Ibuprofen
Place in Therapy
Place in Therapy
The current understanding is that primary dysmenorrhea is caused by prostaglandin release in the menstrual fluid, causing pain and uterine contractions1,2. NSAIDs reduce prostaglandin biosynthesis by directly inhibiting cyclooxygenase (COX) activity1,2. This reduces menstrual fluid prostaglandin levels without affecting the development of the endometrium. Literature has shown that taking NSAIDs during menstruation reduced prostaglandin F2-alpha levels similar to or less than those found in eumenorrheic women2.
The results of a Cochrane review revealed NSAIDs are an effective treatment for primary dysmenorrhea4. There was little evidence to support the superiority of one individual NSAID over another4. The results of another systematic review indicated naproxen, ibuprofen, mefenamicacid, aspirin are all effective in the treatment of primary dysmenorrhea5. However, ibuprofen may be preferred due to its favourable risk-benefit profile5. Additionally, the SOGC 2005 guidelines, in women with primary dysmenorrhea, NSAIDs are first-line treatment (unless contraindicated) for pain relief and improved daily activity (Level 1-A)3. With NSAID therapy, caution should be placed in asthmatic or ASA-sensitive patients6. NSAIDs should be avoided in patients at risk of peptic ulcer and renal impairment6. Therefore, ibuprofen is considered as one of the 1st line non-prescription therapies for primary dysmenorrhea1,2,3,4,5.
References:
1. French L. Dysmenorrhea. Am Fam Physician. 2005;71(2):285-291.
2. Dawood MY. Primary dysmenorrhea: advances in pathogenesis and management. Obstet Gynecol. 2006;108(2):428-441.
3. Antao V, Black A, Burnett M ,et al. Primary Dysmenorrhea Consensus Guideline. J Obstet Gynaecol Can. 2005;169:1117-1130.
4. Marjoribanks J, Proctor M, Farquhar C, Derks RS. Nonsteroidal anti-inflammatory drugs for dysmenorrhea (Cochrane Review). In: Cochrane Database of Systematic Reviews. Issue 2, 2004.
5. Zhang WY, Li Wan Po A. Efficacy of minor analgesics in primary dysmenorrhea: a systematic review. Brit J Obstet Gynaec. 1998;105:780-9.
6.Patient Self-Care 2nd ed. 2010 Chpt 81: Dysmenorrhea; Canadian Pharmacists Association 775-781.
The current understanding is that primary dysmenorrhea is caused by prostaglandin release in the menstrual fluid, causing pain and uterine contractions1,2. NSAIDs reduce prostaglandin biosynthesis by directly inhibiting cyclooxygenase (COX) activity1,2. This reduces menstrual fluid prostaglandin levels without affecting the development of the endometrium. Literature has shown that taking NSAIDs during menstruation reduced prostaglandin F2-alpha levels similar to or less than those found in eumenorrheic women2.
The results of a Cochrane review revealed NSAIDs are an effective treatment for primary dysmenorrhea4. There was little evidence to support the superiority of one individual NSAID over another4. The results of another systematic review indicated naproxen, ibuprofen, mefenamicacid, aspirin are all effective in the treatment of primary dysmenorrhea5. However, ibuprofen may be preferred due to its favourable risk-benefit profile5. Additionally, the SOGC 2005 guidelines, in women with primary dysmenorrhea, NSAIDs are first-line treatment (unless contraindicated) for pain relief and improved daily activity (Level 1-A)3. With NSAID therapy, caution should be placed in asthmatic or ASA-sensitive patients6. NSAIDs should be avoided in patients at risk of peptic ulcer and renal impairment6. Therefore, ibuprofen is considered as one of the 1st line non-prescription therapies for primary dysmenorrhea1,2,3,4,5.
References:
1. French L. Dysmenorrhea. Am Fam Physician. 2005;71(2):285-291.
2. Dawood MY. Primary dysmenorrhea: advances in pathogenesis and management. Obstet Gynecol. 2006;108(2):428-441.
3. Antao V, Black A, Burnett M ,et al. Primary Dysmenorrhea Consensus Guideline. J Obstet Gynaecol Can. 2005;169:1117-1130.
4. Marjoribanks J, Proctor M, Farquhar C, Derks RS. Nonsteroidal anti-inflammatory drugs for dysmenorrhea (Cochrane Review). In: Cochrane Database of Systematic Reviews. Issue 2, 2004.
5. Zhang WY, Li Wan Po A. Efficacy of minor analgesics in primary dysmenorrhea: a systematic review. Brit J Obstet Gynaec. 1998;105:780-9.
6.Patient Self-Care 2nd ed. 2010 Chpt 81: Dysmenorrhea; Canadian Pharmacists Association 775-781.