Selection and efficacy of self-management strategies for dysmenorrhea in young Taiwanese women

The relationship between spino-pelvic alignment and primary dysmenorrhea

Introduction

Most women of reproductive age suffered from the primary dysmenorrhea (PD). Up to date, most studies on the etiology of dysmenorrhea focused on endocrine factors while ignored the effect of spino-pelvic bony anatomy on uterus. In this study, we innovatively shed light on the relationship between primary dysmenorrhea and sagittal spino-pelvic alignment.

Materials and Methods

120 patients diagnosed with primary dysmenorrhea and a control group of 118 healthy volunteers were enrolled into this study. All subjects received the standing full-length posteroanterior plain radiography to evaluate the sagittal spino-pelvic parameters. The visual analog scale (VAS) was used to assess pain rating of primary dysmenorrhea patients. Analysis of variance (ANOVA) or Student's t test was performed to measure statistical significance between differences.

Results

There was a significant difference in pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL) and thoracic kyphosis (TK) between PD group and Normal group (P<0.05). Furthermore, in PD group, the PI and SS was significant different between mild pain group and moderate pain group (P<0.05) and there was a significant negative correlation between pain rating and SS. From the perspective of sagittal spinal alignment, the majority of PD patients were classified with Roussouly type 2, meanwhile most normal people were classified with Roussouly type 3.

Conclusion

Sagittal spino-pelvic alignment was related to primary dysmenorrhea symptoms. Lower SS and PI angles may contribute to a worsen pain in PD patients.

Yabancı Uyruklu Öğrencilerin Kültürel Özellikleri, Kadın Sağlığı ve Sağlık Hizmeti Alımı İlişkisi

Giriş: Yabancı uyruklu öğrencilerin farklı dil ve kültürel özelliklere sahip olması, sağlık hizmeti alımı ve kadın sağlığı açısından önemlidir. Amaç: Çalışmada yabancı uyruklu kadın öğrencilerin kültürel özelliklerinin kadın sağlığı ve sağlık bakım hizmeti alma durumları arasındaki ilişkinin belirlenmesi amaçlanmıştır. Yöntem: Kesitsel ve tanımlatıcı nitelikte olan araştırmanın örneklemini 2019-2020 güz yarıyılında ULUTÖMER’de öğrenim gören, 27 ülkeden oluşan, 62 kadın öğrenci oluşturdu. Verileri toplama aracı olarak “Hemşirelik Bakımında Kültürel Özellikleri Tanılama Rehberi” kullanılmıştır. Bulgular: Yaş ortalaması 20.66±2.52 olan kadın öğrencilerin %93.5’i bekârdır. Bu öğrencilerin menstruasyon ağrısı için geleneksel ya da tıbbi tedavi uygulamalarının ülkeler arasında anlamlı düzeyde farklı olduğu belirlenmiştir (p < .005). Çalışmada öğrencilerin sağlık bakım sistemi ilişkin bilgi engelli ve kadın sağlığına ilişkin kültürel uygulamaları arasında pozitif yönde anlamlı bir ilişki bulunmuştur (r = .253, p = .047). Öğrencilerin sağlık hizmeti alımında iletişim engeli ile inancı gereği sağlık bakım hizmeti alamaya engel olan durumlar arasında orta düzeyde negatif yönlü (r = -.317, p = .012), sağlık bakım hizmetine ulaşım engeli arasında da pozitif yönlü güçlü ilişki olduğu tespit edilmiştir (r = .480, p = .000). Sonuç: Yabancı uyruklu kadın öğrencilerin kadın sağlığına ilişkin kültürel uygulamaları ile sağlık bakım hizmetinde yaşadıkları engeller arasında pozitif yönde ilişki belirlenmiştir. Öğrencilerin sağlık hizmeti alımında iletişim engeli arttıkça, sağlık bakım hizmeti alama engelini de artırdığını göstermiştir.

Medical care-seeking patterns among women with menstrual syndromes-related diagnoses: a longitudinal population-based study

Background

Many women experience menstruation-related health issues during their child-bearing years. This study aimed to evaluate women’s tendency to seek Traditional Chinese Medicine (TCM) and/or Western Medicine (WM) when newly diagnosed with menstrual syndromes and to identify factors associated with their medical care-seeking behaviors.

Methods

The data of a total of 47,097 women aged between 15 and 50 years with newly diagnosed menstrual syndromes in 2005 were extracted from the Taiwan National Health Insurance Database. The follow-up period was divided equally into 6 month segments over 5 years starting with patients’ first visit for obstetric/gynecologic care. Outcomes were outpatient visits and number of TCM or WM visits during each period. Patients’ tendency for medical care utilization was estimated using Poisson regression analysis.

Results

Number of outpatient visits using TCM was 0.62 (29187/47097), and using WM was 1.67 (78697/47097) within 6 months after the first menstrual syndrome diagnosis. The tendency for TCM utilization increased as follow-up time increased after controlling for potential confounders, while WM utilization decreased as follow-up time increased. Age, economic status, infertility, value of prevention, baby delivery, and obstetric/gynecologic inpatient histories were significantly associated with patients’ medical care-seeking behaviors.

Conclusions

TCM and WM medical care-seeking patterns are significantly different among women with diagnoses associated with menstrual syndromes. Related factors affecting medical care-seeking behavior include age, economic status, infertility, value of prevention, childbirth and Ob/Gyn inpatient histories.

Menstrual related discomfort and associated factors among undergraduate students in Ambo University, Central Ethiopia

Background:

Menstruation is a natural phenomenon which is an indicator of women’s health that occurs throughout the reproductive years of every female. This phenomenon is unique to the females and governed by the girl’s general health condition, genetic, socioeconomic, and nutritional factors. Although it is a normal physiological process, most females experience some degree of pain and discomfort in their menstruation period. Even though there are limited studies so far reported about the issue in some other parts of the country, there is no scientific evidence in the present study area.

Objective:

To assess menstrual-associated discomfort and associated factors among undergraduate students in Ambo University, Central Ethiopia, 2018.

Methods:

Institution-based cross-sectional study was conducted at Ambo University from 30 March to 30 April 2018. Stratified sampling technique was used and 748 study participants were randomly selected from faculties using a multi-stage sampling procedure. Only data from 713 study participants were entered into EpiData 3.1 and analyzed using SPSS version 20.0 software. Logistic regression was used to associate factors with menstrual-associated discomfort. All statistical tests were considered as significant at a p-value of < 0.05.

Result:

The prevalence of menstrual-associated discomfort was found to be 68.6%. The variables age (Being younger) (adjusted odds ratio = 3.9 (95% confidence interval: 1.28, 11.78)), Tigire ethnicity (adjusted odds ratio = 2.4 (95% confidence interval: 1.02, 5.75)), unmarried (adjusted odds ratio = 2.1 (95% confidence interval: 1.21, 3.76)), smokers (adjusted odds ratio = 2.2 (95% confidence interval: 1.12, 4.29)), drinking caffeine (adjusted odds ratio = 1.8 (95% confidence interval: 1.17, 2.74)), amount of flow (adjusted odds ratio = 2.4 (95% confidence interval: 1.28, 4.62)), and duration of pain (adjusted odds ratio = 4.2 (95% confidence interval: 1.93, 9.29)) were significantly associated with menstrual-associated discomfort.

Conclusion:

This study revealed that majority of the participants was experienced with menstrual-associated discomfort. As the tendency of smoking cigarettes, drinking caffeine, and amount of flow is increased, menstrual associated discomfort is increased. Therefore, specific plan of action and support is urgently needed in order to enlighten and treat menstrual-associated discomfort.

Therapeutic Exercise in the Treatment of Primary Dysmenorrhea: A Systematic Review and Meta-Analysis

BACKGROUND

Dysmenorrhea is a health problem with a high impact on health and society. Some drugs have been shown to be effective at treating dysmenorrhea. Therapeutic exercise is another option for reducing the symptomatology of this health problem, with a low cost and the absence of side effects.

PURPOSE

The purposes of this review were to study the efficacy of physical exercise for pain intensity in primary dysmenorrhea and to assess its effectiveness in decreasing the duration of pain and improving quality of life.

DATA SOURCES

Searches were conducted between February 2017 and May 2017 in the databases Web of Science, Physiotherapy Evidence Database (PEDro), PubMed, Scopus, CINAHL, and Dialnet, using the terms dysmenorrhea, exercise therapy, exercise movement technique, exercise, physical therapy, physical therapy speciality, treatment, primary dysmenorrhea, prevention, etiology, epidemiology, and pain.

STUDY SELECTION

We included randomized controlled trial studies conducted on women who were 16 to 25 years old and had primary dysmenorrhea, studies that included exercise as a type of therapy, studies that assessed the intensity and duration of pain and quality of life, and studies published in English or Spanish. Studies that included women with irregular cycles, women diagnosed with a gynecological disease, women who had had surgery, women with serious diseases, or women who used intracavitary or oral contraceptives were excluded. We started with 455 studies; 16 were included in the systematic review, and 11 were included in the 3 meta-analyses that were carried out.

DATA EXTRACTION

Two authors selected the studies and extracted their characteristics (participants, intervention, comparators, and outcomes) and results. The evaluation of the methodological quality of the studies was carried out by PEDro scale.

DATA SYNTHESIS

There was moderate evidence that therapeutic exercise can be considered a useful tool in the treatment of primary dysmenorrhea in terms of a reduction in pain intensity. Regarding the duration of pain and quality of life, there was low evidence and very low evidence, respectively. In the 3 meta-analyses, the results were significantly positive in favor of exercise for decreases in both the intensity and the duration of pain.

LIMITATIONS

Limitations of this study include the great heterogeneity of the interventions applied in the studies in terms of type of exercise, in combination or alone, and dosage. This review includes a small number of studies with risk of bias, so the present findings must be interpreted with caution.

CONCLUSIONS

Therapeutic exercise reduces pain intensity in patients with primary dysmenorrhea.

Primary dysmenorrhea and self-care strategies among Chinese college girls: a cross-sectional study

OBJECTIVES

To explore the prevalence of primary dysmenorrhea (PD), the characteristics of PD and self-care strategies for managing PD among Chinese college girls.

DESIGN

Cross-sectional study.

SETTING

Changsha, China.

PARTICIPANTS

A total of 2555 college girls were recruited using multistage cluster random sampling.

OUTCOME MEASURES

A self-report questionnaire was used to measure sociodemographic information, characteristics of PD and self-care strategies for managing PD. Additionally, a Visual Analogue Scale was used to measure pain severity.

RESULTS

Of the 2555 girls, 1306 had experienced PD, representing a 51.1% prevalence. In addition, the prevalence rates of mild, moderate and severe pain in PD were 18.1%, 27.7% and 5.4%, respectively. The most common symptoms associated with PD were cramps (96.9%), weakness (70.0%), backache (65.1%), facial blemishes (55.3%) and irritability (55.3%). Commonly used self-care strategies for managing PD comprised reducing physical activity (94.6%), keeping warm (84.6%), communicating dysmenorrhea with friends or classmates (79.0%), drinking warm beverages (75.7%) and avoiding cold drinks and foods (74.2%). In addition, only 34.8% self-medicated with Western medicine (15.6%), traditional Chinese medicine (8.6%), or both (10.6%). Medical advice was sought by 27.4% of subjects from a Western medical doctor (10.3%), a doctor of traditional Chinese medicine (13.6%), or both (3.5%). Girls who had greater pain severity were more likely to be self-medicated (OR=7.01; 95% CI 4.50 to 10.91), use complementary therapies (OR=2.64; 95% CI 1.70 to 4.10) and seek medical advice (OR=5.93; 95% CI 3.80 to 9.24).

CONCLUSIONS

PD is highly prevalent among Chinese college girls, with a high burden of symptoms. In addition, these girls are most likely to change their lifestyle, communicate dysmenorrhea with friends or mothers, use heat therapy and engage in self-talk, but less likely to self-medicate or seek medical advice for managing PD.

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.

Association of primary dysmenorrhea with anthropometrical and socio-economic factors in Polish university students

AIMS

To examine the prevalence and factors correlated with primary dysmenorrhea in young female subjects.

METHODS

Cross-sectional research was conducted among 1305 female university students aged 19-25 years. The following measurements were taken: height, body mass, waist circumference, hip circumference, the length of index and ring finger. A questionnaire was used to obtain information on menstrual pains, the characteristics of the menstrual cycles (regularity, duration), the number of the days of menstrual bleeding, age at menarche, overall health and socio-economic status of the subjects.

RESULTS

The prevalence of primary dysmenorrhea (PD) in the group was 64.85%, of which 69.60% reported mild pain, and 30.40% moderate and severe pain. PD occurs more frequently both in women with excess and insufficient level of abdominal adiposity. PD occurred more frequently in women who experience first menstruation at earlier age than in women with average and late age at menarche. The prevalence of PD grew along with mother's education and fell along with father's education. Painful menstruations occurred most commonly in women from large families. The impact of the age at menarche and the presence of abnormal body mass and abnormal level of abdominal adiposity on the prevalence of painful menstruation was also confirmed by the results of logistic regression analysis. The risk of PD is the highest in women whose finger 4 is longer than finger 2.

CONCLUSION

The results suggest that healthy body mass and lack of abdominal obesity may reduce the risk of PD.

Prevalence of dysmenorrhea among University students in Northern Ghana; its impact and management strategies

Background

The period of menstruation is an eventful one for a significant number of post-pubescent females as they experience lower abdominal pains referred to as dysmenorrhea. This study conducted among female students of the Tamale campus of the University for Development Studies assessed the prevalence of dysmenorrhea, its impact on the students and treatment methods applied.

Methods

A cross-sectional study using a self-administered questionnaire was used to obtain data from 293 randomly selected female students. Data was analyzed using Graph Pad 5.01. Association between different variables was tested.

Results

The prevalence rate of dysmenorrhea was 83.6% with more than half describing their pain which lasts less than 3 days as moderate. This dysmenorrhea during menstruation affects the daily activities of up to 61.2% of respondents. Lower chronological age (χ² = 8.28; df = 2; p = 0.016) and gynecological age (χ² = 10.09; df = 2; p = 0.006) were the factors that were significantly associated with the presence of dysmenorrhea. Chronological and gynecological ages, age at menarche, menstrual duration or flow level do not influence the severity of dysmenorrhea but irregular menstrual flow is significantly associated with severe dysmenorrhea (χ² = 10.54; df = 2; p = 0.005). Only 16.3% ever reported their dysmenorrhea to the hospital but increasing pain level is significantly associated with respondents visiting a hospital (χ² = 65.61; df = 2; p < 0.0001) or use an allopathic medication (χ² = 32.77; df = 2; p < 0.0001). Paracetamol preparation was the most common medication used notwithstanding the severity of the pain.

Conclusions

There is high prevalence of dysmenorrhea among the female students of the Tamale campus of the University for Development studies which negatively affects the daily activity of majority of them. Although, bed rest was the most common treatment method practised, paracetamol preparation was the most common allopathic drug used in self- management of their dysmenorrhea.

Dysmenorrhea among University Health Science Students, Northern Ethiopia: Impact and Associated Factors

Background

It is estimated that more than half of all women in adolescence age suffer from dysmenorrhea and it often interferes with their daily physical and emotional aspects. It is the leading cause of short-term school absenteeism and is associated with a negative impact on academic and daily activities.

Objectives

To investigate impacts of dysmenorrhea, factors associated with it, and its self-management strategies used by health science students.

Methods

A cross-sectional institution based study was conducted among 246 Mekelle University health science students selected by stratified random sampling technique. Data were collected using self-administered semistructured questionnaire. Data were analyzed using SPSS 16.

Results

The prevalence of dysmenorrhea was 71.8%. Participants who had long menstrual cycle interval, long menses flows, and positive family history and who were alcohol users were more likely to had dysmenorrhea. Participants reported that 28.6% feel depressed, 16.2% are absent from class, and 22.9% had poor personal relationship due to dysmenorrhea and 78.2% of them practiced self-medication.

Conclusion

Dysmenorrhea is common among Mekelle University health science students and it is major problem representing the cause of feeling depressed, poor personal relationship, and class absenteeism. Majority of the study participants used self-medication to treat dysmenorrhea.

Influencing factors of dysmenorrhoea among hospital nurses: a questionnaire survey in Taiwan

OBJECTIVES

Nurses are at high risk of dysmenorrhoea while working with patients. The study objectives were to: (1) describe the demographic and menstruation characteristics of dysmenorrhoea, knowledge about dysmenorrhoea and menstrual attitudes towards menstruation among dysmenorrhoeal and non-dysmenorrhoeal hospital nurses; (2) identify significant differences between the groups; and (3) examine factors influencing dysmenorrhoea.

METHODS

This cross-sectional survey used a structured questionnaire, administered at two hospitals in southern Taiwan. Participants included hospital nurses at least 18 years of age who agreed to participate. All participants were recruited through random sampling. The questionnaire included demographic data, the Dysmenorrhoea Knowledge Scale and Menstrual Attitude Scale (MAS).

RESULTS

A total of 420 nurses completed the questionnaire. Among them, 297 (70.7%) had experienced dysmenorrhoea in the past 6 months and 123 (29.3%) had not. Significant differences in age (P<0.001), marital status (P<0.001), childbearing status (P<0.001), age at menarche (P<0.05) and rotating three shift ratio (P<0.05) were identified between the dysmenorrhoea and non-dysmenorrhoea groups. Analysis of the MAS results revealed significant differences between the groups regarding consideration of menstruation as a debilitating (P<0.001) or bothersome event (P<0.05), anticipation and prediction of menstruation onset (P<0.01) and denial of any effects from menstruation (P<0.001). Results of the multiple logistic regression showed that predictive factors included age <40 years (4.46 vs 1.00), working three shift rotations (2.07 vs 1.00), marital status (2.59 vs 1.00), acknowledging menstruation as a debilitating event (2.72 vs 1.00) and denial of effects from menstruation (2.59 vs 1.00).

CONCLUSIONS

These findings could help nursing managers to create a caring and friendly work environment for hospital nurses at risk of dysmenorrhoea.

Cyclic Perimenstrual Pain and Discomfort and Australian Women's Associated Use of Complementary and Alternative Medicine: A Longitudinal Study

OBJECTIVE

To examine the longitudinal change in Australian women's prevalence of cyclic perimenstrual pain and discomfort and the association between their symptoms and use of complementary and alternative medicine (CAM).

METHOD

Data on endometriosis, premenstrual syndrome (PMS), irregular periods, heavy periods, and severe period pain were collected over a 7-year period from the Australian Longitudinal Study on Women's Health, for women aged 28 to 33 years in 2006, and at 3-year follow-ups. Changes in symptoms and patterns of CAM practitioner and therapy/product use associated with these symptoms were analyzed using longitudinal regression modeling.

RESULTS

Over the 7-year period, prevalence rates of PMS and heavy periods increased, while prevalence rates of endometriosis, irregular periods, and severe period pain remained stable. The most common use of CAM longitudinally associated with the perimenstrual symptoms was use of vitamins/minerals, yoga/meditation, massage therapy, herbal medicine, and aromatherapy. Excluding consultation with a naturopath/herbalist, over the 7-year survey women's use of all other CAM practitioners increased as did their use of vitamin/minerals, yoga/meditation, and Chinese medicines, while aromatherapy use declined.

CONCLUSION

Only the prevalence of PMS and heavy periods increased with aging in this sample of women. While overall use of CAM practitioner and self-prescribed products/therapies increased over time, CAM was chosen by women mainly to treat endometriosis and PMS. The extent to which this use reflects treatment efficacy is uncertain.

Comparison of the Effect of Stretching Exercises and Mefenamic Acid on the Reduction of Pain and Menstruation Characteristics in Primary Dysmenorrhea: A Randomized Clinical Trial

OBJECTIVES

Dysmenorrhea is a common gynecologic disorder. Although non-steroidal anti-inflammatory drugs are commonly used, due to their side effects and lack of response in some individuals, other approaches such as exercise have been considered. This study compared the effect of stretching exercises and mefenamic acid on the reduction of pain and menstruation characteristics in primary dysmenorrhea.

METHODS

In this randomized clinical trial, 122 female students with moderate to severe dysmenorrhea were assessed and were placed in either the exercise or mefenamic acid group. The exercise program was performed for 15 minutes, three times a week and included a five-minute warm up and six belly and pelvic stretching exercises for 10 minutes. The mefenamic acid group received 250 mg capsules every eight hours from the onset of menstruation until pain relief. Both interventions were performed during two consecutive menstrual cycles. Pain intensity was measured using a 10 cm visual analog scale.

RESULTS

The mean pain intensity was significantly higher in the exercise group only in the first cycle (p = 0.058). In the second cycle, the mean difference in pain reduction in the exercise group was higher than the mefenamic group compared to the start of the study (p = 0.056) and the first cycle (p = 0.007). There was no significant difference in the severity and duration of pain between the groups (p > 0.050).

CONCLUSIONS

Stretching exercises were as effective as mefenamic acid in the treatment of primary dysmenorrhea. Our results suggest that the effect of exercise on relieving menstruation pain increases over time.

Prevalence and Factors Affecting Dysmenorrhea in Female University Students: Effect on General Comfort Level

The purpose of this study was to investigate the prevalence and the affecting factors of dysmenorrhea and its effects on overall comfort among female university students. This was a cross-sectional study. The research was carried out between October and November 2013 at a university in Ankara. This study was conducted with 200 female students. The data were analyzed using frequencies, means, SD, χ(2) tests, independent t tests and analysis of variance. Data were collected using an interview questionnaire, the visual analog scale (VAS) and the General Comfort Questionnaire. The mean age of students in this study group was 20.85 ± 2.15 years. The prevalence of dysmenorrhea in the students was 84%. The mean severity of pain was 5.78 ± 2.45 on the VAS. The present study found that 45.8% of female students experienced moderate menstrual pain and the most common co-occurring symptoms were irritability (34.6%) and fatigue (21.5%). One-fourth of the students with dysmenorrhea consulted the advice of a physician and the most commonly used methods for pain were analgesics (69%), heat application (56.5%), and rest (71.4%). Family history of dysmenorrhea, education about menstruation, and frequency of menstrual cycle were identified as important factors in the development of dysmenorrhea (p < .05). The mean general comfort score for students with dysmenorrhea (2.57 ± 0.25) was lower than that of students without the condition (2.65 ± 0.23). Also, use of the methods for management of dysmenorrhea was found to increase students' general comfort levels. Therefore, it is important for nurses to educate and advise adolescents and young women about dysmenorrhea.

Premenstrual symptom clusters and women's coping style in Korea: happy healthy 20s application study

INTRODUCTION

The purpose of this study was to identify premenstrual symptom clusters; and to explore the differences in and effectiveness of coping strategies among symptom cluster groups.

METHODS

Using the happy healthy 20s smartphone application, 349 women with premenstrual symptoms participated in the study. Premenstrual symptoms and health outcomes such as perceived health, depressive feelings, quality of life, suicidal ideation/attempts and coping strategies were explored. Factor analysis and silhouette analysis were used to identify premenstrual symptom clusters. Analysis of variance was used to explore the differences among symptom clusters in health outcomes and coping strategies.

RESULTS

Three premenstrual symptom clusters were identified: general discomfort, negative affect and turmoil. Three symptom cluster groups experienced different health outcomes in perceived health, depressive feelings, quality of life and suicidal ideation. However, few differences were noted in participants' engagement in coping strategies, frequencies and perceived effectiveness among women with different symptom clusters.

DISCUSSION

Findings of this study support previous reports that women do not receive tailored care for their premenstrual symptoms. Learning about the symptom structure, women's ways of coping, and perceived effectiveness is important in identifying the issues in current premenstrual symptoms management and providing tailored care.

A critical review of complementary and alternative medicine use by women with cyclic perimenstrual pain and discomfort: a focus upon prevalence, patterns and applications of use and users' motivations, information seeking and self-perceived efficacy

INTRODUCTION

Complementary and alternative medicine (CAM) is used for treating cyclic perimenstrual pain and discomfort. This critical review examines women's reported CAM use, its perceived effectiveness and information relating to women's attitudes, behaviors, motivations and patterns of CAM use in its treatment.

MATERIAL AND METHODS

An extensive search of the main medical databases EBSCO, CINAHL, Medline, AMED and SCOPUS, as well as additional hand searches, was conducted. Papers included were confined to those that had been peer-reviewed, written in English and that contained original research into CAM use for cyclic perimenstrual pain and discomfort among adult women.

RESULTS

CAM, particularly herbal medicine, nutritional supplements and massage, is widely used for a range of cyclic perimenstrual pain and discomfort symptoms. A large number of CAM modalities are adopted, often simultaneously and with little professional oversight. Women's assessment of efficacy of different CAM modalities is positive, though the majority of users are self-prescribing apparently without professional guidance. Although the uptake of CAM for cyclic perimenstrual pain and discomfort is widespread, few empirical data are available regarding which women are using CAM, their motivations for doing so and, importantly, the sources through which women receive information about CAM.

CONCLUSIONS

This review highlights the extensive use of (often self-prescribed) CAM in a number of countries to alleviate the widespread symptoms of cyclic perimenstrual pain and discomfort. An understanding of all health care use by women with perimenstrual pain and discomfort is vital to help ensure safe, effective and coordinated health care that can lead to optimal patient outcomes.

The use of complementary and alternative medicine by 7427 Australian women with cyclic perimenstrual pain and discomfort: a cross-sectional study

BACKGROUND

To assess the prevalence of cyclic perimenstrual pain and discomfort and to detail the pattern of complementary and alternative (CAM) use adopted by women for the treatment of these symptoms.

METHODS

Data from the 2012 national Australian Longitudinal Study of Women's Health (ALSWH) cross-sectional survey of 7427 women aged 34-39 years were analysed to estimate the prevalence of endometriosis, premenstrual syndrome (PMS), irregular or heavy periods and severe dysmenorrhoea and to examine the association between their symptoms and their visits to CAM practitioners as well as their use of CAM therapies and products in the previous 12 months.

RESULTS

The prevalence of endometriosis was 3.7 % and of the perimenstrual symptoms assessed, PMS was most prevalent at 41.2 % whilst irregular bleeding (22.2 %), heavy periods (29.8 %) and severe period pain (24.1 %) were reported at lower levels. Women with endometriosis were more likely than non-sufferers to have consulted with a massage therapist or acupuncturist and to have used vitamins/minerals, yoga/meditation or Chinese medicines (p < 0.05). PMS sufferers were more likely to consult with an osteopath, massage therapist, naturopath/herbalist or alternative health practitioner and to have used all forms of CAM therapies except Chinese medicines than women who had infrequent PMS (all p < 0.05). Women with irregular periods did not have different patterns of CAM use from non-sufferers and those with heavy periods did not favour any form of CAM but were less likely to visit a massage therapist or use yoga/meditation than non-sufferers (p < 0.05). For women with severe dysmenorrhoea there was no difference in their visits to CAM practitioners compared to non-sufferers but they were more likely to use aromatherapy oils (p < 0.05) and for more frequent dysmenorrhoea also herbal medicines, Chinese medicines and other alternative therapies compared to non-sufferers (all p < 0.05).

CONCLUSIONS

There is a high prevalence of cyclic perimenstrual pain and discomfort amongst women in this age group. Women were using CAM differentially when they had specific symptoms of cyclic perimenstrual pain and discomfort. The use of CAM needs to be properly assessed to ensure their safe, effective use and to ascertain their significance as a treatment option enabling women with menstrual problems and their care providers to improve their quality of life.

Dysmenorrhea Characteristics of Female Students of Health School and Affecting Factors and Their Knowledge and Use of Complementary and Alternative Medicine Methods

The purpose of this study was to examine the menstruation and dysmenorrhea characteristics and the factors affecting dysmenorrhea of health school students, and the knowledge and use of the methods of complementary and alternative medicine (CAM) on the part of those students with dysmenorrhea. This is a descriptive study. A descriptive analysis was made by calculating the number, percentage, mean, Pearson χ, and logistic regression analysis. A total of 488 female students participated in the research and 87.7% (n = 428) of all students experienced dysmenorrhea. It was detected that a family history of dysmenorrhea and regular menstrual cycles of the students were dysmenorrhea-affecting factors (P < .05). Seven of 10 students with dysmenorrhea used CAM methods. Heat application of CAM methods for dysmenorrhea management was the most commonly used and also known by the students. The students who experienced severe pain used analgesics (P < .05) and CAM methods (P < .05).

The effect of mefenamic acid and ginger on pain relief in primary dysmenorrhea: a randomized clinical trial

PURPOSE

The aim of the study was to compare the effect of mefenamic acid and ginger on pain management in primary dysmenorrhea.

METHODS

One hundred and twenty-two female students with moderate to severe primary dysmenorrhea were randomly allocated to the ginger and mefenamic groups in a randomized clinical trial. The mefenamic group received 250 mg capsules every 8 h, and the ginger group received 250 mg capsules (zintoma) every 6 h from the onset of menstruation until pain relief lasted 2 cycles. The intensity of pain was assessed by the visual analog scale. Data were analyzed by descriptive statistics, t test, Chi-square, Fisher exact test and repeated measurement.

RESULTS

The pain intensity in the mefenamic and ginger group was 39.01 ± 17.77 and 43.49 ± 19.99, respectively, in the first month, and 33.75 ± 17.71 and 38.19 ± 20.47, respectively, in the second month (p > 0.05). The severity of dysmenorrhea, pain duration, cycle duration and bleeding volume was not significantly different between groups during the study. The menstrual days were more in the ginger group in the first (p = 0.01) and second cycle (p = 0.04). Repeated measurement showed a significant difference in pain intensity within the groups by time, but not between groups.

CONCLUSION

Ginger is as effective as mefenamic acid on pain relief in primary dysmenorrhea. Ginger does not have adverse effects and is an alternative treatment for primary dysmenorrhea.

Examining Self-Care Behaviors and Their Associated Factors Among Adolescent Girls With Dysmenorrhea: An Application of Orem's Self-Care Deficit Nursing Theory

PURPOSE

To test a hypothesized model that examines the relationship between selected basic conditioning factors, self-care agency, and self-care behaviors among adolescent girls with dysmenorrhea using Orem's self-care deficit nursing theory as a framework.

DESIGN

This was a predictive correlational study conducted with a total of 531 secondary school girls.

METHODS

Self-care agency, self-care behaviors, and 11 variables that have been theoretically or empirically justified in previous studies as relevant to basic conditioning factors were selected and collected by means of structured questionnaires. Path analyses were performed to test the hypothesized linkages among variables.

FINDINGS

Path analysis revealed that age and received menstrual education had both direct and indirect effects through self-care agency on self-care behaviors. Mother's and father's educational level, pain intensity, and self-medication used when experiencing dysmenorrhea only affected the self-care behaviors directly.

CONCLUSIONS

This is the first study that provided information about the relationship between basic conditioning factors, self-care agency, and self-care behaviors among adolescent girls with dysmenorrhea. Knowledge of the factors influencing self-care behaviors in these adolescent girls will assist healthcare professionals in developing effective interventions to promote self-care and ameliorate the adverse impact of this condition.

CLINICAL RELEVANCE

Interventional strategies that aim at promoting self-care behaviors among adolescent girls with dysmenorrhea should strengthen girls' self-care agency and should target those with a younger age, higher pain intensity, mother with a higher educational level, father with a lower educational level, and those who do not take self-medication for dysmenorrhea.

Effects of wheat germ extract on the severity and systemic symptoms of primary dysmenorrhea: a randomized controlled clinical trial

Background:

Primary dysmenorrhea is one of the most common disorders in women and the main cause of absenteeism from work and school.

Objectives:

Considering the anti-inflammatory properties of wheat germ, the present study examined the effects of wheat germ extract on the severity and systemic symptoms of primary dysmenorrhea.

Patients and Methods:

This triple-blinded clinical trial was performed on 80 employed women in hospitals affiliated with Hamadan University of Medical Sciences (Hamadan, IR Iran). Subjects were allocated to two groups of 45 patients. Three 400-mg capsules of wheat germ extract or placebo were used daily٫ between the 16th day of the menstrual cycle to the fifth day of the next menstrual cycle for two consecutive months. Pain intensity was measured by a visual analogue scale thrice a day and a four-point verbal rating scale was employed to assess systemic symptoms.

Results:

Pain severity decreased only in the wheat germ extract group (P < 0.001) and there was no statistically significant change in the placebo group. In the wheat germ extract group, the pain severity decreased from 4.701 at baseline to 1.120 at the second cycle. The reduction in total scores of systemic symptoms of dysmenorrhea was statistically significant only in the wheat germ extract group (P < 0.001) and there was not a statistically significant change in the placebo group. It revealed statistically significant differences in systemic symptoms associated with dysmenorrhea including fatigue, headache, and mood swings in experimental group.

Conclusions:

Wheat germ extract seems to be an effective treatment for dysmenorrhea and its systemic symptoms, probably because of its anti-inflammatory effects.