Do aspirin and acetaminophen affect total menstrual loss?

Two commonly taken over-the-counter analgesics, aspirin and acetaminophen, were compared for: effect on total menstrual loss, effect on total days of menstruation, and effect in reduction of pain due to headaches and/or menstrual cramps. Drugs were administered during a 4-month study according to a double-blind format. During the first 2 months, subjects ingested no drugs whatsoever during their menstrual periods. During the second 2 months, subjects ingested aspirin, acetaminophen, or placebo at the rate of two 325-mg tablets every 4 h to total 8 tablets per day during the first 3 days of their menstrual periods. Statistical analysis of the first 2 periods compared to the last 2 showed no differences in total menstrual weights. The number of days of menstruation in the placebo group was significantly lower (p = 0.0137) than in its own control or in the other groups. Neither analgesic showed a significant reduction in pain due to headache or cramps, although acetaminophen appeared to be slightly more effective than aspirin in reducing menstrual cramps.     

Determination of total menstrual blood loss.

OBJECTIVE: To develop and validate a simple method of measuring total menstrual blood loss using a pictorial representation of blood loss, the menstrual pictogram. DESIGN: A prospective evaluation of total menstrual blood loss measurement by the menstrual pictogram compared to the alkaline hematin technique. SETTING: Academic menorrhagia research clinic. PATIENT(S): One hundred twenty-one women; 62 women complaining of heavy menstrual blood loss, 59 women who considered their menstrual blood loss to be normal. INTERVENTION(S): Participants were asked to complete the menstrual pictogram through the period and collect their feminine hygiene products for an alkaline hematin assessment. MAIN OUTCOME MEASURE(S): Percentage agreement between blood loss measured by the gold standard alkaline hematin method and the menstrual pictogram. Extraneous blood loss was measured using a semiquantitative pictorial method. RESULT(S): The menstrual pictogram had a high level of agreement for blood collected on feminine hygiene products compared with the alkaline hematin method. Some women also lose a significantly large amount of extraneous blood, which is not proportional to the alkaline hematin blood loss assessment. CONCLUSION(S): The menstrual pictogram provides a simple means of measuring menstrual blood loss. It is no longer appropriate to ignore extraneous blood loss, particularly as there is no correlation between extraneous blood loss and that measured on feminine hygiene products.     

Assessment of menorrhagia by total menstrual fluid loss.

Half of the women presenting with heavy periods do not have objective menorrhagia. In the normal woman, blood is a minority component of total menstrual volume. This paper was designed to examine the hypothesis that the volume of total menstrual fluid loss (TMFL) could be more important than blood loss. A total of 115 women complaining of menorrhagia performed a menstrual collection from which TMFL and menstrual blood loss (MBL) was derived. In women complaining of menorrhagia, mean total menstrual fluid loss is 183.5 ml, with a corresponding menstrual blood loss of 110.3 ml. There is a significant correlation between TMFL and MBL (r = 0.82 (95% CI 0.75 - 0.87), p < 0.001). Blood loss accounts for an average of 60.5% of the total menstrual fluid loss with a wide range of 20 - 99.8%. A change in the proportion of TMFL loss that is blood may well be part of the complex reasons why women present.     

A rapid, noninvasive method for evaluation of total menstrual loss

Three types of packages containing enough sanitary supplies for one menstrual period were weighed and distributed to 100 subjects to determine adequacy of supplies and compliance to protocol. Returned packages were then reweighed to determine total menstrual loss. No subject used all the supplies in her package; therefore, packages contents were deemed ample. 7 subjects added their own purchased products to their packages; since added products were specified by name, weight corrections were easily made. 2 subjects lost unused supplies which were specified, and weight corrections were made accordingly. Evaporative loss from sealed and stored and frequently opened packages was measured. 100 g distilled water were added to contents inside 60 packages which were sealed and set aside 7 days. Average loss from these packages was 0.65 +/- 0.57 g. 5 g water were added to 60 packages 4 times daily for 5 days (100 g total). Then packages were set aside for 2 days and weighed on day 7. Average loss from these packages was 1.25 +/- 0.85 g. The combination of storage plus frequent opening resulted in an average loss of 1.90 +/- 0.87 g. Thus, the direct-weight method permits recovery of 97-98% of sample.     

Effect of Ginger and Novafen on menstrual pain: A cross-over trial

Objective

Menstrual pain is a periodic pain which happens during the days of menses. The menstrual disturbances as a health problem among young girls affect not only reproductive, but also psychical health and quality of life. This study was done with the goal of comparing the effect of Ginger and Novafen on the menstrual pain.

Influence of menstrual factors and dietary habits on menstrual pain in adolescence age

OBJECTIVES: The aim of this study was to determine the frequency of the primary dysmenorrhea in adolescence age and investigate correlation between menstrual factors, dietary habits and this pathology. STUDY DESIGN: The sample was constituted from 356 students that were subjected to questionnaire, abdominal ultrasound, and in some cases, hormonal dosing. RESULTS: The frequency of the primary dysmenorrhea was 85%. Early menarche was related to an increase of its prevalence and its severity. A long and heavy menstrual flow was related to an increase of its severity. As far as dietary habits, it was noted that a higher consumption of fish, eggs, fruit and a lower consumption of wine is correlated with a lower frequency. CONCLUSION: Primary dysmenorrhea is very common in young women. The risk factors for this pathology are early menarche, long and heavy menstrual flow, and lower consumption of fish, eggs, and fruit.     

Effect of ibuprofen, naproxen sodium and paracetamol on intrauterine pressure and menstrual pain in dysmenorrhoea

Summary. The effects of ibuprofen (400 mg), naproxen sodium (250 mg) and paracetamol (500 mg) on intrauterine pressure and menstrual pain was assessed in 12 women with dysmenorrhoea in a double–blind parallel study. Intrauterine pressure was recorded with a microtransducer catheter for 4 h and resting pressure, active pressure, frequency of pressure cycles and the area under the curve were analysed in 30–min periods. Ibuprofen, in a single oral dose of 400 mg, significantly reduced resting pressure, active pressure, the frequency of pressure cycles and the area under the curve and this was associated with a significant reduction in pain intensity. Neither paracetamol nor naproxen sodium effected significant changes in intrauterine pressure or pain score.     

Effect of ibuprofen, naproxen sodium and paracetamol on intrauterine pressure and menstrual pain in dysmenorrhoea

The effects of ibuprofen (400 mg), naproxen sodium (250 mg) and paracetamol (500 mg) on intrauterine pressure and menstrual pain was assessed in 12 women with dysmenorrhoea in a double-blind parallel study. Intrauterine pressure was recorded with a microtransducer catheter for 4 h and resting pressure, active pressure, frequency of pressure cycles and the area under the curve were analysed in 30-min periods. Ibuprofen, in a single oral dose of 400 mg, significantly reduced resting pressure, active pressure, the frequency of pressure cycles and the area under the curve and this was associated with a significant reduction in pain intensity. Neither paracetamol nor naproxen sodium effected significant changes in intrauterine pressure or pain score.     

Randomised comparative trial of the levonorgestrel intrauterine system and mefenamic acid for the treatment of idiopathic menorrhagia: a multiple analysis using total menstrual fluid loss, menstrual blood loss and pictorial blood loss assessment charts

OBJECTIVE: To compare the efficacy and tolerability of the levonorgestrel intrauterine system (LNG IUS) with mefenamic acid in the management of objective idiopathic menorrhagia. DESIGN: Phase III, Single centre, open, randomised, comparative, parallel group study. SETTING: District General Hospital in the United Kingdom. POPULATION: Fifty-one women with objective menorrhagia. METHODS: Twenty-five women randomised to receive the LNG IUS and 26 to oral mefenamic acid for six cycles. MAIN OUTCOME MEASURES: Change from baseline in menstrual blood loss (MBL), total menstrual fluid loss (TMFL) and pictorial blood loss assessment chart (PBAC) score at the third and sixth cycle of treatment. RESULTS: After six cycles the median menstrual blood loss was 5 mL in the LNG IUS group and 100 mL in the mefenamic acid group (P < 0.001). Median TMFL was 27 mL in the LNG IUS group and 157 mL in the mefenamic acid group (P < 0.001). Median PBAC score was 25 in the LNG IUS group and 159 in the mefenamic acid group. Changes in menstrual blood loss correlated strongly to changes in TMFL (r= 0.88) but PBAC correlated less well to blood loss and total fluid loss (r= 0.53 and r= 0.58). CONCLUSIONS: Both the LNG IUS and mefenamic acid significantly decreased menstrual blood loss, TMFL and PBAC scores. The LNG IUS produced greater reductions in all parameters than mefenamic acid. Comparison of the different measurements suggests that TMFL assessment may be an easier and a more relevant measure of symptom severity than menstrual blood loss.     

Effects of meclofenamate and acetaminophen on abdominal pain following tubal occlusion

To test the hypothesis that the postoperative abdominal pain of tubal occlusion is mediated by prostaglandins, the effects of meclofenamate, a potent inhibitor of cyclooxygenase, on postoperative analgesia and incidence of abdominal pain were compared with those of acetaminophen, a weak inhibitor of prostaglandin activity. One hundred patients undergoing tubal occlusion under local anesthesia were studied. The patients were randomly divided into four equal groups: control; acetaminophen, 1300 mg; meclofenamate, 100 mg; meclofenamate, 200 mg. The fallopian tubes were occluded by electrocautery in 47 patients and by application of Falope rings in 53 patients. Both acetaminophen and meclofenamate provided substantial analgesia for 4 hours after the operation (p less than 0.05). Meclofenamate reduced the incidence of abdominal pain by one half (p less than 0.02), but acetaminophen did not. These results suggest that a portion of pain relief achieved by meclofenamate may be due to suppression of myosalpingian and/or myometrial contractions, a process mediated by prostaglandins.     

Blood and total fluid content of menstrual discharge

Twenty-eight regularly menstruating female volunteers made careful collections of their sanitary pads and tampons on a daily basis throughout one menstrual period in such a way that the total fluid volume of the menstrual discharge could be accurately measured independently of the blood loss. The percentage contribution of blood (equivalent to mixed venous blood from the cubital fossa) to the total varied very greatly from woman to woman (1.6 to 81.7%) with a mean of 36.1 +/- 3.6% (+/- SEM). There was a highly significant correlation between total fluid loss and blood loss (r = 0.911, P less than .001). The proportion of blood remained approximately the same for different total volumes and on different days of the cycle. Women using no contraception or who had undergone tubal sterilization had similar ratios of blood to total fluid loss, whereas intrauterine device (IUD) users had a higher ratio (P less than .025) and oral contraceptive users a lower ratio that just reached statistical significance (P less than .05). It seems probable that the major component of the fluid loss that cannot be accounted for by blood is from endometrial tissue fluid rather than vaginal or cervical secretions.     

The effects of mefenamic acid and norethisterone on measured menstrual blood loss

Although there are numerous medical treatments for menorrhagia, in many instances neither the precise diagnosis nor the response to therapy have been assessed objectively. Menorrhagia (menstrual blood loss more than 80 mL per cycle) was diagnosed objectively in 32 (44%) of 72 women with a subjective complaint of heavy menses. All of the 32 women had ovulatory cycles. After random allocation to treatment with either mefenamic acid (500 mg three times daily during menses, N = 17) or norethisterone (5 mg twice daily on days 19-26 of the cycle, N = 15) for two additional cycles, the median menstrual blood loss was reduced from 123 mL (range 86-237) to 81 mL (22-193) (P less than .001) and from 109 mL (81-236) to 92 mL (43-189) (P less than .002) with mefenamic acid and norethisterone, respectively. Apart from a decrease in the median number of days of bleeding, from 7 (5-8) to 5 (3-8) in those women treated with mefenamic acid, no other differences were seen between the groups. We conclude that mefenamic acid and norethisterone were similarly effective in reducing the degree of menstrual blood loss in women with proved menorrhagia, but that 52 and 67% of the women, respectively, remained menorrhagic after 2 months of treatment.     

Diet-induced menstrual irregularities: effects of age and weight loss

Luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), and progesterone (P) levels were followed in 22 healthy, normal-weight women (aged 19 to 30 years) for a control and a diet menstrual cycle. During the diet cycle, they lost weight on a high-carbohydrate, vegetarian, 1000-calorie diet. During the control cycle, luteal phase in 5 subjects failed to meet the criteria: length greater than or equal to 8 days and P maximum greater than or equal to 6 ng/ml; during the diet cycle, the number of subjects who failed to meet these criteria was 14 (chi-square test, P less than 0.02). No evidence of follicular phase disturbance was observed during the diet. Age and weight loss significantly changed parameters of the diet luteal phase: length and area under LH, FSH, E2, and P curves. Generally, hormone plasma concentrations during the luteal phase were lower the younger the age and the greater the weight loss.     

A new and simple method of measuring menstrual blood loss

Although it is difficult for women to make reliable judgments about their menstrual blood loss, the direct measurement of such blood loss is useful in diagnosis and in evaluation of therapy. We developed a new and simple procedure for measuring blood on sanitary materials. The procedure is a modification of previous alkaline hematin methods but overcomes some of their major drawbacks. The method involves the separate extraction of blood using a detergent solution and color development of sample aliquots with sodium carbonate. The standard curves obtained for four products tested--regular maxi pads, thin maxi pads and two brands of tampons--were significantly linear over the range of 1-10 mL of blood. The extraction efficiency varied with the four products; tampons exhibited the highest extraction efficiency and thin maxi pads the lowest. Blood loss in normally menstruating women was estimated to be 41.8 +/- 3.9 mL, which correlates well with other estimates reported. Furthermore, the procedure can be used to measure both very low and very concentrated levels of blood on pads or tampons and thus can be used to assess both functional and dysfunctional uterine bleeding.     

Effect of bromocriptine on menstrual cycle length

Forty-seven women with regular ovulatory menstrual cycles and normal plasma prolactin levels were treated with different doses of bromocriptine, and changes in follicular and luteal phase length determined by daily estimation of plasma gonadotrophin concentration. Follicular phase length was highly significantly reduced from a median duration of 12.7 days in the basal cycle to 11.7 days in the first treatment cycle, and to 10.7 days during the second treatment cycles. The length of the luteal phase was unaltered by treatment with bromocriptine. Reduction of follicular phase length was not influenced by the dose of bromocriptine used, and it is concluded that this effect is a consequence of the reduction of plasma prolactin concentration.     

Effect of war on the menstrual cycle

OBJECTIVE: To study the effect of a short period of war on the menstrual cycles of exposed women. METHODS: Six months after a 16-day war, women in exposed villages aged 15-45 years were asked to complete a questionnaire relating to their menstrual history at the beginning, 3 months after, and 6 months after the war. A control group, not exposed to war, was also interviewed. The data collected were analyzed to estimate the effect of war on three groups of women: those who stayed in the war zone for 3-16 days (Group A), those who were displaced within 2 days to safer areas (Group B), and women not exposed to war or displacement (Group C-control). RESULTS: More than 35% of women in Group A and 10.5% in Group B had menstrual aberrations 3 months after the cessation of the war. These percentages were significantly different from each other and from that in Group C (2.6%). Six months after the war most women regained their regular menstrual cycles with the exception of 18.6% in Group A. CONCLUSION: We found a short period of war, acting like an acute stressful condition, resulted in menstrual abnormalities in 10-35% of women and is probably related to the duration of exposure to war. This might last beyond the war time and for more than one or two cycles. In most women the irregular cycles reversed without any medical intervention. LEVEL OF EVIDENCE: II.