Cyclooxygenase-2 specific inhibitors in the treatment of dysmenorrhea

Introduction of specific cyclooxygenase (COX)-2 inhibitors holds the promise of improved treatment for inflammatory processes without the gastrointestinal effects associated with the conventional non-selective nonsteroidal anti-inflammatory drugs (NS-NSAID), which inhibit both COX-1 and COX-2 activity. Dysmenorrhea is a common inflammatory process that affects many adolescent girls, and is the leading cause of recurrent short-term school or work absenteeism among female adolescents and young adults. In vitro studies have shown that the selective COX-2 inhibitors have a potent tocolytic effect. In vivo studies have found the specific COX-2 inhibitors rofecoxib (Vioxx) and valdecoxib (Bextra) effective in treatment of primary dysmenorrhea in women >or=18 years. Adolescents suffering from dysmenorrhea with a prior history of peptic ulcer, or with a history of NS-NSAID gastrointestinal adverse effects, or who require high doses of NS-NSAID during the menstrual period, as well as adolescents with coagulation deficiencies, may benefit from the use of a specific COX-2 inhibitor. Studies are warranted to explore whether the specific COX-2 inhibitors are effective in treating dysmenorrhea in the adolescent age group.