The role of endothelial dysfunction in the development of primary dysmenorrhea in adolescent girls

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OBJECTIVE

To increase the effectiveness of early diagnosis and to develop a differentiated approach to the treatment of adolescent girls with primary dysmenorrhea (PD).

MATERIAL AND METHODS

The study was conducted on 100 adolescent girls aged 15 to 17 years, diagnosed with primary dysmenorrhea, who were initially divided into study and control groups depending on the presence or absence of dysplasia of connective tissue (DCT). Then, to compare the two proposed treatment regimens, each group was divided by randomization into 2 subgroups. Basic therapy included NSAID (Meloxicam 7.5-15 mg per day) and vitamin-mineral complex with a content of Calcium 1000 mg and vitamin D₃ 800 IU per day. The second scheme — the basic treatment was added to the drug L-carnitine 800 mg, affecting collagen formation. Self-assessment of menstrual pain was performed using McGill’s pain questionnaire. The levels of free hydroxyproline, MMP2 and MMP9, tumor necrosis factor α (TNFα), serum magnesium, autoantibodies IgG to cardiolipin, antinuclear antibodies were determined.

RESULTS

In adolescent girls with DCT, the level of free blood hydroxyproline was almost 2 times higher than in patients with PD without DCT (276.78±117.1 ng/ml and 142.64±90.4, respectively, p<0.05). In both groups, no cases of magnesium deficiency in the blood were detected. In the analysis of biochemical parameters in serum after treatment, in all groups all blood parameters significantly improved: free hydroxyproline decreased on average 2.5 times, MMP2 — 3 times, TNFα — 2 times, MMP9 increased 4 times and autoantibodies IgG to cardiolipin decreased on average 4 times (p<0.05).

CONCLUSIONS

The proposed PD therapy with NSAIDs and vitamin-mineral complex, including CA and vitamin D, the effectiveness of which is confirmed not only by clinical data, but also by biochemical studies, it is advisable to appoint patients with PD, including those with signs of DCT. The results of our own research and literature data allow us to recommend prophylactic intake of vitamin and mineral complex containing CA and vitamin D to adolescent girls suffering from PD, to improve the quality of life, reduce the drug load and prevent reproductive disorders in the future.

Keywords:

primary dysmenorrhea

calcium and vitamin D

matrix metalloproteinases 2

free blood hydroxyproline

connective tissue dysplasia

Authors:

Gevorgyan A.P.

Evdokimov Moscow State University of Medicine and Dentistry;
Morozovskaya Pediatric Municipal Clinical Hospital

Arakelyan A.S.

National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russia

Adamyan L.V.

Moscow State Medical and Dental University named after A.I. Evdokimov

SPIN RSCI: 9836-2713
Scopus AuthorID: 7006372422
ResearcherID: Q-1722-2018
ORCID: 0000-0002-3253-4512

Received:

21.11.2020

Accepted:

22.12.2020

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