Herbal and dietary therapies for primary and secondary dysmenorrhoea

The effects of vitamin D and calcium on primary dysmenorrhea: a systematic review

Dysmenorrhea, affecting approximately 80% of adolescents, significantly impairs quality of life, disrupts sleep patterns, and induces mood changes. Furthermore, its economic impact is substantial, accounting for an estimated $200 billion in the United States and $4.2 million in Japan annually. This review aimed to identify the effects of vitamin D and calcium on primary dysmenorrhea. We conducted a comprehensive literature search across Web of Science, PubMed, Scopus, and Science Direct, focusing on studies published from 2010 to 2020. Keywords included 'primary dysmenorrhea', 'vitamin D', '25-OH vitamin D3', 'cholecalciferol', and 'calcium'. The quality assessment of the articles was done using the Consolidated Standards of Reporting Trials (CONSORT) and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklists, and the risk bias was assessed using the Cochrane assessment tool. Abnormal low Vit. D levels increased the severity of primary dysmenorrhea through increased prostaglandins and decreased calcium absorption. Vitamin D and calcium supplements could reduce the severity of primary dysmenorrhea and the need for analgesics. This systematic review found an inverse relation between the severity of dysmenorrhea and low serum Vit. D and calcium.. Vitamin D and calcium supplements could reduce the severity of primary dysmenorrhea and the need for analgesics.

Atherosclerosis and Endometriosis: The Role of Diet and Oxidative Stress in a Gender-Specific Disorder

Background: Accelerated atherosclerosis in patients with endometriosis has been hypothesised, and lifestyle improvement might control cardiovascular risk. We explored cardiometabolic markers and oxidative stress and evaluated the effects of the Mediterranean Diet (MD) in modulating these markers. Methods: In this prospective study, we included 35 women with endometriosis. At baseline (T0) and after 3 (T1) and 6 (T2) months from the start of the diet, we investigated cardiometabolic parameters, lifestyle and oxidative stress. Results: After a 3-month intervention with MD, we observed a significant reduction in total cholesterol (p = 0.01) and LDL-c (p = 0.003). We observed at T1 an increase in B12 and E vitamins, folate and zinc. After 6 months, zinc (p = 0.04) and folate (p = 0.08) increased in comparison to T0. A reduction in homocysteine from T0 to T1 (p = 0.01) was found. After 3 months, an increase in Rapid Assessment of Physical Activity tool 1 (RAPA) (p < 0.001) and RAPA 2 was observed (p = 0.009). We observed high levels of oxidative stress markers at baseline. After 6 months of MD, a significant improvement in lymphocyte Reactive Oxygen Species (ROS) (p < 0.001) and total antioxidant capacity was observed (p = 0.02). Conclusions: The improvement of lifestyle, and in particular the Mediterranean dietary intervention, allowed the improvement of the metabolic and oxidative profile and overall health-related quality of life.

Investigation of Laboratory and Clinical Features of Primary Dysmenorrhea: Comparison of Magnesium and Oral Contraceptives in Treatment

Background The goal of this study was to identify the demographic, clinical, and laboratory characteristics of primary dysmenorrhea (PD) patients, as well as to compare the treatment options of 200 mg magnesium citrate (MgS) and combination oral contraceptive (COC) therapy. Methods This is a case-controlled prospective study consisting of 172 women with PD and a control group consisting of age-matched 172 without PD. The cases in the primary dysmenorrhea group were randomly divided into two groups, with 86 patients in the first group receiving 200 mg MgS, and 86 patients in the second group receiving COC treatment. The Visual Analogue Scale (VAS) was used to measure the severity of dysmenorrhea. VAS scoring was performed on the control group subjects included in the study at their first evaluation and the PD group subjects before treatment and at the third month of treatment (after three menstrual cycles). Results When compared to healthy controls, the PD patients had significantly more menstrual bleeding (p = 0.005), more history of maternal dysmenorrhea (p < 0.001), lower serum calcium (p < 0.001), lower serum 25-hydroxyvitamin D3 (p < 0.001) and more 25-hydroxyvitamin D deficiency (p < 0.001). When compared to the MgS group, the patients in the COC group had significantly lower VAS scores and less need for painkillers following treatment (p < 0.001). The MgS treatment group had significantly lower post-treatment VAS values than pre-treatment VAS values. Conclusion Lower serum calcium and 25-hydroxyvitamin D levels were found in the presence of PD. In addition, it was observed that the administration of 200 mg MgS to PD patients significantly reduced pelvic pain in dysmenorrhea, although not as much as COC administration, and caused significant reductions in the need for painkillers.

Effectiveness and Safety of Chinese Medicine at Shenque (CV 8) for Primary Dysmenorrhea: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Primary dysmenorrhea (PD) is the most common complaint associated with menstruation and affects up to three-quarters of women at some stage of their reproductive life. In Chinese medicine, navel therapy, treatment provided at Shenque (CV 8), is used as a treatment option for PD.

OBJECTIVE

To evaluate the effect of navel therapy on pain relief and quality of life in women with PD, compared with Western medicine (WM).

METHODS

China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), SinoMed and Wanfang Database, MEDLINE, the Cochrane Library, Embase, Web of Science, and the International Clinical Trial Registry of the U.S. National Institutes of Health were searched from their inceptions to April 1, 2021. Randomized controlled trials (RCTs) assessing therapeutic effects of navel therapy on PD were eligible for inclusion. RevMan 5.4 software was used for data analyses. The certainty of the evidence was assessed using the online GRADEpro tool.

RESULTS

Totally 24 RCTs involving 2,614 participants were identified. Interventions applied to acupuncture point CV 8 included: herbal patching, moxibustion or combined navel therapy (using at least 2 types of stimulation). Compared to placebo, there was a significant effect in favor of navel therapy on reducing overall menstrual symptom scores at the end of treatment [mean difference: -0.82, 95% confidence interval (CI): -1.00 to -0.64, n=90; 1 RCT]. As compared with Western medicine, navel therapy had a superior effect on pain intensity as assessed by Visual Analogue Scale at the end of treatment [standardized mean difference (SMD): -0.64, 95% CI: -1.22 to -0.06, I²=80%, n=262; 3 RCTs]; on symptom resolution rate at 3-month follow-up (risk ratio: 1.94, 95% CI: 1.47 to 2.56, n=1527, I²=38%; 13 RCTs); and on global menstrual symptoms score at the end of treatment (SMD: -0.67, 95% CI: -0.90 to -0.45, I²=63%, n=990; 12 RCTs). Subgroup analyses showed either a better or an equivalent effect comparing navel therapy with Western medicine. No major adverse events were reported. The methodological quality of included trials was poor overall.

CONCLUSIONS

Navel therapy appears to be more effective than Western medicine in decreasing menstrual pain and improving overall symptoms of PD. However, these findings need to be confirmed by well-designed clinical trials with adequate sample size (Systematic review registration at PROSPERO, No. CRD42021240350).

Nutritional modulation of blood pressure and vascular changes during severe menstrual cramps

Objectives

This study examined the influence of nutrition on the severity of menstrual pains and associated transient changes in blood pressure (BP) and vascular-health indicators. It has also investigated the influence of nutrition on angiotensin (ANG II) and vascular cell adhesion molecules (VCAM-1).

Methods

A total of 207 university students, aged between 18 and 25 years, were grouped into three groups: a no-dysmenorrhoea (control) group, a moderate dysmenorrhoea (MDys) group, and a severe dysmenorrhoea (SDys) group, using the NRS-11 scale and initial contactin-1 (CNTN-1) levels. The groups were separately fed vegetable, protein, and carbohydrate meals. The meal plan involved three different types of food served three times a day (for breakfast, lunch, and dinner), beginning 48 h before menstruation.

Results

We found that 73.9% and 100% of the MDys patients on the protein and carbohydrate diets, respectively, had severe dysmenorrhoea. As many as 69.6% of the SDys patients on vegetable diets experienced no dysmenorrhoea; the BP of 61% of SDys normalised to the standard values of 120/80. The BP of 87% MDys had systolic BP ≥ 130 and ≥90 diastolic BP after carbohydrate meals. On the other hand, 30% of SDys had higher BP after protein meals. With respect to the choice of food, the severity of menstrual pain was positively correlated with ANG II (r = 0.5158) and VCAM-1 (r = 0.5849). ANG-II. Similarly, VCAM-1 were significantly elevated (p < 0.05) in the dysmenorrhoeal participants. The mean VCAM-1 and ANG-II levels of dysmenorrhoeal participants placed on vegetable meals were comparable to the control baseline levels.

Conclusions

This study recommends the intake of a vegetable meal at least 48 h before menstruation as an effective nutritional approach to preventing and managing severe menstrual cramps. This approach can also prevent associated vascular changes. Carbohydrate meals should be avoided at least 48 h before menstruation.

Role of vitamin D and calcium in the relief of primary dysmenorrhea: a systematic review

Dysmenorrhea is one of the well-established problems among women of reproductive age and can have adverse effects on the quality of life of the individual. Some studies suggest a relationship between vitamin D (Vit D) and calcium deficiency and the emergence of early dysmenorrhea. Accordingly, a systematic study was performed to investigate the role of calcium and Vit D in the relief of primary dysmenorrhea. A systematic literature search was performed in PubMed, Web of Science, Scopus, Science Direct, and Google Scholar for papers published between 2010 and 2020. The Consolidated Standards of Reporting Trials and Strengthening the Reporting of Observational Studies in Epidemiology checklists were used to assess the quality of the studies. The risk of bias was assessed using the Cochrane risk-of-bias assessment tool. Low calcium levels lead to an increase in uterine muscle contraction and can cause pain after decreased uterine blood flow. Furthermore, low levels of Vit D can increase primary dysmenorrhea by increasing prostaglandin production or reducing intestinal calcium absorption. That being the case, Vit D and calcium intake can be effective in reducing the severity of primary dysmenorrhea and in reducing the rate of analgesic use. Low levels of Vit D and calcium are inversely related to the severity of primary dysmenorrhea, and Vit D and calcium intake can reduce the severity of primary dysmenorrhea and its associated systemic symptoms. Therefore, the use of calcium and Vit D supplements can be recommended to relieve dysmenorrhea.

Neutral douche: a hydrotherapeutic tool to manage pain and systemic symptoms in primary dysmenorrhea - a randomised controlled study

BACKGROUND & OBJECTIVES

The douche, one of the hydrotherapeutic treatment modality is commonly used by Naturopathy physicians as a treatment of choice in the management of several ailments. This study was done to assess the effect of full body neutral douche in the management of pain and systemic symptoms in adult females with primary dysmenorrhoea.

METHODS

68 subjects of age 18-22 years with primary dysmenorrhoea were recruited for the study and were randomly divided into two groups: the experimental group (n = 34) and the control group (n = 34). The experimental group received whole body neutral douche, whereas the control group followed the routine as usual. Assessments for the pain, systemic symptoms and menstrual cramps were done by using McGill Pain Questionnaire, Verbal multidimensional scoring system and analog scale for severity of pain and menstrual cramps respectively at baseline, day 30 and day 60 of intervention. Two- way repeated measures of ANOVA was performed to understand the between group changes, adjusted for the respective baseline values and age.

RESULT

Data was analyzed with SPSS (Version 21.0) package. Neutral douche resulted in significant improvement in pain [F(2,66) = 114.564, p < 0.0005, partial ?2 = 0.771], severity of pain [F(2,66) = 70.418, p < 0.0005, partial ?2 = 0.681], cramps [F(2,66) = 75.986, p < 0.0005, partial ?2 = 0.697] and systemic symptoms [F(2,66) = 14.64, p < 0.0005, partial ?2 = 0.307] as compared to the control group.

CONCLUSION

Findings suggest that neutral douche can be used as a non-pharmacological intervention in the management of pain and systemic symptoms in primary dysmenorrhea.

The Effect of Micronutrients on Pain Management of Primary Dysmenorrhea: a Systematic Review and Meta-Analysis

Introduction: Primary dysmenorrhea is considered as one of the main problems in women. This review study aimed to characterize the effect of micronutrients on primary dysmenorrhea.

Methods: In this systematic and meta‐analysis study, the articles were searched at Cochrane library, PubMed, Scopus, Web of Science databases. The searching process was conducted with the key terms related to dysmenorrhea and micronutrients. Risk of bias assessment was performed, using Rev Man 5.3 software. In view of the heterogeneity of some of the studies, they were analyzed, using a qualitative method (n=10), and only 6 studies were included in Meta analyze. STATA statistical software version 11 was used for the analysis.

Results: In this study, finally 16 clinical trials were investigated. Most micronutrients studied in the relevant articles had anti-inflammatory and analgesic properties with a desirable effect on dysmenorrhea pain relief. Vitamins (K, D, B1, and E) and calcium, magnesium, zinc sulfate and boron contributed effectively to dysmenorrhea pain management. Two months after the intervention, there was a significant mean decrease in the pain score for the vitamin D intervention group (SMD: -1.02, 95% CI: -1.9 to – 0.14, P =0.024) , as well as in the vitamin E intervention group compared to placebo group (SMD: -0.47,95% CI:-0.74 to – 0.2, P = 0.001).

Conclusion: Despite the paucity of related research, the studies indicated the potential effects of micronutrients on reducing the pain severity in primary dysmenorrhea. But more studies are needed to confirm the safety and effectiveness of various types of micronutrients on primary dysmenorrhea.

Menstrual Pain: A Review of Foreign Literature

The World Health Organization estimates dysmenorrhea as the most important cause of a chronic pelvic pain. Its prevalence among adolescents and young women ranges from 40 % to 90 %, and varies, depending on age, country of residence and population density of the area. Primary dysmenorrhea is responsible for reducing the quality of life, absenteeism in the workplace or at school, refusing to participate in community and sporting events, changing of pain perception and sleep disturbance. There is evidence of its relationship with an early menarche, a family history, a length of the menstrual cycle, bad habits, poor sleep hygiene, an unbalanced diet, sedentary lifestyle and obesity. Characteristic features of a personality contribute in a certain way, making women prone to neuroticism and pain catastrophizing to be more at risk of developing dysmenorrhea. Irritable bowel syndrome, musculoskeletal pain and interstitial cystitis often accompany dysmenorrhea and respond to its treatment positively. Despite the proven validity of nonsteroidal anti­inflammatory drugs treatment there are resistant forms of menstrual pain, those make a search for alternative therapy relevant.

An Advanced Formulation of a Magnesium Dietary Supplement Adapted for a Long-Term Use Supplementation Improves Magnesium Bioavailability: In Vitro and Clinical Comparative Studies

While general recommendations are for 300-mg magnesium intake a day, an advanced low-dose formulation of magnesium chloride, ChronoMag®, was designed to provide 100 mg of magnesium element, thus decreasing the risk of gastrointestinal side effects and allowing long-term supplementation in health conditions related to low magnesium levels. The present study aimed to compare magnesium release profile and bioavailability between this patented low-dose continuous-release magnesium chloride tablet (100 mg magnesium element) and a reference tablet at the usually prescribed dose (300 mg magnesium element). Magnesium release profile was determined by dissolving the tablets in solutions simulating the gastrointestinal tract environment. A randomized double-blind crossover controlled trial of ChronoMag® versus reference tablet (3 × 100 mg magnesium element tablets) in 12 normo-magnesemic healthy volunteers was conducted to evaluate the bioavailability of the patented magnesium chloride tablets (two 50 mg magnesium tablets, once-a-day intake). While the reference tablet released 100% of its magnesium within 1 h of dissolution, release from the magnesium chloride formulation was continuous for 6 h. Cumulative urinary magnesium levels compared to those with the reference tablet were 76% (0-5 h), 89% (0-10 h), and 87% (0-24 h). Elimination after 24 h was fairly similar with both supplements. Our results suggest that the new magnesium chloride formulation, providing continuous low-dose magnesium release throughout the gastrointestinal tract, improves absorption and bioavailability. This formulation conforms to the physiological mechanism of magnesium absorption throughout the digestive tract, allowing high absorption, and may improve gastrointestinal tolerance in long-term use.

The effect of diet on primary dysmenorrhea in university students: A randomized controlled clinical trial

OBJECTIVE

To evaluate the effect of diet therapy on primary dysmenorrhea in female university students.

METHODS

A randomized controlled pre and post-test design was used to verify the effects of diet therapy on primary dysmenorrhea. The study was conducted on 67 female students who were suffering from primary dysmenorrhea. The participants were divided into diet and control groups. The intensity of dysmenorrhea was determined using Visual Analogue Scale and a modified questionnaire assessing several symptoms of dysmenorrhea. The intervention group received the diet therapy for three months. The assessments were made before intervention and three months later.

RESULTS

Before the intervention, the mean intensity of dysmenorrhea was found to be 7.14 ± 1.3, 7.09 ± 1.4, in diet groups and control groups, respectively, but the difference was not statistically significant. After the diet therapy, a significant difference was found among the two groups regarding the mean intensity of dysmenorrhea after three months and the average score of pain score of diet group was significantly lower (Diet group:5.15±1.15, Control group: 6.74±1.97).

CONCLUSION

Diet therapy was found to be effective in reducing pain in female university students with primary dysmenorrhea complaints.

Major dietary patterns in relation to menstrual pain: a nested case control study

Background

Dysmenorrhea is one of the most prevalent gynecological disorders, experienced by approximately two third of young women during menstruation. According to literature, nutrition can play a key role in the prevalence and severity of dysmenorrhea. This study aims to investigate the relation between dietary patterns and the risk of dysmenorrhea among university students.

Methods

A nested case control study was conducted among 293 students of Urmia University of Medical Sciences who were randomly recruited via a proportional cluster sampling method. From 293 students, 46 students with moderate to severe dysmenorrhea and 54 students without dysmenorrhea were assigned to the case and control groups, respectively. The major dietary patterns of students were identified by factor analysis and the association between dietary patterns and risk of dysmenorrhea was investigated using logistic regression analysis in SPSS 20.

Results

Three major dietary patterns were found and nominated as “Lacto-vegetarian”, “Snacks” and “Mixed food items” patterns. After controlling for family history of dysmenorrhea, subjects in the second and third tertiles of “snacks” pattern had a 4.23 (95% CI = 1.32–13.58, P = 0.01) and 3.41 (95% CI = 1.10–10.50, P = 0.03) times, respectively, higher chance to experience moderate to severe dysmenorrhea in comparison with subjects in the first tertile. There was no significant association between the risk of dysmenorrhea and two other dietary patterns.

Conclusions

The results indicate that adherence to “snacks” pattern is associated with an increased risk of moderate to severe dysmenorrhea during menstruation among young women.

Eotaxin levels in patients with primary dysmenorrhea

Purpose

Primary dysmenorrhea (PD) is a common cause of pelvic pain that can cause limitations in daily activities. Treatment options sometimes result in failure, suggesting that different mechanisms may be effective in etiopathogenesis. Eosinophils are cells that are present in endometrium only in the perimenstrual period. The aim of this study was to evaluate the levels of eotaxin, a potent eosinophilic chemoattractant, in patients with PD.

Patients and methods

Thirty patients with PD and thirty healthy women were included in the study. Venous blood sample of 10 mL was collected from each participant. Blood samples were taken in the first 2 days of the menstrual cycle at any period of the day. Serum eotaxin levels were determined by enzyme-linked immunofluorescence assay.

Results

There were no statistically significant differences between the demographic properties of groups in terms of age and body mass index. Eotaxin levels were significantly different in patients with PD than the control subjects (p=0.012).

Conclusion

Detection of different levels of eotaxin in patients with PD may be a new and important step in determining the factors contributing to the pathogenesis of dysmenorrhea.

Effects of Calcium-Vitamin D and Calcium-Alone on Pain Intensity and Menstrual Blood Loss in Women with Primary Dysmenorrhea: A Randomized Controlled Trial

Objective

There is limited evidence on effectiveness of calcium and vitamin D on dysmenorrhea. The authors aimed to determine the effect of combined calcium-vitamin D and calcium-alone on pain intensity and menstrual blood loss in women with primary dysmenorrhea.

Design

A randomized double-blind trial.

Setting

Dormitories of Tabriz University of Medical Sciences.

Subjects

85 students with moderate or severe primary dysmenorrhea.

Methods

Participants were randomized into three groups: receiving one tablet/day of 1000 mg calcium + 5000 IU vitamin D3, calcium-alone 1000 mg, or matched placebo, from 15th cycle day until menstrual pain disappearance in the following cycle, for three cycles. Pain intensity and menstrual blood loss were assessed one cycle before, three cycles under, and one cycle following intervention using 10-cm visual analog scale and pictorial blood loss assessment chart, respectively. The groups were compared using repeated measures ANOVA.

Results

Time after intervention and interaction of time with group had no significant effects on the outcomes. Compared to the placebo group, mean pain intensity was lower in the both calcium-vitamin D (adjusted difference -0.7, 95% confidence interval -1.6 to 0.3) and calcium-alone (-1.6, -2.6 to -0.6) groups, but the difference was statistically significant only in the calcium-alone group. Menstrual blood loss was not significantly different in the either calcium-vitamin D (-4.7, -21.9 to 12.4) or calcium-alone (-0.4, -17.4 to 16.4) groups compared to placebo.

Conclusions

Intake of the calcium-alone was effective in reducing menstrual pain intensity. The results could not indicate significant effects of calcium-vitamin D on the pain or any of the interventions on menstrual blood loss.

Clinical trial registration

This study was approved by the Ethics committee of Tabriz University of Medical Sciences (code 92145) and registered at the Iranian Registry of Clinical Trials with IRCT201402043706N21.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

ClinialTrials.gov NCT01972906.

Effects of a Bovine Lactoferrin Formulation from Cow's Milk on Menstrual Distress in Volunteers: A Randomized, Crossover Study

Dysmenorrhea is a highly prevalent complaint and highly undiagnosed gynecologic condition. Dairy products have a potential in the management of menstrual distress, and bovine lactoferrin can help the subjective dysphoria associated with dysmenorrhea. In the present study, we aimed to investigate the effects of a lactoferrin formulation isolated from cow’s milk on menstrual symptoms in volunteers. A double-blind, randomized, placebo-controlled, crossover study of the iron-lactoferrin complex (FeLf) was performed in thirty-five healthy Japanese women. Participants received the 150 mg FeLf (per day) or placebo from day ten of the luteal phase to day four of the follicular phase. The Moos Menstrual Distress Questionnaire (MDQ) was measured for menstrual distress, and heart rate variability was measured as an index of autonomic nerve balance during menses. A visual analog scale for menstrual pain, and a verbal rating scale for quality of life during the first three days of menstruation were measured. The MDQ score for the automatic nervous system subscale was lower and the parasympathetic nervous system activity was greater in FeLf than in placebo for intention-to-treat or per-protocol populations. The other variables were not different between the groups. No treatment-related side effects were observed during the study. The results indicate that FeLf can provide a beneficial effect on the psychological symptoms in women affected by menstrual distress.

Beliefs About Dysmenorrhea and Their Relationship to Self-Management

Dysmenorrhea is highly prevalent and is the leading cause of work and school absences among women of reproductive age. However, self-management of dysmenorrhea is not well understood in the US, and little evidence is available on factors that influence dysmenorrhea self-management. Guided by the Common Sense Model, we examined women's representations of dysmenorrhea (beliefs about causes, symptoms, consequences, timeline, controllability, coherence, and emotional responses), described their dysmenorrhea self-management behaviors, and investigated the relationship between representations and self-management behaviors. We conducted a cross-sectional, web-based survey of 762 adult women who had dysmenorrhea symptoms in the last six months. Participants had varied beliefs about the causes of their dysmenorrhea symptoms, which were perceived as a normal part of life. Dysmenorrhea symptoms were reported as moderately severe, with consequences that moderately affected daily life. Women believed they understood their symptoms moderately well and perceived them as moderately controllable but them to continue through menopause. Most women did not seek professional care but rather used a variety of pharmacologic and complementary health approaches. Care-seeking and use of self-management strategies were associated with common sense beliefs about dysmenorrhea cause, consequences, timeline, and controllability. The findings may inform development and testing of self-management interventions that address dysmenorrhea representations and facilitate evidence-based management. © 2016 Wiley Periodicals, Inc.

Dietary supplements for dysmenorrhoea

BACKGROUND

Dysmenorrhoea refers to painful menstrual cramps and is a common gynaecological complaint. Conventional treatments include non-steroidal anti-inflammatory drugs (NSAIDs) and oral contraceptive pills (OCPs), which both reduce myometrial activity (contractions of the uterus). A suggested alternative approach is dietary supplements. We used the term 'dietary supplement' to include herbs or other botanical, vitamins, minerals, enzymes, and amino acids. We excluded traditional Chinese medicines.

OBJECTIVES

To determine the efficacy and safety of dietary supplements for treating dysmenorrhoea.

SEARCH METHODS

We searched sources including the Cochrane Gynaecology and Fertility Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED, PsycINFO (all from inception to 23 March 2015), trial registries, and the reference lists of relevant articles.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of dietary supplements for moderate or severe primary or secondary dysmenorrhoea. We excluded studies of women with an intrauterine device. Eligible comparators were other dietary supplements, placebo, no treatment, or conventional analgesia.

DATA COLLECTION AND ANALYSIS

Two review authors independently performed study selection, performed data extraction and assessed the risk of bias in the included trials. The primary outcomes were pain intensity and adverse effects. We used a fixed-effect model to calculate odds ratios (ORs) for dichotomous data, and mean differences (MDs) or standardised mean differences (SMDs) for continuous data, with 95% confidence intervals (CIs). We presented data that were unsuitable for analysis either descriptively or in additional tables. We assessed the quality of the evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods.

MAIN RESULTS

We included 27 RCTs (3101 women). Most included studies were conducted amongst cohorts of students with primary dysmenorrhoea in their late teens or early twenties. Twenty-two studies were conducted in Iran and the rest were performed in other middle-income countries. Only one study addressed secondary dysmenorrhoea. Interventions included 12 different herbal medicines (German chamomile (Matricaria chamomilla, M recutita, Chamomilla recutita), cinnamon (Cinnamomum zeylanicum, C. verum), Damask rose (Rosa damascena), dill (Anethum graveolens), fennel (Foeniculum vulgare), fenugreek (Trigonella foenum-graecum), ginger (Zingiber officinale), guava (Psidium guajava), rhubarb (Rheum emodi), uzara (Xysmalobium undulatum), valerian (Valeriana officinalis), and zataria (Zataria multiflora)) and five non-herbal supplements (fish oil, melatonin, vitamins B1 and E, and zinc sulphate) in a variety of formulations and doses. Comparators included other supplements, placebo, no treatment, and NSAIDs.We judged all the evidence to be of low or very low quality. The main limitations were imprecision due to very small sample sizes, failure to report study methods, and inconsistency. For most comparisons there was only one included study, and very few studies reported adverse effects. Effectiveness of supplements for primary dysmenorrhoea We have presented pain scores (all on a visual analogue scale (VAS) 0 to 10 point scale) or rates of pain relief, or both, at the first post-treatment follow-up. Supplements versus placebo or no treatmentThere was no evidence of effectiveness for vitamin E (MD 0.00 points, 95% CI -0.34 to 0.34; two RCTs, 135 women).There was no consistent evidence of effectiveness for dill (MD -1.15 points, 95% CI -2.22 to -0.08, one RCT, 46 women), guava (MD 0.59, 95% CI -0.13 to 1.31; one RCT, 151 women); one RCT, 73 women), or fennel (MD -0.34 points, 95% CI -0.74 to 0.06; one RCT, 43 women).There was very limited evidence of effectiveness for fenugreek (MD -1.71 points, 95% CI -2.35 to -1.07; one RCT, 101 women), fish oil (MD 1.11 points, 95% CI 0.45 to 1.77; one RCT, 120 women), fish oil plus vitamin B1 (MD -1.21 points, 95% CI -1.79 to -0.63; one RCT, 120 women), ginger (MD -1.55 points, 95% CI -2.43 to -0.68; three RCTs, 266 women; OR 5.44, 95% CI 1.80 to 16.46; one RCT, 69 women), valerian (MD -0.76 points, 95% CI -1.44 to -0.08; one RCT, 100 women), vitamin B1 alone (MD -2.70 points, 95% CI -3.32 to -2.08; one RCT, 120 women), zataria (OR 6.66, 95% CI 2.66 to 16.72; one RCT, 99 women), and zinc sulphate (MD -0.95 points, 95% CI -1.54 to -0.36; one RCT, 99 women).Data on chamomile and cinnamon versus placebo were unsuitable for analysis. Supplements versus NSAIDSThere was no evidence of any difference between NSAIDs and dill (MD 0.13 points, 95% CI -1.01 to 1.27; one RCT, 47 women), fennel (MD -0.70 points, 95% CI -1.81 to 0.41; one RCT, 59 women), guava (MD 1.19, 95% CI 0.42 to 1.96; one RCT, 155 women), rhubarb (MD -0.20 points, 95% CI -0.44 to 0.04; one RCT, 45 women), or valerian (MD points 0.62 , 95% CI 0.03 to 1.21; one RCT, 99 women),There was no consistent evidence of a difference between Damask rose and NSAIDs (MD -0.15 points, 95% CI -0.55 to 0.25; one RCT, 92 women).There was very limited evidence that chamomile was more effective than NSAIDs (MD -1.42 points, 95% CI -1.69 to -1.15; one RCT, 160 women). Supplements versus other supplementsThere was no evidence of a difference in effectiveness between ginger and zinc sulphate (MD 0.02 points, 95% CI -0.58 to 0.62; one RCT, 101 women). Vitamin B1 may be more effective than fish oil (MD -1.59 points, 95% CI -2.25 to -0.93; one RCT, 120 women). Effectiveness of supplements for secondary dysmenorrhoea There was no strong evidence of benefit for melatonin compared to placebo for dysmenorrhoea secondary to endometriosis (data were unsuitable for analysis). Safety of supplements Only four of the 27 included studies reported adverse effects in both treatment groups. There was no evidence of a difference between the groups but data were too scanty to reach any conclusions about safety.

AUTHORS' CONCLUSIONS

There is no high quality evidence to support the effectiveness of any dietary supplement for dysmenorrhoea, and evidence of safety is lacking. However for several supplements there was some low quality evidence of effectiveness and more research is justified.

The Difference between the Two Representative Kampo Formulas for Treating Dysmenorrhea: An Observational Study

In Kampo medicine, two different formulas are effective for treating dysmenorrhea-tokishakuyakusan and keishibukuryogan; however, the criteria by which specialists select the appropriate formula for each patient are not clear. We compared patients treated with tokishakuyakusan and those with keishibukuryogan and proposed a predictive model. The study included 168 primary and secondary dysmenorrhea patients who visited the Kampo Clinic at Keio University Hospital. We collected clinical data from 128 dysmenorrhea patients, compared the two patient groups and selected significantly different factors as potential predictors, and used logistic regression to establish a model. An external validation was performed using 40 dysmenorrhea patients. Lightheadedness, BMI < 18.5, and a weak abdomen were significantly more frequent in the tokishakuyakusan group; tendency to sweat, heat intolerance, leg numbness, a cold sensation in the lower back, a strong abdomen, and paraumbilical tenderness and resistance were more frequent in the keishibukuryogan group. The final model fitted the data well. Internally estimated accuracy was 81.2%, and a leave-one-out cross-validation estimate of accuracy was 80.5%. External validation accuracy was 85.0%. We proposed a model for predicting the use of two Kampo formulas for dysmenorrhea, which should be validated in prospective trials.

The Effect of External Apple Vinegar Application on Varicosity Symptoms, Pain, and Social Appearance Anxiety: A Randomized Controlled Trial

Aim. We aimed to determine the effect of external apple vinegar application on the symptoms and social appearance anxiety of varicosity patients who were suggested conservative treatment. Method. The study was planned as an experimental, randomized, and controlled study. 120 patients were randomly selected and then were randomly allocated to either experimental or control group by simple blind random sampling method. In the collection of research data, a questionnaire questioning sociodemographic and clinical characteristics, the Visual Analog Scale (VAS) for pain, and the Social Appearance Anxiety Scale (SAAS) were used. The patients in the study group were suggested to apply apple vinegar to the area of the leg with varicosity alongside the treatment suggested by the doctor. The patients in the control group received no intervention during the study. Results. The sociodemographic and clinic characteristics of both groups were found to be similar (p > 0.05). The patients were evaluated with regard to cramps, pain, leg fatigue perception, edema, itching, pigmentation, and weight feelings in the leg, VAS, and SAAS averages in the second evaluation; the control group had a decrease in such symptoms (p > 0.05) although the decrease in the application group was higher and statistically meaningful (p < 0.05). Conclusion. We determined that the external application of apple vinegar on varicosity patients, which is a very easy application, increased the positive effects of conservative treatment.

Pain-Induced Pulsograph Changes in Patients with Primary Dysmenorrhea: A Pilot Study

Objectives. To investigate changes in pulsograph caused by pain in primary dysmenorrhea (PD) patients. Methods. Pulsograph and pain level of PD patients were detected using electropulsograph and Visual-Analogue Scale (VAS), respectively, at four time points, 7-10 days before menstruation (T0), maximal pain during menstruation (T1), immediately after acupuncture analgesia (T2), and 30 mins after acupuncture analgesia (T3). Parameters (t, h, w) and normalized time parameters (t') of pulsograph were analyzed. Results. VAS pain scores decreased from 6.40 ± 1.13 at T1 to 0.70 ± 0.75 at T2 to 0.11 ± 0.32 at T3 (P < 0.001 and 0.001). At T1, compared with those at T0, w1, h3, and h4 significantly increased (P < 0.01), and t2, t2', t3', and h(d) significantly decreased (P < 0.01, 0.001, 0.05, and 0.001). At T2, compared with those at T1, t1, w1, w2, h2, h3, t1', and t4' significantly decreased (P < 0.05, 0.01, 0.01, 0.001, 0.01, 0.001, and 0.05), and h(d) significantly increased (P < 0.001). There was no difference between T2 and T3. Conclusions. There are almost opposite changing trends in pulsographic parameters when pain occurs and when it is relieved in PD patients.

Nonsteroidal anti-inflammatory drugs for dysmenorrhoea

BACKGROUND

Dysmenorrhoea is a common gynaecological problem consisting of painful cramps accompanying menstruation, which in the absence of any underlying abnormality is known as primary dysmenorrhoea. Research has shown that women with dysmenorrhoea have high levels of prostaglandins, hormones known to cause cramping abdominal pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs that act by blocking prostaglandin production. They inhibit the action of cyclooxygenase (COX), an enzyme responsible for the formation of prostaglandins. The COX enzyme exists in two forms, COX-1 and COX-2. Traditional NSAIDs are considered 'non-selective' because they inhibit both COX-1 and COX-2 enzymes. More selective NSAIDs that solely target COX-2 enzymes (COX-2-specific inhibitors) were launched in 1999 with the aim of reducing side effects commonly reported in association with NSAIDs, such as indigestion, headaches and drowsiness.

OBJECTIVES

To determine the effectiveness and safety of NSAIDs in the treatment of primary dysmenorrhoea.

SEARCH METHODS

We searched the following databases in January 2015: Cochrane Menstrual Disorders and Subfertility Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, November 2014 issue), MEDLINE, EMBASE and Web of Science. We also searched clinical trials registers (ClinicalTrials.gov and ICTRP). We checked the abstracts of major scientific meetings and the reference lists of relevant articles.

SELECTION CRITERIA

All randomised controlled trial (RCT) comparisons of NSAIDs versus placebo, other NSAIDs or paracetamol, when used to treat primary dysmenorrhoea.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected the studies, assessed their risk of bias and extracted data, calculating odds ratios (ORs) for dichotomous outcomes and mean differences for continuous outcomes, with 95% confidence intervals (CIs). We used inverse variance methods to combine data. We assessed the overall quality of the evidence using GRADE methods.

MAIN RESULTS

We included 80 randomised controlled trials (5820 women). They compared 20 different NSAIDs (18 non-selective and two COX-2-specific) versus placebo, paracetamol or each other. NSAIDs versus placeboAmong women with primary dysmenorrhoea, NSAIDs were more effective for pain relief than placebo (OR 4.37, 95% CI 3.76 to 5.09; 35 RCTs, I(2) = 53%, low quality evidence). This suggests that if 18% of women taking placebo achieve moderate or excellent pain relief, between 45% and 53% taking NSAIDs will do so.However, NSAIDs were associated with more adverse effects (overall adverse effects: OR 1.29, 95% CI 1.11 to 1.51, 25 RCTs, I(2) = 0%, low quality evidence; gastrointestinal adverse effects: OR 1.58, 95% CI 1.12 to 2.23, 14 RCTs, I(2) = 30%; neurological adverse effects: OR 2.74, 95% CI 1.66 to 4.53, seven RCTs, I(2) = 0%, low quality evidence). The evidence suggests that if 10% of women taking placebo experience side effects, between 11% and 14% of women taking NSAIDs will do so. NSAIDs versus other NSAIDsWhen NSAIDs were compared with each other there was little evidence of the superiority of any individual NSAID for either pain relief or safety. However, the available evidence had little power to detect such differences, as most individual comparisons were based on very few small trials. Non-selective NSAIDs versus COX-2-specific selectorsOnly two of the included studies utilised COX-2-specific inhibitors (etoricoxib and celecoxib). There was no evidence that COX-2-specific inhibitors were more effective or tolerable for the treatment of dysmenorrhoea than traditional NSAIDs; however data were very scanty. NSAIDs versus paracetamolNSAIDs appeared to be more effective for pain relief than paracetamol (OR 1.89, 95% CI 1.05 to 3.43, three RCTs, I(2) = 0%, low quality evidence). There was no evidence of a difference with regard to adverse effects, though data were very scanty.Most of the studies were commercially funded (59%); a further 31% failed to state their source of funding.

AUTHORS' CONCLUSIONS

NSAIDs appear to be a very effective treatment for dysmenorrhoea, though women using them need to be aware of the substantial risk of adverse effects. There is insufficient evidence to determine which (if any) individual NSAID is the safest and most effective for the treatment of dysmenorrhoea. We rated the quality of the evidence as low for most comparisons, mainly due to poor reporting of study methods.

The effects of fish oil capsules and vitamin B1 tablets on duration and severity of dysmenorrhea in students of high school in Urmia-Iran

Aims:

The purpose of this study is the comparison of the effect of vitamin B1 and fish oil with together on severity and duration of dysmenorrhea, and if it is effective, we can administrate both of them with less complication to compare with other chemical drugs which has many disadvantages.

Study Design:

High school of Urmia city, between March 2008 and June 2008.

Methodology:

This study has a double-blind clinical trial design.240 high school female students with dysmenorrhea by a randomized Method were followed up in a double-blind, randomized, placebo-controlled study by dividing into four groups with 60 members. The daily supplement was vit B1 (100 mg/day and fish oil pearl 500 mg/day), taken as a single dose starting at the beginning of the menstrual cycle and continued for 2 consecutive months.

Results:

Intensity of pain in three experimental groups (Vit B1, fish oil and both of them) had significant difference comparing placebo group and intensity of pain had reduced. (p<0.001), (p=0.018), (p<0.001) VS in placebo group (p=0.79). Duration of pain had significantly reduced in all three experimental groups compared with placebo group. (p=0.004), (p=0.008), (p<0.001) VS in placebo group (p=0.32). In all of drugs, results (mean) was better at the end of the second month than the first month.

Conclusion:

Fish oil and vit B1 effects on treatment of primary dysmenorrhea were similar, but vit B1 has less complications and it was more acceptable. We mixed them and compared its results with vit B1, fish oil and placebo separately. Pain duration is the least in Vitamin B1 tablets compare with the others, but its duration was minimum in complex of Vitamin B1 tablets and fish oil capsules. Due to good effects of vitamin B1 and fish oil on symptoms of dysmenorrhea, using of them is suggested.

A preliminary pilot randomized crossover study of uzara (Xysmalobium undulatum) versus ibuprofen in the treatment of primary dysmenorrhea

OBJECTIVE

Preliminary evaluation of efficacy and safety of uzara use in treatment of moderate and severe primary dysmenorrhea in comparison to ibuprofen.

MATERIALS AND METHODS

This randomized, comparative two way cross-over study comprised 60 single female students at Faculty of Medicine, Ain Shams University, Egypt, aged 19-28 years with moderate (n = 46) or severe (n = 14) primary dysmenorrhea. Participants were randomized to take either uzara (80 mg/8 hours for two doses, then 40 mg/8 hours) then ibuprofen (400 mg/6 hours) in two subsequent cycles or vice versa. The pain intensity, using VAS, was recorded immediately before taking the medication (0 hour) and after 4, 12, 24, 48-60, 96-120 hours. Main outcome measures included effectiveness of pain relief defined as drop of VAS to 3 or less, patient's global evaluation of the drug, absence from school, the use of a rescue medication, and, in those who continued the treatment, the pain intensity difference (PID) at different points after start of medication and its sum (SPID).

RESULTS

Uzara was comparably effective to ibuprofen (78.3% vs. 86.7% of cycles; respectively), with comparable rates of effectiveness on global evaluation (being around 50% for either drug), and rates of school absences (11.7% vs. 13.3%; respectively). The need for rescue medication was different (18.3% and 10%; respectively), albeit with no statistical significance. The means of PID at different time points and SPID were comparable, with significantly lower average mean of VAS scores compared to that felt with no medication (1.6 vs. 6.8, p<0.001). Side effects were less with uzara than ibuprofen (0% vs. 8.3%, p<0.05).

CONCLUSIONS

Uzara might be as effective as ibuprofen in management of primary dysmenorrhea but with less side effects. These findings need to be confirmed by a properly designed trial with a larger sample size.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN25618258.

Auricular acupressure to improve menstrual pain and menstrual distress and heart rate variability for primary dysmenorrhea in youth with stress

Background. Dysmenorrhea and accompanying symptoms can have a negative impact on academic achievement, physical activity and functioning, and quality of life. Unfortunately, stress increases the sensitivity and severity of pain, activating sympathetic responses while inhibiting parasympathetic responses. Objective. This study used objective, physiological measurements to evaluate the effects of auricular acupressure on menstrual pain and menstrual distress in young college students with primary dysmenorrhea across two menstrual cycles. The aim was to determine if significant differences could be detected between the intervention and follow-up phases after controlling life stress. Design. A one-group experimental research design was used, and repeated measurements and followups were done. Thirty-two women completed questionnaires and physiological parameters were measured. Results. Significant differences between the intervention and follow-up phases were found for high frequency (HF) and blood pressure on day 1 and no significant differences in menstrual pain and menstrual distress, heart rate variability, low frequency (LF), LF/HF ratio, or heart rate. Conclusion. Auricular acupressure effectively increases parasympathetic activity to maintain autonomic function homeostasis in young women with primary dysmenorrhea and may have a value in alleviating menstrual pain and menstrual distress in a high-stress life. Future studies should consider stress, stimulus dose of auricular acupressure, severity of menstrual pain, and a longitudinal research design.

The Inhibitory Effect of Haloxylon salicornicum on Contraction of the Mouse Uterus

Haloxylon salicornicum (H. salicornicum) is a plant that is frequently taken as a tea by Bedouin women in Egypt who are experiencing difficulties during pregnancy, as well as to provide relief from dysmenorrhoea. Despite its medical use, there has been no detailed evaluation of the effect of this plant on uterine tissue. Therefore, the initial aim of this study was to determine whether H. salicornicum affected the contraction of the mouse uterus in vitro. The crude aqueous extract of H. salicornicum was found to inhibit the spontaneous contractions of the uterus, with the effect being rapid in onset and completely reversible upon washout. Subsequent purification of the plant extract resulted in the identification of synephrine and N-methyltyramine, both of which were found to have inhibitory effects on the spontaneous contractions of the uterus. The EC₅₀ for the purified constituent identified as synephrine was 0.82 ± 0.24 μg/mL. The inhibitory activity of crude H. salicornicum, as well as the isolated constituents, could be prevented by pretreatment of the uterus with the β-adrenoceptor antagonist propranolol. In conclusion, the use of H. salicornicum during preterm labour appears to be justified, and its pharmacologic effect is consistent with it acting as a β-adrenoceptor agonist.

Omega-3 fatty acids for intermittent claudication

BACKGROUND

Omega-3 fatty acids have been used in the treatment and prevention of coronary artery disease although current evidence suggests they may be of limited benefit. Peripheral arterial disease and coronary artery disease share a similar pathogenesis so omega-3 fatty acids may have a similar effect on both conditions. This is an update of a review first published in 2004 and updated in 2007.

OBJECTIVES

To determine the clinical and haematological effects of omega-3 supplementation in people with intermittent claudication.

SEARCH METHODS

For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched September 2012) and the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 9).

SELECTION CRITERIA

Randomised controlled trials of omega-3 fatty acids versus placebo or non-omega-3 fatty acids in people with intermittent claudication.

DATA COLLECTION AND ANALYSIS

One review author identified potential trials. Two review authors independently assessed trial quality and extracted data. We contacted study authors for additional information if necessary.

MAIN RESULTS

Nine studies were included representing 425 participants. All studies compared omega-3 fatty acid supplementation with placebo lasting from four weeks to two years. Three studies with long treatment periods administered additional substances, making any observed effects impossible to attribute to omega-3 fatty acids and were excluded from the statistical analyses. One study did not express any mean values and, therefore, could not be included in statistical analyses.No significant differences between intervention and control groups were observed in pain-free walking distance (mean difference (MD) 11.62 m, 95% confidence interval (CI) -67.74 to 90.98), maximal walking distance (MD 16.99 m, 95% CI -72.14 to 106.11), ankle brachial pressure index (MD -0.02, 95% CI -0.09 to 0.05), total cholesterol levels (MD 0.27 mmol/L, 95% CI -0.48 to 1.01), high-density lipoprotein cholesterol levels (MD 0.00 mmol/L, 95% CI -0.16 to 0.15), low-density lipoprotein cholesterol levels (MD 0.44 mmol/L, 95% CI -0.31 to 1.19), triglyceride levels (MD -0.39 mmol/L, 95% CI -1.10 to 0.33), systolic blood pressure (MD 5.00 mmHg, 95% CI -11.59 to 21.59) or plasma viscosity (MD 0.03 mPa/s, 95% CI -0.02 to 0.08).There was some limited evidence that blood but not plasma viscosity levels decreased with treatment and gastrointestinal side effects such as nausea, diarrhoea and flatulence were observed in two studies.

AUTHORS' CONCLUSIONS

Omega-3 fatty acids appear to have little haematological benefit in people with intermittent claudication and there is no evidence of consistently improved clinical outcomes (quality of life, walking distance, ankle brachial pressure index or angiographic findings). Supplementation may also cause adverse effects such as nausea, diarrhoea and flatulence. Further research is needed to evaluate fully short- and long-term effects of omega-3 fatty acids on the most clinically relevant outcomes in people with intermittent claudication before they can be recommended for routine use.

The effect of aromatherapy abdominal massage on alleviating menstrual pain in nursing students: a prospective randomized cross-over study

Dysmenorrhea is a common cause of sickness absenteeism from both classes and work. This study investigated the effect of aromatherapy massage on a group of nursing students who are suffering of primary dysmenorrhea. A randomized blind clinical trial of crossover design was used. In the first treatment phase, group 1 (n = 48) received aromatherapy abdominal massage once daily for seven days prior to menstruation using the essential oils (cinnamon, clove, rose, and lavender in a base of almond oil). Group 2 (n = 47) received the same intervention but with placebo oil (almond oil). In the second treatment phase, the two groups switched to alternate regimen. Level and duration of pain and the amount of menstrual bleeding were evaluated at the baseline and after each treatment phase. During both treatment phases, the level and duration of menstrual pain and the amount of menstrual bleeding were significantly lower in the aromatherapy group than in the placebo group. These results suggests that aromatherapy is effective in alleviating menstrual pain, its duration and excessive menstrual bleeding. Aromatherapy can be provided as a nonpharmacological pain relief measure and as a part of nursing care given to girls suffering of dysmenorrhea, or excessive menstrual bleeding.

Effect of fennel on pain intensity in dysmenorrhoea: A placebo-controlled trial

The aim of this study was to determine the clinical effect of Foeniculum vulgare on primary dysmenorrhoea. Sixty virgin girls with complaints of dysmenorrhoea were enrolled in this study, out of which 50 cases were completed the course of treatment and were divided in two groups (study and placebo) and were under treatment for two cycles. In study group a capsule of 30 mg fennel extract, four times a day for three days from start of their menstrual period and in placebo a capsule containing wheat flour in same dose was administered. Intensity of pain was reported by using a 10 - point linear analogue technique. In study group the mean age of menarche was 13.1 ± 0.1 and onset age of dysmenorrhoea was 14.5 ± 0.1 years. Both groups were relieved but there was significant difference between study and placebo group. Study group shown more effective results than placebo in pain relief (P`0.05). Based on the observations, it can be concluded that, fennel is an effective herbal drug for menstrual pain.

Initiation rites at menarche and self-reported dysmenorrhoea among indigenous women of the Colombian Amazon: a cross-sectional study

OBJECTIVES

To investigate the association between self-reported dysmenorrhoea and patterns of female initiation rites at menarche among Amazonian indigenous peoples of Vaupés in Colombia.

DESIGN

A cross-sectional study of all women in seven indigenous communities. Questionnaire administered in local language documented female initiation rites and experience of dysmenorrhoea. Analysis examined 10 initiation components separately, then together, comparing women who underwent all rites, some rites and no rites.

SETTINGS

Seven indigenous communities belonging to the Tukano language group in the Great Eastern Reservation of Vaupés (Colombia) in 2008.

PARTICIPANTS

All women over the age of 13 years living in the seven communities in Vaupés, who had experienced at least two menstruations (n=185), aged 13-88 years (mean 32.5; SD 15.6).

PRIMARY AND SECONDARY OUTCOME MEASURES

The analysis rested on pelvic pain to define dysmenorrhoea as the main outcome. Women were also asked about other disorders present during menstruation or the precedent days, and about the interval between two menstruations and duration of each one.

RESULTS

Only 17.3% (32/185) completed all initiation rites and 52.4% (97/185) reported dysmenorrhoea. Women not completing the rites were more likely to report dysmenorrhoea than those who did so (p=0.01 Fisher exact), taking into account age, education, community, parity and use of family planning. Women who completed less than the full complement of rites had higher risk than those who completed all rites. Those who did not complete all rites reported increased severity of dysmenorrhoea (p=0.00014).

CONCLUSIONS

Our results are compatible with an association between traditional practices and women's health. We could exclude indirect associations with age, education, parity and use of family planning as explanations for the association. The study indicates feasibility, possible utility and limits of intercultural epidemiology in small groups.

A comparative study of Dashamoola Taila Matra Basti and Tila Taila Matra Basti in Kashtartava (dysmenorrhea)

Kashtartava is a broad term which covers all the problems and ailments that a woman may suffer from during or around menstruation. It includes both primary and secondary types of dysmenorrhea. For this study, however, we considered only primary dysmenorrhea under the term Kashtartava to cover a larger population and to make a pin-pointed assessment criteria. Thus, 40 patients in the age-group of 15–25 years suffering from primary dysmenorrhea were registered for the study. Of these patients, 35 completed the course of treatment. The selected patients were randomly allotted into two groups. Group A received Dashamoola Taila Matra Basti and group B received Tila Taila Matra Basti. These treatments were selected for the Vatashamaka, Yonishula Prashaman, and Shothahara properties of the drugs. The dose was 60 ml per day and the duration of treatment was for 7 days each cycle for two consecutive cycles. Results were assessed according to a specially prepared grading system for pain, Alpartava, Yatochitkaladarshana, Praseka, Chhardi, Vibandha, Shrama, Atisara, Vankshana, Kati, Janu Shula, Shiroshula, Swedadhikya, and Tamodarshana. Significant improvement was seen in symptoms in both groups, and on comparing the results in the two groups we found that the results were almost equivalent. There was complete remission of symptoms in 38.89% in group A and in 35.39% in group B, while there was marked improvement in 50% in group A and 47.65% in group B. However, there was a marked difference between the two groups with regard to recurrence of symptoms during the follow-up period of 2 months, with recurrence being significantly more in group B. The study suggests that Matra Basti can be a reliable treatment for relieving the symptoms of primary dysmenorrhea. We recommend that more research be done to confirm the findings of this study.

Evaluation of the relationship between endometriosis and omega-3 and omega-6 polyunsaturated fatty acids

BACKGROUND

Endometriosis is a common chronic inflammation causing major problems including infertility. The role of omega-3 and omega-6 fatty acids as their potential anti-inflammatory effects in endometriosis needs to be further explored. The objective of this study was to compare serum phospholipid fatty acid profile in endometriosis patients with controls, and to explore the correlation of this profile with the severity of the disease.

METHODS

Sixty-four endometriosis patients and 74 control women, in reproductive age, participated in this study. Among the endometriosis patients, 19 cases were in stage I, 27 cases in stage II, 8 cases in stage III, and 10 cases in stage IV. Each patient underwent laparoscopy. Before surgery, 5 ml of blood was obtained. After extraction of the total lipids, serum total phospholipid fraction was isolated by thin layer chromatography. Fatty acid composition of the phospholipid fraction was determined by gas chromatography and the resulted profile was compared in endometriosis patients and controls. The profile was also compared in the endometriosis group based on the severity of disease.

RESULTS

Stearic acid was significantly lower in the endometriosis group as compared to controls (P= 0.030). No other fatty acid compositions were significantly different between patients and controls. Serum ratio of eicosapentaenoic acid (EPA) to arachidonic acid (AA) was in reasonable correlation with the severity of endometriosis (r = 0.34, P = 0.006).

CONCLUSION

According to these findings, levels of fatty acids in serum total phospholipids seem not to be a marker for endometriosis, but the EPA to AA ratio was a relevant factor indicating severity of illness.

Effect of Zingiber officinale R. rhizomes (ginger) on pain relief in primary dysmenorrhea: a placebo randomized trial

BACKGROUND

Zingiber officinale R. rhizome (ginger) is a popular spice that has traditionally been used to combat the effects of various inflammatory diseases. The aim of this study was to evaluate the effects of ginger on pain relief in primary dysmenorrhea.

METHOD

This was a randomized, controlled trial. The study was based on a sample of one hundred and twenty students with moderate or severe primary dysmenorrhea. The students were all residents of the dormitories of Shahed University. They were randomly assigned into two equal groups, one for ginger and the other for placebo in two different treatment protocols with monthly intervals. The ginger and placebo groups in both protocols received 500 mg capsules of ginger root powder or placebo three times a day. In the first protocol ginger and placebo were given two days before the onset of the menstrual period and continued through the first three days of the menstrual period. In the second protocol ginger and placebo were given only for the first three days of the menstrual period. Severity of pain was determined by a verbal multidimensional scoring system and a visual analogue scale.

RESULTS

There was no difference in the baseline characteristics of the two groups (placebo n = 46, ginger n = 56). The results of this study showed that there were significant differences in the severity of pain between ginger and placebo groups for protocol one (P = 0.015) and protocol two (P = 0.029). There was also significant difference in duration of pain between the two groups for protocol one (P = 0.017) but not for protocol two (P = 0.210).

CONCLUSION

Treatment of primary dysmenorrhea in students with ginger for 5 days had a statistically significant effect on relieving intensity and duration of pain.

TRIAL REGISTRATION

IRCT201105266206N3.

Effect of three yoga poses (cobra, cat and fish poses) in women with primary dysmenorrhea: a randomized clinical trial

OBJECTIVE

We have evaluated the clinical efficacy of yoga for primary dysmenorrhea. Primary dysmenorrhea occurs in 50% of female adolescents and is a common problem in women of reproductive age. We have assessed whether three yoga poses (Cobra, Cat, and Fish Poses) are able to reduce severity and duration of primary dysmenorrhea.

METHODS

To determine the effectiveness of yoga in adolescents with primary dysmenorrhea, 92 girl students,18-22 years old, were randomly assigned to an experimental group (n = 50) and a control group (n = 42). The Visual Analog Scale for Pain was used to assess intensity of pain and the pain duration was calculated in terms of hours. Each group was evaluated for three menstrual cycles. At first cycle no method was presented; the participants only were asked to complete the questionnaire of menstrual characteristics during their menstrual. Then the participants were asked by the experimental group to do yoga poses at luteal phase, and also to complete the menstrual characteristics questionnaire in during of menstruation. The control group did not receive any intervention except to complete menstrual characteristics questionnaire in during of menstruation.

RESULTS

There was a significant difference in the pain intensity and pain duration in the post-tests compared with the pretest in yoga group (P < 0.05). The results showed that compared with the Control group, there was a significant difference in the pain intensity and pain duration in the experimental group (P < 0.05).

CONCLUSION

Yoga reduced the severity and duration of primary dysmenorrhea. The findings suggest that yoga poses are safe and simple treatment for primary dysmenorrhea.

Medicinal plants traditionally used in Mali for dysmenorrhea

Dysmenorrhea is painful menstrual cramps, which negatively impacts the quality of life of a large percentage of the world's female population in reproductive age. The paper reviews the plants used in the Malian traditional medicine for the treatment of dysmenorrhea. Some medicinal plants were effective for treatments of dysmenorrhea with minimal side effects. Conventional therapy for dysmenorrhea, which usually includes non-steroidal anti-inflammatory drugs (NSAIDs), provides symptomatic relief, but presents increasing adverse effects with long-term use. This article is in the framework of a study supported by International Foundation for Science (IFS) on three medicinal plants used in the treatment of dysmenorrhea in Mali: Maytenus senegalensis Stereospermum kunthianum and Trichilia emetica.

Selection and efficacy of self-management strategies for dysmenorrhea in young Taiwanese women

AIMS

This study investigates the selection and efficacy of various strategies employed by young Taiwanese women in the self-management of dysmenorrhea.

BACKGROUND

Dysmenorrhea is the common gynaecological problem in reproductive-aged women. In the past, non-specific treatments such as heat and exercise were found to be less effective. Current therapies for dysmenorrhea include prostaglandin synthetase inhibitors and herbal remedies.

DESIGN

Descriptive survey.

METHOD

The researcher-designed questionnaire listed common strategies used in Taiwan to self-manage dysmenorrhea. Content validity was applied for the determination of content items in measures. The total reliability of menstrual distress questionnaire was 0·95, menstrual symptoms questionnaire was 0·92 and coping strategies questionnaire was 0·94. The participants were asked to indicate if they used any of the methods over the past 12 months and, if so, if they were effective. Chi-square test comparisons were used to analyse the data collected.

RESULTS

Of the 616 individuals who completed the questionnaire, 570 reported experiencing dysmenorrhea at least once in the past year. Of these, 180 reported dysmenorrhea at every period and were categorised as Group I. The remaining 390 women were classified as Group II. Women in Group I used all of the listed strategies more frequently; however, they benefited less from all therapies except paracetamol. The most effective strategies in both groups were found to be paracetamol and Dang-Qui-Shao-Ya-San.

CONCLUSIONS

Paracetamol and Dang-Qui-Shao-Ya-San are the most effective strategies in relieving dysmenorrhea in young Taiwanese women, while other less effective strategies are used more frequently.

RELEVANCE TO CLINICAL PRACTICE

Identification of the most effective therapies for dysmenorrhea among commonly used strategies will help women choose the right therapy for them. As some young, inexperienced women might take two or more medications simultaneously because of ineffectiveness, thus increasing the risk of adverse effects, this study is of critical importance in promoting the safe use of medication for self-management of dysmenorrhea.

Primary Dysmenorrhea: Assessment and Management Update

Many women are familiar with the experience of dysmenorrhea, which can contribute to significant physical and emotional distress and life disruption. However, women may not seek professional expertise in their attempt to alleviate this condition. It is important to assess the beliefs and experiences of all women with dysmenorrhea, including adolescents, as early in gynecologic care as possible. This article reviews the management of primary dysmenorrhea. Midwives can provide valuable assistance to women in their explorations of the variety of treatment options available for the relief of dysmenorrhea, including lifestyle changes, complementary and alternative approaches, analgesics, and hormones.

Dietary therapy: a new strategy for management of chronic pelvic pain

Chronic pelvic pain (CPP) can be identified as a chronic nociceptive, inflammatory and neuropathic pain characterised by spontaneous pain and an exaggerated response to painful and/or innocuous stimuli. This pain condition is extremely debilitating and usually difficult to treat. Currently, the main approaches to treatment include counselling supported by reassuring ultrasound scanning or psychotherapy, attempting to provide reassurance using laparoscopy to exclude serious pelvic pathology, hormonal therapy and neuroablative treatment to interrupt nerve pathways. Dietary supplementation has been suggested as a means to treat chronic medical illnesses that are poorly responsive to prescription drugs or in which therapeutic options are limited, costly or carry a high side-effect profile. A comprehensive search of the PubMed database was performed using the search terms 'chronic pelvic pain', 'oxidative stress', 'antioxidants' and 'dietary therapy'. The systematic review focuses on both randomised and non-randomised controlled trials from 2005 onwards, in which CPP was the end point. Given the complexity and not well-understood aetiology of CPP, its treatment is often unsatisfactory and limited to partial symptom relief. Dietary therapy with antioxidants improves function of the immune system and in fighting free radical damage. Agents with antioxidant activity are able to improve CPP without undesired effects and any important metabolic changes associated with hormonal suppression therapy. In conclusion, dietary therapy with antioxidants could be considered as a new effective strategy in the long term for CPP, and may be better accepted by patients. Further randomised trials with larger series and long-term follow-up to confirm these observations are needed.

Women's health: selected topics

Complementary and alternative medicine (CAM) therapies have become increasingly popular for the treatment of a variety of conditions. The World Health Organization has recognized the value of traditional healing techniques, which are classified as CAM, for 30 years. In the United States nearly 50% of women use CAM for common medical conditions, significantly more than men. This pattern is frequently seen in the treatment of women's health conditions such as infertility, premenstrual syndrome, and menopause. This article provides an integrative approach for conditions commonly encountered in the primary care setting among women, discusses alternative therapies used to treat these health conditions, and provides an evidence-based summary of recommendations based on a review of the literature.

Dysmenorrhea

Primary dysmenorrhea is commonly a straightforward diagnosis that can be made accurately with an attentive history. In young women who have classic symptoms and no specific indication, a pelvic examination is often unnecessary in the initial evaluation. The opportunity for primary care practitioners to support women in unearthing the best approach to this chronic recurrent discomfort to minimize adverse life impact is significant and valuable. Identification of patients who are incapacitated by their symptoms or have symptoms that represent underlying pathology is a critical component of a careful history. The wide range of treatments available for primary dysmenorrhea virtually ensures that all females troubled by the symptoms can find relief with safe and inexpensive treatments while limiting negative side effects.

Chinese herbal medicine for primary dysmenorrhoea

BACKGROUND

Conventional treatment for primary dysmenorrhoea has a failure rate of 20% to 25% and may be contraindicated or not tolerated by some women. Chinese herbal medicine may be a suitable alternative.

OBJECTIVES

To determine the efficacy and safety of Chinese herbal medicine for primary dysmenorrhoea when compared with placebo, no treatment, and other treatment.

SEARCH STRATEGY

The Cochrane Menstrual Disorders and Subfertility Group Trials Register (to 2006), MEDLINE (1950 to January 2007), EMBASE (1980 to January 2007), CINAHL (1982 to January 2007), AMED (1985 to January 2007), CENTRAL (The Cochrane Library issue 4, 2006), China National Knowledge Infrastructure (CNKI, 1990 to January 2007), Traditional Chinese Medicine Database System (TCMDS, 1990 to December 2006), and the Chinese BioMedicine Database (CBM, 1990 to December 2006) were searched. Citation lists of included trials were also reviewed.

SELECTION CRITERIA

Any randomised controlled trials involving Chinese herbal medicine versus placebo, no treatment, conventional therapy, heat compression, another type of Chinese herbal medicine, acupuncture or massage. Exclusion criteria were identifiable pelvic pathology and dysmenorrhoea resulting from the use of an intra-uterine contraceptive device.

DATA COLLECTION AND ANALYSIS

Quality assessment, data extraction and data translation were performed independently by two review authors. Attempts were made to contact study authors for additional information and data. Data were combined for meta-analysis using either Peto odds ratios or relative risk (RR) for dichotomous data or weighted mean difference for continuous data. A fixed-effect statistical model was used, where suitable. If data were not suitable for meta-analysis, any available data from the trial were extracted and presented as descriptive data.

MAIN RESULTS

Thirty-nine randomised controlled trials involving a total of 3475 women were included in the review. A number of the trials were of small sample size and poor methodological quality. Results for Chinese herbal medicine compared to placebo were unclear as data could not be combined (3 RCTs). Chinese herbal medicine resulted in significant improvements in pain relief (14 RCTs; RR 1.99, 95% CI 1.52 to 2.60), overall symptoms (6 RCTs; RR 2.17, 95% CI 1.73 to 2.73) and use of additional medication (2 RCTs; RR 1.58, 95% CI 1.30 to 1.93) when compared to use of pharmaceutical drugs. Self-designed Chinese herbal formulae resulted in significant improvements in pain relief (18 RCTs; RR 2.06, 95% CI 1.80 to 2.36), overall symptoms (14 RCTs; RR 1.99, 95% CI 1.65 to 2.40) and use of additional medication (5 RCTs; RR 1.58, 95% CI 1.34 to 1.87) after up to three months of follow-up when compared to commonly used Chinese herbal health products. Chinese herbal medicine also resulted in better pain relief than acupuncture (2 RCTs; RR 1.75, 95% CI 1.09 to 2.82) and heat compression (1 RCT; RR 2.08, 95% CI 2.06 to 499.18).

AUTHORS' CONCLUSIONS

The review found promising evidence supporting the use of Chinese herbal medicine for primary dysmenorrhoea; however, results are limited by the poor methodological quality of the included trials.

Hormonal suppression treatment or dietary therapy versus placebo in the control of painful symptoms after conservative surgery for endometriosis stage III–IV. A randomized comparative trial

OBJECTIVE

To evaluate the effectiveness for the outcomes of endometriosis-related pain and quality of life of conservative surgery plus placebo compared with conservative surgery plus hormonal suppression treatment or dietary therapy.

DESIGN

Randomized comparative trial.

SETTING

University hospital.

PATIENT(S)

Two hundred twenty-two consecutive women who underwent conservative pelvic surgery for symptomatic endometriosis stage III-IV (r-AFS).

INTERVENTION(S)

Six months of placebo (n = 110) versus GnRH-a (tryptorelin or leuprorelin, 3.75 mg every 28 days) (n = 39) or continuous estroprogestin (ethynilestradiol, 0.03 mg plus gestoden, 0.75 mg) (n = 38) versus dietary therapy (vitamins, minerals salts, lactic ferments, fish oil) (n = 35).

MAIN OUTCOME MEASURE(S)

Painful symptoms (visual analogue scale score) and quality-of-life endometriosis-related symptoms (SF-36 score) at 12 months' follow-up.

RESULT(S)

Patients treated with postoperative hormonal suppression therapy showed less visual analogue scale scores for dysmenorrhoea than patients of the other groups. Hormonal suppression therapy and dietary supplementation were equally effective in reducing nonmenstrual pelvic pain. Surgery plus placebo showed significative decrease in dyspareunia scores. Postoperative medical and dietary therapy allowed a better quality of life than placebo.

CONCLUSION(S)

Postoperative hormonal suppression treatment or dietary therapy are more effective than surgery plus placebo to obtain relief of pain associated with endometriosis stage III-IV and improvement of quality of life.

Omega-3 fatty acids for intermittent claudication

BACKGROUND

Omega-3 fatty acids are established as being effective in the treatment and prevention of coronary artery disease. It is possible that they may also benefit people with peripheral arterial disease, since the pathogenesis of the two conditions is similar.

OBJECTIVES

To determine the clinical and haematological effects of omega-3 supplementation in people with intermittent claudication.

SEARCH STRATEGY

Trials were identified from the Cochrane Peripheral Vascular Diseases Group trials register (last searched August 2007), and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (last searched Issue 3, 2007). In addition, we searched literature from pharmaceutical companies, manufacturers of omega-3 rich foods and web sites of nutritional organisations dedicated to omega-3 fatty acids.

SELECTION CRITERIA

Randomised controlled trials of omega-3 fatty acids versus placebo or non-omega-3 fatty acids in people with intermittent claudication.

DATA COLLECTION AND ANALYSIS

One author identified potential trials. Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information if necessary.

MAIN RESULTS

Six studies were included representing 313 participants. All studies compared omega-3 fatty acid supplementation with placebo lasting from 4 weeks to 2 years. Two studies with long treatment periods administered additional substances, making any observed effects impossible to attribute to omega-3 fatty acids and were therefore excluded from the statistical analyses. No significant differences between intervention and control groups were observed in ankle brachial pressure index (ABPI) (weighted mean difference (WMD) -0.02; 95% CI -0.09 to 0.05), systolic blood pressure (WMD 5.00 mmHg; 95% CI -11.59 to 21.59), plasma viscosity (WMD 0.03 mPa/s; 95% CI -0.02 to 0.08), pain-free walking distance (PFWD) (WMD 7.46 m; 95% CI -25.47 to 40.39), or maximal walking distance (MWD) (WMD 0.27 m; 95% CI -39.59 to 40.13). Blood viscosity levels decreased. Gastrointestinal side effects were observed in two studies. Omega-3 fatty acid supplementation increased (low-density lipoprotein) LDL cholesterol levels (WMD 0.80 mmol/litre; 95% CI 0.34 to 1.26) and total cholesterol levels (WMD 0.64 mmol/litre; 95% CI 0.08 to 1.20).

AUTHORS' CONCLUSIONS

Omega-3 fatty acids appear to have limited haematological benefits in people with intermittent claudication but there is no evidence of consistent improved clinical outcomes which are the primary outcomes of this review (quality of life, PFWD, MWD, ABPI, angiographic findings). Supplementation may also cause adverse effects such as increased total and LDL cholesterol levels. Further research is needed in this area, to evaluate short- and long-term effects on more clinically relevant outcomes.