Prevalence and impact of dysmenorrhea in Swedish adolescents

Adenomyosis diagnosis among adolescents and young women with dysmenorrhoea and heavy menstrual bleeding

RESEARCH QUESTION

What is the prevalence of adenomyosis at ultrasonography among adolescents and young women reporting dysmenorrhoea and/or heavy menstrual bleeding (HMB)?

DESIGN

This observational cohort study involved adolescents and young women referred for dysmenorrhoea and/or HMB to the Adolescent Medicine Unit at Careggi University Hospital, Italy. Patients with endometriosis and bleeding disorders were excluded. Transvaginal ultrasonography or transrectal sonography using a transvaginal probe was performed. The myometrium was described according to the Morphological Uterus Sonographic Assessment criteria. Details of baseline characteristics, clinical data and symptoms were collected. The presence of sonographic features of adenomyosis and the association between imaging findings and clinical symptoms were evaluated.

RESULTS

The cohort included 95 patients aged between 13 and 25 years, referred for dysmenorrhoea (88.4%), HMB (23.2%) or both (13.7%). According to the MUSA criteria the sonographic diagnosis of adenomyosis was made in 27.4% of patients, with the diffuse type the most prevalent. Uterine wall asymmetry, hyperechoic intramyometrial islands, translesional vascularity and an interrupted junctional zone were the most common features. Patients with imaging findings of adenomyosis had significantly higher rates of HMB than those with a normal myometrial appearance (38.5% versus 17.4%, P = 0.030). In addition, the coexistence of dysmenorrhoea and HMB was significantly associated with adenomyosis (odds ratio 5.68, 95% confidence interval 1.65-19.5).

CONCLUSIONS

Adenomyosis may be diagnosed among teenagers and young women referred with dysmenorrhoea and/or HMB. The clinical presentation is relevant for the diagnosis, with HMB alone and HMB plus dysmenorrhoea significantly associated with the sonographic identification of adenomyosis.

"You're Not Alone": How Adolescents Share Dysmenorrhea Experiences Through Vlogs

Many adolescents experience severe pain during menstruation, yet their attempts to receive medical attention to alleviate or manage this pain are often met with dismissal or disbelief. In light of these barriers to care, many adolescents turn to social media to share their experiences with menstruation and pain, as well as hear from other members of their community. In this study, we investigated how adolescents present their experiences with menstruation in vlogs (or "video blogs"). Using critical qualitative methods and a four-column analysis structure, we transcribed and thematically analyzed the audio and video content of 17 YouTube vlogs wherein adolescents described their experiences with menstrual pain. We found that stylistically, the vloggers modulated between a polished documentary style and an intimate storytime style of video production. We additionally found that vloggers spoke about their menstrual pain experiences from three perspectives: as a Patient managing and diagnosing physical symptoms, as a Self considering how the pain affects their life and ambitions, and as a Teacher educating their audience. Considering both the visual and audio data, we discuss how healthcare providers can use these findings to inform their approach to discussing menstrual pain with adolescents. We further discuss possible future directions for research into health story sharing on social media.

Dysmenorrhea in Tunisian high school adolescent girls: frequency, effects, and absence from school

OBJECTIVES

Dysmenorrhea is a known phenomenon and not just recently, and investigations conducted recently have shown that female adolescents are very susceptible to this condition. Our goal is to determine the prevalence of dysmenorrhea in Tunisia, its risk factors, its impact on truancy rates, and the therapeutic attitudes of girls attending high school about this illness using an epidemiological survey.

METHODS

This eight-month study, which spans from October 2022 to May 2023, focuses on 160 high school girls between the ages of 13 and 21. It is a transversal descriptive study. The required data is gathered through the distribution of a self-administered questionnaire.

RESULTS

The mean age of female adolescent participants is 16.44 years and 68 % of them reported dysmenorrhea. The most common symptoms of the pain were headaches (40.0 %). There is a notable prevalence of absenteeism during the menstrual cycle. There seems to be a trend toward self-medication.

CONCLUSIONS

In Tunisia, primary dysmenorrhea is a common cause of school absenteeism among female adolescents. Girls' attitudes toward dysmenorrhea indicate a lack of knowledge, which is why it is crucial for midwives and physicians to educate teenage girls about the condition.

Determinants of dysmenorrhoea among female adolescents: results from a community-based cohort study in Amsterdam

RESEARCH QUESTION

What is the contribution of sociodemographic, psychosocial, lifestyle and reproductive factors up to the age of 11-12 years to the occurrence of dysmenorrhoea at age 15-16 years within the Amsterdam Born Children and their Development (ABCD) study?

DESIGN

Data of 1038 female adolescents were used. Participants' baseline characteristics were obtained using self-reported questionnaires up to the age of 11-12 years, as well as the obstetric information of their mothers during pregnancy. Dysmenorrhoea was assessed at the age of 15-16 years, and was deemed to be present if an adolescent reported menstrual abdominal and/or back pain and therefore took medication and/or hormonal contraception. Using a backward selection approach, potential determinants of dysmenorrhoea were selected and multivariable associations were determined.

RESULTS

The overall prevalence of dysmenorrhoea was 49.5% among the participants. Intake of 3-4.5 sugar-sweetened beverages/day (P = 0.035) and higher gynaecological age (i.e. years since menarche) (P < 0.001) were significantly associated with higher occurrence of dysmenorrhoea in the final model, which explained 8.1% of the total variance in the occurrence of dysmenorrhoea. No significant associations were found between the occurrence of dysmenorrhoea and sociodemographic or psychosocial factors.

CONCLUSIONS

This investigation of various potential risk factors for dysmenorrhoea suggests that diet and reproductive factors are particularly important predictors of the occurrence of dysmenorrhoea among young adolescents. Specifically, intake of sugar-sweetened beverages and higher gynaecological age were predictive of the occurrence of dysmenorrhoea. Other lifestyle factors were also identified as possible risk factors. Using this knowledge, effective strategies can be developed to reduce the burden of dysmenorrhoea among adolescents, and to provide appropriate care for those suffering from the condition.

Screening women in young adulthood for disabling dysmenorrhoea: a nationwide cross-sectional study from the CONSTANCES cohort

RESEARCH QUESTION

How do different warning indicators help to identify disabling dysmenorrhoea among women in young adulthood?

DESIGN

A nationwide cross-sectional study of women aged 18-25 years from the CONSTANCES cohort was constructed. Disability was assessed with the Global Activity Limitation Indicator question 'For the past 6 months, have you been limited in routine activities?Yes, severely limited/Yes, limited/ No, not limited'. Dysmenorrhoea pain intensity and other chronic pelvic pain symptoms (dyspareunia and non-menstrual pain) were evaluated according to questions from a specific questionnaire. Probability of disability was estimated using a logistic prediction model according to dysmenorrhoea intensity, other indicators of pelvic pain symptoms and other obvious covariates. The results of the predictive model of disabling dysmenorrhoea were presented on a nomogram.

RESULTS

Among 6377 women, the rate of disability was estimated at 7.5%. Increased intensity of dysmenorrhoea (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.04-1.13), increased frequency of dyspareunia (from OR 1.69, 95% CI 1.33-2.14 up to OR 3.41, 95% CI 2.16-5.38) non-menstrual chronic pelvic pain (OR 1.75, 95% CI 1.40-2.19), body mass index over 25 kg/m2 (OR 1.45, 95% CI 1.17-1.80) and non-use of the hormonal contraceptive pill (OR 1.29, 95% CI 1.05-1.59) were significantly associated with disability. According to the nomogram, a predicted probability of 15% or more could be chosen as a threshold. This represents almost 4.6% of young women in this sample being classified at risk of disabling dysmenorrhoea.

CONCLUSIONS

Dysmenorrhoea pain intensity and associated pelvic pain symptoms are warning indicators that can be measured to help screen young women who may suffer from disabling dysmenorrhoea.

Periods Shouldn't Bring Any Adolescents' World to a Full Stop. Period. An Online Survey of Adolescents' Experience of Menstruation

STUDY OBJECTIVE

Few studies have explored what specific outcome measures contained in assessment tools for period and pelvic pain are most relevant to adolescents. Co-design is a valuable method of ensuring input from those with lived experience. The Longitudinal Study of Teenagers with Endometriosis Periods and Pelvic Pain in Australia (LongSTEPPP) Co-Design Periods Survey comprised an anonymous online survey of adolescents' experience of menstruation to inform patient-reported outcome measures for the larger 5-year project.

METHODS

Adolescents aged 12-18 years whose periods had commenced at least 3 months previously and with demonstrated capacity to consent were invited to participate in an online survey. Recruitment was primarily via social media channels.

RESULTS

Of the 1811 adolescents who participated, 85% reported that periods had a "moderate" or greater impact on their life. Pain (90.7%), heavy flow (56.2%), and worry about leakage (49%) were common reasons for missed activities. Menstrual symptoms were wide-ranging and included cramping, nausea, poor energy, and impacts on mood. When asked where adolescents sought assistance with their periods, 39.8% had seen their general practitioner, 21.3% their school nurse, and almost 1 in 10 had consulted a mental health practitioner (9.3%). To manage menstrual symptoms, heat packs (66.0%), over-the-counter medications (55.8%), and prescription medications (28.6%) were used.

CONCLUSION

We found a lack of menstrual health awareness in adolescents. Periods had a significant effect on their lives, and adolescents commonly missed activities. In managing menstruation, a wide range of practitioners were consulted. Nearly a third were prescribed medication to manage their periods. These findings have directed the longitudinal study as to how best to capture outcome measures that reflect the impact of periods on adolescents.

Development and initial validation of the menstrual sensitivity index

OBJECTIVE

The present study sought to develop and perform the initial validation of a scale assessing sensitivity to menstrual pain and symptoms.

METHODS

Data were taken from a larger parent study in which participants were recruited from a nationwide sample of individuals via the UniVox platform (www.univoxcommunity.com). In that study, participants were stratified by age and self-reported menstrual pain. Participants in the parent study completed 2 online surveys, one at baseline and one at a 3-month follow up. Participants who provided complete responses to the potential scale items, as well as a variety of validated questionnaires, were included in the present analyses. Final item selection was determined by factor analyses, and measures of validity and reliability were examined.

RESULTS

Factor analyses support an 8-item scale assessing menstrual sensitivity. This scale, the Menstrual Sensitivity Index, demonstrates excellent internal consistency, good item-total correlations, and good total score test-retest reliability. Convergent validity emerged for menstrual- and pain-specific measures, and divergent validity emerged for anxiety sensitivity, anxiety, depression, nonmenstrual bodily pain, and premenstrual symptoms.

CONCLUSIONS

Menstrual sensitivity is a unique construct that reflects women's attunement to and fear of menstrual symptoms, and the Menstrual Sensitivity Index is a valid and reliable measure of this construct. This scale could be useful in advancing research and clinical work targeting menstrual pain.

Reflections on the group dynamic in a group cognitive behavioral therapy intervention for young adult women with moderate to severe dysmenorrhea: a qualitative analysis

A recent group cognitive behavioral therapy (gCBT) intervention for dysmenorrhea conducted by our team demonstrated feasibility, acceptability, and preliminary efficacy at reducing menstrual pain. This study aimed to use qualitative analyses to explore participants' reflections about the intervention's group dynamic. Participants included 20 young women ages 18-24 years with average menstrual pain of 8.0 (SD = 1.1) on a 0-10 (0 = none, 10 = worst pain possible) numeric rating scale. Semi-structured individual and group interviews were conducted after the intervention. Researchers then conducted deductive, iterative thematic analysis using a template analysis approach. Two themes were generated: benefit and logistics. The benefit theme included two sub-themes: (1) camaraderie (an emotional, psychological, or social connection between participants); and (2) sharing (information, advice, or experiences). The logistics theme highlighted how the structure of the group influenced the dynamic and was divided into two sub-themes according to the time frame being described: (1) reactions (participants' experiences with how the group dynamic was facilitated); and (2) future (how the group structure could be improved). Results of this study contribute to the growing body of literature related to gCBT for pain conditions. Future research is needed to optimize the group dynamic and evaluate its specific therapeutic role in the treatment.

Relationship between menstruation-related experiences and health-related quality of life of Japanese high school students: a cross-sectional study

BACKGROUND

Recently, there has been a growing global movement concerning menstruation, a healthy and natural physiological phenomenon in women. The disadvantages caused by menstruation are "gender-based obstacles." Adolescent girls are also under its influence and perhaps in a more vulnerable situation than adult women. This study investigated the experiences related to menstruation that affect health-related quality of life (HRQOL) of high school students in Japan.

METHODS

This cross-sectional study was conducted at a municipal high school in Fukuoka Prefecture, Japan. The study population comprised 233 female students among which 198 completed the questionnaire. The questionnaire contained items about menstruation and HRQOL measured by the 36-Item Short Form Health Survey (SF-36).

RESULTS

Approximately a quarter had experienced difficulties in obtaining sanitary products in the past year, whether for economic or non-economic reasons. Menstruation-associated symptoms, impact on daily life, trouble with menstruation at an unexpected time, usage of painkillers, unhealthy lifestyle, and negative perception of menstruation were significantly associated with lower HRQOL scores, particularly in the mental component summary scores of the SF-36.

CONCLUSIONS

For the high school students with severe menstruation-associated symptoms that interfere with their daily lives, the results of this study suggest that improving access to medical care, information, and education can contribute to a better HRQOL.

Characteristics of Menstrual Suppression and Its Association With Mental Health in Transgender Adolescents

OBJECTIVE

To investigate the prevalence, nature, and effectiveness of menstrual suppression in transgender and gender-diverse (TGD) adolescents, and to explore whether there is an association between menstrual suppression and mental health in this population.

METHODS

A cross-sectional study was performed of TGD adolescents assigned female at birth attending their first appointment at a specialist pediatric gender service between February 2017 and December 2021. Demographic and mental health data were collected using a questionnaire at the time of first visit, and information regarding menstrual suppression at this time was retrieved from the medical record.

RESULTS

A total of 530 TGD individuals were included; 131 (24.7%) were on menstrual suppression at their initial visit, mainly to help alleviate gender dysphoria. Combined oral contraceptive pills were the most common agent used (n=61, 46.6%), followed by norethindrone (n=39, 29.8%) and intramuscular medroxyprogesterone (n=19, 14.5%). Rates of effectiveness (in stopping menstruation) and patient satisfaction were high. Among the 399 individuals not on menstrual suppression, there was strong interest in starting this treatment. No differences in the risk of gender dysphoria, depression, or anxiety were observed between those who were receiving menstrual suppression and those who were not.

CONCLUSION

Effectiveness of and satisfaction with menstrual suppression were high in TGD adolescents receiving this treatment. These findings support the routine exploration and management of menstrual health in TGD adolescents. However, menstrual suppression was not associated with any difference in gender dysphoria, depression, or anxiety symptoms in this cross-sectional study, and longitudinal studies are required to better investigate this.

Insight into Dysmenorrhea Research from 1992 to 2022: A Bibliometric Analysis

Dysmenorrhea, classified as primary dysmenorrhea and secondary dysmenorrhea, is a common gynecological symptom that seriously affects female daily life. At present, studies on dysmenorrhea are numerous and complex. To better reflect the trend and innovative progress of dysmenorrhea-related research, this study screened papers on the Web of Science from January 1, 1992, to December 31, 2022. A total of 1012 papers were selected and analyzed for their affiliated countries, institutions, authors, keywords, etc. China is the country with the most academic output, Beijing University of Traditional Chinese Medicine is the most influential institution, and Yang Jie, from Chengdu University of Traditional Chinese Medicine, China, is the scholar with the most papers. We consider that the current research focus is on pathogenesis, treatment, epidemiology, and self-management. With increasing research on functional connectivity between dysmenorrhea and various brain regions, functional connectivity has gradually become the forefront of research. We hope our study can promote the further study of dysmenorrhea.

Prevalence of Primary Dysmenorrhoea and Its Impact on Academic Performance among Croatian Students during the COVID-19 Pandemic

Background

Dysmenorrhoea is one of the most common gynaecological problems. Therefore, it is important to investigate its impact during the COVID-19 pandemic which has a great impact on the lives of menstruating people all over the world.

Aim

To determine the prevalence and impact of primary dysmenorrhoea on academic performance among students during the pandemic.

Materials and Methods

This cross-sectional study was conducted in April 2021. All data were collected by an anonymous self-assessed web-based questionnaire. Due to voluntary participation in the study, 1210 responses were received, but 956 were left for analysis after exclusion criteria were applied. Descriptive quantitative analysis was performed and Kendall rank correlation coefficient was used.

Results

The prevalence of primary dysmenorrhoea was 90.1%. Menstrual pain was mild in 7.4% of cases, moderate in 28.8%, and severe in 63.8%. The study found that primary dysmenorrhoea has a great perceived impact on all included aspects of academic performance. Most affected were concentration in class in 810 (94.1%) and doing homework and learning in 809 (94.0%) female students. There is also a correlation between menstrual pain intensity and its impact on academic performance (p < 0.001).

Conclusions

Our study found that the prevalence of primary dysmenorrhoea among students at the University of Zagreb is high. Painful menstruation greatly impacts academic performance and therefore it is important to do more research on this topic.

Association between depression and dysmenorrhea among adolescent girls: multiple mediating effects of binge eating and sleep quality

BACKGROUND

Dysmenorrhea has a significant negative impact on teenagers' quality of life, and its prevalence is increasing annually. Although studies have explored the factors affecting dysmenorrhea, it remains unclear how these factors interact with one another. This study aimed to explore the mediating role of binge eating and sleep quality between depression and dysmenorrhea.

METHODS

This cross-sectional study recruited adolescent girls from the Health Status Survey of adolescents in Jinan, Shandong Province, and used multistage stratified cluster random sampling. Data was collected using an electronic questionnaire between March 9, 2022, and June 20, 2022. The Numerical Rating Scale and Cox Menstrual Symptom Scale were used to assess dysmenorrhea and the Patient Health Questionnaire-9 to assess depression. The mediation model was tested by Mplus 8.0, and the mediating effect was analyzed using the Product of Coefficients approach and the Bootstrap method.

RESULTS

Among the total of 7818 adolescent girls included in this study, the prevalence of dysmenorrhea is 60.5%. A significant positive association was found between dysmenorrhea and depression. Binge eating and sleep quality seemingly mediate this association. The mediating effect of sleep quality (21.31%) was greater than that of binge eating (6.18%).

CONCLUSIONS

The findings of this study point in the right direction for preventing and treating dysmenorrhea in adolescents. For adolescent dysmenorrhea, mental health should be considered and proactive steps taken for educating adolescents on healthy lifestyles to reduce negative consequences of dysmenorrhea. Longitudinal studies on the causal link and influence mechanisms between depression and dysmenorrhea should be conducted in the future.

Early noninvasive diagnosis of endometriosis: dysmenorrhea and specific ultrasound findings are important indicators in young women

OBJECTIVES

To diagnose endometriosis in young patients ≤25y with severe dysmenorrhea through specific ultrasonographic examination findings and to correlate the symptoms to its different forms: ovarian, deep infiltrating endometriosis, and adenomyosis.

DESIGN

A retrospective observational study.

SETTING

University Hospital.

PATIENT(S)

Women aged 12-25 years with severe dysmenorrhea and a visual analog scale score ≥7.

INTERVENTION(S)

This study included 371 women aged 12-25 years referred to our gynecological ultrasound (US) Unit between January 2016 and December 2021 with severe dysmenorrhea and a visual analog scale score ≥7. Two dimensional, 3 dimensional, and power Doppler US pelvic examinations (transvaginal or transrectal in presexually active girls) were performed on all patients. Medical history and symptoms were collected routinely for each patient before the scan.

MAIN OUTCOME MEASURE(S)

All possible locations of endometriosis, isolated or combined occurrence, were evaluated, and recorded using an US dedicated mapping sheet. Painful symptoms were evaluated by visual analog scale and correlated to the different endometriosis forms.

RESULT(S)

At least one US endometriosis feature was identified in 131 (35.3%) patients, whereas the US findings of 170 (45.8%) were normal despite the referred dysmenorrhea. Of the 131 patients with endometriosis, ovarian endometrioma was found in 54 (41.2%), and 22 (16.8%) had an isolated endometrioma. Adenomyosis was detected in 67 (51.1%) patients, and 28 (21.4%) showed its isolated indications. Posterior deep infiltrating endometriosis was found in 70 (53.4%) patients, and uterosacral ligament (USL) fibrotic thickening was found in 63 (48.1%). In 23 patients, the USL lesion was completely isolated. The combined occurrence of dysmenorrhea with dyspareunia, bowel symptoms, and heavy menstrual bleeding increases the presence of endometriosis up to 59%, 63%, and 45%, respectively.

CONCLUSION(S)

In young patients with severe dysmenorrhea, the US-based detection rate of pelvic endometriosis was one-third. USL fibrotic thickening and mild adenomyosis are often the only findings, so an accurate pelvic US scan can provide an early diagnosis by identifying small endometriotic lesions. Young patients with dysmenorrhea should be referred to an expert sonographer to minimize the delay between the onset of symptoms and diagnosis.

Smartphone apps for menstrual pain and symptom management: A scoping review

The past decade marks a surge in the development of mobile apps used to digitally track and monitor aspects of personal health, including menstruation. Despite a plethora of menstruation-related apps, pain and symptom management content available in apps has not been systematically examined. The objective of this study was to evaluate app characteristics, overall quality (i.e., engagement, functionality, design aesthetics, and information), nature and quality of pain and symptom tracking features, and availability and quality of pain-related intervention content. A scoping review of apps targeting facets of the menstrual experience was conducted by searching the Apple App Store. After removal of duplicates and screening, 119 apps targeting menstrual experiences were retained. Pain and menstrual symptoms tracking were available in 64 % of apps. Checkboxes or dichotomous (present/absent) reporting was the most common method of tracking symptoms and was available in 75 % of apps. Only a small subset (n = 13) of apps allowed for charting/graphing of pain symptoms across cycles. Fourteen percent of apps included healthcare professionals or researchers in their development and one app reported use of end-users. Overall app quality measured through the Mobile App Rating Scale (MARS) was found to be acceptable; however, the apps ability to impact pain and symptom management (e.g., impact on knowledge, awareness, behaviour change, etc.) was rated as low. Only 10 % of apps (n = 12) had interventions designed to manage pain. The findings suggest that despite pain and symptom management content being present in apps, this content is largely not evidence-based in nature. More research is needed to understand how pain and symptom management content can be integrated into apps to improve user experiences.

Supporting girls with painful menstruation - A qualitative study with school nurses in Sweden

BACKGROUND

Painful menstruation is common among girls. To optimize school nurses' work more knowledge about their experiences of supporting these girls is needed. The aim of this study was to describe school nurses' experiences of supporting girls with menstrual pain.

METHODS

Interviews were conducted with 15 school nurses in Sweden and analyzed using thematic analysis.

RESULTS

Three themes emerged: Taking menstrual pain seriously, Being a disseminator of knowledge, and External conditions for conducting professional work as a school nurse.

CONCLUSION

School nurses felt competent in supporting girls with menstrual pain. However, they lacked structural, written guidelines and routines for how to treat, support, follow-up and refer girls with menstrual pain.

PRACTICE IMPLICATIONS

School education about menstruation and sexual health needs to be strengthened. Cooperation with other healthcare facilities and networks with other school nurses should be increased. Specific guidelines on how to support girls with menstrual pain should be implemented.

Prevalence of menstrual symptoms change and influencing factors among international female students studying in china during acculturation period

Background

A number of previous studies have explored international students’ adaptation process with regards to language, lifestyle, food, and environment. However, there have yet been no studies conducted to address the menstrual symptoms challenges faced by international female students during the acculturation period. Thus, this study aims to describe the prevalence of menstrual symptoms change and to explore the influencing factors among international female students studying in China during the acculturation period.

Methods

An online cross sectional study was conducted among international female students studying in China during the acculturation period (defined as the first six months of living in the host country) in Hunan Province of China from March 2019 to July 2019. Menstrual symptoms questionnaire, sociocultural adaptation scale, China higher education student satisfaction scale, perceived stress scale, and Pittsburgh sleep quality index were used for data collection. Descriptive analysis, ANOVA, paired t-test, Pearson correlation, and multivariate linear regressions were used to analyze the data using SPSS 21.0 software.

Results

Three hundred and forty-five (97.18%, 345/355) female students from 45 countries fully completed the questionnaire. The mean age of the participants was (26.59 ± 6.439) years. In total, 18.49% of participants had encountered menstrual symptoms change. There were significant differences in the menstrual symptoms score between before arrival and evaluation during the first six months of living in China (t = − 11.700, p = 0.000). The main menstrual symptoms change included cramps (17.68%), irritation (14.78%), abdominal pain (12.46%), fatigue (12.46%), and headaches (9.85%). Cultural adaptation level (β = 0.198, 95% CI: 0.934, 2.995), sleep quality (β = 0.166, 95% CI: 0.112, 0.496), perceived stress (β = 0.193, 95% CI: 0.123, 0.410), time spent in the host environment, (β = − 0.270, 95% CI: − 3.200, − 1.444) and experience of visiting foreign countries (β = 0.184, 95% CI: 1.134, 4.125) were significantly correlated with menstrual symptoms change.

Conclusion

The prevalence of menstrual symptoms change among international female students should not be overlooked when considering menstrual health in this population. Poorer cultural adaptation, poorer sleep quality, higher stress, and lack of overseas living experiences significantly influence the menstrual symptoms of international female students studying in China.

Myofascial Trigger Points and Central Sensitization Signs, but No Anxiety, Are Shown in Women with Dysmenorrhea: A Case-Control Study

Background primary dysmenorrhea (PD) is considered to be a cyclic chronic pelvic pain, with its onset in menstrual periods, often accompanied by the presence of myofascial trigger points (MTP). Most MTPs in subjects with chronic pelvic pain are in the inferior part of the abdomen, in the rectus abdominis (RA) area. Central sensitization is closely related to chronic pain processes. Previous studies in women with chronic pelvic pain reported central sensitization signs in their subjects, such as lower pain pressure threshold (PPT). Several authors agree that PPT in the tibialis anterior (TA) muscle, seems to be a reliable reference for signs of central sensitization. Amongst the factors that seem to accompany central sensitization, the presence of anxiety needs to be considered. The aim of the present study was to analyze the existence of hyperalgesic MTPs in RA, central sensitization signs and anxiety in women with PD, in comparison with a control group (CG). Methods: This study was designed following an observational, cross-sectional, case-control model. A total sample of 80 subjects was recruited trough social webs and advertising (PD n = 39) (CG n = 41). PPT in RA and AT was assessed bilaterally through algometry, and anxiety was evaluated through the State−Trait Anxiety Inventory. Results: Statistically significant differences (p < 0.001) were shown for NRS average and maximum increase, as well as lower bilaterally RA and TA PPT in favor of PD group compared to CG. State or trait STAI did not show any statistically significant differences (p > 0.05) between groups. Conclusions: In this study, women with PD reported symptoms of myofascial pain syndrome and central sensitization, when compared with healthy controls, without any sign of anxiety acting as a confounder for pain sensitivity.

Primary dysmenorrhoea in adolescents and young women: A twin family study of maternal transmission, genetic influence and associations

AIMS

The extent to which maternal transmission of primary dysmenorrhoea is genetically determined in adolescents and young women has yet to be determined. We aimed to assess heritability and associations relevant to primary pain syndromes using a twin family study.

METHODS

Participants were young menstruating female twins, and their oldest sisters and mothers, whose families were registered with Twins Research Australia and previously participated in a twin family study of primary paediatric pain disorders. Questionnaire packs were mailed, assessing current maximum and average menstrual pain intensity, current pain interference with activities and retrospective dysmenorrhea secondary symptoms.

RESULTS

The sample comprised 206 twin individuals (57 monozygous (MZ) and 46 dizygous (DZ) pairs) aged 10-22 years, eldest siblings (n = 38) aged 13-28 years and mothers (n = 101) aged 32-61 years. The estimated regression coefficient of the relationship between mother-daughter and twin-sibling dyads indicated significant associations for the measures of dysmenorrhea and supported heritability. Adjusted for age, the within twin-pair correlation for MZ twins was generally more than twice that of DZ twins. Heritability estimates were maximal pain intensity 0.67 (P = 3.8 × 10^-11 ), average pain intensity 0.63 (P = 3.7 × 10^-10 ), pain interference 0.57 (P = 1.8 × 10^-8 ) and retrospective symptoms 0.57 (P = 1.8 × 10^-8 ). Twin individuals with a lifetime (three-month) history of iron deficiency and those with painless restless legs syndrome (RLS) were significantly more likely to have more intense pain associated with menstruation.

CONCLUSION

Primary dysmenorrhea in adolescents and young women was shown to be relatively strongly genetically influenced and associated especially with a history of iron deficiency and painless RLS which have potential therapeutic implications.

The prevalence of menstrual disorders and premenstrual syndrome among adolescent girls living in North Borneo, Malaysia: a questionnaire-based study

Background

This study aimed to determine menstrual characteristics and related morbidities among adolescent girls living in Sabah, North Borneo, a less-developed state in Malaysia.

Methods

Data were obtained from a quantitative survey conducted in three government high schools located in Ranau, Sabah. The participants were adolescent girls who had attained menarche between the ages of 14 and 19.

Results

Based on the analysis of questionnaires completed by 757 adolescent girls, the mean age at the time of the survey was 17 ± 1.4 years, and the mean menarche age was 12.2 ± 1.1 years. Our data demonstrated that 85.7% of the participants experienced dysmenorrhoea, of which at least 42.1% (mean pain score ± SD: 4.81 ± 0.76, 95% confidence interval (CI) 4.72, 4.90) experienced moderate dysmenorrhoea, and 11.2% (mean pain score ± SD: 7.86 ± 0.94, 95% CI 7.64, 8.08) experienced severe dysmenorrhoea. Over 70% of these girls complained of tiredness, headache, and appetite changes during menses.

Conclusions

The prevalence of menstrual disorders and related morbidities was high among the girls residing in Sabah. Reproductive health issues in rural and socioeconomically deprived areas remains poorly addressed. The main consequence of neglecting menstrual disorders and their related morbidities is impaired future sexual reproductive health in adults. Thus, addressing adolescent reproductive health issues is crucial, especially for girls living in areas where access to healthcare is difficult. The information gathered from this study can be used to strategize effective interventions to improve adolescents' reproductive health status in rural areas.

Sexual function and quality of life in women with endometriosis

Endometriosis may exert a profound negative influence on the lives of individuals with the disorder, adversely affecting quality of life, participation in daily and social activities, physical and sexual functioning, relationships, educational and work productivity, mental health, and well-being. Symptoms of endometriosis represent a great source of stress and cause a substantial negative impact on the psychological parameters, on the daily life and on the physical functioning of patients. The impact of endometriosis on work attendance has very significant economic consequences, as lost productivity has an associated cost, as do career changes resulting from a decline in education due to symptoms. Endometriosis is a pathology that affects all aspects of women's lives and that thus, it must be treated with a multidisciplinary vision that includes not only a medical approach but also psychological, work, and economic support. In this specific long-term vision of patient-centered endometriosis care, aspects of quality of life and sexual health play a key role and should always be evaluated with any patient as part of a multidisciplinary management.

Effect of varash oil to decrease menstrual pain in primary dysmenorrhea of senior high school student at Palu City

OBJECTIVE

menstrual pain is a common gynecological symptom at women on or near their menstrual period. Two third of them experienced moderate to severe pain. However, just several seek for medical help. This research aims to know the effect of ginger oil used on decreasing menstrual pain scale.

MATERIALS AND METHODS

this cross over experimental study was held from February until May 2020 on 64 grade XI high school students at Palu city. Participants were grouping cluster randomly into group A which applied 5ml ginger oil five days before until the second day of the first menstrual period, and group B that given the same treatment in the next period. A visual pain scale measured the pain scale on the second day of the menstrual period.

RESULT

most participants were in the age of 17 years old. The study found a lowering of pain scale significantly at both groups after treatment. The main menstrual pain scale were 6.87 ± 1.817 and 6.46±1.362 decreased to 3.48±1.928 and 4.24±2.010 after treatment (p=0.0001). Differences between the two groups were significant in the first period (p=0.0001) but not significant in the second period (p=0.410).

CONCLUSION

the use of ginger oil several days before menstruation can reduce menstrual pain scale on students with primary dysmenorrhea; therefore, its use can be recommended to prevent the pain.

Comparisons of the Prevalence, Severity, and Risk Factors of Dysmenorrhea between Japanese Female Athletes and Non-Athletes in Universities

This study aimed to investigate the difference in the prevalence, severity, and risk factors of dysmenorrhea between Japanese female athletes and non-athletes in universities. The participants were 18 to 30 years old with no history of a previous pregnancy and/or childbirth. After application of the exclusion criteria, the cohort comprised 605 athletes and 295 non-athletes. An anonymous questionnaire, which included self-reported information on age, height, weight, age at menarche, menstrual cycle days, menstrual duration, dysmenorrhea severity, sleeping hours, dietary habits, exercise habits, training hours, and competition level was administered. Compared with athletes, non-athletes had a higher prevalence of dysmenorrhea (85.6% in athletes, 90.5% in non-athletes, p < 0.05); non-athletes also demonstrated increased severity (none/mild 27.8%, moderate 19.3%, and severe 52.9% in athletes; none/mild 21.2%, moderate 17.2%, and severe 61.6% in non-athletes; p < 0.05). Factors related to severe dysmenorrhea in athletes included long training hours, early menarche, and prolonged menstrual periods. In non-athletes, short menstrual cycle days and extended menstrual periods were related to severe dysmenorrhea. The prevalence and severity of dysmenorrhea were higher among non-athletes than among athletes; different factors were related to severe dysmenorrhea in these two groups. Thus, different strategies are necessary to manage dysmenorrhea for athletes and non-athletes in universities.

Prevalence and Impact of Dysmenorrhea Among University Students in Ireland

OBJECTIVE

Primary dysmenorrhea (PD), or painful menstruation, is a common gynecological condition that can cause intense pain and functional disability in women of reproductive age. As a nonmalignant condition, PD is relatively understudied and poorly managed. The purpose of this study was to estimate the prevalence and impact of PD among third-level students in Ireland.

DESIGN

A cross-sectional observational design was used.

METHODS

Students (n = 892; age range = 18-45 years) completed an online survey on menstrual pain characteristics, pain management strategies, pain interference, and pain catastrophizing.

RESULTS

The prevalence of PD was 91.5% (95% confidence interval = 89.67-93.33). Nonpharmacological management strategies were most popular (95.1%); of these, heat application (79%), rest (60.4%), hot shower/bath (40.9%), and exercise (25.7%) were most common. Perceived effectiveness of these methods varied between participants. Analgesic use was also common (79.5%); of these, paracetamol was most used (60.5%) despite limited perceived effectiveness. Pain catastrophizing was a significant predictor of variance in both pain intensity and pain interference scores such that those with higher pain catastrophizing scores reported more intense pain and greater interference with daily activities and academic demands.

CONCLUSIONS

This article presents the first investigation into PD among third-level students in Ireland. Poorly managed menstrual pain may impact functional ability across several domains. Future research should focus on improving menstrual pain management education and support and promoting menstrual health literacy for women affected by PD.

Women's experiences of dysmenorrhoea - preliminary study

INTRODUCTION

Dysmenorrhoea is a significant interdisciplinary problem that requires intensified activities of specialists, mainly in the fields of health sciences, gynaecology, and pharmacology.

AIM OF THE STUDY

The aim of the study is to learn about women's experiences of dysmenorrhoea.

MATERIAL AND METHODS

The study was conducted between January and March, 2020 using a diagnostic research questionnaire developed for the purpose of the study. Based on the inclusion criteria, a total of 166 out of 192 completed questionnaires were analysed. The analysis of collected data was performed with the aid of Microsoft Office Excel 2007 and Statistica 13.1.

RESULTS

Most of the respondents, during menstruation, experienced severe pain. Among the study participants, 86.14% used pharmacological methods to relieve menstrual pain, and non-pharmacological methods were popular among 74.10% of women. Almost half of the study participants reported that the occurrence of menstrual pain involved the reorganization of previous arrangements. Most women cancelled classes/appointments and gave up sports because of menstrual pain.

CONCLUSIONS

In most cases, the symptoms of dysmenorrhoea lead to changes in daily functioning, which can have a negative impact on the academic, professional, and social lives of affected women. The early diagnosis of dysmenorrhoea is of key importance. Therefore, women who have menstrual pain and other accompanying symptoms during menstruations should be referred to experienced gynaecologists for differential diagnosis.

Adolescent Endometriosis

Importance

Endometriosis is a major health concern in the adolescent population and significantly impacts daily physical and psychosocial functioning. Endometriosis can have differing presentations in this population, and the diagnosis often involves long delays and multiple visits to specialists.

Objective

The aim of this review is to discuss adolescent endometriosis, factors specific to this population, accurate diagnosis, and evidence-based surgical and medical management.

Evidence Acquisition

Computerized searches on the topic of endometriosis and adolescent endometriosis were completed. References from identified sources were then searched manually to allow for a thorough review. Data from relevant sources were synthesized to create the review.

Results

The literature supports endometriosis as a frequent cause of secondary dysmenorrhea. The characteristics of adolescents with endometriosis are shown to differ from those of adults. Initial medical therapy includes nonsteroidal anti-inflammatory drugs and combined hormonal contraceptives, but laparoscopy does have a role in the adolescent population, particularly those who have inadequate response to these treatments. Adolescent endometriosis may have a different appearance and be of all stages. Medical therapies are similar to that of the adult population; however, the benefits of medical and surgical management must be tailored to the adolescent patient.

Conclusions and Relevance

Adolescent endometriosis is likely a more prevalent cause of dysmenorrhea than currently appreciated. A high index of suspicion combined with recognition of risk factors and history-based markers of endometriosis may help identify adolescent endometriosis earlier and avoid delays in diagnosis. Expert opinion supports earlier laparoscopic evaluation in patients with symptoms unresponsive to oral medications, those who have failed initial medical therapy, or those who have evidence of deeply invasive disease, such as an endometrioma. Surgeons should be familiar with the unique appearance of lesions in the adolescent and understand the evidence as it relates to surgical therapy. Postoperative medical management is generally advocated by many, although the efficacy remains unclear at present.

Impact of Endometriosis on Life-Course Potential: A Narrative Review

Endometriosis may exert a profound negative influence on the lives of individuals with the disorder, adversely affecting quality of life, participation in daily and social activities, physical and sexual functioning, relationships, educational and work productivity, mental health, and well-being. Over the course of a lifetime, these daily challenges may translate into limitations in achieving life goals such as pursuing or completing educational opportunities; making career choices or advancing in a chosen career; forming stable, fulfilling relationships; or starting a family, all of which ultimately alter one's life trajectory. The potential for endometriosis to impact the life course is considerable, as symptom onset generally occurs at a time of life (menarche through menopause, adolescence through middle age) when multiple life-changing and trajectory-defining decisions are made. Using a life-course approach, we examine how the known effects of endometriosis on life-domain satisfaction may impact health and well-being across the life course of affected individuals. We provide a quasi-systematic, narrative review of the literature as well as expert opinion on recommendations for clinical management and future research directions.

The effect of tens for pain relief in women with primary dysmenorrhea: A systematic review and meta-analysis

OBJECTIVE

Primary dysmenorrhea (PD) is a chronic health condition that affects primarily young women and interferes with daily activities, causes loss of work productivity, and reduces quality of life. Transcutaneous electrical nerve stimulation (TENS) is a complementary and alternative therapy used to reduce pain related to PD. The purpose of this meta-analysis study was to evaluate the effectiveness of TENS in the treatment of pain in women with PD.

METHODS

A search of the English literature in the Cochrane Library, MEDLINE (EBSCO), Physiotherapy Evidence Database (PEDro), CINAHL (EBSCO), PUBMED, OVID, Science Direct, Scopus, Academic Search Complete databases was conducted using combinations of the following search terms: 'primary dysmenorrhea', 'pain', 'transcutaneous electrical nerve stimulation', 'TENS', and 'electrical stimulation'. All content from database inception through April 2020 was included in the search.

RESULTS

The initial search strategy based on date range and language yielded 571 relevant records and 4 of them were about both TENS and PD. A total of 260 patients were enrolled in the included studies. In all of the included studies, the comparison intervention consisted of sham TENS. The primary outcome of interest was pain intensity. Our analysis indicated that TENS was statistically more effective than sham TENS in reducing PD-related pain (SMD=1.384; 95% CI=0.505, 2.262; p = 0.002).

CONCLUSION

TENS is a safe and well-tolerated electrophysical therapy that may be effective for relieving pain in PD.

Type of Dysmenorrhea, Menstrual Characteristics and Symptoms in Nursing Students in Southern Spain

Dysmenorrhea is a form of chronic pain associated with menstruation that affects a high percentage of young people. This study sought to determine the prevalence of primary and secondary dysmenorrhea among female nursing students in southern Spain and to compare their menstrual characteristics and symptoms. A cross-sectional observational study was conducted using a self-report questionnaire that included sociodemographic variables, menstrual characteristics and related symptoms. Descriptive bivariate analysis and binary logistic regression were performed in which the dependent variable was secondary dysmenorrhea. The prevalence of dysmenorrhea was 73.8% (of which 63.3% had primary dysmenorrhea and 10.5% had secondary dysmenorrhea), and was more likely in women with longer periods, heavier bleeding and those not using oral hormonal contraception (OCP). Secondary dysmenorrhea was 31.75, (confidence interval (CI)95% = 4.44–238.59; p < 0.01) times more likely among those with menstrual headache, 8.37 (CI95% = 2.35–19.80; p < 0.01), times greater among those suffering nausea during menstruation, 6.60 (CI95% = 1.42–30.67; p < 0.01), times greater among those suffering from menstrual vomiting, it was also 1.17 (CI95% = 1.08–1.26; p < 0.01) times more likely for each day that the period was prolonged and 6.63 (CI95% = 1.47–30.01; p = 0.014) times more likely in women with a heavy menstrual flow. These findings may help guide professionals towards the prescription of additional tests in certain cases in which secondary dysmenorrhea is suspected.

Efficacy and safety of over-the-counter analgesics for primary dysmenorrhea: A network meta-analysis

BACKGROUND

Primary dysmenorrhea is common and troublesome. The comparative efficacy of over-the-counter analgesics (OTCAs) for dysmenorrhea is unclear. This study was aimed at conducting a network meta-analysis to assess the efficacy and safety of 5 OTCAs - naproxen, ibuprofen,diclofenac, aspirin, and ketoprofen - in patients with primary dysmenorrhea.

METHODS

The study was registered with PROSPERO (number: CRD42019133556). The search strategy involved a review of PubMed, Embase, Cochrane Library, Web of Science, and CINAHL for relative randomized controlled trials of the 5 analgesics from the date of database establishment to July 2019. The outputs are presented as odds ratios (ORs), their corresponding 95% confidence intervals (CIs), and the surface under the cumulative ranking area (SUCRA) probabilities.

RESULTS

Thirty-five trials with 4383 participants were included in our study. As for efficacy outcomes, all the included analgesics except aspirin were more effective than placebo in treating dysmenorrhea [naproxen (OR 3.99, 95% CI 2.18-7.30), ibuprofen (OR 10.08, 95% CI 3.29-30.85), diclofenac (OR 11.82, 95% CI 2.66-52.48), and ketoprofen (OR 5.12, 95% CI 1.57-16.69). The OTCAs were superior to the placebo in terms of pain relief in primary dysmenorrhea. Aspirin was less effective than ibuprofen (OR 0.17, 95% CI 0.04-0.73) and diclofenac (OR 1.17, 95% CI 0.02-0.85). The SUCRA curves showed that diclofenac and ibuprofen were the most and second most effective (85.1% and 83.8%, respectively), followed by ketoprofen, naproxen, and aspirin. Regarding safety, there was no significant difference between the 5 OTCAs included and the placebo. Diclofenac versus ibuprofen (OR 4.31, 95% CI 1.18-15.67), ketoprofen versus diclofenac (OR 0.18, 95% CI 0.04-0.78), and ketoprofen versus aspirin (OR 0.41, 95% CI 0.18-0.97) presented statistically significant differences. Ketoprofen and ibuprofen were ranked the best (SUCRA 90.6% and 79.6%), followed by naproxen, aspirin, and diclofenac.

CONCLUSION

Considering the efficacy and safety, ibuprofen is recommended as the optimal OTCA for primary dysmenorrhea. Further well-designed studies that directly compare these analgesics are needed to support our conclusion.

Self-care strategies and sources of knowledge on menstruation in 12,526 young women with dysmenorrhea: A systematic review and meta-analysis

Introduction: Dysmenorrhea (period pain) is common and affects around three quarters of all young women under the age of 25. The majority of young women, for a variety of reasons, think of period pain as ‘normal’ and something to be managed or endured. This normalisation of pain often is reinforced by family and friends and results in young women using self-care strategies to manage their pain rather than seeking medical advice. This systematic review and meta-analysis examined observational studies reporting on the prevalence of different types of self-care, both pharmaceutical and non-pharmaceutical, self-rated effectiveness of self-care and the sources of information on menstruation in young women under 25 Methods: A search of Medline, PsychINFO, EMBASE and CINAHL in English was carried out from 1980 to December 2018. Studies that reported on menstrual self-care strategies in young women were included. Results: Nine hundred and forty-seven articles were screened. Twenty-four studies including 12,526 young women were eligible and included in the meta-analysis. Fifteen studies were from low, lower-middle or upper-middle-income countries (LMIC) and nine studies were from high income countries (HIC). Self-care was used by over half of all young women (55%, 95%CI 34.1–74.3) with both pharmaceutical (48%, 95%CI 40.0–57.0) and non-pharmaceutical (51.8%, 95%CI 31.3–71.7) options used. Paracetamol was the most common analgesic used (28.7%, 95%CI 19.6–39.9) but did not always provide sufficient pain relief in almost half of those using it. Contraceptive use was significantly higher (P<0.001) in HIC (22%) compared to LMIC (1%). Only 11% (95%CI 8.4–15.2) of young women reported seeing a medical doctor for their period pain. Conclusions: Self-care usage, both pharmaceutical and non-pharmaceutical, was common, but young women were not necessarily choosing the most effective options for pain management. High-quality information on self-care for period pain is urgently needed.

Gynaecology problems in puberty

With the onset of puberty a range of problems may be encountered by the young girl. Some of these include a range of gynaecological issues relating to delayed onset of puberty, delayed menarche, atypical pubertal changes and the identification of anomalies of the genital tract. The distinction between physiological events and pathological problems is important to avoid unnecessary distress and anxiety. The onset of cyclic hormonal changes also provokes a number of "non-gynaecological" problems - where the link to cyclic hormonal events is often overlooked and an important opportunity to potentially intervene and assist is missed. From a global perspective there are a range of problems that are particularly encountered with the onset of puberty including the risks of sexual violence, which in the setting of having achieved the age of reproductive potential result in unplanned pregnancies, unsafe abortions and adolescent pregnancy all of which pose life threatening risks. Sex education in its broadest sense is important for all young people. Access to contraception for adolescents is vital, such that clinicians across all streams of health care who are involved in the care of young people should take the opportunity to educate and provide this care.