COX-2 inhibitors and their role in gynecology.
This review summarizes current knowledge about the roles of cyclooxygenases and prostaglandins in reproductive medicine. With the development of COX-2 specific inhibitors, new therapeutic options are available to obstetricians and gynecologists, offering better-tolerated alternatives to conventional NSAIDs. The analgesic effectiveness of COX-2 specific inhibitors is well established, and they are already in use in a range of painful conditions. Both celecoxib and valdecoxib are indicated for the treatment of primary dysmenorrhea, and may be effective in postoperative pain, including hysterectomy, and pain associated with endometriosis. There is also speculation that COX-2 specific inhibitors may be effective tocolytic agents without the risks to the fetus seen with conventional NSAIDs. The role of COX-2 in oncogenesis is also under investigation, and COX-2 specific inhibitors may eventually be used in the prevention and treatment of gynecologic malignancies.


BACKGROUND
Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader will be able to describe the two types of cylooxygenase enzymes (COX), to list the effects and side effects of NSAIDs and COX-2 medications, and to outline the various changes in COX expression during pregnancy.
Hayes
Ellen C
EC
Reproductive Endocrinology and Infertility, Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, Georgia, USA. ehayes2@emory.edu
Rock
John A
JA
D000068579:Celecoxib; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004412:Dysmenorrhea / Q000188:drug therapy / Q000201:enzymology; D004715:Endometriosis / Q000201:enzymology; D005260:Female; D005831:Genital Diseases, Female / Q000188:drug therapy* / Q000201:enzymology*; D006801:Humans; D007247:Infertility, Female / Q000201:enzymology; D007527:Isoenzymes / Q000037:antagonists & inhibitors* / Q000378:metabolism; D007555:Isoxazoles / Q000627:therapeutic use; D007743:Labor, Obstetric / Q000378:metabolism*; D008565:Membrane Proteins; D008595:Menorrhagia / Q000188:drug therapy / Q000201:enzymology; D008597:Menstrual Cycle / Q000378:metabolism*; D010053:Ovary / Q000201:enzymology; D010060:Ovulation / Q000378:metabolism; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D011085:Polycystic Ovary Syndrome / Q000201:enzymology; D011247:Pregnancy; D011451:Prostaglandin-Endoperoxide Synthases / Q000378:metabolism; D011720:Pyrazoles; D013449:Sulfonamides / Q000627:therapeutic use; D000096926:Benzenesulfonamides
D000068579:Celecoxib; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D007555:Isoxazoles; D008565:Membrane Proteins; D011451:Prostaglandin-Endoperoxide Synthases; D011720:Pyrazoles; D013449:Sulfonamides; C406224:valdecoxib; D000096926:Benzenesulfonamides; C496540:PTGS2 protein, human