Guaifenesin as a Treatment for Primary Dysmenorrhea
Guaifenesin as a Treatment for Primary Dysmenorrhea
Background: Dysmenorrhea is highly prevalent and causes much work loss and discomfort. A treatment with a new mechanism of action could benefit women of menstruating age. A study was undertaken to assess the efficacy of guaifenesin as a treatment for primary dysmenorrhea because of its effects of cervical dilation and cervical mucous thinning.
Methods: Thirty-four subjects with primary dysmenorrhea were enrolled in a double-blind, placebo-controlled study. Three treatment surveys measured 10 symptoms (lower abdominal pain, general abdominal pain, back pain, headache, nausea, diarrhea, constipation, menstrual flow, weakness, and activities of daily living) on a 100-mm visual analog scale. Nonstudy analgesic use was also measured.
Results: Twenty-five subjects returned the first treatment survey, and 17 returned all 3 surveys. Results were nonsignificant, but guaifenesin trended toward being better than placebo for dysmenorrhea pain and associated constitutional symptoms and caused no worsening of symptoms. Lower abdominal mean pain scores from the first survey decreased 38 mm for guaifenesin versus 7 mm for placebo. By the third survey, only 2 of 8 guaifenesin participants took nonstudy analgesics compared with all 9 placebo subjects.
Conclusions: Guaifenesin may be useful in the treatment of primary dysmenorrhea. A larger study is needed to validate these initial findings.
Dysmenorrhea is a disorder characterized by lower abdominal pain that occurs during menstruation, but the pain may start 2 or more days before menstruation. It is sometimes associated with headache, nausea, vomiting, diffuse abdominal pain, backache, general malaise, weakness, and other gastrointestinal symptoms. Dysmenorrhea is often under-treated because physicians are not fully aware of its high prevalence and morbidity. Primary dysmenorrhea is generally believed to affect 50% of menstruating women, and some degree of dysmenorrhea may be present in as many as 90%. Many women do not consider dysmenorrhea noteworthy enough to answer positively about it or to bring it up with their physician even if it restricts their daily activities, yet a great deal of absenteeism and decreased productivity is caused by dysmenorrhea, and some patients are not using adequate doses of treatment.
Dysmenorrheic women may have contractions reaching intrauterine pressures of 200 mm Hg (versus 100 mm Hg for a nondysmenorrheic woman) at very frequent disorganized intervals. Uterine arterial pulsations disappear, suggesting ischemia in the dysmenorrheic uterus. Transdermal glyceryl trinitrate decreases uterine pain. Decreasing intrauterine pressure can be achieved through decreasing the frequency and strength of uterine contractions and/or decreasing cervical os resistance.
For many women, current therapies offer inadequate treatment. Estimates of the effectiveness of current treatments (including oral contraceptives and nonsteroidal anti-inflammatory drugs) range from 64 to 90% of patients but some women have intolerable side effects (such as gastric upset and infertility). The available treatments decrease impairment but not to the nonmenstruating level of productivity for all women. Some patients resort to surgical treatment. The long-term and associated health risks of dysmenorrhea have not been studied. Adding a medication with a different mechanism of action to the treatment of dysmenorrhea may benefit some women.
Guaiacol glyceryl ether (guaifenesin) has been used for years to promote expectoration of secretions in patients with pulmonary disease. The drug is derived from the resin of guaiacum trees and was introduced to European medicine in the 16th century as an analgesic. Guaifenesin is also used as a muscle relaxant in veterinary anesthesia to aid in induction. It has been reported to be effective for prostatitis, seminal vesiculitis, benign prostatic hypertrophy, prostatic abscess, bladder neck hypertrophy, and urinary tract infection pain. A European patent application claims guaiacol and its derivatives are useful for the treatment of heartburn and constipation.
Guaifenesin has also been shown to have effects on the uterine cervix. Guaifenesin (200 mg) 3 times a day improves fertility; perhaps by improving spinnbarkheit, ferning, and cellularity of cervical mucus. The 2 types of cells that produce this mucus are muciparous, similar to those found in other mucus epithelia, and other mucus cells that respond under the stimulus of ovarian hormones. Three obstetric articles mention the use of a guaifenesin compound in labor to speed the effacement of the cervix. In a study using 1000 to 2000 mg of guaifenesin intravenously, the mean labor time was reduced by half in both primiparas and multiparas compared with the control group.
Compounds of guaifenesin with paracetamol, caffeine, phenobarbital, or acetylsalicylic acid are used for pain control. The guaifenesin is thought to speed absorption of the other ingredients. Dolmina, a drug consisting of 200 mg of guaifenesin and 325mg of acetylsalicylic acid per tablet, was compared with an indomethacin product in a study of women with primary dysmenorrhea. Although the difference in pain scores was insignificant, there was a strong patient preference for the guaifenesin compound.
A patient with severe dysmenorrhea was tried on prescription dose guaifenesin (2400 mg/day) during menses, aiming for a decrease in cervical os resistance via the thinning effect of the guaifenesin on cervical mucus. She experienced resolution of her symptoms.
We hypothesized that guaifenesin alone, through its possible effects of analgesia, muscle relaxation, cervical dilation, and cervical mucous thinning, could be effective in the treatment of primary dysmenorrhea.
Background: Dysmenorrhea is highly prevalent and causes much work loss and discomfort. A treatment with a new mechanism of action could benefit women of menstruating age. A study was undertaken to assess the efficacy of guaifenesin as a treatment for primary dysmenorrhea because of its effects of cervical dilation and cervical mucous thinning.
Methods: Thirty-four subjects with primary dysmenorrhea were enrolled in a double-blind, placebo-controlled study. Three treatment surveys measured 10 symptoms (lower abdominal pain, general abdominal pain, back pain, headache, nausea, diarrhea, constipation, menstrual flow, weakness, and activities of daily living) on a 100-mm visual analog scale. Nonstudy analgesic use was also measured.
Results: Twenty-five subjects returned the first treatment survey, and 17 returned all 3 surveys. Results were nonsignificant, but guaifenesin trended toward being better than placebo for dysmenorrhea pain and associated constitutional symptoms and caused no worsening of symptoms. Lower abdominal mean pain scores from the first survey decreased 38 mm for guaifenesin versus 7 mm for placebo. By the third survey, only 2 of 8 guaifenesin participants took nonstudy analgesics compared with all 9 placebo subjects.
Conclusions: Guaifenesin may be useful in the treatment of primary dysmenorrhea. A larger study is needed to validate these initial findings.
Dysmenorrhea is a disorder characterized by lower abdominal pain that occurs during menstruation, but the pain may start 2 or more days before menstruation. It is sometimes associated with headache, nausea, vomiting, diffuse abdominal pain, backache, general malaise, weakness, and other gastrointestinal symptoms. Dysmenorrhea is often under-treated because physicians are not fully aware of its high prevalence and morbidity. Primary dysmenorrhea is generally believed to affect 50% of menstruating women, and some degree of dysmenorrhea may be present in as many as 90%. Many women do not consider dysmenorrhea noteworthy enough to answer positively about it or to bring it up with their physician even if it restricts their daily activities, yet a great deal of absenteeism and decreased productivity is caused by dysmenorrhea, and some patients are not using adequate doses of treatment.
Dysmenorrheic women may have contractions reaching intrauterine pressures of 200 mm Hg (versus 100 mm Hg for a nondysmenorrheic woman) at very frequent disorganized intervals. Uterine arterial pulsations disappear, suggesting ischemia in the dysmenorrheic uterus. Transdermal glyceryl trinitrate decreases uterine pain. Decreasing intrauterine pressure can be achieved through decreasing the frequency and strength of uterine contractions and/or decreasing cervical os resistance.
For many women, current therapies offer inadequate treatment. Estimates of the effectiveness of current treatments (including oral contraceptives and nonsteroidal anti-inflammatory drugs) range from 64 to 90% of patients but some women have intolerable side effects (such as gastric upset and infertility). The available treatments decrease impairment but not to the nonmenstruating level of productivity for all women. Some patients resort to surgical treatment. The long-term and associated health risks of dysmenorrhea have not been studied. Adding a medication with a different mechanism of action to the treatment of dysmenorrhea may benefit some women.
Guaiacol glyceryl ether (guaifenesin) has been used for years to promote expectoration of secretions in patients with pulmonary disease. The drug is derived from the resin of guaiacum trees and was introduced to European medicine in the 16th century as an analgesic. Guaifenesin is also used as a muscle relaxant in veterinary anesthesia to aid in induction. It has been reported to be effective for prostatitis, seminal vesiculitis, benign prostatic hypertrophy, prostatic abscess, bladder neck hypertrophy, and urinary tract infection pain. A European patent application claims guaiacol and its derivatives are useful for the treatment of heartburn and constipation.
Guaifenesin has also been shown to have effects on the uterine cervix. Guaifenesin (200 mg) 3 times a day improves fertility; perhaps by improving spinnbarkheit, ferning, and cellularity of cervical mucus. The 2 types of cells that produce this mucus are muciparous, similar to those found in other mucus epithelia, and other mucus cells that respond under the stimulus of ovarian hormones. Three obstetric articles mention the use of a guaifenesin compound in labor to speed the effacement of the cervix. In a study using 1000 to 2000 mg of guaifenesin intravenously, the mean labor time was reduced by half in both primiparas and multiparas compared with the control group.
Compounds of guaifenesin with paracetamol, caffeine, phenobarbital, or acetylsalicylic acid are used for pain control. The guaifenesin is thought to speed absorption of the other ingredients. Dolmina, a drug consisting of 200 mg of guaifenesin and 325mg of acetylsalicylic acid per tablet, was compared with an indomethacin product in a study of women with primary dysmenorrhea. Although the difference in pain scores was insignificant, there was a strong patient preference for the guaifenesin compound.
A patient with severe dysmenorrhea was tried on prescription dose guaifenesin (2400 mg/day) during menses, aiming for a decrease in cervical os resistance via the thinning effect of the guaifenesin on cervical mucus. She experienced resolution of her symptoms.
We hypothesized that guaifenesin alone, through its possible effects of analgesia, muscle relaxation, cervical dilation, and cervical mucous thinning, could be effective in the treatment of primary dysmenorrhea.
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