New concepts in dysmenorrhea

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: the biology of a neglected disease

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a chronic, debilitating disease characterised by a wide range of symptoms that severely impact all aspects of life. Despite its significant prevalence, ME/CFS remains one of the most understudied and misunderstood conditions in modern medicine. ME/CFS lacks standardised diagnostic criteria owing to variations in both inclusion and exclusion criteria across different diagnostic guidelines, and furthermore, there are currently no effective treatments available. Moving beyond the traditional fragmented perspectives that have limited our understanding and management of the disease, our analysis of current information on ME/CFS represents a significant paradigm shift by synthesising the disease's multifactorial origins into a cohesive model. We discuss how ME/CFS emerges from an intricate web of genetic vulnerabilities and environmental triggers, notably viral infections, leading to a complex series of pathological responses including immune dysregulation, chronic inflammation, gut dysbiosis, and metabolic disturbances. This comprehensive model not only advances our understanding of ME/CFS's pathophysiology but also opens new avenues for research and potential therapeutic strategies. By integrating these disparate elements, our work emphasises the necessity of a holistic approach to diagnosing, researching, and treating ME/CFS, urging the scientific community to reconsider the disease's complexity and the multifaceted approach required for its study and management.

Scientific Knowledge Graph of Dysmenorrhea: A Bibliometric Analysis from 2001 to 2021

Purpose

This study aims to help researchers master the most active hotspots and trends quickly through bibliometric analysis in the field of dysmenorrhea.

Methods

We retrieved literature on Web of Science from 2001 to 2021, and bibliometric analysis software CiteSpace was used in combination with VOSviewer.

Results

We finally acquired 944 papers and an upward trend in articles continued in this field overall. Through the map, China contributed the most, followed by the USA and Turkey. For institutions, Beijing University of Chinese Medicine in China contributed the most, followed by National Yang-Ming University in Taiwan, China. Hsieh JC and Hellman KM were both the most prolific authors with 14 articles. Five major research groups, respectively, with Hsieh JC, Hellman KM, Zhu J, Liang F and Dun W were the key group. Dawood MY was the most dominant author and most frequently cited author. The Cochrane Database of Systematic Reviews Journal was the most productive, and the Fertility and Sterility Journal was the most cited. Advances in pathogenesis and management for primary dysmenorrhea written by Dawood MY was most cited and influential. Pathophysiology, the potential central mechanism, syndrome, evaluation index, diagnosis of adenomyosis-associated dysmenorrhea, treatment, etc., were the main trends and hotspots.

Conclusion

Dysmenorrhea research has received a lot of attention from scholars. Strengthening international cooperation may promote the development of this field. The pathophysiology of dysmenorrhea, its impact on public health and its treatment are current research hotspots and are likely to be the focus of future study.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Comorbidities: Linked by Vascular Pathomechanisms and Vasoactive Mediators?

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is often associated with various other syndromes or conditions including mast cell activation (MCA), dysmenorrhea and endometriosis, postural tachycardia (POTS) and small fiber neuropathy (SFN). The causes of these syndromes and the reason for their frequent association are not yet fully understood. We previously published a comprehensive hypothesis of the ME/CFS pathophysiology that explains the majority of symptoms, findings and chronicity of the disease. We wondered whether some of the identified key pathomechanisms in ME/CFS are also operative in MCA, endometriosis and dysmenorrhea, POTS, decreased cerebral blood flow and SFN, and possibly may provide clues on their causes and frequent co-occurrence. Our analysis indeed provides strong arguments in favor of this assumption, and we conclude that the main pathomechanisms responsible for this association are excessive generation and spillover into the systemic circulation of inflammatory and vasoactive tissue mediators, dysfunctional β2AdR, and the mutual triggering of symptomatology and disease initiation. Overall, vascular dysfunction appears to be a strong common denominator in these linkages.

Integrated UPLC-Q-TOF-MS and network pharmacology approach-driven quality marker discovery of Danggui Shaoyao San for primary dysmenorrhea

Danggui Shaoyao San (DSS), a famous prescription, has been clinically proved to be effective in treating primary dysmenorrhea (PD). Currently there is no valid quality control data available for DSS. The main aim of the current research was to explore quality markers (Q-markers) of DSS. The chemical constituents of DSS were qualitatively identified using ultra-performance liquid chromatography tandem quadrupole time of flight mass spectrometry (UPLC-Q-TOF-MS) technology. On this basis, the targets of DSS and PD were predicted and screened using the TCMSP, SwissTargetPrediction, GeneCards, OMIM and TTD databases. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis was performed on the core intersection targets using string and Cytoscape 3.7.1 software. Then molecular docking was conducted to screen the Q-markers of DSS in PD. A total of 126 chemical constituents, including 22 organic acids, 14 phthalides, 24 monoterpenoids, five sesquiterpene lactones, 22 triterpenoids, four phenylpropanoids and 35 other compounds were preliminarily characterized. According to network pharmacology prediction analysis, six compounds containing polyporenic acid C, senkyunolide P, alisol B 23-acetate, naringenin, gallic acid, ferulic acid and albiflorin were regarded as Q-markers of DSS. The present research established an integrative UPLC-Q-TOF-MS and network pharmacology method to discover the latent Q-markers of DSS and provided a theoretical data for the follow-up quality control of DSS.

Effect of Low-Power Visible-Light-Activated Photodynamic Therapy (PDT) on Primary Dysmenorrhea: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial

Background

Primary dysmenorrhea (PD) is one of the most common complaints in women of childbearing age. Therefore, this trial aimed to assess the efficacy and safety of low-power visible-light-activated photodynamic therapy (PDT) in the treatment of primary dysmenorrhea (PD), and to further investigate their possible mechanisms of action.

Methods

This study was conducted by using a multicenter, randomized, open, parallel control design. Qualified subjects are randomly assigned to two groups: Group A (low-power visible-light-activated PDT group), Group B (placebo group) and are treated with corresponding protocols for three consecutive menstrual cycles. Baseline data are collected during the trial period. Changes in the scores of VAS scales and the fluctuation of pain factors (PGE2, PGF2α) are recorded before and after the treatment for each group. A comparison of effectiveness in pain control and symptom control is made among the two groups.

Results

After treatment, for the PDT group, the scores of VAS scales decline compared with the scores before treatment. The level of pain factors including PGE2 and PGF2α also drops significantly (P < 0.05). There are no serious adverse events during the study.

Conclusion

Low-power visible-light-activated PDT is a new type of treatment for primary dysmenorrhea which is safe, effective and does not affect normal pregnancy preparation. It may exert its therapeutic effect by adjusting downward the level of PGE2, PGF2α in the body. These factors can be used not only to study the treatment mechanism for primary dysmenorrhea, but also to serve as quantitative indicators for objective assessment of whether dysmenorrhea is relieved.

A one-year observational cohort study of menstrual cramps and ovulation in healthy, normally ovulating women

This is a prospective, observational community cohort study with the objective of investigating menstrual cramp occurrence related to ovulatory characteristics. Women reported cramp intensity on daily Menstrual Cycle Diary© records over one year. Ovulation and luteal phase lengths were assessed by validated Quantitative Basal Temperature© (QBT) analysis. Healthy, normal-weight, non-smoking community dwelling premenopausal women ages 21-41 years with two consecutive, normally ovulatory, normal-length menstrual cycles were enrolled. All 53 women, with 13.6 ± 2.8 cycles per woman, reported at least one cramp episode of median intensity 1.5 [0-4 scale; range 1.0-3.5], and 2.2 days' [range 1.0-10.2] duration. Within the 49 women who experienced all ovulatory cycle types (normal, short luteal length [SLL < 10 days] and anovulatory), median cramp intensity was greater in normal-length cycles having subclinical ovulatory disturbances (SLL and anovulatory; median 1.4 [range 0.0-2.8]) than in normally ovulatory cycles (median 1.2 [range 0.0-2.3]) (P = 0.023). Cramp Scores did not differ by ovulatory status within the 19 women having both normally ovulatory and anovulatory cycles (P = 0.222). Within-woman 1-year Cramp Scores were not different in anovulatory and normally ovulatory menstrual cycles but were more intense with ovulatory disturbances.

Prevalence of dysmenorrhea and associated factors among students in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Dysmenorrhea is one of the most common gynecological complaints among adolescent women. It has been associated with short-term absenteeism in school and has a negative impact on academic and daily activities. Therefore, the aim of the study was to show the evidence on the magnitude and correlates of dysmenorrhea in Ethiopia.

METHOD

In this systematic review and meta-analysis, we searched the literature from different databases such as PubMed/Medline, Science Direct, PsycINFO, and Cochrane library. We also used unpublished literature from Google, Google Scholar. The quality of the included articles was assessed using the Newcastle-Ottawa Scale. Data were extracted using a Microsoft Excel data extraction format. STATA version 14 statistical software was used for data analysis. To assess the heterogeneity of the primary articles, the Cochrane Q test statistics and the I² test were carried out. Publication bias was inspected by funnel plot, and Egger's test was performed to confirm the presence of publication bias. A random-effects meta-analysis was used to estimate the pooled prevalence of dysmenorrhea and its associated factors.

RESULT

A total of 12 studies were included in the final meta-analysis. The pooled prevalence estimate of dysmenorrhea among female students in Ethiopia is 71.69% (66.82%-76.56%). In our systematic review, among factors associated with dysmenorrhea, the family history of dysmenorrhea was frequently reported in included studies. Therefore, dysmenorrhea was significantly associated with a family history of dysmenorrhea (adjusted odds ratio = 4.69 (95% confidence interval: 2.80-7.85)).

CONCLUSION

The pooled prevalence estimate of dysmenorrhea among students was much higher in Ethiopia. Health professionals and teachers should educate and support students to follow their menstrual cycle regularly in the event of irregular periods. There should be an awareness of the negative consequences of dysmenorrhea to reduce the physical and psychological stresses that affect women and their families.

Opioid prescription for pain after osmotic dilator placement in abortion care: A randomized controlled trial

OBJECTIVE

To compare the overnight maximum pain scores after osmotic dilator placement prior to a dilation and evacuation (D&E) procedure in participants assigned to a prescription for ibuprofen alone or to ibuprofen plus oxycodone.

STUDY DESIGN

We conducted a nonblinded pragmatic, randomized controlled trial to evaluate pain management among women undergoing osmotic dilator placement prior to D&E. We randomly assigned 70 participants at 12 weeks 6 days to 23 weeks 6 days gestation to receive a prescription for ibuprofen alone, or ibuprofen plus oxycodone. We assessed pain using a numeric rating scale (NRS; scale 0-10) at the following time points: Baseline, dilator placement, 2 and 6 hours, and preoperatively, where we also asked participants their maximum pain score. The primary outcome was mean individual NRS pain score change from baseline to maximum pain score.

RESULTS

Maximum mean pain score (change from baseline) was 4.7 ± 2.9 in the ibuprofen group, and 6.5 ± 2.5 in the ibuprofen plus oxycodone group (p < 0.01). Participants in both groups reported highest NRS pain scores 2 hours after dilator placement, 3.9 ± 2.5 and 5.3 ± 2.6 respectively (p = 0.02). Average ibuprofen use in both arms was similar, and 81% of participants used at least 1 dose of ibuprofen after dilator placement. Of those randomized to prescription to ibuprofen plus oxycodone, only 51% used a dose of oxycodone.

CONCLUSIONS

Compared to participants randomized to receive a prescription for ibuprofen, those randomized to receive a prescription for ibuprofen plus oxycodone reported higher maximum overnight pain scores.

IMPLICATIONS

Participants receiving a prescription for ibuprofen alone had lower maximum overnight pain scores following osmotic dilator placement. Given that opioid prescriptions did not appear to reduce overnight pain, minimizing these prescriptions would avoid opioid exposure for patients undergoing D&E.

Prevalence and factors associated with dysmenorrhea in women at child bearing age in the Dschang Health District, West-Cameroon

Introduction

dysmenorrhea is a painful phenomenon at the pelvis region preceding or following menstruation. Dysmenorrhea accounts among the most frequent problem of women at child bearing age and affects 45% to 95% of them. According to the WHO, 16.8 to 81% of women are affected by dysmenorrhea. The present study was carried out at the Dschang Health District in order to determine the prevalence of dysmenorrhea and associated factors among women at child bearing age.

Methods

a transversal community-based study was carried out from March to June 2018. Information regarding socio-demographic features, prevalence, factors associated with the dysmenorrhea and the effect of dysmenorrhea on daily activities were collected using structured questionnaire and data were analyzed using Epi Info version 7.1.3.3 Software.

Results

a total of 637 women aged 12 to 50 years were interviewed in the present study. The mean body mass index was 25.94 with an average weight of 66.41 kilogram. Fifty six point twenty percent (56.20%) of participants had dysmenorrhea. From all risks factors fund only the normal body mass index (OR = 3.08, P-value = 0.01) having a significant association with the occurrence of dysmenorrhea. Daily activities were affected in 73.25% of participants dysmenorrheic and those who had some episodes of dysmenorrhea.

Conclusion

the present study showed that more than a half of respondents were dysmenorrheic and several factors were associated with this pathology. This study also suggests that dysmenorrhea have a negative impact on the daily activities of women at child bearing age.

A Complex Case of Dysmenorrhea and Concurrent Acute Appendicitis

Dysmenorrhea is a common problem experienced by many women on a regular basis. It is characterized by recurrent bouts of crampy abdominal pain that is associated with the menstrual cycle. These episodes can vary in severity and frequency and may require treatment. The objective of this study is to shed light on a case of severe dysmenorrhea that occurred simultaneously with acute appendicitis. The patient underwent appendectomy, but despite this continued to have abdominal pain in the postoperative period. This led to many investigations for possible post-surgical complications that had no yield. The diagnosis of dysmenorrhea was made with help from family members who disclosed that the patient had heavy bleeding and severe crampy menstrual pain associated with nausea and vomiting. This information was unknown to the medical team as this patient did not disclose this information. The coincidence of dysmenorrhea and concurrent acute appendicitis led to difficulty in diagnosing the etiology of the lingering postoperative abdominal pain.

A Unifying Hypothesis of the Pathophysiology of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Recognitions from the finding of autoantibodies against ß2-adrenergic receptors

Myalgic Encephalomyelitis or Chronic Fatigue Syndrome (CFS/ME) is a complex and severely disabling disease with a prevalence of 0.3% and no approved treatment and therefore a very high medical need. Following an infectious onset patients suffer from severe central and muscle fatigue, chronic pain, cognitive impairment, and immune and autonomic dysfunction. Although the etiology of CFS/ME is not solved yet, there is numerous evidence for an autoantibody mediated dysregulation of the immune and autonomic nervous system. We found elevated ß2 adrenergic receptor (ß2AdR) and M3 acetylcholine receptor antibodies in a subset of CFS/ME patients. As both ß2AdR and M3 acetylcholine receptor are important vasodilators, we would expect their functional disturbance to result in vasoconstriction and hypoxemia. An impaired circulation and oxygen supply could result in many symptoms of ME/CFS. There are consistent reports of vascular dysfunction in ME/CFS. Muscular and cerebral hypoperfusion has been shown in ME/CFS in various studies and correlated with fatigue. Metabolic changes in ME/CFS are also in line with a concept of hypoxia and ischemia. Here we try to develop a unifying working concept for the complex pathomechanism of ME/CFS based on the presence of dysfunctional autoantibodies against ß2AdR and M3 acetylcholine receptor and extrapolate it to the pathophysiology of ME/CFS without an autoimmune pathogenesis.

Menstrual Pain: A Review of Foreign Literature

The World Health Organization estimates dysmenorrhea as the most important cause of a chronic pelvic pain. Its prevalence among adolescents and young women ranges from 40 % to 90 %, and varies, depending on age, country of residence and population density of the area. Primary dysmenorrhea is responsible for reducing the quality of life, absenteeism in the workplace or at school, refusing to participate in community and sporting events, changing of pain perception and sleep disturbance. There is evidence of its relationship with an early menarche, a family history, a length of the menstrual cycle, bad habits, poor sleep hygiene, an unbalanced diet, sedentary lifestyle and obesity. Characteristic features of a personality contribute in a certain way, making women prone to neuroticism and pain catastrophizing to be more at risk of developing dysmenorrhea. Irritable bowel syndrome, musculoskeletal pain and interstitial cystitis often accompany dysmenorrhea and respond to its treatment positively. Despite the proven validity of nonsteroidal anti­inflammatory drugs treatment there are resistant forms of menstrual pain, those make a search for alternative therapy relevant.

Comparative efficacy and safety of NSAIDs-controlled acupuncture in the treatment of patients with primary dysmenorrhoea: a Bayesian network meta-analysis

Background

Acupuncture and non-steroidal anti-inflammatory drugs (NSAIDs) are used frequently to treat primary dysmenorrhoea. However, it is unclear whether this treatment greatly reduces the risk of primary dysmenorrhoea.

Methods

Eight databases were searched up to January 2018. Pair-wise and network meta-analyses were conducted to synthesize data from eligible studies.

Results

Seventeen randomized controlled trials were included. The following acupuncture types showed more efficacy than NSAIDs in reducing primary dysmenorrhoea risk: traditional acupuncture (odds ratio [OR] = 6.70, 95% confidence interval [CI] 2.60–20.0), eye acupuncture (OR = 3.50, 95% CI 1.40–8.90), wrist–ankle acupuncture (OR = 6.00, 95% CI 1.30–32.0), superficial acupuncture (OR= 5.10, 95% CI 1.20–26.0), moxibustion (OR = 7.70, 95% CI 2.90–25.0), electroacupuncture (OR = 23.0, 95% CI 4.80–130), ear acupuncture (OR = 13.0, 95% CI 2.80–100) and abdominal acupuncture (OR = 5.30, 95% CI 2.10–16.0). Surface under the cumulative ranking curve values were traditional acupuncture (53.0%), eye acupuncture (22.0%), wrist–ankle acupuncture (81.5%), superficial acupuncture (50.0%), moxibustion (57.8%), electroacupuncture (99.9%), ear acupuncture (41.6%) and abdominal acupuncture (44.1%).

Conclusion

Acupuncture is more efficacious than NSAIDs in reducing primary dysmenorrhoea risk. Acupuncture, particularly electroacupuncture, can decrease the risk of primary dysmenorrhoea.

Abdominal pain mimicking dysmenorrhea in luteal phase

We treated four patients with severe abdominal pain in the luteal phase that showed a remarkable resemblance to dysmenorrhea. The symptoms began when the patients were in their twenties and thirties, and the pain was identical to the high phase of basal body temperature. No other abnormal findings were revealed in physical examinations, except for leiomyoma in two patients. Oral contraceptive use led to symptom exacerbation, while gonadotropin-releasing hormone agonist administration completely inhibited the pain. One patient underwent a hysterectomy for leiomyoma, with ovulation later confirmed, though luteal phase abdominal pain completely disappeared. Based on our findings, the postulated mechanism for the pain is uterine contractions induced by progesterone through various mechanisms. The symptoms in our patients were successfully treated by ovulation inhibition obtained with cyclic administration of conjugated estrogen.

Prevalence and associated factors of dysmenorrhea among secondary and preparatory school students in Debremarkos town, North-West Ethiopia

BACKGROUND

Dysmenorrhea is one of the most common gynecologic disorders and a frequently observed cause of anxiety and discomfort among female adolescents. Its prevalence varies between 16% and 91% in women of reproductive age. Its population statistics are too scant in Ethiopia. This study was aimed to determine the prevalence and associated factors of dysmenorrhea among secondary and preparatory school students in Debremarkos town, 2016.

METHODS

Institutional based cross-sectional study was employed from Sept.26 to Oct.17, 2016 among secondary and preparatory school students in Debremarkos town. Self-administered questionnaire was used to collect data from 539 individuals selected by simple random sampling technique. Data were checked, coded and entered into Epi-data version 3.1 and exported to SPSS version 20 for analysis. Univariate, bivariate and multivariable analysis were carried out. Binary logistic regression model was computed and P value < 0.05 was considered as significant. All ethical procedures were considered.

RESULTS

The prevalence of dysmenorrhea was 69.3%. Age, AOR (95% CI) =1.38(1.15, 1.65), family history of dysmenorrhea, AOR (95% CI) = 9.79(4.99, 19.20), physical activity, AOR (95% CI) =0.39(0.13, 0.82), sugar intake, AOR (95% CI) =2.94 (1.54, 5.61), early menarche AOR (95% CI) =4.10(1.21,13.09), late menarche AOR (95% CI) =0.50 (0.27, 0.91), heavy menstrual periods AOR (95% CI) =2.91(1.59, 5.35) and sexual intercourse AOR (95% CI) =0.24 (0.10.0.55) had statistically significant association with the occurrence of dysmenorrhea.

CONCLUSIONS

Age, positive family history of dysmenorrhea, physical activity, excessive sugar intake, early menarche, late menarche, sexual intercourse and heavy menstrual periods had a statistically significant association with the occurrence of dysmenorrhea.

Effects of acupoint-stimulation for the treatment of primary dysmenorrhoea compared with NSAIDs: a systematic review and meta-analysis of 19 RCTs

Background

Primary dysmenorrhoea (PD), defined as painful menses in women with normal pelvic anatomy, is one of the most common gynaecological syndromes. Acupoint-stimulation could potentially be an effective intervention for PD. Our aim was to determine the effectiveness of acupoint-stimulation compared with Non-Steroidal Anti-Inflammatory Drugs (NASIDs) in the treatment of PD.

Methods

Six databases were searched to December 2014. Sixteen studies involving 1679 PD patients were included. We included randomized controlled trials that compared acupoint-stimulation with NASIDs for the treatment of PD. The main outcomes assessed were clinical effectiveness rate, symptom score, visual analogue score, variation in peripheral blood prostaglandin F2α (PGF2α) and side effects. All analyses were performed using Comprehensive Meta-Analysis statistical software.

Results

(1) The total efficacy was better than control group: odds ratio = 5.57; 95% confidence interval (95% CI) = 3.96, 7.83; P < 0.00001; (2) The effect of intervention was positive in relieving the severity of PD symptoms: mean difference (MD) = 2.99; 95%CI = 2.49, 3.49; P < 0.00001; (3) No statistical difference existed between two groups in terms of a reduction in the VAS: MD = 1.24; 95%CI = −3.37, 5.85; P = 0.60; (4) The effect of intervention on the variation in peripheral blood PGF2α between two groups was positive: MD = 7.55; 95%CI = 4.29,10.82; P < 0.00001; (5) The side effects of control groups was more than the acupoint-stimulation group: OR = 0.03; 95%CI =0.00,0.22; P = 0.0005.

Conclusions

According to this article, acupoint-stimulation can relieve pain effectively in the treatment of PD and offers advantages in increasing the overall effectiveness.

Experience of dysmenorrhea among a group of physical therapy students from Cairo University: an exploratory study

INTRODUCTION

Dysmenorrhea is a condition describing the painful cramps that women feel before or during the menstrual period. While dysmenorrhea is the most common gynecologic complaint affecting adolescent and young women and there has been significant progress in understanding its pathophysiology and managing the symptoms, many young women do not seek medical consultation and remain untreated.

AIM OF THE STUDY

The aim of the study was to explore the prevalence of dysmenorrhea, its physical impact, and associated coping behaviors among university students.

METHODS

A total of 269 female college students volunteered to participate in the study. Data regarding the students' experience with dysmenorrhea were collected via self-reported questionnaire developed based on relevant literature. Pain was scored on visual analog scale (VAS).

RESULTS

Most respondents (84.01%) reported feeling pain in the abdomen and back (VAS score, 5.00). Mood swings (84.8%) and dizziness (48.2%) were, respectively, the most common affective and somatic symptoms related to menstruation. There was a significant difference in the amount of menstrual flow (p=0.004) and incidence of dysmenorrhea (p=0.03) according to menstrual regularity. Most students (91.2%) did not seek medical consultation for dysmenorrhea, and 62.4% used analgesics. However, no significant correlation (p=0.25) was found between analgesic intake and pain relief. While most students (90.7%) did not miss exams, 48.7% reported poor satisfaction with their academic performance because of dysmenorrhea.

CONCLUSION

Dysmenorrhea is highly prevalent among college students, with many physical impacts and associated activity limitations. Collaborative efforts from health care providers, program coordinators, and parents should focus on increasing awareness and improving management strategies to treat dysmenorrhea.

WITHDRAWN: Exercise for dysmenorrhoea

BACKGROUND

Dysmenorrhoea is characterised by cramping lower abdominal pain that may radiate to the lower back and upper thighs and is commonly associated with nausea, headache, fatigue and diarrhoea. Physical exercise has been suggested as a non-medical approach to the management of these symptoms.

OBJECTIVES

To assess the evidence for the effectiveness of exercise in the treatment of dysmenorrhoea.

SEARCH METHODS

A search was conducted using the methodology of the Menstrual Disorders and Subfertility Group (August 2009). CENTRAL (The Cochrane Library), MEDLINE, EMBASE, AMED and PsycINFO electronic databases were searched. Handsearching of relevant bibliographies and reference lists was also conducted.

SELECTION CRITERIA

Randomised controlled trials comparing exercise with a control or no intervention in women with dysmenorrhoea.

DATA COLLECTION AND ANALYSIS

Trials were independently selected and data extracted by two review authors.

MAIN RESULTS

Four potential trials were identified of which one was included in the review. The available data could only be included as a narrative description. There appeared to be some evidence from the trial that exercise reduced the Moos' Menstrual Distress Questionnaire (MDQ) score during the menstrual phase (P < 0.05) and resulted in a sustained decrease in symptoms over the three observed cycles (P < 0.05).

AUTHORS' CONCLUSIONS

The results of this review are limited to a single randomised trial of limited quality and with a small sample size. The data should be interpreted with caution and further research is required to investigate the hypothesis that exercise reduces the symptoms associated with dysmenorrhoea.

Systems pharmacology exploration of botanic drug pairs reveals the mechanism for treating different diseases

Multi-herb therapy has been widely used in Traditional Chinese medicine and tailored to meet the specific needs of each individual. However, the potential molecular or systems mechanisms of them to treat various diseases have not been fully elucidated. To address this question, a systems pharmacology approach, integrating pharmacokinetics, pharmacology and systems biology, is used to comprehensively identify the drug-target and drug-disease networks, exemplified by three representative Radix Salviae Miltiorrhizae herb pairs for treating various diseases (coronary heart disease, dysmenorrheal and nephrotic syndrome). First, the compounds evaluation and the multiple targeting technology screen the active ingredients and identify the specific targets for each herb of three pairs. Second, the herb feature mapping reveals the differences in chemistry and pharmacological synergy between pairs. Third, the constructed compound-target-disease network explains the mechanisms of treatment for various diseases from a systematic level. Finally, experimental verification is taken to confirm our strategy. Our work provides an integrated strategy for revealing the mechanism of synergistic herb pairs, and also a rational way for developing novel drug combinations for treatments of complex diseases.

The effect of lumbar-pelvic alignment and abdominal muscle thickness on primary dysmenorrhea

[Purpose] The purpose of this study was to identify effects of malalignment of the lumbar pelvis, as a passive element, and the thicknesses of abdominal muscles, as active elements, on primary dysmenorrhea. [Subjects and Methods] The subjects were divided into a primary dysmenorrhea group and normal group according to Visual Analogue Scale, and ultimately there were 28 subjects in the dysmenorrhea group and 22 subjects in the normal group. Alignment of the lumbar pelvis was measured by using a Formetric 4D analysis system, and the thicknesses of abdominal muscles were measured by using ultrasound imaging. [Result] Scoliosis was 6.7 ± 4.3° in the primary dysmenorrhea group and 3.8 ± 2.0° in the normal group, and the lordotic angles of the two groups were 0.6 ± 0.5° and 0.1 ± 0.3°, respectively. The thickness of the internal oblique was 3.8 ± 1.3 mm in the primary dysmenorrhea group and 6.0 ± 1.9 mm in the thicknesses of the transverse abdominis in the two groups were 2.6 ± 6.8 mm and 3.5 ± 6.1 mm, respectively. Furthermore, the thickness of the normal group, and the external oblique was 4.0 ± 0.8 mm in the primary dysmenorrhea group and 5.4 ± 1.4 mm in the normal group. [Conclusion] This study showed significant differences between the primary dysmenorrhea group and the normal group in lumbar-pelvic alignment and thicknesses of abdominal muscles.

Primary dysmenorrhea magnitude, associated risk factors, and its effect on academic performance: evidence from female university students in Ethiopia

BACKGROUND

Primary dysmenorrhea (PD) is the most common gynecologic compliant among adolescent females. There is a wide variation in the estimate of PD, which ranges from 50% to 90%, and the disorder is the most common cause of work and school absenteeism in adolescent females.

OBJECTIVE

To assess the prevalence and associated risk factors of PD among female university students and understand its effects on students' academic performance.

METHODS

A cross-sectional study was employed in 440 research participants. A multistage stratified sampling technique was employed to select the study units. Structured and pretested self-administered questionnaires were used and weight and height measurements were conducted. The severity of dysmenorrheal pain was assessed by using a verbal multidimensional scoring system and visual analog scale. The data were double entered in Epi Info version 3.1 and analyzed using SPSS version 17. Descriptive statistics, chi-square test, and logistic regression analysis were performed.

RESULTS

A total of 440 students participated in this study. The prevalence of PD was 368 (85.4%). Of these, 123 (28.5%) had mild, 164 (38.1%) moderate, and 81 (18.8%) severe primary dysmenorrheal pain. Among students with PD, 88.3% reported that PD had a negative effect on their academic performance. Of these, 80% reported school absence, 66.8% reported loss of class concentration, 56.3% reported class absence, 47.4% reported loss of class participation, 37.8% reported limited sport participation, 31.7% reported limitation in going out with friends, and 21% reported inability to do homework. Based on the multivariate logistic regression, PD was statistically significant with those who had lower monthly stipends, a history of attempt to lose weight, a history of depression or anxiety, disruption of social network of family, friends or people they love, who consumed more than four glasses of tea per day, who drunk one or more Coca-Cola or Pepsi per day, in nullipara, and students with a family history of dysmenorrhea.

CONCLUSION

PD is more prevalent among female students attending university. It has a significant negative impact on students' academic performance. Thus, it needs medical attention. There are various identified associated risk factors and considering them in the management of the disorder is fundamental. It is also wise to recommend future studies to better identify risk factors for PD and lighten its effect on students' academic performance at a larger scale in the country.

Importance of cervical length in dysmenorrhoea aetiology

The objective of this prospective case-control study was to determine whether uterine corpus and cervical length measurements have a role in dysmenorrhoea aetiology in virgins. Patients with severe primary dysmenorrhoea with visual analog scale scores of ≥7 composed the dysmenorrhoea group (n = 51), while the control group (n = 51) was of women with painless menstrual cycles or with mild pain. Longitudinal and transverse axes of the uterine cervix and uterine corpus were measured. Correlation between severity of dysmenorrhoea and uterine cervix and corpus axes was calculated. Longitudinal and transverse axes of uterine cervix as well as uterine cervix volume were significantly higher in the dysmenorrhoea group compared to the controls. There was a significant positive correlation between severity of dysmenorrhoea and the length of cervical longitudinal and transverse axes and uterine cervical volume. Our findings reveal longer cervical length and greater cervical volume in young virgin patients with dysmenorrhoea and severe pain compared to those with no or less pain.

Emotional labor and dysmenorrhea in women working in sales and call centers

Objectives

This study was conducted to investigate the association between emotional labor and dysmenorrhea among women working in sales and call centers in Seoul, South Korea.

Methods

Working women in sales jobs and call centers in Seoul were interviewed face-to-face by well-trained interviewers. In total, 975 participants were analyzed in the final model. Emotional labor was measured using a constructed questionnaire with two components: an emotive effort component with three questions and an emotive dissonance component with five questions. To examine the association between emotional labor and dysmenorrhea, chi-squared tests and logistic regression were applied.

Results

The prevalence of dysmenorrhea among sales workers and call center workers were 43.0% and 61.1%, respectively. The adjusted odds ratios (OR) of emotive effort and emotive dissonance for dysmenorrhea in call center workers were 1.88 (95% confidence interval [CI], 1.07–3.28) and 1.72 (95% CI, 1.13–2.63), respectively. The adjusted OR of emotive effort and emotive dissonance for dysmenorrhea in sales workers were 1.71 (95% CI, 0.92–3.16) and 1.15 (95% CI, 0.67–1.98), respectively.

Conclusions

Emotional labor was found to be associated with dysmenorrhea in call center workers. Further studies to investigate other factors, such as management strategies and the relationship between emotional labor and dysmenorrhea, are needed to support interventions to prevent dysmenorrhea that will further promote the quality of health and life of working women.

Estradiol valerate plus dienogest versus ethinylestradiol plus levonorgestrel for the treatment of primary dysmenorrhea

OBJECTIVE

To demonstrate the superiority of estradiol valerate plus dienogest (E(2)V/DNG) over ethinylestradiol plus levonorgestrel (EE/LNG) in reducing the number of days with dysmenorrheic pain among women with primary dysmenorrhea.

METHODS

In a phase IIIb trial conducted at 44 centers worldwide between April 2009 and November 2010, otherwise healthy women aged 14-50 years requesting contraception were randomized to daily oral administration of E(2)V/DNG (n = 253) or EE/LNG (n = 254) for three 28-daycycles. The primary efficacy variable was number of days with dysmenorrheic pain, the category of which (none, mild, moderate, severe) was self-assessed on a daily basis (irrespective of menstrual bleeding status) and recorded on diary cards. Notably, the women documented their pain as they experienced it before taking any (permitted) rescue medication.

RESULTS

Overall, 217 and 209 women receiving E(2)V/DNG and EE/LNG, respectively, completed the study. The mean ± SD change from baseline in number of days with dysmenorrheic pain was -4.6 ± 4.6 days and -4.2 ± 4.2 days for the E(2)V/DNG and EE/LNG groups, respectively (P = 0.34).

CONCLUSION

Both E(2)V/DNG and EE/LNG led to considerable relief of dysmenorrheic complaints among women with primary dysmenorrhea, decreasing the number of days with dysmenorrheic pain from baseline to a similar extent. ClinicalTrials.gov:NCT00909857.

Impact of Yoga Nidra on menstrual abnormalities in females of reproductive age

OBJECTIVES

The aim of this study was to observe the effect of Yoga Nidra practice on hormone levels in patients who had menstrual irregularities.

DESIGN

The study was a randomized controlled trial.

SETTINGS/LOCATION

The study was conducted in the Department of Obstetrics and Gynecology at Chhatrapati Sahuji Maharaj Medical University, Uttar Pradesh, Lucknow, India. SUBJECTS were divided randomly into 2 groups-an intervention and a control group, with 75 subjects in each group. Of these subjects, 126 completed the study protocol.

SUBJECTS

This study involved 150 subjects with menstrual irregularities; 126 of whom completed the protocol.

INTERVENTIONS

The intervention was the practice of Yoga Nidra. The yogic intervention duration was 35-40 minutes/day, five times/week for 6 months. An estimation of hormonal profile was done for both groups at baseline and after 6 months.

RESULTS

Thyroid-stimulating hormone (p<0.002), follicle-stimulating hormone (p<0.02), luteinizing hormone (p<0.001), and prolactin (p<0.02) were decreased significantly in the intervention group, compared with the control group.

CONCLUSIONS

The present study demonstrated the efficacy of Yoga Nidra on hormone profiles in patients with menstrual irregularities. Yoga Nidra practice was helpful in patients with hormone imbalances, such as dysmenorrhea, oligomenorrhea, menorrhagia, metrorrhagia, and hypomenorrhea.

Oral contraceptives in adolescent women

Taking into account the biological and psychosocial changes during the transition from childhood to adulthood adolescents would need a contraceptive method which ideally would be very effective, independent of compliance, without major health risks during use and no negative impact on the future health of the adolescent, protective against STI, favorable for bone development, with no or only few side effects and having some preventive and therapeutic potential with respect to frequent health problems of adolescent girls. Combined oral contraceptives (COC) used regularly and consistently have a more than 99% efficacy to prevent a pregnancy. COCs have a very low health risk (almost exclusively thromboembolic disease) which seems to differ marginally with respect to dosage and type of the components. Progestogen only oral contraceptives do not have any major negative health impact. The leading side effect is irregular bleeding which in COC users is mainly during the first 3 months and in progestogen only users during the period of use. Other side effects are reported but their frequency is similar to placebo. COC protect against endometrial and ovarian cancer and they may have beneficial effects on a variety of menstrual complaints and acne, which are frequent problems during adolescence. To be effective COCs have to be taken regularly which is frequently not the case. This diminishes considerably their effectiveness depending on the individual compliance. They do not protect against STI and may even have an inhibitory effect on the use of condoms. For most adolescents the risk benefit profile of oral contraceptives is favorable and makes this method valuable. At the same time the prescription of oral contraceptives for adolescents need to be individualized by taking into account the individual risk/benefit profile. Specialized counseling with a high degree of confidentiality adapted to the knowledge and needs of the individual adolescent is desirable.

Morinda citrifolia (Noni) as an Anti-Inflammatory Treatment in Women with Primary Dysmenorrhoea: A Randomised Double-Blind Placebo-Controlled Trial

Introduction. Noni (Morinda citrifolia) has been used for many years as an anti-inflammatory agent. We tested the efficacy of Noni in women with dysmenorrhea. Method. We did a prospective randomized double-blind placebo-controlled trial in 100 university students of 18 years and older over three menstrual cycles. Patients were invited to participate and randomly assigned to receive 400 mg Noni capsules or placebo. They were assessed for baseline demographic variables such as age, parity, and BMI. They were also assessed before and after treatment, for pain, menstrual blood loss, and laboratory variables: ESR, hemoglobin, and packed cell volume. Results. Of the 1027 women screened, 100 eligible women were randomized. Of the women completing the study, 42 women were randomized to Noni and 38 to placebo. There were no significant differences in any of the variables at randomization. There were also no significant differences in mean bleeding score or pain score at randomization. Both bleeding and pain scores gradually improved in both groups as the women were observed over three menstrual cycles; however, the improvement was not significantly different in the Noni group when compared to the controls. Conclusion. Noni did not show a reduction in menstrual pain or bleeding when compared to placebo.

Acupuncture to treat primary dysmenorrhea in women: a randomized controlled trial

We examined the effectiveness of acupuncture to reduce the severity and intensity of primary dysmenorrhea. A randomized controlled trial compared acupuncture with control acupuncture using a placebo needle. Eligible women were aged 14–25 years with a diagnosis of primary dysmenorrhea. Women received nine sessions of the study treatment over 3 months. The primary outcomes were menstrual pain intensity and duration, overall improvement in dysmenorrhea symptoms and reduced need for additional analgesia, measured at 3, 6 and 12 months from trial entry. A total of 92 women were randomly assigned to the intervention (acupuncture n = 46 and control n = 46). At 3 months although pain outcomes were lower for women in the acupuncture group compared with the control group, there was no significant difference between groups. Women receiving acupuncture reported a small reduction in mood changes compared with the control group, relative risk (RR) 0.72, 95% confidence interval (CI) 0.53–1.00, P = .05. Follow-up at 6 months found a significant reduction in the duration of menstrual pain in the acupuncture group compared with the control group, mean difference –9.6, 95% CI –18.9 to –0.3, P = .04, and the need for additional analgesia was significantly lower in the acupuncture group compared with the control group, RR 0.69, 95% CI 0.49–0.96, P = .03, but the follow-up at 12 months found lack of treatment effect. To conclude, although acupuncture improved menstrual mood symptoms in women with primary dysmenorrhea during the treatment phase, the trend in the improvement of symptoms during the active phase of treatment, and at 6 and 12 months was non-significant, indicating that a small treatment effect from acupuncture on dysmenorrhea may exist. In the study, acupuncture was acceptable and safe, but further appropriately powered trials are needed before recommendations for clinical practice can be made.

Inhibitory effects of active fraction and its main components of Shaofu Zhuyu decoction on uterus contraction

Shaofu Zhuyu decoction is a famous formula for treating primary dysmenorrhea in China since the Qing dynasty. In this paper, the inhibitory effects of active-guided fraction and its main bioactive components of Shaofu Zhuyu decoction on a model of non-pregnant mice uterine contraction induced by oxytocin in vitro were investigated. Qualitative and quantitative chemical analyses were used to correlate the chemical composition of active fraction with the spasmolytic effects. Seven ingredients in the active fraction were identified and quantified by HPLC-DAD. Three ingredients, ferulic acid, vanillic acid, and typhaneoside, were evaluated for their effects on mice isolated uterine contraction induced by oxytocin in vitro. The ED(50) of them were 63.0 microg/ml, 57.6 microg/ml, 109.7 microg/ml, respectively. Furthermore, the inhibitory activity of the combination of these three compounds was prior to the fraction and seven compounds group. The ED(50) was 65.5 microg/ml. The data stated that ferulic acid, vanillic acid, and typhaneoside were possibly the main active components in the bioactive fraction of Shaofu Zhuyu decoction. The study also implied that Shaofu Zhuyu decoction may have direct inhibitory effects on the contractility of the mice uterus and justified the traditional use of the prescription for treating the uterine cramping associated dysmenorrhea.

Exercise for dysmenorrhoea

BACKGROUND

Dysmenorrhoea is characterised by cramping lower abdominal pain that may radiate to the lower back and upper thighs and is commonly associated with nausea, headache, fatigue and diarrhoea. Physical exercise has been suggested as a non-medical approach to the management of these symptoms.

OBJECTIVES

To assess the evidence for the effectiveness of exercise in the treatment of dysmenorrhoea.

SEARCH STRATEGY

A search was conducted using the methodology of the Menstrual Disorders and Subfertility Group (August 2009). CENTRAL (The Cochrane Library), MEDLINE, EMBASE, AMED and PsycINFO electronic databases were searched. Handsearching of relevant bibliographies and reference lists was also conducted.

SELECTION CRITERIA

Randomised controlled trials comparing exercise with a control or no intervention in women with dysmenorrhoea.

DATA COLLECTION AND ANALYSIS

Trials were independently selected and data extracted by two review authors.

MAIN RESULTS

Four potential trials were identified of which one was included in the review. The available data could only be included as a narrative description. There appeared to be some evidence from the trial that exercise reduced the Moos' Menstrual Distress Questionnaire (MDQ) score during the menstrual phase (P < 0.05) and resulted in a sustained decrease in symptoms over the three observed cycles (P < 0.05).

AUTHORS' CONCLUSIONS

The results of this review are limited to a single randomised trial of limited quality and with a small sample size. The data should be interpreted with caution and further research is required to investigate the hypothesis that exercise reduces the symptoms associated with dysmenorrhoea.

Effects of calcium channel blockers on the female genital tract

Contractile activity and vascular resistance in the female genital tract are influenced by several smooth muscle tissues with individual mechanisms for control of mechanical activation. Calcium channel blockers have potent relaxant effects on preparations of human myometrium. The myometrial arteries utilize multiple sources of calcium for contractile activation, and excitation-contraction coupling in isolated vessels from non-pregnant uteri seems comparatively less sensitive to nifedipine than in corresponding myometrial preparations. Contractile activation of myometrial and placental arteries at term is inhibited by nitrendipine and nifedipine. Human oviductal smooth muscle depends on superficially bound calcium for mechanical activation, but only phasic contractions can be abolished by nifedipine, while tonic contractions induced by various agents are more resistant to the calcium channel blocker. Menstrual uterine contractions and pain are effectively counteracted by nifedipine in normal and dysmenorrhoeic women. Such therapy may represent an alternative principle in the treatment of dysmenorrhea. Nifedipine has potent relaxant effects on the mid-term pregnant and the post-partum uterus and calcium channel blockers may prove useful in the treatment of premature labor. Nifedipine and related compounds may further show effective in the treatment of pregnancy-associated hypertension. Whether such treatment in late pregnancy involves maintained or even improved placental perfusion could be assumed from in vitro data but needs further studies.

Passive smoking, cytochrome P450 gene polymorphisms and dysmenorrhea

PURPOSE

This study investigated whether the association between passive smoking exposure and dysmenorrhea is modified by two susceptibility genes, CYP1A1MspI and CYP1A1HincII.

METHODS

This report includes 1,645 (1,124 no dysmenorrhea, 521 dysmenorrhea) non-smoking and non-drinking newly wedding female workers at Anqing, China between June 1997 and June 2000. Multiple logistic regression models were used to estimate the associations of passive smoking exposure and genetic susceptibility with dysmenorrhea, adjusting for maternal age, BMI, age of menarche, education, vibration exposure, shift work, noise exposure, pregnancy history, perceived stress and physical laboring stress.

RESULTS

In the passive smoking group, women who have C/C6235 genotype (OR = 1.8, 95% CI = 1.0-3.3) in CYP1A1MspI and Ile/Ile462 genotype (OR = 2.9, 95% CI = 1.1-7.7) in CYP1A1HincII was associated with an increased risk of dysmenorrhea. When stratified by women genotype, the adjusted OR of dysmenorrheal was 1.6 (95% CI = 1.2-2.1) for passive smoking group with Ile/Ile462 genotype, and 1.5 (95% CI = 1.0-2.1) with C/C6235 genotype, compared to non-passive smoking group, respectively. The data further showed that there was a significant combined effect between passive smoking and the CYP1A1 Msp1C/C6235 (OR = 1.5, 95% CI = 1.0-2.1), and HincII Ile/Ile462 (OR = 1.6, 95% CI = 1.2-2.1), respectively.

CONCLUSION

CYP1A1 MspI and HincII genotypes modified the association between passive smoking and dysmenorrhea.

CYP1A1 gene polymorphisms in modifying the association between passive smoking and primary dysmenorrhea

PURPOSE

This study investigated whether the association between passive smoking exposure and primary dysmenorrhea is modified by two susceptibility genes, cytochrome P450 1A1 (CYP1A1)MspI and CYP1A1HincII.

METHODS

We recruited 1645 female textile workers from 1997 to 2000 in Anqing, China, collecting information about passive smoking and status of primary dysmenorrhea and taking blood samples. We analyzed the association of CYP1A1 gene polymorphisms and passive smoking exposure with primary dysmenorrhea using multiple logistic regression.

RESULTS

In the passive smoking group, women who had the C/C6235 genotype (odds ratio [OR] = 1.8; 95% confidence intervals [CI] = 1.0-3.3) in CYP1A1MspI and Ile/Ile462 genotype (OR = 2.9; 95% CI = 1.1-7.7) in CYP1A1HincII had increased risk of dysmenorrhea. When stratified by genotype, the adjusted OR of dysmenorrhea was 1.6 (95% CI = 1.2-2.1) for the passive smoking group with the Ile/Ile462 genotype and 1.5 (95% CI = 1.0-2.1) with the C/C6235 genotype, compared with the nonpassive smoking group. The data further showed that there was a significant combined effect between passive smoking and the CYP1A1MspI C/C6235 and HincII Ile/Ile462 genotypes (OR = 2.4; 95% CI = 1.2-4.9).

CONCLUSIONS

CYP1A1MspI and HincII genotypes modified the association between passive smoking and primary dysmenorrhea.

Behavioural interventions for primary and secondary dysmenorrhoea

BACKGROUND

Dysmenorrhoea refers to the occurrence of painful menstrual cramps of uterine origin and is a common gynaecological condition with considerable morbidity. The behavioural approach assumes that psychological and environmental factors interact with, and influence, physiological processes. Behavioural interventions for dysmenorrhoea may include both physical and cognitive procedures and focus on both physical and psychological coping strategies for dysmenorrhoeic symptoms rather than modification of any underlying organic pathology.

OBJECTIVES

To determine the effectiveness of any behavioural interventions for the treatment of primary or secondary dysmenorrhoea when compared to each other, placebo, no treatment, or conventional medical treatments for example non-steroidal anti-inflammatory drugs (NSAIDs).

SEARCH STRATEGY

We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (searched April 2005), Cochrane Central Register of Controlled Trials (CENTRAL on The Cochrane Library, Issue 2, 2005), MEDLINE (1966 to April 2005), EMBASE (1980 to April 2005), Social Sciences Index (1980 to April 2005), PsycINFO (1972 to April 2005) and CINAHL (1982 to April 2005) and reference lists of articles.

SELECTION CRITERIA

Randomised controlled trials comparing behavioural interventions with placebo or other interventions in women with dysmenorrhoea.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed trial quality and extracted data.

MAIN RESULTS

Five trials involving 213 women were included. Behavioural intervention vs control: One trial of pain management training reported reduction in pain and symptoms compared to a control. Three trials of relaxation compared to control reported varied results, two trials showed no difference in symptom severity scores however one trial reported relaxation was effective for reducing symptoms in menstrual sufferers with spasmodic symptoms. Two trials reported less restriction in daily activities following treatment with either relaxation of pain management training compared to a control. One trial also reported less time absent from school following treatment wit pain management training compared to a control. Behavioural intervention vs other behavioural interventions: Three trials showed no difference between behavioural interventions for the outcome of improvement in symptoms. One trial showed that relaxation resulted in a decrease in the need for resting time compared to the relaxation and imagery.

AUTHORS' CONCLUSIONS

There is some evidence from five RCTs that behavioural interventions may be effective for dysmenorrhoea however results should be viewed with caution as they varied greatly between trials due to inconsistency in the reporting of data, small trial size, poor methodological quality and age of the trials.

Passive smoking, Cyp1A1 gene polymorphism and dysmenorrhea

OBJECTIVE

This study investigated whether the association between passive smoking exposure and dysmenorrhea is modified by two susceptibility genes, CYP1A1MspI and CYP1A1HincII.

METHODS

This report includes 1645 (1124 no dysmenorrhea, 521 dysmenorrhea) nonsmoking and nondrinking newly wed female workers at Anqing, China between June 1997 and June 2000. Multiple logistic regression models were used to estimate the associations of passive smoking exposure and genetic susceptibility with dysmenorrhea, adjusting for perceived stress.

RESULTS

When stratified by women genotype, the adjusted OR of dysmenorrhea was 1.6 (95%CI=1.3-2.1) for passive smoking group with Ile/Ile462 genotype, and 1.5 (95%CI=1.1-2.1) with C/C6235 genotype, compared to nonpassive smoking group, respectively. The data further showed that there was a significant combined effect between passive smoking and the CYP1A1 MspI C/C6235 and HincII Ile/Ile462 genotype (OR=2.6, 95%CI=1.3-5.2).

CONCLUSION

CYP1A1 MspI and HincII genotypes modified the association between passive smoking and dysmenorrhea.

Clinical efficacy and differential inhibition of menstrual fluid prostaglandin F2alpha in a randomized, double-blind, crossover treatment with placebo, acetaminophen, and ibuprofen in primary dysmenorrhea

OBJECTIVE

The purpose of this study was to compare acetaminophen with ibuprofen for pain relief and menstrual fluid prostaglandin F2alpha (PGF2alpha) suppression in primary dysmenorrhea.

STUDY DESIGN

Twelve subjects were randomized to placebo, acetaminophen (1000 mg orally, 4 x daily for 3 days) or ibuprofen (400 mg orally, 4 x daily for 3 days), once during each cycle in a prospective, double-blinded, crossover study. Using preweighed super absorbent tampons, menstrual fluid was collected, extracted, and PGF2alpha radioimmunoassayed.

RESULTS

Ten patients completed the study. Ibuprofen (P = .002) and acetaminophen (P = .022) were rated significantly better than placebo. Total menstrual fluid PGF2alpha with placebo was 36.2 + 6.1 microg but were 14.8 + 3.0 microg with ibuprofen (P = .001) and 21.4 + 3.4 microg with acetaminophen (P = .008). PGF2alpha concentrations with placebo were 0.34 + 0.054 microg/mL, with ibuprofen 0.16 + 0.026 microg/mL (P = .001), and with acetaminophen 0.23 + 0.029 microg/mL (P = .016).

CONCLUSION

Both ibuprofen and acetaminophen were superior to placebo for pain relief and menstrual fluid PGF2alpha suppression, with ibuprofen being more potent.

Primary dysmenorrhea: advances in pathogenesis and management

Primary dysmenorrhea is painful menstrual cramps without any evident pathology to account for them, and it occurs in up to 50% of menstruating females and causes significant disruption in quality of life and absenteeism. Current understanding implicates an excessive or imbalanced amount of prostanoids and possibly eicosanoids released from the endometrium during menstruation. The uterus is induced to contract frequently and dysrhythmically, with increased basal tone and increased active pressure. Uterine hypercontractility, reduced uterine blood flow, and increased peripheral nerve hypersensitivity induce pain. Diagnosis rests on a good history with negative pelvic evaluation findings. Evidence-based data support the efficacy of cyclooxygenase inhibitors, such as ibuprofen, naproxen sodium, and ketoprofen, and estrogen-progestin oral contraceptive pills (OCPs). Cyclooxygenase inhibitors reduce the amount of menstrual prostanoids released, with concomitant reduction in uterine hypercontractility, while OCPs inhibit endometrial development and decrease menstrual prostanoids. An algorithm is provided for a simple approach to the management of primary dysmenorrhea.