Relief of dysmenorrhea with the prostaglandin synthetase inhibitor ibuprofen: effect on prostaglandin levels in menstrual fluid.

The prostaglandin synthetase inhibitor ibuprofen was evaluated for relief of severe primary dysmenorrhea in a controlled, double-blind, cross-over study in seven patients for a total of 23 menstrual cycles. In eight untreated cycles, the amount of prostaglandin (PG) in the menstrual fluid was higher than in nondysmenorrheic subjects. There was good to excellent relief of dysmenorrhea in seven ibuprofen-treated cycles, which was associated with a threefold to fourfold reduction in menstrual PG released. When a placebo was given in five cycles, only poor or minimal relief of dysmenorrhea was obtained and the menstrual PG released was similar to that in control cycles. In individual patients, there was a remarkable correlation between the severity of menstrual pain as assessed daily by the patient and the level of menstrual PG released during the corresponding period. The effect of ibuprofen therapy on menstrual fluid volume was inconsistent. The study shows that in severe primary dysmenorrhea there is increased release of PG in the menstrual fluid; this can be effectively suppressed with ibuprofen, which provides excellent relief from the symptoms of dysmenorrhea.