Effects of menstrual pain on the academic performance and participation in sports and social activities in Turkish university students with primary dysmenorrhea: A case control study

Exploring the role of negative expectations and emotions in primary dysmenorrhea: insights from a case-control study

BACKGROUND

Primary dysmenorrhea, characterized by painful menstruation, significantly impacts the quality of life for women worldwide. Negative expectations and associated emotions are known to trigger nocebo effects and may also influence cyclic menstrual pain. In this study, we investigated the role of pain expectations and negative anticipatory emotions as potential contributing factors to hyperalgesia in women with severe menstrual pain, compared to women with absent or mild menstrual pain.

METHODS

We conducted a prospective case-control study in women with severe menstrual pain due to primary dysmenorrhea, comparing them with age-matched women with absent or mild menstrual pain. Data collection included the Depression, Anxiety, and Stress Scale (DASS-21) at baseline, as well as daily numeric rating scales (NRS) to evaluate pain expectations, anticipatory negative emotions, and daily stress during the 10 days preceding menstruation. Saliva samples were collected to evaluate the Cortisol Awakening Response (CAR) before menstruation, and pain was assessed during the first 3 days of menstruation.

RESULTS

Women with high menstrual pain reported significantly higher DASS-21 anxiety levels compared to low-pain controls, although still within the normal range (median [IQR], 3 [2; 5] vs. 1 [1; 3], p <.05). In the 10 days preceding menstruation, the high-pain group expected significantly higher maximum pain levels than controls (median [IQR], 8 [7.3; 8.5] vs. 2.1 [1; 3.3], p <.001), which aligned with their actual experiences of maximum pain during menstruation (6.5 [4.8; 7.7] vs. 1.2 [0.7; 2.3], p <.001). Anticipatory stress (2.1 [0.9; 4.2] vs. 0.2 [0; 0.9], p <.001), anticipatory anxiety (0.7 [0.0; 2.3] vs. 0 [0; 0], p <.001), anticipatory worry (1.3 [0.4; 2.6] vs. 0.1 [0; 0.3], p <.001), and anticipatory anger (0.7 [0; 1.5] vs. 0 [0; 0.2], p <.01) were also significantly higher in the high-pain group in the 10 days before menstruation. The CAR showed no significant differences between groups in the days before menstruation. Correlational analyses revealed multiple positive associations between expected pain levels, anticipatory negative emotions, and subsequently perceived levels of menstrual pain in both groups (all p-values < 0.05).

CONCLUSIONS

This pioneering study supports the hypothesis that cognitive-emotional factors such as heightened pain anticipation and negative emotions intensify menstrual pain severity in primary dysmenorrhea, although causal conclusions cannot be drawn from this observational study. Strategies aimed at optimizing expectations could play a significant role in managing primary dysmenorrhea.

Efficacy of Arogya Rakshak Panchatantra (Five Lifestyle Principles) on Heart Rate Variability and Menstrual Symptoms in Primary Dysmenorrhea: A Randomized Controlled Trial

Introduction: Primary dysmenorrhea (PD) is associated with decreased performance and reduced quality of life in young adults. This study aims to evaluate the effectiveness of implementing Arogya Rakshak Panchatantra (ARP), a naturopathic lifestyle practice, among young female adults with PD. Method: This open-label, parallel-arm, randomized controlled trial included 52 young female adults with PD aged between 16 and 25 years. They were randomly assigned to the ARP group practicing the ARP module for 2 months or the control group maintaining their routine lifestyle. The primary outcome was changes in heart rate variability (HRV), while secondary outcomes included menstrual distress, quality of life, pain, and daytime sleepiness, all evaluated at baseline and during the first three menstrual cycles in both groups. To evaluate the feasibility, the study also monitored self-reported symptoms, emotions, adverse events, calorie intake, and adherence to the intervention. The effectiveness of ARP was evaluated using repeated measures analysis of variance and a generalized linear model. Results: In the intervention group, we observed significant improvements in the high frequency component of HRV (p = 0.007), as well as reductions in weight (p = 0.017), visual analog scale pain (p = 0.000), and retrospective symptom scale score (p < 0.011). There were no significant changes in other HRV metrics, quality of life, or daytime sleepiness. Participants reported mild symptoms such as headaches, colds, body pain, diarrhea, constipation, fever, and weakness, with no serious adverse events. Discussion: This trial is the first to examine the long-term impact of ARP on young females with PD, suggesting it could be an effective and feasible management option. Further research with larger sample sizes is needed to confirm these findings.

Menstrual Disturbances and Associated Factors Among Female University Students in the United Arab Emirates: A Cross-Sectional Study

BACKGROUND

Menstrual disturbances are prevalent among young females worldwide. However, the literature addressing this topic in the United Arab Emirates (UAE) is scarce. This study aimed to measure the prevalence of menstrual disturbances among female university students across the UAE and identify the most common practices and lifestyle factors associated with menstrual disturbances.

METHODS

This cross-sectional study utilized convenience sampling and was distributed to female university students. The questionnaire was developed after a careful assessment of the literature and was conducted between February and March of 2023. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria were used to evaluate the prevalence of premenstrual dysphoric disorder (PMDD) among the study population.

RESULTS

Of the total 390 participants, 73.6% had at least one menstrual disturbance, with PMDD being the most common at 50.8%. Furthermore, PMDD was significantly associated with caffeine consumption (p = 0.047). Conditions such as oligomenorrhea (p = 0.005), hypomenorrhea (p = 0.021), and PMDD (p ≤ 0.001) were associated with higher stress scores. For managing menstrual disturbance, 71.5% did not seek professional advice, and only 7.7% of patients took prescribed medications. Most participants opted for self-management by bed rest (75.4%), consumption of tea and herbs (63.1%), and self-medication (54.4%).

CONCLUSION

The prevalence of menstrual problems among female university students in the UAE was 73.6%, which was high, with higher stress scores being correlated with multiple menstrual disturbances; thus, awareness programs and the provision of proper counseling are recommended to all universities across the UAE.

Comparison of factors associated with the occurrence of menstruation-related symptoms in Japanese women without exercise habits and female soccer players: a cross-sectional study

PURPOSE

The aims of this study were to identify factors associated with menstruation-related symptoms and compare them between female soccer players and women without exercise habits.

METHODS

This cross-sectional study was conducted between June and August 2022. Participants were healthy Japanese women aged 18-29 years, divided into two groups for comparison by exercise habits: women without exercise habits and female college soccer players. Participants responded to a self-administered questionnaire pertaining to their physical and menstrual characteristics, menstruation-related symptoms, and lifestyle habits. For menstruation-related symptoms, the Andersch and Milsom Scale was used to assess the severity of each of the 16 symptoms before and during menstruation. Lifestyle habits included stress, sleep, diet, and physical activity, which were assessed using Perceived Stress Scale, Japanese version of the Pittsburgh Sleep Quality Index, Food Frequency Questionnaire, and International Physical Activity Questionnaire, respectively. Data were analyzed using the t-test and multiple logistic regression analysis. All analyses were performed with a statistical significance of 5%.

RESULTS

A total of 428 women (192 without exercise habits; 236 soccer players) participated in the study, and 244 women (99 without exercise habits; 125 soccer players) were analyzed. For women without exercise habits, long menstrual days (OR = 5.627; 95% CI, 1.046-30.259) and high levels of stress (1.082; 1.011-1.157) were factors before menstruation, and stress (1.131; 1.045-1.225) was a factor during menstruation were significantly associated with severe menstruation-related symptoms. Contrastingly, for soccer players, high body mass index (BMI) (1.460; 1.080-1.973), late bedtime (0.288; 0.110-0.753) before menstruation, older age (1.662; 1.073-2.575), high BMI (1.468; 1.089-1.980), family history of menstruation-related symptoms (3.090; 1.179-8.098), late bedtime (0.358; 0.133-0.958), caffeine consumption ( 0.359; 0.139-0.930), and less frequent breakfast intake (0.807; 0.653-0.997) were significant factors. Additionally, the factors associated with the occurrence of menstruation-related symptoms differed according to the symptom type. The most frequently associated factor in women without exercise habits was stress (13 symptoms). In female soccer players, the most frequently associated factor was BMI (8 symptoms).

CONCLUSION

Women presented different factors for menstruation-related symptoms depending on the presence or absence of exercise habits in their routine.

Impact of symptoms, experiences, and perceptions of the menstrual cycle on recreational physical activity of cyclically menstruating individuals: A systematic review

OBJECTIVE

The menstrual cycle often presents barriers to participation in daily life activities, including physical activity (PA), which is a cornerstone of health and well-being. The purpose of this systematic review was to explore and summarize the impact of symptoms, experiences, and perceptions of the menstrual cycle on recreational PA (RPA), including sports, exercise and active recreation, in the general population.

METHODS

Six databases were searched for studies that investigated the impact of the menstrual cycle on PA among individuals who were cyclically menstruating, healthy, and not involved in professional sports training.

RESULTS

The search yielded 3025 studies that were screened for relevance and eligibility, resulting in 25 eligible studies, which were found to be of moderate-to-high quality following a quality and risk-of-bias assessment. Thematic synthesis of qualitative and quantitative data from the selected studies, constituting 16,557 adults and 3715 adolescents, identified the impact of menstrual symptoms on the physical and psychological capability to participate in RPA, social opportunity barriers to RPA (e.g., social pressure due to the sociocultural taboo against menstruation), as well reflective (knowledge) and automatic (habit) motivation on RPA behaviours.

CONCLUSION

The variability in menstrual symptoms and corresponding experiences suggested the need for an individualized approach to RPA promotion. Furthermore, this review highlighted the need to address the sociocultural taboo against menstruation, as well as improve the provision of knowledge and resources related to the menstrual cycle and RPA, in order to promote and facilitate RPA for cyclically menstruating individuals throughout the menstrual cycle.

Auricular Acupuncture Prior to Menstruation Can Reduce Primary Dysmenorrhea: A Randomized Controlled Trial

Objective

Primary dysmenorrhea is a common condition that impacts quality of life significantly. Auricular therapies have shown promise for treating primary dysmenorrhea, but there is a lack of evidence specifically for auricular acupuncture (AA). This study evaluated the safety and efficacy of AA for managing primary dysmenorrhea.

Materials and Methods

A randomized, double-blinded controlled trial was conducted on 90 females with primary dysmenorrhea: an AA group; n = 45) and a sham-AA (SA) group; n = 45. Specific ear acupoints (i.e., Uterus, Endocrine, Shenmen, Subcortex, Liver, and Kidney) were used for the intervention, which was 1 or 2 days prior to the expected menstruation onset. Outcomes were visual analogue scale (VAS) scores, ibuprofen needs, and adverse events (AEs).

Results

The AA group had significantly lower VAS scores, compared to the SA group at menstruation onset and for up to 12 hours (mean differences [MDs] and 95% confidence intervals [CIs]: -1.08 [-1.96, -0.21] and -1.17 [-2.16, -0.18], respectively). Both groups had reductions in pain levels, compared to the prior menstrual cycle; the AA group had a significantly greater improvement. The AA group needed fewer ibuprofen tablets (MD: -0.28; 95% CI: -0.58, 0.00]). AEs were mild pain and irritation at insertion sites, all resolved spontaneously with no lasting effects.

Conclusions

AA is safe. It may be effective for managing primary dysmenorrhea. Further studies are warranted on AA's effectiveness in diverse populations and extended times.

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.

Factors Associated with the Prevalence and Severity of Menstrual-Related Symptoms: A Systematic Review and Meta-Analysis

This study aimed to identify factors associated with the prevalence and severity of menstrual-related symptoms. The protocol was registered in PROSPERO (CRD42021208432). We conducted literature searches of PubMed and Ichushi-Web and used the Jonna Briggs Institute critical appraisal checklist to assess the quality. Of the 77 studies included in the meta-analysis, significant odds ratios (ORs) were obtained for eight factors associated with primary dysmenorrhea (PD): age ≥ 20 years (OR: 1.18; 95% confidence interval [CI]: 1.04−1.34), body mass index (BMI) < 18.5 kg/m2 (OR: 1.51; 95% CI: 1.01−2.26), longer menstrual periods (OR: 0.16; 95% CI: 0.04−0.28), irregular menstrual cycle (OR: 1.28; 95% CI: 1.13−1.45), family history of PD (OR: 3.80; 95% CI: 2.18−6.61), stress (OR: 1.88; 95% CI: 1.30−2.72), sleeping hours < 7 h (OR: 1.19; 95% CI: 1.04−1.35), and bedtime after 23:01 (OR: 1.30; 95% CI: 1.16−1.45). Two factors were associated with severity of PD (moderate vs. severe): BMI < 18.5 kg/m2 (OR: 1.89; 95% CI: 1.01−3.54) and smoking (OR: 1.94; 95% CI: 1.08−3.47). PD severity (mild vs. severe) and prevalence of premenstrual syndrome were associated with BMI < 18.5 kg/m2 (OR: 1.91; 95% CI: 1.04−3.50) and smoking (OR: 1.86; 95% CI: 1.31−2.66), respectively. The identified risk factors could be utilized to construct an appropriate strategy to improve menstrual symptoms and support women’s health.

A cross-sectional study on prevalence of menstrual problems, lifestyle, mental health, and PCOS awareness among rural and urban population of Punjab, India

INTRODUCTION

Menstrual cycle gets affected by various modifiable risk factors. To assess prevalence of various types of menstrual problems, lifestyle and mental health status, identification of variables as predictors for menstrual problems and level of polycystic ovary syndrome (PCOS) awareness among rural and urban population of Punjab, the present study has been carried out.

METHODS

The study was conducted from November 2019 to July 2020 in the Malwa region of Punjab, India, with 2673 participants (15-25 years). Epidemiological information was collected using predesigned questionnaire along with depression, anxiety and stress (DASS-21) score mental health assessment tool. MS-Excel (2019) and IBM SPSS 18.0 (SPSS Inc., Chicago, IL) was used for statistical analysis.

RESULTS

The overall prevalence of different menstrual problems was 60.61%, with dysmenorrhea (50.64%) being most common problem. Body mass index (BMI), menarche age, physical activity, and mental health status are significant (p < 0.05) predictors of menstrual problem both in rural and urban population. Overall, only 3.30% subjects were aware about PCOS.

CONCLUSION

Dysmenorrhea is the most common menstrual problem, both in rural and urban population. BMI, sedentary lifestyle, electronic gadgets usage, and mental health are associated with menstrual problems. Low awareness on PCOS indicates need to create awareness as the condition can be easily managed with early intervention.

[Impact of primary dysmenorrhea on the academic performance of university students]

OBJECTIVE

Primary dysmenorrhea has a high prevalence among the student population. The objective of this study was to determine the prevalence of dysmenorrhea, its severity and its impact on academic performance in Mexican university students.

METHODS

Cross-sectional study. An anonymous multiple-choice questionnaire was applied in class hours in the classrooms. The visual pain scale (VAS) was used for the measurement of pain. A descriptive and inferential analysis of the variables studied was carried out using the program SPSS® IBM.

RESULTS

A total of 2154 (n=2154) students were surveyed. The average age of the women was 20.4 ±1.9years. The general prevalence of dysmenorrhea was 78.9%, with psychology students having the highest value (83.7%). The VAS mean pain score was of 64.0. The severity of menstrual pain in students was reported as mild in 9.0%, and moderate-severe in 91.0%. The VAS mean pain scores and intensity of pain of gerontology students were significantly higher than those reported by dentistry and medicine students (P&lt;.05). Limitation of daily activities was reported in 90.4% of women, with medical students reporting the highest percentage (93.3%). Women reported school absenteeism in 37.0%, with medical students presenting the highest percentage (41.4%). The severity of menstrual pain as a risk factor (independent variable) positively influenced various dependent variables involved in students' academic performance (P&lt;.05), including: stop doing their activities due to pain in 1 to 6 menstruations a year, minor concentration, absenteeism, low school performance, and lower grades during dysmenorrhea.

CONCLUSION

A high prevalence of dysmenorrhea was observed and it is concluded that the severity of the symptomatology significantly interferes with the academic performance of the participants.

Impact of Dysmenorrhea on Academic Performance Among Haramaya University Undergraduate Regular Students, Eastern Ethiopia

Background:

Dysmenorrhea is the most common gynecological problem among students. The disease affects students' academic performance, although studies carried out in Ethiopia primarily focused on the prevalence aspects rather than the impacts of dysmenorrhea on academic performance and its associated factors. Therefore, this study focused on the prevalence of the impact of dysmenorrhea on academic performance and its associated factors among undergraduate female students of Haramaya University in eastern Ethiopia.

Methods

A cross-sectional study design was conducted from February to March 2020. A multistage random sampling technique was applied and a total of 356 students were included in the study. To select students, simple random sampling was used and the sample size was proportionally allocated with respect to the total number of each selected department. A semi-structured and a pre-tested self-administered questionnaire were used. The descriptive result was presented as a proportion whereas the analytic part was presented with an adjusted odds ratio.

Result

The prevalence of the impact of dysmenorrhea on academic performance was 266 [(74.7%):95%CI (70.0, 79.5%)]. Premenstrual syndrome [AOR = 4.86:95%CI (2.13, 11.06)], early menarche [AOR = 4.89:95%CI (2.03, 11.77)], moderate/severe dysmenorrhea pain intensity [AOR = 8.53:95%CI (4.45, 16.39)], and students monthly pocket money <150ETB [AOR = 3.91:95%CI (1.48, 10.29)] were significantly associated with the occurrence of the impact of dysmenorrhea on academic performance. The most common impacts were difficulty in studying followed by loss of concentration in the class.

Conclusion and Recommendation

There was a high prevalence of impact of dysmenorrhea on academic performance among undergraduate female students of the Haramaya University. Awareness should be created among Haramaya university authorities and teachers about the academic performance impact of premenstrual syndrome and dysmenorrhea pain intensity to provide psychological and academic guidance, and managing mechanisms for the affected students. Haramaya University should also establish medical care for the affected students.

Efficacy and safety of external therapy of TCM for primary dysmenorrhea: A protocol for systematic review and meta-analysis

BACKGROUND

Primary dysmenorrhea (PD) is a painful disease that severely affects the daily lives of young women. External therapy using traditional Chinese medicine (TCM) is widely used in the clinical treatment of this disease and has achieved a good effect. There are many kinds of TCM external therapies, but the effectiveness, safety, and advantages of various methods have not been confirmed by high-quality meta-analyses. The purpose of this study was to evaluate the efficacy and safety of representative TCM external therapies in patients with PD.

METHODS

Published randomized controlled trials that assessed the efficacy of these interventions in patients with PD were included. We searched the following electronic databases: PubMed, Cochrane Library, Embase, Web of Science, China Science and Technology Journal, China National Knowledge Infrastructure, Wanfang, and Chinese Biomedical Literature Database and other sources. The main outcomes included menstrual pain intensity and the clinical effectiveness rate. The secondary outcomes were the quality of life and safety. The meta-analysis will be performed using the Review Manager version 5.3 software.

RESULTS

We will provide more practical results investigating the efficacy of external TCM therapy with high clinical frequency for PD patients in several respects, including the improvement of menstrual pain intensity, quality of life, and safety.

CONCLUSION

This review systematically reviews the effectiveness and safety of common TCM external therapies for PD and provides clinicians with the best treatment options.

ETHICS AND DISSEMINATION

This systematic review aimed to evaluate the efficacy and safety of external TCM therapy for PD. Since all data included were published, the systematic review did not require ethical approval.

REGISTRATION NUMBER

CRD42021297078.

Prevalence of Dysmenorrhea and Associated Factors Among Haramaya University Students, Eastern Ethiopia

Purpose

Dysmenorrhea is the most common gynecological problem among adolescents and a common cause of school absenteeism. Previously, there was no study conducted on prevalence of dysmenorrhea and associated factors among university students in Ethiopia. Therefore, the aim of this study was to assess prevalence and associated factors of dysmenorrhea among Haramaya university undergraduate regular students in Eastern Ethiopia.

Materials and Methods

An institution-based cross-sectional study design was conducted from February to March 2020. A multistage random sampling technique was applied and a total of 569 participants were included into the study. The total sample size was proportionally allocated based on the total number of students in each departments, and simple random sampling technique was employed to select participants. The data were entered to EPI‑info version 3.5.4 and then exported to Statistical Package for Social Science version 23.0 software for analysis. The associations between independent variables and outcome variable were explored using bivariate and multivariable logistic regression models. The results of these analysis were reported as odds ratios with 95% confidence intervals.

Results

The prevalence of dysmenorrhea in this study was 356 (64.7%) 95% CI [60.7%, 68.7%]. Premenstrual syndrome (AOR = 5.20:95% CI [2.82, 9.61]), early menarche (AOR = 4.67:95% CI [2.33, 9.37]), history of anxiety (AOR = 4.08:95% CI [2.31, 7.19]), taking of ≥4 glass of tea per day (AOR = 5.69:95% CI [1.49, 21.77]), usually eating fat and oil (AOR = 2.03:95% CI [1.15, 3.59]) and usual use of meat food (AOR = 3.61:95% CI [2.03, 6.39]) were positively and independently associated with the occurrence of dysmenorrhea.

Conclusion

Dysmenorrhea was a common problem among Haramaya University female students. History of anxiety, early menarche, premenstrual syndrome, tea consumption, usual use of fat and oil containing food and usual use of meat food were significantly associated to dysmenorrhea. We recommend Haramaya University to provide accessible and appropriate medical treatment and counseling service for dysmenorrhea affected students.

Lumbopelvic muscle endurance, morphology, alignment, and mobility in women with primary dysmenorrhea: A case-control study

BACKGROUND

In the literature, it is thought that spine or pelvic malalignment and changes in the abdominal muscle structure may affect the uterine position and cause menstrual pain. However, the overall lumbopelvic structure related to lumbopelvic muscle endurance, thickness, alignment, and mobility in women with primary dysmenorrhea has not been well investigated. This study aimed to compare women with primary dysmenorrhea and asymptomatic controls in terms of lumbopelvic structure.

METHODS

Women with primary dysmenorrhea (primary dysmenorrhea group, n: 38, age: 21 years (18-28), body mass index (BMI): 20.70 (17.31-28.73) kg/m²) and without primary dysmenorrhea (asymptomatic group, n: 39, age: 20 years (19-23), BMI: 20.83 (17.31-27.10) kg/m²) were included. The severity of menstrual pain, lumbopelvic muscle endurance, morphology, alignment, and mobility were assessed with the Visual Analogue Scale, McGill trunk muscle endurance tests, ultrasonographic imaging, and a Valedo® Shape device, respectively.

FINDINGS

The median value of the menstrual pain in the primary dysmenorrhea group was 6.5 cm (min-max: 4.0-10.0). Lumbopelvic muscle endurance (p < 0.001), muscle thickness (p < 0.001), frontal lumbar angle (p: 0.05), sagittal pelvic mobility (p < 0.001), and frontal lumbar mobility (p: 0.002) were lower in the primary dysmenorrhea group compared to the asymptomatic group.

INTERPRETATION

Muscle endurance, thickness, alignment, and mobility of the lumbopelvic structure in women with primary dysmenorrhea compared to asymptomatic women have been affected negatively. These findings should be considered in management of primary dysmenorrhea.

Prevalence of Dysmenorrhea and Determinants of Pain Intensity Among University-Age Women

OBJECTIVE

The study was conducted to determine the prevalence of dysmenorrhea and investigate factors associated with dysmenorrhic pain among university students in Lahore, Pakistan.

DESIGN AND SETTING

A cross-sectional study was conducted across various public and private sector universities in Lahore.

METHODS

A self-administered structured questionnaire was used to collect data from 600 randomly selected female university students.

RESULTS

The prevalence of dysmenorrhea was 91.5%. Age at menarche (odds ratio [OR] = 1.96, 95% confidence interval [CI] = 1.10-3.50) was the only significant factor associated with dysmenorrhea. The mean pain severity score among dysmenorrhic students was 5.62 ± 2.28. Most of the participants (65.8%) were experiencing moderate/severe pain. Univariate analysis showed that irregular cycle (OR [95% CI] = 1.62 [1.13-2.33]), age at menarche of ≤14 years (OR [95% CI] = 1.46 [1.05-2.04]), duration of menses of more than 5 days (OR [95% CI] = 1.42 [1.02-1.99]), stress (OR [95% CI] = 2.16 [1.54-3.03]), moderate meat/protein consumption (OR [95% CI] = 1.55 [1.08-2.21]), and medical specialization (OR [95% CI] = 1.72 [1.17-2.52]) were significantly associated with pain severity among dysmenorrhic female students. Multivariate binary logistic regression analysis revealed that medical specialization (OR [95% CI] = 1.83 [1.22-2.73]), age at menarche (OR [95% CI] = 0.603 [0.42-0.86]), regularity of menses (OR [95% CI] = 1.52 [1.04-2.22]), moderate meat/protein consumption (OR [95% CI] = 1.69 [1.16-2.45]), and stress (OR [95% CI] = 1.87 [1.32-2.66]) were independent predictors of moderate/severe dysmenorrhic pain.

CONCLUSION

The study revealed an alarmingly high prevalence of dysmenorrhea among university students. High levels of stress and early menarche were the potent determinants of moderate/severe dysmenorrhea that disturbs quality of life.

Impact of the awareness and fear of COVID-19 on menstrual symptoms in women: a cross-sectional study

The researchers' aim was to determine the impact of the awareness and fear of COVID-19 on menstrual symptoms. We conducted the cross-sectional study with 125 women and collected using the Visual Analog Scale, the Menstruation Symptom Scale, the Awareness of COVID-19 Scale and the Fear of COVID-19 Scale. While 39% of the women reported that there was no change in the menstrual pattern during the pandemic process, 22.4% reported an increase in menstrual pain and 25.6% reported deterioration in the menstrual pattern. A one-unit increase in the women's fear of COVID-19 scale score increases the Menstrual Symptom Scale total score by 1016 points (p < .001). However, the awareness of COVID-19 had no impact on menstrual symptoms. As fear of COVID-19 increases menstrual symptoms, when providing nursing care, nurses should be aware that women need more support to cope with this condition.

A systematic review of the menstrual experiences of university students and the impacts on their education: A global perspective

Background

Higher education attainment is linked to improved health and employment outcomes but the impact of university students’ experiences of menstruation on their education is less clear. The objective of this review was to synthesise qualitative and quantitative research on university students’ menstrual experiences and educational impacts.

Methods

Eligible studies were identified through systematic searching across eight peer-reviewed databases, websites for menstrual health organisations, grey literature databases, and reference lists of included studies. Eligible studies must have reported on at least one of the antecedents or components of menstrual experience outlined in the integrated model of menstrual experience in relation to university students or reported on the impact of their menstrual experiences on their education. Study characteristics and findings were extracted, analysed and presented as a narrative synthesis. The quality of evidence was assessed with the Mixed Methods Appraisal Tool. This study is registered on PROSPERO, number CRD42020178470.

Results

Eighty-three studies were eligible for inclusion. Most studies (n = 74; 89%) were quantitative and the highest proportion of studies were conducted in lower-middle-income countries (n = 31; 37%). Self-reported dysmenorrhea, other physical and emotional menstrual-related symptoms, and menstrual stigma contributed to negative menstrual experiences among female students. Very few studies considered the menstrual experiences of non-binary and transgender menstruating students, and culturally diverse students. Dysmenorrhea contributed to university absenteeism, impaired participation and concentration, and declining academic performance. Inadequate sanitation facilities for menstrual management and challenges containing menstruation also negatively impacted education.

Conclusions

Female university students’ experiences of menstruation can negatively impact their education, highlighting the need for program and policy responses at university to improve students’ wellbeing and educational engagement. Further research on the menstrual experiences of gender diverse, migrant and international students is needed as there is insufficient evidence to date.

A mixed-methods study to evaluate the effectiveness and cost-effectiveness of aerobic exercise for primary dysmenorrhea: A study protocol

BACKGROUND AND PURPOSE

Several studies have evaluated the effects of high-intensity aerobic training (HIAT) on pain severity and quality of life (QoL) among women with primary dysmenorrhea. However, to date, no studies have evaluated the effectiveness of HIAT on academic performance or absenteeism or examined the cost-effectiveness of HIAT relative to other treatments in women with primary dysmenorrhea. Furthermore, the mechanisms underlying aerobic exercise-induced analgesia in primary dysmenorrhea remain unclear. The objectives of this study are to: (1) evaluate the effects of HIAT on absenteeism and academic performance among university students, (2) identify the underlying mechanisms associated with aerobic exercise-induced analgesia in primary dysmenorrhea, and (3) determine the cost-effectiveness of HIAT compared with a wait-list control (WLC) group receiving usual care.

METHODS

A sequential, embedded, mixed-methods study design, including a crossover, randomised controlled trial (RCT) and semi-structured focus groups, will be conducted alongside an economic evaluation. A total of 130 women aged 18-24 years will be randomised into either HIAT (n = 65) or wait-list control (n = 65) groups. Primary outcomes will include average pain intensity, absenteeism from university, and academic performance. Primary mediators will include salivary progesterone and prostaglandin F2α levels. Outcome and meditator variables will be assessed at baseline and post-treatment, at 12 and 28 weeks. An economic analysis will be conducted from the societal and healthcare perspective of Hong Kong. Semi-structured focus groups will be conducted at 32 weeks. Of the 130 participants included in the RCT, 70 will be included in the focus groups.

STATISTICAL ANALYSIS

All statistical analyses will be performed on an intention-to-treat basis, using SPSS (version 24). Preliminary analysis using an independent samples t-test and a two-sided, unpaired Student's t-test will be performed to exclude carryover effects and identify within-participant differences in outcome variables between the study periods, respectively. Treatment effects will be evaluated using analysis of variance via a mixed-effects model with fixed effects for intervention, period, and sequence. In all models, random effects will include the participants nested within the sequence as a sampling cluster. The mediation effects will be assessed using the Sobel test. The EQ-5D responses will be converted into utility scores to estimate the gain or loss of quality-adjusted life-years. Seemingly unrelated regression analyses will be used to estimate the total cost differences and effect differences. Qualitative data will be analysed using the process of thematic analysis.

Pain Prevalence, Management and Interference Among University Students in South Korea: An Exploratory Cross-Sectional Study

BACKGROUND

Pain is a global health issue with a significant impact on young adults. Adverse effects caused by inappropriate pain management among university students are related to poor mental/physical health. This study aimed to explore pain prevalence, management, and interference among university students in South Korea.

METHODS

Pain intensity, painful body areas, pain management, and pain interference were measured in a convenience sample of 404 students. Descriptive statistics are reported, and a multivariable binomial logistic regression was conducted to reveal factors associated with pain interference.

RESULTS

The prevalence of acute and chronic pain was 73.5%, while 7.8% reported chronic pain (≥ 3 months). Half of university students who experienced pain reported at least four painful body areas. The average pain intensity during the past 6 months was 4.8/10. About 56% of university students who experienced pain used over-the-counter pain pills for pain management. Rest and massage were the most used non-pharmacological pain management strategies. Mood was the most reported pain interference complaint amongst university students. Greater pain interference was associated with longer pain duration, more painful body areas, and greater pain intensity.

DISCUSSION

Pain is highly prevalent among South Korean university students. Pain management programs, including education about appropriate methods of pain relief, should be developed for university students. Attention should be given to university students with widespread acute and chronic pain of high intensity to mitigate the negative impacts caused by pain interference.

Efficacy of Physiotherapy Treatment in Primary Dysmenorrhea: A Systematic Review and Meta-Analysis

Primary dysmenorrhea (PD) refers to painful cramps before and/or during menstruation. There is a need for emphasis on alternative methods of conservative treatment, so as to reduce the dependence on drugs for alleviating the symptoms. The aim was to find out the effectiveness of some physiotherapy techniques in the treatment of PD. A systematic review and meta-analysis was conducted according to PRISMA standards. The descriptors were “dysmenorrhea”, “physical the-rapy”, “physiotherapy”, and “manual therapy”. The search was performed in five databases: Scopus, PubMed, PEDro, Web of Science, and Medline, in February 2021. The inclusion criteria were randomized controlled trials over the last six years. Articles not related to the treatment of PD or using pharmacology as the main treatment were excluded. Nine articles met the objectives and criteria, with a total of 692 participants. The most used scale to measure pain was the VAS (visual analogue scale). The main techniques were isometric exercises, massage therapy, yoga, electrotherapy, connective tissue manipulation, stretching, kinesio tape, progressive relaxation exercises and aerobic dance. Meta-analysis shows benefits of physiotherapy treatment for pain relief compared with no intervention or placebo (MD: −1.13, 95% CI: −1.61 to −0.64, I²: 88%). The current low-quality evidence suggests that physiotherapy may provide a clinically significant reduction in menstrual pain intensity. Given the overall health benefits of physiotherapy and the low risk of side effects reported, women may consider using it, either alone or in conjunction with other therapeutic modalities.

[Primary dysmenorrhea and psychological resources used by adolescent girls: observational study of 247 high school girls in Finistère]

INTRODUCTION

Primary dysmenorrhea affects 60% of adolescent girls between 14 and 19 years of age and higher rates of depression and absenteeism are found in these young women. Having developed a sense of coherence (SOC) protects against depression associated with and improves the experience of primary dysmenorrhea. The aim of the study was to describe the association between primary dysmenorrhea and SOC. MéTHODS: A multicentric and cross-sectional study was performed on 247 high school girls from Finistère (France).

RESULTS

Sixty point seven per cent of high school girls suffer from primary dysmenorrhea: average VAS greater than or equal to 4 out of 10 with an improvement in pain by analgesics if severe pain (greater than 7 out of 10) to eliminate secondary dysmenorrhea (3.6% suspected). Thirty five point six per cent do not present dysmenorrhea (VAS between 0 and 3). This study shows that having a high SOC reduces menstrual pain (P=0.014). The main treatments used are not those recommended by Clinical practice guidelines.

DISCUSSION

Interventions based on Comprehensive Sexuality Education, medical consultations respecting salutogenic model would provide a better quality of life for adolescent girls by promoting the development of psycho-social skills.

Pudendal Nerve Block in Hemorrhoid Surgery: A Systematic Review and Meta-analysis

BACKGROUND

Postoperative pain represents an important issue in traditional hemorrhoidectomy. Optimal pain control is mandatory, especially in a surgical day care setting.

OBJECTIVE

The aim of this study was to investigate the use of pudendal nerve block in patients undergoing hemorrhoidectomy.

DATA SOURCES

PubMed, Google Scholar, Cochrane Library, and Web of Science databases were searched up to December 2020.

STUDY SELECTION

Randomized trials evaluating the pudendal nerve block effect in patients undergoing hemorrhoidectomy were selected.

INTERVENTIONS

Hemorrhoidectomy under general or spinal anesthesia with or without pudendal nerve block was performed.

MAIN OUTCOME MEASURES

Opioid consumption, pain on the visual analogue scale, length of hospital stay, and readmission rate were the main outcomes of interest and were plotted by using a random-effects model.

RESULTS

The literature search revealed 749 articles, of which 14 were deemed eligible. A total of 1214 patients were included, of whom 565 received the pudendal nerve block. After hemorrhoidectomy, patients in the pudendal nerve block group received opioids less frequently (relative risk, 0.364; 95% CI, 0.292-0.454, p < 0.001) and in a lower cumulative dose (standardized mean difference, -0.935; 95% CI, -1.280 to -0.591, p < 0.001). Moreover, these patients experienced less pain at 24 hours (standardized mean difference, -1.862; 95% CI, -2.495 to -1.228, p < 0.001), had a shorter length of hospital stay (standardized mean difference, -0.742; 95% CI, -1.145 to -0.338, p < 0.001), and had a lower readmission rate (relative risk, 0.239; 95% CI, 0.062-0.916, p = 0.037). Sensitivity analysis excluded the occurrence of publication bias on the primary end point, and the overall evidence quality was judged "high."

LIMITATIONS

Occurrence of publication bias among some secondary end points and heterogeneity are the main limitations of this study.

CONCLUSIONS

This systematic review and meta-analysis show significant advantages of pudendal nerve block use. A reduction in opioid consumption, postoperative pain, complications, and length of stay can be demonstrated. Despite the limitations, pudendal nerve block in patients undergoing hemorrhoidectomy should be considered.

Prevalence of dysmenorrhea, its association with overall academic engagement, and management among nursing undergraduates at Peradeniya University, Sri Lanka: A cross-sectional study

Background:

Dysmenorrhea or painful menstrual periods is one of the common health issues the female university students experience which intervenes with academic activities and quality of life.

Objectives:

We aimed to find the prevalence, intensity, extent of impairment in academic engagement, and efficacy of the management of dysmenorrhea among nursing students at Peradeniya University, Sri Lanka.

Methodology:

This cross sectional study comprised 86 female nursing students who represented all four academic years. A self-administered questionnaire was used. The intensity and level of dysmenorrhea were assessed. Association of the extent of working impairment with the level of pain determined by Pearson correlation. Duration of dysmenorrhea persisted before and after management was compared using paired sample t-test. The effectiveness of management was analyzed using Wilcoxon signed-rank test.

Results:

The prevalence of dysmenorrhea was 97.7%. The majority (54.7%) suffered moderate pain. Mean age of the participants was 24.02 (±1.503). During the period of dysmenorrhea, 32.6%, 33.7%, and 17.4% students experienced slight, moderate, and heavy impairment of overall academic engagement. A positive correlation was observed between level of pain and extent of academic impairment ( p < 0.05). The majority practiced pharmacological and non-pharmacological pain relieving methods together. Wilcoxon signed-rank test value revealed more negative ranks and statistically significant reduction in intensity in post-management period ( z = −7.793, p = 0). Post-management dysmenorrhea duration was significantly reduced than pre-management ( t76 = 8.984, p = 0).

Conclusion:

A substantial percent of undergraduates suffer from dysmenorrhea. It is associated impairment of overall academic engagement. The nursing students were able to manage dysmenorrhea successfully.

Factors Related to Primary Dysmenorrhea in Turkish Women: a Multiple Multinomial Logistic Regression Analysis

This study aimed to evaluate the factors related to the severity of menstrual pain in Turkish women with primary dysmenorrhea (PD). The study included 504 women with PD aged 18 years or older. A Visual Analogue Scale (VAS), a self-developed structured questionnaire, the International Physical Activity Questionnaire-Short Form (IPAQ-SF), State and Trait Anxiety Inventory, Beck Depression Inventory, and Nottingham Health Profile (NHP) were used to measure outcomes. Multiple multinomial logistic regression analysis was used to determine the factors related to the severity of menstrual pain. In this model, categorical menstrual pain severity levels (mild, moderate, and severe) were considered as dependent variables and the category of "severe menstrual pain" was determined as the reference category. p value less than 0.05 was considered statistically significant. The individuals were divided into 3 groups according to their VAS scores: mild-pain group (n = 132, 26.19%), moderate-pain group (n = 189, 37.50%), and severe-pain group (n = 183, 36.30%). BMI increase (OR = 1.10 and OR = 1.09), decreased chocolate consumption (OR = 1.88), menstruation duration (OR = 2.48) and menstrual pain duration (OR = 1.33 and OR = 1.61), and increased physical activity level (OR = 1.10) were found to increase the tendency to have less severe pain. The positive family history (OR = 0.35), a decrease in the age of menarche (OR = 0.47), the presence of irregular menstruation (OR = 0.36), and decreased quality of life (OR = 0.98 for NHP pain and emotional reaction) were found to be associated with a reduced likelihood of less severe pain (p < 0.05). In Turkey as well as in the rest of the world, PD is an important public health problem and many factors are associated with menstrual pain in Turkish women.

Association between cigarette smoking and the risk of dysmenorrhea: A meta-analysis of observational studies

BACKGROUND

Emerging studies have found inconsistent results on the potential relationship between cigarette smoking and dysmenorrhea. Therefore, the aim of this study was to quantitatively synthesize the previous findings on the preceding relationship using meta-analysis.

METHODS

Previous studies on the association between cigarette smoking and dysmenorrhea, published not later than November 2019, were systematically searched, using MeSH heading and/or relevant terms, in the electronic databases of PubMed, Medline, Web of Science and EMBASE. The I2 statistic was used to assess heterogeneity, whose source was explored using subgroup analysis. A pooled effect size was obtained using random effects model, and sensitivity analysis was performed to assess the consistency of the pooled effect size.

RESULTS

After a rigorous screening process, 24 studies involving 27,091 participants were included in this meta-analysis. The results indicated that smokers were 1.45 times more likely to develop dysmenorrhea than non-smokers (odds ratio (OR) = 1.45, 95% confidence interval (CI): 1.30-1.61). In addition, individuals classified as currently smoking were 1.50 times more likely to develop dysmenorrhea than those who were classified as never smoking (OR = 1.50, 95% CI: 1.33-1.70), whereas being a former smoker was 1.31 times more likely to develop dysmenorrhea than being a never smoker (OR = 1.31, 95% CI: 1.18-1.46). Sensitivity analysis showed that exclusion of any single study did not materially alter the overall combined effect.

CONCLUSION

The evidence from this meta-analysis indicated a significant association between cigarette smoking (both current and former smoking) and dysmenorrhea. The adverse effects of smoking provide further support for prevention of dysmenorrhea and emphasize the need to target women.

Effects of kinesio tape application on pain, anxiety, and menstrual complaints in women with primary dysmenorrhea: A randomized sham-controlled trial

AIM

To investigate the effects of kinesio tape (KT) application on pain, anxiety, and menstrual complaints in women with PD and compare this application with control and sham tape (ST).

METHODS

Fifty-one women with PD were randomized into three groups: KT, ST, and control groups. No tape application was performed in the control group. KT was applied on the sacral and suprapubic regions with the ligament technique in the KT group, while it was applied on the trochanter major with no technique in the ST group. Pain, anxiety level, and menstrual complaints were assessed before and after the applications.

RESULTS

The decreases in pain, anxiety levels, and some menstrual complaints after the application were higher in the KT group than those in the other two groups (p < 0.05).

CONCLUSION

KT application seems to be an effective method in decreasing pain, anxiety level, and some menstrual complaints in women with PD.

Absenteeism during Menstruation among Nursing Students in Spain

Absenteeism can clearly have a negative impact on academic performance among university students. Certain experiences or symptoms such as menstrual pain are very common in women and can lead to absenteeism. The current study was aimed at examining the presence of menstrual experiences or symptoms and their impact upon absenteeism among healthy (illness-free) female university nursing students in Spain. A total of 299 students participated in this research, which was a descriptive cross-sectional, observational study. An ad hoc online questionnaire was used based on sociodemographic and gynecological data, together with the noted menstrual experiences; the most prevalent of which were bloating, which affected 87.3% of students; dysmenorrhea and irritability, which affected 76.3%; and fatigue, which affected 70.6%. Students with dysmenorrhea had a 6.95 higher (odds ratio (OR) 6.95; 95% confidence interval (CI) 3.39-14.25) odds of absenteeism; in those who reported dizziness, the odds of absenteeism was 4.82 times higher (OR 4.82; 1.76-13.23); in those who manifested nausea and vomiting, the percentage of absenteeism was 3.51 higher (OR 3.51; 95% CI 1.51-8.15); in those who presented sleep alterations, the odds were 2.95 higher (OR 2.95; 95% CI 1.39-6.25); and for those who felt depressed the odds were 2.18 times higher (OR 2.18; 95% CI 1.21-3.94) Absenteeism was found to be more likely in women with dysmenorrhea. However, in addition, higher odds of absenteeism were also found in women with nausea and vomiting, dizziness, sleep disorders, and those who feel depressed. These menstrual experiences can be considered a relevant problem among young women, leading to absenteeism, and a negative influence on academic performance. It is essential to raise awareness of the socioeconomic impact of absenteeism and establish new strategies for improving menstrual experiences.

Prevalence, Wellbeing, and Symptoms of Dysmenorrhea among University Nursing Students in Greece

Dysmenorrhea (pain during menstruation) is one of the most common medical conditions among women of reproductive age. Dysmenorrhea has been studied around the world but not yet in Greece. The aim of the present study was to investigate the prevalence, characteristics, and impact of dysmenorrhea on the wellbeing (exercising, and social and academic functioning) among nursing students in Greece. A cross-sectional study of 637 nursing students was conducted by administering a questionnaire at a university in Athens. The prevalence of dysmenorrhea was 89.2% and the rate of severe intensity was 52.5%. Factors that were associated with severe dysmenorrhea were family history (p = 0.02), early menarche (p = 0.05) and menstruation duration (p = 0.05). Women with moderate and severe pain reported using pain relievers (non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol etc., p < 0.0005). Finally, activities affected by severe pain were class attendance (p = 0.01), personal studying (p < 0.0005), exercising (p < 0.0005), and socializing (p < 0.0005). Exam attendance (p = 0.27) and clinical placement attendance (p = 0.48) were not affected by severe dysmenorrhea. Dysmenorrhea has a high prevalence among nursing students and seems to affect important aspects of wellbeing and academic performance when the pain intensity is severe. The present findings lay the foundation for further investigation of dysmenorrhea both in the Greek population and cross-culturally.