Primary Dysmenorrhea Consensus Guideline

Efficacy of progressive muscle relaxation technique in primary dysmenorrhea: A randomized controlled trial

OBJECTIVE

To examine the effects of Jacobson's Progressive Muscle Relaxation Technique (JPMRT) on menstrual pain and symptoms, anxiety, quality of life (QoL), social activity, and work/school performance in primary dysmenorrhea (PD).

MATERIALS AND METHODS

Women with PD were randomly divided into two groups as relaxation and control groups. JPMRT was applied three times a week from the estimated date of ovulation to the onset of the next menstruation. No treatment was performed in the control group. Pain intensity, menstrual symptoms, anxiety, impacts on QoL, social activity, and work/school performance were assessed before and after the interventions.

RESULTS

After the interventions, there was a further decrease in menstrual pain intensity, menstrual symptoms, anxiety level, the impact of QoL, and the work/school performance scores in the relaxation group than in the control group (p < 0.05).

CONCLUSION

JPMRT might be used as an alternative method in the treatment of PD.

Prevalence, pain intensity and symptoms associated with primary dysmenorrhea: a cross-sectional study

BACKGROUND

Primary dysmenorrhea (PD) is an etiological cyclic pelvic pain related to the menstrual period; it can negatively impact women's quality of life and productivity. The aim of the present study was to estimate the prevalence of PD and analyze associated symptoms in Brazilian women.

METHODS

An online cross-sectional study was carried out in Brazil, with a structured questionnaire regarding dysmenorrhea and associated symptoms. PD intensity was measured with the Numerical Rating Scale for Pain and classified as mild (1-3), moderate (4-7) and severe (> 8). The association between qualitative variables was performed using Pearson's Chi-Square Test. The quantification of this association was measured using multinomial logistic regression models, with calculation of Odds Ratio and confidence interval. A significance level of 5% was considered.

RESULTS

A total of 10,070 women were included. Most participants classified PD intensity as moderate (40.4%, 41.9% and 49.7%) and severe (21.2%, 24.8% and 28.4%) in the previous month, 3 months and 5 years, respectively. The most common symptoms associated with PD were irritability, abdominal distension sensation, anxiety and feeling more emotional. The increased of the risk (OR > 1.0) for moderate and severe PD-related pain intensity is related to age, nulliparity and presence PD since adolescence.

CONCLUSION

There is a high prevalence of PD among Brazilian women, and the most common symptoms reported were irritability, abdominal distension sensation, anxiety and feeling more emotional.

The effect of yoga practice on pain intensity, menstruation symptoms and quality of life of nursing students with primary dysmenorrhea

The researchers aimed to determine the effects of yoga on pain severity, menstrual symptoms and quality of life of undergraduate nursing students with primary dysmenorrhea. The 60 female students were divided into intervention (n = 30) and control groups (n = 30) by block randomization. In the study, data were evaluated with the Visual Analog Scale for Pain, the Menstruation Symptom Scale and the Short Form-36 Health Survey Scale. The 12-week intervention program, which included all components of Hatha yoga, was carried out twice a week for a total of 24 sessions of 60 min. The control group did not receive any intervention. The severity of menstrual pain and symptoms decreased in yoga group compared to control group, and there were significant improvements in quality of life (p < 0.001). The researchers shows that regular Hatha yoga may be a possible nonpharmacological treatment for primary dysmenorrhea in young women in this study.

Altered cognitive control network mediates the association between long-term pain and anxiety symptoms in primary dysmenorrhea

Neuroimaging studies have demonstrated the association of the cognitive control network (CCN) with the maintenance of chronic pain. However, whether and how dorsolateral prefrontal cortex (DLPFC), a key region within the CCN, is altered in menstrual pain is unclear. In this study, we aimed to investigate alterations in the DLPFC functional connectivity network in patients with primary dysmenorrhea (PDM). The study comprised 41 PDM patients and 39 matched healthy controls (HCs), all of whom underwent a resting-state functional MRI scan during the menstrual stage. All participants were instructed to complete the clinical assessment before the MRI scan. We used the DLPFC as the seed in resting-state functional connectivity (rsFC) analysis to investigate the difference between PDM patients and HCs. Compared to HCs, PDM patients showed increased right DLPFC rsFC at the bilateral lingual gyrus, dorsal anterior cingulate cortex (dACC), and middle cingulate cortex, and decreased left DLPFC rsFC at the right orbital frontal cortex. In addition, increased right DLPFC-bilateral dACC connectivity mediated the association between disease duration and the self-rating anxiety scale (SAS) scores in PDM patients. We confirmed that the DLPFC-dACC rsFC was associated with higher SAS scores, which could mediate the association between disease duration and anxiety symptoms in patients with PDM. Our findings provide central pathological evidence for an abnormal rsFC of the CCN in PDM patients, which may contribute to a better understanding of the neuropathophysiological mechanisms underlying PDM.

Systematic review of the effectiveness of menstrual health interventions in low- and middle-income countries in the East Asia and Pacific region

Background

In the context of rapidly expanding policy and practice, this systematic review collates and appraises evidence for the effectiveness of menstrual health interventions in the East Asia and Pacific region.

Methods

Structured searches were undertaken in 7 databases and Google Scholar. Grey literature was identified through searching and survey of stakeholders. Quantitative evaluations were eligible. We audited the interventions and outcomes assessed in current evidence, undertook risk of bias assessment, and narrative synthesis of findings. The review protocol was registered prior to searching (PROSPERO: 343613).

Findings

Eighteen studies were eligible; categorised according to the requirements for menstrual health they addressed. Information and education intervention studies (n = 11) found school-based programs improved menstrual knowledge test scores but did not evaluate impacts on broader outcomes. Evaluations of interventions providing materials, facilities, and services for menstruation (n = 4) focused on product acceptability. Studies exhibited a serious risk of bias without adequate controls, limitations in intervention allocation, adherence, and participant retention. Six studies of interventions to improve care for menstrual discomforts found decreased self-reported pain but had serious bias without placebo controls. Two interventions targeted the supportive social environment for menstruation.

Interpretation

There is insufficient evidence for the effectiveness of menstrual health interventions in the East Asia and Pacific region. Future research must improve reporting, provide clear intervention theory of change, and improve measurement of core concepts. Evaluations of interventions that align with policy and practice are needed, facilitated by partnerships between researchers, government, and practitioners.

Funding

UNICEF. Reckitt Global Hygiene Institute. NHMRC.

Help-seeking behaviour in dysmenorrhoea: A cross-sectional exploration using the Behavioural Model of Health Services Use

BACKGROUND

Dysmenorrhoea, or period pain, is a prevalent gynaecological condition that can result in functional interference during menstruation. Despite the significant disruption dysmenorrhoea can have on functioning and well-being, medical help-seeking rates are low. Little is known about what factors may predict help-seeking for dysmenorrhoea.

OBJECTIVES

The current study aimed to test the predictive validity of the Behavioural Model of Health Services Use (BMHSU) for help-seeking behaviour in dysmenorrhoea, whereby help-seeking behaviour was operationalised as having attended to a healthcare professional for dysmenorrhoea-related care.

DESIGN

A cross-sectional observational design was used.

METHODS

Participants (N = 439) completed an online survey, which measured the following eight predictor variables: menstrual pain characteristics, health beliefs, self-efficacy, social support utilisation and satisfaction, perceived healthcare availability, and pain intensity and interference. Participants were also asked to report whether they had ever attended to a healthcare professional for their menstrual pain.

RESULTS

The BMHSU accounted for 8% of the variance in help-seeking behaviour. Pain interference and appointment availability were significant predictors of the variance in past help-seeking behaviour, such that those who experienced greater pain interference, and those who perceived greater availability of healthcare appointments were less likely to have visited a healthcare professional for their menstrual pain. The BMHSU had an overall 69% classification accuracy in predicting help-seeking behaviour.

CONCLUSION

Although the BMHSU demonstrated reasonably good model fit, it does not appear to be a particularly robust model for predicting help-seeking behaviour for dysmenorrhoea. Future research should explore whether a refined BMHSU or an alternative theoretical model can provide more useful insight into this behaviour. Better understanding of the determinants of help-seeking behaviour will enable the development of interventions to promote appropriate help-seeking and improve health outcomes for individuals with menstrual pain.

Skin Temperature of Acupoints in Health and Primary Dysmenorrhea Patients: A Systematic Review and Meta-Analysis

Objective

Dysmenorrhea is a common clinical condition and some studies shown that the skin temperature of some acupoints changes in primary dysmenorrhea (PD) patients. This study aimed to evaluate the changes in skin temperature at specific acupoints in PD patients and healthy subjects.

Methods

The literature for assessing skin temperature at acupoints in PD patients and healthy subjects was searched in eight databases. The literatures obtained from the search was independently screened by two authors, and the quality of the included articles was evaluated using the consensus checklist of the Thermographic Imaging in Sports and Exercise Medicine (TISEM) and the Newcastle-Ottawa Scale (NOS) scale. The skin temperature of the relevant acupoints or the difference between the left and right acupoints of the same name was used as the outcome during any period of menstruation. Finally, the meta-analysis was performed using RevMan 5.4.1 software to evaluate the changes in skin temperature in the related acupoints.

Results

Seven eligible studies were included, which included 328 patients with PD and 279 healthy subjects. The results of the meta-analysis revealed a significant difference in skin temperature around the Sanyinjiao (SP6)(MD: 0.04, 95% CI: 0.00, 0.08), Xuehai (SP 10)(MD: -0.07, 95% CI:-0.11, -0.02) and Taixi (KI 3)(MD: 0.06, 95% CI:0.01, 0.11) acupoints between PD and healthy subjects. PD patients also showed a difference in skin temperature at the Taixi (KI 3)(MD: 0.14, 95% CI:0.04, 0.24), Shuiquan (KI 5)(MD: 0.11, 95% CI: 0.03,0.19), Taichong (LR 3)(MD: -0.10, 95% CI: -0.19,-0.01), Diji (SP 8)(MD: -0.09, 95% CI: -0.16, -0.01), and Xuehai (SP 10)(MD: -0.14, 95% CI: -0.23, -0.06) acupoint areas at different times of menstruation compared to that of healthy subjects, as revealed by the subgroup analysis.

Conclusion

Primary dysmenorrhea patients showed some differences in the skin temperature of the special acupoints are as Sanyinjiao (SP6), Diji (SP 8), Xuehai (SP 10), Shuiquan (KI 5), Taichong (LR 3), and Taixi (KI 3) compared with healthy subjects.

Registration Number

CRD42022381387.

Effect of Turmeric-Boswellia-Sesame Formulation in Menstrual Cramp Pain Associated with Primary Dysmenorrhea-A Double-Blind, Randomized, Placebo-Controlled Study

Primary dysmenorrhea is a common menstrual disorder that significantly impacts women's quality of life, productivity, and healthcare utilization. In this randomized, double-blinded, placebo-controlled trial, sixty women with primary dysmenorrhea were randomly divided into two groups with thirty participants each, and were allocated either turmeric-boswellia-sesame formulation (treatment) or placebo. The participants were advised to take two softgels of 500 mg as a single dose of allocated study intervention (total dose 1000 mg) when their menstrual pain reached 5 or more on a numerical rating scale (NRS). Menstrual cramp pain intensity and relief were evaluated every 30 min post-dose until 6 h. Results indicated a promising role of turmeric-boswellia-sesame formulation for menstrual pain relief compared to the placebo. The mean total pain relief (TOTPAR) of the treatment group (18.9 ± 0.56) was found to be 12.6 times better than the placebo group (1.5 ± 0.39). The NRS analysis showed that there was a statistically significant difference in pain intensity between the treatment and placebo groups (p < 0.001) at every timepoint. Additionally, the sum of pain intensity difference at 6 h (SPID6) of the treatment group (34.32 ± 1.41) showed a significant difference (p < 0.0001) and was 20.19 times better when compared to placebo (1.7 ± 0.56). Based on the study results, the turmeric-boswellia-sesame formulation exhibited remarkable menstrual pain relief as compared to the placebo.

Efficacy of individualized homeopathic medicines in primary dysmenorrhea: a double-blind, randomized, placebo-controlled, clinical trial

OBJECTIVES

Homeopathic treatment is claimed to be beneficial for primary dysmenorrhoea (PD); still, systematic research evidences remain compromised. This study was undertaken to examine the efficacy of individualized homeopathic medicines (IH) against placebo in the treatment of PD.

METHODS

A double-blind, randomized, placebo-controlled trial was conducted at the gynecology outpatient department of Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, West Bengal, India. Patients were randomized to receive either IH (n=64) or identical-looking placebo (n=64). Primary and secondary outcome measures were 0-10 numeric rating scales (NRS) measuring intensity of pain of dysmenorrhea and verbal multidimensional scoring system (VMSS) respectively; all measured at baseline, and every month, up to 3 months. Group differences and effect sizes (Cohen's d) were calculated on intention-to-treat (ITT) sample.

RESULTS

Groups were comparable at baseline (all p>0.05). Attrition rate was 10.9% (IH: 7, placebo: 7). Differences between groups in both pain NRS and VMSS favoured IH over placebo at all time points (all p<0.001, unpaired t-tests and two-ways repeated measures analysis of variance) with medium to large effect sizes. Natrum muriaticum and Pulsatilla nigricans (n=20 each; 15.6%) were the most frequently prescribed medicines. No harms, serious adverse events and intercurrent illnesses were recorded in either of the groups.

CONCLUSIONS

Homeopathic medicines acted significantly better than placebo in the treatment of PD. Independent replication is warranted. Trial registration: CTRI/2018/10/016013.

Exercise Therapy and Electrotherapy as an Intervention for Primary Dysmenorrhea: A Systematic Review and Meta-Analysis

Primary Dysmenorrhea (PD) is characterized by painful cramps before or during menstruation. It is generally treated with nonpharmacological methods. However, with the advancement of research and the passage of time, physiotherapy plays an increasingly important role in treating patients with PD. Electrotherapy and exercise therapy are conservative methods to treat PD. Alternative methods to minimize reliance on medicinal-based treatments are the need of the hour. This review aims to determine the efficacy of exercise-based therapies and electrotherapy modalities in treating PD. Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards have been used in the present systematic review and meta-analysis. Cochrane, PubMed, and Google Scholar were searched to facilitate the same. The articles from 2011 to 2021 were included in this review. The quality of the review was assessed using the Cochrane risk of bias tool. The visual analog scale was taken as a measure of pain intensity in the meta-analysis, and other outcomes have been included in the systematic review discussed. A total of 15 publications have been included, with a meta-analysis of 7. All included studies were of high quality (PEDro ≥ 5), and demonstrated the efficacy of exercise-based therapies and electrotherapy modalities in treating pain in females with PD. This review aims to check the impact of exercise and electrotherapy in females suffering from PD.

Influence of Psychological Factors in Primary Dysmenorrhea Patients on De qi: a Secondary Analysis of a Randomized Controlled Trial

Background

De qi , the needling sensation, is important in acupuncture treatment. Almost all studies believe that deep needling and manipulation could achieve a significant de qi sensation. However, relatively few studies have examined the effect of psychological factors on de qi, and those that did often reached different conclusions.

Objectives

To explore the influence of psychologic factors on de qi in patients with primary dysmenorrhea (PD).

Methods

Sixty-eight PD patients with cold and dampness stagnation were randomly allocated to de qi (deep insertion using thick needles, with manipulation, n=17) and non-de qi groups (shallow insertion using thin needles, without manipulation, n=51). Both groups received bilateral needling at Sanyinjiao (SP6) for 30 min. De qi was assessed using the Acupuncture De qi Clinical Assessment Scale (ADCAS). The patients' acupuncture-related anxiety and their expectations of the relationship between needle sensation and curative effect were evaluated using a five-point and four-point scale, respectively.

Results

Within the de qi group, all patients experienced the de qi sensation, although anxiety levels were unrelated to de qi. Patients' expectations correlated negatively with de qi timing, and positively with electric sensation. Within the non-de qi group, 59.5% of patients experienced de qi. Between those who experienced it and those who did not, no significant differences were found in anxiety levels, although patients' expectations differed significantly. Among patients who experienced de qi sensations in the non-de qi group, anxiety and throbbing were positively correlated. Additionally, patients' expectations correlated positively with de qi intensity, as well as coldness, and numbness.

Conclusion

Psychological factors should be considered when studying de qi since PD patients' expectations could influence the de qi sensation at SP6.

Myofascial Pain Syndrome in Women with Primary Dysmenorrhea: A Case-Control Study

There is limited information on myofascial trigger points (MTrPs) and specific symptoms of chronic pelvic pain and, more specifically, dysmenorrhea. The objective of this study was to determine whether patients suffering from primary dysmenorrhea present alterations in mechanosensitivity and pain patterns, and greater presence of MTrPs in the abdominal and pelvic floor muscles. A case-control study was carried out with a total sample of 84 participants distributed based on primary dysmenorrhea and contraceptive treatment. The sample was divided into four groups each comprising 21 women. Data on pain, quality of life, and productivity and work absenteeism were collected; three assessments were made in different phases of the menstrual cycle, to report data on pressure pain threshold, MTrP presence, and referred pain areas. One-way ANOVA tests showed statistically significant differences (p < 0.01) between the groups, for the Physical Health domain and the total score of the SF-12 questionnaire, and for all the domains of the McGill questionnaire; but no significant differences were found in the data from the WPAI-GH questionnaire. Statistically significant data (p < 0.01) were found for mechanosensitivity in the abdominal area and limbs, but not for the lumbar assessment, within the group, with very few significant intergroup differences. The frequency of active MTrPs is higher in the groups of women with primary dysmenorrhea and during the menstrual phase, with the prevalence of myofascial trigger points of the iliococcygeus muscle being especially high in all examination groups (>50%) and higher than 70% in women with primary dysmenorrhea, in the menstrual phase, and the internal obturator muscle (100%) in the menstrual phase. Referred pain areas of the pelvic floor muscles increase in women with primary dysmenorrhea.

Prevalence of Primary Dysmenorrhea, Its Intensity and Associated Factors Among Female Students at High Schools of Wolaita Zone, Southern Ethiopia: Cross-Sectional Study Design

Introduction

Primary dysmenorrhea is a highly prevalent gynecological problem and one of the most common causes of school absenteeism among school adolescents. Nearly, half of females with primary dysmenorrhea missed school or work at least once per cycle. Therefore, this study aimed to assess the prevalence of primary dysmenorrhea and its associated factors among female students in Wolaita soddo town high schools.

Methods

An institution-based cross-sectional study was conducted among female students at Wolaita soddo town high schools from October 1–30/2021. A total of 733 students were selected using a simple random sampling technique. The data were entered using Epi data version 3.1 and exported to SPSS version 25 for analysis. Binary logistic regression analysis was used. Variables with a p-value of <0.05 in the multivariable logistic regression analysis model were considered statistically significant.

Results

The prevalence of primary dysmenorrhea was 70% (95% CI (66.6%, 73.4%)). Factors such as age <18 years (AOR 2.55; 95% CI (1.77, 3.68)), long duration of menstrual flow (AOR 2.72; 95% CI (1.42, 5.17)), irregular menstrual cycle (AOR 2.39; 95% CI (1.68, 3.41)), family history of dysmenorrhea (AOR 2.46; 95% CI (1.67, 3.64)) and skipping breakfast (AOR 1.62; 95% CI (1.13, 2.33)) were associated with primary dysmenorrhea.

Conclusion

The prevalence of primary dysmenorrhea was high among high school students in the study area. Being younger age, long menstrual flow duration, irregular monthly menstrual cycle, family history of dysmenorrhea, and skipping breakfast were determinants of primary dysmenorrhea.

Moxibustion for primary dysmenorrhea: A resting-state functional magnetic resonance imaging study exploring the alteration of functional connectivity strength and functional connectivity

Introduction

Primary dysmenorrhea (PDM) is a common gynecological disease and chronic pain disorder. Moxibustion, a form of traditional Chinese medicine therapy, has proven to be effective for PDM. However, the central mechanisms of PDM and moxibustion for PDM are still unclear. This study aims to explore the potential central mechanism of PDM and clarify the possible mechanism of moxibustion for relieving pain.

Materials and methods

A total of 23 PDM patients and 23 matched healthy controls (HCs) were enrolled. For PDM patients, resting-state functional magnetic resonance imaging (rs-fMRI) data were collected pre- and post-moxibustion treatment of 3 consecutive menstrual cycles, respectively. For HCs, rs-fMRI data were collected in the baseline. The resting-state functional connectivity strength (rs-FCS) analysis and the resting-state functional connectivity (rs-FC) analysis based on the region of interest (ROI) were combined to be conducted.

Results

Compared to HCs, PDM patients showed weaker rs-FCS in the left inferior frontal gyrus (IFG). After the moxibustion treatment, rs-FCS in the left IFG was increased with clinical improvement. Then, the left IFG was chosen as ROI, and the rs-FC analysis was conducted. It showed that the left IFG rs-FC in the bilateral anterior cingulate cortex (ACC)/middle cingulate cortex (MCC), the left posterior cingulate cortex (PCC)/precuneus (PCU), and the left parahippocampal gyrus (PHG) decreased after moxibustion treatment, most of which belong to the default mode network (DMN).

Conclusion

Our results highlight the role of the left IFG and the DMN in PDM. Specifically, the central mechanism of moxibustion for analgesia may be related to modulating the disorders of the reappraisal and processing of pain stimuli through influencing the cognition of pain.

Acupuncture modulates the frequency-specific functional connectivity density in primary dysmenorrhea

Background

The study aimed to investigate how acupuncture modulates brain activities across multiple frequency bands to achieve therapeutic effects in PDM.

Methods

A total of 47 patients with PDM were randomly assigned to the verum acupuncture group and sham acupuncture group with three menstrual cycles of the acupuncture course. The fMRI scans, visual analog scale (VAS) scores, and other clinical evaluations were assessed at baseline and after three menstrual-cycles treatments. The global functional connectivity density (gFCD) analyses were performed between the pre-and post-acupuncture course of two groups at full-low frequency band, Slow-3 band, Slow-4 band, and Slow-5 band.

Results

After the acupuncture treatments, the patients with PDM in the verum acupuncture group showed significantly decreased VAS scores (p &lt; 0.05). The frequency-dependent gFCD alternations were found in the verum acupuncture group, altered regions including DLPFC, somatosensory cortex, anterior cingulate cortex (ACC), middle cingulate cortex (MCC), precuneus, hippocampus, and insula. The sham acupuncture modulated regions including angular gyrus, inferior frontal gyrus, and hippocampus. The gFCD alternation in DLPFC at the Slow-5 band was negatively in the patients with PDM following verum acupuncture, and S2 at the Slow-4 band was positively correlated with VAS scores.

Conclusion

These findings supported that verum acupuncture could effectively modulate frequency-dependent gFCD in PDM by influencing abnormal DLPFC at Slow-5 band and hippocampus at the Slow-3 band. The outcome of this study may shed light on enhancing the potency of acupuncture in clinical practice.

Analysis of Healthcare Utilization for Primary Dysmenorrhea in Korea: A Retrospective, Cross-Sectional Study

Purpose

This study is a retrospective, cross-sectional study aiming to present basic data on the treatment modalities and cost of care for primary dysmenorrhea (PD) by analyzing healthcare utilization and patient distributions using the 2010 to 2018 Health Insurance Review and Assessment Service (HIRA) data.

Patients and Methods

We used the HIRA-National Patient Sample (NPS) data to analyze medical service utilization for PD (ICD-10 code: N94.4, N94.6) in Western medicine (WM) or Korean medicine (KM) care between January 2010 and December 2018.

Results

There were 41,139 patients diagnosed with PD who utilized Western medicine (WM) or Korean medicine (KM) care at least once during the study period. The number of claims and patients steadily rose over the years from 7430 claims for 3989 patients in 2010 to 11,523 claims for 6226 patients in 2018. The predominant age group was 15 to 24 years. Regarding the frequency of service categories for PD in the claims, consultation was the most common and costly service category in WM (72,120 cases, 47.89%; 631,912 USD, 69.74%), while injection and analogous treatments was the most common and costly service category in KM (97,157 cases, 72.41%; 314,696 USD, 55.86%). Regarding the drug prescriptions, nonsteroidal anti-inflammatory drugs (NSAIDs) (26,617 cases, 40.47%) were the most frequently prescribed drug for PD in pharmacies and hospitals.

Conclusion

The result shows an annual increase in healthcare utilization for PD with the fastest rate in individuals aged 15 to 24 years. This study provides data on the current utilization of WM and KM care for PD for policymakers. Furthermore, we analyzed the frequency and cost of common treatment modalities in WM and KM, which would be useful data for clinicians and researchers.

Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates

Primary dysmenorrhea (PD) is a common, disregarded, underdiagnosed, and inadequately treated complaint of both young and adult females. It is characterized by painful cramps in the lower abdomen, which start shortly before or at the onset of menses and which could last for 3 days. In particular, PD negatively impacts the quality of life (QOL) of young females and is the main reason behind their absenteeism from school or work. It is suggested that increased intrauterine secretion of prostaglandins F2α and E2 are responsible for the pelvic pain associated with this disorder. Its associated symptoms are physical and/or psychological. Its physical symptoms include headache, lethargy, sleep disturbances, tender breasts, various body pains, disturbed appetite, nausea, vomiting, constipation or diarrhea, and increased urination, whereas its psychological symptoms include mood disturbances, such as anxiety, depression, and irritability. While its diagnosis is based on patients’ history, symptoms, and physical examination, its treatment aims to improve the QOL through the administration of nonsteroidal anti-inflammatory drugs, hormonal contraceptives, and/or the use of non-pharmacological aids (e.g., topical heat application and exercise). Patients must be monitored to measure their response to treatment, assess their adherence, observe potential side effects, and perform further investigations, if needed.

Lumbopelvic muscle endurance, morphology, alignment, and mobility in women with primary dysmenorrhea: A case-control study

BACKGROUND

In the literature, it is thought that spine or pelvic malalignment and changes in the abdominal muscle structure may affect the uterine position and cause menstrual pain. However, the overall lumbopelvic structure related to lumbopelvic muscle endurance, thickness, alignment, and mobility in women with primary dysmenorrhea has not been well investigated. This study aimed to compare women with primary dysmenorrhea and asymptomatic controls in terms of lumbopelvic structure.

METHODS

Women with primary dysmenorrhea (primary dysmenorrhea group, n: 38, age: 21 years (18-28), body mass index (BMI): 20.70 (17.31-28.73) kg/m²) and without primary dysmenorrhea (asymptomatic group, n: 39, age: 20 years (19-23), BMI: 20.83 (17.31-27.10) kg/m²) were included. The severity of menstrual pain, lumbopelvic muscle endurance, morphology, alignment, and mobility were assessed with the Visual Analogue Scale, McGill trunk muscle endurance tests, ultrasonographic imaging, and a Valedo® Shape device, respectively.

FINDINGS

The median value of the menstrual pain in the primary dysmenorrhea group was 6.5 cm (min-max: 4.0-10.0). Lumbopelvic muscle endurance (p < 0.001), muscle thickness (p < 0.001), frontal lumbar angle (p: 0.05), sagittal pelvic mobility (p < 0.001), and frontal lumbar mobility (p: 0.002) were lower in the primary dysmenorrhea group compared to the asymptomatic group.

INTERPRETATION

Muscle endurance, thickness, alignment, and mobility of the lumbopelvic structure in women with primary dysmenorrhea compared to asymptomatic women have been affected negatively. These findings should be considered in management of primary dysmenorrhea.

The Prevalence, Management and Impact of Dysmenorrhea on Medical Students' Lives-A Multicenter Study

Introduction: Dysmenorrhea is defined as the presence of painful menstruation, and it affects daily activities in different ways. The aims of this study were to assess the prevalence and management of dysmenorrhea and to determine the impact of dysmenorrhea on the quality of life of medical students. Material and methods: The study conducted was prospective, analytical and observational and was performed between 7 November 2019 and 30 January 2020 in five university centers from Romania. The data was collected using an original questionnaire regarding menstrual cycles and dysmenorrhea. The information about relationships with family or friends, couples’ relationships and university activity helped to assess the effects of dysmenorrhea on quality of life. The level of significance was set at p < 0.05. Results: The study comprised 1720 students in total. The prevalence of dysmenorrhea was 78.4%. During their menstrual period, most female students felt more agitated or nervous (72.7%), more tired (66.9%), as if they had less energy for daily activities (75.9%) and highly stressed (57.9%), with a normal diet being difficult to achieve (30.0%). University courses (49.4%), social life (34.5%), couples’ relationships (29.6%), as well as relationships with family (21.4%) and friends (15.4%) were also affected, depending on the duration and intensity of the pain. Conclusion: Dysmenorrhea has a high prevalence among medical students and could affect the quality of life of students in several ways. During their menstrual period, most female students feel as if they have less energy for daily activities and exhibit a higher level of stress. The intensity of the symptoms varies considerably and, with it, the degree of discomfort it creates. Most student use both pharmacological and non-pharmacological methods to reduce pain (75.7%). University courses, social life, couples’ relationships, as well as relationships with family and friends are affected, depending on the duration and intensity of the pain.

Expenditure on complementary and alternative medicine and productivity losses in patients with primary dysmenorrhea: a survey of women in Korea

In women with primary dysmenorrhea (PD), the use of complementary and alternative medicine (CAM) and productivity losses at both workplaces and schools have not been comprehensively assessed. In this study, researchers evaluated the disease burden in women with PD in patients' perspective in two categories: direct cost (the use of CAM and associated costs) and indirect cost (productivity losses). Women with PD aged 16-49 years were asked to fill an online survey in 2017. The survey consisted of 49 questions. CAM included traditional Korean medicines, over-the-counter products, dietary supplements, and traditional remedies. All costs were expressed in US dollars in this study. The survey data from 86 patients with PD were analyzed. The total mean annual cost per patient with PD was $4053, comprising direct costs ($1245) and indirect costs ($2807). PD causes considerable expenditure on CAM and impairs work productivity (especially in presenteeism).

Metabolomics Study of Guizhi Fuling Capsules in Rats With Cold Coagulation Dysmenorrhea

Dysmenorrhea refers to a kind of uterine cramping pain that occurs in women during the period of menstrual. Guizhi Fuling Capsules are mainly used for the treatment of various pain syndromes and especially effective in treating primary dysmenorrhea. However, the research on its modern pharmacology and mechanism of action have not been thoroughly carried out. It is not clear about the main active ingredients, potential targets and metabolic pathways involved in its efficacy. Therefore, this research project employed estradiol benzoate sensitization combined with oxytocin pain to construct the cold coagulation syndrome dysmenorrhea model, observed the anti-dysmenorrhea effect of Guizhi Fuling Capsules, and used the metabolomics to explore its mechanism. The results showed that Guizhi Fuling Capsules could considerably reduce the number of writhing times in dysmenorrhea rats, increasing the level of PGE2 and β-EP and reducing the contents of PGF2α in rat serum. Pathological sections of uterus and ovaries also showed that Guizhi Fuling Capsules could significantly relieve endometrial hyperplasia and improve ovarian function. The LC/MS-based metabolomics of rat uterine indicated that the model group has a great deviation from the control group. Compared with the model group, the Guizhi Fuling Capsules group had a tendency to shift to the control group, and the main metabolic changes was mainly concentrated on saturated and unsaturated fatty acids. Among them, arachidonic acid is in a pivotal position, and the expression of its rate-limiting enzyme (COX-2) involved in its cyclooxygenase metabolic pathway was significantly up-regulated in the model group, but significantly decreased after the intervention of Guizhi Fuling Capsules. In conclusion, Guizhi Fuling Capsules can effectively relieve primary dysmenorrhea, and this effect may be attributed to the regulation effects of Guizhi Fuling Capsules on endogenous metabolism, such as inhibiting arachidonic acid converted to prostaglandins through downregulate the expression of COX-2, which plays an anti-inflammatory effect.

A mixed-methods study to evaluate the effectiveness and cost-effectiveness of aerobic exercise for primary dysmenorrhea: A study protocol

BACKGROUND AND PURPOSE

Several studies have evaluated the effects of high-intensity aerobic training (HIAT) on pain severity and quality of life (QoL) among women with primary dysmenorrhea. However, to date, no studies have evaluated the effectiveness of HIAT on academic performance or absenteeism or examined the cost-effectiveness of HIAT relative to other treatments in women with primary dysmenorrhea. Furthermore, the mechanisms underlying aerobic exercise-induced analgesia in primary dysmenorrhea remain unclear. The objectives of this study are to: (1) evaluate the effects of HIAT on absenteeism and academic performance among university students, (2) identify the underlying mechanisms associated with aerobic exercise-induced analgesia in primary dysmenorrhea, and (3) determine the cost-effectiveness of HIAT compared with a wait-list control (WLC) group receiving usual care.

METHODS

A sequential, embedded, mixed-methods study design, including a crossover, randomised controlled trial (RCT) and semi-structured focus groups, will be conducted alongside an economic evaluation. A total of 130 women aged 18-24 years will be randomised into either HIAT (n = 65) or wait-list control (n = 65) groups. Primary outcomes will include average pain intensity, absenteeism from university, and academic performance. Primary mediators will include salivary progesterone and prostaglandin F2α levels. Outcome and meditator variables will be assessed at baseline and post-treatment, at 12 and 28 weeks. An economic analysis will be conducted from the societal and healthcare perspective of Hong Kong. Semi-structured focus groups will be conducted at 32 weeks. Of the 130 participants included in the RCT, 70 will be included in the focus groups.

STATISTICAL ANALYSIS

All statistical analyses will be performed on an intention-to-treat basis, using SPSS (version 24). Preliminary analysis using an independent samples t-test and a two-sided, unpaired Student's t-test will be performed to exclude carryover effects and identify within-participant differences in outcome variables between the study periods, respectively. Treatment effects will be evaluated using analysis of variance via a mixed-effects model with fixed effects for intervention, period, and sequence. In all models, random effects will include the participants nested within the sequence as a sampling cluster. The mediation effects will be assessed using the Sobel test. The EQ-5D responses will be converted into utility scores to estimate the gain or loss of quality-adjusted life-years. Seemingly unrelated regression analyses will be used to estimate the total cost differences and effect differences. Qualitative data will be analysed using the process of thematic analysis.

Frequency-Specific Alterations in Brain Function in Patients with Primary Dysmenorrhea

OBJECTIVE

Recent neuroimaging studies have found that brain function is abnormal in primary dysmenorrhea (PDM). The present study aimed to explore frequency-specific brain alterations and their occurrence in the PDM.

METHODS

Forty-seven patients with PDM and 36 matched healthy controls were enrolled in the study and underwent resting-state functional magnetic resonance imaging. The alterations in brain function in patients with PDM were assessed using different frequency filter bands (Slow5, Slow4, Slow3, and full low frequency) and functional connectivity density (FCD) approach. The clinical significance of the altered FCD was then explored. Additionally, mediation analysis was employed to detect the altered FCD-mediated clinical relationships in PDM.

RESULTS

Frequency-specific FCD alterations have been observed in patients with PDM, especially in the central executive, default mode, sensorimotor networks, and the hippocampus. The altered full low-frequency FCD in the hippocampus was associated with the duration of disease and pain severity scores. The altered Slow 5 FCD in the second somatosensory area (S2) was associated with the severity of pain in PDM. Furthermore, the FCD in S2 mediated the duration associated with pain symptoms in PDM.

CONCLUSION

The present study identified frequency-specific FCD alterations in PDM and suggested that the S2 area is a potential treatment target for PDM.

Development of an Assessment Tool of Menstrual-Cycle-Related Signs and Symptoms Based on Thai Traditional Medicine Principles for Evaluation of Women's Health

Background

Utilization of Thai traditional medicine (TTM) was considered in menstrual-cycle-related signs and symptoms (MCSs) to evaluate women's health. TTM clinicians diagnosed the MCSs by signs, symptoms, and associated factors of patients including a physical examination to find patterns of imbalance elements and the origin of the disorder to optimize treatment. Thus, the purpose of this study was to develop a new assessment tool, the menstrual-cycle-related signs and symptoms questionnaire (MCSQ) based on TTM principles for evaluation of women's menstrual health.

Methods

The items and components of the MCSQ were adjusted by TTM expert consensus using the Delphi technique. The content validity of the MCSQ was quantified by the content validity index (CVI). MCSQ were examined by construct validity and internal consistency reliability using exploratory factor analysis (EFA) and Cronbach's α coefficient, respectively.

Results

: All 19 experts (100%) responded to the questionnaires in the three rounds of the Delphi technique. The MCSQ showed high content validity of individual items (I-CVI = 0.83-1.00) and high overall content validity of the questionnaire (S-CVI/AVE = 0.98). Overall, 429 of 432 participants completed the questionnaire (99.31%). After factor analysis, the final MCSQ was divided into two sections, which consisted of 49 items. The first had 23 items focusing on the MCSs. And, the second had 14 items of personal and medical data including 12 items of associated factors. Cronbach's α coefficient of the final MCSQ was 0.87, and that of each component was between 0.32 and 0.82.

Conclusions

This study reports a new MCS questionnaire tool, which was developed from TTM knowledge to evaluate women's health. This questionnaire showed an acceptable level of validity and reliability. Thus, it is also expected to be useful in clinical practice and ongoing research on evaluation of women's health.

Effect of progressive relaxation exercises on primary dysmenorrhea in Turkish students: A randomized prospective controlled trial

BACKGROUND

A randomized prospective controlled study was conducted concerning the effects of progressive relaxation exercises on the reduction of pain in primary dysmenorrhea.

MATERIALS AND METHODS

The research control group (CG) consisted of 60 students while the experimental group (EG) consisted of 64 students. The progressive relaxation exercises were self-administered via compact disc (CD) by participants for two menstrual cycles. A descriptive information form, a visual analog scale (VAS) and a dysmenorrhea monitoring form (DMF) were used for data collection.

RESULTS

The difference between the average first and final post-exercise measurements of the VAS scores of students in the experimental group was statistically significant (p < 0.001), whereas the difference in the control group was not statistically significant (p > 0.05).

CONCLUSION

Progressive relaxation exercises are an effective method for reducing dysmenorrhea when they are performed on a regular basis.

Assessment of clinical efficacy of traditional Chinese medicine for the management of primary dysmenorrhea in the UK: A protocol of systematic review

BACKGROUND

This study aims to appraise the clinical efficacy of traditional Chinese medicine (TCM) for the management of patients with primary dysmenorrhea (PD) in the UK.

METHODS

We will comprehensively search electronic databases (Cochrane Library, PUBMED/MEDLINE, EMBASE, PsycINFO, AMED, Web of Science, and CNKI) and additional resources for original articles on randomized controlled trials published in English, Chinese, German, Spanish, Korean and Japanese. Outcomes will be the pain intensity, pain duration, menstrual cramps, amount of bleeding, and severity of dysmenorrhea symptoms, quality of life, and adverse events. Two authors will independently check all citations, extract data, and assess study quality. All potential conflicts will be solved through discussion by consulting another experienced author. A narrative synthesis will summarize the characteristics and findings of eligible trials. If it is possible, we will also pool the data and carry out meta-analysis.

RESULTS

The available evidence of the clinical efficacy of TCM for the treatment of PD in UK will be assessed through outcome measurements.

CONCLUSION

The findings of this study will determine whether or not TCM is effective and safe for the treatment of PD in UK. OSF REGISTRATION NUMBER:: osf.io/jyc95.

Evaluation of Anti-Inflammatory Components of Guizhi Fuling Capsule, an Ancient Chinese Herbal Formula, in Human Umbilical Vein Endothelial Cells

Background

Guizhi Fuling capsule (GFC), a well-known formula composed of five medicinal herbs, is commonly prescribed to treat primary dysmenorrhea, as well as to achieve good clinical efficacy in China. However, the active components of GFC have not been identified. Here, the anti-inflammatory functions of GFC, as well as its major ingredients, were evaluated in human umbilical vein endothelial cells (HUVECs).

Methods

Lipopolysaccharide (LPS) was used in HUVECs to imitate the cellular inflammation. Then, GFC-triggered mRNA expressions of cyclooxygenase-1 (COX-1) and COX-2 were determined by real-time PCR, while the expression of COX-2 protein was revealed by western blotting. Besides, nine components of GFC were evaluated for their contribution value in the anti-dysmenorrhea effects.

Results

The application of GFC downregulated the mRNA expressions of COX-1 and COX-2 mRNAs. Nine major components of GFC were tested in the inflammatory system, and three compounds, including paeoniflorin, benzoylpaeoniflorin, and amygdalin, exhibited robust activation in HUVECs. The combination of paeoniflorin, benzoylpaeoniflorin, and amygdalin showed over 80% of the anti-inflammatory activation.

Conclusion

Our study supports that GFC plays a promising role in anti-dysmenorrhea function by decreasing COXs' expression. Besides, paeoniflorin, benzoylpaeoniflorin, and amygdalin could be considered as major regulators for the anti-dysmenorrhea effects of GFC.

Thyme Tea and Primary Dysmenorrhea Among Young Female Students

Background

Thyme tea, locally known as “tossign tea”, is one of the most popular herbal-tea in Ethiopia used for the medicinal attribute, besides adding aroma and flavor to the tea. Therefore, this study aimed to assess the effect of thyme tea-drinking and other dietary factors of school girls on primary dysmenorrhea.

Methods

An institutional case–control study was conducted from December 2019 to March 2020 in the suburbs of Debre Berhan town, Ethiopia. Data were collected through a face-to-face interview using a pre-tested semi-structured questionnaire on 252 (86 cases and 166 controls) study participants. Data were entered to Epi Data version 3.1 and then exported to IBM SPSS version 24 for analysis. Bivariable and multivariable logistic regressions were carried out to identify factors significantly associated with primary dysmenorrhea.

Results

The mean (±SD) age of cases was 15.98 (±1.60) years and controls was 15.73 (±1.35) years. Thyme tea drinking was reported by 19 (22.1%) of cases and 56 (33.7%) of controls. Thyme tea-drinking decreased the risk of primary dysmenorrhea by 63.2% (AOR: 0.368, 95% CI: 0.145–0.934). Coffee drinking tends to increase the odds of severe dysmenorrhea on young female students. Besides, age, age at menarche, meal frequency, and residence were significantly associated with primary dysmenorrhea.

Conclusion

Thyme tea-drinking, consumption of vegetables and fruits had primary dysmenorrhea related pain-relieving tendency. Delayed onset of menarche decreased the risk of primary dysmenorrhea. Coffee drinking was positively associated with primary dysmenorrhea. Further studies on the effect of thyme tea on primary dysmenorrhea are required.

Manual acupuncture versus sham acupuncture and usual care for the prevention of primary dysmenorrhea (PD): study protocol for a randomized controlled trial

Background

Primary dysmenorrhea (PD) is a leading cause of dysmenorrhea among adolescent girls. Manual acupuncture may be considered as an effective treatment for PD, but high-quality evidence remains limited. This trial aims to evaluate the efficacy and safety of acupuncture for the prevention of PD as compared with sham acupuncture and usual care.

Methods/design

This is a three-arm, randomized, controlled clinical trial in which the patients, assessors, and statisticians will be blinded. A total of 300 acupuncture-naive patients who were diagnosed as PD will be randomly allocated to the verum acupuncture, sham acupuncture, or usual care groups in a 2:2:1 ratio. Patients in the verum acupuncture group will receive manual acupuncture at specific acupuncture points with penetrating needling, while those in the sham acupuncture group will receive non-penetrating needling at non-acupuncture points. They will be given five sessions over a menstrual cycle for 3 menstrual cycles. Patients in the usual care group will receive health education and informed to receive manual acupuncture for free after waiting for 7 menstrual cycles. The primary outcome will be the change from baseline in the Cox Menstrual Symptom Scale Score (CMSS). The secondary outcomes will be the changes in Massachusetts General Hospital Acupuncture Sensation Scale (MASS), visual analog scale (VAS), Short-Form McGill Pain Questionnaire 2 (SF-MPQ-2), Pittsburgh Sleep Quality Index (PSQI), Beck Anxiety Inventory (BAI), Beck Depression Inventory II (BDI- II), Acupuncture Expectancy Scale (AES), 60-item NEO Personality Inventory-Short Form (NEO-FFI), and acute medication intake. The adverse events will be recorded at every visit. The analyses will be performed base on a full analysis set (FAS) and a per-protocol set (PPS).

Discussion

This study may provide high-quality evidence regarding the efficacy and safety of manual acupuncture for PD. In addition, the results of this study will help to identify the efficacy of acupuncture due to the specific effects of acupuncture or placebo effects of acupuncture ritual.

Trial registration

Clinical Trials.gov NCT02783534. Registered on 26 May 2016

Relation between uterine morphology and severity of primary dysmenorrhea

Objective

This study aimed to evaluate whether uterine dimensions including uterine volume, uterine shape, uterine length, cervix length, and cervix thickness measurements have a role in the severity of primary dysmenorrhea in virgin girls.

Materials and Methods

Enrollment included 90 virgin girls suffering from primary dysmenorrhea. The girls were divided into three groups according to the severity of dysmenorrhea, which was determined by the visual analog scale (VAS). Patients with VAS scores of 8-10 comprised the severe primary dysmenorrhea group (n=30), 4-7 the moderate primary dysmenorrhea group (n=30), and 1-3 the mild primary dysmenorrhea group (n=30). Uterine characteristics including uterine volume, uterine shape, uterine length, cervix length, and cervix thickness were measured by a high-resolution four-dimensional ultrasound device with real-time capacity. They were recorded to determine if they can be predictors of dysmenorrhea severity.

Results

Girls with severe primary dysmenorrhea were more likely to complain of midline pain as opposed to mild and moderate cases with lateral or diffuse pain. None of the uterine characteristics on ultrasonography examination were significant for predicting the severity of primary dysmenorrhea. There were no significant positive correlations between the dysmenorrhea severity and uterine corpus length, cervix length, and uterine volume degree. Any combination of the measured uterine features was not predictive for determining the severity of dysmenorrhea.

Conclusion

Ultrasonographic measurements of uterine dimensions in virgins have low accuracy for predicting the severity of pain in primary dysmenorrhea.

Factors Related to Primary Dysmenorrhea in Turkish Women: a Multiple Multinomial Logistic Regression Analysis

This study aimed to evaluate the factors related to the severity of menstrual pain in Turkish women with primary dysmenorrhea (PD). The study included 504 women with PD aged 18 years or older. A Visual Analogue Scale (VAS), a self-developed structured questionnaire, the International Physical Activity Questionnaire-Short Form (IPAQ-SF), State and Trait Anxiety Inventory, Beck Depression Inventory, and Nottingham Health Profile (NHP) were used to measure outcomes. Multiple multinomial logistic regression analysis was used to determine the factors related to the severity of menstrual pain. In this model, categorical menstrual pain severity levels (mild, moderate, and severe) were considered as dependent variables and the category of "severe menstrual pain" was determined as the reference category. p value less than 0.05 was considered statistically significant. The individuals were divided into 3 groups according to their VAS scores: mild-pain group (n = 132, 26.19%), moderate-pain group (n = 189, 37.50%), and severe-pain group (n = 183, 36.30%). BMI increase (OR = 1.10 and OR = 1.09), decreased chocolate consumption (OR = 1.88), menstruation duration (OR = 2.48) and menstrual pain duration (OR = 1.33 and OR = 1.61), and increased physical activity level (OR = 1.10) were found to increase the tendency to have less severe pain. The positive family history (OR = 0.35), a decrease in the age of menarche (OR = 0.47), the presence of irregular menstruation (OR = 0.36), and decreased quality of life (OR = 0.98 for NHP pain and emotional reaction) were found to be associated with a reduced likelihood of less severe pain (p < 0.05). In Turkey as well as in the rest of the world, PD is an important public health problem and many factors are associated with menstrual pain in Turkish women.

Efficacy and safety of herbal medicine (Dangguijagyag-san) for primary dysmenorrhea: study protocol for a randomized, double-blind, placebo-controlled, parallel-group, multi-center trial

BACKGROUND

Dangguijagyag-san, also known as Dangguishaoyao-san in Chinese and Toki-shakuyakui-san in Japanese, has been frequently used to treat symptoms associated with dysmenorrhea. The purpose of this trial is to evaluate the efficacy and safety of the herbal medicine, Dangguijagyag-san, relative to those of active control, Gamisoyo-san, and a placebo control for primary dysmenorrhea.

METHODS

This protocol details a randomized, double-blind, parallel-group, multi-center, investigator-initiated, controlled trial evaluating treatment of primary dysmenorrhea. Two hundred and forty participants will be randomly divided into one of three groups: 1) the Dangguijagyag-san experimental group (EG) (n = 105), 2) the Gamisoyo-san active control group (ACG) (n = 30), and 3) the placebo control group (PCG) (n = 105). The interventions will be administered for two menstrual cycles, and the follow-up will be carried out for the following six menstrual cycles. The primary outcomes are difference in response rates between the EG and the ACG (non-inferiority comparison) and difference in changes from baseline in average pain intensity measured by the visual analogue scale between the EG and PCG (superiority comparison). The secondary outcomes are pain scores derived from pain assessment tools (verbal multidimensional scoring system, retrospective symptom scale, and short form McGill pain questionnaire), dosage of analgesics, pattern diagnosis questionnaires, and short form 36 health survey. Adverse events and vital signs will be checked at every visit, and laboratory tests will be performed for safety evaluation.

DISCUSSION

The results of this clinical trial will offer evidence for the efficacy and safety of Dangguijagyag-san for primary dysmenorrhea.

TRIAL REGISTRATION

Clinical Research Information Service of Korea: KCT0003005.

Transcutaneous Electrical Nerve Stimulation (TENS) for Primary Dysmenorrhea: An Overview

Primary dysmenorrhea is a chronic health condition that affects primarily young women. Transcutaneous electrical nerve stimulation (TENS) has been suggested as an effective pain reduction modality in primary dysmenorrhea. TENS is a noninvasive, inexpensive, portable method with minimal risks and a few contraindications. When necessary, it can be self-administered on a daily basis during everyday activities. Several studies have investigated the effectiveness of TENS in reducing pain, decreasing the use of analgesics, and improving the quality of life in primary dysmenorrhea patients. These studies have some limitations in methodological quality and therapeutic validation. However, the overall positive effects of TENS in primary dysmenorrhea encountered in all prior studies indicated its potential value. This review presents the clinical recommendations for TENS parameters for treating primary dysmenorrhea symptoms based on previously published studies.

Prevalence of primary dysmenorrhea, its intensity, impact and associated factors among female students' at Gondar town preparatory school, Northwest Ethiopia

BACKGROUND

Primary dysmenorrhea is defined as a crampy pain in the lower abdomen before or during the menstrual period in the absence of any pelvic pathology. It is the leading motherhood problem worldwide but there is limited evidence on the prevalence of primary dysmenorrhea in the study area as well in Ethiopia. Researching primary dysmenorrhea helps to focus on the treatment plan. The study aimed to assess the prevalence, intensity, impact, and associated factors of primary dysmenorrhea among female students at Gondar town preparatory school.

METHODS

A cross-sectional study design conducted among female students at Gondar town Preparatory School from May 1-10/2017. A total of 459 study participants were used. A simple random sampling technique was used to select study participants. A self-administered structured questionnaire was employed. Epi Info version 7 and SPSS version 20 were used for data entry and analysis respectively. A binary logistic regression model was computed. Variables having a p-value < 0.05 in the multivariate logistic regression model were considered as statistically significant.

RESULTS

A total of 459 female students participated in the study with a response rate of 96.29%. The prevalence of primary dysmenorrhea among female students was found to be 64.7% (95% CI; 60.2-69.2%). Around 61% reported moderate intensity of menstrual pain and 50.7% complain about lower abdominal pain. Sixty-five percent of study participants reported that absenteeism from school was the impact of menstrual pain. Having irregular monthly menstrual cycle (AOR = 1.70, 95% CI; 1.02, 2.84) and positive family history of dysmenorrhea (AOR = 5.19, 95% CI: 3.21, 8.37) were significantly associated with primary dysmenorrhea.

CONCLUSIONS

The prevalence of primary dysmenorrhea was found to be high. Having an irregular monthly menstrual cycle and a positive family history of dysmenorrhea were determinants of primary dysmenorrhea.

Effect of an Acupuncture Technique of Penetrating through Zhibian (BL54) to Shuidao (ST28) with Long Needle for Pain Relief in Patients with Primary Dysmenorrhea: A Randomized Controlled Trial

Background

Primary dysmenorrhea (PD) is the commonest gynecological disorder in young women of reproductive age, and there is not always satisfactory relief of pain treated by common medications. Therefore, acupuncture has been used as an alternative therapy to relieve the symptoms of PD. In clinical practice, a penetrating method of acupuncture with long needle has been shown to be particularly effective for improving primary dysmenorrhea. This study was conducted to evaluate the effectiveness of this technique for pain relief in patients with primary dysmenorrhea as compared with a conventional pain medication.

Methods

The present study is a perspective, randomized, ibuprofen-controlled trial. Sixty-two eligible participants were randomly assigned in a 1 : 1 ratio to receive either acupuncture treatment or ibuprofen administration. The treatment lasted for three menstrual cycles for both groups. The primary outcome was the intensity of menstrual pain measured by using the visual analogue scale at the completion of treatment. Secondary outcomes included the severity of symptoms associated with menstrual pain, responder rate, and safety of acupuncture treatment. The clinical outcomes were measured on each menstrual cycle at baseline, treatment course (3 cycles), and follow-up period.

Results

Sixty-four patients of primary dysmenorrhea were recruited, and 62 subjects were included in the final analysis. At trial completion, acupuncture was shown to be associated with a significantly lower pain intensity and decreased symptom severity of primary dysmenorrhea as compared with ibuprofen (p < 0.05). A significantly higher responder rate was found in the acupuncture group as compared with the control group (p < 0.05). No serious adverse events were reported by patients in either group.

Conclusions

The penetrating method of acupuncture with long needle may be an effective and safe therapy for pain relief in patients with primary dysmenorrhea. This trial was registered with the Chinese Clinical Trial Registry (ChiCTR-IOR-17012621).

Significant, long-lasting pain relief in primary dysmenorrhea with low-dose naproxen sodium compared with acetaminophen: a double-blind, randomized, single-dose, crossover study

Objectives: Many women experience menstrual cramps, which adversely affects quality-of-life. Both naproxen and acetaminophen are indicated to relieve menstrual pain. This study assessed the analgesic efficacy of a single, maximum non-prescription dose of naproxen sodium compared with that of acetaminophen in the treatment of primary dysmenorrhea.Methods: Healthy females with primary dysmenorrhea were included in our double-blind, randomized, crossover study (trial registration no. NCT03448536). When pain was moderate (≥5 on 0-10 numerical rating scale), subjects took a single dose of naproxen sodium (440 mg) and crossed over to acetaminophen (1000 mg) in the next cycle, or vice versa. Total pain relief over 12 h (TOTPAR0-12) was the primary outcome, while secondary outcomes included summed pain intensity differences (SPID) and TOTPAR scores throughout 12 h, and subject overall evaluation of treatment.Results: The per protocol population (n = 189) used naproxen sodium (n = 170) and acetaminophen (n = 160). TOTPAR0-12 was significantly greater with naproxen sodium than acetaminophen (least-squares (LS) mean difference = 4.31; p < .001), and pain intensity was significantly lower (SPID0-12 LS mean difference = 9.80; p < .001). Some measures of pain intensity favoring naproxen sodium became significant at earlier time points (e.g. SPID4-6 LS mean difference = 1.49; p = .02). After 6 h post-dose, naproxen sodium was significantly more effective than acetaminophen, maintained for 12 h (SPID6-12 LS mean difference = 8.27; TOTPAR6-12 LS mean difference = 3.75; both p < .001). Significantly more subjects rated naproxen sodium as good-to-excellent (70.6%) vs acetaminophen (63.1%) (p = .002).Conclusions: A single, maximum non-prescription dose of naproxen sodium was more effective than acetaminophen over 12 h.

Immediate Analgesic Effect of Perpendicular Needling or Transverse Needling at SP 6 in Primary Dysmenorrhea: A Pilot Study

Objective: Needling technique is an important factor contributing to the efficacy of an acupuncture point. In previous studies, Sanyinjiao (SP 6) had an immediate analgesic effect on primary dysmenorrhea (PD) with strengthened acupuncture stimulation. Transverse needling without De Qi is accepted more easily by patients who dislike De Qi. This kind of needling also has certain effects on some conditions. This study compared the immediate analgesic effect of perpendicular De Qi needling with transverse non-De Qi needling at SP 6 in patients with PD. Materials and Methods: Twenty-six participants with PD were randomly allocated to a perpendicular needling group (Group A; n = 13) or a transverse needling group (Group B; n = 13). Visual analogue scale (VAS; 0-100 mm) pain levels and skin-temperature measurements were determined at 4 acupuncture points before and after the interventions. Results: Severity of dysmenorrhea was significantly decreased at 30 minutes after the interventions and at 10 minutes after needle removal in both groups (Group A: 35.77 mm and 39.62 mm less pain, respectively, on VAS; P < 0.001; Group B: 22.69 mm and 30.38 mm less pain, respectively, on VAS; P < 0.001). There was no significant difference in VAS-P [VAS for pain] scores after the interventions between the 2 groups (P > 0.05). Skin temperature at CV 4 was significantly increased after the intervention in group A only (P = 0.001). Conclusions: Both perpendicular and transverse needling at SP 6 had an immediate analgesic effect on primary dysmenorrhea. Proper needling techniques may be applied according to the tolerance of patients.

Influence of the Intensity, Components, and Spreading of the Deqi Sensation on the Analgesic Effect of SP6 Needling in Primary Dysmenorrhea Patients: A Secondary Analysis of a Randomised Controlled Trial

Although deqi, the phenomenon whereby excitation of Qi in the meridians occurs with needling, is critical to the practice of acupuncture and its efficacy, it is poorly understood. So we investigate the influence of the deqi sensation on the analgesic effects of acupuncture in patients who were enrolled in a randomised controlled trial for the treatment of patients with primary dysmenorrhea, a painful and common condition, and cold and dampness stagnation. Two groups were assessed: a deqi group (undergoing deep needling with thick needles and manipulation, n=17) and a non-deqi group (undergoing shallow needling with thin needles and no manipulation, n=51). The Sanyinjiao (SP6) was needled for 30 min in both groups. Pain scores at baseline, upon needle removal, and at 10, 20, and 30 min after needle removal were evaluated by the Visual Analogue Scale for pain. The deqi sensation was evaluated by the Acupuncture Deqi Clinical Assessment Scale. Patients who experienced a genuine deqi sensation (n=39) were selected for further analysis. Compared with patients in the non-deqi group who experienced deqi (n=25), patients who self-reported deqi in the deqi group (n=14) felt a stronger deqi sensation, experienced soreness and fullness more frequently, felt a greater intensity of soreness, fullness, electric sensation, spreading, and radiating, and experienced larger spreading distances. In those who experienced the deqi sensation in the deqi group, the intensity of the sensation, as well as their degree of soreness and fullness, was negatively correlated with pain reduction. In patients who experienced the deqi sensation in the non-deqi group, deqi intensity was positively correlated with pain reduction, while soreness was negatively correlated with pain reduction. The distance of spreading was not correlated with pain reduction in either group. We found, in SP6 needling of patients with primary dysmenorrhea with cold and dampness stagnation, that a moderate deqi response predicted a prolonged analgesic effect better than a strong deqi response.

Effectiveness of a treadmill-based aerobic exercise intervention on pain, daily functioning, and quality of life in women with primary dysmenorrhea: A randomized controlled trial

OBJECTIVE

To evaluate the effectiveness of a treadmill-based aerobic exercise intervention on pain and associated symptoms of primary dysmenorrhea.

METHODS

Seventy women with primary dysmenorrhea were included in the study. The experimental group underwent supervised aerobic training for 4 weeks followed by unsupervised home exercise for the next 6 months. The control group continued usual care. The primary outcome was pain. Secondary outcomes included quality of life (QoL), daily functioning, and sleep.

RESULTS

After the 4-week training, compared to the control group exercise significantly improved primary outcomes pain quality (mean difference (MD) -1.9, 95% CI 3.8 to -0.04, p < .05), and intensity (MD -4.7, 95% CI -9.3 to -0.09, p < .05), but not present pain. Significant effects were also reported for pain interference (MD -1.7, 95% CI -3.4 to -0.02, p < .05) at 4 weeks; the other outcomes did not significantly differ between groups at this time. During the follow-up period of 7-months, the effect on pain improved to 22 mm (95% CI 18 to 25). Significant benefits of exercise were maintained up to 7-months for present pain, QoL and daily functioning.

CONCLUSION

Exercise has significant effects on primary dysmenorrhea-related pain, QoL and function.

TRIAL REGISTRATION

ACTRN12613001195741.

Randomized Trial of Modified Stretching Exercise Program for Menstrual Low Back Pain

This study aimed to examine the effectiveness of a modified stretching exercise program on young women with menstrual low back pain. Overall, 127 young women were randomly assigned to the experimental ( n = 63) and control ( n = 64) groups. The experimental group followed the modified stretching exercise program, whereas the control group performed their usual activities. At 1, 4, 8, and 12 months, the experimental group had significantly lower scores on the visual analog scale for pain (95% confidence interval [CI] = [0.73, 1.96]; p < .05) and the Oswestry Low Back Pain Disability Questionnaire than the control group (95% CI = [0.68, 2.03]; p < .001). At 12 months, the experimental group showed significantly higher exercise self-efficacy than the control group (95% CI = [-6.87, 0.62]; p = .003). These findings can be used to enhance self-care capabilities by using the modified stretching exercise program for young women with menstrual low back pain.

Continuous vs. cyclic combined hormonal contraceptives for treatment of dysmenorrhea: a systematic review

Objective

This systematic review aims to evaluate the benefits of oral continuous combined hormonal contraceptives (CHCs) in managing dysmenorrhea by comparing randomized controlled trials (RCTs) evaluating the efficacy of continuous vs. cyclic CHC use for the following outcomes: (a) reducing dysmenorrhea duration and frequency, (b) severity, (c) recurrence and (d) interference with daily activity.

Study design

Cochrane, PUBMED and Popline databases were searched from 1934 to 2018 for all relevant studies evaluating CHC for treatment of dysmenorrhea. A study was selected if it (a) compared continuous regimen vs. cyclic regimen of oral CHC, (b) measured dysmenorrhea as a primary or secondary outcome, (c) was an RCT and (d) was published in English. Due to differences in CHC used and outcome measurement, a systematic analysis of individual study results and a limited meta-analysis were conducted.

Results

Of 780 studies that were screened by title and abstract, 8 were included in the final analysis; 6 evaluated cyclic vs. continuous CHC, and 2 evaluated cyclic vs. extended/flexible CHC use. Quality of evidence was low for all outcome measures. Overall, compared to cyclic use, flexible/extended CHC resulted in 4 fewer days of dysmenorrhea. Studies revealed conflicting results for interference with daily activity, pain severity and pain recurrence. Side effects were few in both comparison groups.

Conclusions

Continuous or extended/flexible CHC use may reduce dysmenorrhea duration compared to cyclic regimen; however, more rigorous research is needed.

Implications

This systematic review shows that continuous CHC use may reduce dysmenorrhea duration compared to cyclic regimen, although the quality of evidence is low. Future double-blinded RCTs with more rigorous study design, consistent outcome measures and comprehensive outcome reporting are needed.

The effectiveness of self-care and lifestyle interventions in primary dysmenorrhea: a systematic review and meta-analysis

Background

Menstrual pain is very common amongst young women. Despite the significant impact that menstrual pain has on academic attendance and performance, social activities and quality of life, most young women do not seek medical treatment but prefer to use self-care; commonly OTC analgesic medications and rest. Many women do not get significant pain relief from these methods, therefore other low cost, easy to learn self-care methods may be a valuable approach to management.

This review and meta-analysis examines the evidence for participant lead self-care techniques.

Methods

A search of Medline, PsychINFO, Google Scholar and CINAHL was carried out in September 2017.

Results

Twenty-three trials including 2302 women were eligible and included in the meta-analysis. Studies examined self-delivered acupressure, exercise and heat as interventions. Risk of bias was unclear for many domains. All interventions showed a reduction in menstrual pain symptoms; exercise (g = 2.16, 95% CI 0.97 to 3.35) showed the largest effect size, with heat (g = 0.73, 95% CI 0.06 to 1.40) and acupressure (g = 0.56, 95% CI 0.10 to 1.03) showing more moderate effect sizes. Exercise (g = 0.48, 95% CI 0.12 to 0.83) and heat (g = 0.48, 95% CI 0.10 to 0.87), were more effective than analgesics in reducing pain intensity, whereas acupressure was significantly less effective (g = − 0.76, 95% CI -1.37 to − 0.15).

Conclusion

Exercise showed large effects, while acupressure and heat showed moderate effects in reducing menstrual pain compared to no treatment. Both exercise and heat are potential alternatives to analgesic medication. However, difficulties in controlling for non-specific effects, along with potential for bias, may influence study findings.

Increased mast cells in endocervical smears of women with dysmenorrhea

Background:

Mast cells are observed in peritoneal endometriosis which causes dysmenorrhea. However, there is no report about the relationship between endocervical mast cells and dysmenorrhea. The aim of this study is to evaluate the relationship using endocervical smears.

Materials and Methods:

Between January 2016 and June 2016, patients filled out a questionnaire regarding dysmenorrhea and were classified into the dysmenorrhea or the control group (without dysmenorrhea). Patients underwent endocervical brushing and endocervical smears were obtained. The smears were stained with methylene blue to detect mast cells. The number of mast cells per slide was counted by microscopy and recorded.

Results:

Eighty-nine patients were enrolled in this study (dysmenorrhea group, 34; control group, 55). The median number of mast cells present in the endocervical one slides was 35 (interquartile range, 17–58) and 2 (interquartile range, 0–6) in the dysmenorrhea and control groups, respectively. There was a significant difference in the number of mast cells between the two groups (P < 0.0001).

Conclusion:

More mast cells were observed in the endocervical smears of women with dysmenorrhea than in those of women without dysmenorrhea.