Katherine Morrison's List: PMS / Dysmenorrhea

Magnesium
 
A Cochrane data analysis in 2001 found three small trials comparing magnesium with placebo for relief of primary dysmenorrhea.65 Magnesium was more effective, but the dose and regime were widely variable. Magnesium has been given as magnesium pidolate.66 In one study, magnesium reduced menstrual fluid PGF2[alpha] to 45% of its pretreatment levels,67 which provides a mechanistic rationale for this therapy. Currently, it is not clear what dose, preparation, and regime to use for magnesium in treating primary dysmenorrhea. Further studies are needed.

 
Calcium Antagonists
 
Nifedipine, a calcium channel blocker, inhibits myometrial contractility, thereby relieving primary dysmenorrhea.68-70 By blocking calcium entry into smooth muscle cell, intracellular free calcium is reduced, the muscle relaxes, contractions are reduced, vasodilatation is promoted, and ionic stimulation of prostanoids release is decreased. Adverse effects reported from the studies include transient facial flush, increased pulse rate, palpitations, and headache.

Cochrane Database Syst Rev. 2001;(3):CD002124.Herbal and dietary therapies for primary and secondary dysmenorrhoea.Proctor ML, Murphy PA.SourceDepartment of Obstetrics and Gynaecology, National Women's Hospital, Claude Road, Epsom, Auckland, New Zealand, 1003. ml.wilson@auckland.ac.nz
"MAGNESIUM: Three small trials were included that compared magnesium and placebo. Overall magnesium was more effective than placebo for pain relief and the need for additional medication was less. There was no significant difference in the number of adverse effects experienced.

Results suggest that magnesium is a promising treatment for dysmenorrhoea. It is unclear what dose or regime of treatment should be used for magnesium therapy, due to variations in the included trials, therefore no strong recommendation can be made until further evaluation is carried out"

"VITAMIN B1: One large trial showed vitamin B1 to be more effective than placebo in reducing pain.  

Vitamin B1 is shown to be an effective treatment for dysmenorrhoea taken at 100 mg daily, although this conclusion is tempered slightly by its basis on only one large RCT."

"Magnesium is an essential mineral with evidence of effectiveness in treating eclampsia and preeclampsia, arrhythmia, severe asthma, and migraine (Table 3).

Studies have shown the effectiveness of magnesium in eclampsia and preeclampsia, arrhythmia, severe asthma, and migraine. Other areas that have shown promising results include lowering the risk of metabolic syndrome, improving glucose and insulin metabolism, relieving symptoms of dysmenorrhea, and alleviating leg cramps in women who are pregnant. The use of magnesium for constipation and dyspepsia are accepted as standard care despite limited evidence."

"Early signs of magnesium deficiency include loss of appetite, nausea, vomiting, fatigue, and weakness. Persons may experience numbness, tingling, muscle contractions and cramps, seizures, personality changes, abnormal heart rhythms, and coronary spasms as magnesium levels decrease. "

"There are challenges in diagnosing magnesium deficiency because of its distribution in the body. Magnesium is an intracellular cation and its blood concentrations may not accurately mirror magnesium status.6 However, reductions in normal serum magnesium concentrations (1.8 to 2.3 mg per dL [0.74 to 0.95 mmol per L]) signify deficiency. Therefore, serum magnesium concentrations are specific, but not sensitive, to magnesium deficiency.7"

"wo Cochrane reviews showed that magnesium use in patients with eclampsia was superior to that of phenytoin (Dilantin) and lytic cocktail,21,22 with another study showing magnesium to be more effective than nimodipine (Nimotop).23 A different 2003 Cochrane review showed that 1 to 2 g of intravenous magnesium sulfate per hour reduced the risk of eclampsia in patients with preeclampsia by more than one half.24 "