Oral zinc sulphate for primary dysmenorrhea in adolescent females

Primary tabs

SCIENCE
Oral zinc sulphate for primary dysmenorrhea in adolescent females
Key Take-Away: 
  • Pain duration and pain severity were decreased by taking oral zinc in primary dysmenorrhoea (PD).
  • More evidence is needed to determine the effectiveness and role of each in the treatment of PD.

Primary dysmenorrhea (PD) is the most common gynaecologic problem of adolescent females and a total of 74–86.1% adolescent females suffer from PD. Different mechanisms such as deficient uterine microcirculation and oxidative stress may promote cramps in PD. In treatment guidelines of PD, nonsteroidal anti-inflammatory drugs (NSAIDs) are used and they should be used for at least 3 months. 

ABSTRACT: 
Background: 

Primary dysmenorrhea (PD) is the most common gynaecologic problem of adolescent females and a total of 74–86.1% adolescent females suffer from PD. Different mechanisms such as deficient uterine microcirculation and oxidative stress may promote cramps in PD. In treatment guidelines of PD, nonsteroidal anti-inflammatory drugs (NSAIDs) are used and they should be used for at least 3 months.

Combined oral contraceptive pills (OCP) are the second choice to treat PD. OCPs prevent ovulation and improve dysmenorrhea directly by reducing endometrial tissue available for PG and leukotrienes (LT). Zinc, necessary for the function of over 300 metallo enzymes, plays an essential role in cellular differentiation and production. Zinc deficiency has been associated with growth restriction, skin changes, impaired immune response and increased susceptibility to infections. Many hypotheses have shown that treatment with oral zinc may prevent PD. However, the effect of zinc in treating PD has not been proved in a well-designed interventional study.

Rationale behind research

  1. Effect of zinc in treating PD has not been proved in a well-designed interventional study.
  2. Hypotheses that zinc supplementation improves PD by promoting microcirculation and prevents ischaemia, decreases and regulates the level of cyclooxygenase-2 enzyme.
  • Objective

To compare the effect of zinc sulphate with that of placebo on the control of pain severity and duration in adolescent girls with primary dysmenorrhoea 

Methods: 

 

Study outcomes

  • Duration and severity of primary dysmenorrhea were determined
  • Severity scoring was performed by using a 0–10 scaling system.

Time-points

  • Baseline and up to 3 month
Results: 

 

Study outcomes

  • In first month, the duration of pain was significantly lower in zinc group than placebo group (P-value = 0.044), while there was no significant difference in pain severity between the groups (P-value = 0.497).
  • In the second and third month, pain severity and duration in zinc group were significantly lower than the placebo group (P-value <0.001).

 Figure1: Comparison of pain duration in three menstrual cycles between intervention and control groups

Figure2: Comparison of pain severity in three menstrual cycles between intervention and control groups

Conclusion: 

The result of our interventional study strengthens the evidence base supporting zinc as a treatment of PD in adolescents. Moreover, compared with NSAIDs and OCPs, zinc is more affordable in developing countries.

Previous studies reported that symptoms of premenstrual tension (PMT) did not occur in women consuming 31 mg of zinc, while in those consuming 15 mg of zinc, symptoms of PMT did occur (P < 0.001). Kelly and Able reported that zinc inhibits the metabolism of prostaglandin leading cramps in menstruation. The clinical trials have shown the beneficial effects of various NSAIDs and OCPs on PD, but NSAIDs do not significantly relieve PD. Although studies have shown that OCPs significantly treat PD, the relief of premenstrual pain was not found to occur until 3 months and furthermore the duration pain was not shortened. It was observed that the use of NSAIDs for primary dysmenorrhea could result in moderate to excellent pain relief with an odd ratio more than four. NSAIDs are also associated with different types of adverse effects such as neurological and gastrointestinal complications. Further well-designed clinical trials are needed to compare the efficacy and safety of all three drugs (Zinc, NSAIDs and OCPs) to determine the effectiveness and role of each in treating PD.

Australian and New Zealand Journal of Obstetrics and Gynecology 2015; 55: 369–373
Log in or register to post comments