Help-seeking behaviour in dysmenorrhoea: A cross-sectional exploration using the Behavioural Model of Health Services Use.

BACKGROUND: Dysmenorrhoea, or period pain, is a prevalent gynaecological condition that can result in functional interference during menstruation. Despite the significant disruption dysmenorrhoea can have on functioning and well-being, medical help-seeking rates are low. Little is known about what factors may predict help-seeking for dysmenorrhoea. OBJECTIVES: The current study aimed to test the predictive validity of the Behavioural Model of Health Services Use (BMHSU) for help-seeking behaviour in dysmenorrhoea, whereby help-seeking behaviour was operationalised as having attended to a healthcare professional for dysmenorrhoea-related care. DESIGN: A cross-sectional observational design was used. METHODS: Participants (N = 439) completed an online survey, which measured the following eight predictor variables: menstrual pain characteristics, health beliefs, self-efficacy, social support utilisation and satisfaction, perceived healthcare availability, and pain intensity and interference. Participants were also asked to report whether they had ever attended to a healthcare professional for their menstrual pain. RESULTS: The BMHSU accounted for 8% of the variance in help-seeking behaviour. Pain interference and appointment availability were significant predictors of the variance in past help-seeking behaviour, such that those who experienced greater pain interference, and those who perceived greater availability of healthcare appointments were less likely to have visited a healthcare professional for their menstrual pain. The BMHSU had an overall 69% classification accuracy in predicting help-seeking behaviour. CONCLUSION: Although the BMHSU demonstrated reasonably good model fit, it does not appear to be a particularly robust model for predicting help-seeking behaviour for dysmenorrhoea. Future research should explore whether a refined BMHSU or an alternative theoretical model can provide more useful insight into this behaviour. Better understanding of the determinants of help-seeking behaviour will enable the development of interventions to promote appropriate help-seeking and improve health outcomes for individuals with menstrual pain.

What makes people with period pain seek help?Many people experience common period pain, which can be severe and debilitating. Even though it can make daily life difficult, not many people seek medical help for period pain.The purpose of this study was to find out why people with period pain might or might not go to a doctor for help. We used a theoretical framework called the Behavioural Model of Health Services Use to try to understand this. This framework tells us that predisposing factors like age or health beliefs, enabling factors like family support and access to healthcare, and need factors like severe symptoms, can predict whether someone will go to the doctor. We wanted to test if this way of thinking could accurately predict if someone with period pain had been to see a doctor.We asked people with period pain to fill in an online survey. We asked about things like how painful their periods were, what they believed about their menstrual health, how confident they felt in managing their pain, whether they got support from others, if they thought healthcare was available, and how much the pain affected their lives. We also asked if they had ever gone to a doctor for help with their period pain.We found that these factors were not very accurate in predicting whether people sought help for period pain. The most important predictors were how much the pain affected their lives and whether they believed that healthcare appointments were available to them. If the pain was very disruptive, and if they felt there were free appointments, people were less likely to have gone to see a doctor.This study was the first to use this way of thinking to understand help-seeking for people with period pain. In the future, researchers should test different models to see if they work better for understanding help-seeking behaviour for period pain. It is important to find ways to understand this behaviour to help people seek help for their pain when they need it.

A new treatment for Robert's uterus with adenomyosis: a case report and review of the literature.

PURPOSE: To provide a method for the differential diagnosis of Robert's uterus with adenomyosis, a rare uterine malformation, and determine the best course of treatment. METHODS: A patient who had Robert's uterus with adenomyosis was admitted to our hospital in December 2022. We analyzed and summarized her case . RESULTS: Our patient complained of progressively worsening primary dysmenorrhea over the course of 3 years and lower abdominal pain lasting for 2 days. Her carbohydrate antigen 125 (CA125) level was 372.10 U/mL. Examinations conducted by several hospitals indicated that she had a single-horned uterus and a residual horned uterus, and our hospital's examination identified Robert's uterus. This malformation was corrected by open abdominal surgery. For the procedure, pelvic adhesions were first isolated, after which the closed uterine cavity and adenomyosis were resected. Subsequently, the left ovarian endometriosis cyst was resected and right tubal ligation was performed. After surgery, three injections of gonadotropin-releasing hormone A (GnRH-A) were administered, which lowered the patient's CA125 level to 14 U/mL and normalized her condition. CONCLUSION: We pioneered a new therapeutic approach for the treatment of Robert's uterus with adenomyosis. Some valuable references are provided for clinical practice.

[Fu's subcutaneous needling combined with monkshood cake-separated moxibustion for primary dysmenorrhea with cold congealing and blood stasis: a randomized controlled trial].

OBJECTIVE: To observe the clinical efficacy of Fu's subcutaneous needling combined with monkshood cake-separated moxibustion for primary dysmenorrhea with cold congealing and blood stasis. METHODS: Sixty patients with primary dysmenorrhea of cold congealing and blood stasis were randomly divided into an observation group (30 cases, 1 case dropped out) and a control group (30 cases, 2 cases dropped out). The control group received monkshood cake-separated moxibustion at Shenque (CV 8) and bilateral Zigong (EX-CA 1), while the observation group received Fu's subcutaneous needling based on the control group. The muscles were palpated and the affected muscles were determined. Needles were inserted 5-10 cm away from the affected muscles and reperfusion activity was performed simultaneously. All the treatment started on the first day of menstrual cycle pain, once a day, for 3 days, totaling for 3 menstrual cycles. The visual analogue scale (VAS) score, Cox menstrual symptom scale (CMSS) score, and traditional Chinese medicine (TCM) syndrome score in the two groups were observed before treatment, after 2 treatment courses and after 3 treatment courses. The serum prostaglandin F2α(PGF2α) levels before and after 3 treatment courses were measured, and the clinical efficacy of the two groups was evaluated. RESULTS: After 2 and 3 treatment courses, the VAS scores, CMSS scores, and TCM syndrome scores in the two groups were lower than those before treatment (P<0.05), and the scores in the observation group were lower than those in the control group (P<0.05). After 3 treatment courses, the PGF2α level in the observation group was decreased (P<0.05), and were lower than that in the control group (P<0.05). The total effective rate was 96.6% (28/29) in the observation group, which was higher than 64.3% (18/28) in the control group (P<0.05). CONCLUSION: Fu's subcutaneous needling combined with monkshood cake-separated moxibustion could effectively reduce the pain intensity, improve clinical symptoms of dysmenorrhea, and lower PGF2α level in patients with primary dysmenorrhea of cold congealing and blood stasis.

Comparative study of different dosages of grain-sized moxibustion on uterine artery blood flow in patients with cold and dampness primary dysmenorrhea. / ä¸åŒå‰‚é‡éº¦ç²’ç¸å¯¹å¯’æ¹¿å‡æ»žåž‹åŽŸå‘æ€§ç—›ç»æ‚£è€ å­å®«åŠ¨è„‰è¡€æµå½±å“çš„æ¯”è¾ƒç ”ç©¶.

OBJECTIVES: To observe the differences in the effects of different dosages of grain-sized moxibustion on uterine artery blood flow in patients with cold and dampness primary dysmenorrhea (PD). METHODS: A total of 60 patients with PD were randomly divided into 3 groups with 20 cases in each group. Acupoints Sanyinjiao (SP6), Diji (SP8) and Xuehai (SP10) were selected in all the 3 groups, and different dosages of grain-sized moxibustion were used (3 moxa cones, 6 moxa cones, 9 moxa cones) respectively. Treatment started 7 days before menstruation for 3 times, lasting for a total of 3 menstrual cycles. The values of uterine artery blood flow parameters including pulsatility index (PI), resistance index (RI), and systolic/diastolic ratio (S/D) were recorded before and after treatment. The visual analog scale (VAS) score and cox menstrual symptom scale (CMSS) score (including severity ［CMSS-S］ and time of duration ［CMSS-T］) were evaluated before treatment, at the end of each menstrual cycle, and one menstrual cycle after treatment. RESULTS: The values of uterine artery blood flow parameters (PI, RI, S/D) after treatment in the 9 moxa cones group were lower than those before treatment, as well as lower than those in the 3 and 6 moxa cones groups after treatment (P<0.05). The VAS scores of the 3 moxa cones group were lower than those before treatment in the first and second cycle (P<0.05). The VAS scores of the 6 and 9 moxa cones groups were lower than those before treatment at each observation point (P<0.05), and were lower than those of the 3 moxa cones group in the third cycle of treatment and follow-up period (P<0.05). And the VAS score of the 9 moxa cones group was lower than that of the 6 moxa cones group during the follow-up period (P<0.05). Compared with the scores before treatment, the CMSS-T scores at each observation point after treatment were lower in the 9 moxa cones group (P<0.05)；the CMSS-T scores in the second and third cycle after treatment, and follow-up period were lower in the 6 moxa cones group (P<0.05), with the CMSS-S scores in the second and third cycle after treatment, and follow-up period lower in the 6 and 9 moxa cones groups (P<0.05). The CMSS-T and CMSS-S scores of the 6 and 9 moxa cones groups were lower than those of the 3 moxa cones group in the third cycle and follow-up period (P<0.05). The CMSS-T and CMSS-S scores of the 9 moxa cones group were lower than those of the 6 moxa cones group during the follow-up period (P<0.05). CONCLUSIONS: Grain-Sized moxibustion has dose-effect relationship in the treatment of PD. Compared with 3 and 6 moxa cones groups, 9 moxa cones group has advantages in improving uterine artery blood flow parameters and alleviating dysmenorrhea symptoms in PD patients.

Evaluation of Electromagnetic Therapy in the Treatment of Severe Dysmenorrhea in Young Women of Basrah.

INTRODUCTION: Primary dysmenorrhea (PD) is a public disease of young female worldwide, it affects their daily performances. Severe recurrent uterine cramps are the main complaints in 90% of adolescents and 50% of reproductive-age females. This study aimed to evaluate the use of magnetic field therapy in the treatment of severe dysmenorrhea grade 3 and provide an encouraging goal to continue daily work without pain. METHODS: Two hundred and fifty female patients were recruited in this study from gynecological clinics in Basrah, southern Iraq. All had severe dysmenorrhea, patients were subjected to a questionnaire form, Visual Analog Scale, and verbal multidimensional scoring system to determine the pain intensity and grade of dysmenorrhea. Only 38 young females had severe dysmenorrhea grade 3 with ages ranging from 16 to 28 years with a mean age of 22.04 ± 1.43 years and body mass index 23.81 ± 1.94, patients subjected to electromagnetic field therapy (EMFT), two sessions per week for 20 min each for 6 weeks. Three categories were assessed, working ability, associated symptoms, and drugs used. Data were collected and statistically analyzed using SPSS version 22. RESULTS: The present study showed statistically significant progress (P < 0.05) in reducing pain, rare physical and mental complaints, and improved working ability with no need for drugs in majority of patients. CONCLUSION: EMFT has better results than other methods in relieving pain and symptoms of dysmenorrhea with a settled lifestyle.

Résumé Introduction :La dysménorrhée primaire (MP) est une maladie publique touchant les jeunes femmes dans le monde entier, elle affecte leurs performances quotidiennes. Sévère récurrent les crampes utérines constituent la principale plainte chez 90 % des adolescentes et 50 % des femmes en âge de procréer. Cette étude visait à évaluer l'utilisation de la thérapie par champ magnétique dans le traitement de la dysménorrhée sévère de grade 3 et constitue un objectif encourageant pour poursuivre le travail quotidien sans douleur.Méthodes:Deux cent cinquante patientes ont été recrutées dans cette étude dans des cliniques gynécologiques de Bassorah, dans le sud de l'Irak. Tous souffraient de dysménorrhée sévère, les patientes ont été soumises à un questionnaire, à une échelle visuelle analogique et à un système de notation verbale multidimensionnelle. pour déterminer l'intensité de la douleur et le degré de dysménorrhée. Seules 38 jeunes femmes souffraient de dysménorrhée sévère de grade 3, avec des âges variés de 16 à 28 ans avec un âge moyen de 22,04 ± 1,43 ans et un indice de masse corporelle de 23,81 ± 1,94, patients soumis à un champ électromagnétique thérapie (EMFT), deux séances par semaine de 20 minutes chacune pendant 6 semaines. Trois catégories ont été évaluées, la capacité de travail, les symptômes associés et les drogues consommées. Les données ont été collectées et analysées statistiquement à l'aide de SPSS version 22.Résultats:La présente étude a montré des résultats statistiquement significatifs. progrès (P < 0,05) dans la réduction de la douleur, des plaintes physiques et mentales rares et amélioration de la capacité de travail sans recours à des médicaments dans la majorité des cas de malades.Conclusion:L'EMFT donne de meilleurs résultats que les autres méthodes pour soulager la douleur et les symptômes de la dysménorrhée avec un mode de vie sédentaire.

Prevalence of chronic pelvic pain and associated factors among indigenous women of reproductive age in Ecuador.

BACKGROUND: Chronic pelvic pain is a common disease that affects approximately 4% of women of reproductive age in developed countries. This number is estimated to be higher in developing countries, with a significant negative personal and socioeconomic impact on women. The lack of data on this condition in several countries, particularly those in development and in socially and biologically vulnerable populations such as the indigenous, makes it difficult to guide public policies. OBJECTIVES: To evaluate the prevalence of chronic pelvic pain (dysmenorrhea, dyspareunia, non-cyclical pain) and identify which variables are independently associated with the presence of the condition in indigenous women from Otavalo-Ecuador. DESIGN: A cross-sectional study was carried out including a sample of 2429 women of reproductive age between 14 and 49 years old, obtained from April 2022 to March 2023. A directed questionnaire was used, collected by bilingual interviewers (Kichwa and Spanish) belonging to the community itself; the number of patients was selected by random sampling proportional to the number of women estimated by sample calculation. Data are presented as case prevalence, odds ratio, and 95% confidence interval, with p < 0.05. RESULTS: The prevalence of primary dysmenorrhea, non-cyclic pelvic pain, and dyspareunia was, respectively, 26.6%, 8.9%, and 3.9%.all forms of chronic pain were independently associated with each other. Additionally, dysmenorrhoea was independently associated with hypertension, intestinal symptoms, miscegenation, long cycles, previous pregnancy, use of contraceptives and pear body shape. Pain in other sites, late menarche, exercise, and pear body shape were associated with non-cyclic pelvic pain. And, urinary symptoms, previous pregnancy loss, miscegenation, and pear body shape were associated with dyspareunia. CONCLUSION: The prevalence of primary dysmenorrhea and non-cyclical chronic pelvic pain was notably high, in contrast with the frequency of reported dyspareunia. Briefly, our results suggest an association between dysmenorrhoea and conditions related to inflammatory and/or systemic metabolic disorders, including a potential causal relationship with other manifestations of pelvic pain, and between non-cyclical pelvic pain and signs/symptoms suggesting central sensitization. The report of dyspareunia may be influenced by local cultural values and beliefs.

Effectiveness of high-intensity focused ultrasound combined with gonadotropin-releasing hormone agonist or combined with levonorgestrel-releasing intrauterine system for adenomyosis: A systematic review and meta-analysis.

Gonadotropin-Releasing Hormone Agonist (GnRH-a) and levonorgestrel releasing intrauterine system (LNG-IUS) are conventional conservative treatments for adenomyosis, and high-intensity focused ultrasound (HIFU) is a novel ablation technique. This study aimed to investigate the effectiveness of HIFU combined with GnRH-a or LNG-IUS for adenomyosis patients. In this systematic review and meta-analysis, Pubmed, Embase, Cochrane Library and Scopus databases were searched up to December 2021. Published studies comparing HIFU plus GnRH-a with HIFU plus LNG-IUS in adenomyosis patients were assessed for eligibility by two independent authors. Risk of bias tool was utilized for risk evaluation. We selected treatment effective rate of dysmenorrhea (pain during menstruation) as the primary outcome; effective rate of menorrhagia severity and reduction rate of adenomyotic lesion as the secondary outcomes. Adverse effects were assessed. Four studies with a total 729 patients were enrolled in the meta-analysis. HIFU plus LNG-IUS showed lower dysmenorrhea [within 6 months: risk ratio (RR) 0.88, 95% confidence interval (CI) 0.83-0.93, p < 0.00001; over 1 year: RR 0.73, 95% CI 0.65-0.82, p < 0.00001] and less menorrhagia severity (RR 0.63, 95% CI 0.60-0.66, p < 0.00001) than HIFU plus GnRH-a. Both groups demonstrated equal efficacy in adenomyotic lesion reduction rate (RR 1.03, 95% CI 0.97-1.09, p = 0.30). Adverse effects happened equally in both groups. Combination therapy of HIFU and LNG-IUS revealed better effectiveness in treating dysmenorrhea and menorrhagia than that of HIFU and GnRH-a. However, interpreting the conclusion should be approached with caution as a result of significant heterogeneity.

Self-management of primary dysmenorrhea-related pain: cross-sectional study on non-pharmacological interventions.

Aim: Different nonpharmacological strategies are adopted to decrease primary dysmenorrhea (PD)-related pain. The present study aimed to verify women's use of nonpharmacological methods for pain and compare them with evidence from the literature.Materials & methods: A two-step study was conducted, comprising an online survey with 9144 women to assess nonpharmacological strategies for relieving PD-related pain, and a literature review on PubMed of verify the evidence of nonpharmacological methods.Results: Many women reported using heat therapy (61.5%), tea (42.4%) and massage (30.9%) to alleviate menstrual pain. However, the literature on these methods is limited.Conclusion: Several nonpharmacological methods are used by women to relieve PD-related pain and studies with low bias risk are needed to prove their effectiveness.

What is this article about This article explores how women manage menstrual pain, known as primary dysmenorrhea (PD), using non-drug methods. The study investigates the common self-care techniques women employ to ease their pain and compares these practices with scientific evidence.What were the results? The study found that many women use non-drug methods such as heat therapy (61.5%), tea (42.4%) and massage (30.9%) to relieve menstrual pain. Despite their popularity, sometimes the scientific evidence supporting the effectiveness of these methods is limited.What do these results mean? These results indicate that while women frequently use various self-care methods to manage menstrual pain, there is a need for more high-quality scientific studies to confirm whether these methods are truly effective. This highlights a gap between common practices and scientific effectiveness.

The role of transcutaneous electrical nerve stimulation for menstrual pain relief: A randomized control trial.

BACKGROUND: Abdominal pain due to menses (primary dysmenorrhea) is an extremely pervasive and debilitating symptom affecting up to 90% of menstruating individuals. OBJECTIVE: The objective of this randomized control trial was to investigate the effect of a commercial transcutaneous electrical nerve stimulation unit, Therabody PowerDot® (Therabody Inc., Los Angeles) on dysmenorrhea compared with non-steroidal anti-inflammatory drug use. DESIGN: This was a randomized cross-over study. METHODS: A total of 47 participants agreed to participate in the study, with 34 completing it. Participants completed treatments across three consecutive menstrual cycles in randomized order: single-unit transcutaneous electrical nerve stimulation (Uno), dual unit transcutaneous electrical nerve stimulation (Duo), and non-steroidal anti-inflammatory drug use (Control). Upon onset of dysmenorrhea, participants applied transcutaneous electrical nerve stimulation to their abdomen for a minimum of 30 min. Control participants were instructed to take non-steroidal anti-inflammatory drugs as needed. Surveys were used to record pain before and after treatment. We hypothesized that the PowerDot would decrease self-reported pain scores, and decrease non-steroidal anti-inflammatory drug consumption during menses. RESULTS: Participants experienced a statistically and clinically significant reduction in pain during the Control (-3.52 ± 1.9), Uno (-2.10 ± 1.6), and Duo (-2.19 ± 1.7) cycles (p < 0.001). The doses of non-steroidal anti-inflammatory drugs consumed during the Control cycle (3.5 ± 2.6), was significantly different as compared with that of Uno (1.5 ± 3.0), or Duo (1.1 ± 2.6) (p = 0.004). CONCLUSIONS: Use of a commercial transcutaneous electrical nerve stimulation unit results in significant decrease in pain. Although not as robust as the relief in pain induced by non-steroidal anti-inflammatory drugs, the adverse events of transcutaneous electrical nerve stimulation are minimal in comparison. Therefore, transcutaneous electrical nerve stimulation appears to be a viable alternative to pain relief from dysmenorrhea. CLINICAL TRIAL REGISTRATION: NCT05178589.

The role of electrical signals for period pain reliefMenstruation, also known as the period, is a cyclicly occurring event in people who are assigned female at birth. Often, the period is associated with abdominal pain that can be debilitating for many. This abdominal pain is typically treated using over-the-counter medications, such as ibuprofen; however, there several noted side effects that can arise from use of such medication. As such, this study aimed to understand if a device (Therabody PowerDot^®; Therabody Inc., Los Angeles) that sends an electrical current to pads placed over the abdomen, much like a heating pad, could be used to decrease pain during the period to a similar level as medication. The research team studied three consecutive periods with differing setups: a single, elongated pad, placed on the lower abdomen (Uno), two circular pads placed on the lower abdomen (Duo), or no use of the device, only medication (Control). The researchers analyzed data from 34 individuals. It was found that all three cycles experienced a significant decrease in pain, with the control cycle having a greater decrease in pain than both the Uno and Duo. This study suggests that the electrical stimulation used here can greatly decrease pain during the period, though not as substantial as medication.

[Regulating effect of Gegen Decoction on hypothalamic-pituitary-ovarian axis in mice with primary dysmenorrhea].

This study aimed to explore the regulating effect of Gegen Decoction(GGD) on the hypothalamic-pituitary-ovarian axis(HPOA) dysfunction in the mouse model of primary dysmenorrhea(PD). The mouse model of PD with periodic characteristics was established by administration of estradiol benzoate and oxytocin. Mice were randomized into control, model, GGD, and ibuprofen groups. The writhing response, hypothalamus index, pituitary index, ovary index, and uterus index were observed and determined. The serum levels of prostaglandin F_(2α)(PGF_(2α)), gonadotropin-releasing hormone(GnRH), follicle-stimulating hormone(FSH), luteinizing hormone(LH), and estrogen(E_2) levels were measured by ELISA kits. Western blot and qPCR were employed to determine the protein and mRNA levels, respectively, of gonadotropin-releasing hormone receptor(GnRH-R) in the pituitary tissue, follicle-stimulating hormone receptor(FSHR) and luteinizing hormone receptor(LHR) in the ovarian tissue, and estrogen receptor(ER) in the uterine tissue. The results showed that the writhing response, serum levels of PGF_(2α), GnRH, FSH, LH, and E_2, ovarian and uterine indexes, the protein and mRNA levels of GnRH-R in the pituitary tissue, FSHR and LHR in the ovarian tissue, and ER in the uterine tissue were significantly increased in the model group compared with those in the control group. GGD inhibited the writhing response, reduced the serum levels of PGF_(2α), GnRH, FSH, LH, and E_2, decreased the ovarian and uterine indexes, and down-regulated the protein and mRNA levels of GnRH-R in the pituitary tissue, FSHR and LHR in the ovarian tissue, and ER in the uterine tissue. The data suggested that GGD can regulate the HPOA and inhibit E_2 generation in the mice experiencing recurrent PD by down-regulating the expression of proteins and genes related to HPOA axis, thus exerting the therapeutic effect on PD.

Lesion size and location in deep infiltrating bowel endometriosis: Correlation with gastrointestinal dysfunction and pain.

INTRODUCTION: Presence of deep infiltrating bowel endometriosis (DE) is associated with occurrence of dyschezia and gastrointestinal symptoms. The degree of the disease, the lesion length, and the location, that is, lesion-to-anal-verge distance (LAVD) of DE, as well as the severity of the symptoms appear to be correlated. Nevertheless, it is not yet known to what extent the size and LAVD of bowel DE influence the severity of gastrointestinal symptoms. The present study aims to evaluate a possible correlation of lesion location (LAVD) and size (according to the #Enzian classification) with preoperative symptoms. MATERIAL AND METHODS: In this prospective study, premenopausal patients with histologically confirmed DE undergoing modified limited nerve-vessel sparing rectal segmental bowel resection or full-thickness discoid resection were evaluated. Extent of endometriosis was defined according to the #Enzian classification during surgery. The primary outcome measure was the correlation between lesion size and location with the GI function impairment reflected by presurgical lower anterior resection syndrome (LARS) scores; the secondary outcome was differences in presurgical numeric rating scale pain scores of dyschezia, dyspareunia, and dysmenorrhea as well as the impact of concomitant DE of other locations on symptom intensity. RESULTS: Of 162 consecutive patients, 151 were included in the final analysis. No significant correlation was observed between lesion size (#Enzian compartments C1/C2/C3) or LAVD and GI dysfunction reflected by LARS-like symptoms (p = 0.314 and p = 0.185, respectively) or pain symptoms (dyschezia, p = 0.440; dyspareunia, p = 0.136; and dysmenorrhea p = 0.221). Furthermore, no significant correlation was observed between lesion size and GI dysfunction when merging two severity grades (#Enzian compartments C1 plus C2 vs. C3; p = 0.611). In addition, LAVD did not affect the degree of dyschezia (p = 0.892), dyspareunia (p = 0.395), or dysmenorrhea (p = 0.705). Finally, the presence of concomitant DE lesions infiltrating the vagina/rectovaginal space (#Enzian compartment A) and/or sacrouterine ligaments/parametrium (#Enzian compartment B) did not alter the severity of preoperative dyschezia (p = 0.493) or dysmenorrhea (p = 0.128) but showed a trend toward affecting gastrointestinal function (p = 0.078) and was significantly associated with dyspareunia (p = 0.035). CONCLUSIONS: In present study, we could not find a correlation between colorectal DE lesion size and location (LAVD) and gastrointestinal function impairment or intensity of dyschezia and dysmenorrhea. Additional involvement of vagina/rectovaginal space (#Enzian compartment A) and/or sacrouterine ligaments/parametrium (#Enzian compartment B) exerts a significant impact on the degree of dyspareunia in women with colorectal DE.

Transcutaneous electrical nerve stimulation (TENS) for pain control in women with primary dysmenorrhoea.

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological treatment that works by delivering electrical currents via electrodes attached to the skin at the site of pain. It can be an alternative to pharmacological treatments. The mechanism of action of TENS for pain relief is related to the inhibition of the transmission of painful stimuli, release of endogenous opioids, and reduced muscle ischaemia of the uterus. Although it has been used for primary dysmenorrhoea ((PD); period pain or menstrual cramps), evidence of the efficacy and safety of high-frequency TENS, low-frequency TENS, or other treatments for PD is limited. OBJECTIVES: To evaluate the effectiveness and safety of transcutaneous electrical nerve stimulation (TENS) in comparison with placebo, no treatment, and other treatments for primary dysmenorrhoea (PD). SEARCH METHODS: We searched the Gynaecology and Fertility Group's Specialized Register of controlled trials, CENTRAL, MEDLINE, Embase, PsycINFO, AMED, CINAHL, and the Korean and Chinese language databases up to 9 April 2024. We also searched for ongoing trials in trials registries and the reference lists of relevant studies for additional trials. Language restrictions were not applied. SELECTION CRITERIA: We included randomized controlled trials (RCTs) that included women (aged 12 to 49 years) with PD. Included trials compared low-frequency TENS or high-frequency TENS with other TENS, placebo, or other treatment. DATA COLLECTION AND ANALYSIS: Four review authors screened the trials, extracted the data according to the protocol, assessed the risk of bias using RoB 2, and assessed the certainty of evidence for all review comparisons and primary outcomes (i.e. pain relief and adverse effects) using the GRADE approach. MAIN RESULTS: This review replaces the current review, published in 2009. We included 20 RCTs involving 585 randomized women with high-frequency TENS, low-frequency TENS, placebo or no treatment, or other treatment. We included five comparisons: high-frequency TENS versus placebo or no treatment, low-frequency TENS versus placebo or no treatment, high-frequency TENS versus low-frequency TENS, high-frequency TENS versus other treatments, and low-frequency TENS versus other treatments. High-frequency TENS versus placebo or no treatment High-frequency TENS may reduce pain compared with placebo or no treatment (mean difference (MD) -1.39, 95% confidence interval (CI) -2.51 to -0.28; 10 RCTs, 345 women; low-certainty evidence; I2 = 88%). Two out of three RCTs reported no adverse effects and hence we were unable to estimate the effect of high-frequency TENS on adverse effects. Low-frequency TENS versus placebo or no treatment Low-frequency TENS may reduce pain compared with placebo or no treatment (MD -2.04, 95% CI -2.95 to -1.14; 3 RCTs, 645 women; low-certainty evidence; I2 = 0%). No trials reported adverse effects for this comparison. High-frequency TENS versus low-frequency TENS It is uncertain whether high-frequency TENS had an effect on pain relief compared with low-frequency TENS (MD 0.89, 95% CI -0.19 to 1.96; 3 RCTs, 54 women; low-certainty evidence; I2 = 0%). One trial contributed data on adverse effects but no adverse events occurred. High-frequency TENS versus other treatments It is uncertain whether high-frequency TENS had an effect on pain relief compared to acupressure (MD -0.66, 95% CI -1.72 to 0.40; 1 RCT, 18 women; very low-certainty evidence), acetaminophen (paracetamol) (MD -0.98, 95% CI -3.30 to 1.34; 1 RCT, 20 women; very low-certainty evidence), and interferential current therapy (MD -0.03, 95% CI -1.04 to 0.98; 2 RCTs, 62 women; low-certainty evidence; I2 = 0%). The occurrence of adverse effects did not differ significantly between high-frequency TENS and NSAIDs (OR 12.06, 95% CI 0.26 to 570.62; 2 RCTs, 88 women; low-certainty evidence; I2 = 78%). Low-frequency TENS versus other treatments It is uncertain whether low-frequency TENS had an effect on pain relief compared with acetaminophen (MD -1.48, 95% CI -3.61 to 0.65; 1 RCT, 20 women; very low-certainty evidence). No trials reported adverse effects for this comparison. AUTHORS' CONCLUSIONS: High-frequency TENS and low-frequency TENS may reduce pain compared with placebo or no treatment. We downgraded the certainty of the evidence because of the risk of bias. Future RCTs should focus more on secondary outcomes of this review (e.g. requirement for additional analgesics, limitation of daily activities, or health-related quality of life) and should be designed to ensure a low risk of bias.

Menstrual pain self-medication relates to poor mental health outcomes from Al-Zaatri refugees' camp.

Dysmenorrhea, the most common gynecological pain syndrome reported in women, is understudied in refugee communities. In addition, the association between dysmenorrhea self-medication and mental health symptoms in this population is poorly understood. We aimed to examine whether the use of dysmenorrhea analgesic self-medications and other clinical factors are associated with post-traumatic stress disorder (PTSD), depression, anxiety and insomnia severity in female war refugees residing in Zaatari Camp. This study followed a cross-sectional design and was performed on a cohort of women with predefined inclusion criteria. The severity of PTSD, depression, anxiety and insomnia were assessed using Davidson Trauma Scale, the Patient Health Questionnaire-9, the General Anxiety Disorder-7, and the Arabic version of the Insomnia Severity Index, respectively. Data were analysed from 386 participants. Using OTC paracetamol was significantly associated with higher PTSD severity (B=4.16, t= 2.43, p=0.01), and severe depression (OR=1.88, 95% CI= 1.07-3.28, p=0.03), while OTC non-steroidal anti-inflammatory drugs (NSAIDs) was significantly associated with severe insomnia (OR=1.62, 95% CI= 1.05-2.49, p= 0.02). In conclusion, self-medication with analgesics was correlated with poor mental health; close medical and psychiatric follow-up are required to supervise pain self-medication and implement non-pharmacological strategies to manage dysmenorrhea in this fragile community.

La dysménorrhée, le syndrome douloureux gynécologique le plus fréquemment signalé chez les femmes, est peu étudiée dans les communautés de réfugiés. De plus, l'association entre l'automédication de la dysménorrhée et les symptômes de santé mentale dans cette population est mal comprise. Nous avions pour objectif d'examiner si l'utilisation d'automédicaments analgésiques contre la dysménorrhée et d'autres facteurs cliniques sont associés au trouble de stress post-traumatique (SSPT), à la dépression, à l'anxiété et à la gravité de l'insomnie chez les réfugiées de guerre résidant dans le camp de Zaatari. Cette étude a suivi une conception transversale et a été réalisée sur une cohorte de femmes avec des critères d'inclusion prédéfinis. La gravité du SSPT, de la dépression, de l'anxiété et de l'insomnie a été évaluée à l'aide de l'échelle de traumatisme de Davidson, du questionnaire sur la santé du patient-9, du trouble d'anxiété général-7 et de la version arabe de l'indice de gravité de l'insomnie, respectivement. Les données ont été analysées auprès de 386 participants. L'utilisation de paracétamol en vente libre était significativement associée à une gravité plus élevée du SSPT (B = 4,16, t = 2,43, p = 0,01) et à une dépression sévère (OR = 1,88, IC à 95 % = 1,07-3,28, p = 0,03), tandis que les médicaments non stéroïdiens en vente libre les anti-inflammatoires (AINS) étaient associés de manière significative à l'insomnie sévère (OR = 1,62, IC à 95 % = 1,05-2,49, p = 0,02). En conclusion, l'automédication avec des analgésiques était corrélée à une mauvaise santé mentale ; un suivi médical et psychiatrique étroit est nécessaire pour encadrer l'automédication de la douleur et mettre en œuvre des stratégies non pharmacologiques pour prendre en charge la dysménorrhée dans cette communauté fragile.

Incidence of menstrual symptoms suggestive of possible endometriosis in adolescents: and variance in these by ethnicity and socio-economic status.

BACKGROUND: Dysmenorrhoea affects up to 94% of adolescents who menstruate; approximately one third miss school and activities. Dysmenorrhoea can occur without identified pelvic pathology (primary dysmenorrhoea) or in association with other conditions (secondary dysmenorrhoea). In adolescence, the commonest cause of secondary dysmenorrhoea is endometriosis. The incidence of symptoms in adolescence suggesting possible endometriosis has not been previously documented in GP records. AIM: To document incidence of adolescent endometriosis and symptoms associated with endometriosis in English GP records. METHOD: Data from the QResearch primary care database were used for adolescent females aged 10- 19 years between 1 January 2011 and 30 June 2021, reported using descriptive statistics. RESULTS: The population cohort included 2 843 347 female adolescents; 98 887 participants had coded dysmenorrhoea (3.48%) and 1994 (0.07%) had documented endometriosis. The cumulative incidence for the cohort who turned 10 years old in 2011 was 7.2% for dysmenorrhoea and 0.12% for endometriosis. The period prevalence of coded symptoms during adolescence potentially associated with dysmenorrhoea and endometriosis includes: heavy menstrual bleeding (3.73%), irregular menstrual bleeding (2.21%), pelvic pain (0.63%), dyspareunia (0.40%), premenstrual syndrome (PMS)/premenstrual dysphoric disorder (PMDD) (0.22%), cystitis (8.45%), and irritable bowel syndrome (IBS) (1.00%). Disparities in coding were observed for these variables by ethnicity and socioeconomic status. Incidence of prescribed hormonal medication, with and without coded dysmenorrhoea, varied by ethnicity. This was less apparent for non-steroidal anti-inflammatory medications. CONCLUSION: Prevalence of coded dysmenorrhoea in GP records is significantly lower than community surveys suggest; however, adolescent menstrual symptoms are commonly encountered in primary care, and deserve specific guidance and resources. There are demographic patterns, likely structural, that warrant further exploration.

Translation, cross-cultural adaptation, and measurement properties of the dysmenorrhea symptom interference (DSI) scale-Brazilian version.

BACKGROUND: The Dysmenorrhea Symptom Interference (DSI) scale is a reliable, valid, and responsive tool to assess the interference of menstrual pain in the physical, mental, and social activities of women. OBJECTIVE: To translate and cross-culturally adapt the DSI scale into Brazilian-Portuguese (DSI-BrPt) and investigate the measurement properties of this version in on- and off-menses versions. METHODS: The original (United States) scale was translated and culturally adapted following existing guidelines. Measurement properties of the DSI-BrPt were investigated in 1387 women with dysmenorrhea. Reliability was analyzed via intraclass correlation coefficients (ICC) and test-retest reliability. Furthermore, structural validity, internal consistency (Cronbach's alpha), cross-cultural validity, construct validity (correlation with WHODAS 2.0 and SPS-6 scores questionnaires), and floor and ceiling effects were determined. RESULTS: No significant adaptations were needed during the translation process of the DSI-BrPt. The values of Cronbach's α were adequate (α ≥0.87) for the unidimensional scale. The test-retest reliability was considered adequate (ICC >0.78) and there was no systematic error for both on-menses and off-menses versions. Moreover, the DSI had a positive and strong correlation with WHODAS 2.0. There were no floor and ceiling effects neither for the total sample, nor among off-menses, or on-menses women. CONCLUSION: The DSI-BrPt scale has been translated and cross-culturally adapted successfully. The DSI-BrPt scale presented adequate measurement properties. The scale is valid and reliable, and, therefore, an adequate tool for monitoring dysmenorrhea symptoms in Brazilian women during and between menses.

Factors associated with dysmenorrhoea and menorrhagia improvement in patients with adenomyosis after uterine artery embolisation.

BACKGROUND: This study examined the improvement of dysmenorrhoea and menorrhagia after uterine artery embolisation (UAE) in women with symptomatic adenomyosis and identified factors that could predict the improvement of dysmenorrhoea and menorrhagia. METHODS: This retrospective study included women with adenomyosis who underwent bilateral UAE between December 2014 and December 2016. The percentage of the volume of the absence of contrast enhancement on T1-weighted images was evaluated 5-7 days after UAE. A receiver operating characteristic (ROC) analysis was used to determine a cut-off point and predict the improvement of dysmenorrhoea and menorrhagia. RESULTS: Forty-eight patients were included. At 24 and 36 months after UAE, the improvement rates for dysmenorrhoea and menorrhagia were 60.4% (29/48) and 85.7% (30/35), and the recurrence rates were 19.4% (7/36) and 9.1% (3/33), respectively. Only the percentage of the volume of the absence of contrast enhancement on T1-weighted images was associated with the improvement of dysmenorrhoea (p = 0.001, OR = 1.051; 95% CI: 1.02-1.08) and menorrhagia (p = 0.006, OR = 1.077; 95% CI: 1.021-1.136). When the cut-off value of the ROC analysis was 73.1%, sensitivity, specificity, positive predictive value, and negative predictive value for the improvement of dysmenorrhoea were 58.6%, 94.7%, 94.4%, and 60%, while they were 58.9%, 80%, 100%, 100%, and 45.5% for the improvement of dysmenorrhoea. CONCLUSION: Bilateral UAE for symptomatic adenomyosis led to good improvement of dysmenorrhoea and menorrhagia. The percentage of the volume of the absence of contrast enhancement on T1-weighted images of the uterus in postoperative magnetic resonance imaging might be associated with the improvement of dysmenorrhoea and menorrhagia.

This study examined the improvement of dysmenorrhoea and menorrhagia after uterine artery embolisation in women with symptomatic adenomyosis and identified factors that could predict the improvement of dysmenorrhoea and menorrhagia. This retrospective study included women with adenomyosis who underwent uterine artery embolisation. A total of 48 patients were included. Only the percentage of the volume of the absence of contrast enhancement on T1-weighted images was associated with improvement of dysmenorrhoea and menorrhagia. Bilateral uterine artery embolisation for symptomatic adenomyosis led to good improvement. The percentage of the volume of the absence of contrast enhancement on images in postoperative T1-weighted magnetic resonance imaging of the uterus might be associated with the improvement of dysmenorrhoea and menorrhagia.

Adenomyosis and Abnormal Uterine Bleeding: Review of the Evidence.

BACKGROUND: Thomas Cullen described bleeding abnormalities and dysmenorrhea as the "expected" presentations of adenomyomas. Adenomyosis is included within the FIGO classification of structural causes of abnormal uterine bleeding (AUB). Nevertheless, this long-standing association has been questioned by some authors who reported a high incidence of adenomyosis in uteri removed for indications other than AUB or dysmenorrhea. Here, we examine evidence for the link between adenomyosis and AUB. METHODS: A comprehensive Medline literature review of all publications to October 2023. RESULTS: Sixty-three articles were identified and included in the review. Despite a large body of studies, the available literature does not provide conclusive evidence of a link between adenomyosis and AUB. This is because of unsuitable study design, or poor characterization of the study population or of the inclusion or exclusion criteria. Additional challenges arise because of the lack of agreed criteria for diagnosing adenomyosis and the often absence of detailed assessment of menstrual blood loss. Adenomyosis often coexists with other conditions that have also been linked to similar symptoms, and many cases of adenomyosis are asymptomatic. CONCLUSION: Most of the existing literature and studies that addressed treatment outcome of adenomyosis started from the premise that a link between the condition and AUB had been proven. Yet, published information shows that aspects such a relationship is still uncertain. Further research is needed to address the relation between AUB and adenomyosis burden (or subtypes), distribution, and concomitant pathology.

Long-term efficacy and safety of levonorgestrel releasing intrauterine system in the treatment of adenomyosis: evidence mapping.

PURPOSE: To summarize evidence on levonorgestrel releasing intrauterine system (LNG-IUS) in the treatment of adenomyosis (AM) and to identify potential research gaps. METHODS: Search was conducted in MEDLINE, The Cochrane Library, EMBASE, CBM, CNKI, and Wanfang. We included studies investigating patients with AM treated with LNG-IUS combined with conservative therapy. RESULTS: Thirty-nine studies compared LNG-IUS with other conservative therapeutic drugs. The most common comparison was GnRH-a + LNG-IUS vs. LNG-IUS alone, followed by LNG-IUS vs. mifepristone, expected treatment, and GnRH-a. GnRH-a + LNG-IUS was more beneficial in reducing the intensity of dysmenorrhea than LNG-IUS alone at the 6-month follow-up in patients with an enlarged uterus and moderate to severe dysmenorrhea. Large and well-designed studies are needed to confirm the efficacy of LNG-IUS and GnRH-a on reducing uterine volume at 6-month follow-up. Thirty-two studies investigated LNG-IUS as the postoperative management. The most common comparison was surgical excision + LNG-IUS vs. surgical excision. Results showed VAS scores were lower in the surgical excision + LNG-IUS group than in the surgical excision group at the 1-year follow-up. Evidence on endometrial thickness, quality of life, adverse events and beneficial effect at 3 and 5 years are needed. CONCLUSIONS: Combined GnRH-a and LNG-IUS treatment was more efficacious than LNG-IUS alone for patients with an enlarged uterus and moderate to severe dysmenorrhea. Moreover, LNG-IUS seemed to show potential long-term benefits in postoperative therapy, warranting further meta-analysis for confirmation.