DANSK
| FRANCAIS | NEDERLANDS
Most of us with endometriosis know quite
a bit about having pain. Unfortunately, we know a
lot less about how to manage that pain. In our attempts
to deal with pain, many of us have used various medications
such as aspirin, Paracetamol, Panadol, or Tylenol.
These drugs alleviate pain by reducing the body's
sensitivity to pain.
Fewer of us are familiar with the use of the non-steroidal
anti-inflammatory drugs (NSAIDs) for managing pain.
Some of the more common NSAIDs include ibuprofen (ACT-3,
Advil, Brufen, Motrin, Nurofen), naproxen sodium (Aleve,
Naprogesic, Naprosyn, Naproxen), ketoprofen (Orudis
KT), and mefenamic acid (Ponstan). These drugs can
be effective in alleviating pain and inflammation,
but to do so, they must be used correctly. Too often,
women are prescribed NSAIDs without clear instructions
about their use, so they use them the same way they
use analgesic drugs. However, when used incorrectly,
NSAIDs don’t work.
It is thought that much of the pain of endometriosis,
especially menstrual pain, is due to inflammation
that may be caused in part by high levels of “bad
prostaglandins.” Prostaglandins are hormone-like
chemicals that can be found in every cell of the body.
Prostaglandins have beneficial effects (enhance immune
function, block inflammation, relax muscles, maintain
the integrity of the stomach lining, dilate blood
vessels, etc.), as well as detrimental effects (produce
inflammation, decrease oxygen flow, contract muscles,
induce pain, etc.). The bad news is that women with
endometriosis have been shown to produce an excess
of a prostaglandin called PGE2, which causes inflammation,
pain, and uterine contractions.
Theoretically, NSAIDs would seem to be a good choice
for relieving menstrual pain because most of them
work by blocking the production of all prostaglandins.
The result is less pain, swelling, and inflammation.
However, since NSAIDs work by stopping the production
of the pain-causing prostaglandins, they must be taken
before any of these chemicals are produced. In other
words, you must start taking NSAIDs at least 24 hours
before you expect to experience pain. If you delay
taking them until after you feel pain, the medication
cannot block the pain-producing chemicals that have
already been released, so they will not alleviate
pain.
If you are using NSAIDs for ovulation pain or menstrual
pain, it is recommended that you start taking them
as directed at least 24 hours before you expect to
ovulate or 24 hours before you expect to start bleeding.
If you have an unpredictable menstrual cycle, you
may want to take them for a week or more before you
expect menstruation to begin. To be effective, it
is important to take NSAIDs regularly every six hours
so that no pain-producing chemicals are produced during
ovulation or menstruation. Another advantage of taking
certain NSAIDs is that they decrease the amount of
menstrual bleeding (1, 2).
There are many different brands of the NSAIDs available.
Some are available over-the-counter at your local
pharmacy, while some are available by prescription
only. It is difficult to predict which type of NSAID
will be effective for a particular individual, so
you may need to try two or three brands before finding
one that relieves your pain. Talk to your pharmacist
or doctor about suitable brands to try. If you’ve
already tried an NSAID without success, you may want
to try again. If you were using them incorrectly before,
try starting them well in advance of your pain so
that no pain-producing prostaglandins are produced.
The most important thing to remember is that unlike
analgesics, NSAIDs do not block existing pain. Instead,
they block the production of prostaglandins that produce
the pain. Therefore, they must be taken before you
feel any pain. And they must be taken every six hours
around the clock if they are to work effectively.
Like many drugs, NSAIDs can have side effects –
some quite serious. Because NSAIDs block all prostaglandin
production, they also block the good prostaglandins
responsible for maintaining the integrity of the stomach
lining. That’s why the most common side effects
of NSAIDs include nausea, vomiting, diarrhoea, irritation
of the stomach, and stomach ulcers. To help reduce
stomach irritation, NSAIDs should be taken with food.
Newer NSAIDs called selective COX-2 inhibitors (Vioxx,
Celebrex, Bextra) were originally thought to cause
less bleeding and fewer ulcers than traditional NSAIDs.
However, follow-up studies on these drugs have shown
there is no clinically meaningful safety advantage
over traditional NSAIDs. Therefore, COX-2 inhibitors
should be used with the same caution as any other
NSAID. If you are considering taking any type of NSAID,
be sure to ask for a complete list of potential side
effects, warnings, and possible drug interactions
from your pharmacist or healthcare practitioner. Also
be sure to inquire about the types of side effects
that should be reported to your doctor immediately.
Finally, it’s important for you to know that
the effects of “bad prostaglandins” can
also be moderated in part by diet and supplements.
As we’ve discussed in prior articles and interviews
with Dian Shepperson Mills,
reducing animal fats, caffeine, and alcohol, and adding
flax oil, fish oil, and olive oil to your diet can
increase the production of “good prostaglandins”
and decrease the production of “bad prostaglandins.”
If you cannot take NSAIDs (or choose not to), dietary
changes may be a good option to try.
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