Monday 19 April 2010, 2:32PM
PEARLS 236 March 2010, written by Brian R McAvoy
Clinical question
How effective are non-steroidal anti-inflammatory drugs (NSAIDs)
in the treatment of primary dysmenorrhoea?
Bottom line
Compared with placebo, NSAIDs are a highly effective treatment
for dysmenorrhoea, though women using them need to be aware of the
significant overall risk that they may cause adverse effects, such
as indigestion, headaches or drowsiness. There is insufficient
evidence to indicate whether any individual NSAID is more effective
or safer than others. It appears NSAIDs are more effective than
paracetamol, though there were only 3 relevant studies. Nineteen
different types of cox-1 NSAIDs were evaluated in the included
studies.
Caveat
The included studies used a wide variety of continuous pain
scales as their primary or sole measure of effectiveness. The
measurement and reporting of adverse effects was generally poor. At
least half the studies were co-authored or financially supported by
pharmaceutical company associates and it was unclear how most of
the other studies were funded.
Context
Dysmenorrhoea is a common gynaecological problem, consisting of
painful cramps accompanying menstruation, which in the absence of
any underlying abnormality is known as primary dysmenorrhoea.
Research has shown women with dysmenorrhoea have high levels of
prostaglandins, hormones known to cause cramping abdominal pain.
NSAIDs are drugs which act by blocking prostaglandin production.
Cochrane Systematic Review
Marjoribanks J et al. Non-steroidal anti-inflammatory drugs for
dysmenorrhoea. Cochrane Reviews 2010, Issue 1. Article No.
CD001751. DOI: 10.1002/14651858.CD001751.pub2. This review contains
73 studies involving 5156 participants.