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Viagra reported effective for relief of menstrual cramps

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Most are aware that Viagra (sildenafil citrate) is a guy’s drug that can treat erectile dysfunction. The medication is a vasodilator—a dilator of blood vessels; thus, researchers at Penn State University Medical Center theorized that it might benefit menstrual cramps. They published their findings online on August 6 in the journal Human Reproduction.

The researchers note that Viagra is a drug that stimulates nitrous oxide production in the blood stream, which cases vasodilation. They also note that prostaglandins, which circulate at the time of menstruation cause constriction of the blood vessels in the uterine muscle (myometrium), which results in painful cramps. Thus, the nitric oxide counters the effect of the prostaglandins and relaxes the uterine blood vessels. This increased blood flow can alleviate cramping

The study group comprised 62 women. It was a double-blind, randomized, controlled trial, meaning that half the women were given the Viagra and the other half were given a placebo. Neither the women nor the researchers knew who was receiving the Viagra. At the onset of menstrual cramps, the women were administered either a 100 mg dose of the Viagra preparation or a placebo. The primary outcome measure of the study was total pain relief over four hours (TOPAR4). This measurement compared Viagra to the placebo, where higher TOPAR4 scores represent superior pain relief. Secondary outcome measures were pain relief, which was measured by the visual analog scale (VAS) and uterine artery pulsatility index (PI).

The subjects were recruited from December 2007 through January 2011. The trial was halted prematurely because the funding ran out. The women were aged 18-35 years and all were in good health. In addition, all the women suffered from moderate to severe menstrual cramps. The women were asked to assess their menstrual pan at 0, 1, 2, 3, and 4 hours after application of the medication. Two scales were used to measure pain relief: (1)) pain on the five-level scale used for TOPAR4 calculation; and (2) pain level on the VAS.

Only 25 women completed the study. The researcher found that, compared to the placebo group, the women who received Viagra had significantly more pain relief. With the VAS, Viagra provided superior pain relief than the placebo at each time point. At the 2 hour time point, the PI was significantly lower in the sildenafil citrate group compared with the placebo group. None of the women who received Viagra experienced any negative side-effects.

The researchers noted some limitations. They noted that they were not able to attain their sample size because funding was cut off before they could attain it. Thus, they recommended that larger studies conducted for a longer duration were necessary to confirm their findings. They explained that a number of drugs have been investigated for the treatment of menstrual cramps; however, most have proven to be ineffective or to have an unfavorable risk/benefit ratio. They added that most women suffer from painful menses and seek treatment for at some point in their lives; therefore, their study offers hope that vaginal Viagra is a safe and effective option for patients who do not desire or are unresponsive to treatments currently available on the market.

Take home message:
Although the sample size was small, it appears that vaginal Viagra is effective in alleviating menstrual cramps and has no negative side effects. A negative factor for Viagra is its cost. A 100 mg tablet costs about $10 and it is not covered by most drug plans. Non-steroidal anti-inflammatory drugs (NSAIDS), such as Tylenol, Motrin, and aspirin are inexpensive and provide relief for some women. Exercise can also reduce menstrual cramping. For example, I once had a patient who was a professional cyclist. She suffered from painful menses and had no desire to get on her bike. However, maintaining conditioning was important, she forced herself to ride. She found that as she rode, her cramps decreased significantly.

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