Dysmenorrhea Research Papers - Academia.edu (original) (raw)

Although dysmenorrhea is a leading cause of gynecologic complaints among adolescents, its pathogenesis is incompletely understood. The purpose of this study was to determine the role of prostaglandins and leukotrienes in the pathogenesis of dysmenorrhea. Twenty patients with dysmenorrhea aged 16.2+/-1.2 years and 20 healthy age-matched controls with eumenorrhea (absence of pain during menstruation) were included in the study. Serial measurements of serum PGF2alpha and urinary LTE4 levels during the menstrual cycle were obtained; serum progesterone was measured and ultrasonographic evaluations were made. LTE4 and PGF2alpha levels decreased on the third day and recovered on the 10th day of the menstrual cycle in both groups. Urinary LTE4 levels were higher in the control group than in the patient group on the 1st, 3rd and 10th days of the cycle (p<0.05 for each). This study suggests that there is a distinct pattern of leukotriene production during the menstrual cycle, but the chang...

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- Adolescent, Progesterone, TURKISH, Menstrual Cycle

Two cases of juvenile cystic adenomyoma of the uterus treated by laparoscopic surgery are reported. Preoperative diagnostic imaging procedures located a cystic structure within the uterine nodule of each of these young women with severe dysmenorrhea. Under a diagnosis of cystic adenomyoma, laparoscopic excision was performed. Histopathologic examination of the resected tissues showed the presence of an endometrial structure composed of epithelium and stroma within myometrial nodule. In both of these patients, dysmenorrhea disappeared postoperatively.

- by Neerja Bhatla
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- Biophysical Chemistry, Adolescent, Young Adult, Dysmenorrhea

The aim of the study was to compare the effect of mefenamic acid and ginger on pain management in primary dysmenorrhea. One hundred and twenty-two female students with moderate to severe primary dysmenorrhea were randomly allocated to the ginger and mefenamic groups in a randomized clinical trial. The mefenamic group received 250 mg capsules every 8 h, and the ginger group received 250 mg capsules (zintoma) every 6 h from the onset of menstruation until pain relief lasted 2 cycles. The intensity of pain was assessed by the visual analog scale. Data were analyzed by descriptive statistics, t test, Chi-square, Fisher exact test and repeated measurement. The pain intensity in the mefenamic and ginger group was 39.01 ± 17.77 and 43.49 ± 19.99, respectively, in the first month, and 33.75 ± 17.71 and 38.19 ± 20.47, respectively, in the second month (p > 0.05). The severity of dysmenorrhea, pain duration, cycle duration and bleeding volume was not significantly different between groups ...

- by Abbas alipour
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- Pain, Treatment Outcome, Pain Management, Phytotherapy

Objective: To evaluate rate and determinants of long-term recurrence of endometriosis in a population of young women. Design: Retrospective cohort study. Setting: University tertiary care referral center for women with benign gynecologic diseases. Participants: Young women undergoing first-line conservative surgery for endometriosis were eligible for the study. Data on age at surgery, disease stage, anatomical characteristics of endometriotic lesions, and endometriosis-related symptoms were collected. After diagnosis, patients were treated according to the standard care of the center. The protocol required all women to be followed up 1 month after surgery, and every 6 months afterward, with an interview to investigate persistence of symptoms, a clinical examination, and an ultrasound pelvic assessment. Results: Fifty-seven women aged # 21 (mean age at diagnosis AE SD: 19.0 AE 1.1 years) entered the study. During a 5-year follow-up, 32 (56%, 95% confidence interval [CI]: 43%-68%) recurrences of endometriosis were diagnosed. A second laparoscopy to treat the recurrence was performed in 11 (34%) cases and confirmed the presence of the disease in all of them. In the remaining 21 (66%) cases, the recurrence was based on the reappearance of the symptoms or clinical or sonographic findings. The recurrence rate increased constantly with time from first surgery. No association emerged between recurrence rate and endometriosis-related symptoms, site/stage of the disease, type of surgery, and post-surgical medical treatment. Conclusions: The recurrence rate of endometriosis in young women appears higher than in older women. Since no determinants for recurrence have been detected among the factors examined, a profile of women at increased risk cannot be drawn.

- by Edgardo Somigliana
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- Adolescent, Young Adult, Follow-up studies, Pediatric

The purpose of this study was to describe the patterns of GI, somatic, and psychological symptoms across the menstrual cycle in women with irritable bowel syndrome, and to determine whether symptoms differed by oral contraceptive use or predominant bowel pattern. A daily diary was used to assess symptoms across one menstrual cycle. Repeated-measures analysis of covariance, controlling for age and body mass index, was used to compare patterns of symptoms across the menstrual cycle by oral contraceptive use and predominant bowel pattern (diarrhea, constipation, alternating). Data from control women are presented for comparison. For somatic and psychological as well as GI symptoms, women with irritable bowel syndrome had higher symptom severity than did controls. Women with irritable bowel syndrome using oral contraceptives had lower cognitive, anxiety, and depression symptoms (p < 0.05, but not significant after multiple comparison adjustment), but no differences were seen for most...

- by Margaret Heitkemper
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- Diarrhea, Premenstrual Syndrome, Variability, Constipation
- by Roberto Marci and +1
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- Chronic Pain, Prospective studies, Fascia, Young Adult

Objective: To detect the rate of female genital cutting among a sample of newly married women in Benha city, and make a comparison between circumcised and non-circumcised women regarding long-term health problems. Methods: Randomly selected (264) newly married women were the subjects of this work. Results: Circumcised group constitutes 75.8% of the sample. All non-circumcised women were living in an urban area. Dysmenorrhea was more common among circumcised rather than non-circumcised, with statistically significant difference (P b 0.01). Marital problems (dyspareunia, loss of libido, failure of orgasm and husband's unsatisfaction) had statistically different levels of significance among circumcised women. Obstetric problems such as tears, episiotomy and consequently distressed babies were more events among circumcised mothers with statistical significance. Circumcised females had significant mental problems such as somatization, anxiety and phobia (P b 0.001). Conclusion: Female genital cutting remains a widely practiced custom in our society. Grave complications of circumcision may last throughout women's life particularly the time of consummation of marriage and the time of childbirth.

- by Aboubakr Elnashar
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- Obstetrics, Reproduction, Female Circumcision, Culture

The objective of this study is to assess the literature concerning the effect of diet on endometriosis and dysmenorrhea and to elucidate evidential support, to give dietary recommendations to women suffering from these conditions. A systematic search in electronic databases on a relationship between diet and endometriosis/dysmenorrhea was performed. Data on diet and endometriosis were limited to four trials of which two were animal studies. The articles concerning human consumption found some relation between disease and low intake of vegetable and fruit and high intake of vegetarian polyunsaturated fat, ham, beef and other red meat. Results concerning fish intake were not consistent. Eight trials of different design, with a total of 1097 women, investigated the relationship between diet and dysmenorrhea. Intake of fish oil seemed to have a positive effect on pain symptoms.

- by Ulla Knudsen
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- Animal Studies, Diet, Fish Oil, Endometriosis

Dysmenorrhea is a very common problem affecting women and may be primary or secondary. Pain in dysmenorrhea is mediated by hypersecretion of prostaglandins and uterine hypercontractility. Secondary dysmenorrhea is due to some underlying pathology like endometriosis, adenomyosis. The treatment options include NSAIDS as first-line drugs, Oral contraceptives alone or in combination with NSAIDS or progestins. Cases refractory to combined therapy need further evaluation to rule out the secondary cause.

- by Ijariit Journal
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- Dysmenorrhea

Objective To determine the prevalence of primary dysmenorrhea and attitudes and behavior toward dysmenorrhea in the female students of an university toward this problem. Materials and methods A total of 1,266 female university students were anonymously surveyed by doctors. Results It was found that mean age of the surveyed students was 21.02 § 2.13 years, mean menarche age was 13.3 § 1.4 years, and menstruation frequency was 32.58 § 19.8 days. Of the students, 45.3% were found to suVer pain in each menstruation, 42.5% in some and 12.2% in none. Of those with primary dysmenorrhea, 66.9% were established to take analgesic drugs. Conclusion Prevalence of primary dysmenorrhea was found higher than that cited in the literature. It was established that although the rate of consultation with health professionals about menstruation and related changes was low, use of agents known to be eVective in primary dysmenorrhea treatment was highly common.

- by Mehmet Kavaklı
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- Turkey, Adolescent, Students, Young Adult

To determine the prevalence of dysmenorrhea, limitations in daily living and health care use due to menstrual pain. Observational transversal study of 274 adolescents and young adults (age ≤ 26) who had menstruated in the six months prior to the study, assisted at a Primary Health Care Center. Data were obtained by a 24-item anonymous questionnaire, which included questions about socio-demographic variables, menstrual cycle, presence, duration, severity, treatment and limitations of dysmenorrhea. One hundred and seventy-two (62.8%) subjects experienced menstrual pain. Of these, 65.7% reported having limitations in their daily activities due to dysmenorrhea. The prevalence of limitations in daily living was influenced by the presence of additional symptoms (r=0.331; p <0.001), pain intensity (r=0.281; p <0.001) and pain duration (r=0.172; p=0.027). The most commonly mentioned limitation was anxiety/depression (42.5%). Fourteen of the subjects reported missing school or work due...

- by Ana Lucia Rodrigues
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- Quality of life, Adolescent, Child, Young Adult

Consumers frequently use herbs and dietary supplements to treat chronic conditions that are poorly responsive to prescription drugs or when prescription drugs carry a high side effect burden. Women may use herbs and supplements for chronic gynecologic conditions, such as menopause, premenstrual syndrome, dysmenorrhea, cyclic mastalgia, and infertility. This review is an evidence-based evaluation of herbs and supplements for these conditions. Therapies that carry a higher level of support from randomized controlled trial evidence include black cohosh for menopause; vitamins B 1 and E for dysmenorrhea; calcium, vitamin B 6 , and chasteberry for premenstrual syndrome; and chasteberry for cyclic mastalgia. There were too few trials involving herbs and supplements in infertility to warrant a solid recommendation, but chasteberry, antioxidants, and Fertility Blend have some preliminary support. Midwives may want to consider these alternatives in addition to more traditional treatment options when meeting with patients. J Midwifery Womens Health 2006;51:402-409

- by Cathi Dennehy
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- Nursing, Evidence Based Medicine, Life Style, Midwifery
- by Chelsy Ann Herrera
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- Dysmenorrhea, Kinesio tape

The demand of personalized medication has grown to leaps and bounds since last few years. Ayurveda, the
oldest system of medicine, emphasized on such personalized medication by analyzing the personal health
status of individual through different assessment criteria. Cuminum cyminum L. called as Jeeraka in
Sanskrit and Jeera in Hindi, is one of the herb which was used since many centuries for various ailments.
Traditionally the herb is well-known for its action in various alimentary diseases like, indigestion,
diarrhea, gynecological diseases, etc. This herb is also screened for various pharmacological activities like
antibacterial, anticancer, antiulcer and others. The condition of painful menstruation is affecting more
than half of young adolescent girl population. The current article is an effort to establish the mode of
action of Cuminum cyminum L in terms of Ayurveda pathogenesis as well as contemporary science. Various
pathogenic pathways of Dysmenorrhoea according to Ayurveda are discussed with conclusion of using
Jeeraka in dysmenorrhoea under which particular pathogenesis. Such comparison will help to establish
personalized medicine for other diseases and this may be a novel approach towards same

- by iTz Dzikry
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- Dysmenorrhea, Menstruasi

Aim: The purpose of this study was to clarify the effects of saffron odor on symptoms unique to women, such as premenstrual syndrome (PMS), dysmenorrhea (menstrual pain) and irregular menstruation. Materials and methods: Thirty-five women with a normal sense of smell were exposed to saffron odor for 20 min. Saliva samples were then collected to measure levels of cortisol (C), testosterone (T) and 17-␤ estradiol (E) by enzyme immunoassay, and the State-Trait Anxiety Inventory (STAI) was administered as a psychological test. Results: Saffron odor significantly decreased C levels after short-term stimulation (20 min) in both follicular and luteal phases. E level after exposure to saffron odor was increased in both the follicular-and luteal-phase groups. STAI score decreased in the follicular and luteal phases in the saffron group.

Background & Objective: Menstruation with cramping pain is one of the problems that appear during adolescence. The severity of dysmenorrhea affects the extent of activity limitation. Given the high prevalence of dysmenorrhea in adolescents and the personal-social effect of this condition on their daily lives, using reliable tools for assessing the severity of this condition in different populations of different countries can significantly contribute to the standard diagnosis, evaluation, and treatment of people suffering from dysmenorrhea.
Materials & Methods: This cross-sectional study was performed on a population of adolescent girls (Iran) in 2019. The research was approved and monitored by the relevant supervisory body, which issued the pertinent ethics licenses and letters of introduction. Sampling was performed using the cluster method from public schools. Inclusion criteria were Iranian nationality and not having any underlying diseases. The exclusion criterion was the unwillingness to continue participation. The data collection tools were a questionnaire of demographic and menstrual information as well as verbal rating scale (VRS; for both drug and pain) and working ability, location, intensity, days of pain, dysmenorrhea (WaLIDD) questionnaires.
Results: The participants had a mean age of 15.6±2.3 years and a mean age of menarche of 12.5±1.3 years. The best sensitivity and specificity of the tools were respectively calculated as 63.7% and 56.9% for WaLIDD (at point 4.5), 57.3% and 70.8% for VRS (pain; at point 1.5), and 33.9% and 72.2% for VRS (drug; at point 0.5).
Conclusion: According to the results of this study, none of the tools had high specificity and sensitivity at the same time. However, WaLIDD had high sensitivity, and VRS (for both pain and drug) exhibited high specificity.

Objectives: This is a controlled, prospective study which compares the effects of a low-dose heat patch for self-medication on the reduction of pain symptoms in dysmenorrhea. Methods: The sample group included female sophomore students studying at a university in Istanbul, Turkey, between 2007 and 2008. These female participants completed the Dysmenorrhea Identification Form to determine the sample group, and a total of 193 female students possessed the eligible criteria. The research control group consisted of 66 patients, the analgesia group consisted of 61, and the heat patch group consisted of 66. The control group did not use any treatments, while the self-medication group used analgesic medication (single dose), and the heat patch group applied a heat patch on the lower abdomen, against the skin, for an application period of 2 menstrual cycles. Using a visual analog scale (VAS), the pain severity was recorded at the baseline, after 4 hours of intervention, and after 8 hours of intervention. The data were examined using ANOVA. Results: There were significant differences between the groups in terms of pain severity after 8 hours of application (P ! .001). All groups had similar pain levels at baseline and during the fourth and eighth hours, with no significant differences between the groups during the first and the second menstrual cycles (P O .05). Conclusion: The authors conclude that the heat patch is an effective method for reducing dysmenorrhea.

- by DİLEK COSKUNER POTUR
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- Adolescent, Prospective studies, Young Adult, Self-administration

Objective: This study examined the association between depressive and menstrual symptoms in adolescent girls in a 3-year longitudinal study. It was hypothesized that menstrual symptoms would increase in early adolescence and decrease in later adolescence, that girls with greater depressive symptoms would report greater menstrual symptoms, and that effects would persist after adjusting for general somatic complaints. Methods: A community sample of girls (n = 262) enrolled in an observational study by age cohort (11, 13, 15, 17 years) completed three annual visits. At each time point, girls completed the Menstrual Symptom Questionnaire, Children's Depression Inventory, and the Youth Self Report to assess general somatic complaints. Results: Menstrual symptoms increased significantly across adolescence ( p = .006) and began to plateau in later adolescence ( p = .020). Depressive symptoms at study entry were significantly associated with menstrual symptoms ( p G .001). When general somatic complaints were included in the models, the effect of depressive symptoms on menstrual symptoms remained significant for the sum score ( p = .015) and the menstrual somatic symptoms subscale ( p = .001). After adjusting for somatic complaints, initial report of depressive symptoms predicted change in menstrual symptoms only for girls with the lowest menstrual symptoms sum score ( p = .025). Initial report of somatic complaints predicted change in menstrual symptoms ( p = .020). Conclusions: Girls with higher depressive symptoms and higher somatic complaints are at greater risk for experiencing menstrual symptoms and increasing symptoms across adolescence, with a heightened vulnerability for girls with lower baseline menstrual symptoms. Key words: menstrual symptoms, depression, adolescence, female, menstruation, somatic. BMI = body mass index; CDI = Children's Depression Inventory; MDD = major depressive disorder; MSQ = Menstrual Symptoms Questionnaire; PMDD = premenstrual dysphoric disorder; SD = standard deviation; SE = standard error; SES = socioeconomic status.

- by Lisa Sontag-Padilla
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- Depression, Adolescent, Psychosomatic Medicine, Child

Objective The aim of this study was to: (1) establish the typical experience of menstruation for senior high school girls and (2) determine how many experience considerable menstrual disturbance that could require further investigation... more

- by M. Parker and +1
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- Australia, Quality of life, Menstruation, Adolescent
- by D. Raudrant
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- Treatment Outcome, Prospective studies, Pregnancy, Questionnaires

with naproxen-sodium in the dosages indicated.

- by Björn Andersch
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- Pain, Adolescent, Gynecology and Obstetrics, Ibuprofen
- by Diana Taylor
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- Nursing, Self Care, Premenstrual Syndrome, Dysmenorrhea

Objectives: This study is aimed to evaluate if the osteopathic manipulative treatment (OMT) is effective in patients with primary dysmenorrhea (PD). Methods: Randomized single-blinded controlled trial with OMT group and light- touch treatment (LTT) group. Recruited women were 18-40 years (mean age 27 years), with regular menstrual cycle, normal body mass index (BMI), and a medical diagnosis of PD. Intervention: Patients received five OMT or five LTT over a menstrual cycle. The primary outcomes were average menstrual pain assessed by the numeric rating scale (NRS), the duration of pain, and quality of life (QoL) assessed by the SF-12 Short Form Health Survey and Patient Global Impression Change (PGIC). The secondary outcomes were NSAIDs intake, hours of absence from school/work, and menstrual-related symptoms. Results: 31 subjects were enrolled, of which five were excluded and the remaining 26 were randomized. Patients in OMT group had significant improvement in every outcome, including the average menstrual pain that decreased from 5.35 ± 0.28 to 1.98 ± 0.24 (-63.0%; p<0.001). The mean SF-12 physical component score (PCS) improved from 31.35 ± 1.70 to 49.56 ± 1.92 (+58.1%, p<0.001), the mean SF-12 mental component score (MCS) improved from 38.36 ± 1.16 to 52.04 ± 0.94 (+35.7%; p<0.001). LTT group showed no improvements. Conclusion: OMT was effective in reducing menstrual pain and improving Quality of Life of dysmenorrheic women.

- by Dario Zecchillo
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- Clinical Trial, Quality of life, Manual Therapy, Pain Management

This study considers primary dysmenorrhea from a biopsychosocial perspective in examining the relationship between physical exercise and menstrual pain. Despite widespread claims of the benefits of exercise for perimenstrual symptoms, the evidence seems weak. Stronger evidence indicates that exercise helps relieve stress and elevates mood and that stress heightens menstrual discomfort. Student nurses (n=176) completed a questionnaire disguised as a general health survey that contained these measures. The hierarchial regression analysis demonstrated that, contrary to the expected, regular exercise increased with the severity of menstrual symptoms, after controlling for medications, disposition, perceived stress, and mood. The findings suggest that exercise presents a tradeoff; it relieves the stress that may intensify dysmenorrhea, yet it may aggravate these same symptoms.

- by William Metheny
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- Behavioral Medicine, Affect, Regression Analysis, Exercise

In the last decade, more research interest has focused on the sleep of women across the life cycle. A significant body of literature has endorsed the view that the sleep of women differs in many respects from that of men. Beyond gender differences, however, are questions about sleep within cohorts of women. For example, in adult women ages 20-45 years, there are women with regular menstrual cycles, women taking oral contraceptives, pregnant and lactating women, and women entering menopause. Given that each of these states is associated with a unique hormonal environment, it is important to determine whether there are clinically significant differences in the sleep of women in these phases of life. This article presents what is known currently about the sleep of women from adulthood through menopause and provides recommendations for evaluation and treatment.

- by Lauren Broch
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- Menopause, Adolescent, Premenstrual Syndrome, Pregnancy

Menstrual health problems are a largely neglected priority within the sexual and reproductive health domain in most low-income coun- tries. We examined the prevalence of menstrual health problems and their association with various socio-economic, demographic, and reproductive health factors using a population-based survey. Pain during menstruation (5.6%) and irregular menstrual cycles (4.3%) were the most common menstrual problems reported. The odds of reporting menstrual problems were higher among women who had had an abortion, had reproductive tract infections, and had ever used contraception, after we controlled for confounds. Findings of the study reinforce the need to provide menstrual health care serv- ices at the primary level.

- by Enu Anand
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- Sexual and Reproductive Health, Menstruation, Public Health, Reproductive health
- by Stephen Bird
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- Mechanical Engineering, Sports Medicine, Thermoregulation, Women

Objective: To evaluate the efficacy and safety of aceclofenac-drotaverine combination against aceclofenac alone in patients with primary dysmenorrhoea. Study design: This double-blind, double-dummy, randomized, comparative, multicentric study enrolled 200 women (100 women in each arm) in the age range of 18-35 years with primary dysmenorrhoea at four centers. The patients were randomly allocated to either aceclofenac 100 mg-drotaverine 80 mg b.i.d or aceclofenac 100 mg alone b.i.d for a maximum of 3 days. Primary efficacy parameters were total area under pain relief (PR) score up to 4 and 8 h (TOPAR/4 and TOPAR/8). Secondary efficacy measurements were pain-intensity difference (PID), sum of PID over 4 and 8 h (SPID/4 and SPID/8), peak PID over 4 and 8 h and peak PR over 4 and 8 h, total study drug consumption, and patient's and investigator's global evaluation of the efficacy. Results: Both treatments showed significant improvement in baseline values in all efficacy parameters. The combination was significantly superior to monotherapy in terms of TOPAR/4 (24.0 vs 18.54) (p = 0.000) and TOPAR/8 (40.3 vs 35.2) (p = 0.003), SPID/4 (À17.9 vs À13.88) (p = 0.000) and SPID/8 (À31.06 vs À26.8) (p = 0.001), peak PID/4 (À6.60 vs À5.75) (p = 0.001) and peak PR/4 (8.26 vs 7.10) (p = 0.000). At the end of 8 h, both treatments were comparable with respect to peak PID/8 and peak PR/8 (p > 0.05). The total number of doses consumed by patients treated with combination therapy was less than with monotherapy (150 vs 168 doses). The combination was significantly superior to monotherapy with respect to patient's and investigator's global evaluation of the efficacy (p = 0.002 and p = 0.001, respectively). Both treatments were well tolerated. Conclusion: This study establishes the efficacy of aceclofenac-drotaverine combination in patients with primary dysmenorrhoea. The fixed-dose combination of aceclofenac and drotaverine should therefore be considered as a suitable, effective and well tolerated treatment option for primary dysmenorrhoea. ß

- by Anil Pareek
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- Obstetrics, Treatment, Treatment Outcome, Adolescent

The objective was to evaluate the prevalence of dysmenorrhea and determine its effect on health-related quality of life (HRQoL) among a group of female university students. This cross-sectional study was conducted between 15 March and 15 April 2009 at Dumlupinar University, Kutahya, Health High School, Western Turkey. The study group included 623 female students. The severity of dysmenorrhea was determined with a 10-point visual analog scale. The Short Form-36 (SF-36) form was used to determinate HRQoL. Chi-square test, Student's t test, and logistic regression and variance analyses (ANOVA) were used for statistical analyses. The average age of the study group was 20.8 ± 1.8 years (range 17-30). Prevalence of dysmenorrhea was found to be 72.7% and was significantly higher in coffee consumers, females with menstrual bleeding duration ‡7 days, and those who had a positive family history of dysmenorrhea when compared to the others (P < 0.05, for each one). By multivariate analysis, coffee consumption (OR 2.084), menstrual bleeding duration ‡7 days (OR 1.590), and positive family history of dysmenorrhea (OR 3.043) were important risk factors for dysmenorrhea. Except for social functioning, roleemotional, and mental health domains, the SF-36 points received from the other domains were higher in females with dysmenorrhea (for each one P < 0.05). With the exception of the scores received from physical functioning and role-emotional domains, the scores received from the other domains of the SF-36 scale showed a decrease with increasing severity of dysmenorrhea (P < 0.05, for each one). Dysmenorrhea is a common health problem, having negative effects on the HRQoL among university female students.

- by Elif Calik
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- Quality of life, Turkey, Adolescent, Universities

Herbal medicines can be used alone to prevent and treat primary dysmenorrhea or used to augment other therapies (nutritional, hydrotherapy, and/or pharmaceutical). The major categories of herbs reviewed in this article include uterine spasmolytics, inflammation modulators, and astringent tonics. Herbs a covered include Viburnum opulus (cramp bark) and V. prunifolium (black haw), Foeniculum vulgare (fennel), Atropa belladonna (belladonna), the Chinese formula Dāng guī shaó yào sǎn (dong quai and peony powder), Zingiber officinale (ginger), Trillium spp. (bethroot), Rosa spp. (rose), and Psidium guajava (guava). Details of dosing and safety are discussed with each herb. g-Linolenic acid, a component of several plants, is also discussed.

- by Eric L Yarnell
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- Naturopathic Medicine, Herbal Medicine, Phytomedicine, Phytotherapy

Study Objective: To evaluate the feasibility of hysteroscopic resection of large submucous uterine myomas. Design: Prospective study (Canadian Task Force classification II-3). Setting: Surgery unit of minimally invasive gynecology. Patients: Thirty-three women with submucous myomas 5 cm or larger in diameter with menorrhagia, dysmenorrhea, or infertility. Intervention: Hysteroscopic myomectomy. Measurements and Main Results: Satisfaction with the surgery and an improvement in symptoms were the primary outcomes. Possibility of 1-step resection; complication rate, and disease recurrence were also considered. Menorrhagia was the most frequent indication (91%). According to the Wamsteker classification, 84.8% were type II myomas, whereas 93.9% scored 5 or higher according to the classification of Lasmar and colleagues. Mean operating time was 50 minutes (interquartile range, 35-65). One-step excision was achieved in 81.8% of patients. Of 5 women with incomplete resection, 3 needed a second surgery, and 2 were symptom-free. Patients with myomas larger than 5 cm or with a Lasmar score higher than 7 were more likely to undergo a 2-step procedure. In patients with myomas larger than 6 cm, recovery time was significantly longer than in those with smaller myomas. We recorded 3 complications: intravasation, uterine perforation, and postoperative anemia, in 1 patient each; at present, all 3 women are symptom-free. Median (range) follow-up was 10 (6-22) months. Twenty-seven patients (81.2%) reported they were very satisfied; 5 patients (15.2%) were satisfied; and 1 patient (3%) was dissatisfied. Conclusions: Hysteroscopic myomectomy can be the treatment of choice in symptomatic patients with a submucous myoma with diameter of 6 cm or less. Although this technique raises the possibility that complete resection may require 2 surgical sessions, it is a feasible surgical procedure. However, for myomas 6 cm or larger in diameter, this approach is less attractive. Nevertheless, we believe that all of the limiting criteria defined in the available literature should be evaluated individually, bearing in mind each patient's particular condition and the surgeon's experience and skill.

- by Giuseppe Migliaretti
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- Treatment Outcome, Prospective studies, Patient Satisfaction, Hysteroscopy

Patients with chronic pain conditions demonstrate altered central processing of experimental noxious stimuli, dysfunction of the hypothalamic-pituitary-adrenal axis, and reduced quality of life. Dysmenorrhoea is not considered a chronic pain condition, but is associated with enhanced behavioural responses to experimental noxious stimuli. We used behavioural measures, functional magnetic resonance imaging, and serum steroid hormone levels to investigate the response to experimental thermal stimuli in otherwise healthy women, with and without dysmenorrhoea. Women with dysmenorrhoea reported increased pain to noxious stimulation of the arm and abdomen throughout the menstrual cycle; no menstrual cycle effect was observed in either group. During menstruation, deactivation of brain regions in response to noxious stimulation was observed in control women but not in women with dysmenorrhoea. Without background pain (ie, in nonmenstrual phases), activity in the entorhinal cortex appeared to mediate the increased responses in women with dysmenorrhoea. Mean cortisol was significantly lower in women with dysmenorrhoea and was negatively correlated with the duration of the symptom. Additionally, women with dysmenorrhoea reported significantly lower physical but not mental quality of life. Thus, many features of chronic pain conditions are also seen in women with dysmenorrhoea: specifically a reduction in quality of life, suppression of the hypothalamic-pituitary-adrenal axis, and alterations in the central processing of experimental noxious stimuli. These alterations persist when there is no background pain and occur in response to stimuli at a site distant from that of the clinical pain. These findings indicate the potential importance of early and adequate treatment of dysmenorrhoea.

- by Charlotte Stagg and +1
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- Pain, Chronic Pain, Quality of life, Cortisol

Abnormalities of the reproductive tract interest a little more than 1% of the women. The symptoms are not specific: abdominal pain seems like appendicitis, invalidating dysmenorrheas in the girl, urinary manifestations. They should be discovered and treated because they could bring about obstetric complications later. We present three observations, illustrated with a recent review of the literature, and describe the

- by Pierre-françois Ceccaldi
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- Medicine, Child, Dysmenorrhea, Abdominal Pain

Background Membranous dysmenorrhea is a rare entity involving expulsion of fragments of endometrium retaining the shape of the uterus. The condition is often linked to high progesterone levels. An association with a chronic fatigue syndrome was never described. Case A 44-year-old woman with a chronic fatigue syndrome (CFS), presented with membranous dysmenorrhea after taking an oral contraceptive pill containing ethinylestradiol 0.02 mg and desogestrel 0.15 mg for 3 months in a continuous regimen as treatment for dysfunctional bleeding. Oral contraception was discontinued and she resumed normal menstruations. Remarkably, she mentioned complete disappearance of the CFS since expulsion of the tissue and started working again. Conclusion The occurrence of membranous dysmenorrhea with a dissolving chronic fatigue syndrome is very rare and was never described before. This case suggests a hormonal dysfunction as a possible cause of chronic fatigue syndrome. A review of the literature on membranous dysmenorrhea is presented.

- by Jasper Verguts and +1
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- Physiology, Research Methodology, Biology, Health

Increasing the ectopic uterine motility is the major reason for primary dysmenorrhea. This motility is the basis for several symptoms including for pain is the main complaints of patients with primary dismenorrhea. There are several mechanisms, which initiate dysmenorrhea. Therefore, different compounds can be employed to control its symptoms. In long-term therapy, combination of oestrogens and progestins may be useful. In short-term therapy, dysmenorrhea sometimes non-steroidal anti-inflammatory drugs (NSAIDs) are used. Most of NSAIDs in long-term therapy show severe adverse effects. In an attempt to find agents with less adverse effect the fennel essential oil (FEO) was chosen for this investigation. In this article, effects of FEO on the uterine contraction and estimation of LD 50 in rat were described. For assessment of pharmacological effects on the isolated rat uterus, oxytocin (0.1, 1 and 10 mu/ml) and prostaglandin E 2 (PGE 2 ) (5× 10 − 5 M) were employed to induce muscle contraction. Administration of different doses of FEO reduced the intensity of oxytocin and PGE 2 induced contractions significantly (25 and 50 mg/ml for oxytocin and 10 and 20 mg/ml PGE 2 , respectively). FEO also reduced the frequency of contractions induced by PGE 2 but not with oxytocin. LD 50 of FEO was obtained in the female rats by using moving average method. The estimated LD 50 was 1326 mg/kg. No obvious damage was observed in the vital organs of the dead animals.

Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacologic treatment for pain relief. TENS has been used to treat a variety of painful conditions. This review updates the basic and clinical science regarding the use of TENS that has been published in the past 3 years (ie, 2005–2008). Basic science studies using animal models of inflammation show changes in the peripheral nervous system, as well as in the spinal cord and descending inhibitory pathways, in response to TENS. Translational studies show mechanisms to prevent analgesic tolerance to repeated application of TENS. This review also highlights data from recent randomized, placebo-controlled trials and current systematic reviews. Clinical trials suggest that adequate dosing, particularly intensity, is critical to obtaining pain relief with TENS. Thus, evidence continues to emerge from both basic science and clinical trials supporting the use of TENS for the treatment of a variety of painful conditions while identifying strategies to increase TENS effectiveness.

- by Kathleen Sluka
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- Dentistry, Pain, Clinical Trial, Treatment Outcome

Study Objective. To evaluate the relationship between prevalence and severity of chronic pelvic pain (CPP) and stage, site, and type of endometriosis. Design. Prospective, observational study (Canadian Task Force classification 11-2). Setting. University Hospital. Patients. Of 90 consecutive women with biopsy-proved endometriosis, laparoscopy was performed in 69 for pelvic pain and in 21 for infertility or clinical and ultrasonographic suspicion of ovarian endometriosis. Intervention. Preoperatively, using a 10-point visual analog scale, the severity of dysmenorrhea, CPP, and deep dyspareunia was assessed. During laparoscopy all visible endometriotic lesions were recorded and treated. Measurements and Main Results. Ten women (11.1%) had no pain; 72 had dysmenorrhea (mild in 13, moderate in 37, severe in 22); 55 had CPP (mild in 11, moderate in 25, severe in 19); and 39 deep dyspareunia (mild in 5, moderate in 31, severe in 3). The severity of dysmenorrhea significantly correlated with the presence and extent of pelvic adhesions (p = 0.004); the severity of CPP correlated with deep endometriosis on the uterosacral ligaments (p = 0.0001) and extent of pelvic adhesions (p = 0.02); and deep dyspareunia correlated with deep endometriosis on the uterosacral ligaments (p = 0.04). Total pain score significantly correlated with deep endometriosis on the uterosacral ligaments (p = 0.0001), peritoneal adhesions (p = 0.01), and extent of adnexal adhesions (p = 0.01). No significant correlation was found among revised American Fertility Society stage of endometriosis; presence and size of ovarian endometriomas; extent, type, and site of peritoneal lesions; and pain scores. By logistic regression analysis, the presence and intensity of total pain could be predicted simultaneously by the presence of deep endometriosis (p = 0.0001) and presence and extent of adnexal adhesions without cystic endometriosis (p = 0.01), and by the presence of ovarian endometrioma with periovarian adhesions (p = 0.03). Chronic pelvic pain was predicted by both deep endometriosis (p = 0.0001) and ovarian endometriomas with adnexal adhesions (p = 0.03).

- by Maria Porpora
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- Adolescent, Prospective studies, Chronic Disease, Endometriosis

Introduction: Primary dysmenorrhea is characterized by pain during menstruation without
any pelvic pathology. It is a common problem among females in their reproductive age.
However, exercise is a known intervention to relieve the symptoms. This study aimed to assess
the effect of core stability exercises on pain severity, pain duration, and drug consumption in
primary dysmenorrhea in adult females.
Materials and Methods: Thirty-four non-athletic, unmarried girls, aged 18-
25 years, who
suffered from moderate to severe primary dysmenorrhea, were randomly assigned to the
experimental (n=17) and control groups (n=17). The experimental group performed 8
weeks of core stability exercise (3 sessions/week, 45-60 min/session). Before and after the
exercise program, pain intensity, pain duration, and the medication usage of the participants
were assessed by “Numeric Pain Scale” (10-point scale), “the number of hours that the pain
continued” and “the total amount of painkiller consumption for the pain reduction” for 2
days prior to menstruation, and 2 days after menstruation onset. The statistical analysis was
performed using ANCOVA and dependent t-test. The confidence interval was considered at
0.95 (α<0.05).
Results: In comparison with the control group, there was a significant decrease in pain intensity
(P=0.008), pain duration (P=0.021), and the number of painkillers consumed (P=0.018) in the
experimental group.
Conclusion: Core stability exercises may be effective in reducing pain intensity, pain duration,
and consumed painkillers.

- by Journal of Modern Rehabilitation (JMR)
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- Pain, Exercise, Dysmenorrhea, Lumbosacral Region

Setting: Government schools of Colombo. Main Outcome Measures: Premenstrual symptomatology (PMS) was determined by a modified version of Premenstrual Symptom screening tool and American College of Obstetricians and Gynecologists (ACOG) diagnostic criteria were used in categorizing study units as having PMS. Other outcome measures were demographic and reproductive factors thought to be correlates of PMS, health seeking behavior for premenstrual symptoms, and how premenstrual symptoms impact their daily life. Results: Individual premenstrual symptoms were experienced by 65.7% of the population. The most common somatic symptom was fatigue (29.9%) and affective symptom was feeling sad/hopeless (29.6%). Prevalence of PMS was 8.75% (95%CI: 6.43e11.07). Multivariate analysis revealed the presence of: chronic physical illness (P 5 0.001); dysmenorrhea (P ! 0.0001), and regular menstrual cycles (P 5 0.006) as correlates of PMS. Presence of PMS significantly disturbed "in school" activities, relationships and daily routines (P ! 0.005) indicating a high negative influence on adolescents' daily life. Only 9.7% sought help from (western) medical practitioners for their premenstrual symptoms and a majority has not perceived it as a condition to report. Conclusion: Premenstrual syndrome is a common condition among adolescent schoolgirls with a high negative influence on their daily life. The health care seeking behavior is poor, indicating the necessity to address the subject at adolescent reproductive health programs.

- by Nalika Gunawardena
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- Quality of life, Sri Lanka, Adolescent, Premenstrual Syndrome

To determine if systemic processing of pain differs in women with and without dysmenorrhea. METHODS: Twenty-two dysmenorrheic women and 31 nondysmenorrheic women were studied by pain threshold and supra-threshold magnitude estimation to heat stimuli, pain-evoked potentials by laser stimuli, and anxiety scores four times across their menstrual cycles. RESULTS: Significant differences were found between dysmenorrheic and nondysmenorrheic women. In all four examinations across the menstrual cycle, dysmenorrheic women had longer latencies of pain-evoked potentials (383.08 ؎ 6.8 msec versus 345.05 ؎ 7.0 msec, P < .001), higher magnitude estimations on visual analog scale of supra-threshold pain (83.29 ؎ 2.87 versus 63.50 ؎ 3.82, P < .001), and higher state anxiety scores (37.69 ؎ 1.7 versus 29.20 ؎ 1.9, P ‫؍‬ .002). CONCLUSION: Women with dysmenorrhea show enhanced pain perception compared to nondysmenorrheic women. This augmentation of pain perception may be part of the development of dysmenorrhea.

- by Michal Granot
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- Obstetrics, Perception, Pain, Comparative Study

Members of this consensus group were selected based on individual expertise to represent a range of practical and academic experience both in terms of location in Canada and type of practice, as well as subspecialty expertise along with general gynaecology backgrounds. The consensus group reviewed all available evidence through the English and French medical literature and available data from a survey of Canadian women. Recommendations were established as consensus statements. The final document was reviewed and approved by the Executive and Council of the SOGC. This document provides a summary of up-to-date evidence regarding the diagnosis, investigations, and medical and surgical management of dysmenorrhea. The resulting recommendations may be adapted by individual health care workers when serving women who suffer from this condition. Dysmenorrhea is an extremely common and sometimes debilitating condition for women of reproductive age. A multidisciplinary approach involving a com...

- by Margaret Burnett
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- Quality of life, Differential Diagnosis, Risk factors, Dysmenorrhea

Our aim was to assess the role of surgical intervention for symptom control and reproductive performance improvement in the management of subfertile women with symptomatic extensive uterine adenomyosis. Methods: Sixty-five subfertile women with pathology-proven extensive uterine adenomyosis, who were treated with conservative surgery or medical treatment with 6-month gonadotrophin-releasing hormone (GnRH) agonist or combination therapy, were retrospectively reviewed and their data analyzed. Twenty-eight women received conservative surgery with/without GnRH agonist (group A), and 37 received 6-month GnRH agonist therapy only (group B). Follow-up evaluations, including subjective symptoms (a self-reported 6-point verbal numeric rating scale and an analgesic usage score for dysmenorrhea) and objective parameters (serum CA125 level, and uterine size), and clinical pregnancy and successful delivery rates were made semi-annually over the ensuing 3 or more years. Results: The women in group A had higher serum CA125 levels, more infertile years, and a larger uterine size. Subjective symptom control and objective parameters were better in group A during the entire 36-month follow up compared with those in group B. Cumulative 3-year clinical pregnancy and successful delivery rates were significantly higher in group A, compared with those in group B (46.4% [13/28] versus 10.8% [4/37], P = 0.002, and 32.1% [9/28] versus 8.1% [3/37], P = 0.022, respectively). Conclusion: Conservative surgery or combination therapy provides more effective and longer durable symptom control in the management of symptomatic women with extensive uterine adenomyosis, compared with GnRH agonist alone. Reproductive performance was also better in patients treated with conservative surgery with/without GnRH agonist. *Fisher's exact tests; Total 1 : cumulative 3-year pregnancy rate; Total 2 : cumulative 3-year successful delivery rate. AUS, analgesic usage score (see Materials and Methods); Gr, Group; NE, no evaluation; SD, standard deviation; Uterine size, the maximal diameter (mm); VNRS-6, a self-reported 6-point verbal numeric rating scale (See Materials and Methods).

- by Jong-ling Fuh
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- Obstetrics, Treatment Outcome, Pregnancy, Obstetrics and Gynaecology

Endometriosis is a significant gynecologic condition that can cause both pain and infertility and affects up to 15% of women during their reproductive years. In peritoneal endometriotic lesions, the expression of peroxisome proliferation-activated receptor gamma, a nuclear receptor with antiinflammatory and neuroprotective roles, is positively correlated with the pain reported by patients. (Fertil Steril Ò 2010;93:293-6. Ó2010 by American Society for Reproductive Medicine.) Endometriosis is defined by the growth of endometriotic epithelial and stromal cells outside the uterine cavity and affects 7%-15% of women during their reproductive years. Endometriosis symptoms can include debilitating pain and reduced fecundity. The relationship between these symptoms and the ectopic cell growth is, however, unclear (1). Current pharmacologic treatments of the pain associated with endometriosis are manifestly inadequate and have significant side effects (2, 3).