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International Journal of Research in
Pharmacology & Pharmacotherapeutics
ISSN Print: 2278 – 2648 IJRPP Vol 3 Issue 1 Jan - Mar -2014
ISSN Online: 2278- 2656 Journal Home page: www.ijrpp.com

Research article Open Access
A prospective study of the pattern of drug use in primary
dysmenorrhea in a tertiary care hospital
Ramya Sugumar*1, Vasundara Krishniah2, Suvarna2, H.P.Pundarikaksha2, Prathap.B1,
Gladius Jennifer H1.

1Karpaga Vinayaga Institute of Medical Sciences, Madurantakam, Kanchipuram District, Tamil
Nadu, India – 603308.
2Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India – 560070
*Corresponding author: Ramya Sugumar.
Email address :
drramya.sugumar@gmail.com
Aim
To study the pattern of drug use in primary dysmenorrhea in a tertiary care hospital.
Materials and Methods
This prospective study of nine months duration was carried in Obstetrics and Gynecology OPD, in a tertiary care
teaching hospital among 100 patients with PD. The analysis was done for the pattern of drug use, prescribing
frequency of individual drug, to evaluate association between severity of dysmenorrhea and prescription pattern and
adequacy of prescription details.
Results
The mean age of the patients was 22.32 ± 4.5 years. Majority (61%) of patients experienced severe dysmenorrhea.
Mefenamic acid with dicyclomine combination was most frequently (72%) prescribed, followed by mefenamic acid
alone (16%) and diclofenac (12%) and none were prescribed hormonal preparations. Although majority (43%) of the
patients with severe dysmenorrhea were prescribed mefenamic acid with dicyclomine combination, the severity of
dysmenorrhea did not influence the prescription pattern and choice of drug (p>.05). Instructions regarding dose,
frequency and duration of drug administration were present in the prescriptions.
Conclusion
In our present study, NSAIDs and their combination with antispasmodics were prescribed most frequently. Majority
of the drugs were prescribed by their brand names. Instructions regarding the prophylactic benefit of NSAIDs were
not present in the prescriptions.
Keywords: Drug use study, NSAIDS, Primary dysmenorrhea, Tertiary care hospital.
gynecological disorder characterized by painful adolescent girls is particularly high.3 The medical, menstruation in the absence of any underlying pelvic social and economic consequence of PD are Ramya sugumar et al / Int. J. of Res. in Pharmacology & Pharmacotherapeutics Vol-3(1) 2014 [80-84]
substantial causing interference with daily activities, The study was conducted after prior approval from disruption of educational and social life leading to Institutional Ethics Committee. The data from 100 school absenteeism and loss of labour.3 patients fulfilling the inclusion and exclusion criteria Prostaglandins (PGs) have a well recognized were recorded and analyzed. For each patient, pathophysiological role in PD by inducing intense demographic data, menstrual history (including onset, uterine contractions, decreasing uterine blood flow, duration and severity of dysmenorrhea and its increasing peripheral nerve hypersensitivity and associated symptoms), prescription details including resulting in pain. Patients with PD usually present name of drug, dose, route and frequency of with colicky suprapubic pain, nausea, vomiting, administration, and also prescription by generic or diarrhea and rarely syncopal attacks.1 brand names were documented on a case record form. The pharmacological measures for PD include various anti-inflammatory Inclusion criteria
(NSAIDs), antispasmodics and hormonal therapy. Data of patients with PD between 12-35 years of age NSAIDs which are PG synthesis inhibitors form the and with regular menstrual cycle (28±7 days). main stay of treatment. Among them the most Exclusion criteria
commonly used are ibuprofen, mefenamic acid, Data of patients with underlying pelvic pathology (abnormal USG) indicating secondary dysmenorrhea. Hormonal therapy in the form of oral contraceptive Statistical analysis was done using SPSS version pills (OCPs) are reserved for patients with suboptimal 19.0. The characteristics of demographic details, or lack of response to NSAIDs. Medroxy dysmenorrhea and drug prescription patterns were progesterone acetate, levonorgestral releasing intra described using descriptive statistics. The association uterine device and leuprolide are the other hormonal of prescription pattern and severity of pain was agents that may be used.5 analyzed using Chi square test (p<.05 considered PD being a common gynecological disorder requires statistically significant). adequate treatment failing which it may be responsible for the silent suffering among young women.6 However, there is no unanimity or universally accepted and standardized guidelines Total of 100 prescriptions of patients with PD were regarding the choice of drug therapy, criteria for analyzed. Their mean age and mean age at menarche selection, the dose, frequency and duration of was 22.32 ± 4.5 and 12.8 ±1.7 years respectively. The administration. Hence the present study is taken up to age distribution of the patients is given in Table 1. study the pattern of drug use in PD. Majority (93%) of them were from urban background. Dysmenorrhea was experienced on 1st day of menstrual flow by majority (76%) of patients, MATERIALS & METHODS
1 day before menstrual flow in 13% patients, 2 days Study design
before menstrual flow in 6% patients and >2 days A prospective observational study. before menstrual flow in 5% patients. Mean duration of dysmenorrhea was 2.2 days with 74% of patients Study duration
experiencing pain in the first 2-3 days of menstrual Nine months from March 2012 – November 2012 cycle. Figure 1 shows the severity of dysmenorrhea among the patients which was categorized using Study subjects
verbal multi dimentional scoring system.7 The drug 100 consecutive patients attending Obstetrics & prescribing pattern was as follows: A majority (72%) Gynecology OPD, KIMS Hospital and Research of patients were prescribed a combination of Centre, Bangalore and diagnosed as PD by the mefenamic acid (250mg) + dicyclomine (10mg) (MA + Di) t.i.d, followed by mefenamic acid (250mg) (MA) t.i.d in 16% and diclofenac (50mg) (D) in 12% Study procedure
patients respectively. Among the patients with severe dysmenorrhea 42% were prescribed MA+Di, 10% Ramya sugumar et al / Int. J. of Res. in Pharmacology & Pharmacotherapeutics Vol-3(1) 2014 [80-84]
MA, and 9% were prescribed D. Among those with The prescribing pattern for PD included mefenamic moderate dysmenorrhea 29% were prescribed MA + acid with dicyclomine combination (most commonly Di, 6% MA and 3% patients were prescribed D. One prescribed), mefenamic acid alone and diclofenac percent patients with mild dysmenorrhea were which are among the most commonly preferred drugs prescribed MA + Di (Table 2). There was no for PD.4 None of the patients were prescribed OCPs statistically significant relationship between drug as they are indicated only when there is suboptimal or prescription and severity of dysmenorrhea (p>.05) lack of response to NSAIDs and when contraception is required in addition to pain relief.5 The severity of dysmenorrhea did not influence the prescribing DISCUSSION
pattern indicating that severity of pain was not taken Though PD is common in adolescents, in our study as a criteria for choice of drug in PD (p>.05, Table only 27% belonged to adolescent age group (12-19 2). Most of the drugs were prescribed by their brand years) (Table 1). This may probably be due to lack of names which may undermine the essential drug awareness regarding existing medical treatment for concept. Instructions to the patients regarding dose, dysmenorrhea, practice of non-pharmacological frequency and duration of drug administration were methods and prevalence of self medication practice in present in all prescriptions but prophylactic analgesic them.8,9,10,11,12 The mean age at menarche was 12.8 benefit of NSAIDs (that they can be taken 1-2 days years which was akin to the previous studies.13,14,15 before the onset of menstruation) was not present. If Majority (93%) of the patients were from urban advice is given to the patients with severe background and only 7% were from rural, indicative dysmenorrhea to take NSAIDs prophylactically the of better awareness and accessibility to institutional burden of pain and its consequences can be reduced health care facilities among the urban population. With respect to onset of dysmenorrhea, in our study To conclude, the drug prescription pattern for PD majority (76%) of the patients experienced it on 1st included NSAIDs and antispasmodics which were day of menstrual flow which is similar to the results prescribed irrespective of the severity of pain. The of previous studies.16 The mean duration of results of this study along with other extensive drug dysmenorrhea was 2.2 days and majority(74%) of utilization studies on primary dysmenorrhea will be patients experienced pain on 1st 2-3 days of menstrual helpful in the future for the appropriate and efficient cycle which is in accordance with previous study and treatment and thereby decrease the social and probably because PG levels are highest during first economic consequences associated with it. two days of menses.6 Table 1. Age distribution of patients
Age group % of patients
Ramya sugumar et al / Int. J. of Res. in Pharmacology & Pharmacotherapeutics Vol-3(1) 2014 [80-84]
Figure 1: Dysmenorrhea severity based on verbal multidimensional scoring system
Dysmenorrhea severity
Table: 2 Pattern of drug prescription and severity of dysmenorrhea
Dysmenorrhea severity MA MA + Di D
*Chi square test

REFERENCES
[1] Ropkin AJ, Howe NC. Pelvic pain and dysmenorrhea. In: Berek JS, editor. Novak's Gynecology. 14th ed. Philadelphia: Lippincot Williams & Wilkins; 2007. p. 505-40. [2] Umland EM, Weinstein LC, Buchanan C. Menstruation related disorders. In Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LW, editors. Pharmacotherapy a pathophysiologic approach. 7th ed. New York: McGraw Hill; 2008. p. 1329-44. [3] Agarwal AK, Agarwal A. A study of dysmenorrhea during menstruation in adolescent girls. India J Community Med 2010;35:159-64. [4] Mackay HT. Dysmenorrhea. In: McPhee ST, Papadakis MA, Gonzales R, Zeiger R, editors. Current Medical Diagnosis and Treatment. 49th ed. New York:McGraw Hill Lange; 2010. p. 655-86. [5] Sanfilippo J, Erb T. Evaluation and management of dysmenorrhea in adolescents. Clin Obstet Gynecol [6] Esimai OA, Omoniyi Esan GO. Awareness of menstrual abnormality amongst college students in urban area of Ile-Ife, Osun state, Nigeria. Indian Journal of Community Medicine 2010;35(1):63-6. [7] Andersch B, Milsom I. An epidemiological study among young women with dysmenorrhea. Am J Obstet Gynecol 1982;144:655-60. [8] Kolhe S, Deb S. Dysmenorrhea. Obstetrics, Gynecology and Reproductive Medicine 2011 Nov; Ramya sugumar et al / Int. J. of Res. in Pharmacology & Pharmacotherapeutics Vol-3(1) 2014 [80-84]
[9] Unsal A, Ayranci U, Tozun M. Arslan G, Calik E. Prevalence of dysmenorrhea and its effect on quality of life among a group of female university students. Upsala Journal of Medical Sciences 2010;115:138-45. [10] Lefebvre G, Pinsonneault O. SOGC Clinical Practice Guideline: Primary dysmenorrhea Consensus Guideline. JOGC 2005 Dec:1117-30. [11] Ropkin AJ, Howe NC. Pelvic pain and dysmenorrhea. In: Berek JS editor. Novak's Gynecology. 14th ed. Philadelphia: Lippincot Williams & Wilkins; 2007. p. 505-40. [12] Hillen TIJ, Grbavac SL, Johnston PJ, Straton JAY, Keogh JMF. Primary dysmenorrhea in young Wesatern Australian women: prevalence, impact and knowledge of treatment. Journal of Adolescent Health 1999;25:40-5. [13] Singh A, Kiran D, Singh H, Nel B, Singh P, Tiwari P. Prevalence and severity of dysmenorrhea: A problem related to menstruation, among first and second year female medical students. Indian J Physiol Pharmacol 2008;52(4):389-97. [14] Cakir M, Mungan I, Karakas T, Girisken I, Okten A. Menstrual pattern and common menstrual disorders among university students in Turkey. Pediatr Int 2007 Dec;49(6):938-42. [15 Dysfunctionsl uterine bleeding and other menstrual problems of secondary school students in Turkey. Pediatr Int 2007 Dec;49(6):938-42. [16] Eryilmaz G, Ozdemir F. Evaluation of menstrual pain management approaches by Northeastern Anatolian adolescents. Pain management Nursing 2009;10(1):40-7.

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Ajcn093294 1.13

AJCN. First published ahead of print February 25, 2015 as doi: 10.3945/ajcn.114.093294. Community-based management of severe acute malnutrition in India:new evidence from Bihar1–3 Sakib Burza, Raman Mahajan, Elisa Marino, Temmy Sunyoto, Chandra Shandilya, Mohammad Tabrez, Kabita Kumari,Prince Mathew, Amar Jha, Nuria Salse, and Kripa Nath Mishra Background: An estimated one-third of the world's children who are