Altered sleep and diurnal consequences in women with dysmenorrhea: study from the EPISONO database.

PURPOSE: Our study aimed to identify alterations in sleep, inflammatory mediators, fatigue and quality of life in women with dysmenorrhea and compare them to women without dysmenorrhea. METHODS: The sample comprised 328 women from a Brazilian cross-sectional sleep study, EPISONO (2007), who had undergone 1-night polysomnography (PSG) type I and completed questionnaires related to sleep quality, daytime sleepiness, insomnia, fatigue, anxiety, depression, and quality of life. Blood samples were used to assess levels of interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and C-reactive protein (CRP). The 2 groups were distributed based on the presence or absence of dysmenorrhea symptoms. RESULTS: Sleep efficiency was significantly lower in the group of women with dysmenorrhea (82.5% ± 13.8) compared to the non-dysmenorrhea group (86.2% ± 10.9). Dysmenorrhea was associated with significantly higher scores of fatigue and worse scores in the physical quality of life. No statistical differences were detected in inflammatory markers between the 2 groups. DISCUSSION: Fatigue and physical quality of life were presented in women with dysmenorrhea, as was reduced sleep efficiency, although no alteration on inflammatory markers were observed. CONCLUSION: These findings show that dysmenorrhea can have a deleterious effect on women's sleep, with repercussions on daily routines and quality of life.

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.

Measurement properties of patient-reported outcome measures for women with dysmenorrhea: A systematic review.

BACKGROUND: Dysmenorrhea, or menstrual pain, is a subjective experience, and can only be assessed by patient-reported outcomes. These instruments should be reliable, valid and responsive. AIM: To identify and critically appraise the available evidence for the measurement properties of specific patient-reported outcome measures used for dysmenorrhea. METHODS: The PRISMA statement was used to report this systematic review. Databases searched were PubMed, SCOPUS, CINAHL, Web of Science, ScienceDirect and Google Scholar (April 2021; updated on February 2023). Original studies with primary data collection, with no restriction on language and publication date that reported psychometric properties of one or more dysmenorrhea-related patient-reported outcome measure. The literature searches, selection of studies, data extraction and assessment of the risk of bias were performed independently by two reviewers and followed the COSMIN guidelines. RESULTS: Thirty studies were analysed in this review, and 19 patient-reported outcome measures were evaluated. The instruments varied in relation to the measured construct and measurement properties (validity, reliability and responsiveness). The methodological quality of the studies and the quality of evidence of the patient-reported outcome measures were variable. Among the 13 studies that reported the development of patient-reported outcome measures, most had inadequate methodological quality, and the overall rating was insufficient or inconsistent. CONCLUSIONS: The Dysmenorrhea Symptom Interference (DSI) scale was the only identified patient-reported outcome measure that has the potential to be recommended because of its sufficient rating combined with moderate quality of evidence for content validity. Future studies should further evaluate the measurement properties of the existing patient-reported outcome measures, or develop new patient-reported outcome measures following the COSMIN methodology. PATIENT OR PUBLIC CONTRIBUTION: Not applicable as this is a systematic review. TRIAL REGISTRATION: PROSPERO protocol: CRD42021244410. Registration on April 22, 2021.

The Relationship between Serum Ischemia-Modified Albumin Levels and Uterine Artery Doppler Parameters in Patients with Primary Dysmenorrhea.

OBJECTIVE: Primary dysmenorrhea occurs due to abnormal levels of prostanoids, uterine contractions, and uterine blood flow. However, the reasons for pain in primary dysmenorrhea have not yet been clarified. We examined the blood flow alterations in patients with primary dysmenorrhea and determined the relationship between ischemia-modified albumin (IMA) levels, as an ischemia indicator, and primary dysmenorrhea. METHODS: In the present study, 37 patients who had primary dysmenorrhea and were in their luteal and menstrual phase of their menstrual cycles were included. Thirty individuals who had similar demographic characteristics, who were between 18 and 30 years old and did not have gynecologic disease were included as control individuals. Their uterine artery Doppler indices and serum IMA levels were measured. RESULTS: Menstrual phase plasma IMA levels were significantly higher than luteal phase IMA levels, both in the patient and in the control groups (p < 0.001). Although the menstrual phase IMA levels of patients were significantly higher than those of controls, luteal phase IMA levels were not significantly different between the two groups. Menstrual uterine artery pulsatility index (PI) and resistance index (RI) of primary dysmenorrhea patients were significantly different when compared with luteal uterine artery PI and RI levels. There was a positive correlation between menstrual phase IMA and uterine artery PI and RI in the primary dysmenorrhea. CONCLUSION: Ischemia plays an important role in the etiology of the pain, which is frequently observed in patients with primary dysmenorrhea. Ischemia-modified albumin levels are considered as an efficient marker to determine the severity of pain and to indicate ischemia in primary dysmenorrhea.

The relationship between serum ischemia-modified albumin levels and uterine artery doppler parameters in patients with primary dysmenorrhea

Abstract Objective Primary dysmenorrhea occurs due to abnormal levels of prostanoids, uterine contractions, and uterine blood flow. However, the reasons for pain in primary dysmenorrhea have not yet been clarified. We examined the blood flow alterations in patients with primary dysmenorrhea and determined the relationship between ischemia-modified albumin (IMA) levels, as an ischemia indicator, and primary dysmenorrhea. Methods In the present study, 37 patients who had primary dysmenorrhea and were in their luteal and menstrual phase of their menstrual cycles were included. Thirty individuals who had similar demographic characteristics, who were between 18 and 30 years old and did not have gynecologic disease were included as control individuals. Their uterine artery Doppler indices and serum IMA levels were measured. Results Menstrual phase plasma IMA levels were significantly higher than luteal phase IMA levels, both in the patient and in the control groups (p < 0.001). Although the menstrual phase IMA levels of patients were significantly higher than those of controls, luteal phase IMA levels were not significantly different between the two groups. Menstrual uterine artery pulsatility index (PI) and resistance index (RI) of primary dysmenorrhea patients were significantly different when compared with luteal uterine artery PI and RI levels. There was a positive correlation between menstrual phase IMA and uterine artery PI and RI in the primary dysmenorrhea. Conclusion Ischemia plays an important role in the etiology of the pain, which is frequently observed in patients with primary dysmenorrhea. Ischemia-modified albumin levels are considered as an efficient marker to determine the severity of pain and to indicate ischemia in primary dysmenorrhea.

Scientific and technological prospection on transdermal formulations and complementary therapies for the treatment of primary dysmenorrhea.

INTRODUCTION: Primary dysmenorrhea (PD) is another term for idiopathic menstrual cramps. Treatments include the use of oral non-steroidal anti-inflammatory drugs (NSAIDs). These drugs have several side effects. The objective of this study was to perform a systematic review on the transdermal administration of drugs and the use of alternative therapies for the treatment of PD. AREAS COVERED: The article bases were Web of Science, PubMed and Sciencedirect and the patent bases were INPI, EPO and WIPO with publications on Primary Dysmenorrhea and associations with Transdermal Administration; Complementary Therapies and Medicinal Plants. 21 articles and 12 patents were analyzed. The results demonstrate the need for alternative therapies for the treatment of PD, with greater effectiveness and lower side effects, mainly in an attempt to reduce the intensity and duration of pain as well as reducing the continuous use of medications. EXPERT OPINION: The study of technological prospection highlighted the relevant importance in seeking new methods for the relief of the symptoms provoked by this condition. The perspectives coexist in the discovery of new natural and biotechnological pharmacological applications, mainly in the development of new devices capable of facilitating and optimizing this form of administration in an attempt to reduce side effects.

Naproxen, paracetamol and pamabrom versus paracetamol, pyrilamine and pamabrom in primary dysmenorrhea: a randomized, double-blind clinical trial. / Naproxeno, paracetamol y pamabrom versus paracetamol, pirilamina y pamabrom en dismenorrea primaria: estudio aleatorizado, doble ciego.

INTRODUCTION: Dysmenorrhea is caused by the discharge of prostaglandins into the uterine tissue; therefore, non-steroidal anti-inflammatory drugs (NSAIDs) are the established initial therapy for dysmenorrhea. Dysmenorrhea therapy may include the administration of drug monotherapy or combination therapy. However, clinical scientific evidence on the efficacy of medications with two or three drugs combined is scarce or nonexistent. OBJECTIVE: To evaluate and compare the efficacy and safety of two oral fixed-dose combinations for the relief of the symptoms of primary dysmenorrhea among Mexican women. One of the combinations is widely used in Mexico (paracetamol, pyrilamine and pamabrom) and the selected comparison was a medication with naproxen sodium, paracetamol and pamabrom based on the pathophysiology of primary dysmenorrhea. METHODS: This was a single-centre, double blind, experimental, parallel group, randomized trial. Female patients with primary dysmenorrhea, older than 17 years and with pain intensity greater than 45 mm on a visual analogue scale, were included. The patients were then randomized to receive tablets with naproxen sodium, paracetamol and pamabrom or tablets with paracetamol, pyrilamine and pamabrom for one menstrual cycle. Patient evaluations of symptomatology and pain intensity were recorded throughout one menstrual period. Descriptive and inferential statistical analyses were utilized. RESULTS: An intention-to-treat population of 91 women, with a mean age of 21.3 ± 3.2 years, received paracetamol, pyrilamine and pamabrom tablets, and 98 participants, with a mean age of 21.0 ± 3.2 years, received naproxen sodium, paracetamol and pamabrom tablets. The participants’ assessments of pain on the Visual Analogue Scale during the menstrual cycle demonstrated a significant reduction in both treatment groups (p<0.05). There is no significant difference in efficacy between both groups (p>0.05). CONCLUSIONS: The results showed that both drug combinations were not different in reducing dysmenorrheic pain. Likewise, both treatments were well tolerated. Therefore, both treatments may be used for the treatment of primary dysmenorrhea.

INTRODUCCIÓN: La dismenorrea primaria es causada por la descarga de las prostaglandinas en el tejido uterino. Por lo tanto, los fármacos antiinflamatorios no esteroideos son la terapia inicial para la dismenorrea. El tratamiento para la dismenorrea puede incluir la administración de monoterapia o la combinación de fármacos. Sin embargo, la evidencia clínica científica sobre la eficacia de los medicamentos con dos o tres fármacos combinados es escasa o ausente. OBJETIVO: Evaluar y comparar la eficacia y seguridad de dos combinaciones, en dosis fija y oral para el alivio de los síntomas de la dismenorrea primaria en mujeres mexicanas. Basados en la fisiopatología de la dismenorrea primaria, se utilizó una combinación comercializada en México de paracetamol, pirilamina y pamabrom. El comparador seleccionado fue un medicamento que contiene naproxeno sódico, paracetamol y pamabrom. MÉTODOS: Se realizó un estudio en un solo centro, a doble ciego, experimental, paralelo y aleatorizado. Las pacientes con dismenorrea primaria que se incluyeron fueron mayores de 17 años de edad y con una intensidad del dolor mayor a 45 milímetros en una escala visual analógica. Las pacientes fueron aleatorizadas para recibir tabletas con naproxeno sódico, paracetamol y pamabrom o tabletas con paracetamol, pirilamina y pamabrom para un ciclo menstrual. Se evaluó la intensidad de la sintomatología y el dolor de las pacientes a lo largo de un período menstrual. Se utilizó análisis estadístico descriptivo e inferencial. RESULTADOS: Se incluyó una población con intención de tratar de 91 mujeres, con una edad media de 21,3 ± 3,2 años la cual recibió tabletas de paracetamol, pirilamina y pamabrom. Otras 98 participantes, con una edad media de 21,0 ± 3,2 años, recibieron tabletas de naproxeno sódico, paracetamol y pamabrom. Las evaluaciones de dolor de las participantes con la escala visual analógica durante el ciclo menstrual demostraron una reducción significativa en ambos grupos de tratamiento (p<0,05). No hubo diferencia significativa en la eficacia entre los dos grupos (p>0,05). CONCLUSIONES: Los resultados mostraron que ambas combinaciones de fármacos no fueron diferentes en reducir el dolor dismenorreico. Del mismo modo, ambos tratamientos fueron bien tolerados. Por lo tanto, ambos tratamientos se pueden utilizar para el tratamiento de la dismenorrea primaria.

Dismenorrea primaria en adolescentes: revisión de la literatura / Primary dysmenorrhea in adolescent: literature review

En la población adolescente, la dismenorrea es la principal causa de consulta ginecológica y también de ausentismo escolar, laboral o de otras actividades. Aproximadamente el 10 por ciento de las adolescentes que refieren dismenorrea presentan una causa orgánica secundaria. Dismenorrea primaria comienza a manifestarse característicamente con la menarca o poco tiempo después de ésta, que coincide con la aparición del ciclos ovulatorios regulares. El clínico debe ser capaz de diferenciar las múltiples etiologías del dolor pélvico crónico: una historia clínica detallada y un buen examen físico pueden ser suficientes para diagnosticar esta entidad. Pese a la alta prevalencia de dismenorrea en las adolescentes, es alto el porcentaje que no solicita atención médica o es subtratada, por lo que el objetivo de esta revisión fue presentar una actualización de lo publicado en la literatura sobre la fisiopatología, enfrentamiento y manejo de la dismenorrea primaria, desde tratamientos clásicos a la medicina más alternativa. De esta manera podremos entregar a la adolescente un manejo más integral, y así, disminuir el impacto que provoca la dismenorrea primaria (DP) en la vida de nuestras pacientes.

Dysmenorrhea in adolescent is an important cause of gynecological consult, school and employment absenteeism. Approximately 10 percent of adolescents who report dysmenorrhoea have an organic cause. Primary dysmenorrhea begins to manifest characteristically with menarche or shortly thereafter, coinciding with the onset of regular ovulatory cycles. The clinician should beable to differentiate multiple etiologies of chronic pelvic pain: a detailed history and physical exam may be sufficient to diagnose this entity. Despite the high prevalence of dysmenorrhea in adolescent girls, a high percentage doesn’t seek medical treatment or are undertreated. The objective of this review was to provide an update of the pathophysiology, and management of primary dysmenorrhea, from traditional treatments to alternative medicine. In this way adolescent can obtain a more integrated management, and improve her life quality.

Subendometrial microvascularization and uterine artery blood flow in IUD-induced side effects (levonorgestrel intrauterine system and copper intrauterine device).

BACKGROUND: A better understanding of the uterine and endometrial vascularization in intrauterine device (IUD)-induced side effects is clearly of paramount importance in terms of both physiological and pathophysiological changes and may permit assessment for future therapeutic treatments. The aim of the study was to quantify the subendometrial microvascularization and uterine artery blood flow in IUD-induced side effects using power Doppler analysis as well as pulsatility index (PI) and resistance index (RI) in the exact midluteal phase 3 months after IUD insertion. There were 27 patients using the levonorgestrel-releasing intrauterine system and 25 patients using TCu 380A. STUDY DESIGN: This study has a prospective clinical trial design. RESULTS: There is an increased subendometrial blood flow in patients with severe dysmenorrhea and/or bleeding, after controlling for IUD type, age and parity. Moreover, the PI and RI were not different in such women. CONCLUSION: The results provide new data on the bleeding patterns related to these IUD types that may be relevant during contraception use. This method could be used as a prognostic factor to better evaluate women for the risk of developing dysmenorrhea and/or bleeding after IUD insertion.

Tratamento fisioterapêutico em mulheres com dismenorréia primária / Physiotherapeutic treatment in women with primary dysmenorrhoea

A dismenorréia primária constitui um fator de desconforto e desequilíbrio psicossomático e é a principal responsável pela ausência da mulher ao trabalho, estudo e outras atividades. O presente estudo teve por objetivo identificar qual recurso fisioterapêutico, cinesioterapia ou Massagem do Tecido Conjuntivo (MTC), é mais eficiente no tratamento da disfunção. Quarenta e cinco pacientes com diagnóstico clínico de dismenorréia primária e sintomatologia nos últimos três meses, entre 16 e 43 anos, sendo a média etária de 23,06 anos, foram submetidas a um ensaio clínico randomizado, realizado no ambulatório de Fisiatria do Hospital das Clínicas da Universidade Federal de Goiás (HC/UFG) entre os meses de janeiro e março de 2005. A amostra foi dividida aleatoriamente em três grupos: grupo A, cuja intervenção fisioterapêutica adotada foi a cinesioterapia; grupo B, cuja intervenção adotada foi a MTC e o grupo C ou grupo-controle, constituído por pacientes que não receberam intervenção fisioterapêutica. Tanto a MTC quanto a cinesioterapia mostraram-se eficazes no tratamento dessa disfunção, entretando, a MTC destacou-se como um recurso mais eficiente do que a cinesioterapia na maioria dos parâmetros avaliados.

Gonadal function in adolescents and young women with juvenile systemic lupus erythematosus.

The authors analysed the gonadal function and age of menarche of 23 female adolescents and young women with SLE, and correlated these with clinical, SLEDAI and therapeutic parameters. The presence of one or more clinical and laboratory parameters defined normal gonadal function: normal menstrual cycles with or without dysmenorrhea; elevated cervical mucus length; normal levels of plasma FSH, LH, estradiol, progesterone, prolactin and testosterone; normal urinary hormonal cytology; serial pelvic ultrasound compatible with ovulatory pattern; and present or previous pregnancy. The mean age of menarche (13.5 +/- 1.4 years) was greater than that found among 2578 healthy Brazilian adolescents (12.5 +/- 1.3 years; P = 0.0002). The delay in menarche correlated with an increase in the duration of the disease (P = 0.0085) and the cumulative dose of prednisone (P = 0.0013) used until the appearance of the menarche. The mean phase length in SLE was 31.5 +/- 10.3. Sixteen female (70%) patients showed normal and seven (30%) abnormal gonadal function. Gonadal function was not correlated with parameters of SLE. These results suggest that the patients of this study reach adulthood with a high chance of fertility.

Revisäo - O ibuprofeno e seu uso na dismenorréia primária / Review - Ibuprofen and its use in primary dysmenorrhea

Os autores apresentam uma revisäo sobre as propriedades farmacológicas do ibuprofeno, droga antiinflamatória-näo-esteroidal (AINE), e seu emprego na dismenorréia primária (DP), enfermidade de importante aspecto sócio-econômico devido a seus sintomas incapacitantes quando na forma severa. Säo abordados aspectos sobre farmacocinética, farmacodinâmica, indicaçöes clínicas, interaçöes medicamentosas e efeitos adversos da droga, revelando-se o ibuprofeno como o AINE que apresenta, na vigência de seu uso, a menor incidência de distúrbios gastrointestinais quando comparado aos demais AINE. Em relaçäo a seu uso na DP, säo analisados estudos onde compara-se a eficácia do ibuprofeno à eficácia de outros AINES em relaçäo ao alívio dos sintomas dismenorreícos. Conclui-se ser o ibuprofeno, devido à sua ótima eficácia no alívio da dor e sua baixíssima incidência efeitos adversos, e a droga de escolha no tratamento da DP, tendo nesta sua grande indicaçäo

[Video-taped utero-sacral ablation, an alternative treatment of primary incapacitating dysmenorrhea]. / Ablación de úterosacros por videolaparoscopia, una alternativa en dismenorrea primaria incapacitante.

Incapacitating dysmenorrhea has been treated in many different ways both medical and surgical. The best result yet is by uterosacral ablation. The purpose of this study is to demonstrate the utility of uterosacral ablation as treatment for incapacitating dysmenorrhea. This is a prospective longitudinal study of a cohort in which patients were their own controls. The no probabilistic sample of work was of 15 patients in the service of Gynecology being studied for incapacitating primary dysmenorrhea, under treatment for at least three months without favorable response. Videolaparoscopy was performed using CO2 as distention gas. A 10 mm lens grand angular Storz Karl and monopolar feeding was used for the ablation. Follow up was for six to sixteen months, grading the response to treatment in absent, mild, moderated and good. Considering a good response was when pain allowed daily activity. X2 was used at a level of significance of 0.05. In relationship with pain one (7%) was asintomatic, nine (50%) were mild, three (20%) moderate, two (13%) remained with no changes. Comparing the difference pre and post treatment had, statistical significance on a P 0.0025 was in favor of the improvement. We conclude in spite of the smallness of the sample, results are encouraging because any degree of improvement is of benefit to the patient for her quality of life.

Ablación de úterosacros por videolaparoscopia, una alternativa en dismenorrea primaria incapacitante / Ablation of uterosacral ligaments by video laparoscopy. A resource in primary, incapacitating dysmenorrhea

En la dismenorrea incapacitante se han utilizado múltiples tratamientos médicos y quirúrgicos, de ellos la ablación de ligamentos úterosacros es la que ha tenido una mejor respuesta. El objetivo del estudio es demostrar la utilidad de la ablación de los ligamentos úterosacros como tratamiento en la dismenorrea primaria incapacitante. Se efectúo un estudio prospectivo, longitudinal, de una cohorte, en el cual las pacientes fueron sus propios controles. La muestra de trabajo de tipo no probabilístico se integró por 15 pacientes del servicio de ginecología, que se encontraban en estudio por dismenorrea primaria incapacitante y que habían recibido tratamiento médico mínimo de tres meses, sin respuesta favorable al mismo, habiéndose descartado patología pélvica. Se les realizó videolaparoscopia diagnóstica, se utilizó como medio de distensión CO2, para revisión pélvica, lente de 10 mm, gran angular, marca Storz y corriente monopolar para ablación de úterosacros cuando no existió otra patología asociada. Su seguimiento fue de 6 a 16 meses, calificándose la respuesta al dolor dismenorreico en ausente, leve, moderado y severo; considerándose éxito cuando el dolor permitió la actividad diaria al pasar de severo a leve, etc. Se utilizó X2 a un nivel de significancia de p 0.05. En relación al dolor se observó que uno (7 por ciento) permaneció asintomática, nueve (50 por ciento) se transformó en leve, tres (20 por ciento) en mdoerada y dos (13 por ciento) permaneció sin cambio. Al comparar las diferencias pre y post tratamiento fueron estadísticamente significativas a una P 0.0025 a favor de la mejoría de la dismenorrea. Concluimos que no obstante que se trata de una muestra pequeña, los resultados son alentadores ya que cualquier grado de mejoría observado beneficia a nuestras pacientes para la realización de su actividad diaria normal

Importancia médico-social de la dismenorrea primaria / Medico-social importance of the primary dysmenorrhea

Se hace una evaluación de la importancia de la dismenorrea primaria den relación al ausentismo laboral y escolar que causa, a través de una encuesta realizada a 1204 universitarios de diferentes carreras de la Universidad San Francisco Xavier, procedentes de diversas regiones del pais. La encuesta fue anónima y contenia en cada pregunta todas las alternativas de respuesta posible de tal manera que lass mismas fueran precisas, no dieran lugar a confución, ni exigieran esfuerzo al responderlas. Paralelamente se interrogo sobre algunos otros aspectos relacionados con al menstruación. Los resultados permitidos establecen que las caracteristicas menstruales fisiológicas de nuestra población son similares a las ya descritas en literatura médica ; que la dismenorrea afecta al 76 porciento de las mujeres , que el 77 porciento de ellas alcanza grados de moderada e intensa; que los sintomas concomitantes más frecuentes son la depresión y la mastodinia; que el ausentismo laboral y escolar importantes que llega al 27 porciento y que en el 40 porciento de las mujeres afectadas exiten antecedentes familiares de la misma.

[Analgesic-antispasmodic effect and safety of lysine clonixinate and L-hyoscinbutylbromide in the treatment of dysmenorrhea]. / Efecto analgésico antiespasmódico y seguridad del clonixinato de lisina y bromuro de L-butilhioscina en el tratamiento oral de la dismenorrea.

The purpose of this longitudinal open but not comparative study was to confirm the safety and efficacy of Lysine clonixinate (125 mg) and hyoscinbutylbromide (10 mg) capsules, during a period of observation of there menstrual cycles on 30 women with uterine dysfunction due to primary or secondary dysmenorrhea. The time of evolution for primary dysmenorrhea was of 4.46 years, and for secondary was of 1.77 years. Some associated manifestations of dysmenorrhea were: nausea (92%), vomit (92%), general pain (82.1%), abdominal pain (85.7%) and headache (46.4%). Regarding to the menstrual pain intensity, at first was highly severe in 10.7% severe in 42.9%, and moderate in 46.4%. At the end of the study, only 1 of 28 patients showed menstrual pain of moderate intensity. Only three adverse effects of light intensity were found without needing treatment, related to the manifestations of gastralgia and sleepiness. The association of a spasmolytic analgesic (Lysine clonixinate and hyoscinbutylbromide bromide) on the treatment for primary or secondary dysmenorrhea, reduces and prevents the menstrual pain (colic) as well as the associated manifestations with few spasmolytic association is efficacy and safety.

[Laparoscopic findings in patients with pelvic pain, dysmenorrhea and sterility]. / Hallazgos laparoscópicos en pacientes con dolor pélvico, dismenorrea y esterilidad.

Endometriosis is a frequent gynecologic disease and is associated with dysmenorrhea, pelvic pain and infertility. We evaluated 71 patients who had any of these entities and were treated with laparoscopic procedures. We found a higher frequency of endometriosis in these groups in comparation with the reports of the literature but, there was no direct relation between the severity of endometriosis and the three groups (Revised Classification of the American Fertility Society). The organic pathology was the principal factor associated with the pelvic pain in most cases. Finally, we established the utility of laparoscopy in the diagnosis stading and treatment of endometriosis.

Estudio paralelo, comparativo, doble a ciegas, con distribución aleatoria de tratamientos, para determinar la eficacia, seguridad y tolerancia de la combinación espasmo-analgesica del N-Butil Bromuro de Hioscina (Buscapina) + Ibuprofen en tabletas, vs Buscapina tabletas en pacientes con dismenorrea primaria i funcional / Parallel doble-blind, comparative, randomly distributed study of treatments to determine the efficacy, safety and tolerance of a combination of N-butil bromide of hioscine (Buscapina) + Ibuprofen in tablets vs Buscapina in tablets in patients with primary or functional dysmenorrhea

Aunque la fisiopatología de la dismenorrea primaria no está del todo entendida, se cree que el dolor de tipo cólico experimentado por algunas mujeres durante la menstruación está relacionado con las prostaglandinas, en particular la prostaglandina PGF alfa 2, la cual se encuentra en el endometrio durante la menstruación y en el sangrado menstrual. Actualmente la dismenorrea primaria es tratada con antiinflamatorios no esteroides, como el ácido acetilsalicílico, la indometacina, fenamatos y ácidos arilpropiónicos (ibuprofén, naproxeno). Sin embargo, los resultados obtenidos con esta medicación no han sido los esperados ya que estos fármacos no tienen efecto alguno sobre los espasmos del miometrio. El objetivo del presente estudio fue evaluar y comparar la eficacia, seguridad y tolerancia de la combinación de N-butil bromuro de hioscina (Buscapina) + Ibuprofen vs Buscapina en pacientes con dismenorrea primaria, así como el empleo de medicación de rescate en los casos de ineficacia al tratamiento. Las pacientes recibieron en forma aleatoria Buscapina 20 mg + Ibuprofén 400 mg o Buscapina 20 mg al día durante 4 días por 4 ciclos menstruales consecutivos. Los resultados mostraron que en los cuatro ciclos de tratamiento la combinación de Buscapina + Ibuprofén fue significativamente superior a la Buscapina sola. En ambos grupos la tolerancia al tratamiento y el empleo de medicación de rescate fue similar, así como la presencia de eventos adversos. Se puede concluir que la combinación de Buscapina + Ibuprofén es una excelente alternativa para el tratamiento del dolor asociado al síndrome dismenorreico por su alta eficacia y buen perfil de tolerancia.