A prospective study of the pattern of drug use in primary dysmenorrhea in a tertiary care hospital.pdf

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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
.
1
Karpaga Vinayaga Institute of Medical Sciences, Madurantakam, Kanchipuram District, Tamil
Nadu, India – 603308.
2
Kempegowda 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.
INTRODUCTION
Primary dysmenorrhea (PD) is a common
gynecological disorder characterized by painful
menstruation in the absence of any underlying pelvic
pathology.1,2
Its prevalence (71.9%) among
adolescent girls is particularly high.3
The medical,
social and economic consequence of PD are
International Journal of Research in
Pharmacology & Pharmacotherapeutics

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substantial causing interference with daily activities,
disruption of educational and social life leading to
school absenteeism and loss of labour.3
Prostaglandins (PGs) have a well recognized
pathophysiological role in PD by inducing intense
uterine contractions, decreasing uterine blood flow,
increasing peripheral nerve hypersensitivity and
resulting in pain. Patients with PD usually present
with colicky suprapubic pain, nausea, vomiting,
diarrhea and rarely syncopal attacks.1
The pharmacological measures for PD include
various non-steroidal anti-inflammatory drugs
(NSAIDs), antispasmodics and hormonal therapy.
NSAIDs which are PG synthesis inhibitors form the
main stay of treatment. Among them the most
commonly used are ibuprofen, mefenamic acid,
naproxen, ketoprofen, celecoxib, diclofenac.4
Hormonal therapy in the form of oral contraceptive
pills (OCPs) are reserved for patients with suboptimal
or lack of response to NSAIDs. Medroxy
progesterone acetate, levonorgestral releasing intra
uterine device and leuprolide are the other hormonal
agents that may be used.5
PD being a common gynecological disorder requires
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
regarding the choice of drug therapy, criteria for
selection, the dose, frequency and duration of
administration. Hence the present study is taken up to
study the pattern of drug use in PD.
MATERIALS & METHODS
Study design
A prospective observational study.
Study duration
Nine months from March 2012 – November 2012
Study subjects
100 consecutive patients attending Obstetrics &
Gynecology OPD, KIMS Hospital and Research
Centre, Bangalore and diagnosed as PD by the
gynecologist.
Study procedure
The study was conducted after prior approval from
Institutional Ethics Committee. The data from 100
patients fulfilling the inclusion and exclusion criteria
were recorded and analyzed. For each patient,
demographic data, menstrual history (including onset,
duration and severity of dysmenorrhea and its
associated symptoms), prescription details including
name of drug, dose, route and frequency of
administration, and also prescription by generic or
brand names were documented on a case record form.
Inclusion criteria
Data of patients with PD between 12-35 years of age
and with regular menstrual cycle (28±7 days).
Exclusion criteria
Data of patients with underlying pelvic pathology
(abnormal USG) indicating secondary dysmenorrhea.
Statistical analysis was done using SPSS version
19.0. The characteristics of demographic details,
dysmenorrhea and drug prescription patterns were
described using descriptive statistics. The association
of prescription pattern and severity of pain was
analyzed using Chi square test (p<.05 considered
statistically significant).
RESULTS
Total of 100 prescriptions of patients with PD were
analyzed. Their mean age and mean age at menarche
was 22.32 ± 4.5 and 12.8 ±1.7 years respectively. The
age distribution of the patients is given in Table 1.
Majority (93%) of them were from urban
background. Dysmenorrhea was experienced on 1st
day of menstrual flow by majority (76%) of patients,
1 day before menstrual flow in 13% patients, 2 days
before menstrual flow in 6% patients and >2 days
before menstrual flow in 5% patients. Mean duration
of dysmenorrhea was 2.2 days with 74% of patients
experiencing pain in the first 2-3 days of menstrual
cycle. Figure 1 shows the severity of dysmenorrhea
among the patients which was categorized using
verbal multi dimentional scoring system.7
The drug
prescribing pattern was as follows: A majority (72%)
of patients were prescribed a combination of
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%
patients respectively. Among the patients with severe
dysmenorrhea 42% were prescribed MA+Di, 10%

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MA, and 9% were prescribed D. Among those with
moderate dysmenorrhea 29% were prescribed MA +
Di, 6% MA and 3% patients were prescribed D. One
percent patients with mild dysmenorrhea were
prescribed MA + Di (Table 2). There was no
statistically significant relationship between drug
prescription and severity of dysmenorrhea (p>.05)
(Table 2).
DISCUSSION
Though PD is common in adolescents, in our study
only 27% belonged to adolescent age group (12-19
years) (Table 1). This may probably be due to lack of
awareness regarding existing medical treatment for
dysmenorrhea, practice of non-pharmacological
methods and prevalence of self medication practice in
them.8,9,10,11,12
The mean age at menarche was 12.8
years which was akin to the previous studies.13,14,15
Majority (93%) of the patients were from urban
background and only 7% were from rural, indicative
of better awareness and accessibility to institutional
health care facilities among the urban population.
With respect to onset of dysmenorrhea, in our study
majority (76%) of the patients experienced it on 1st
day of menstrual flow which is similar to the results
of previous studies.16
The mean duration of
dysmenorrhea was 2.2 days and majority(74%) of
patients experienced pain on 1st
2-3 days of menstrual
cycle which is in accordance with previous study and
probably because PG levels are highest during first
two days of menses.6
The prescribing pattern for PD included mefenamic
acid with dicyclomine combination (most commonly
prescribed), mefenamic acid alone and diclofenac
which are among the most commonly preferred drugs
for PD.4
None of the patients were prescribed OCPs
as they are indicated only when there is suboptimal or
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
pattern indicating that severity of pain was not taken
as a criteria for choice of drug in PD (p>.05, Table
2). Most of the drugs were prescribed by their brand
names which may undermine the essential drug
concept. Instructions to the patients regarding dose,
frequency and duration of drug administration were
present in all prescriptions but prophylactic analgesic
benefit of NSAIDs (that they can be taken 1-2 days
before the onset of menstruation) was not present. If
advice is given to the patients with severe
dysmenorrhea to take NSAIDs prophylactically the
burden of pain and its consequences can be reduced
substantially.
To conclude, the drug prescription pattern for PD
included NSAIDs and antispasmodics which were
prescribed irrespective of the severity of pain. The
results of this study along with other extensive drug
utilization studies on primary dysmenorrhea will be
helpful in the future for the appropriate and efficient
treatment and thereby decrease the social and
economic consequences associated with it.
Table 1. Age distribution of patients
Age group
(yrs)
% of patients
12-19 27
20-22 32
23-26 23
27-31 14
32-35 4
Total 100
Mean±SD 22.3±4.5

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Figure 1: Dysmenorrhea severity based on verbal multidimensional scoring system
Table: 2 Pattern of drug prescription and severity of dysmenorrhea
*Chi square test
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Dysmenorrhea severity MA MA + Di D
Mild 0 1 0
Modearte 6 29 3
Severe 10 42 9
Total 16 72 12
p* >.05
0
10
20
30
40
50
60
70
Mild Moderate Severe
Percentage(%)
Dysmenorrhea severity

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