"Atypical" depression following childbirth

It is common knowledge that women often get depressed after childbirth. Yet there has been little evaluation of what this depression amounts to. Transitory tearfulness in the early puerperium, as observed in maternity wards, is commonplace; has been designated “the Blues”—3rd, 4th or 10th day, Maternity or Mother's—and is generally regarded as a normal phenomenon. It has been variously attributed to psychological difficulties and physical discomfort at the onset of lactation, “narcissistic loss before rediscovery of the child” (Sclare, 1955), perineal soreness and hormonal changes.

Clinical features of women with chronic lower abdominal pain and pelvic congestion

The clinical features of 35 women with pelvic pain and demonstrable congestion on pelvic venography have been characterized by comparing their symptoms and signs with those of 22 women with pelvic pain due to classical pathology. Women with pelvic pain and congestion had a mean age of 32.4 years, were more often multiparous and had had symptoms for 6 months to 20 years. The pain was dull and aching with sharp exacerbations. In individual women it commonly occurred on one side of the abdomen but unlike the pain due to 'classical pathology', it could occur on the other side. The pain was exacerbated by postural changes, and walking. Congestive dysmenorrhoea, deep dyspareunia and postcoital ache were common findings in women with pelvic congestion and 60% had evidence of significant emotional disturbance. The combination of tenderness on abdominal palpation over the ovarian point and a history of postcoital ache was 94% sensitive and 77% specific for discriminating pelvic congestion from other causes of pelvic pain.

Chronic pelvic pain in the community--symptoms, investigations, and diagnoses

OBJECTIVES

This study was undertaken to investigate the overlap between chronic pelvic pain, dysmenorrhea, dyspareunia, irritable bowel syndrome, and genitourinary symptoms in the community and also to examine associated investigations and diagnoses.

STUDY DESIGN

A postal questionnaire was used to survey 3916 women aged 18 through 49 randomly selected from the Oxfordshire Health Authority Register. The number of responders was 2304 (74% of 3106 questionnaire recipients). Chronic pelvic pain was described as recurrent or constant pelvic pain of > or =6 months' duration unrelated to periods, intercourse, or pregnancy. Case patients (n = 483) were subgrouped as follows: (1) chronic pelvic pain only, (2) chronic pelvic pain and irritable bowel syndrome, (3) chronic pelvic pain and genitourinary symptoms, and (4) chronic pelvic pain, genitourinary symptoms, and irritable bowel syndrome.

RESULTS

Half the women with chronic pelvic pain also had either genitourinary symptoms or irritable bowel syndrome, or both. Prevalences of dysmenorrhea and dyspareunia were higher among women with chronic pelvic pain (81% and 41%, respectively) than among women without chronic pelvic pain (58% and 14%, respectively); rates did not differ among the chronic pelvic pain subgroups. Irritable bowel syndrome and stress were the most common diagnoses received by patients with chronic pelvic pain, but 50% had never received a diagnosis.

CONCLUSIONS

There is substantial overlap between chronic pelvic pain and other abdominal symptoms in the community. Despite a high prevalence of chronic pelvic pain, many women have never had the condition diagnosed.

Endometriosis: its association with retrograde menstruation, dysmenorrhoea and tubal pathology

Seventy-five women admitted for sterilization were laparoscoped during menstruation. Retrograde spillage of menstrual blood was observed in 76%. The occurrence of dysmenorrhoea was not associated with spillage of menstrual blood, observed endometriosis or tubal pathology. Mild or stage I endometriosis was detected in 43% of all the women but in only 54% of those who had retrograde spill. Retrograde spill was seen in 97% of those with endometriosis. A significant association (P less than 0.001) was found between endometriosis and tubal damage not due to endometriosis. The implication of these findings are discussed.

Primary dysmenorrhea in adolescent girls and treatment with oral contraceptives

This review examines the prevalence, associated morbidity, and treatment of primary dysmenorrhea in adolescent girls. Relevant literature was examined by systematic, evidence-based review using MEDLINE and Cochrane Collaboration databases. Dysmenorrhea is highly prevalent during adolescence. Despite differences in measurement methods, 20%-90% of adolescent girls report dysmenorrhea and about 15% of adolescents describe their dysmenorrhea as severe. During adolescence, dysmenorrhea leads to high rates of school absence and activity nonparticipation. Most adolescents with dysmenorrhea self-medicate with over-the-counter preparations; few consult healthcare providers. Combined oral contraceptives (COC) are an accepted treatment for dysmenorrhea in nonadolescent women. However, data supporting the efficacy of COC is limited. Very small studies show decreased prostaglandin in menstrual fluid associated with high-dose COC use. Larger studies are limited to cross-sectional comparisons showing lower prevalence of dysmenorrhea in low-dose COC users compared to non-COC users. One small, randomized controlled trial including some adolescents demonstrated an improvement in dysmenorrhea with high-dose COC treatment compared to placebo. The efficacy of low-dose COC in the treatment of adolescent dysmenorrhea has yet to be determined. If effective, well-established safety and noncontraceptive health benefits may make COC an ideal treatment for dysmenorrhea in adolescent girls.

Psychiatric disorder and gynaecological symptoms in middle aged women: a community survey

In a community survey 521 women aged 35-59 were selected at random from all patients registered in two groups practices. They were interviewed at home and assessed by means of standardised psychiatric measures and detailed gynaecological inquiry. Levels of psychiatric morbidity were found to be within the expected range for such a sample. Both psychiatric morbidity and the personality dimension of neuroticism were significantly associated with gynaecological symptoms, including dysmenorrhoea and premenstrual tension, some symptoms of excessive menstruation, and flushes and sweats but not disappearance of menstruation for over six months. Current psychiatric state was significantly associated with recent adverse life events and with indices of psychiatric vulnerability (neuroticism and previous psychiatric history), suggesting possible aetiological links with gynaecological symptoms. The findings of this study have implications for the management of gynaecological complaints in general practice.

Sexual dysfunction in diabetic females

Problems of sexual function in male diabetics are well-known, but studies have not been previously published documenting the incidence of such distress in diabetic females. One hundred and twenty-five diabetic women and 100 nondiabetic women between the ages of eighteen and forty-two were interviewed to determine the incidence of sexual dysfunction in these two groups. Forty-four of the 125 diabetic women (35.2 per cent) and six of the 100 nondiabetic women (6 per cent) reported complete nonorgasmic function in the preceding year, a difference significant at the P < .01 level. The appearance of sexual dysfunction in diabetic women correlated strongly with duration of diabetes, but there was little association with age, insulin dose, or such complications of diabetes as neuropathy, retinopathy, nephropathy or vaginitis. The term “secondary orgasmic dysfunction” is proposed for cases where impaired sexual response is felt to be on an organic basis, but appears only after a phase of normal sexual functioning.

Knowledge, attitudes, and consequences of menstrual health in urban adolescent females

PURPOSE

There is a lack of current information concerning the knowledge and attitudes of urban adolescents regarding menstruation. The purpose of this research was to determine: (1) The prevalence of dysmenorrhea, premenstrual symptoms and other menstrual disorders among adolescents who receive their health care at an urban adolescent health center; (2) The attitudes and expectations adolescents have relating to their menstrual period; and (3) The relationship between teens' attitudes and expectations regarding menses and actual menstrual-related morbidities such as school absenteeism.

METHODS

A 35-item, survey was administered to postmenarcheal adolescents ages 12-21 years. Descriptive analysis of the prevalence of the menstrual disorders was completed. Chi-square testing was used to compare the prevalence of menstrual-related morbidities with the level of adolescents' expectations regarding menstruation.

RESULTS

91.5% of the respondents were African-American. Premenstrual syndrome (PMS) was the most prevalent reported menstrual disorder (84.3%) followed by dysmenorrhea (65%), abnormal cycle lengths (13.2%), and excessive uterine bleeding (8.6%). Only 2% of teens report receiving information about menstruation from their health care provider. Negative expectations regarding menstruation were associated with higher rates of school absenteeism and missed activities (P = 0.0790 and P = 0.0297 respectively).

CONCLUSIONS

PMS and dysmenorrhea are prevalent medical disorders among urban adolescents. Morbidities, including school absenteeism, are higher among those with negative period expectations. Since only 2% of teens received information regarding menstruation from their health care provider, it is imperative that health care providers increase their anticipatory guidance regarding normal menstruation. This may aid in the prompt diagnosis and treatment of menstrual disorders, and decrease their associated morbidities.

Menstrual symptoms in women with pelvic endometriosis

OBJECTIVE

To investigate menstrual symptoms in relation to pelvic pathology.

DESIGN

A prospective questionnaire-based study.

SETTING

Aberdeen Royal Infirmary, Scotland.

SUBJECTS

1250 questionnaires were sent out prior to planned admission and 1200 women (96%) brought the completed questionnaires. They comprised 598 women undergoing laparoscopic sterilization, 312 having laparoscopy because of infertility, 156 having laparoscopy because of chronic pelvic pain and 134 women undergoing abdominal hysterectomy for dysfunctional uterine bleeding.

MAIN OUTCOME MEASURES

The occurrence of dysmenorrhoea, menorrhagia, menstrual regularity, premenstrual spotting, deep dyspareunia and pelvic pain in women with either endometriosis and post infective pelvic adhesions or a normal pelvis.

RESULTS

Menorrhagia, menstrual irregularity and premenstrual spotting occurred with equal frequency in all groups. Deep dyspareunia, pain after intercourse and recurrent pain unrelated to menstruation or coitus was more common in women with endometriosis and those with post infective pelvic adhesions than in those with a normal pelvis. Dysmenorrhoea appears to be more prevalent among women having endometriosis.

CONCLUSIONS

Menstrual symptoms, while raising a high index of suspicion for endometriosis, are not entirely reliable as indicators of disease. Dysmenorrhoea is the most common reported symptom in endometriosis sufferers. Diagnostic laparoscopy should be considered before institution of treatment in women complaining of pelvic pain and menstrual symptoms.

A life of pelvic pain

Pelvic pain associated with menstruation, i.e., dysmenorrhea, is a chronic pelvic pain that not only interferes with a woman's wellbeing for a large part of her life but also often co-occurs with other chronic painful conditions such as interstitial cystitis and irritable bowel syndrome and others. Little has been known about mechanisms underlying these chronic pelvic pains. This paper reviews 37 years of research in my laboratory at Florida State University on such mechanisms. Our research, mostly on rats, has contributed to the following findings: (1) Female reproductive organs are innervated in a topographic fashion by afferents in the pelvic (vagina/cervix) and hypogastric (cervix/uterine horn) nerves. (2) The input contributes to uterine and vaginal perceptions (nociception) that are modified by reproductive status. (3) Throughout the CNS, neurons responsive to stimulation of the reproductive tract also respond to stimulation of skin and other internal organs, in a manner modifiable by reproductive status and peripheral pathophysiology. (4) This dynamic physiological convergence may reflect extensive anatomical divergence of and interconnections between pathways entering the CNS via gateways through the spinal cord, dorsal column nuclei, and solitary nucleus. (5) The convergence also indicates the existence of extensive cross-system, viscero-visceral interactions within the CNS, that, while organized for coherent bodily functioning, serves as a substrate by which pathophysiology in one organ can influence physiology and responses to pathophysiology in other organs. (6) Some cross-system effects observed so far include: (a) Bladder inflammation reduces the rate of uterine contractions and the effects of drugs on the uterus. (b) Colon inflammation produces signs of inflammation in the otherwise healthy bladder and uterus. (c) A surgical model of endometriosis produces vaginal hyperalgesia, exacerbates pain behaviors induced by a ureteral stone, and reduces volume voiding thresholds if the bladder. These cross-system effects, which likely involve CNS mechanisms, likely also underlie co-occurrence of painful clinical conditions. Research continues on details of these mechanisms and their relevance for clinical diagnosis and therapy. None of this work could have been done without collegial support of colleagues and technical staff at Florida State University.

Early menstrual characteristics associated with subsequent diagnosis of endometriosis

OBJECTIVE

The aim of this study was to investigate the association between early menstrual characteristics, before symptom onset, and later diagnosis of endometriosis.

STUDY DESIGN

This was a case-control study of 268 Australian women with surgically confirmed moderate-to-severe endometriosis (cases) and 244 women without endometriosis (controls). Early menstrual cycle characteristics, before age at symptom onset, were analyzed.

RESULTS

Menarche after age 14 years was strongly and inversely associated with endometriosis (odds ratio, 0.3; 95% confidence interval, 0.1-0.6). A history of dysmenorrhea was associated with subsequent endometriosis (odds ratio, 2.6; 95% confidence interval, 1.1-6.2). Despite a suggestive trend, shorter menstrual cycle length was not associated with endometriosis. Duration of natural menstruation and heaviness of flow were not associated with subsequent risk of endometriosis; neither was the reported type of sanitary protection used nor history of sexual intercourse during menstruation.

CONCLUSION

There is a decreased risk of endometriosis with late age at menarche and an increased risk in women who report an early history of dysmenorrhea.

Sensitivity to cold pressor pain in dysmenorrheic and non-dysmenorrheic women as a function of menstrual cycle phase

Pain responses (threshold, tolerance, and visual analog ratings) to the cold pressor task were studied in 46 normally menstruating dysmenorrheic and non-dysmenorrheic women during 2 phases of the menstrual cycle. Twenty-six women provided measurements during the follicular (days 8-14) and 20 during the luteal (days 15-21) phases of the menstrual cycle. A significantly lower pain threshold was obtained during the luteal as compared to the follicular phase. Pain tolerance showed a similar but non-significant trend. Visual analog ratings were significantly lower in dysmenorrheic women during the follicular than the luteal phase. Also, these ratings were lower than those of non-dysmenorrheic women in the follicular phase. This finding may support an adaptation-levels model, in that dysmenorrheic women report less pain than do non-dysmenorrheic women because they compare cold pressor pain with internal menstrual pain.

Determinants of adenomyosis in women who underwent hysterectomy for benign gynecological conditions: results from a prospective multicentric study in Italy

OBJECTIVE

We conducted a cross-sectional study on the frequency and risk factors for adenomyosis in women who underwent hysterectomy for benign gynecological conditions.

STUDY DESIGN

All women who consecutively underwent hysterectomy during the study period for benign gynecological conditions at 18 gynecological departments were eligible for the study. A total of 820 women entered the study. Pathological data were collected prospectically.

RESULTS

Adenomyosis was identified in 231 women (28.2%, 95% confidence interval, CI, 24.6-32.5). The frequency of adenomyosis was similar in women with indication for surgery fibroids/menorrhagia (143 cases, 28.5%) or genital prolapse (69 cases, 28.2%). The rate ratio (RR) of adenomyosis was 1.9 (95% CI 1.2-2.8) in women reporting one or more induced abortions, in comparison with those reporting no induced abortion. Women with adenomyosis reported more frequently dysmenorrhoea and chronic pelvic pain, but not dyspareunia.

CONCLUSIONS

This study shows that adenomyosis is common in women who undergo hysterectomy and that it is more frequent among women reporting induced abortions dysmenorrhoea and chronic pelvic pain.

Menstrual cycle and menstrual pain problems and related risk factors among Japanese female workers

Women's employment in Japan has increased substantially in recent decades, however little large scale research has been done on the impact of various types of working conditions on women's health. The aim of this study was to assess the menstrual cycle and menstrual pain problems of female workers and to investigate the factors that relate to them. The questionnaire was distributed to 8,150 women and 2,166 responded (26.6%). An anonymous self-administered questionnaire was used to get information about demographics, menstrual cycle status, the degree of menstrual pain, and employment and environmental factors. Irregular cycle menstruation was experienced in 17.1% of responded workers. We discovered the relationship between irregular menstrual cycles and stress, smell of cigarettes, age and smoking habits. Some degree of menstrual pain was experienced in 77.6% of responded workers. This study showed the relationship between menstrual pain and stress, high temperature and humidity, age, BMI, and number of births. In conclusion, we found that stress is thought to be an important factor related with menstrual cycle irregularities and menstrual pain among Japanese female workers.

Rofecoxib, a specific cyclooxygenase-2 inhibitor, in primary dysmenorrhea: a randomized controlled trial

OBJECTIVE

To determine whether rofecoxib is effective for treating primary dysmenorrhea and whether cyclooxygenase-2 is involved in the pathophysiology of primary dysmenorrhea.

METHODS

A double-masked, randomized, placebo and active-comparator-controlled clinical trial including 127 subjects with histories of primary dysmenorrhea was conducted in an outpatient clinical research center. Subjects were randomly assigned to placebo, rofecoxib 25 or 50 mg followed by 25 mg every 24 hours as needed, or naproxen sodium 550 mg every 12 hours as needed for up to 3 days. Subjects took all four treatments in a balanced, complete-block, crossover design. Measurements included self-administered questionnaires of analgesic efficacy, spontaneous reports of adverse experiences, physical examinations, and laboratory safety tests.

RESULTS

Rofecoxib 25 and 50 mg provided analgesic efficacy greater than placebo (P < or = .006) for the primary endpoint of total pain relief over the first 8 hours. For other efficacy endpoints (sum of the pain intensity difference over the first 8 hours, subject's global evaluation, peak pain relief, peak pain intensity difference, and time to remedication) both doses of rofecoxib were better than placebo (P < or = .006) and were not distinguishable from naproxen sodium for all efficacy endpoints. All treatments were well tolerated.

CONCLUSION

Rofecoxib effectively treated primary dysmenorrhea, and cyclooxygenase-2-derived prostanoids play a role in the pathophysiology of primary dysmenorrhea.

What women say about their dysmenorrhea: a qualitative thematic analysis

BACKGROUND

Dysmenorrhea is highly prevalent and is the leading cause of absence from school and work among women of reproductive age. Evidence suggests that dysmenorrhea may also be a risk factor for other chronic pain conditions. Limited research has examined women's experience with dysmenorrhea using qualitative data. Research is warranted to address issues and needs that are important from women's own perspectives. Therefore, the purpose of this study was to describe women's salient thoughts about their experiences of dysmenorrhea.

METHODS

We analyzed data collected from an open-ended question within a cross-sectional survey study conducted in the United States. Using qualitative thematic analysis, free text responses to a question asking women to share their experience with dysmenorrhea were analyzed.

RESULTS

The sample consisted of 225 women who provided valid responses to the open-ended question. Six themes were identified: (1) The dysmenorrhea symptom experience varied among women; (2) The dysmenorrhea symptom experience varied across time, (3) A variety of factors influenced the dysmenorrhea symptom experience, (4) Dysmenorrhea symptoms could have a negative impact on the women's daily lives, (5) Dysmenorrhea was not seen as a legitimate health issue by the women, health care providers, or society, and (6) Treatment for women with dysmenorrhea varied in acceptability and effectiveness.

CONCLUSIONS

The findings of this study have important implications for dysmenorrhea symptom assessment and the development of personalized interventions to support dysmenorrhea management.

High-intensity focused ultrasound (HIFU) for adenomyosis: Two-year follow-up results

OBJECTIVE

To evaluate the long-term improvement of clinical symptoms of adenomyosis after treatment with ultrasound-guided high intensity focused ultrasound (USgHIFU).

METHODS

From January 2010 to December 2011, 350 patients with adenomyosis were treated with USgHIFU. Among the 350 patients, 224 of them completed the two years follow-up. The patients were followed up at 3 months, 1 year, and 2 years after HIFU treatment. Adverse effects and complications were recorded.

RESULTS

All patients completed HIFU ablation without severe postoperative complications. 203 of the 224 patients who showed varying degrees of dysmenorrhea before treatment had the symptom scores decreased significantly after treatment (P<0.001). The relief rate was 84.7%, 84.7%, and 82.3%, respectively at 3 months, 1 year, and 2 years after treatment. The menstrual volume in 109 patients with menorrhagia was significantly improved after treatment (P<0.001) with a relief rate of 79.8%, 80.7%, and 78.9%, respectively at 3 months, 1 year, and 2 years after HIFU treatment.

CONCLUSION

With its ability to sustain long-term clinical improvements, HIFU is a safe and effective treatment for adenomyosis.

Dysmenorrhoea is associated with hypersensitivity in the sigmoid colon and rectum

Dysmenorrhoea patients experience intense visceral pain during menstruation. Recurrent and/or intense visceral pain can induce facilitation of somatic and visceral nociceptive processing which can lead to viscero-somatic (referred) and viscero-visceral hyperalgesia. Our aim was to study if dysmenorrhoea is associated with hypersensitivity in the referred somatic skin area or in the large bowel, i.e., viscero-visceral hyperalgesia. We measured skin sensitivity in the referred area of the sigmoid colon as well as stimulus-response relationships in the sigmoid colon and rectum. The latter were measured using mechanical (balloon) distension applied via a Barostat in 11 dysmenorrhoea patients without gastro-intestinal complaints and 10 healthy and age matched women, again without gastrointestinal complaints. We found no skin hypersensitivity in the colonic referred area. In contrast, significantly lower distension volumes were seen at each threshold in dysmenorrhoea patients, particularly in the sigmoid colon. The mean reduction in colonic distension volume thresholds for dysmenorrhoea patients vs. controls was 57% at the detection threshold and 39% at the pain threshold. There were no differences in compliance between the groups. These findings suggest that, despite the absence of overt gastro-intestinal symptoms or viscero-somatic sensitisation, dysmenorrhoea patients demonstrate intestinal hypersensitivity. This can be regarded as the result of centrally mediated viscero-visceral hyperalgesia due to recurrent intense menstrual pain.

Moxibustion for pain relief in patients with primary dysmenorrhea: A randomized controlled trial

BACKGROUND

Though moxibustion is frequently used to treat primary dysmenorrhea in China, relevant evidence supporting its effectiveness is still scanty.

METHODS

This study was a pragmatic randomized, conventional drug controlled, open-labeled clinical trial. After initial screen, 152 eligible participants were averagely randomized to receive two different treatment strategies: Moxibustion and conventional drugs. Participants and practitioners were not blinded in this study. The duration of each treatment was 3 months. The primary outcome was pain relief measured by the Visual Analogue Scale. The menstrual pain severity was recorded in a menstrual pain diary.

RESULTS

152 eligible patients were included but only 133 of them eventually completed the whole treatment course. The results showed that the menstrual pain intensity in experimental group and control group was reduced from 6.38±1.28 and 6.41±1.29, respectively, at baseline, to 2.54±1.41 and 2.47±1.29 after treatment. The pain reduction was not significantly different between these two groups (P = 0.76), however; the pain intensity was significantly reduced relative to baseline for each group (P<0.01). Three months after treatment, the effectiveness of moxibustion sustained and started to be superior to the drug's effect (-0.87, 95%CI -1.32 to -0.42, P<0.01). Secondary outcome analyses showed that moxibustion was as effective as drugs in alleviating menstrual pain-related symptoms. The serum levels of pain mediators, such as PGF2α, OT, vWF, β-EP, PGE2, were significantly improved after treatment in both groups (P<0.05). No adverse events were reported in this trial.

CONCLUSIONS

Both moxibustion and conventional drug showed desirable merits in managing menstrual pain, given their treatment effects and economic costs. This study as a pragmatic trial only demonstrates the effectiveness, not the efficacy, of moxibustion for menstrual pain. It can't rule out the effect of psychological factors during treatment process, because no blind procedure or sham control was used due to availability. In clinical practice, moxibustion should be used at the discretion of patients and their physicians.

TRIAL REGISTRATION

ClinialTrials.gov NCT01972906.

Relationship between the onset of dysmenorrhea and histologic findings in adenomyosis

An attempt was made to evaluate the relationship between histologic findings of adenomyosis and onset of dysmenorrhea. Thirty-four cases of histologically diagnosed adenomyosis were investigated in this study. One large sample cut along the longitudinal axis was made and examined to evaluate the histologic parameters and CA 125 levels. Dysmenorrhea was classified into grade I (absent or mild) and grade II (severe). Localization of adenomyosis was divided into type I, adenomyosis continuous from the surface endometrium (29 cases), and type II, adenomyosis present on the serous side of the uterus and not continuous from the surface endometrium (five cases). We made type I adenomyosis, which included 13 cases of grade I and 16 cases of grade II, the focus of our investigation. The parameters that correlated with dysmenorrhea were the number of islands of adenomyosis and glands, distance of invasion, relative rate of invasion, and CA 125 levels. The differences between grades I and II were apparent in the frequency distribution tables, with dysmenorrhea occurring at invasion rates of 80% and greater.

Effectiveness of Transcutaneous Electrical Nerve Stimulation and Interferential Current in Primary Dysmenorrhea

OBJECTIVE

To compare the effectiveness of transcutaneous electrical nerve stimulation and interferential current in primary dysmenorrhea.

DESIGN

A prospective, randomized, and controlled study.

SETTING

Hacettepe University School of Physical Therapy and Rehabilitation.

PATIENTS

Thirty-four volunteer subjects with primary dysmenorrhea (mean age: 21.35 +/- 1.70 years) were included. Statistical analyses were performed in 32 subjects who completed all measures.

INTERVENTIONS

Fifteen subjects received interferential current application for 20 minutes and 17 subjects received transcutaneous electrical nerve stimulation for 20 minutes when they were experiencing dysmenorrhea.

OUTCOME MEASURES

Physical characteristics, years since menarche, length of menstrual cycle (days), and duration of menstruation (days) were recorded. Visual analog scale ( VAS) intensities of menstrual pain, referred lower limb pain, and low back pain were recorded before treatment, and immediately, 8 hours, and 24 hours after treatment.

RESULTS

Intensities of the evaluated parameters decreased beginning from just after the applications in both groups (P<0.05). Intensity of referring low back pain in first three measurement times was different between the groups (P<0.05), but this difference is thought to be due to the baseline values of the groups. So, it can be said that no superiority existed between the methods (P>0.05).

CONCLUSION

Both transcutaneous electrical nerve stimulation and interferential current appear to be effective in primary dysmenorrhea. As they are free from the potentially adverse effects of analgesics, and no adverse effects are reported in the literature nor observed in this study, a clinical trial of their effectiveness in comparison with untreated and placebo-treated control groups is warranted.

High nocturnal body temperatures and disturbed sleep in women with primary dysmenorrhea

Primary dysmenorrhea is characterized by painful uterine cramps, near and during menstruation, that have an impact on personal life and productivity. The effect on sleep of this recurring pain has not been established. We compared sleep, nocturnal body temperatures, and hormone profiles during the menstrual cycle of 10 young women who suffered from primary dysmenorrhea, without any menstrual-associated mood disturbances, and 8 women who had normal menstrual cycles. Dysmenorrheic pain significantly decreased subjective sleep quality, sleep efficiency, and rapid eye movement (REM) sleep but not slow wave sleep (SWS), compared with pain-free phases of the menstrual cycle and compared with the controls. Even before menstruation, in the absence of pain, the women with dysmenorrhea had different sleep patterns, nocturnal body temperatures, and hormone levels compared with the controls. In the mid-follicular, mid-luteal, and menstrual phases, the dysmenorrheics had elevated morning estrogen concentrations, higher mean in-bed temperatures, and less REM sleep compared with the controls, as well as higher luteal phase prolactin levels. Both groups of women had less REM sleep when their body temperatures were high during the luteal and menstrual phases, implying that REM sleep is sensitive to elevated body temperatures. We have shown that dysmenorrhea is not only a disorder of menstruation but is manifest throughout the menstrual cycle. Furthermore, dysmenorrheic pain disturbs sleep, which may exacerbate the effect of the pain on daytime functioning.

Possible roles of oxytocin receptor and vasopressin-1α receptor in the pathomechanism of dysperistalsis and dysmenorrhea in patients with adenomyosis uteri

OBJECTIVE

To investigate the expression of oxytocin (OTR) and/or vasopressin (VP1αR) receptor in patients with and without adenomyosis uteri.

DESIGN

Retrospective nonrandomized study.

SETTING

University hospital endometriosis research center.

PATIENT(S)

Forty patients with histologically proven adenomyosis and 40 patients without adenomyosis who had undergone hysterectomy for dysmenorrhea, bleeding disorders, and fibroids.

INTERVENTION(S)

Immunohistochemical examination of both OTR and VP1αR expression in endometrium, myometrium, and adenomyotic lesions, and identification of smooth muscle cells using antibodies against OTR, VP1αR, and smooth muscle actin (sm-actin).

MAIN OUTCOME MEASURE(S)

The immunoreactive score (IRS) was used for expression of OTR, VP1αR, and sm-actin.

RESULT(S)

Expression of OTR in epithelial cells of adenomyotic lesions and surrounding myometrial cells was detectable. VP1αR was expressed only in myometrial cells and blood vessels. Using a specific anti-sm-actin antibody, another spindle cell population was characterized to represent smooth muscle cells which are in direct contact with the adenomyotic stroma. Compared with the unaffected myometrium, the surrounding adenomyosis-associated myometrium overexpressed OTR and showed changes in morphology. In the uteri of patients with adenomyosis, the junctional zone was often seen to be quite fissured.

CONCLUSION(S)

In addition to the specific expression of VP1αR, OTR expression and morphologic changes in the myometrial architecture of uteri having adenomyosis support the hypothesis that dysperistalsis plays an essential role in the development of endometriosis and dysmenorrhea. In the near future, specific inhibition of this receptor might yield a promising treatment for therapy.