dysmenorrhoea. A double-blind crossover study. Efficacy and tolerability of lumiracoxib in the treatment of primary dysmenorrhoea.
To prove the efficacy of oral vitamin B1 administration for the treatment of primary dysmenorrhoea, a randomised, double-blind, placebo-controlled study was carried out on 556 girls aged 12-21 yr, having moderate to very severe spasmodic dysmenorrhoea. Thiamine hydrochloride (vitamin B1) was given in a dose of 100 mg orally, daily for 90 days. The combined final results of both the 'active treatment first' group and the 'placebo first' group, after 90 days of vitamin B1 administration, were 87 per cent completely cured, 8 per cent relieved (pain almost nil to reduced) and 5 per cent showed no effect whatsoever. The results remained the same two months later as well when no drug was administered. Unlike all the current treatments which are suppression-oriented, this curative treatment directly treats the cause, is free from side effects, is inexpensive and easy to administer. 50 patients suffering from primary dysmenorrhoea were treated with Magnesium (Mg 5-longoral, Artesan GmbH) in a double-blind study. After a six-month period 21 out of 25 women showed a decline of symptoms, only 4 ones reported no therapeutical effect. For monitoring treatment results prostaglandin F2 alpha (PGF2 alpha) was measured every second month. On Mg-therapy conditions we achieved a reduction of PGF2 alpha in menstrual blood to 45% of value before treatment started. As against that 90% of basic concentration were estimated from women who received a placebo. Probably, the specific therapeutical effect of Mg based on inhibition of biosynthesis of PGF2 alpha but also on its direct muscle relaxant and vasodilatory effect. Beside the PG-synthesis and ovulation inhibitors the use of Magnesium is a potential, natural opportunity to treat primary dysmenorrhoea, which is widely free of side effects. Primary dysmenorrhea is a common gynaecological symptom complex characterized by a painful syndrome occurring predominantly on the first and the second day of the cycle and associated with concomitant autonomic phenomena. In a randomized double-blind study, the therapeutic effect of magnesium has been investigated in 32 women (16 to 42 years old) who have been treated in the gynaecological outpatient-department at our clinic because of primary dysmenorrhea. The dosage of Magnesiocard comprised 3 X 5 mmol granulate orally on the day preceding menstruation and on the first and the second day of the cycle. At the end of the study, which covered six cycles, we were able to analyze the results in 21 patients, 11 having been treated with magnesium and 10 with placebo. While in the magnesium group only a slight effect was noted on the first day of the cycle under therapy when compared to both the placebo group and the dysmenorrhea disturbances persisting before therapy was started, magnesium had a therapeutic effect on both back pain and lower abdominal pain on the second and the third day of the cycle. Parallel to this therapeutic influence on the symptomatology of dysmenorrhea, a marked reduction in absences from work due to the dysmenorrhea was also noted. The possibilities of magnesium therapy in dysmenorrhea should be investigated further in multicentre studies. A double-blind cross-over trial of flufenamic acid three times a day (200 mg) was carried out in forty-four patients with primary dysmenorrhoea. While on flufenamic for 3 months 82% of patients experienced significant pain relief. Associated gastrointestinal symptoms, i.e--vomiting and diarrhoea--were relieved in 66% and 52% patients respectively while on flufenamic acid. It is concluded that the fenamates are useful and safe drugs in the treatment of primary dysmenorrhoea. Two randomised, multicentre, double-blind, placebo- and active-controlled, 3-way crossover studies were performed to evaluate the efficacy and tolerability of the novel COX-2 selective inhibitor lumiracoxib in the treatment of primary dysmenorrhoea. Subjects with moderate-to-severe dysmenorrhoea received lumiracoxib 400 mg once daily (od), rofecoxib 50 mg od and placebo (Study 1; n = 84) or lumiracoxib 400 mg od, naproxen 500 mg twice daily and placebo (Study 2; n = 99). For the primary variable, summed pain intensity difference from 0 to 8 h on day 1 (SPID-8), all active treatments were superior to placebo in each study (p < 0.001); lumiracoxib was comparable to rofecoxib and naproxen. For PID (categorical scale), all active treatments were significantly better than placebo from 2 to 12 h; lumiracoxib was generally comparable to rofecoxib and naproxen. All treatments were well tolerated. Lumiracoxib 400 mg is effective and well tolerated in the treatment of primary dysmenorrhoea, with efficacy comparable to rofecoxib and naproxen.
Vitamin B1 is shown to be an effective treatment for dysmenorrhoea taken at 100 mg daily, although this conclusion is tempered slightly by its basis on only one large RCT. Results suggest that magnesium is a promising treatment for dysmenorrhoea. It is unclear what dose or regime of treatment should be used for magnesium therapy, due to variations in the included trials, therefore no strong recommendation can be made until further evaluation is carried out. Overall there is insufficient evidence to recommend the use of any of the other herbal and dietary therapies considered in this review for the treatment of primary or secondary dysmenorrhoea.