Yoga and Quality of Life in Women with Primary Dysmenorrhea: A Systematic Review

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.

The role of probiotics in improving menstrual health in women with primary dysmenorrhoea: A randomized, double-blind, placebo-controlled trial (the PERIOD study)

BACKGROUND

Primary dysmenorrhea is associated with poorer quality of life; however, the causal mechanism remains unclear. A vast body of literature supports the use of oral probiotics for relief from the symptoms of endometriosis; however, to our knowledge, no study has prescribed probiotics for primary dysmenorrhea.

OBJECTIVE

The aim of this study is to investigate the effects of 3-month supplementation with oral probiotics on quality of life and inflammatory markers in women with primary dysmenorrhea.

DESIGN

Randomized placebo-controlled trial.

METHODS

A total of 72 patients (36 patients in each arm) were randomized to receive either oral sachets containing 5 billion colony-forming units each of Lactobacillus acidophilus BCMC (BCrobes Microbial Cells) 12130, Lactobacillus casei subsp BCMC 12313, Lactobacillus lactis BCMC 12451, Bifidobacterium bifidum BCMC 02290, Bifidobacterium longum BCMC 02120, and Bifidobacterium infantis BCMC 02129 each or placebo twice daily for 3 months. Main outcome measures were visual analog scale, verbal rating scale, physical and mental health scores using Short-Form 12-Item version 2 questionnaire, frequency of nonsteroidal anti-inflammatory drug use, and changes in inflammatory markers (interleukin-6, interleukin-8, and tumor necrosis factor alpha) before and after treatment.

RESULTS

There was no significant difference in the quality of life scores between the probiotic and placebo groups. Both groups showed significant improvement in pain (visual analog scale) and severity (verbal rating scale) scores but the probiotic group had much lower nonsteroidal anti-inflammatory drug use (odds ratio: 0.69, 95% confidence interval: 0.26-1.83) and better mental health scores (mean change: 6.5, p = 0.03 versus 6.1, p = 0.08) than the placebo group. There was a significant confounding effect of nonsteroidal anti-inflammatory drug use on quality of life scores. No significant difference was found in inflammatory cytokines.

CONCLUSION

Tested oral probiotics improved mental health and potentially reduced the use of nonsteroidal anti-inflammatory drugs; however, there was no significant change in inflammatory markers. Further research with a larger sample size is needed to confirm the findings.

REGISTRATION

This study is registered under ClinicalTrials.gov (NCT04119011).

Effects of therapeutic exercise in primary dysmenorrhea: an umbrella and mapping review

PURPOSE

Primary dysmenorrhea (PD) is 1 of the most prevalent gynecologic conditions. The main aim of this umbrella review was to assess the effects of therapeutic exercise (TE) on PD.

METHODS

A systematic search was carried out in PubMed, Embase, SPORTDiscus, CINAHL, and PEDro (December 10, 2022). The outcome measures assessed were menstrual pain intensity, menstrual pain duration, and quality of life. Methodological quality was analyzed using the AMSTAR and ROBIS scales, and the strength of evidence was established according to the advisory committee grading criteria guidelines.

RESULTS

Nine systematic reviews were included. The results showed that TE, regardless of the exercise model and intensity, has a clinical effect in improving menstrual pain intensity in women with PD with moderate quality of evidence. In addition, the results showed that TE has a clinical effect in improving the duration of menstrual pain in women with PD with a limited quality of evidence. However, the results are controversial on the improvement of quality of life in women with PD with a limited quality of evidence.

CONCLUSIONS

TE seems an effective option to implement in women with PD to improve the intensity and duration of menstrual pain. We cannot draw robust results for quality of life due to the low number of primary studies. More research in this field can help us establish more robust conclusions, as well as to assess whether there is one exercise model or intensity of training that is more effective than others.PROSPERO number: This review was previously registered in PROSPERO (CRD42022371428).

The cross-cultural adaptation and psychometric properties of the menstrual symptom questionnaire (MSQ) among Chinese women of reproductive age

Objective

This study reports on a translation of the Menstrual Symptom Questionnaire (MSQ) into Chinese, a cross-cultural adaptation among Chinese women of reproductive age, and an assessment of its reliability and validity.

Methods

Previously published translation guidelines were followed to translate and cross-culturally adapt the English version of MSQ to produce a Chinese version. This Chinese version was then administered to 2800 Chinese women of reproductive age recruited by convenience sampling method. The reliability of the Chinese MSQ was tested for internal consistency and test-retest reliability. The concurrent and construct validity of the questionnaire was evaluated using correlation and factor analysis.

Results

The Chinese version of the MSQ showed no linguistic or semantic issues. The internal consistency of the Chinese MSQ Cronbach'α = 0.912, and the test-retest reliability r = 0.911. The exploratory factor analysis identified four factors. The confirmatory factor analysis demonstrated that the four factor structure of the Chinese version of the MSQ (Pain Experience, Emotional Changes, Pain Coping Strategies, and Other Physical Symptoms) is reasonable among Chinese women of reproductive age. There was a significant correlation found between these four factors and both the Pittsburgh Sleep Quality Index and the SF-8 Health Survey.

Conclusion

The Chinese version of the MSQ achieved semantic equivalence in translation and demonstrated good reliability and validity among Chinese women of reproductive age. Thus, it can serve as an effective tool to assess the experience of menstrual symptoms among Chinese women.

Experiences of dysmenorrhea and its treatment among allistic and autistic menstruators: a thematic analysis

BACKGROUND

Dysmenorrhea (i.e., period pain) is common and debilitating. Autistic people are known to experience pain differently, yet little is known about the menstrual pain experiences of autistic menstruators relative to non-autistic peers. This study aimed to explore the experience of period pain and treatment uptake for period pain among allistic and autistic populations.

METHODS

This study used a qualitative design and opportunity sampling approach. Thirty-seven participants (of whom 17 were autistic) were interviewed via video-conferencing software using a semi-structured topic guide. Transcriptions of interviews were analysed using Braun and Clarke's Reflexive Thematic Analysis. Data were initially analysed together for common themes. Autistic menstruators' data was subsequently analysed separately to elucidate the unique experiences of this group.

RESULTS

A total of six themes were constructed from the data. Initial analysis determined three themes related to experiences of period pain and treatment uptake in both allistic and autistic menstruators. Social perception of menstruation was discussed, highlighting the normalisation of pain, the taboo nature, and gendered experience of menstruation, contributing to untreated menstrual pain. Issues within menstrual healthcare were also shared, including experiences of ineffective treatment, dismissive interactions, and insufficient menstrual education. Impaired functionality was repeatedly highlighted, with menstruators detailing significant limitations to their usual functioning due to menstrual pain and ineffective treatment. Three further themes were constructed from separate analysis of data from autistic menstruators. Autistic menstruators discussed the impact of menstruation on their sensory experiences and needs, with many identifying overstimulation during menstruation. Social exclusion was discussed as a factor contributing to the experience of menstrual pain and poor treatment uptake. The final theme identified pain communication differences between autistic and allistic menstruators resulting in reports of ineffective treatment and challenges in healthcare interactions.

CONCLUSIONS

Communication differences, sensory aspects, and social factors contributed to the experience of period pain and treatment uptake for autistic menstruators. The perception of menstruation within society was highlighted by allistic and autistic menstruators as influential to their pain experience and engagement with treatment. Functionality was significantly impacted by pain for this sample. The study highlights societal and healthcare factors that could be improved to ensure accessibility of support and treatment for menstrual issues.

The Effect of Yoga on Pain and Quality of Life in Primary Dysmenorrhea: A Cross Sectional Survey

Dysmenorrhea is a painful syndrome that accompanies the menstrual cycles. Objectives: The main objective of this research was to determine the effects of yoga exercises on pain and quality of life in female undergraduate students suffering from primary dysmenorrhea. Methods: After taking approval from Ethical review committee of Rawal Institute of Health Sciences, an observation type of cross-section survey was conducted in 470 young undergraduate female students of age between 17-26, suffering from primary dysmenorrhea. By non-probability sampling participants were divided into two groups. Group-1 was of those females who had active lifestyle and doing yoga exercises and group-2 were of those who had sedentary lifestyle and didn’t do any kind of exercise. To measure the outcome variables, EQ-5D-5L questionnaire was used to measure QoL & NPRS to measure pain. Data were taken at baseline and after 12th week. Wilcoxon rank test was used for within group analysis and Mann Whitney U test was used to compare mean between groups. Data was analyzed in SPSS software version 21 along with Microsoft Excel 2019. Results: 21.16+2.66 &22.27+2.53 was the Mean+SD of age of group-1 & group-2 respectively. Between groups analysis revealed that p-value for NPRS was <0.05 but was >0.05 in quality of life. Conclusion: Yoga exercises are safer and easiest way to manage pain of primary dysmenorrhea in undergraduate females without any drug use.

Prevalence of menstrual symptoms change and influencing factors among international female students studying in china during acculturation period

Background

A number of previous studies have explored international students’ adaptation process with regards to language, lifestyle, food, and environment. However, there have yet been no studies conducted to address the menstrual symptoms challenges faced by international female students during the acculturation period. Thus, this study aims to describe the prevalence of menstrual symptoms change and to explore the influencing factors among international female students studying in China during the acculturation period.

Methods

An online cross sectional study was conducted among international female students studying in China during the acculturation period (defined as the first six months of living in the host country) in Hunan Province of China from March 2019 to July 2019. Menstrual symptoms questionnaire, sociocultural adaptation scale, China higher education student satisfaction scale, perceived stress scale, and Pittsburgh sleep quality index were used for data collection. Descriptive analysis, ANOVA, paired t-test, Pearson correlation, and multivariate linear regressions were used to analyze the data using SPSS 21.0 software.

Results

Three hundred and forty-five (97.18%, 345/355) female students from 45 countries fully completed the questionnaire. The mean age of the participants was (26.59 ± 6.439) years. In total, 18.49% of participants had encountered menstrual symptoms change. There were significant differences in the menstrual symptoms score between before arrival and evaluation during the first six months of living in China (t = − 11.700, p = 0.000). The main menstrual symptoms change included cramps (17.68%), irritation (14.78%), abdominal pain (12.46%), fatigue (12.46%), and headaches (9.85%). Cultural adaptation level (β = 0.198, 95% CI: 0.934, 2.995), sleep quality (β = 0.166, 95% CI: 0.112, 0.496), perceived stress (β = 0.193, 95% CI: 0.123, 0.410), time spent in the host environment, (β = − 0.270, 95% CI: − 3.200, − 1.444) and experience of visiting foreign countries (β = 0.184, 95% CI: 1.134, 4.125) were significantly correlated with menstrual symptoms change.

Conclusion

The prevalence of menstrual symptoms change among international female students should not be overlooked when considering menstrual health in this population. Poorer cultural adaptation, poorer sleep quality, higher stress, and lack of overseas living experiences significantly influence the menstrual symptoms of international female students studying in China.

Effect of Yoga on Dysmenorrhea in 6th Grade Elementary School Students at Rusunawa Health Center: A Quasi-Experimental Study

BACKGROUND: From 35 elementary school students in Marunda, 23 students (65.7%) had primary dysmenorrhea. Dysmenorrhea can interfere with student learning activities and concentration. Interventions need to be given so that students can increase their productivity and learning achievement. AIM: This study aims to analyze the effect of yoga on dysmenorrhea in 6th grade elementary school students at Rusunawa Health Center. MATERIALS AND METHODS: This study used a quasi-experimental approach with a non-equivalent control group design. The yoga group was given yoga practice for 3 months of the menstrual cycle. The sample consisted of 33 students in the yoga group and 33 students in the control group. Dysmenorrhea pain intensity was measured by Wong Baker Pain Rating Scale. Statistical tests used were Friedman test, Mann–Whitney test, and Ordinal Regression test. RESULTS: There was a significant difference in pain duration and pain intensity of dysmenorrhea in the past 3 months in the yoga group (p < 0.001). There was a significant difference in pain duration and pain intensity of dysmenorrhea between the yoga group and control group on the measurements in the 2nd month (p = 0.009; p < 0.001) and the 3rd month (p < 0.001; p < 0.001). CONCLUSIONS: Yoga had a significant effect in reducing the pain duration and pain intensity of dysmenorrhea in 6th grade elementary school students at Rusunawa Health Center. Midwives can educate elementary school students and young women in the working area of Rusunawa Health Center to use yoga as an alternative therapy to reduce dysmenorrhea.

The effects of yoga on quality of life among postmenopausal women: A systematic review study

INTRODUCTION

The quality of life in menopausal women is considered to be an important health issue in different societies and one of the main objectives of health care in this period. This study aimed to investigate the effects of yoga on improving the quality of life in menopausal women.

METHOD

English databases of Google Scholar, Science Direct, PubMed, Scopus, and Cochrane Library were searched to access related articles using keywords of menopause, quality of life, and yoga. Furthermore, Persian equivalents of the same keywords were searched in databases of Google Scholar, SID, and Magiran, in addition to a combination of the keywords. The search interval was from the inspection to January 2020. The quality of the included studied was assessed based on CONSORT 2017 checklist.

RESULTS

Out of 120 articles found in the databases, six articles entered the study based on the inclusion criteria and were investigated for intervention methods and consequences. The results indicated the positive impact of yoga on the quality of life in menopausal women.

CONCLUSION

Considering the effects of yoga on the symptoms and quality of life in menopausal women, it is suggested that this low-cost method be used to improve their quality of life and health.

Pain management and coping strategies for primary dysmenorrhea: A qualitative study among female nursing students

AIM

Primary dysmenorrhea is a problem that affects both young and adult women, with a significant impact on their daily lives. This pain is primarily managed through the consumption of non-steroidal anti-inflammatories and non-pharmacological approaches such as exercise, acupressure and heat. The present study aimed to describe how Spanish university students manage dysmenorrhea.

DESIGN

Qualitative case study.

METHODS

Nursing students (N = 33) from the region of Andalusia (Spain) participated in focus groups. A purposive sampling method was used, and the data were collected through videoconferencing and subsequently analysed thematically. The guidelines for conducting qualitative studies established by the consolidated criteria for reporting qualitative research (COREQ) and the standards for reporting qualitative research (SRQR) were followed.

RESULTS

Four principal themes were identified: (a) Strategies for pain management; (b) using painkillers; (c) choosing the ideal treatment; (d) non-pharmacological interventions.

CONCLUSIONS

The nursing students experienced difficulties in managing primary dysmenorrhea, they self-medicated, expressed reluctance to seek professional medical advice, used non-pharmacological strategies and seeked advice from other women within their family/social circle.

The effect of yoga on pain level in primary dysmenorrhea

This study was conducted to evaluate the effect of yoga on pain levels in female students with primary dysmenorrhea. This study is a randomized experimental study with control group and pretest post-test practice. This study included 60 volunteer female students (30 experimental and 30 control groups). The patients in the experimental group took part in the yoga program a total of 12 sessions, once per week for 12 weeks. "Personal Information Form", "Visual Analog Skala (VAS)" and "Dysmenorrhea Monitoring Form (DMF)" were used in data collection process. To measure dysmenorrhea pain, the students were requested to mark a number between 1 and 10 on the VAS scale according to the severity of their pain on the menstruation starting date. The yoga applications were used for three menstrual cycles. The mean age of the students in the experimental group was 20.30 ± 0.46, while the mean age of the students in the control group was 20.46 ± 0.50. The difference between the pain levels of the students in the experimental group in the first, second, third and fourth measurements was found to be statistically significant (p < 0.001). It was determined that the difference between the pain levels of the students in the control group in the first, second, third and fourth measurements was not statistically significant (p > 0.05). Yoga can be used as an effective intervention in reducing menstrual pain in women with primary dysmenorrhea.

Effect of yoga on posttraumatic growth and quality of life in first-time mothers: A randomized controlled trial

AIM

This study aims to examine the effect of yoga on posttraumatic growth and quality of life in postpartum mothers.

METHODS

The study was conducted as randomized controlled. There were 160 participant mothers, including 80 for the yoga group and 80 for the control group. Mothers in the yoga group participated in individual yoga practices at their homes every weekday for 10 weeks. The personal information form, posttraumatic growth inventory (PTGI), and short form-36 (SF-36) Quality of Life Scale were used to collect data.

RESULTS

The results showed that total and subscale mean scores of the PTGI were higher in the yoga group than the control group after the intervention. In comparison to the control group, the mean scores of the yoga group were higher in subscales as physical functioning, role-physical, bodily pain, general health, vitality, social functioning, mental health of the SF-36, after the intervention.

CONCLUSION

The yoga increased psychological growth and quality of life in the postpartum period. Health professionals could use yoga to increase the quality of life of mothers and to ensure their psychological growth in health care.

Regulation of Mild Moxibustion on Uterine Vascular and Prostaglandin Contents in Primary Dysmenorrhea Rat Model

Objective

Primary dysmenorrhea (PD) is a common and high incidence disease in gynecology, which seriously affects the quality of life in young women. Our previous study found that mild moxibustion could treat abdominal pain of PD patients, but the mechanism is still unclear. Therefore, this study aims to partly investigate the treatment mechanism of moxibustion for PD, especially on uterine microcirculation.

Methods

Forty 3-month-old Sprague Dawley female rats were randomly divided into four groups, including group A (saline control group, n = 10), group B (control plus moxibustion group, n = 10), group C (PD model group, n = 10), group D (PD. model plus moxibustion group, n = 10). The PD rat model was established by injecting estradiol benzoate and oxytocin. Mild moxibustion on Sanyinjiao (SP6) and Guanyuan (CV4) acupoints was once a day, 20 minutes per time, for 10 consecutive days. A vaginal smear was used to test the estrous cycle of rats. Uterine microvascular thickness was observed by stereomicroscope. And we detected the content of prostaglandin F_2α (PGF_2α ) and prostaglandin E₂ (PGE₂) in uterine tissue by enzyme-linked immunosorbent assay.

Results

Mild moxibustion can enlarge the microvessels, improve the microcirculation disturbance, and relieve the swelling of the uterus in PD rats. During the mild moxibustion intervention, the contents of PGF_2α and PGE₂ in uterus issues were synchronous increases or decreases and the changes of PGE₂ were more obvious, but the changes of uterine microvasculature and morphology caused by the decrease of PGF_2α were greater than PGE₂.

Conclusion

Mild moxibustion at SP6 and CV4 acupoints may relax uterine microvascular obstacle by reducing the content of PGF_2α in uterine tissue, improve the microcirculation disorder, and then alleviate the PD rat's uterine swelling.

The Therapeutic Effect of Ge-Gen Decoction on a Rat Model of Primary Dysmenorrhea: Label-Free Quantitative Proteomics and Bioinformatic Analyses

Ge-Gen decoction (GGD) is widely used for the treatment of primary dysmenorrhea (PD) in China. However, the mechanisms that underlie this effect are unclear. We investigated the protective mechanism of GGD in a rat model of PD using label-free quantitative proteomics. The model was established by the administration of estradiol benzoate and oxytocin. Thirty rats were divided into three groups (ten rats/group): a control group (normal rats), a model group (PD rats), and a treatment group (PD rats treated with GGD). The serum levels of prostaglandin E2 (PGE2) and prostaglandin F2α (PGF2α) were measured by ELISA. Nanohigh-performance liquid chromatography-tandem mass spectrometry (nano-HPLC-MS/MS) was used to identify differentially expressed proteins (DEPs), and bioinformatics was used to investigate the protein function. Proteomic data were validated by western blot analysis. Oxytocin-induced writhing responses and abnormal serum levels of PGE2 and PGF2α were reversed following the administration of GGD. A total of 379 DEPs were identified; 276 were identified between the control group and the model group, 144 were identified between the model group and the treatment group, and 41 were identified as DEPs that were common to all groups. Bioinformatics revealed that the DEPs between the control group and the model group were mainly associated with cellular component biogenesis and binding processes. The DEPs between the model group and the treatment group were mainly involved in the protein binding and metabolic process. The expression levels of HSP90AB1 and the phosphorylation levels of ERK, JNK, and P-p38 in the uteri of rats in the three groups were consistent with the proteomic findings; MAP kinases (ERK, JNK, and p38) are known to be involved in the production of inflammatory cytokines and oxytocin signaling while HSP90AB1 is known to be associated with estrogen signaling. Collectively, these data indicate that GGD may exert its protective function on PD by regulating the inflammatory response and signaling pathways associated with oxytocin and estrogen.

Integrating Lifestyle Focused Approaches into the Management of Primary Dysmenorrhea: Impact on Quality of Life

OBJECTIVE

This narrative review aims to identify alternative ways to improve the symptoms of primary dysmenorrhea (PD).

BACKGROUND

PD refers to endometrial painful cramps during the premenstrual period. This condition affects a lot of women worldwide and is accompanied with absenteeism and high economic costs, thus, risk-free, and effective therapeutic approaches are needed. Pharmacological agents such as non-steroidal anti-inflammatory drugs (NSAIDs) and oral contraceptive pills (OCPs), which are widely prescribed for these women, demonstrate adequate efficacy in alleviating pain and discomfort. The long natural course of the disease dictates remedies that focus on lifestyle changes and on improvement of Quality-of-Life (QoL) for women suffering with PD.

MATERIALS AND METHODS

Five major search engines, namely MEDLINE, PubMed, EMBASE, and Cochrane Library were searched for articles published prior to October 2020 focused in PD. A total of 74 paper were included.

DISCUSSION

Physical activity, for instance yoga, aromatherapy massage, and other forms of relaxation, vitamins and dietary changes, acupressure and acupuncture,a and some psychological interventions are just few of the proposed health behavior targeted approaches in cases of PD. This review focuses on lifestyle changes and alternative methods that could potentially result in minimizing symptoms of PD and in improving overall QoL for these patients, by providing current scientific evidence on their efficacy.

CONCLUSION

Complementary and alternative medicine practices (CAM) are widely accepted by women. International literature provides controversial scientific evidence, thus further studies need to be conducted in order to prove or disregard their efficacy in cases of PD.

Menstrual Migraine Among Spanish University Students

PURPOSE

This study sought to determine the prevalence of menstrual migraine among female university students at the Nursing Faculty of Ciudad Real and to determine possible risk factors.

DESIGN AND METHODS

A cross-sectional observational study was performed using a self-report questionnaire. Two hundred and ninety-nine female university students participated in the study; all were enrolled in the 2017/2018 academic year at the Faculty of Nursing. Participants were over the age of 18 years and without any diagnosed gynecological pathology. The main measurement tools were menstrual migraine between days -2 and +3 of the menstrual cycle, over the previous six cycles.

RESULTS

The prevalence of menstrual migraine was 45.15%, identifying the following possible risk factors: dysmenorrhea (OR 9.19; 1.62-6.28% CI), use of hormonal contraceptive methods (OR 2.60; 95% CI 1.30-5.20), menstrual irritability (OR 2.34; 95% CI 1.25-4.40), menstrual dizziness (OR 2.05; 95% CI % 1.12-3.75) and daily consumption of cola beverages (OR 1.85; 95% CI % 1.04-3.32).

CONCLUSIONS

The prevalence of this problem is high among our population and the approach is complex.

PRACTICE IMPLICATIONS

It is necessary to continue to research the pharmacological measures and methods of pharmacological pain relief as well as interventions directed at lifestyle modifications considering the potential risk factors involved in menstrual migraine.

Living with Restrictions. The Perspective of Nursing Students with Primary Dysmenorrhea

Primary dysmenorrhea (PD) affects a large number of female university students, diminishing their quality of life and hindering academic performance, representing a significant cause of absenteeism. The purpose of our study was to determine how nursing students experienced restrictions as a result of primary dysmenorrhea. A qualitative exploratory study was conducted among 33 nursing students with primary dysmenorrhea. A purposeful sampling strategy was applied. Data were collected from five focus groups (two sessions each) and the field notes of 10 researchers. A video meeting platform was used to conduct the focus groups. A thematic inductive analysis was performed. Thirty-three female nursing students participated in the study with a mean age of 22.72 (SD 3.46) years. Three broad themes emerged: (a) restrictions on daily activities and sports; (b) academic restrictions, and (c) restrictions on social and sexual relationships. The students described restrictions in performing everyday activities, such as carrying weight, and shopping. Some students even gave up the practice of sports and were absent from classes at the university, and from clinical practices at the hospital. The pain affected their ability to maintain and create new social relationships. Primary dysmenorrhea caused restrictions in the personal, social and academic life of the nursing students.

Interference and Impact of Dysmenorrhea on the Life of Spanish Nursing Students

Dysmenorrhea is a cause of absenteeism in universities which, in the context of nursing studies, may affect mandatory attendance. Moreover, presenteeism is associated with medication errors, patient falls, and a reduced quality of patient care. This study sought to identify the degree of interference of dysmenorrhea on daily life and its impact on academic performance among Spanish nursing students, and to explore the reasons for presenteeism. A cross-sectional descriptive study was conducted on 261 nursing students. Data were collected using a self-administered questionnaire. The chi square tests, chi-square linear trend, Student's t-test, one-way analysis of variance of polynomial contrasts, and post hoc tests for the bi-variate analysis were used to compare the participants' responses regarding their type of dysmenorrhea and pain intensity. In addition, a multivariate regression was performed to predict absenteeism. The answers to the open questions were analyzed using thematic content analysis techniques. We observed 62.8% of absenteeism and 92.7% of presenteeism due to dysmenorrhea. Absenteeism was observed to be 3.079 (confidence interval (CI): 95%1.724-5.499; p < 0.001) times more likely among women with severe menstrual pain, 2.513 (CI 95%1.314-4.807; p = 0.005) times more in those suffering from menstrual nausea and 1.936 (CI 95%1.098-3.411; p = 0.022) times more frequent in those suffering from diarrhea. The reasons for presenteeism were grouped into five categories: the pain was bearable, it is not a reason to be absent, others don't consider it a reason to be absent, responsibility and guilt, and academic consequences. Dysmenorrhea can have a significant impact on academic performance. The concern among students about the academic repercussions and even feelings of guilt and incomprehension from others leads to high rates of presenteeism with potentially negative consequences for patient care.

Perception of Menstrual Normality and Abnormality in Spanish Female Nursing Students

Menstrual problems are usually taboo; and often, some, such as dysmenorrhea, are presumed normal. This study seeks to compare the menstrual characteristics and symptoms of female university students reporting self-perceived normality concerning their cycles and menstruation with those who perceive their menstruation as being abnormal. A cross-sectional descriptive study was conducted among 270 nursing students using a self-report questionnaire that included sociodemographic and gynecological issues, together with Visual Analog Scale, the Andersch and Milsom Scale, and the Spanish version of the EuroQol-5 Dimension (EuroQol-5D) to measure self-perceived health status. A bivariate analysis was performed using the chi-square test, linear trend chi-square, and Student's t-test, and a multivariate analysis of stepwise binary logistic regression was performed to predict the perception of cycle abnormality. In total, 77.4% of participants displayed normality; however, in self-reporting of menstrual characteristics, 67.4% identified alterations. Young women suffering from menstrual dizziness were 1.997 (CI95% = 1.010-3.950; p = 0.047) more likely to manifest abnormal menstruation, 4.518 (CI95% = 1.239-16.477; p = 0.022) more likely if they suffered from Grade 3 menstrual pain, and 2.851 (CI95% = 1.399-5.809; p = 0.004) more likely if they perceived that menstruation interfered with their daily lives. Many menstrual changes and symptoms are still considered normal, making it difficult to identify and address these issues. Therefore, it is necessary to develop health policies and strategies to improve menstrual health literacy for increased knowledge and earlier diagnosis.

Quality of Life in Japanese Patients with Dysmenorrhea Treated with Ethinylestradiol 20 μg/Drospirenone 3 mg in a Real-World Setting: An Observational Study

Background

Dysmenorrhea affects approximately 80% of women in Japan and has a negative impact on health-related quality of life (HRQoL). Low-dose estrogen/progestin combined oral contraceptives have been shown to reduce the severity of dysmenorrhea symptoms. This study characterized HRQoL in Japanese women with dysmenorrhea before and after ethinylestradiol/drospirenone (EE/DRSP) treatment.

Methods

This prospective, observational study recruited 531 patients, of which 186 were evaluated after treatment with EE 20 μg/DRSP 3 mg for dysmenorrhea in a 24/4 cyclic regimen. The primary endpoints were mean baseline and post-treatment 36-Item Short-Form Health Survey version 2.0 (SF-36v2) scores for study patients compared with the general female population of Japan (calculated using norm-based scoring), and mean changes in study patient SF-36v2 scores between baseline and 6 to 8 treatment cycles.

Results

Compared with Japanese norms, women with dysmenorrhea had lower pre-treatment SF-36v2 scores, except for the physical functioning domain. After 6-8 cycles of EE/DRSP treatment, all 8 SF-36v2 domain scores were significantly higher than baseline. The greatest improvements were observed in bodily pain and social functioning (mean change [standard deviation (SD)]: physical functioning: 1.4 [5.7], role physical: 3.2 [8.1], bodily pain: 7.8 [10.0], general health: 3.0 [7.0], vitality: 2.7 [8.1], social functioning: 3.5 [9.8], role emotional: 3.3 [9.2], and mental health: 3.0 [7.3]; p< 0.001 for all). Compared with the Japanese general population, study patients' post-treatment scores were significantly higher for the general health domain (p= 0.008) and physical summary scores (p= 0.033).

Conclusion

Dysmenorrhea has a profound impact on all aspects of functioning and well-being. This study, conducted in a real-world setting, found that physical, social, and mental HRQoL improved significantly after a cyclic regimen of EE/DRSP in Japanese patients with dysmenorrhea. This regimen may have the potential to provide an effective option to improve patient HRQoL.

Trial Registration

Study sample was drawn from patients enrolled in a post-marketing surveillance study, registered June 20, 2011 (NCT01375998).

The effect of yoga on sleep quality and insomnia in women with sleep problems: a systematic review and meta-analysis

BACKGROUND

To examine the effectiveness and safety of yoga of women with sleep problems by performing a systematic review and meta-analysis.

METHODS

Medline/PubMed, ClinicalKey, ScienceDirect, Embase, PsycINFO, and the Cochrane Library were searched throughout the month of June, 2019. Randomized controlled trials comparing yoga groups with control groups in women with sleep problems were included. Two reviewers independently evaluated risk of bias by using the risk of bias tool suggested by the Cochrane Collaboration for programming and conducting systematic reviews and meta-analyses. The main outcome measure was sleep quality or the severity of insomnia, which was measured using subjective instruments, such as the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), or objective instruments such as polysomnography, actigraphy, and safety of the intervention. For each outcome, a standardized mean difference (SMD) and confidence intervals (CIs) of 95% were determined.

RESULTS

Nineteen studies in this systematic review included 1832 participants. The meta-analysis of the combined data conducted according to Comprehensive Meta-Analysis showed a significant improvement in sleep (SMD = - 0.327, 95% CI = - 0.506 to - 0.148, P < 0.001). Meta-analyses revealed positive effects of yoga using PSQI scores in 16 randomized control trials (RCTs), compared with the control group in improving sleep quality among women using PSQI (SMD = - 0.54; 95% CI = - 0.89 to - 0.19; P = 0.003). However, three RCTs revealed no effects of yoga compared to the control group in reducing insomnia among women using ISI (SMD = - 0.13; 95% CI = - 0.74 to 0.48; P = 0.69). Seven RCTs revealed no evidence for effects of yoga compared with the control group in improving sleep quality for women with breast cancer using PSQI (SMD = - 0.15; 95% CI = - 0.31 to 0.01; P = 0.5). Four RCTs revealed no evidence for the effects of yoga compared with the control group in improving the sleep quality for peri/postmenopausal women using PSQI (SMD = - 0.31; 95% CI = - 0.95 to 0.33; P = 0.34). Yoga was not associated with any serious adverse events.

DISCUSSION

This systematic review and meta-analysis demonstrated that yoga intervention in women can be beneficial when compared to non-active control conditions in term of managing sleep problems. The moderator analyses suggest that participants in the non-breast cancer subgroup and participants in the non-peri/postmenopausal subgroup were associated with greater benefits, with a direct correlation of total class time with quality of sleep among other related benefits.

Online information on dysmenorrhoea: An evaluation of readability, credibility, quality and usability

AIMS AND OBJECTIVES

To evaluate online information on dysmenorrhoea, including readability, credibility, quality and usability.

BACKGROUND

Menstrual pain impacts 45%-95% of women of reproductive age globally and is the leading cause of school and work absences among women. Women often seek online information on dysmenorrhoea; however, little is known about the information quality.

DESIGN

This was a descriptive study to evaluate online information on dysmenorrhoea.

METHODS

We imitated search strategies of the general public. Specifically, we employed the three most popular search engines worldwide-Google, Yahoo and Bing-and used lay search terms, "period pain" and "menstrual cramps." We screened 60 web pages. Following removal of duplicates and irrelevant web pages, 25 met the eligibility criteria. Two team members independently evaluated the included web pages using standardised tools. Readability was evaluated with the Flesch-Kincaid Reading Ease and Flesch-Kincaid Grade formulas; credibility, quality and usability were evaluated with established tools. We followed the STROBE checklist for reporting this study.

RESULTS

For readability, the mean Flesch-Kincaid level was 10th grade. For credibility, 8% of web pages referenced scientific literature and 28% stated the author's name and qualifications. For quality, no web page employed user-driven content production; 8% of web pages referenced evidence-based guidelines, 32% of web pages had accurate content, and 4% of web pages recommended shared decision-making. Most web pages were interactive and included nontextual information. Some nontextual information was inaccurate.

CONCLUSION

Online information on dysmenorrhoea has generally low readability, mixed credibility and variable quality.

RELEVANCE TO CLINICAL PRACTICE

Strategies to improve health information on dysmenorrhoea include avoiding complex terms, incorporating visual aids, presenting evidence-based information and developing a decision aid to support shared decision-making. Healthcare providers should be aware of the problematic health information that individuals are exposed to and provide education about how to navigate online health information.

Yoga for menstrual pain in primary dysmenorrhea: A meta-analysis of randomized controlled trials

OBJECTIVES

To assess the overall effect size of the impact of yoga on menstrual pain in primary dysmenorrhea.

METHODS

Randomized controlled trials that were published in the English language until December 2018 in PubMed, EMBASE, Web of Science, and the Cochrane Library electronic databases were searched. The methodologies from 4 trials conducted on 230 participants with primary dysmenorrhea were included in this meta-analysis to compare the effects that performing a yoga program has on menstrual pain (n = 129) to the effects of not performing yoga (n = 101).

RESULTS

The overall effect size of the impact of a yoga program on menstrual pain in primary dysmenorrhea was high with a standardized mean difference of -2.09 (-3.99 to -0.19) (p = 0.031) among the effect sizes of the 4 trials (95% confidence interval).

CONCLUSIONS

Yoga is an effective intervention for alleviating menstrual pain in women with primary dysmenorrhea.

The Impact of Dysmenorrhea on Quality of Life Among Spanish Female University Students

(1) Background: Primary dysmenorrhea, which is characterized by menstrual pain in the absence of a pelvic pathology, is one of the main reasons for gynecological consultation. This study aimed to assess the prevalence of dysmenorrhea in a sample of university students, as well as their quality of life, and to examine the most common methods used for alleviating symptoms. (2) Methods: The participants comprised 305 female university students with a mean age of 20.32 ± 3.19 years who completed a self-report survey comprising sociodemographic, gynecological and lifestyle questions. EuroQol-5 dimensions-5 levels (EQ-5D-5L) was used to measure quality of life. (3) Results: In total, 76% of the sample suffered from dysmenorrhea. Among the students who did not suffer from dysmenorrhea, a significantly greater proportion participated in activities such as jogging or Pilates on a regular basis (several times per week). Concerning quality of life, patients with dysmenorrhea showed significant differences on the pain/discomfort scale and on the total score for perceived quality of life. However, this perception showed no correlation with the VAS (visual analogue scale) pain scale. Additionally, 90.5% of students with dysmenorrhea used pharmacological treatment, and 80% self-medicated. (4) Conclusions: Dysmenorrhea represents a major problem among youth today and the impact on the quality of life (QoL) of patients is evident. Physical activity may alleviate symptoms of dysmenorrhea and this and other complementary treatments should be promoted within health services.