Dismenorrea, un dolor que incapacita / Dysmenorrhea: a disabling pain

La dismenorrea es una afección menstrual común en mujeres de edad reproductiva, caracterizada por dolor pélvico durante el ciclo menstrual. En este artículo, se revisan los factores de riesgo, la clínica y el diagnóstico de la dismenorrea primaria con el objetivo de proponer un enfoque de tratamiento multimodal para esta condición. La dismenorrea primaria es el dolor pélvico asociado al período menstrual sin una patología pélvica subyacente. La dismenorrea secundaria es el dolor pélvico que se presenta como síntoma de otras afecciones ginecológicas. El diagnóstico se basa en la historia clínica, la exploración física y ginecológica, y se pueden realizar pruebas complementarias en casos específicos. El tratamiento de la dismenorrea primaria es multimodal y tiene como objetivo aliviar el dolor y mejorar la calidad de vida de las pacientes. Los fármacos antiinflamatorios no esteroideos son la primera línea de tratamiento, aunque se pueden utilizar otros enfoques terapéuticos(AU)

Dysmenorrhea is a common menstrual condition in women of reproductive age, characterized by pelvic pain during the menstrual cycle. This article reviews the risk factors, clinic and diagnosis of primary dysmenorrhea to propose a multimodal treatment approach for this condition. Primary dysmenorrhea is pelvic pain associated with the menstrual period without underlying pelvic pathology. In contrast, secondary dysmenorrhea refers to pelvic pain that presents as a symptom of other gynecologic conditions. Diagnosis is based on detailed clinical history, physical and gynecological examination, and complementary tests may be performed in specific cases. Treatment of primary dysmenorrhea is multimodal and aims to relieve pain and improve the patient's quality of life. Nonsteroidal anti-inflammatory drugs are the first line of treatment, although other therapeutic approaches can be employed(AU)

Clinical Study on Yangxue Sanhan Tongmai Prescription for the Treatment of Endometriosis of Blood Deficiency and Cold Coagulation Type / 广州中医药大学学报

Objective To observe the clinical efficacy of Yangxue Sanhan Tongmai Prescription(derived from the modification of Danggui Sini plus Wuzhuyu Shengjiang Decoction,i.e.,Danggui Sini Decoction with Euodiae Fructus and Zingiberis Rhizoma Recens added)for the treatment of endometriosis(EMS)of blood deficiency and cold coagulation type.Methods A total of 120 cases of EMS with blood deficiency and cold coagulation syndrome were randomly divided into the study group and the control group,with 60 cases in each group.The study group was treated with Yangxue Sanhan Tongmai Prescription,and the control group was treated with Shaofu Zhuyu Granules.Both groups were treated for a period of 3 months,and were followed up for one year after the completion of the treatment.The two groups were observed in the changes of the visual analogue scale(VAS)scores of menstrual abdominal pain,the grading scores of dysmenorrhea,non-menstrual pelvic pain,pain during sexual intercourse,pelvic pressure pain and sacral ligament tenderness,the size of ovarian endometriosis cysts,and the serum levels of carbohydrate antigen 125(CA125),vascular endothelial growth factor(VEGF),soluble intercellular adhesion molecule 1(SICAM-1),matrix metalloproteinase 9(MMP-9)and tissue inhibitor of metalloproteinase 2(TIMP-2).After treatment,the clinical efficacy and safety,recurrence and pregnancy in the two groups were evaluated.Results(1)In the course of the trial,3 cases fell off in the study group and 5 cases fell off in the control group,and a total of 112 patients were eventually included in the statistical analysis,including 57 cases in the study group and 55 cases in the control group.(2)After 3 months of treatment,the total effective rate in the study group was 92.98%(53/57)and that in the control group was 85.45%(47/55),and the intergroup comparison showed that the efficacy of the study group was significantly superior to that of the control group(P＜0.05).(3)After treatment,VAS scores of menstrual abdominal pain and the grading scores of dysmenorrhea,non-menstrual pelvic pain,pain during sexual intercourse,pelvic pressure pain and sacral ligament tenderness in the two groups were significantly reduced compared with those before treatment(P＜0.05),and the reduction in the study group was significantly superior to that in the control group(P＜0.05).(4)After treatment,the ovarian endometriosis cysts of the two groups were slightly reduced,but the intragroup pre-and post-treatment differences and the intergroup post-treatment differences were not statistically significant(P＞0.05).(5)After treatment,the levels of serum CA125,VEGF,SICAM-1 and MMP-9 were decreased and the serum TIMP-2 level was increased in both groups compared with those before treatment(P＜0.05).And the decrease of serum CA125,VEGF,SICAM-1 and MMP-9 as well as the increase of serum TIMP-2 in the study group were significantly superior to those in the control group(P＜0.05).(6)The results of one-year follow-up showed that the recurrence rate of the study group was 30.19%(16/53),which was significantly lower than that of the control group(68.09%,32/47),and the difference was statistically significant between the two groups(P＜0.05).In the study group,there were 21 patients having the fertility desire,and then 14 cases of them were pregnant after treatment,with a pregnancy rate of 66.67%(14/21);in the control group,there were 20 cases having fertility desire,and then 4 cases of them were pregnant after treatment,with a pregnancy rate of 20.00%(4/20).The intergroup comparison showed that the pregnancy rate of the study group was significantly higher than that of the control group,and the difference was statistically significant(P＜0.05).(7)During the treatment period,there were no obvious adverse reactions in the two groups,and there were no abnormal changes in the safety indexes of blood,urine,and stool routine test,electrocardiogram,and liver and kidney function.Conclusion Yangxue Sanhan Tongmai Prescription exerts certain effect in treating patients with endometriosis of blood deficiency and cold coagulation type,which can significantly alleviate various pain symptoms,improve pregnancy outcomes,and effectively regulate the levels of serum CA125,VEGF,SICAM-1,MMP-9 and TIMP-2 of the patients.

Modified Fixation of Levonorgestrel-releasing Intrauterine System for the Treatment of Adenomyosis / 中山大学学报(医学科学版)

ObjectiveTo introduce a fixation technique with the modified levonorgestrel-releasing intrauterine system （LNG-IUS） and evaluate its efficacy in the treatment of adenomyosis patients with previous LNG-IUS expulsion. MethodsA retrospective analysis was done on 22 adenomyosis patients who underwent modified LNG-IUS fixation due to LNG-IUS expulsion at three hospitals from June 2022 to June 2023. The baseline clinical characteristics， operative and postoperative details were collected and analyzed. The Visual analogu scale （VAS） scores and pictorial blood loss assessment chart （PBAC） scores were measured and compared before， 3 and 6 months after the LNG-IUS fixation. ResultsThe mean operative time was （19.51±7.41） min and intraoperative bleeding was （6.71±5.30） mL. Of the patients， 13 were operated under local anaesthesia and the other 9 under intravenous anaesthesia. There were 4 operations performed by a resident doctor， 15 by an attending doctor and 3 by a senior doctor. No intraoperative or postoperative complication was found. The mean follow-up was 11.51 months and no patient had a recurrence of LNG-IUS expulsion during the follow-up period. The mean level of hemoglobin at 1 month after operation was significantly higher than that before （P<0.001）. VAS scores and PBAC scores at 3 and 6 months postoperatively were all improved significantly than those preoperatively （P<0.001）. ConclusionsEffectively preventing the recurrence of LNG-IUS expulsion， modified LNG-IUS fixation is a safe and efficient method for adenomyosis patients with previous LNG-IUS expulsion. Modified LNG-IUS fixation deserves the clinical application due to its easy operation and wide range of use on women.

Effects of Mild Moxibustion on Proteins Expression of BDNF/TrkB Signaling Pathway in Hypothalamus of Primary Dysmenorrhea Rats with Cold and Dampness Stagnation Syndrome / 中国中医药信息杂志

Objective To observe the analgesic effects of mild moxibustion on primary dysmenorrhea(PD)rats with cold and dampness stagnation syndrome and its effect on BDNF/TrkB signaling pathway in hypothalamus;To explore its mechanism for the treatment of PD.Methods A total of 32 Wistar non-pregnant female rats were randomly divided into blank group,model group,Western medicine group and mild moxibustion group,with 8 rats in each group.Except for the blank group,the other groups received estradiol benzoate intraperitoneal injection combined with ice bath treatment + oxytocin intraperitoneal injection to establish PD with cold and dampness stagnation syndrome model.The mild moxibustion group received treatment at"Shenque"and"Guanyuan"from the eighth day of modeling for 10 min,and the Western medicine group was given ibuprofen solution intragastically for 4 days.The latency period of rats twisting was observed and the twisting score was calculated,Western blot and PCR were used to detect the expressions of c-fos,BDNF,TrkB protein and mRNA in hypothalamic tissue.Results Compared with the blank group,the model group showed a shortened latency period and an increased twisting score(P<0.01),the expressions of c-fos,BDNF,TrkB protein and mRNA in hypothalamic tissue increased(P<0.01,P<0.05).Compared with the model group,the mild moxibustion group had a longer latency period and lower twisting score(P<0.01),while the expressions of c-fos,BDNF,TrkB protein and mRNA in hypothalamic tissue increased(P<0.01,P<0.05).Conclusion Mild moxibustion may effectively improve the pain state of PD rats with cold and dampness stagnation syndrome.This mechanism may be related to downregulating c-fos expression,inhibiting BDNF/TrkB signaling pathway activation,thereby inhibiting pain signal transmission,regulating pain occurrence and maintenance.

Translation, cross-cultural adaptation to Brazilian Portuguese and measurement properties of the WaLIDD score

Abstract Objective: Dysmenorrhea is the pain related to menstruation; to screen for the symptoms, a working ability, location, intensity of days of pain, and dysmenorrhea (WaLIDD) score was created. The purpose of this work was to culturally adapt and assess the measurement properties of the WaLIDD score for dysmenorrhea in Brazilian women. Methods: In this cross-sectional online study, we evaluated women with and without dysmenorrhea. Criterion validity and construct validity were assessed, respectively, by the Receiver Operator Characteristic (ROC) curve and correlations with the bodily pain and social functioning domains of medical outcomes study 36-item short-form health survey (SF-36), self-report of absenteeism and Stanford Presenteeism Scale for presenteeism. Test-retest reliability and measurement errors were assessed, respectively, by intraclass correlation coefficient (ICC) and Bland and Altman Graph. Results: 430 women completed the test, 238 (55.4%) women had dysmenorrhea, and 199 (46.3%) answered the questionnaire twice for the retest. The cutoff points ≥4, ≥5, and ≥5 could discriminate between women with and without dysmenorrhea, absenteeism, and presenteeism related to dysmenorrhea, respectively. Correlations between SF-36 - pain and social functioning domains and WaLIDD score were weak to strong and negative. For WaLIDD total Score, ICC was 0.95 and the limits of agreement were −1.54 and 1.62. Conclusion: WaLIDD score is a short, valid and reliable instrument to screen and predict dysmenorrhea and could predict absenteeism and presenteeism related to dysmenorrhea in Brazilian women.

Avaliação do perfil clínico e nutricional de adolescentes com dismenorreia primária / Assessment of the clinical and nutritional profile of adolescents with primary dysmenorrhea

A dor pélvica em adolescentes, especialmente durante o período menstrual, é frequentemente subestimada como problema de saúde e impacta significativamente a qualidade de vida. Objetivou-se avaliar o perfil clínico e nutricional de adolescentes com dismenorreia. Selecionou-se 40 adolescentes, com idade entre 11 e 19 anos, atendidas em uma clínica escola de São Paulo, bem como pela técnica de snow-ball. Avaliou-se a dor pélvica pelo questionário validado de escala de dor e o consumo alimentar por meio de recordatório alimentar de 24 horas e Questionário de Frequência Alimentar. Todas as participantes tinham estatura adequada para a idade e 72,5% estavam eutróficas. Trinta e cinco pacientes (87,5%) apresentaram dor de moderada a intensa, enquanto cinco (12,5%) tinham dor leve ou inexistente. A prática de atividade física mostrou-se menos comum entre o grupo com dor moderada a intensa (34,3%). Não houve diferença significativa na duração dos ciclos menstruais entre os grupos. Observou-se menor ingestão de cálcio no grupo com dor menstrual de maior intensidade. Ademais, notou-se menor consumo de alimentos 'in natura' e 'processados' no grupo com dor moderada a intensa durante as refeições de almoço e jantar, respectivamente. Identificou-se uma correlação negativa entre o consumo de cálcio e folato e a duração da dor em dias. A amostra estudada sugere que uma dieta balanceada, rica em cálcio, folato e alimentos naturais, pode ser importante no manejo da dismenorreia. Contudo, são necessárias mais pesquisas para compreender plenamente essa relação e desenvolver intervenções efetivas para o tratamento dessa condição comum entre adolescentes.

Pelvic pain in adolescents, especially during the menstrual period, is often underestimated as a health problem and significantly impacts quality of life. The objective was to evaluate the clinical and nutritional profile of adolescents with dysmenorrhea. 40 adolescents were selected, aged between 11 and 19 years old, treated at a teaching clinic in São Paulo, as well as using the snowball technique. Pelvic pain was assessed using a validated pain scale questionnaire and food consumption was assessed using a 24-hour dietary recall and Food Frequency Questionnaire. All participants had adequate height for their age and 72.5% were eutrophic. Thirty-five patients (87.5%) had moderate to severe pain, while five (12.5%) had mild or no pain. Practicing physical activity was less common among the group with moderate to severe pain (34.3%). There was no significant difference in the length of menstrual cycles between the groups. Lower calcium intake was observed in the group with more intense menstrual pain. Furthermore, there was a lower consumption of 'fresh' and "processed" foods in the group with moderate to severe pain during lunch and dinner meals, respectively. A negative correlation was identified between calcium and folate consumption and the duration of pain in days. The sample studied suggests that a balanced diet, rich in calcium, folate and natural foods, may be important in the management of dysmenorrhea. However, more research is needed to fully understand this relationship and develop effective interventions to treat this common condition among adolescents.

Efectos de un Programa de Ejercicios y Educación en Dolor mediante Tele-rehabilitación en la Calidad de Vida de Mujeres Jóvenes con Dismenorrea Primaria / Effects of an Exercise and Pain Education Program via Telerehabilitation on the Quality of Life of Young Women with Primary Dysmenorrhea

Introducción. La dismenorrea primaria afecta la calidad de vida de mujeres jóvenes. Este estudio investiga los efectos de un protocolo de ejercicios y educación en dolor mediante telerehabilitación. Objetivo. Determinar los efectos de un protocolo de ejercicios y educación en dolor y su impacto en la calidad de vida mediante tele-rehabilitación en mujeres jóvenes con dismenorrea primaria. Métodos. Se realizó un estudio experimental pre y post test con un grupo control, utilizando tele-rehabilitación. Participaron 21 mujeres jóvenes con dismenorrea primaria, asignadas aleatoriamente a dos grupos: el grupo experimental (10 mujeres) y el grupo control (11 mujeres). Se utilizaron cuestionarios específicos de calidad de vida relacionada con la menstruación y dolor (cuestionario breve de McGill) para evaluar los efectos del programa de ejercicios y educación en dolor. Resultados. En el grupo control, no se observaron diferencias significativas en las puntuaciones de calidad de vida relacionada con la menstruación ni en la intensidad del dolor antes y después de la intervención (p>0,05). En contraste, el grupo experimental experimentó mejoras significativas en ambas áreas después de la intervención (todos los p<0,001). Conclusiones. Este estudio demuestra que un protocolo de ejercicios y educación en dolor realizado mediante telerehabilitación tiene un impacto positivo y significativo en la calidad de vida y la intensidad del dolor percibido en mujeres jóvenes con dismenorrea primaria. Estos resultados sugieren que la telerehabilitación puede ser una estrategia efectiva para abordar este problema de salud en esta población.

Background. Primary dysmenorrhea impacts the quality of life of young women. This study investigates the effects of an exercise and pain education protocol through telerehabilitation. Objective: To determine the effects of an exercise and pain education protocol and its impact on the quality of life through telerehabilitation in young women with primary dysmenorrhea. Methods: A pre and post-test experimental study with a control group was conducted using telerehabilitation. Twenty-one young women with primary dysmenorrhea participated, randomly assigned to two groups: the experimental group (10 women) and the control group (11 women). Specific questionnaires related to menstruation-related quality of life and pain (McGill short-form questionnaire) were used to assess the effects of the exercise and pain education program. Results: In the control group, no significant differences were observed in menstruation-related quality of life scores or pain intensity before and after the intervention (p>0.05). In contrast, the experimental group experienced significant improvements in both areas after the intervention (all p<0.001). Conclusion: This study demonstrates that an exercise and pain education protocol conducted through telerehabilitation has a positive and significant impact on the perceived quality of life and pain intensity in young women with primary dysmenorrhea. These results suggest that telerehabilitation can be an effective strategy for addressing this health issue in this population.

AN ANALYTICAL STUDY OF ABNORMAL UTERINE BLEEDING IN WOMEN OF PERIMENOPAUSAL AGE GROUP

BACKGROUND: Abnormal uterine bleeding complaints constitute about one-third ofpatients attending the Obstetrics and Gynaecology OPD. To standardize nomenclature ofAUB, a new system known by the acronym PALM-COEIN, was introduced in 2011 byFIGO.AIMS AND OBJECTIVES:To study the various abnormal patterns of bleeding presenting in perimenopausal agegroup.To study the etiology, predisposing and associated factors of AUB.To study the various treatment options available for AUB.METHODS: This study was carried in department of obstetrics and gynaecology amongperimenopausal women attending out patient department. The clinical presentation,ultrasonographic findings associated medical disorders, routes of hysterectomy werecorelated.RESULTS: Menorrhagia is the predominant symptom of 109 patients. 101 were associatedwith complain of heavy menstrual bleeding followed by dysmenorrhea. Adenomyosis wasthe most common abnormality found on TVS followed by Endometrial Hyperplasia,Fibroid and polyp. Treatment was initiated in form of conservative medical therapyfollowed by, combination therapy of hormonal drugs-Progesterone and COC and nonhormonal drugs like tranexamic acid + mefenamic acid were used to control bleeding.Hysterectomy was served as a final measure for all patients who didn’t respond toconservative management.CONCLUSION: AUB is a common problem in peri-menopausal age group and itsaccounts for one third of patients visiting Gynecological OPD. It significantly affects thequality of life in general population.

Association of Clinical Presentation at Different Stages of Carcinoma Cervix

Background: Cancer cervix is the most common cancer in women in developing countries where screening facilities are inadequate. The incidence of cervical cancer is steadily declining in the developed world. The rate of cervical cancer is decreasing day by day due to their awareness of cervical cancer, especially its risk factors, and undertaking measure like routine screening tests. It may present with vaginal bleeding but symptoms may be absent until the cancer is in its advanced stage. This study aimed to analyze the association of clinical presentation at different stages of carcinoma cervix. Material & Methods: This descriptive study was conducted in Chittagong Medical College Hospital, taking 100 randomly selected patients of carcinoma cervix over one year (July 2019 to June 2020). The research protocol was approved by the research committee (Local Ethical committee). Informed written consent was taken from each patient. Results: Among the study subjects, most of the respondents (32, 32.0%) belonged to 51-60 years old followed by (24, 24.0%) 41-50 years and >60 years of age. Most (76, 76.0%) of the patients presented with blood-stained vaginal discharge. Significant numbers of the patient presented with foul smelling per vaginal discharge (72, 72.0%) and post-coital bleeding (68, 68.0%). Only 8% of the patients had haematuria signifying the advanced stage of the disease. Most of the patients about 72.0% sought medical advice within one year of developing symptoms. 56.0% of patients were menopausal, only 20.0% of patients had regular menstruation, and 24.0% of patients had irregular menstruation. 24.0% of patients had metrorrhagia and 2.0% of patients had dysmenorrhoea. Some degree of anemia was present in almost all patients. Only 16.0% of the patients had severe anemia 6.0% of the patients had dependent edema and 4.0% had lymphadenopathy. Most of the patients had cauliflower-type (54.0%) lesions in the cervix followed by 36.0% of patients who had the ulcerative type of growth in the cervix. Among the respondents, 96.0% of the patients had squamous cell carcinoma and only 4% had adenocarcinoma. Most (44, 44.0%) of the patients presented in the hospital with stage II ca cervix, followed by stage III (40, 40.0%). Conclusion: Most common presentation was blood-stained per-vaginal discharge, followed by foul-smelling per-vaginal discharge and post-coital bleeding. All the patients were clinically anemic, some showed severe anemia. The majority of the patient in this series showed a cauliflower-like lesion, followed by an ulcerative lesion. Among all patients majority (96.0%) had squamous cell carcinoma and the remaining had adenocarcinoma. Most of the patients presented in the hospital with stage II ca cervix, followed by stage III.

How does my pain look like? Characterizing dysmenorrhea-related pain using the body map / Como se parece a minha dor? Caracterizando a dor relacionada à dismenorreia utilizando o mapa corporal da dor

ABSTRACT BACKGROUND AND OBJECTIVES: Primary dysmenorrhea (PD) is a common gynaecological disorder characterized by pain in the abdominal region without pelvic disease. Evidence suggests that PD-related pain may not be restricted to the pelvis region, hence body mapping could be helpful in assessing the subjective location, intensity, and distribution of pain areas in women with PD. The objective of this study was to characterize dysmenorrhea-related pain location and intensity using body map. METHODS: We conducted a web-based cross-sectional study for adult women to self-report menstrual pain during three menstrual cycles. Each participant was instructed through a messaging application to paint the body map after printing it and rank their pain according to the 11-point Numerical Rating Scale. RESULTS: Seventy-three women (24.1 ± 3.0 years) participated in the study. A considerable proportion of participants reported pain in the lower abdomen (90.4%) and other body areas, such as the lower back (82.1%), head (54.6%), breasts (32.9%), upper abdomen (31.5%), and legs (28.8%). CONCLUSION: Our findings revealed that women with PD also present pain outside the uterine referral area during their period. In this way, body maps can help healthcare professionals to record specific regions of pain and track changes or patterns in the location or intensity pain during menses, helping to determine treatment strategies appropriate to the individual needs of each woman with PD. Therefore, we strongly recommend the clinical use of the self-report body map to evaluate menstrual pain and help health providers to improve PD symptoms in this population.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dismenorreia primária (DP) é um distúrbio ginecológico comum caracterizado por dor na região abdominal sem doença pélvica. Evidências sugerem que a dor relacionada à DP pode não estar restrita à região da pelve, portanto, o mapeamento corporal pode ser útil para avaliar a localização subjetiva, a intensidade e a distribuição das áreas de dor em mulheres com DP. O objetivo deste estudo foi caracterizar a localização e a intensidade da dor relacionada à dismenorreia por meio do mapa corporal. MÉTODOS: Conduziu-se um estudo transversal baseado na web para mulheres adultas para autorrelato de dor menstrual durante três ciclos menstruais. Cada participante foi instruído por meio de um aplicativo de mensagens a pintar o mapa corporal após imprimi-lo e classificar sua dor de acordo com a Escala de Avaliação Numérica de 11 pontos. RESULTADOS: Setenta e três mulheres (24,1±3,0 anos) participaram do estudo. Uma proporção considerável de participantes relatou dor na parte inferior do abdômen (90,4%) e em outras áreas do corpo, como a parte inferior das costas (82,1%), cabeça (54,6%), mamas (32,9%), parte superior do abdômen (31,5%) e pernas (28,8%). CONCLUSÃO: Os presentes achados revelaram que mulheres com DP também apresentam dor fora da área de referência uterina durante o período menstrual. Dessa forma, os mapas corporais podem ajudar os profissionais de saúde a registrar regiões específicas de dor e rastrear mudanças ou padrões na localização ou intensidade da dor durante a menstruação, ajudando a determinar estratégias de tratamento adequadas às necessidades individuais de cada mulher com DP. Portanto, recomenda-se fortemente o uso clínico do mapa corporal de autorrelato para avaliar a dor menstrual e ajudar os profissionais de saúde a melhorar os sintomas de DP nessa população.

Aromatherapy with oil of Lavandula angustifolia for pain in women: scoping review / Aromaterapia com óleo essencial de Lavandula angustifolia para dor em mulheres: revisão de escopo

ABSTRACT BACKGROUND AND OBJECTIVES: Aromatherapy with lavender essential oil has been used to reduce pain, anxiety, nausea and vomiting, among others. As the painful experience is unique, responses to therapeutic approaches may vary among individuals and there are specific conditions related to women's health that deserve to be examined. The objective of this study was to analyze the uses of aromatherapy with essential oil of lavender (Lavandula angustifolia), by nurses, for pain control in women. CONTENTS: This is a scoping literature review. The search was carried out in the following portals and/or databases: BVS, Pubmed, Cochrane, on June 3, 2022, and was updated on June 9, 2023. The sample consisted of four controlled clinical trials addressing aromatherapy with lavender essential oil in the "inhalation" and "massage" modalities, to treat acute labor pain and dysmenorrhea. In all studies, the intervention provided a reduction in pain without unwanted effects (p<0.05) and the nurse participated as a member of the multidisciplinary team. CONCLUSION: Aromatherapy with lavender essential oil during labor and dysmenorrhea proved to be effective in reducing pain in the analyzed sample.

RESUMO JUSTIFICATIVA E OBJETIVOS: A aromaterapia com óleo essencial de lavanda tem sido utilizada para redução de dor, ansiedade, náuseas e vômitos, dentre outros. Assim como a experiência dolorosa é única, as respostas às abordagens terapêuticas podem variar entre os indivíduos e há condições específicas relacionadas à saúde da mulher que merecem ser examinadas. O objetivo deste estudo foi analisar os usos da aromaterapia com óleo essencial de lavanda (Lavandula angustifolia), por enfermeiros, no controle da dor em mulheres. CONTEÚDO: Esta é uma revisão de escopo da literatura. A busca foi realizada nos seguintes portais e/ou bases de dados: BVS, Pubmed, Cochrane, em 03 junho de 2022, sendo atualizada em 09 de junho de 2023. A amostra foi composta de quatro ensaios clínicos controlados abordando aromaterapia com óleo essencial de lavanda nas modalidades "inalação" e "massagem", para tratar dor aguda do parto e da dismenorreia. Em todos os estudos a intervenção proporcionou redução na dor sem efeitos adversos (p<0,05) e o enfermeiro participou como integrante da equipe multidisciplinar. CONCLUSÃO: A aromaterapia com óleo essencial de lavanda no trabalho de parto e dismenorreia mostrou-se eficaz para a redução da dor na amostra analisada.

Menstrual Abnormalities Among Adolescent Females Attending a Tertiary Care Hospital in North India

Background: To study the menstrual abnormalities among adolescent females attending a gynaecolocial outpatient department (OPD) in a tertiary care hospital. Material & Methods: It was a cross sectional study which was carried at outpatient department (OPD) of obstetrics and gynaecology, Government medical college Srinagar over a period of 6 months. A total of 90 adolescent females in the age group 10-19 years were included in the study. Along with the demographic profile, menstrual abnormalities were evaluated with the help of self-structured questionnaire. Results: The mean age of the study population was 15.6 ± 2.8 years. Majority of the adolescent females were in the age group of 16-19 years (44.4%), literate with formal education above 10th class (37.8%) and from rural background (56.7%).Dysmenorrhea was the most common menstrual morbidity in 64.4% of adolescent females followed by menorrhagia (26.7%). Pain abdomen was the most common premenstrual symptom encountered by 62.2% of females. Conclusion: Menstrual abnormalities are common in the adolescent females with dysmenorrhea being the commonest.

Evaluación clínica y manejo de la endometriosis: resumen de la orientación técnica MINSAL para el manejo de personas con endometriosis / Clinical evaluation and management of endometriosis: summary of the national ministry of health guidance for the management of people with endometriosis

La endometriosis es una de las enfermedades más comunes en las edades reproductivas y afecta la calidad de vida y la fertilidad de las pacientes. A la fecha, no existen guías clínicas nacionales disponibles para la evaluación y el manejo de esta patología. El presente corresponde a una síntesis del trabajo liderado por la Sociedad Chilena de Obstetricia y Ginecología y el Ministerio de Salud para la conformación de una Orientación Técnica que sirva a los profesionales de salud para el mejor manejo de las personas con esta dolencia. Esta revisión presenta pautas para el diagnóstico y el manejo de la endometriosis en el ciclo de vida de la persona, incluyendo la adolescencia y la menopausia, y en personas infértiles. De igual manera, da directrices para el manejo médico, terapias complementarias y tratamiento quirúrgico, junto con el seguimiento en el tiempo y la estructuración en red del manejo de las personas con endometriosis.

Endometriosis is one of the most common diseases in reproductive ages and affects the quality of life and fertility of patients. To date, there are no national clinical guidelines available for the evaluation and management of this pathology. This paper corresponds to a synthesis of af effort led by the Chilean Society of Obstetrics and Gynecology and the Ministry of Health to create a national Guideline that serves health professionals for the better management of people with this condition This review presents recommendations for the diagnosis and management of endometriosis in the life cycle of the person with endometriosis including adolescence, menopause and in infertile persons. Moreover, provides guidelines for medical management, complementary therapies and surgical management, along with monitoring over time and network structuring of the management of people with this disease.

El alivio natural: Sauzgatillo (Vitex agnus-castus) para el síndrome premenstrual y la dismenorrea / The natural relief: Chasteberry (Vitex agnus-castus) for premenstrual syndrome and dysmenorrhea

El síndrome premenstrual es un trastorno común en mujeres en edad reproductiva y se caracteriza por al menos un síntoma físico, emocional o conductual, que aparece en la fase lútea del ciclo menstrual y se resuelve poco después del inicio de la menstruación. Los tratamientos convencionales para el dolor perimenstrual cíclico tienen inconvenientes que incluyen efectos secundarios, interferencia con la función reproductiva de las mujeres o escasa efectividad en el alivio de los síntomas. Muchas mujeres recurren a terapias naturales para tratar una gran variedad de síntomas menstruales. Esta revisión se centra en una de esas opciones naturales, el Sauzgatillo (Vitex agnus-castus). Se realizó una búsqueda e identificación de artículos publicados hasta mayo de 2022 recopilados por medio de sistemas de búsqueda electrónicos como Google Scholar, Medline, PubMed y Scopus. Las palabras de búsqueda fueron: “Premenstrual syndrome”, “dysmenorrhea” AND “Vitex agnus-castus”. Los estudios preclínicos señalan un mecanismo de acción en su implicación sobre el sistema serotoninérgico, así como su unión a los receptores de dopamina. Los estudios clínicos demuestran la seguridad y el efecto positivo sobre el síndrome premenstrual y la dismenorrea.

Premenstrual syndrome is a common disorder in women of reproductive age and is characterized by at least one physical, emotional, or behavioral symptom, which appears in the luteal phase of the menstrual cycle and resolves shortly after the onset of menstruation. Conventional treatments for cyclical perimenstrual pain have drawbacks that include side effects, interference with womens reproductive function, or limited effectiveness in relieving symptoms. Many women turn to natural therapies to treat a wide variety of menstrual symptoms. This review focuses on one of those natural options, Chasteberry (Vitex agnus-castus). The information available until May 2022 was collected via the library and electronic search systems such as Google Scholar, Medline, PubMed, and Scopus. The search words were: “Premenstrual syndrome”, “dysmenorrhea” AND “Vitex agnus-castus”. Preclinical studies point to a mechanism of action in its involvement in the serotoninergic system, as well as its binding to dopamine receptors. Clinical studies prove safety and positive effect on premenstrual syndrome and dysmenorrhea.

Unraveling Prostaglandin and NLRP3 Inflammasomemediated Pathways of Primary Dysmenorrhea and the Role of Mefenamic Acid and Its Combinations

Painful menstrual cramps during or around the time of the monthly cycle are known as dysmenorrhea. The estimated global prevalence in women of reproductive age ranges from 45% to 95%. It has a significant negative impact on regular activities and productivity at work. However, despite the severe consequences on quality of life, primary dysmenorrhea (PD) is underdiagnosed. Dysmenorrhea has complex pathogenesis. It involves the release of prostaglandins and activation of the nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome and also includes the involvement of other mediators such as bradykinin, histamine and acetylcholine. Even though nonsteroidal anti-inflammatory drugs (NSAIDs) remain the most common type of pain medication, the question of which one should be the most preferred is still open to debate. The current review examines the existing evidence for the pathogenesis of PD and makes evidence based and clinical experience based recommendations for the use of mefenamic acid and its combination in the treatment of dysmenorrhea. Mefenamic acid alleviates PD by inhibiting endometrial prostaglandin formation, restoring normal uterine activity, and reducing the inflammatory response by inhibiting the NLRP3 inflammasome and reducing the release of cytokines such as interleukin (IL)-1?. It is also known to have bradykinin antagonist activity. Dicyclomine has a dual action of blocking the muscarinic action of acetylcholine in postganglionic parasympathetic effect or regions and acting directly on uterine smooth muscle by blocking bradykinin and histamine receptors to relieve spasms. According to the experts, mefenamic acid and dicyclomine act synergistically by acting on the different pathways of dysmenorrhea by blocking multifactorial agents attributed to the cause of dysmenorrhea. Hence, the combination of mefenamic acid and dicyclomine should be the preferred treatment option for dysmenorrhea.

Effects of electroacupuncture on NLRP3 inflammasome and pyroptosis protein GSDMD in uterine tissue in rats with primary dysmenorrhea / 中国针灸

OBJECTIVE@#To observe the effects of electroacupuncture (EA) on NLRP3 inflammasome and its downstream protein gastermin D (GSDMD) in rats with primary dysmenorrhea (PDM), and to explore the potential mechanism of EA on the treatment of PDM.@*METHODS@#Forty healthy female SD rats without pregnancy were randomly divided into a control group, a model group, an EA group and an ibuprofen group, 10 rats in each group. PDM model was prepared by injection of estradiol benzoate and oxytocin. Except the control group, the rats in each group were subcutaneously injected with estradiol benzoate for 10 days, and oxytocin was injected on the 11th day. The rats in the EA group were intervened with EA (dense wave, frequency of 50 Hz) at "Guanyuan" (CV 4) and "Sanyinjiao" (SP 6) at the same time of modeling, once a day, 20 min each time, for 10 consecutive days. The rats in the ibuprofen group were treated with 0.8 mL of ibuprofen by gavage (concentration of ibuprofen solution was 1.25 mg/mL) for 10 consecutive days. After modeling, the writhing reaction was observed. After intervention, the HE staining method was used to observe the histological morphology of uterus and evaluate the pathological damage score of uterus; ELISA method was used to detect the serum levels of prostaglandin E2 (PGE2) and prostaglandin F2α (PGF2α); Western blot method was used to detect the protein expression of NLRP3, apoptosis related spot like protein (ASC), caspase-1, GSDMD, GSDMD-N and inflammatory factors (interleukin [IL]-1β, IL-18) in uterine tissue.@*RESULTS@#In the model group, a large number of vacuolar degeneration and death of endometrial epithelial cells, spiral arterioles congestion in lamina propria and neutrophil infiltration were observed. In the EA group, there was a small amount of vacuolar degeneration and death of endometrial epithelial cells, a small amount of spiral arterioles congestion in the lamina propria, and a small amount of neutrophils infiltration. In the ibuprofen group, there was very small number of degeneration and death of endometrial epithelial cells, and no obvious arterial congestion was found in lamina propria, and neutrophil infiltration was occasionally seen. Compared with the control group, in the model group the number of writhing was increased (P<0.01), the writhing reaction score and serum level of PGF2α and PGF2α/PGE2 value were increased (P<0.01), the level of PGE2 was decreased (P<0.01). Compared with the model group, in the EA group and the ibuprofen group the number of writhing were decreased (P<0.05), the latency of writhing was prolonged (P<0.01), the writhing reaction scores and serum levels of PGF2α and PGF2α/PGE2 values were decreased (P<0.05, P<0.01), the levels of PGE2 were increased (P<0.01). Compared with the control group, the protein expression of NLRP3, ASC, caspase-1, GSDMD, GSDMD-N, IL-1β and IL-18 in the uterine tissues of rats was increased in the model group (P<0.01). Compared with the model group, the protein expression of NLRP3, ASC, caspase-1, GSDMD, GSDMD-N, IL-1β and IL-18 in the uterine tissues of rats was decreased in the EA group and the ibuprofen group (P<0.01, P<0.05). There was no significant difference between the EA group and the ibuprofen group in the above indexes (P>0.05).@*CONCLUSION@#EA could alleviate pain and uterine tissue injury in rats with PDM. The mechanism may be related to the inhibition of the activation of NLRP3 inflammasome in rat uterine tissues, thereby inhibiting pyroptosis and its inflammatory factors release.

Material basis and mechanism of Curcuma longa tuberous roots with and without vinegar processing in treating primary dysmenorrhea / 中国中药杂志

Liquid chromatography-mass spectrometry was employed to analyze the chemical components in Curcuma longa tuberous roots(HSYJ), C. longa tuberous roots processed with vinegar(CHSYJ), and rat serum after the administration. The active components of HSYJ and CHSYJ absorbed in serum were identified based on the secondary spectrum of database and literature. The targets of primary dysmenorrhea was screened out from database. The protein-protein interaction network analysis, gene ontology(GO) functional annotation, and Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway enrichment analysis were performed for the common targets shared by the drug active components in serum and primary dysmenorrhea, and the component-target-pathway network was constructed. AutoDock was used to conduct molecular docking between the core components and targets. A total of 44 chemical components were identified from HSYJ and CHSYJ, including 18 absorbed in serum. On the basis of network pharmacology, we identified 8 core components(including procurcumenol, isobutyl p-hydroxybenzoate, ferulic acid, and zedoarondiol) and 10 core targets \[including interleukin-6(IL-6), estrogen receptor 1(ESR1), and prostaglandin-endoperoxide synthase 2(PTGS2)\]. The core targets were mainly distributed in the heart, liver, uterus, and smooth muscle. The molecular docking results showed that the core components were well bound to the core targets, indicating that HSYJ and CHSYJ may exert therapeutic effect on primary dysmenorrhea via estrogen, ovarian steroidogenesis, tumor necrosis factor(TNF), hypoxia-inducible factor-1(HIF-1), IL-17 and other signaling pathways. This study clarifies the HSYJ and CHSYJ components absorbed in serum, as well as the corresponding mechanism, providing a reference for further elucidating the therapeutic material basis and clinical application of HSYJ and CHSYJ.

Effect of processing with vinegar on efficacy of Curcuma longa in treatment of dysmenorrhea in rats with syndrome of liver depression and Qi stagnation / 中国中药杂志

This study compared the effects of Curcuma longa before and after processing with vinegar on the rat model of dysmenorrhea with the syndrome of liver depression and Qi stagnation to reveal the mechanism of vinegar processing in improving the role of C. longa in soothing liver and relieving pain. The rat model of dysmenorrhea with the syndrome of liver depression and Qi stagnation was established according to the Preparation of the Animal Model of Dysmenorrhea(Draft) and the chronic unpredictable stress me-thod. The changes in the body weight, organ indexes, writhing latency, writhing score, and serum levels of six liver function indicators, sex hormones, pain factors, and blood rheological indicators were measured to evaluate the efficacy of C. longa processed with vinegar or not in treating dysmenorrhea in the rats with syndrome of liver depression and qi stagnation. Compared with the model group, the C. longa group(processed with vinegar or not) showed slow weight loss, increase in writhing latency, and decrease in writhing response(P<0.05). The inhibition rates on writhing in raw C. longa, vinegar-processed C. longa, and positive groups were 33.780%, 64.611%, and 62.466%, respectively. The significantly higher inhibition rate of the vinegar processing group indicated that vinegar-processed C. longa demonstrated more significant therapeutic effect. The vinegar-processed C. longa group showed lower levels of alanine aminotransferase(ALT), alkaline phosphatase(ALP), aspartate aminotransferase(AST), direct bilirubin(DBIL), and total bilirubin(TBIL) and higher level of albumin(ALB)(P<0.05), which indicated that vinegar processing enhanced the therapeutic effect of C. longa on liver injury. The serum levels of estradiol(E_2) and oxytocin(OT) were lower in the vinegar-processed C. longa group(P<0.05), indicating that the vinegar-processed C. longa could regulate the sex hormone levels, reduce the activity of uterine smooth muscle and contraction of uterus, and alleviate the symptoms of dysmenorrhea in rats. Moreover, the vinegar-processed C. longa group showed lower interleukin-6(IL-6) and arginine vasopressin(AVP) levels and higher beta-endorphin(β-EP) level(P<0.05), which indicated that vinegar-processed C. longa regulated the levels of pain factors to exert the pain-relieving effect. Drug intervention decreased the whole blood viscosity low-cut, medium-cut and high-cut values, plasma viscosity, whole blood reduction viscosity low-cut and high-cut values, erythrocyte cumulative pressure, and equation K value of erythrocyte sedimentation rate(P<0.05), and the vinegar-processed C. longa group outperformed other groups. This result indicated that vinegar processing enhanced the function of C. longa in improving the local blood rheology. C. longa processed with vinegar can enter the liver to relieve the da-mage to the heart, liver, kidney, and uterus, repair the liver function, and recover the sex hormone levels and immune function by regulating the levels of sex hormones and pain factors and improving the blood rheology. It activates the pain-relieving mechanism to relieve the pain, protect the liver, and fight inflammation, which is consistent with the theory that vinegar processing facilitates C. longa entering the liver to sooth liver and relieve pain.

The Clinical Effect of Pretreatment with Heat-sensitive Moxibustion on Primary Dysmenorrhea and Its Influence on Uterine Artery Blood Flow： A Randomized， Blinded Controlled Trial / 中医杂志

ObjectiveTo compare the clinical effect of heat-sensitive moxibustion before menstruation and since the first day of menstruation on primary dysmenorrhoea （PD）， thereby optimizing the clinical treatment plan. MethodsSixty patients with PD were randomly divided into pretreatment group （treated before menstruation） and conventional treatment group （treated since the first day of menstruation） of 30 cases each. For all patients， the area surrounded by bilateral Zigong （EX-CA1） and bilateral Guilai （ST 29） in the supine position， and that formed by bilateral Shenshu （BL 23） and Ciliao （BL 32） in the prone position were selected for circling moxibustion （2 min）， sparrow-pecking moxibustion （1 min）， and then moxibustion along the channels to stimulate the moxibustion sensation and obtain two heat-sensitive points with the best sensation for treatment. In the pretreatment group， moxibustion was applied 3-7 days before the onset of menstruation， and in the conventional treatment group， moxibustion was applied on the day of menstruation. Both groups were treated once daily for 7 days per menstrual cycle for 3 consecutive cycles. The clinical outcomes of the two groups were measured before and after treatment in terms of the COX menstrual pain symptom scale （CMSS） scores， visual analogue scale for pain （VAS） scores， and uterine artery hemodynamic indicators including blood pulsation index （PI） and resistance index （RI）， and the clinical effect was compared. ResultsAfter treatment， the CMSS scores， VAS scores， PI and RI in the two groups decreased， and lower scores were found in the pretreatment group （P＜0.05 or P＜0.01）. The total effective rate after treatment was 93.3% （28/30） in the pretreatment group， which was better than 73.3% （22/30） in the conventional treatment group （P＜0.05）. ConclusionThe clinical effect of heat-sensitive moxibustion before the menstruation for PD was better than that implemented since the first day of menstruation， by significantly improving the patients' dysmenorrhoea symptoms and uterine artery blood flow index.

Network pharmacology and validation by experiment of Shuerjing Capsule in the treatment of primary dysmenorrhea / 国际中医中药杂志

Objective:To explore the mechanism of Shuerjing Capsule in treating primary dysmenorrhea based on molecular docking of network pharmacology and in vivo experiment.Methods:By using TCMSP to screen the active components and targets of Shuerjing Capsule; by using GeneCards and DrungBank databases to retrieve targeted proteins of primary dysmenorrhea, and the intersection targets of drugs and diseases were obtained through Weishengxin online platform; by using Cytoscape 3.9.1 software to produce component-target network of Shuerjing Capsule for the treatment of primary dysmenorrhea; by STRING databases to construct drug-disease target PPI network; by DAVID database to perform GO and KEGG pathway enrichment analysis.The key active components of the drug and the core targets of the disease were obtained with molecular docking. The rats were randomly divided into control group, model group, the low-dose group, medium-dose group and high-dose group of Shujing Capsule (0.15, 0.21, 0.42 g/kg), and ibuprofen group (20 mg/kg), with 10 rats in each group. The animal model of primary dysmenorrhea was established by subcutaneous injection of estradiol benzoate and intervented by drugs. The number of writhing reaction, uterine contractile inhibition rate and uterine index of rats were observed. The expressions of TNF-α, IL-6 and IL-1 in serum and the levels of PTGS2 and VEGFA in uterine tissue were detected by ELISA.Results:A total of 188 active ingredients of Shuerjing Capsule were screened, and 51 targets of Shuerjing Capsule and primary dysmenorrhea were identified. TNF, IL-6, AKT1 and TP53 may be the key targets of Shuerjing Capsule in the treatment of primary dysmenorrhea. A total of 519 GO biological processes and 119 related signaling pathways were obtained, among which estrogen, IL-17, HIF-1 and other signaling pathways were closely related to the treatment of primary dysmenorrhea. The results of molecular docking were good, among which stigmasterol had the strongest binding ability to TP53. The experimental results showed that compared with the model group, the uterine index and the number of torsion were decreased in the low -, medium - and high-dose Shuojing Capsule groups ( P<0.05), the uterine contraction inhibition rate increased ( P<0.05); Serum levels of TNF-α, IL-6 and IL-1 of medium and high dose group decreased ( P<0.05), the levels of PTGS2 and VEGFA in uterine tissues decreased ( P<0.05). Conclusion:Shuerjing Capsule has the effect of anti-inflammatation and improveing hypoxia, which may be related to the inhibition of TNF-α, IL-6 and IL-1 inflammatory factors in serum and the expression of PTGS2 and VEGFA proteins in uterine tissues.