Clinical epidemiology of premenstrual disorder: informing optimized patient outcomes.

Premenstrual disorders encompass a spectrum that ranges from mild cyclical psychological and somatic symptoms to the rarer but much-more-severe premenstrual dysphoric disorder. This condition is serious and the etiology is unclear, but possible causes include genetic factors, hormonal fluctuations, and neurotransmitter dysfunctions. Differentiation from other affective disorders can be difficult but is key to providing appropriate management. This comprehensive review will discuss the most-recent classification of premenstrual disorders, etiology, diagnosis, and potential current management strategies.

Continuous and interrupted suturing techniques for repair of episiotomy or second-degree tears.

BACKGROUND: Millions of women worldwide undergo perineal suturing after childbirth and the type of repair may have an impact on pain and healing. For more than 70 years, researchers have been suggesting that continuous non-locking suture techniques for repair of the vagina, perineal muscles and skin are associated with less perineal pain than traditional interrupted methods. OBJECTIVES: To assess the effects of continuous versus interrupted absorbable sutures for repair of episiotomy and second-degree perineal tears following childbirth. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (20 January 2012). SELECTION CRITERIA: Randomised trials examining continuous and interrupted suturing techniques for repair of episiotomy and second-degree tears after vaginal delivery. DATA COLLECTION AND ANALYSIS: Three review authors independently assessed trial quality. Two of the three authors independently extracted data and a third review author checked them. We contacted study authors for additional information. MAIN RESULTS: Sixteen studies, involving 8184 women at point of entry, from eight countries, were included. The trials were heterogeneous in respect of operator skill and training. Meta-analysis showed that continuous suture techniques compared with interrupted sutures for perineal closure (all layers or perineal skin only) are associated with less pain for up to 10 days' postpartum (risk ratio (RR) 0.76; 95% confidence interval (CI) 0.66 to 0.88, nine trials). There was an overall reduction in analgesia use associated with the continuous subcutaneous technique versus interrupted stitches for repair of perineal skin (RR 0.70; 95% CI 0.59 to 0.84). There was also a reduction in suture removal in the continuous suturing groups versus interrupted (RR 0.56; 95% CI 0.32 to 0.98), but no significant differences were seen in the need for re-suturing of wounds or long-term pain. AUTHORS' CONCLUSIONS: The continuous suturing techniques for perineal closure, compared with interrupted methods, are associated with less short-term pain, need for analgesia and suture removal. Furthermore, there is also some evidence that the continuous techniques used less suture material as compared with the interrupted methods (one packet compared to two or three packets, respectively).

Absorbable suture materials for primary repair of episiotomy and second degree tears.

BACKGROUND: Approximately 70% of women will experience perineal trauma following vaginal delivery and will require stitches. This may result in pain, suture removal and superficial dyspareunia. OBJECTIVES: To assess the effects of different suture materials on short- and long-term morbidity following perineal repair. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (February 2010). SELECTION CRITERIA: Randomised trials comparing different suture materials for perineal repair after vaginal delivery. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. MAIN RESULTS: We included 18 trials with 10,171 women; comparisons included: catgut with standard synthetic (nine trials), rapidly absorbing synthetic (two trials), and glycerol impregnated catgut sutures (two trials); and standard synthetic sutures with rapidly absorbing synthetic (five trials) and monofilament sutures (one trial).Compared with catgut, standard synthetic sutures were associated with less pain up to three days after delivery (risk ratio (RR) 0.83, 95% confidence interval (CI) 0.76 to 0.90); and less analgesia up to ten days postpartum (RR 0.71, 95% CI 0.59 to 0.87). More women with catgut sutures required resuturing (15/1201) compared with synthetic sutures (3/1201) (RR 0.25, 95% CI 0.08 to 0.74); while more women with standard synthetic sutures required the removal of unabsorbed suture material (RR 1.81, 95% CI 1.46 to 2.24). Comparing standard synthetic with rapidly absorbing sutures, short- and long-term pain were similar; in one trial fewer women with rapidly absorbing sutures reported using analgesics at 10 days (RR 0.57, 95% CI 0.43 to 0.77). More women in the standard synthetic suture group required suture removal compared with those in the rapidly absorbed group (RR 0.24, 95% CI 0.15 to 0.36). There was no evidence of significant differences between groups for long-term pain (three months after delivery) or for dyspareunia at three, or at six to 12 months. When catgut and glycerol impregnated catgut were compared, results were similar for most outcomes, although the latter was associated with more short-term pain. One trial examining monofilament versus standard polyglycolic sutures found no differences for most outcomes. AUTHORS' CONCLUSIONS: Catgut may increase short-term pain compared with synthetic sutures. There were few differences between standard and rapidly absorbing synthetic sutures but more women needed standard sutures removing. For other materials, there was insufficient evidence to draw conclusions. Findings should be interpreted in the context of the related Cochrane review on suturing techniques.

Chinese herbal medicine for premenstrual syndrome.

BACKGROUND: Traditional Chinese herbal medicines are frequently used to treat premenstrual syndrome (PMS) in China. Until now, their efficacy has not been systematically reviewed. OBJECTIVES: To evaluate the effectiveness and safety of traditional Chinese herbal medicines in the treatment of women with premenstrual syndrome. SEARCH STRATEGY: We searched MEDLINE (January 1950 to December, 2007), EMBASE (January 1980 to December, 2007), Chinese Biomedical Database (CBM) (January 1975 to December, 2007), China National Knowledge Infrastructure (CNKI) (January 1994 to December, 2007), and the VIP Database (January 1989 to December, 2007). SELECTION CRITERIA: Randomised controlled trials (RCTs) studying the efficacy of traditional Chinese herbal medicine(s) for treatment of the premenstrual syndrome were included. DATA COLLECTION AND ANALYSIS: Two review authors telephoned the original authors of the RCTs to confirm the randomisation procedure, extracted and analysed data from the trials that met the inclusion criteria. MAIN RESULTS: Two RCT considering 549 women were included. One trial which was identified to be of higher methodological quality demonstrated the therapeutic effectiveness of Jingqianping granule. The other study was considered of lower quality due to the inherent risk of various biases in it. Two studies showed statistically significant differences in elimination of symptoms in proliferative phase and premenstrual phase by taking Jingqianping granule than taking Xiaoyaowan (RR 3.50, 95% CI1.74 to 7.06). Women treated by Cipher decoction had a higher rate of recovery than those taking Co-vitamin B6 capsules (RR 48.99, 95% CI 3.06 to 783.99). AUTHORS' CONCLUSIONS: It is rare in PMS management that efficacy claims are substantiated by clinical trials. One of the identified trials was well designed and reported on the effectiveness of Jingqianping in the treatment of premenstrual syndrome Qiao 2002. However, currently there is insufficient evidence to support the use of chinese herbal medicine for PMS and further, well controlled, trials are needed before any final conclusions could be drawn.