Anita Kant
Dept. of Obstetrics and Gynecology, Asian Institute of Medical Sciences, Faridabad, Haryana, India
Jayam Kannan
Dept. of Obstetrics and Gynecology, Garbba Rakshambigai Fertility Centre, Chennai, Tamil Nadu, India
Sunita Chandra
Dept. of Obstetrics and Gynecology, Rajendra Nagar Hospital & IVF Center and Morpheus Lucknow Fertility Center, Lucknow, Uttar Pradesh, India
Chandravati
Dept. of Obstetrics and Gynecology, Krishna Medical Centre, Lucknow, Uttar Pradesh, India
Bharti kalra
Dept. of Obstetrics and Gynecology, Bharti Hospital, Karnal, Haryana, India
Helen Mary
Dept. of Obstetrics and Gynecology, St. John's Medical College Hospital, Bengaluru, Karnataka, India
Prabhu Kasture
Deputy Director-Medical Services and Pharmacovigilance, Blue Cross Laboratoires Pvt Ltd., Mumbai, Maharashtra, India
Bharati Rajshekhar
Dept. of Obstetrics and Gynecology, Vaatsalya Hospital, Hassan, Karnataka, India
Anshu Jindal
Dept. of Obstetrics and Gynecology, IVF Specialist, Jindal Hospital and Fertility Center, Meerut, Uttar Pradesh, India
Amuthambigai
Dept. of Obstetrics and Gynecology, Uma Hospital, Tindivanam, Tamil Nadu, India
Sachin Dalal
Dept. of Obstetrics and Gynecology, IVF Specialist, Madhu Hospital and Embrion IVF & Fortis Hospital, Mumbai, Maharashtra, India
Reema Jain
Dept. of Obstetrics and Gynecology, Laparoscopic Surgeon and Infertility Specialist, Vaishnavi Nursing Home, Gurugram, Haryana, India
Sujata Kulkarni
Dept. of Obstetrics and Gynecology, Seeta Nursing Home, Nashik, Maharashtra, india
Surekha Vinay
Dept. of Obstetrics and Gynecology, Infertility Specialist and Laproscopic Surgeon, Gipson Clinic, Kurnool, Andhra Pradesh, India
Ummamaheshwar Sindur
Dept. of Obstetrics and Gynecology, Laparoscopic Surgeon, Sindur Hospital, Vijayapura, Karnataka, India
Pragya Ojha
Dept. of Obstetrics and Gynecology, VAMA - Centre for Women Health, Varanasi, Uttar Pradesh, India
Renu Chakravarty
Dept. of Obstetrics and Gynecology, Chakravarty Nursing Home, Panchkula, Haryana, India
Harini
Dept. of Obstetrics and Gynecology, Chikkaballapur Institute of Medical Sciences, Karnataka, India
Archana Mayekar
Dept. of Obstetrics and Gynecology, VN Desai Municipal General Hospital, Mumbai, Maharashtra, India
Jayanta Kumar Gupta
Dept. of Obstetrics and Gynecology, Apollo Multispecialty Hospitals, Kolkata, West Bengal, India
Ruchika Garg
Dept. of Obstetrics and Gynecology, Garg Clinic, Lucknow, Uttar Pradesh, India
Tushar Palve
Dept. of Obstetrics and Gynecology, Cama and Albless Hospital, Mumbai, Maharashtra, India
Nithya Vaidya
Dept. of Obstetrics and Gynecology, Yashada Nursing Home and Lifewave Hospital, Mumbai, Maharashtra, India
Nupur Chandan
Dept. of Obstetrics and Gynecology, Surya Clinic, Dhanbad, Jharkhand, India
Sonam Kumari
Infertility Consultant, Aveta Test Tube Baby Centre, Jharkhand, India
Vaishali Chaudhary
Dept. of Obstetrics and Gynecology, Siddhivinayak Hospital, Jalgaon, Maharashtra, India
Abstract
Painful menstrual cramps during or around the time of the monthly cycle are known as dysmenorrhea. The estimated global prevalence in women of reproductive age ranges from 45% to 95%. It has a significant negative impact on regular activities and productivity at work. However, despite the severe consequences on quality of life, primary dysmenorrhea (PD) is underdiagnosed. Dysmenorrhea has complex pathogenesis. It involves the release of prostaglandins and activation of the nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome and also includes the involvement of other mediators such as bradykinin, histamine and acetylcholine. Even though nonsteroidal anti-inflammatory drugs (NSAIDs) remain the most common type of pain medication, the question of which one should be the most preferred is still open to debate. The current review examines the existing evidence for the pathogenesis of PD and makes evidence based and clinical experience based recommendations for the use of mefenamic acid and its combination in the treatment of dysmenorrhea. Mefenamic acid alleviates PD by inhibiting endometrial prostaglandin formation, restoring normal uterine activity, and reducing the inflammatory response by inhibiting the NLRP3 inflammasome and reducing the release of cytokines such as interleukin (IL)-1β. It is also known to have bradykinin antagonist activity. Dicyclomine has a dual action of blocking the muscarinic action of acetylcholine in postganglionic parasympathetic effect or regions and acting directly on uterine smooth muscle by blocking bradykinin and histamine receptors to relieve spasms. According to the experts, mefenamic acid and dicyclomine act synergistically by acting on the different pathways of dysmenorrhea by blocking multifactorial agents attributed to the cause of dysmenorrhea. Hence, the combination of mefenamic acid and dicyclomine should be the preferred treatment option for dysmenorrhea.