Harel Zeev
Warren Alpert Medical School of Brown University, Hasbro Children's Hospital/Rhode Island Hospital, Division of Adolescent Medicine, Department of Pediatrics, 593 Eddy Street, Providence, RI 02903, USA.
Expert Opin Pharmacother. 2008 Oct;9(15):2661-72. doi: 10.1517/14656566.9.15.2661.
Dysmenorrhea is the most common gynecologic complaint among adolescent and young adult females. Dysmenorrhea is usually primary and is associated with normal ovulatory cycles and with no pelvic pathology. In approximately 10% of females with severe dysmenorrhea symptoms, pelvic abnormalities such as endometriosis or uterine anomalies may be found.
To review the current knowledge regarding the pathophysiology of dysmenorrhea, as well as review pharmacological treatments and strategies for management of dysmenorrhea in adolescent and young adult females.
Review of original articles on dysmenorrhea that have been published in the medical literature.
RESULTS/CONCLUSIONS: Potent prostaglandins and potent leukotrienes play an important role in generating primary dysmenorrhea symptoms. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most common pharmacologic treatment for dysmenorrhea. A loading dose of NSAIDs (typically twice the regular dose) should be used as initial treatment for dysmenorrhea, followed by a regular dose until symptoms abate. Adolescents and young adults with symptoms that do not respond to treatment with NSAIDs for three menstrual periods should be offered hormonal treatment such as combined estrogen/progestin oral contraceptive pills (OCPs) for three menstrual cycles. If dysmenorrhea does not improve within 6 months of treatment with NSAID and OCPs, a laparoscopy is indicated to look for endometriosis. The goal of pharmacological treatment for endometriosis is to block its abnormal positive feedback loop. The abnormal loop consists of high local levels of estrogen in the lesions, which induce transcription of COX-2 and synthesis of prostaglandin E(2.) This results in further expression and activity of aromatase and a further increase in estrogen.
痛经是青春期和年轻成年女性中最常见的妇科主诉。痛经通常为原发性，与正常排卵周期相关且无盆腔病变。在约10%有严重痛经症状的女性中，可能会发现盆腔异常，如子宫内膜异位症或子宫异常。
回顾关于痛经病理生理学的现有知识，以及青少年和年轻成年女性痛经的药物治疗和管理策略。
回顾医学文献中发表的关于痛经的原始文章。
结果/结论：强效前列腺素和强效白三烯在原发性痛经症状的产生中起重要作用。非甾体抗炎药（NSAIDs）是治疗痛经最常用的药物。NSAIDs的负荷剂量（通常为常规剂量的两倍）应用于痛经的初始治疗，随后给予常规剂量直至症状缓解。对NSAIDs治疗三个月经周期无反应的青少年和年轻成年人，应给予激素治疗，如联合雌激素/孕激素口服避孕药（OCPs）三个月经周期。如果痛经在使用NSAIDs和OCPs治疗6个月内未改善，则需进行腹腔镜检查以寻找子宫内膜异位症。子宫内膜异位症的药物治疗目标是阻断其异常的正反馈回路。该异常回路包括病变中局部高水平的雌激素，其诱导COX-2转录和前列腺素E（2）合成。这导致芳香化酶的进一步表达和活性增加以及雌激素进一步升高。
