Study of the recommended dosage of the N-Acetyl Cysteine, Alpha Lipoic Acid, Bromelain and Zinc preparation as a treatment for dysmenorrhea

Abstract

Dysmenorrhea, defined as pain during menstruation, is the most common gynecological condition, affecting a large percentage of women with varying degrees of pain. In recent years, the management of dysmenorrhea has become increasingly important because of the emotional, health and economic burden it entails and because of the need for new studies and research for effective treatments to alleviate its symptoms. The most common treatments for dysmenorrhea are NSAIDs or oral contraceptives, although gynecologists also recommend the preparation composed of N-acetyl cysteine (NAC), alpha lipoic acid (LA), bromelain (Br) and Zinc (Zn), (NAC/LA/Br/Zn) due to its anti-inflammatory and anti-oxidative properties and efficacy in reducing pain. However, there is no data on what dosage of the preparation should be recommended for patients with dysmenorrhea. Therefore, the aim of this study is to determine how the NAC/LA/Br/Zn preparation is recommended for the treatment of dysmenorrhea in daily clinical practice and what specialists base their decision on. A survey was conducted among gynecologists with extensive experience recommending the preparation, with a participation rate of 97% (N=73). The most frequently recommended regimen is to begin with continuous administration for 90 days with 10-day breaks (69%) or without breaks (31%). Specialists recommend the preparation for any type of pain and may recommend discontinuous administration (in the days around menstruation) when the pain is moderate or mild. In patients with primary dysmenorrhea with mild pain, the most recommended approach is discontinuous therapy in the days around menstruation (50.7%) followed by continuous administration for 90 days with 10-day breaks (24.7%). When pain is moderate or severe, the most recommended approach is 90-day continuous therapy with 10-day breaks (47.9% and 71.2%, respectively). In the case of secondary dysmenorrhea, the most recommended approach is 90-day continuous therapy with 10-day breaks for any degree of pain (41.1%, 57.5% and 76.7% for mild, moderate and severe pain, respectively). Most gynecologists (79%) adapt the regimen after clinical assessment of the degree of pain towards discontinuous administration patterns, on the days around menstruation. Most of the specialists consulted do not modify the recommended regimen if the patient is being treated with other drugs such as NSAIDs, hormonal contraception or a combination of progestogens (78%, 59% and 58%, respectively). The preparation is recommended in conjunction with hygienic-dietary measures without modification of the dosage (90%). This is the first study that addresses how specialists recommend the NAC/LA/Br/Zn preparation to patients with dysmenorrhea. The most common regimen for dysmenorrhea is to start treatment with continuous administration of the preparation for 90 days with 10 days of break, continuing the regimen or adapting it according to the degree of pain reported by the patient during treatment.