Primary dysmenorrhoea.
Primary dysmenorrhoea.
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DOI：
10.1136/bmj.1.6053.65
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发表时间：
1977-01
影响因子：
--
通讯作者：
中科院分区：
文献类型：
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Between 5 and 100o of girls in their late teens or early twenties are severely incapacitated by dysmenorrhoea for several hours each month.' Time is lost from school and work, and the financial loss to employers must be substantial. For some of those afflicted reassurance and a mild analgesic may make life bearable, but many others demand more from their family doctors and gynaecologists. Powerful analgesics tend to be habit-forming and are best avoided. In true, primary dysmenorrhoea suppressing ovulation by one of the oestrogenprogestogen oral contraceptive pills is likely to give relief. Even so, not all women are happy to have this treatment, and some find the side effects too troublesome to continue. Cervical dilatation has long been accepted as a reasonable minor surgical procedure where there has been no relief from medical treatment. Slow dilatation of the fibromuscular tissue at the level of the internal os is said,2 in properly selected cases, to cure 60°,, of cases and help another 20%. There is, however, always the risk of cervical damage and recurrent abortion in later life.2 Presacral neurectomy did have a vogue at one time once all simpler procedures had failed, but it has now become unfashionable. Akerlund et a13 have recently reported on myometrial activity and uterine blood flow in 11 women aged 19 to 33 who were so disabled by primary dysmenorrhoea that they were off work from one to three days each month. All had intrauterine pressures between 200 and 350 mm Hg during uterine contractions, and these high pressures were associated with a decrease in local uterine blood flow. Whatever the cause of this uterine hyperactivity (and the authors believe that excessive prostaglandin synthesis is a possibility), treatment with the selective 32-receptor stimulator terbutaline gave considerable relief to all their patients. Within minutes of the injection or infusion of 100 lg of terbutaline uterine contractions were either totally inhibited or their frequency and amplitude notably reduced, with well-defined periods of relaxation between contractions. At the same time local uterine blood flow increased significantly. The effect of the terbutaline lasted between one and two hours; the pain then gradually returned. Five patients had continuous recordings made from this point onwards, and both the myometrial contractions and the associated variations in local uterine blood flow were found to revert to their original pattern. Unfortunately the treatment induced distressing side effects: an increase in the heart rate, palpitations, tremors, and flushes. In a pilot study of giving the drug by mouth several patients stopped treatment because of these side effects, especially tremors. From their own studies and from a careful review of published work Halbert et a14 concluded that prostaglandin concentrations were raised in some but not all patients with primary dysmenorrhoea. They believed that excess production of prostaglandin was likely to be only part of the problem; in some patients the myometrium might be unduly sensitive to certain prostaglandins. In the belief that primary dysmenorrhoea and associated gastrointestinal symptoms were caused by excessive amounts of prostaglandin arising from the breakdown of premenstrual endometrium Schwartz et a15 treated patients with flufenamic acid, an inhibitor of prostaglandin synthesis. Sixteen women with typical, severe primary dysmenorrhoea (in whom treatment with other analgesic, spasmolytic, and tranquillising drugs and with placebos had been ineffective) were given 125 mg of the drug three times daily. The drug gave symptomatic relief in all 16 cases. These results do suggest that excessive prostaglandin formation may play a key part in primary dysmenorrhoea. Nevertheless, the authors wisely advise that the wider use of flufenamic acid for dysmenorrhoea should await the results of more extensive laboratory tests for toxicity and teratogenicity.
