Menstrual problems in adolescence: relationship to serum vitamins A and E, and systemic inflammation

Curcuminoid-Piperine Combination Improves Radical Scavenging Activity in Women with Premenstrual Syndrome and Dysmenorrhea: A Post-hoc Analysis of a Randomized Clinical Study

Oxidative stress maybe involved in the patho-etiology of menstrual-associated complications. Curcuminoids, are polyphenolic natural compounds that have potentially important functional activities. This triple-blind, randomized, placebo-controlled trial was performed to investigate the effects of a curcuminoids on oxidative stress and antioxidant capacity in girls with premenstrual syndrome (PMS) and dysmenorrhea. Eighty young girls with both PMS and dysmenorrhea were randomly given either curcuminoids (500 mg+5 mg piperine) or a placebo daily, for a period from 7 days pre- until 3 days post- initiation of menstrual bleeding for 3 successive menstrual cycles. The total antioxidant capacity and free radical scavenging activity of serum and urine were quantified via ferric reducing/antioxidant power (FRAP) and 1,1-diphenyl-2-picrylhydrazyl (DPPH) methods, respectively. There were no significant differences between the placebo and curcumin groups, with respect to the age, dietary intake and biochemical/anthropometric indices (p>0.05). The curcumin treatment significantly increased the free-radical scavenging activity of serum compared to the treatment with placebo (p=0.031). Although, no significant changes were found in serum and urinary levels of FRAP, DPPH and MDA between the groups (p>0.05). Curcumin treatment did increase free-radical scavenging activity and antioxidant potential in girls with PMS and dysmenorrhea. Investigations with higher doses and duration of curcumin are required to verify our findings.

Effect of Curcumin on Dysmenorrhea and Symptoms of Premenstrual Syndrome: A Systematic Review and Meta-Analysis

BACKGROUND

Dysmenorrhea and premenstrual syndrome (PMS) are common periodic and frequent complications in women of reproductive age that can negatively affect health and quality of life. The present study examined the effects of curcumin on the severity of dysmenorrhea and PMS symptoms.

METHODS

A systematic review and meta-analysis of randomized controlled trials was conducted by searching databases such as the Cochrane Library, EMBASE, Scopus, PubMed, and Web of Science from inception to January 2023. Article screening was performed using Endnote ver. X8 (Clarivate). Review Manager (RevMan ver. 5.3; Cochrane) was used for the quality assessment and meta-analysis. A total of 147 studies were screened, of which five were finally selected for quantitative and qualitative analyses. The studies were conducted between 2015 and 2021, and a total of 379 participants with a mean age of 23.33±5.54 years had been recruited in these studies.

RESULTS

The meta-analysis showed that curcumin consumption could significantly reduce the severity of dysmenorrhea (mean difference, -1.25; 95% confidence interval [CI], -1.52 to -0.98; three studies; I2=31%) and the overall score of PMS (standardized mean difference, -1.41; 95% CI, -1.81 to -1.02; two studies; I2=0%).

CONCLUSION

The reduction in the severity of PMS and dysmenorrhea has been attributed to curcumin's anti-inflammatory and antidepressant activities. Although the findings suggest that curcumin may be an effective treatment for reducing the severity of PMS and dysmenorrhea, further research with a larger number of participants from various socioeconomic levels and a longer duration of treatment is needed to evaluate the effective dose of curcumin.

Effects of the PREMEN-CALM® in the Management of the Premenstrual Syndrome: A Randomized, Double-Blind, Placebo-Controlled Pilot Study

Premenstrual syndrome is a common disorder in women of reproductive age characterized by a variety of cyclical symptoms with a great impact on their lifestyle. Available pharmacological options include both antidepressants and oral contraceptives, both of which have side effects, are expensive and not always effective. Vitamins, minerals and plant extracts have been proven to alleviate the symptomatology of the premenstrual syndrome. For this reason, the purpose of this study was to test the effectiveness of a commercial phytotherapeutic dietary supplement (PREMEN-CALM®: γ-aminobutyric acid, Rhodiola rosea L., Vitex agnus-castus, vitamin B6 and melatonin) as an alternative treatment for this condition. A randomized, double-blind, and placebo-controlled pilot study was performed. Participants (n = 42) were assessed before and after 3 months of taking the supplement (n = 21) or the placebo (n = 21). Outcome measures include antioxidant and inflammatory biomarkers, body composition, subjective sleep quality, mood state profile, quality of life, and certain characteristics of the menstrual cycle. The within-group analysis revealed a significant improvement in the total antioxidant status (1.49 ± 0.34 vs reference value 1, p = 0.002), mood state profile (p = 0.02), and affective symptoms (p = 0.01) in the women receiving the commercial phytotherapeutic dietary supplement PREMEN-CALM®. On the contrary, the between-group analysis showed no statistical differences, suggesting a plausible placebo effect. The phytotherapeutic supplement PREMEN-CALM® might be effective in treating or alleviating the symptoms of the premenstrual syndrome without adverse events. Integrative medicine approaches in the clinical practice may help improve the health of women suffering from this and other gynecological conditions.

Pelvic pain symptoms and endometriosis characteristics in relation to oxidative stress among adolescents and adults with and without surgically-confirmed endometriosis

Background: While the majority of reproductive-aged females will experience pelvic pain during their lives, biological mechanisms underlying pelvic pain are not well understood. We investigated associations between pelvic pain symptoms and oxidative stress among people with and without surgically-confirmed endometriosis. Methods: Using an enzyme-linked immunosorbent assay, we measured 8-Hydroxy-2'-deoxyguanosine (8-OHdG) in urine samples and corrected for creatinine levels in 434 surgically-confirmed endometriosis participants compared to 605 participants never diagnosed with endometriosis. At enrollment, participants reported details of their pelvic pain symptoms. Linear regression was used to compute geometric mean (GM) creatinine-corrected 8-OHdG levels with 95% confidence intervals (CI) among all participants and those with and without endometriosis separately, adjusting for potential confounders. Interactions by surgically-confirmed endometriosis status were tested by Wald statistics. Results: No trends in 8-OHdG were observed among those with or without endometriosis for severity or frequency of dysmenorrhea, acyclic pelvic pain, dyspareunia or pain with bowel movements. Among endometriosis participants, lower 8-OHdG levels were observed for participants with any white, blue/black, or brown lesions (GM=76.7 versus 82.9 ng/mg; p=0.10), which was primarily driven by lower levels of 8-OHdG for any blue/black lesions (GM=72.8 versus 81.6 ng/mg; p=0.05). Conclusion: While no associations were observed between 8-OHdG and pelvic pain symptoms, future research is needed to assess how other pathways of oxidative damage, e.g. through proteins or lipids, may affect endometriosis-associated symptoms. Additionally, further research is needed to understand differences in oxidative stress among endometriosis lesion sub-phenotypes.

From genes to systems: The role of food supplementation in the regulation of sepsis-induced inflammation

Systemic inflammation includes a widespread immune response to a harmful stimulus that results in extensive systemic damage. One common example of systemic inflammation is sepsis, which is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Under the pro-inflammatory environment of sepsis, oxidative stress contributes to tissue damage due to dysfunctional microcirculation that progressively causes the failure of multiple organs that ultimately triggers death. To address the underlying inflammatory condition in critically ill patients, progress has been made to assess the beneficial effects of dietary supplements, which include polyphenols, amino acids, fatty acids, vitamins, and minerals that are recognized for their immuno-modulating, anticoagulating, and analgesic properties. Therefore, we aimed to review and discuss the contribution of food-derived supplementation in the regulation of inflammation from gene expression to physiological responses and summarize the precedented potential of current therapeutic approaches during systemic inflammation.

Effect of curcumin on inflammatory biomarkers and iron profile in patients with premenstrual syndrome and dysmenorrhea: A randomized controlled trial

Premenstrual syndrome (PMS) and primary dysmenorrhea are common gynecological problems and inflammation may have a role in their etiology. Curcumin is a polyphenolic natural product for which there is increasing evidence of anti-inflammatory and iron chelation effects. This study assessed the effects of curcumin on inflammatory biomarkers and iron profile in young women with PMS and dysmenorrhea. A sample of 76 patients was included in this triple-blind, placebo-controlled clinical trial. Participants were randomly allocated to curcumin (n = 38) and control groups (n = 38). Each participant received one capsule (500 mg of curcuminoid+ piperine, or placebo) daily, from 7 days before until 3 days after menstruation for three consecutive menstrual cycles. Serum iron, ferritin, total iron-binding capacity (TIBC) and high-sensitivity C-reactive protein (hsCRP), as well as white blood cell, lymphocyte, neutrophil, platelet counts, mean platelet volume (MPV) and red blood cell distribution width (RDW), were quantified. Neutrophil: lymphocyte ratio (NLR), platelet: lymphocyte ratio (PLR), and RDW: platelet ratio (RPR) were also calculated. Curcumin significantly decreased the median (interquartile range) serum levels of hsCRP [from 0.30 mg/L (0.0-1.10) to 0.20 mg/L (0.0-1.3); p = 0.041] compared with placebo, but did not show any difference for neutrophil, RDW, MPV, NLR, PLR and RPR values (p > 0.05). The treatment schedule was well-tolerated, and none of markers of iron metabolism statistically changed after the intervention in the curcumin group (p > 0.05). Curcumin supplementation may have positive effects on serum hsCRP, a marker of inflammation, with no any changes on iron homeostasis in healthy women with PMS and dysmenorrhea.

Vitamin Effects in Primary Dysmenorrhea

BACKGROUND

Primary dysmenorrhea is considered to be one of the most common gynecological complaints, affecting women's daily activities and social life. The severity of dysmenorrhea varies among women, and its management is of high importance for them. Given that non-steroidal anti-inflammatory drugs (NSAIDs), the established treatment for dysmenorrhea, are associated with many adverse events, alternative therapeutic options are under evaluation. Emerging evidence correlates management of dysmenorrhea with micronutrients, especially vitamins.

PURPOSE

The aim of this narrative review is to highlight and provide evidence of the potential benefits of vitamins for the management of dysmenorrhea.

METHODS

The articles were searched on PubMed, Scopus and Google Scholar. The searching process was based on keywords, such as "primary dysmenorrhea", "vitamins", "supplementation", "vitamin D", "vitamin E" and others. Our search focused on data derived from clinical trials, published only during the last decade (older articles were excluded).

RESULTS

In this review, 13 clinical trials were investigated. Most of them supported the anti-inflammatory, antioxidant and analgesic properties of vitamins. Particularly, vitamins D and E revealed a desirable effect on dysmenorrhea relief Conclusion: Despite the scarcity and heterogeneity of related research, the studies indicate a role of vitamins for the management of primary dysmenorrhea, proposing that they should be considered as alternative therapeutic candidates for clinical use. Nevertheless, this correlation warrants further research.

Maternal Adherence to a Dietary Approaches to Stop Hypertension (DASH) Dietary Pattern and the Relationship to Breast Milk Nutrient Content

BACKGROUND

Maternal lifestyle factors, such as diet and nutritional status are likely to affect the composition of breast milk (BM). This study aimed to investigate the association between adherence to a Dietary Approaches to Stop Hypertension (DASH) dietary pattern (DP) and BM nutrient content.

METHOD

A total of 700 milk samples were obtained from 350 lactating women. The dietary intakes of the women in the study were estimated using a validated food frequency questionnaire, which included 65 food items. The total antioxidant activity (TAC) of BM samples was evaluated using the Ferric reducing antioxidant power (FRAP), 2,2'-diphenyl-1-picrylhydrazyl (DPPH), thiobarbituric acid reactive substances (TBARS), and Ellman's assay. Also using commercially available kits, the total protein, calcium, and triglyceride contents in milk were determined.

RESULTS

Individuals in the 3rd tertile of adherence to the DASH diet (highest adherence) consumed more dietary fiber, fruits, vegetables, nuts, legumes, and seeds, low-fat dairy, whole grain, less red and processed meat, sweetened beverages, and sodium than those in the first tertile (lowest adherence). Subjects in the 3rd tertile of DASH DP had higher values of milk DPPH and calcium compared to those in the first tertile (P < 0.05). Milk MDA and triglyceride were significantly lower in the 3rd tertile of DASH diet versus the first tertile (P < 0.05).

CONCLUSION

Our study showed that high adherence to the DASH DP was associated with higher BM DPPH and calcium levels and lower amounts of BM MDA and triglyceride. The adherence to the healthy DPs such as the DASH can improve the quality of BM in lactating women.

Serum fat-soluble vitamins and the menstrual cycle in women of childbearing age

Evidence suggests that fat-soluble vitamins are involved in reproduction, but their association with the menstrual cycle, the proxy of female fecundity, remains largely unexplored in women of childbearing age. Serum fat-soluble vitamin levels were measured by HPLC-MS/MS and menstrual cycle data were acquired from 3123 women of reproductive age in Nanjing, China, using standard questionnaires. Irregular and long menstrual cycles occurred in 725 (23.2%) and 604 (19.3%) participants, respectively. Participants with higher levels of vitamins A and K had increased odds of irregular menstrual cycles (vitamin A: OR = 1.39 (95% CI: 1.12, 1.74); vitamin K: OR = 1.41 (95% CI: 1.13, 1.76)) and long menstrual cycles (vitamin A: OR = 1.34 (95% CI: 1.06, 1.69); vitamin K: OR = 1.27 (95% CI: 1.00, 1.61)), and the relationship showed a linear dose-response pattern (P-overall < 0.05, P-nonlinearity > 0.05). Vitamin A was positively associated with the average menstrual cycle length (β: 1.83, 95% CI: 0.28, 3.39). Vitamins A and K were interacted in their associations with irregular menstrual cycles and long cycles. In sensitivity analysis with further exclusion of participants with abnormal thyroid function or a history of polycystic ovary syndrome (PCOS), the association of vitamins A and K with the menstrual cycle remained robust. This study indicates that higher serum vitamin A and K levels in women of childbearing age are significantly associated with higher odds of irregular and long menstrual cycles with a linear dose-response curve. Further investigations are warranted to determine the appropriate fat-soluble vitamin levels for women of childbearing age.

Factors Associated with the Prevalence and Severity of Menstrual-Related Symptoms: A Systematic Review and Meta-Analysis

This study aimed to identify factors associated with the prevalence and severity of menstrual-related symptoms. The protocol was registered in PROSPERO (CRD42021208432). We conducted literature searches of PubMed and Ichushi-Web and used the Jonna Briggs Institute critical appraisal checklist to assess the quality. Of the 77 studies included in the meta-analysis, significant odds ratios (ORs) were obtained for eight factors associated with primary dysmenorrhea (PD): age ≥ 20 years (OR: 1.18; 95% confidence interval [CI]: 1.04−1.34), body mass index (BMI) < 18.5 kg/m2 (OR: 1.51; 95% CI: 1.01−2.26), longer menstrual periods (OR: 0.16; 95% CI: 0.04−0.28), irregular menstrual cycle (OR: 1.28; 95% CI: 1.13−1.45), family history of PD (OR: 3.80; 95% CI: 2.18−6.61), stress (OR: 1.88; 95% CI: 1.30−2.72), sleeping hours < 7 h (OR: 1.19; 95% CI: 1.04−1.35), and bedtime after 23:01 (OR: 1.30; 95% CI: 1.16−1.45). Two factors were associated with severity of PD (moderate vs. severe): BMI < 18.5 kg/m2 (OR: 1.89; 95% CI: 1.01−3.54) and smoking (OR: 1.94; 95% CI: 1.08−3.47). PD severity (mild vs. severe) and prevalence of premenstrual syndrome were associated with BMI < 18.5 kg/m2 (OR: 1.91; 95% CI: 1.04−3.50) and smoking (OR: 1.86; 95% CI: 1.31−2.66), respectively. The identified risk factors could be utilized to construct an appropriate strategy to improve menstrual symptoms and support women’s health.

The Sprint-Interval Exercise Using a Spinning Bike Improves Physical Fitness and Ameliorates Primary Dysmenorrhea Symptoms Through Hormone and Inflammation Modulations: A Randomized Controlled Trial

Dysmenorrhea with high prevalence has been categorized as primary dysmenorrhea (PD) and secondary dysmenorrhea due to differences in pathogenesis. A significant number of reproductive females suffering from monthly menstruation have to deal with negative impacts on their quality of life, work/study productivity, activities, and social relationships. In addition to medical treatment, exercise has been recognized as a complementary and alternative strategy for disease prevention, alleviation, and rehabilitation. This study aimed to investigate the potential effects of exercise on the severity of primary dysmenorrhea, physiological modulation, and physical fitness. Participants consisted of university students who were enrolled in the study and divided into a non-PD (Control) and a PD group based on recruiting criteria, the latter being randomly assigned to either an untreated dysmenorrhea group or a dysmenorrhea group that underwent 10 weeks of high intensity interval training (HIIT) exercise (Dysmen and DysmenHIIT, respectively). The DysmenHIIT group used spinning bikes and the training intensity was validated by heart rate monitors and BORG rating of perceived exertion. Forms containing participant information (premenstrual symptoms, menstrual distress, and a Short Form McGill Pain Questionnaire) as well as physical fitness, biochemical variables, hormone and prostaglandin (PGE2 and PGF2α) levels were assessed before and after the exercise intervention. After intervention, premenstrual symptoms (anger, anxiety, depression, activity level, fatigue, etc.), menstrual distress symptoms (cramps, aches, swelling, etc.), and pain severity were shown to be significantly mitigated, possibly through hormone (estradiol, prolactin, progesterone, and cortisol) modulation. Furthermore, high-sensitivity C-reactive protein (HsCRP), PGE2 and PGF2α levels were also down-regulated, resulting in the amelioration of uterine contraction and inflammation. Participants' physical fitness, including cardiovascular endurance and explosive force, was significantly improved after HIIT. The 10-week HIIT spinning bike exercise used in this study could be employed as a potential and complementary treatment for PD symptoms alleviation and considered as part of an educational health plan for promoting women's health. However, the effects of HIIT utilizing different exercise methods and accounting for different age populations and secondary PD warrant further investigation.

Acupuncture for Primary Dysmenorrhea: A Potential Mechanism from an Anti-Inflammatory Perspective

The low adverse effects of acupuncture for primary dysmenorrhea (PD), known as one of the most commonly reported gynecological debilitating conditions affecting women's overall health, have been thus far confirmed. Moreover, it has been increasingly recognized that inflammation is involved in such menstrual cramps, and recent studies have further shown that the anti-inflammatory effects of acupuncture are helpful in its control. This review portrays the role of inflammation in PD pathophysiology, provides evidence from clinical and animal studies on acupuncture for inflammation-induced visceral pain, and reflects on acupuncture-related therapies for dysmenorrhea with regard to their anti-inflammatory characteristics. Further research accordingly needs to be carried out to clarify the effects of acupuncture on proinflammatory factors in PD, particularly chemokines and leukocytes. Future studies on this condition from an anti-inflammatory perspective should be also performed in line with the notion of emphasizing stimulation modes to optimize the clinical modalities of acupuncture. Additionally, the effects and mechanism of more convenient self-healing approaches such as TENS/TEAS for PD should be investigated.

Plasma Carotenoids and Premenstrual Symptoms in a Multi-Ethnic Population of Young Women

Premenstrual symptoms are experienced by most women of reproductive age, but effective therapies are limited. Carotenoids may have an attenuating effect on premenstrual symptoms; however, studies to date are equivocal. The objective of the present study was to examine the association between plasma concentrations of seven carotenoids and premenstrual symptom severity in 553 women from the Toronto Nutrigenomics and Health study. Participants provided information on fifteen common premenstrual symptoms and severities. Each participant completed a General Health and Lifestyle Questionnaire and provided a fasting blood sample from which plasma carotenoid concentrations were measured. Multinomial logistic regressions were used to determine associations between plasma carotenoid concentrations and premenstrual symptom severity. Beta-cryptoxanthin was associated with moderate/severe increased appetite for women in the highest compared to the lowest tertile (OR: 2.33; 95% CI: 1.39, 3.89). This association remained significant after adjusting for multiple comparisons. There were no observed associations between other plasma carotenoids and any premenstrual symptoms. In summary, higher concentrations of beta-cryptoxanthin were associated with an increased appetite as a premenstrual symptom, but no associations were observed for any other carotenoid and for any other symptom.

Effects of curcumin on menstrual pattern, premenstrual syndrome, and dysmenorrhea: A triple-blind, placebo-controlled clinical trial

Premenstrual syndrome (PMS) and primary dysmenorrhea are common complaints among young women. This study evaluated the effects of curcumin supplements on symptoms of pain in young women with PMS and dysmenorrhea. A randomized, triple-blinded, placebo-controlled clinical trial was undertaken. Women who suffered from both PMS and dysmenorrhea were enrolled, and were randomly allocated to the curcumin (n = 62), or placebo (n = 62) groups. Each subject received one capsule (500 mg of curcuminoid, or placebo) daily, from 7 days pre- until 3 days post-menstruation for three successive menstrual cycles. Participants recorded the severity of PMS, or dysmenorrhea using a Premenstrual Syndrome Screening Tool (PSST) and the visual analog scale, respectively. Baseline characteristics of participants did not differ between the curcumin and placebo groups. At the end of the trial, the PSST scores were significantly lower in both the curcumin (32.5 ± 9.8 vs. 21.6 ± 9.8); and placebo groups (31.7 ± 9.4 vs. 23.4 ± 12.8). There was a significant reduction of dysmenorrhea pain in both the curcumin and placebo groups (by 64% and 53.3%, respectively). Hence, curcumin had comparable effects as placebo, regarding the amelioration of symptoms of PMS and dysmenorrhea. Further studies are required with larger samples, using higher doses curcumin for longer durations, and perhaps in combination therapy.

Is Premenstrual Syndrome Associated with Inflammation, Oxidative Stress and Antioxidant Status? A Systematic Review of Case-Control and Cross-Sectional Studies

Premenstrual syndrome (PMS) is a cyclically occurring combination of various symptoms, leading to decreased life quality among approximately 30% of women of childbearing age. PMS etiology remains unknown; however, there are some suggestions that inappropriate inflammatory response and oxidative stress are involved. This study aimed to systematically review case–control and cross-sectional studies investigating inflammation markers, oxidative stress, and antioxidant status among women with PMS and controls. The study protocol was registered with PROSPERO (no. CRD42020178545), and the authors followed the guidelines for performing a systemic review recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). By searching PubMed and Scopus databases (up to 8 January 2021), six case–control studies and five cross-sectional studies of medium or high quality were classified to the review. The systematic review included 652 women with PMS and 678 controls, for whom 36 eligible markers were determined. Limited evidence indicates increased levels of inflammatory parameters and suggests decreased antioxidant status in PMS women. Insufficient data with inconsistent results made it impossible to formulate a firm conclusion on the contribution of oxidative stress in PMS occurrence. To acknowledge the role of inflammation, oxidative stress, and antioxidant status in the pathophysiology of PMS, further research with case–control design and large study groups is needed.