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Chen CX, Rogers SK, Li R, Hinrichs RJ, Fortenberry JD, Carpenter JS. Social Determinants of Health and Dysmenorrhea: A Systematic Review. THE JOURNAL OF PAIN 2024; 25:104574. [PMID: 38788887 PMCID: PMC11347097 DOI: 10.1016/j.jpain.2024.104574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
Social determinants of health play a key role in health disparities. Dysmenorrhea is a highly prevalent and impactful public health problem affecting reproductive-age females. Systematically examining social determinants of health (SDoH) in dysmenorrhea is important for identifying gaps in the literature and informing research, policy, and clinical practice to reduce the public health burden associated with dysmenorrhea. The purpose of this systematic review was to synthesize the literature on SDoH and dysmenorrhea. The review protocol was prospectively registered. We searched Medline, EMBASE, CINAHL, PsycINFO, Scopus, and Google Scholar through February 2024 using search strategies informed by the literature. Screening of the articles, data extraction, and risk-of-bias (RoB) assessment were conducted independently by at least 2 reviewers on the Covidence platform. Among 2,594 unique records screened, 166 met eligibility criteria and were included for data extraction and RoB assessment. Evidence suggests traumatic experiences, toxic environmental exposures, female genital mutilation, job-related stress, lack of menstrual education, and low social support were associated with worse dysmenorrhea outcomes. However, evidence was equivocal regarding the relationships between dysmenorrhea outcomes and SDoH factors, including socioeconomic status, geographical location, race/ethnicity, employment, and religion. Nearly all articles (99.4%) had a high or very high overall RoB. The relationships between SDoH and dysmenorrhea outcomes were often inconsistent and complicated by heterogeneous study populations and methodologies. More rigorous research examining SDoH in dysmenorrhea is needed to inform policy and clinical practice. PERSPECTIVE: This systematic review synthesizes evidence linking SDoH and dysmenorrhea. The relationships between SDoH and dysmenorrhea were often equivocal and complicated by heterogeneous study populations and methodologies. We identify directions for future research and SDoH factors that could be addressed clinically (eg, trauma, menstrual education, and occupational stress).
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Affiliation(s)
- Chen X Chen
- Indiana University School of Nursing, Indianapolis, Indiana.
| | - Sarah K Rogers
- Department of Psychology, School of Science, Indiana University Purdue University-Indianapolis, Indianapolis, Indiana
| | - Rui Li
- Seattle Children's Research Institute, Seattle, Washington; Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, Washington
| | - Rachel J Hinrichs
- Indiana University Indianapolis, University Library, Indianapolis, Indiana
| | - J Dennis Fortenberry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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Casola AR, Medley L, Kunes BC, McGlone N, Silverio A. "It shouldn't be just hush-hush": A qualitative community-based study of menstrual health communication among women in Philadelphia. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024. [PMID: 39073267 DOI: 10.1111/psrh.12277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Although menstruation is a natural biological process, many people feel embarrassed of their menses and struggle to discuss it. To mitigate menstrual communication stigma, it is necessary to first elucidate communication experiences and perceptions. Thus, we qualitatively explore menstrual communication among cisgender women who menstruate and their family, friends, healthcare providers, and community. METHODOLOGY In partnership with No More Secrets (NMS), a Philadelphia menstrual health non-profit, we conducted a community-based participatory research (CBPR) project in Fall 2020. Cisgender, menstruating individuals ages 18-45 recruited from NMS' catchment in Philadelphia participated in semi-structured interviews about their menstrual experiences and communication (N = 20). A deductive, theory-driven approached based on the social-ecological model was used to analyze the data. RESULTS Varying emotional responses arose across social-ecological levels: communication was awkward and simplistic with family; positive and supportive with friends and community members; and uncomfortable and frustrating with healthcare providers. Participants echoed the importance of menstrual communication as a means of sharing information, feeling less alone, and decreasing menstrual stigma. DISCUSSION Findings can inform future CBPR workshops that address stigma in familial, healthcare, and community-based discussions to improve menstrual health and experiences for cisgender girls and women, transgender men, and gender non-binary individuals who menstruate.
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Affiliation(s)
- Allison R Casola
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lynette Medley
- No More Secrets Mind Body Spirit Inc., Philadelphia, Pennsylvania, USA
| | - Brianna C Kunes
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nya McGlone
- No More Secrets Mind Body Spirit Inc., Philadelphia, Pennsylvania, USA
| | - Alexis Silverio
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Ishida R, Koga K, Ohbe H, Izumi G, Matsui H, Yasunaga H, Osuga Y. Impact of government-issued financial incentive to medical facilities on management of secondary dysmenorrhea. J Obstet Gynaecol Res 2024; 50:1208-1215. [PMID: 38597093 DOI: 10.1111/jog.15946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/31/2024] [Indexed: 04/11/2024]
Abstract
AIM In April 2020, the Japanese government introduced a Specific Medical Fee for managing secondary dysmenorrhea (SD). This initiative provided financial incentives to medical facilities that provide appropriate management of SD with hormonal therapies. We aimed to assess how this policy affects the management processes and outcomes of patients with SD. METHODS Using a large Japanese administrative claims database, we identified outpatient visits of patients diagnosed with SD from April 2018 to March 2022. We used an interrupted time-series analysis and defined before April 2020 as the pre-introduction period and after April 2020 as the post-introduction period. Outcomes were the monthly proportions of outpatient visits due to SD and hormonal therapy among women in the database and the proportions of outpatient visits for hormonal therapy and continuous outpatient visits among patients with SD. RESULTS We identified 815 477 outpatient visits of patients diagnosed with SD during the pre-introduction period and 920 183 outpatient visits during the post-introduction period. There were significant upward slope changes after the introduction of financial incentives in the outpatient visits due to SD (+0.29% yearly; 95% confidence interval, +0.20% to +0.38%) and hormonal therapies (+0.038% yearly; 95% confidence interval, +0.030% to +0.045%) among the women in the database. Similarly, a significant level change was observed after the introduction of continuous outpatient visits among patients with SD (+2.68% monthly; 95% confidence interval, +0.87% to +4.49%). CONCLUSIONS Government-issued financial incentives were associated with an increase in the number of patients diagnosed with SD, hormonal therapies, and continuous outpatient visits.
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Affiliation(s)
- Risa Ishida
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Reproductive Medicine, Chiba University, Chiba, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Gentaro Izumi
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Liu W, Ding Y, Xie H, Liu H, Liang C. Efficacy and safety of transcutaneous electrical acupoint stimulation for the management of primary dysmenorrhoea: protocol for a randomised controlled trial in China. BMJ Open 2024; 14:e078895. [PMID: 38866569 PMCID: PMC11177670 DOI: 10.1136/bmjopen-2023-078895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 05/29/2024] [Indexed: 06/14/2024] Open
Abstract
INTRODUCTION Primary dysmenorrhoea (PD) is a common menstrual concern with significant physical and psychosocial impacts. The effectiveness and safety of transcutaneous electrical acupoint stimulation (TEAS) in alleviating PD symptoms remain uncertain due to insufficient evidence. This single-centre, parallel, randomised controlled study intends to evaluate the efficacy and safety of TEAS for PD management. METHODS AND ANALYSIS 60 participants aged 18-40 years diagnosed with moderate to severe PD will be recruited from Tai'an Hospital of Traditional Chinese Medicine (TCM) and randomly assigned to either a TEAS group or a TEAS-sham group (1:1). The TEAS group will undergo 12 sessions of TEAS treatment over two menstrual cycles, with 30 min per session, three sessions weekly. Participants in the TEAS-sham group will receive TEAS stimulation using identical devices and protocols but without current output. The primary outcome is the Visual Analogue Scale (VAS) for pain assessment. Secondary outcomes are Short-Form McGill Pain Questionnaire, total effective rate, uterine artery haemodynamics, prostaglandin and β-endorphin level, mental well-being and quality of life. Adverse events and their potential reasons and the use of analgesics will also be recorded. ETHICS AND DISSEMINATION This study was approved by the Medical Ethics Committee of Tai'an Hospital of TCM. Written informed consent will be obtained from each participant. The results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ChiCTR2300071686.
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Affiliation(s)
- Weiting Liu
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Yanting Ding
- Department of Massage, Tai'an Hospital of Traditional Chinese Medicine, Tai'an, Shandong Province, China
| | - Honggang Xie
- Department of Massage, Tai'an Hospital of Traditional Chinese Medicine, Tai'an, Shandong Province, China
| | - Hansheng Liu
- General Department of Gynecology, Tai'an City Central Hospital, Tai'an, Shandong Province, China
| | - Changhao Liang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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Rodrigues JC, de Arruda GT, de Moraes PC, Firão CB, Avila MA, Driusso P. Self-management of primary dysmenorrhea-related pain: cross-sectional study on non-pharmacological interventions. Pain Manag 2024; 14:265-272. [PMID: 39041620 PMCID: PMC11340746 DOI: 10.1080/17581869.2024.2376519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 06/25/2024] [Indexed: 07/24/2024] Open
Abstract
Aim: Different nonpharmacological strategies are adopted to decrease primary dysmenorrhea (PD)-related pain. The present study aimed to verify women's use of nonpharmacological methods for pain and compare them with evidence from the literature.Materials & methods: A two-step study was conducted, comprising an online survey with 9144 women to assess nonpharmacological strategies for relieving PD-related pain, and a literature review on PubMed of verify the evidence of nonpharmacological methods.Results: Many women reported using heat therapy (61.5%), tea (42.4%) and massage (30.9%) to alleviate menstrual pain. However, the literature on these methods is limited.Conclusion: Several nonpharmacological methods are used by women to relieve PD-related pain and studies with low bias risk are needed to prove their effectiveness.
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Affiliation(s)
- Jéssica Cordeiro Rodrigues
- Women's Health Research Laboratory, Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, São Paulo, 13565-905, Brazil
| | - Guilherme Tavares de Arruda
- Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, 13565-905,Brazil
| | - Pâmela Calixto de Moraes
- Women's Health Research Laboratory, Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, São Paulo, 13565-905, Brazil
| | - Caren Beatriz Firão
- Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, 13565-905,Brazil
| | - Mariana Arias Avila
- Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, 13565-905,Brazil
| | - Patricia Driusso
- Women's Health Research Laboratory, Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, São Paulo, 13565-905, Brazil
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Cameron L, Mikocka-Walus A, Sciberras E, Druitt M, Stanley K, Evans S. Menstrual pain in Australian adolescent girls and its impact on regular activities: a population-based cohort analysis based on Longitudinal Study of Australian Children survey data. Med J Aust 2024; 220:466-471. [PMID: 38717022 DOI: 10.5694/mja2.52288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 11/23/2023] [Indexed: 05/20/2024]
Abstract
OBJECTIVES To determine the proportion of Australian adolescent girls who experience menstrual pain (dysmenorrhea); to assess associations of dysmenorrhea and period pain severity with adolescents missing regular activities because of their periods. STUDY DESIGN Prospective, population-based cohort study; analysis of Longitudinal Study of Australian Children (LSAC) survey data. SETTING, PARTICIPANTS Female adolescents in the nationally representative cross-sequential sample of Australian children recruited in 2004 for the Kinder cohort (aged 4-5 years at enrolment). Survey data from waves 6 (mean age 14 years), wave 7 (16 years) and wave 8 (18 years) were analysed. MAIN OUTCOME MEASURES Severity of period pain during the preceding three months (very, quite, a little, or not at all painful); number of activity types missed because of periods; relationship between missing activities and period pain severity. RESULTS Of the 1835 participating female members of the LSAC Kinder cohort at waves 6 to 8, 1600 (87%) responded to questions about menstruation during at least one of waves 6 to 8 of data collection. At wave 6 (14 years), 227 of 644 respondents (35%) reported dysmenorrhea, 675 of 1341 (50%) at wave 6 (16 years), and 518 of 1115 (46%) at wave 8 (18 years). Of the 366 participants who reported period pain severity at all three waves, 137 reported no dysmenorrhea at all three waves (37%), 66 reported dysmenorrhea at all three waves (18%), 89 reported increasing period pain over time (24%), and 38 reported declining pain (10%). At wave 6, 223 of 647 participants reported missing at least one activity because of their periods (34%), 454 of 1341 at wave 7 (34%), and 344 of 1111 at wave 8 (31%). Of the participants who experienced very painful periods, 72% (wave 6), 63% (wave 7), and 65% (wave 8) missed at least one activity type because of their periods, as did 45% (wave 6), 36% (wave 7), and 40% (wave 8) of those who experienced quite painful periods. CONCLUSIONS A large proportion of adolescent girls in Australia experience period pain that affects their engagement in regular activities, including school attendance. Recognising adolescent period pain is important not only for enhancing their immediate quality of life with appropriate support and interventions, but also as part of early screening for chronic health conditions such as endometriosis.
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Affiliation(s)
- Lauren Cameron
- Deakin University, Melbourne, VIC
- Monash University, Melbourne, VIC
| | | | | | - Marilla Druitt
- Deakin University, Geelong, VIC
- University Hospital Geelong, Geelong, VIC
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Mohammed SS, Gagnon MM, Cummings JA. "You're Not Alone": How Adolescents Share Dysmenorrhea Experiences Through Vlogs. QUALITATIVE HEALTH RESEARCH 2024; 34:540-551. [PMID: 38127003 PMCID: PMC11080392 DOI: 10.1177/10497323231216654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
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.
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Affiliation(s)
- Sarah S. Mohammed
- Department of Psychology and Health Studies, University of Saskatchewan, Saskatoon, SK, Canada
| | - Michelle M. Gagnon
- Department of Psychology and Health Studies, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jorden A. Cummings
- Department of Psychology and Health Studies, University of Saskatchewan, Saskatoon, SK, Canada
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Özcan H, Burger NB, Derksen ME, Peute LW, Huirne JAF, De Leeuw RA. The differences between adults and adolescents using a mobile health application for menstrual complaints: A usability and qualitative study. Int J Med Inform 2024; 185:105382. [PMID: 38437753 DOI: 10.1016/j.ijmedinf.2024.105382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/19/2024] [Accepted: 02/16/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND A "Menstruatie Educatie Kalender" application (Menstruation Education Calendar, (MEK-APP)) was developed for adults to evaluate menstrual complaints. The future aim of this app is to use it as a self-diagnostic instrument for menstrual abnormalities for both adults and adolescents. Early identification of the potential of an application for future use by both user groups would increase implementation success and adoption of the application. OBJECTIVE To compare differences in experienced usability by adults versus adolescents and to identify factors influencing future use for both age groups in one mHealth application (in this study the MEK-APP). METHODS This study consisted of three phases: (1) usability testing of the MEK-APP for iOS and Android by think-aloud method, (2) two-month daily use and (3) in-depth individual interview. During the think-aloud sessions, twelve tasks were performed in the application while they were thinking aloud. Usability problems were rated for their severity with Nielsen' Severity Scale. Both the think-aloud sessions and in-depth interviews were verbatim transcribed and thematically analyzed to determine the factors influencing future use for both groups. In addition, the System Usability Scale (SUS) and Intrinsic Motivation Inventory (IMI) questionnaires were filled out during the interviews. RESULTS Seven adults (>18 years) and seven adolescents (14-18 years) evaluated the MEK-APP. There were 14 usability issues and 16 bugs in both groups. There were no differences between adults and adolescents. In the thematic qualitative analysis, the following future use factors were identified: user-expectation, motivation, privacy, understandability, and user-experience. The user-expectation, motivation and privacy differed between both groups but did not influence usage. No differences were observed in SUS and IMI scores between both groups. CONCLUSIONS There are five factors influencing the future use of a menstrual-related mHealth application for both adults and adolescents. It is possible to serve different age groups with a single application.
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Affiliation(s)
- Habibe Özcan
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Location AMC and VUmc, Amsterdam, the Netherlands
| | - Nicole B Burger
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Location AMC and VUmc, Amsterdam, the Netherlands
| | - Marloes E Derksen
- Department of Medical Informatics, eHealth Living & Learning Lab Amsterdam, Amsterdam UMC, Location University of Amsterdam, the Netherlands; Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
| | - Linda W Peute
- Department of Medical Informatics, eHealth Living & Learning Lab Amsterdam, Amsterdam UMC, Location University of Amsterdam, the Netherlands; Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Location AMC and VUmc, Amsterdam, the Netherlands
| | - Robert A De Leeuw
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Location AMC and VUmc, Amsterdam, the Netherlands.
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Özcan H, Burger NB, Dulmen-den Broeder EV, van Baal MW, den Boogaard EV, De Leeuw RA, Huirne JAF. Instruments to Identify Menstrual Complaints and Their Impact on Adolescents: A Systematic Review. J Pediatr Adolesc Gynecol 2024; 37:106-120. [PMID: 38104798 DOI: 10.1016/j.jpag.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
STUDY OBJECTIVE The aim of this review was to create an overview of available instruments used to evaluate the menstrual complaints of dysmenorrhea and heavy menstrual bleeding (HMB) in adolescents. METHODS The search was conducted in PubMed, Web of Science, Embase, and PsycINFO on December 1, 2022. Studies published in English reporting on menstrual complaints among girls aged 10-19 were included. The quality and bias risk was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. RESULTS Of 8994 identified studies, 57 were included. In these studies, 19 instruments were described, of which 8 were validated in adolescents. One was difficult to use in daily practice, 1 had low sensitivity and specificity in the detection of HMB, 2 were validated by face validity, and 2 were not specifically developed to evaluate (the impact of) menstrual complaints. Therefore, only 2 were validated and feasible to measure adolescent menstrual complaints: the Period ImPact and Pain Assessment (PIPPA) and the Adolescent Menstrual Bleeding Questionnaire (aMBQ). Remarkably, the Pictorial Blood Loss Assessment Chart (PBAC) was the most frequently used instrument in adolescents. There was one modified version of the PBAC for adolescents, which had a lower cutoff value for HMB and low sensitivity and specificity. CONCLUSION We found that the PIPPA and aMBQ are suitable for assessing menstrual complaints and their impact on daily activities and health-related quality of life in adolescents. The PBAC, which is used frequently in adults, needs to be further assessed specifically for adolescents. In particular, the clinical relevance of the PBAC cutoff value for HMB should be determined for this age group. Considering the different interpretations, experiences, and limited knowledge of menstrual complaints, instruments suitable for adults may not be suitable for adolescents.
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Affiliation(s)
- Habibe Özcan
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands
| | - Nicole B Burger
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands
| | - Eline van Dulmen-den Broeder
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands
| | - Marchien W van Baal
- Department of Obstetrics and Gynaecology, Flevo Hospital, Almere, The Netherlands
| | - Emmy van den Boogaard
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands
| | - Robert A De Leeuw
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands.
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Avila MA, de Arruda GT, de Godoy AG, Driusso P. Translation, cross-cultural adaptation to Brazilian Portuguese and measurement properties of the WaLIDD score. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo16. [PMID: 38765510 PMCID: PMC11075383 DOI: 10.61622/rbgo/2024ao16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 08/08/2023] [Indexed: 05/22/2024] Open
Abstract
Objective Dysmenorrhea is the pain related to menstruation; to screen for the symptoms, a working ability, location, intensity of days of pain, and dysmenorrhea (WaLIDD) score was created. The purpose of this work was to culturally adapt and assess the measurement properties of the WaLIDD score for dysmenorrhea in Brazilian women. Methods In this cross-sectional online study, we evaluated women with and without dysmenorrhea. Criterion validity and construct validity were assessed, respectively, by the Receiver Operator Characteristic (ROC) curve and correlations with the bodily pain and social functioning domains of medical outcomes study 36-item short-form health survey (SF-36), self-report of absenteeism and Stanford Presenteeism Scale for presenteeism. Test-retest reliability and measurement errors were assessed, respectively, by intraclass correlation coefficient (ICC) and Bland and Altman Graph. Results 430 women completed the test, 238 (55.4%) women had dysmenorrhea, and 199 (46.3%) answered the questionnaire twice for the retest. The cutoff points ≥4, ≥5, and ≥5 could discriminate between women with and without dysmenorrhea, absenteeism, and presenteeism related to dysmenorrhea, respectively. Correlations between SF-36 - pain and social functioning domains and WaLIDD score were weak to strong and negative. For WaLIDD total Score, ICC was 0.95 and the limits of agreement were -1.54 and 1.62. Conclusion WaLIDD score is a short, valid and reliable instrument to screen and predict dysmenorrhea and could predict absenteeism and presenteeism related to dysmenorrhea in Brazilian women.
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Affiliation(s)
- Mariana Arias Avila
- Universidade Federal de São CarlosSão CarlosSPBrazilUniversidade Federal de São Carlos, São Carlos, SP, Brazil.
| | - Guilherme Tavares de Arruda
- Universidade Federal de São CarlosSão CarlosSPBrazilUniversidade Federal de São Carlos, São Carlos, SP, Brazil.
| | - Amanda Garcia de Godoy
- Universidade Federal de São CarlosSão CarlosSPBrazilUniversidade Federal de São Carlos, São Carlos, SP, Brazil.
| | - Patricia Driusso
- Universidade Federal de São CarlosSão CarlosSPBrazilUniversidade Federal de São Carlos, São Carlos, SP, Brazil.
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Barbosa-Silva J, Avila MA, de Oliveira RF, Dedicação AC, Godoy AG, Rodrigues JC, Driusso P. Prevalence, pain intensity and symptoms associated with primary dysmenorrhea: a cross-sectional study. BMC Womens Health 2024; 24:92. [PMID: 38311716 PMCID: PMC10840141 DOI: 10.1186/s12905-023-02878-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/31/2023] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Primary dysmenorrhea (PD) is an etiological cyclic pelvic pain related to the menstrual period; it can negatively impact women's quality of life and productivity. The aim of the present study was to estimate the prevalence of PD and analyze associated symptoms in Brazilian women. METHODS An online cross-sectional study was carried out in Brazil, with a structured questionnaire regarding dysmenorrhea and associated symptoms. PD intensity was measured with the Numerical Rating Scale for Pain and classified as mild (1-3), moderate (4-7) and severe (> 8). The association between qualitative variables was performed using Pearson's Chi-Square Test. The quantification of this association was measured using multinomial logistic regression models, with calculation of Odds Ratio and confidence interval. A significance level of 5% was considered. RESULTS A total of 10,070 women were included. Most participants classified PD intensity as moderate (40.4%, 41.9% and 49.7%) and severe (21.2%, 24.8% and 28.4%) in the previous month, 3 months and 5 years, respectively. The most common symptoms associated with PD were irritability, abdominal distension sensation, anxiety and feeling more emotional. The increased of the risk (OR > 1.0) for moderate and severe PD-related pain intensity is related to age, nulliparity and presence PD since adolescence. CONCLUSION There is a high prevalence of PD among Brazilian women, and the most common symptoms reported were irritability, abdominal distension sensation, anxiety and feeling more emotional.
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Affiliation(s)
- Jordana Barbosa-Silva
- Women's Health Research Laboratory (LAMU), Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Mariana Arias Avila
- Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil
| | - Raissa Fernanda de Oliveira
- Women's Health Research Laboratory (LAMU), Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Anny Caroline Dedicação
- Women's Health Research Laboratory (LAMU), Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.
- Multiprofessional Residency Program, Hospital Israelita Albert Einstein (HIAE), São Paulo, Brazil.
| | - Amanda Garcia Godoy
- Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil
| | - Jessica Cordeiro Rodrigues
- Women's Health Research Laboratory (LAMU), Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Patricia Driusso
- Women's Health Research Laboratory (LAMU), Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
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12
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McLagan B, Dexheimer J, Strock N, Goldstein S, Guzman S, Erceg D, Schroeder ET. The role of transcutaneous electrical nerve stimulation for menstrual pain relief: A randomized control trial. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241266455. [PMID: 39066557 PMCID: PMC11282568 DOI: 10.1177/17455057241266455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/15/2024] [Accepted: 06/13/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Abdominal pain due to menses (primary dysmenorrhea) is an extremely pervasive and debilitating symptom affecting up to 90% of menstruating individuals. OBJECTIVE The objective of this randomized control trial was to investigate the effect of a commercial transcutaneous electrical nerve stimulation unit, Therabody PowerDot® (Therabody Inc., Los Angeles) on dysmenorrhea compared with non-steroidal anti-inflammatory drug use. DESIGN This was a randomized cross-over study. METHODS A total of 47 participants agreed to participate in the study, with 34 completing it. Participants completed treatments across three consecutive menstrual cycles in randomized order: single-unit transcutaneous electrical nerve stimulation (Uno), dual unit transcutaneous electrical nerve stimulation (Duo), and non-steroidal anti-inflammatory drug use (Control). Upon onset of dysmenorrhea, participants applied transcutaneous electrical nerve stimulation to their abdomen for a minimum of 30 min. Control participants were instructed to take non-steroidal anti-inflammatory drugs as needed. Surveys were used to record pain before and after treatment. We hypothesized that the PowerDot would decrease self-reported pain scores, and decrease non-steroidal anti-inflammatory drug consumption during menses. RESULTS Participants experienced a statistically and clinically significant reduction in pain during the Control (-3.52 ± 1.9), Uno (-2.10 ± 1.6), and Duo (-2.19 ± 1.7) cycles (p < 0.001). The doses of non-steroidal anti-inflammatory drugs consumed during the Control cycle (3.5 ± 2.6), was significantly different as compared with that of Uno (1.5 ± 3.0), or Duo (1.1 ± 2.6) (p = 0.004). CONCLUSIONS Use of a commercial transcutaneous electrical nerve stimulation unit results in significant decrease in pain. Although not as robust as the relief in pain induced by non-steroidal anti-inflammatory drugs, the adverse events of transcutaneous electrical nerve stimulation are minimal in comparison. Therefore, transcutaneous electrical nerve stimulation appears to be a viable alternative to pain relief from dysmenorrhea. CLINICAL TRIAL REGISTRATION NCT05178589.
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Affiliation(s)
- Bailey McLagan
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | | | | | - Shayna Goldstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Stephanie Guzman
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - David Erceg
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - E Todd Schroeder
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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13
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Wiggleton-Little J. "Just" a painful period: A philosophical perspective review of the dismissal of menstrual pain. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241255646. [PMID: 38773901 PMCID: PMC11113068 DOI: 10.1177/17455057241255646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 05/24/2024]
Abstract
Science and society typically respond to dysmenorrhea-or painful menstrual cramps-as a normal, natural, and inevitable part of menstruation. This normalization has greatly contributed to the systemic dismissal of painful menstrual cramps. Stigma, secrecy, and the expectation to "cope" fuel the normalization of menstrual pain. In this article, I argue that the normalization of menstrual pain restricts the ability to share an excruciating menstrual pain in a way that would otherwise elicit alarm or concern. This can cause clinicians to downgrade menstrual pain, and even menstruating persons to downgrade their own pain. I refer to the dismissal of menstrual pain as an example of a pain-related motivational deficit. A pain-related motivational deficit describes instances in which an utterance fails to motivate due to societal practices and ideas that make it difficult to recognize the import of the embodied experience being shared.
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14
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Rogers SK, Ahamadeen N, Chen CX, Mosher CE, Stewart JC, Rand KL. Dysmenorrhea and psychological distress: a meta-analysis. Arch Womens Ment Health 2023; 26:719-735. [PMID: 37632569 DOI: 10.1007/s00737-023-01365-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 08/14/2023] [Indexed: 08/28/2023]
Abstract
Dysmenorrhea is characterized by pelvic pain associated with menstruation. Similar to people with other pain conditions, females who experience dysmenorrhea report increased psychological distress. However, the pooled magnitude of this association has not been quantified across studies. Accordingly, this meta-analytic review quantifies the magnitude of the associations between dysmenorrhea severity and psychological distress. We conducted a systematic search of the literature using PsycINFO, PubMed, CINHAL, Embase, and Web of Science. Analyzed studies provided observational data on dysmenorrhea severity and anxiety symptoms, depressive symptoms, and/or global psychological distress. A total of 44 studies were included, and three random-effects meta-analyses were conducted, with average pooled effect sizes calculated using Person's r. We found significant, positive associations between measures of dysmenorrhea severity and measures of depressive symptoms (r = 0.216), anxiety symptoms (r = 0.207), and global psychological distress (r = 0.311). Our review suggests that females with greater dysmenorrhea severity experience greater psychological distress. Future directions include defining a clinically meaningful dysmenorrhea severity threshold, understanding the mechanisms and directionality underlying the dysmenorrhea-psychological distress relationship, and designing and testing interventions to jointly address dysmenorrhea and psychological distress.
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Affiliation(s)
- Sarah K Rogers
- School of Science, Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., LD 113A, Indianapolis, IN, 46202, USA.
| | - Naheeda Ahamadeen
- School of Science, Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., LD 113A, Indianapolis, IN, 46202, USA
| | - Chen X Chen
- School of Nursing, Indiana University, Indianapolis, IN, USA
| | - Catherine E Mosher
- School of Science, Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., LD 113A, Indianapolis, IN, 46202, USA
| | - Jesse C Stewart
- School of Science, Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., LD 113A, Indianapolis, IN, 46202, USA
| | - Kevin L Rand
- School of Science, Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., LD 113A, Indianapolis, IN, 46202, USA
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15
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Cook AS, van den Hoek R. Period pain presenteeism: investigating associations of working while experiencing dysmenorrhea. J Psychosom Obstet Gynaecol 2023; 44:2236294. [PMID: 37466378 DOI: 10.1080/0167482x.2023.2236294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/08/2023] [Accepted: 07/08/2023] [Indexed: 07/20/2023] Open
Abstract
Although menstrual pain (dysmenorrhea) is common and can have detrimental effects on work and social functioning, little is known about how people manage it in their professional life. Existing evidence indicates that people with dysmenorrhea often engage in presenteeism, meaning they work despite experiencing symptoms and report perceptions of social stigma around menstruation. In this study, we investigated individual health-related factors, psychosocial factors, and work factors associated with period pain presenteeism in a cross-sectional survey study including N = 668 employed people with experiences of dysmenorrhea. Our results show that symptom severity, disclosure of menstrual pain to the leader, and remote work are directly associated with period pain presenteeism. We further found that the presence of medical diagnosis moderates the association between symptom severity and presenteeism. Disclosure to the leader was associated with leader gender, leader-member exchange (LMX), and the absence of a medical diagnosis, indicating a potential mediating effect. We did not, however, find the perceptions of public beliefs regarding the concealment of menstruation to be related to presenteeism or disclosure. Our findings have important implications for research on menstrual health and occupational health management practice.
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Affiliation(s)
- Alexandra Sasha Cook
- Psychological Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Robin van den Hoek
- Psychological Research Institute, University of Amsterdam, Amsterdam, Netherlands
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16
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Seidman LC, Handy AB, Temme CR, Greenfield SF, Payne LA. Reflections on the group dynamic in a group cognitive behavioral therapy intervention for young adult women with moderate to severe dysmenorrhea: a qualitative analysis. J Psychosom Obstet Gynaecol 2023; 44:2264486. [PMID: 37800565 PMCID: PMC10640904 DOI: 10.1080/0167482x.2023.2264486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023] Open
Abstract
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.
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Affiliation(s)
| | | | | | | | - Laura A. Payne
- McLean Hospital, Belmont, MA
- Harvard Medical School, Boston, MA
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17
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Mohamad Bakro R, Farrukh MJ, Rajagopal M, Kristina SA, Ramatillah DL, Ming LC, Paneerselvam GS, Hadi MA. Assessment of prevalence, knowledge and health-related practices of dysmenorrhea among Malaysian women in Kuala Lumpur: a cross-sectional survey. Ann Med 2023; 55:2281655. [PMID: 38010360 PMCID: PMC10763855 DOI: 10.1080/07853890.2023.2281655] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Menstruation is a natural phenomenon considered an important indicator of women's health, reflecting their endocrine function. Women in low middle income countries face substantial menstrual hygiene management challenges. Data on the knowledge of dysmenorrhea and health-related practices among Malaysian women are scarce. The present study aimed to investigate the prevalence of dysmenorrhea among Malaysian women in Kuala Lumpur and its association with socio-demographic factors, knowledge level, and general practices. METHOD A cross-sectional study was carried out among Malaysian women in Kuala Lumpur. A total of 362 unmarried women, nulliparous and aged between 18 and 25 years old, were included in this study. Participants were conveniently recruited through online platforms as well as face to face using a self-administered questionnaire with five sections consisting of demographics, menstrual characteristics, Working ability, Location, Intensity, Days of pain, Dysmenorrhea (WaLIDD) score for diagnosing and assessing the severity of dysmenorrhea as well as an evaluation of respondents' general knowledge and practices towards dysmenorrhea. The collected data were analysed using the SPSS tool, a descriptive statistic was used to report demographic characteristics. Inferential statistics was used to report the differentiation, association, and correlations of the variables. RESULTS The prevalence of primary dysmenorrhea was 73.2%. It was found that the majority of the respondents had poor knowledge (60%) and poor practices (61.88%) of dysmenorrhea. The most common preventive practices among the respondents were using dietary supplements, and herbs, taking a rest and exercising. The findings also indicated that dysmenorrhea among the respondents was significantly associated with family history of dysmenorrhea (p = 0.002), monthly income (p = 0.001), and knowledge level (p = 0.001). CONCLUSION Dysmenorrhea has a high prevalence among women in Malaysia in Kula Lumpur driven by low knowledge and lack of evidence-based practices among these women. Thus, it is critical for Government and healthcare authorities to promote education related to women health among Malaysian women.
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Affiliation(s)
- Rana Mohamad Bakro
- Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
| | | | - Mogana Rajagopal
- Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Susi Ari Kristina
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Long Chiau Ming
- School of Medical and Life Sciences, Sunway University, Sunway City, Malaysia
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18
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Getahun SB, Berhe S, Mekonnen B, Melaku G. Reasons for Not Seeking Healthcare Among Students with Dysmenorrhea: A Qualitative Study. Int J Womens Health 2023; 15:1733-1744. [PMID: 38020940 PMCID: PMC10649844 DOI: 10.2147/ijwh.s437233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background Dysmenorrhea is a significant health burden for women and a global public health issue. Despite its notable prevalence and impact, dysmenorrhea is mostly poorly identified, treated, and accepted as normal by patients themselves. To create strategies that enable care seeking and ideal symptom management for dysmenorrhea, it is vital to have a better understanding of the reasons why women do not seek medical attention. This study aimed to explore the reasons for not seeking healthcare among students with dysmenorrhea at Dilla University in 2023. Methods A qualitative phenomenological study was conducted with purposively selected Colleges of Dilla University students with dysmenorrhea. An individual in-depth interview with a semi-structured interview guide was used to collect data from March 1-30/2023. Snowball sampling was used to obtain study participants, and sampling was determined based on the level of data saturation. The interviews were conducted in a separate private room at Dilla University. Data analysis was started simultaneously with data collection and thematic analysis was performed. ATLAS. ti 9 qualitative software was used to support the data analysis and management. Results The study enrolled 20 students with dysmenorrhea, with a mean age of 21.55 years and a mean age of menarche of 14.45 years. It explored three themes for reasons for not seeking healthcare: sociocultural and personal factors, healthcare system-related perceptions and experiences, and preference for self-management of symptoms. The study also reported myths and misconceptions, negative attitudes and experiences, and self-care practices as barriers to accessing and utilizing health care services. Conclusion This study identified various reasons for not seeking healthcare among students with dysmenorrhea. Most of these reasons indicate that there is insufficient awareness and misconception of dysmenorrhea and its management. Therefore, this study advances the literature on dysmenorrhea and emphasizes the need for more awareness, education, and quality healthcare services for students with dysmenorrhea. The study also proposes future research directions to address the problem of dysmenorrhea among female students in Ethiopia.
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Affiliation(s)
- Senait Belay Getahun
- Department of Midwifery, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Semarya Berhe
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bazie Mekonnen
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getnet Melaku
- Department of Midwifery, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
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19
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Moreno Gómez A, Guo P, de la Llave Rincón AI, Efstathiou N. Women's experiences of primary dysmenorrhea symptoms: a systematic review of qualitative evidence and meta-aggregation. Women Health 2023; 63:658-668. [PMID: 37726871 DOI: 10.1080/03630242.2023.2255289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 08/28/2023] [Indexed: 09/21/2023]
Abstract
Primary dysmenorrhea (PD) has a significant impact on women's lives, especially among young women who miss school and work due to painful periods. Experiences and how women manage PD have been explored to some extent, but the evidence has not been systematically collated and reviewed to allow health professionals to better understand women's experiences of and perceptions about PD. Hence, we aim to synthesize the qualitative evidence related to women's experiences of PD and associated symptoms. For this purpose, seven databases (Ovid MEDLINE®, PubMed, Embase, APA PsycINFO, Web of Science, CINAHL and OpenGrey) were searched for relevant papers published in English, Spanish, Greek and Chinese between January 1997 and May 2021. All studies investigating women's experiences with PD were included; besides, The Critical Appraisal Skills Programme (CASP) tool for qualitative studies was used to critically appraise the papers. A data extraction form was developed using JBI template and findings from the papers were analyzed and synthesized using meta-aggregation. Sixteen articles were included and during the analysis five themes were identified: Experiencing pain and associated symptoms, the psychological dimension of PD, knowledge and support, day-to-day living with PD, and coping strategies. We concluded taboos and deeply rooted beliefs around menstruation can potentially lead to gender inequalities; hence, women's common concerns and their experiences with PD need to be considered. Training and treatment protocols for health practitioners are needed. Future research should focus on development and testing of protocols for diagnosis, pharmacological and non-pharmacological management and men's perceptions of menstruation of their lovers.
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Affiliation(s)
- Ana Moreno Gómez
- Student in Health Sciences, Universidad Rey Juan Carlos, Alcorcón (Madrid), Spain
| | - Ping Guo
- School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ana Isabel de la Llave Rincón
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Nikolaos Efstathiou
- College of Medical and Dental Sciences, Institute of Clinical Sciences, School of Nursing, University of Birmingham, Birmingham, UK
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20
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Loke SXY, Chew EYH, Siew AL, Glass GF, Chan EY. Transiting Back Home: Caregivers' Lived Experiences in Caring for Loved Ones on the Nasogastric Tube in the Home-Setting in Singapore. J Transcult Nurs 2023; 34:343-355. [PMID: 37226459 DOI: 10.1177/10436596231175163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION Little is understood about caregivers' lived experiences when first caring for patients on the nasogastric tube at home in an Asian setting. To enhance understanding, our study aimed to chart these caregivers' psycho-emotional evolutions felt during such caregiving experiences in Singapore. METHOD Utilizing purposive sampling, a descriptive phenomenological study was performed, with semi-structured interviews of 10 caregivers of persons on nasogastric tube feeding conducted. Thematic analysis was utilized. RESULTS Our findings chart four psycho-emotional transitions of a caregiver's journey in nasogastric tube feeding and the cultural dynamics involved-(a) Disruption of Caregivers' Normality: Attempting to Grasp Reality, (b) Encountering Road-Blocks: Despondency Arises and Frustrations Abound, (c) Adjusting to the New Normal: Reclaiming Confidence and Positivity, (d) Thriving and Integrating into the New Normal, and (e) Cultural Dynamics At Play. DISCUSSION Our findings illuminate the understanding of caregivers' varying needs, guiding delivery of culturally-congruent caregiver support targeted at each psycho-emotional evolution.
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Affiliation(s)
| | | | | | | | - Ee Yuee Chan
- Tan Tock Seng Hospital, Singapore
- Geriatric Education and Research Institute, Singapore
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21
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Rogers SK, Galloway A, Hirsh AT, Zapolski T, Chen CX, Rand KL. Efficacy of psychological interventions for dysmenorrhea: a meta-analysis. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1086-1099. [PMID: 37154693 DOI: 10.1093/pm/pnad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
Dysmenorrhea is pelvic pain associated with menstruation and is one of the most common pain conditions among reproductive-age women. It is commonly treated with medications, complementary and alternative medicine, and self-management techniques. However, there is increased focus on psychological interventions which modify thoughts, beliefs, emotions, and behavioral responses to dysmenorrhea. This review examined the efficacy of psychological interventions on dysmenorrhea pain severity and interference. We conducted a systematic search of the literature using PsycINFO, PubMed, CINHAL, and Embase. A total of 22 studies were included; 21 examined within-group improvement (ie, within-group analysis) and 14 examined between-group improvement (ie, between-group analysis). Random-effects meta-analyses were conducted on pain severity and interference, with average effect sizes calculated using Hedges's g. Within-group analyses showed decreased pain severity and interference at post-treatment (g = 0.986 and 0.949, respectively) and first follow-up (g = 1.239 and 0.842, respectively). Between-group analyses showed decreased pain severity at post-treatment (g = 0.909) and decreased pain severity and interference at first follow-up (g = 0.964 and 0.884, respectively) compared to control groups. This review supports the efficacy of psychological interventions for dysmenorrhea, but conclusions are tempered by suboptimal methodological quality of the included studies and high heterogeneity across studies. Additional, rigorous research is needed to determine the clinical utility of psychological interventions for dysmenorrhea.
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Affiliation(s)
- Sarah K Rogers
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Amanda Galloway
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Adam T Hirsh
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Tamika Zapolski
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Chen X Chen
- Indiana University School of Nursing, Indianapolis, IN 46202, United States
| | - Kevin L Rand
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
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Heaney S, Galeotti M, Aventin Á. Pregnancy loss following miscarriage and termination of pregnancy for medical reasons during the COVID-19 pandemic: a thematic analysis of women's experiences of healthcare on the island of Ireland. BMC Pregnancy Childbirth 2023; 23:529. [PMID: 37480006 PMCID: PMC10360341 DOI: 10.1186/s12884-023-05839-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/09/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Losing a baby during pregnancy can be a devastating experience for expectant parents. Many report dedicated, compassionate healthcare provision as a facilitator of positive mental health outcomes, however, healthcare services have been severely impacted during the COVID-19 pandemic. AIM To explore women's experiences of healthcare service provision for miscarriage and termination of pregnancy for medical reasons (TFMR) on the island of Ireland during the COVID-19 pandemic. METHODS Findings combine data from elements of two separate studies. Study 1 used a mixed methods approach with women who experienced miscarriage and attended a hospital in Northern Ireland. Study 2 was qualitative and examined experiences of TFMR in Northern Ireland and Ireland. Data analysed for this paper includes open-ended responses from 145 women to one survey question from Study 1, and semi-structured interview data with 12 women from Study 2. Data were analysed separately using Thematic Analysis and combined for presentation in this paper. RESULTS Combined analysis of results indicated three themes, (1) Lonely and anxiety-provoking experiences; (2) Waiting for inadequate healthcare; and (3) The comfort of compassionate healthcare professionals. CONCLUSIONS Women's experiences of healthcare provision were negatively impacted by COVID-19, with the exclusion of their partner in hospital, and delayed services highlighted as particularly distressing. Limited in-person interactions with health professionals appeared to compound difficulties. The lived experience of service users will be helpful in developing policies, guidelines, and training that balance both the need to minimise the risk of infection spread, with the emotional, psychological, and physical needs and wishes of parents. Further research is needed to explore the long-term impact of pregnancy loss during a pandemic on both parents and health professionals delivering care.
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Affiliation(s)
- Suzanne Heaney
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Martina Galeotti
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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23
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Gray LJ, Durand H. Experiences of dysmenorrhea and its treatment among allistic and autistic menstruators: a thematic analysis. BMC Womens Health 2023; 23:288. [PMID: 37231369 DOI: 10.1186/s12905-023-02370-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Dysmenorrhea (i.e., period pain) is common and debilitating. Autistic people are known to experience pain differently, yet little is known about the menstrual pain experiences of autistic menstruators relative to non-autistic peers. This study aimed to explore the experience of period pain and treatment uptake for period pain among allistic and autistic populations. METHODS This study used a qualitative design and opportunity sampling approach. Thirty-seven participants (of whom 17 were autistic) were interviewed via video-conferencing software using a semi-structured topic guide. Transcriptions of interviews were analysed using Braun and Clarke's Reflexive Thematic Analysis. Data were initially analysed together for common themes. Autistic menstruators' data was subsequently analysed separately to elucidate the unique experiences of this group. RESULTS A total of six themes were constructed from the data. Initial analysis determined three themes related to experiences of period pain and treatment uptake in both allistic and autistic menstruators. Social perception of menstruation was discussed, highlighting the normalisation of pain, the taboo nature, and gendered experience of menstruation, contributing to untreated menstrual pain. Issues within menstrual healthcare were also shared, including experiences of ineffective treatment, dismissive interactions, and insufficient menstrual education. Impaired functionality was repeatedly highlighted, with menstruators detailing significant limitations to their usual functioning due to menstrual pain and ineffective treatment. Three further themes were constructed from separate analysis of data from autistic menstruators. Autistic menstruators discussed the impact of menstruation on their sensory experiences and needs, with many identifying overstimulation during menstruation. Social exclusion was discussed as a factor contributing to the experience of menstrual pain and poor treatment uptake. The final theme identified pain communication differences between autistic and allistic menstruators resulting in reports of ineffective treatment and challenges in healthcare interactions. CONCLUSIONS Communication differences, sensory aspects, and social factors contributed to the experience of period pain and treatment uptake for autistic menstruators. The perception of menstruation within society was highlighted by allistic and autistic menstruators as influential to their pain experience and engagement with treatment. Functionality was significantly impacted by pain for this sample. The study highlights societal and healthcare factors that could be improved to ensure accessibility of support and treatment for menstrual issues.
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Affiliation(s)
- Lauren J Gray
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, Scotland
- Department of Psychology, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Hannah Durand
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, Scotland.
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Stroke Risk in Young Women with Primary Dysmenorrhea: A Propensity-Score-Matched Retrospective Cohort Study. J Pers Med 2023; 13:jpm13010114. [PMID: 36675775 PMCID: PMC9866310 DOI: 10.3390/jpm13010114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/26/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Studies on strokes associated with dysmenorrhea are limited. We conducted a propensity-score-matched retrospective cohort study to assess the risk of stroke in women with primary dysmenorrhea (PD). METHODS From the claims data of one million people in Taiwan's insurance program, we identified 18,783 women aged 15-40 years, newly diagnosed with PD in 2000-2010, without a history of stroke. We randomly selected a comparison cohort without stroke history and dysmenorrhea, with the same sample size matched by age, index date, and propensity score. We began a follow-up with individuals one year after cohort entry to the end of 2013 to capture stroke events. RESULTS The two study cohorts were well-matched for age and comorbidities, with 54% of women aged 15-24. Stroke incidence was 1.5-fold higher in the PD cohort than in the comparison cohort (6.05 vs. 4.01 per 10,000 person-years, or 99 vs. 65 cases), with an adjusted hazard ratio (aHR) of 1.51 (95%CI 1.11-2.06) after adjustment for matched pairs. Nearly 70% of strokes were ischemic strokes, which occurred 1.6 times more frequently in the PD cohort than in the comparison cohort (4.40 vs. 2.71 per 10,000 person-years, or 72 vs. 44 cases), aHR = 1.61 (95% CI 1.11-2.33), after adjustment for matched pairs. The incidence of hemorrhagic stroke was also higher in the PD cohort than in the comparison cohort (1.65 vs. 1.29 per 10,000 person-years, or 27 versus 21 cases), but the difference was not significant. CONCLUSION Women of reproductive age with PD are at increased risk for ischemic stroke.
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“It’s Just Another Unfortunate Part of Being Female”: A Qualitative Study on Dysmenorrhea Severity and Quality of Life. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09930-4. [PMID: 36436072 DOI: 10.1007/s10880-022-09930-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/28/2022]
Abstract
The present study sought to understand similarities and differences in the experiences of women with mild, moderate and severe menstrual pain. Women aged 18-50 years were recruited from the community between May and July 2019 (n = 624). Participants were asked to rate their menstrual pain severity using a Numerical Rating Scale categorised into mild (scores 1-4), moderate (scores 5-7), and severe dysmenorrhea (scores 8-10) and respond to three open-ended questions about the impact of menstrual pain. Inductive template thematic analysis was used to understand patterns of meaning and compare and contrast the experience of menstrual pain across severity. Three themes were derived, including 'Dysmenorrhea is more than menstrual pain;' 'It puts a hold on lives;' and 'Lack of health-related information.' Women across all pain severities reported disabling symptoms, disrupted physical activity and the need for education and treatment. Those experiencing mild pain reported relatively brief symptoms and minor impacts, whilst those with moderate, and especially severe pain reported debilitating symptoms and extensive impacts. Supportive care including education is needed for all menstruating people.
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Ní Chéileachair F, McGuire BE, Durand H. Coping with dysmenorrhea: a qualitative analysis of period pain management among students who menstruate. BMC Womens Health 2022; 22:407. [PMID: 36199106 PMCID: PMC9533282 DOI: 10.1186/s12905-022-01988-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dysmenorrhea, or period pain, affects up to 95% of menstruating individuals and is a common cause of educational absenteeism among students who menstruate worldwide. Evidence suggests that students may lack sufficient knowledge about their menstrual health, which may impede self-management. The aim of the current study was to explore pain management strategies used by students in Ireland with painful periods and to identify their unaddressed needs across physical, psychological, educational, and social domains. METHODS This study used a qualitative, interpretive design and opportunity sampling approach to collect and interpret individual accounts of dysmenorrhea from third-level students in Ireland. Data from 21 students were collected using semi-structured online one-to-one interviews and analysed using reflexive thematic analysis. RESULTS Analysis resulted in the construction of five themes: (1) Pain management is self-directed trial-and-error, (2) Home as safe haven, (3) Prioritising productivity over pain, (4) We're missing an option between 'normalise' and 'medicalise', and (5) Cycle of censorship and concealment. Overall, limited formal education on dysmenorrhea and prevailing negative attitudes towards menstruation create an unsupportive environment for students to learn adequate coping skills. Beyond education, menstrual stigma may also restrict the availability of clear management guidance in domestic and medical spheres. Experiences of dysmenorrhea were also influenced by the COVID-19 pandemic, where work-from-home measures were viewed favourably by individuals with dysmenorrhea. CONCLUSIONS This study indicates that students in Ireland are inadequately prepared to cope with dysmenorrhea. The current findings have substantial implications for evaluating and reforming current menstrual education standards, in addition to clarifying the negative effects of social stigma on menstrual health literacy.
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Affiliation(s)
- Fódhla Ní Chéileachair
- School of Psychology, University of Galway, Galway, Ireland ,Centre for Pain Research, University of Galway, Galway, Ireland
| | - Brian E. McGuire
- School of Psychology, University of Galway, Galway, Ireland ,Centre for Pain Research, University of Galway, Galway, Ireland
| | - Hannah Durand
- School of Psychology, University of Galway, Galway, Ireland ,Centre for Pain Research, University of Galway, Galway, Ireland ,grid.11918.300000 0001 2248 4331Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, Scotland, UK
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Arruda GT, Driusso P, Rodrigues JC, Godoy AG, Degani A, Danna-Dos-Santos A, Avila MA. Are menstrual symptoms associated with central sensitization inventory? A cross-sectional study. Eur J Pain 2022; 26:1759-1767. [PMID: 35761773 DOI: 10.1002/ejp.1999] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/13/2022] [Accepted: 06/26/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Dysmenorrhea is a prevalent pain condition that affects women of reproductive age, who are monthly exposed to this pain, usually until they reach the adult age, or even after that, which can predispose them to Central Sensitization. The present study aimed to observe the association between menstrual characteristics and central sensitivity symptoms in women. METHODS Cross-sectional study. Brazilian women (n=10,402) answered an online form comprised of questions regarding their gynecological history, the Numerical Rating Scale for pain and the Central Sensitization Inventory, part A. For the analysis, we separated women into two groups: Central Sensitivity Symptoms group (n=5,200) and No-Central Sensitivity Symptoms group (n=5,202). We performed a binary logistic regression with the backward insertion method for the variables with p<0.05 in the bivariate analysis between groups. The significance level was set at 5%. RESULTS Prevalence of dysmenorrhea was 67.3%, and 32.2% of women in the Central Sensitivity Symptoms group reported pain >8 during their menstrual period. The logistic regression showed that greater levels of menstrual pain (Odds Ratio 1.12), gynecological diseases (Odds Ratio 1.51), presence of dysmenorrhea since adolescence (Odds Ratio 1.20) and irregular menstrual cycles (Odds Ratio 1.47) increased the likelihood of women presenting with Central Sensitivity Symptoms (p<0.05 for all comparisons). CONCLUSIONS The present study shows that Central Sensitivity Symptoms are present in about 50% of women and are associated with menstrual characteristics such as dysmenorrhea-related pain intensity, cycle regularity, presence of dysmenorrhea since adolescence accompanied by gynecological diseases. SIGNIFICANCE Central sensitivity symptoms occur in 50% of women, and are more present in women with dysmenorrhea. They are associated with cycle regularity, presence of dysmenorrhea since adolescence, and gynecological diseases. LIMITATIONS Women that suffer from dysmenorrhea and of higher socioeconomic and educational levels may have been more propense to respond to the invitation; as such, the findings of the present study should be carefully interpreted.
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Affiliation(s)
- G T Arruda
- Physical Therapy Post-Graduate Program and Physical Therapy Department, UFSCar, Brazil.,Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, UFSCar, Brazil
| | - P Driusso
- Physical Therapy Post-Graduate Program and Physical Therapy Department, UFSCar, Brazil.,Laboratory of Research on Women's Health (LAMU), Physical Therapy Department, UFSCar, Brazil
| | - J C Rodrigues
- Physical Therapy Post-Graduate Program and Physical Therapy Department, UFSCar, Brazil.,Laboratory of Research on Women's Health (LAMU), Physical Therapy Department, UFSCar, Brazil
| | - A G Godoy
- Physical Therapy Post-Graduate Program and Physical Therapy Department, UFSCar, Brazil.,Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, UFSCar, Brazil
| | - A Degani
- Laboratory for Advancements in Rehabilitation Science, Department of Physical Therapy at Western Michigan University, Kalamazoo, MI, USA
| | - A Danna-Dos-Santos
- Laboratory for Advancements in Rehabilitation Science, Department of Physical Therapy at Western Michigan University, Kalamazoo, MI, USA
| | - M A Avila
- Physical Therapy Post-Graduate Program and Physical Therapy Department, UFSCar, Brazil.,Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, UFSCar, Brazil
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Menstrual Symptoms, Health-Related Quality of Life, and Work Productivity in Japanese Women with Dysmenorrhea Receiving Different Treatments: Prospective Observational Study. Adv Ther 2022; 39:2562-2577. [PMID: 35362862 PMCID: PMC9123075 DOI: 10.1007/s12325-022-02118-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/07/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Dysmenorrhea is a physical and mental burden for women, negatively affecting health-related quality of life (HRQL) and work productivity. However, data on HRQL and work productivity of Japanese women are scarce. METHODS In this prospective observational study, 397 Japanese women received low-dose estrogen/progestin (LEP) or non-LEP treatment (non-steroidal anti-inflammatory drugs or Chinese herbal medicines) for primary/secondary dysmenorrhea and completed survey questionnaires online regarding menstrual symptoms, HRQL, and work productivity. Regression analysis was performed to compare the groups and evaluate outcomes over time using the paired t test. Subgroup analysis was performed using stratification by patient background, and correlations between improvement in menstrual symptoms/HRQL and work productivity were investigated using Spearman's rank correlation coefficient. RESULTS Significant reductions in the modified Menstrual Distress Questionnaire (mMDQ) total score were shown in the LEP group (n = 251) (P < 0.01), but not the non-LEP group (n = 146). Significant improvements in HRQL, measured by the 36-Item Short-Form Health Survey v2.0 (SF-36v2.0), were shown in the LEP group, but not the non-LEP group. Improvements were seen in mental component summary and 7/8 domains (role physical, bodily pain, general health, role emotional, mental health, vitality, and social functioning) in the LEP group, but not the non-LEP group. There were no differences in the physical component summary and role functioning in either group. Improvements in work productivity, measured by the modified Work Productivity and Activity Impairment Questionnaire (mWPAI), were greater in the LEP group vs. non-LEP group. Regression analysis showed differences in improvements between the groups in the mMDQ total score, SF-36v2.0, and mWPAI. A correlation between mMDQ or HRQL and work productivity was seen. CONCLUSION In Japanese women, dysmenorrhea is associated with reduced HRQL and work productivity. In real-world clinical practice, improvements in physical and mental menstrual symptoms, HRQL, and work productivity were observed with LEP treatment. TRIAL REGISTRATION NCT04607382 (ClinicalTrials.gov).
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Oh H, Ehrenpreis ED, Tu FF, Dillane KE, Garrison EF, Leloudas N, Prasad PV, Hellman KM. Menstrual Cycle Variation in MRI-Based Quantification of Intraluminal Gas in Women With and Without Dysmenorrhea. FRONTIERS IN PAIN RESEARCH 2022; 3:720141. [PMID: 35634451 PMCID: PMC9130698 DOI: 10.3389/fpain.2022.720141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 04/06/2022] [Indexed: 11/17/2022] Open
Abstract
Women frequently report increased bloating, flatulence, and pain during the perimenstrual period. However, it is unknown whether women have more intraluminal gas during menses. To evaluate whether pain-free women or women with dysmenorrhea have different amounts of intraluminal bowel gas during the menses, we utilized magnetic resonance imaging (MRI) to determine colonic gas volumes throughout the menstrual cycle. To avoid dietary influence, the participants were instructed to avoid gas-producing foods before their scheduled MRI. We verified the measurement repeatability across the reviewers and obtained an intraclass correlation coefficient of 0.92. There were no significant differences in intraluminal gas volume between menses and non-menses scans (p = 0.679). Even among the women with dysmenorrhea, there was no significant difference in the intraluminal gas volume between menses and non-menses (p = 0.753). During menstruation, the participants with dysmenorrhea had less intraluminal gas than participants without dysmenorrhea (p = 0.044). However, the correlation between the bowel gas volume and the pain symptoms were not significant (p > 0.05). Although increased bowel symptoms and bloating are reported in the women with dysmenorrhea during menses, our results do not support the hypothesis that increased intraluminal gas is a contributing factor. Although dietary treatment has been shown in other studies to improve menstrual pain, the mechanism responsible for abdominal symptoms requires further investigation. Our findings demonstrate that the intraluminal bowel gas volume measurements are feasible and are unaffected by menses under a controlled diet. The method described might prove helpful in future mechanistic studies in clarifying the role of intraluminal bowel gas in other conditions.
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Affiliation(s)
- Hyeyoung Oh
- Department of Obstetrics & Gynecology, North Shore University Health System, Evanston, IL, United States
| | - Eli D. Ehrenpreis
- Advocate Lutheran General Hospital, Department of Medicine, Evanston, IL, United States
| | - Frank F. Tu
- Department of Obstetrics & Gynecology, North Shore University Health System, Evanston, IL, United States
- Department of Obstetrics & Gynecology, University of Chicago, Pritzker School of Medicine, Chicago, IL, United States
| | - Katlyn E. Dillane
- Department of Obstetrics & Gynecology, North Shore University Health System, Evanston, IL, United States
| | - Ellen F. Garrison
- Department of Obstetrics & Gynecology, North Shore University Health System, Evanston, IL, United States
| | - Nondas Leloudas
- Department of Radiology, North Shore University Health System, Evanston, IL, United States
| | - Pottumarthi V. Prasad
- Department of Radiology, North Shore University Health System, Evanston, IL, United States
- Department of Radiology, University of Chicago, Pritzker School of Medicine, Chicago, IL, United States
| | - Kevin M. Hellman
- Department of Obstetrics & Gynecology, North Shore University Health System, Evanston, IL, United States
- Department of Obstetrics & Gynecology, University of Chicago, Pritzker School of Medicine, Chicago, IL, United States
- *Correspondence: Kevin M. Hellman
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Dysmenorrhea across the lifespan: a biopsychosocial perspective to understanding the dysmenorrhea trajectory and association with comorbid pain experiences. Pain 2022; 163:2069-2075. [PMID: 35420567 DOI: 10.1097/j.pain.0000000000002649] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/01/2022] [Indexed: 11/26/2022]
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Sima RM, Sulea M, Radosa JC, Findeklee S, Hamoud BH, Popescu M, Gorecki GP, Bobircă A, Bobirca F, Cirstoveanu C, Ples L. The Prevalence, Management and Impact of Dysmenorrhea on Medical Students' Lives-A Multicenter Study. Healthcare (Basel) 2022; 10:healthcare10010157. [PMID: 35052320 PMCID: PMC8775858 DOI: 10.3390/healthcare10010157] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/03/2022] [Accepted: 01/11/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction: Dysmenorrhea is defined as the presence of painful menstruation, and it affects daily activities in different ways. The aims of this study were to assess the prevalence and management of dysmenorrhea and to determine the impact of dysmenorrhea on the quality of life of medical students. Material and methods: The study conducted was prospective, analytical and observational and was performed between 7 November 2019 and 30 January 2020 in five university centers from Romania. The data was collected using an original questionnaire regarding menstrual cycles and dysmenorrhea. The information about relationships with family or friends, couples’ relationships and university activity helped to assess the effects of dysmenorrhea on quality of life. The level of significance was set at p < 0.05. Results: The study comprised 1720 students in total. The prevalence of dysmenorrhea was 78.4%. During their menstrual period, most female students felt more agitated or nervous (72.7%), more tired (66.9%), as if they had less energy for daily activities (75.9%) and highly stressed (57.9%), with a normal diet being difficult to achieve (30.0%). University courses (49.4%), social life (34.5%), couples’ relationships (29.6%), as well as relationships with family (21.4%) and friends (15.4%) were also affected, depending on the duration and intensity of the pain. Conclusion: Dysmenorrhea has a high prevalence among medical students and could affect the quality of life of students in several ways. During their menstrual period, most female students feel as if they have less energy for daily activities and exhibit a higher level of stress. The intensity of the symptoms varies considerably and, with it, the degree of discomfort it creates. Most student use both pharmacological and non-pharmacological methods to reduce pain (75.7%). University courses, social life, couples’ relationships, as well as relationships with family and friends are affected, depending on the duration and intensity of the pain.
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Affiliation(s)
- Romina-Marina Sima
- Department of Obstetrics and Ginecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-M.S.); (M.S.); (L.P.)
- The “Bucur” Maternity, “Saint John” Hospital, 040294 Bucharest, Romania;
| | - Mihaela Sulea
- Department of Obstetrics and Ginecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-M.S.); (M.S.); (L.P.)
| | - Julia Caroline Radosa
- Department for Gynaecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Kirrberger Straße 100, Building 9, 66421 Homburg, Germany; (J.C.R.); (S.F.); (B.H.H.)
| | - Sebastian Findeklee
- Department for Gynaecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Kirrberger Straße 100, Building 9, 66421 Homburg, Germany; (J.C.R.); (S.F.); (B.H.H.)
| | - Bashar Haj Hamoud
- Department for Gynaecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Kirrberger Straße 100, Building 9, 66421 Homburg, Germany; (J.C.R.); (S.F.); (B.H.H.)
| | - Mihai Popescu
- Department of Anaesthesia and Critical Care, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Gabriel Petre Gorecki
- The “Bucur” Maternity, “Saint John” Hospital, 040294 Bucharest, Romania;
- Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania
| | - Anca Bobircă
- Department of Internal Medicine and Rheumatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Correspondence: ; Tel.: +40-07-2615-7827
| | - Florin Bobirca
- Department of Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Catalin Cirstoveanu
- Department of Pediatrics, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Pediatrics Department, ‘Maria Sklodowska Curie’ Emergency Children Clinical Hospital, 041451 Bucharest, Romania
| | - Liana Ples
- Department of Obstetrics and Ginecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-M.S.); (M.S.); (L.P.)
- The “Bucur” Maternity, “Saint John” Hospital, 040294 Bucharest, Romania;
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Durand H, Monahan K, McGuire BE. Prevalence and Impact of Dysmenorrhea Among University Students in Ireland. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:2835-2845. [PMID: 33822197 PMCID: PMC8666000 DOI: 10.1093/pm/pnab122] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
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.
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Affiliation(s)
- Hannah Durand
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Katie Monahan
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Brian E McGuire
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- School of Psychology, National University of Ireland, Galway, Ireland
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Tinkler M, Reid J, Brazil K. Co-Design of an Evidenced Informed Service Model of Integrated Palliative Care for Persons Living with Severe Mental Illness: A Qualitative Exploratory Study. Healthcare (Basel) 2021; 9:1710. [PMID: 34946437 PMCID: PMC8701131 DOI: 10.3390/healthcare9121710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Globally, close to one billion people are living with a mental health disorder, and it is one of the most neglected areas in Public Health. People with severe mental illness have greater mortality risk than the general population, experience health care inequalities throughout life and represent a vulnerable, under-served and under-treated population, who have been overlooked in health inequality research to date. There is currently a dearth of evidence in relation to understanding the palliative care needs of people with severe mental illness and how future care delivery can be designed to both recognise and respond to those needs. This study aims to co-design an evidenced informed service model of integrated palliative care for persons living with a severe mental illness. METHODS This qualitative sequential study underpinned by interpretivism will have six phases. An expert reference group will be established in Phase 1, to inform all stages of this study. Phase 2 will include a systematic literature review to synthesise current evidence in relation to palliative care service provision for people with severe mental illness. In Phase 3, qualitative interviews will be undertaken with both, patients who have a severe mental illness and in receipt of palliative care (n = 13), and bereaved caregivers of people who have died 6-18 months previously with a diagnosis of severe mental illness (n = 13), across two recruitment sties in the United Kingdom. Focus groups (n = 4) with both mental health and palliative care multidisciplinary staff will be undertaken across the two recruitment sites in Phase 4. Phase 5 will involve the co-design of a service model of integrated palliative care for persons living with severe mental illness. Phase 6 will develop practice recommendations for this client cohort. DISCUSSION Palliative care needs to be available at all levels of care systems; it is estimated that, globally, only 14% of patients who need palliative care receive it. Reducing inequalities experienced by people with severe mental illness is embedded in the National Health Service Long Term Plan. Internationally, the gap between those with a mental illness needing care and those with access to care remains considerable. Future policy and practice will benefit from a better understanding of the needs of this client cohort and the development of a co-designed integrated care pathway to facilitate timely access to palliative care for people with a severe mental illness.
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Affiliation(s)
- Marianne Tinkler
- Northern Health and Social Care Trust, Antrim BT41 2RL, UK;
- Medical Biology Centre, School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK;
| | - Joanne Reid
- Medical Biology Centre, School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK;
| | - Kevin Brazil
- Medical Biology Centre, School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK;
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Leake HB, Moseley GL, Stanton TR, O'Hagan ET, Heathcote LC. What do patients value learning about pain? A mixed-methods survey on the relevance of target concepts after pain science education. Pain 2021; 162:2558-2568. [PMID: 33960326 DOI: 10.1097/j.pain.0000000000002244] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/15/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Pain education is a popular treatment approach for persistent pain that involves learning a variety of concepts about pain (ie, target concepts), which is thought to be an important part of recovery. Yet, little is known about what patients value learning about pain. A mixed-methods survey was conducted to identify pain concepts that were valued by people with persistent pain who improved after a pain science education intervention. An online survey was distributed to 123 people who were treated for persistent pain with a pain science education approach; responses of participants who self-identified as "improved" were analysed. Open-ended survey questions were analysed using reflexive thematic analysis and close-ended questions were analysed for frequency of responses. Each question-type was analysed separately, before integration for complementarity. We analysed the data of 97 participants. We constructed 3 themes from the open-ended questions. Pain does not mean my body is damaged (theme 1) captured the importance of abandoning preexisting ideas that pain indicated damage. Thoughts, emotions and experiences affect pain (theme 2) captured the value of recognising multifactorial influences on pain. I can retrain my overprotective pain system (theme 3) captured the importance of conceptualising pain as a heightened protective response that could be lessened. Responses from close-ended questions confirmed that the target concepts represented by these themes are among those most valued, although divergence with the qualitative data suggests differences between patient and clinician language. These data offer patient-centred conceptualizations and language that could assist in further refining pain education interventions.
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Affiliation(s)
- Hayley B Leake
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Tasha R Stanton
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Edel T O'Hagan
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Lauren C Heathcote
- Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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Chen CX, Carpenter JS, LaPradd M, Ofner S, Fortenberry JD. Perceived Ineffectiveness of Pharmacological Treatments for Dysmenorrhea. J Womens Health (Larchmt) 2021; 30:1334-1343. [PMID: 33026968 PMCID: PMC8558084 DOI: 10.1089/jwh.2020.8581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Dysmenorrhea affects most reproductive-aged women. Common dysmenorrhea treatments vary in their effectiveness across individuals. Little is known about factors associated with perceived treatment ineffectiveness. The objectives of this study were to describe the perceived ineffectiveness of common pharmacological treatments for dysmenorrhea and investigate factors associated with perceived treatment ineffectiveness. Materials and Methods: In this cross-sectional study, 678 women with dysmenorrhea (aged 14-42) provided data on perceived treatment ineffectiveness, dysmenorrhea symptom-based phenotypes, demographics, clinical factors, and psychobehavioral characteristics. We used Fisher's exact tests to compare treatment ineffectiveness across three symptom-based phenotypes. We used logistic regressions to explore associations of phenotype, demographic, clinical, and psychobehavioral correlates of perceived treatment ineffectiveness. Results: Percentages perceiving treatments as ineffective were 29.3%-35.6% nonsteroidal anti-inflammatory drugs, 49.9% acetaminophen, and 39.3% combined oral contraceptive pills (OCPs). Factors associated with perceived ineffectiveness varied across treatments and included symptom-based phenotypes, clinical, and psychobehavioral factors. For ibuprofen and acetaminophen, women with severe (vs. mild) pain phenotype and higher number of chronic pain conditions were more likely to perceive the treatments as ineffective. For OCPs, women with severe pain (vs. mild) phenotype, comorbid gynecological condition, less anxiety, and worse depressive symptoms were more likely to perceive the treatment as ineffective. Conclusion: A significant percentage of women reported ineffectiveness of dysmenorrhea treatments. Phenotypes, clinical, and psychobehavioral factors were associated with treatment ineffectiveness. Future research should test if symptom-based phenotypes are associated with treatment effectiveness in clinical trials and investigate other factors that affect dysmenorrhea treatment effectiveness, so treatments can be tailored to individuals.
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Affiliation(s)
- Chen X. Chen
- Department of Community and Health Systems, Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Janet S. Carpenter
- Department of Science of Nursing Care, Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Michelle LaPradd
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Susan Ofner
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - J. Dennis Fortenberry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Tataj-Puzyna U, Ilczuk P, Kalita-Kurzyńska K, Gotlib J. Women's experiences of dysmenorrhoea - preliminary study. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2021; 20:133-139. [PMID: 34703414 PMCID: PMC8525260 DOI: 10.5114/pm.2021.109771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/19/2021] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Urszula Tataj-Puzyna
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Patrycja Ilczuk
- Faculty of Health Sciences of Medical University of Warsaw, Warsaw, Poland
| | - Kinga Kalita-Kurzyńska
- Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Family Hospital, Department of Medical Biology, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Gotlib
- Department of Education and Research of Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
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Barrington DJ, Robinson HJ, Wilson E, Hennegan J. Experiences of menstruation in high income countries: A systematic review, qualitative evidence synthesis and comparison to low- and middle-income countries. PLoS One 2021; 16:e0255001. [PMID: 34288971 PMCID: PMC8294489 DOI: 10.1371/journal.pone.0255001] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/07/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND There is growing recognition of the importance of menstruation in achieving health, education, and gender equality for all. New policies in high income countries (HICs) have responded to anecdotal evidence that many struggle to meet their menstrual health needs. Qualitative research has explored lived experiences of menstruating in HICs and can contribute to designing intervention approaches. To inform the growing policy attention to support people who menstruate, here we review and synthesise the existing research. METHODS AND FINDINGS Primary, qualitative studies capturing experiences of menstruation in HICs were eligible for inclusion. Systematic database and hand searching identified 11485 records. Following screening and quality appraisal using the EPPI-Centre checklist, 104 studies (120 publications) detailing the menstrual experiences of over 3800 individuals across sixteen countries were included. We used the integrated model of menstrual experiences developed from studies in low- and middle-income countries (LMICs) as a starting framework and deductively and inductively identified antecedents contributing to menstrual experiences; menstrual experiences themselves and impacts of menstrual experiences. Included studies described consistent themes and relationships that fit well with the LMIC integrated model, with modifications to themes and model pathways identified through our analysis. The socio-cultural context heavily shaped menstrual experiences, manifesting in strict behavioural expectations to conceal menstruation and limiting the provision of menstrual materials. Resource limitations contributed to negative experiences, where dissatisfaction with menstrual practices and management environments were expressed along with feelings of disgust if participants felt they failed to manage their menstruation in a discrete, hygienic way. Physical menstrual factors such as pain were commonly associated with negative experiences, with mixed experiences of healthcare reported. Across studies participants described negative impacts of their menstrual experience including increased mental burden and detrimental impacts on participation and personal relationships. Positive experiences were more rarely reported, although relationships between cis-women were sometimes strengthened by shared experiences of menstrual bleeding. Included studies reflected a broad range of disciplines and epistemologies. Many aimed to understand the constructed meanings of menstruation, but few were explicitly designed to inform policy or practice. Few studies focused on socioeconomically disadvantaged groups relevant to new policy efforts. CONCLUSIONS We developed an integrated model of menstrual experience in HICs which can be used to inform research, policy and practice decisions by emphasising the pathways through which positive and negative menstrual experiences manifest. REVIEW PROTOCOL REGISTRATION The review protocol registration is PROSPERO: CRD42019157618.
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Affiliation(s)
- Dani Jennifer Barrington
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
- School of Civil Engineering, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - Hannah Jayne Robinson
- School of Civil Engineering, University of Leeds, Leeds, West Yorkshire, United Kingdom
| | - Emily Wilson
- Irise International, Sheffield, South Yorkshire, United Kingdom
| | - Julie Hennegan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Rodrigues JC, Avila MA, Driusso P. Transcutaneous electrical nerve stimulation for women with primary dysmenorrhea: Study protocol for a randomized controlled clinical trial with economic evaluation. PLoS One 2021; 16:e0250111. [PMID: 34014922 PMCID: PMC8136645 DOI: 10.1371/journal.pone.0250111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 03/29/2021] [Indexed: 12/02/2022] Open
Abstract
Primary dysmenorrhea (PD) is a common gynecological disorder characterized by cramping pain in the lower abdomen during menstruation, in the absence of identifiable pathology. While Transcutaneous Electrical Nerve Stimulation (TENS) is used to promote PD pain relief, there is still a need to understand the parameters and cost-effectiveness of this intervention. As such, this study aims to disclose a study that will evaluate the effectiveness and cost-effectiveness of TENS on pain intensity in women with PD. This is a protocol for an assessor-blinded randomized controlled trial that includes 174 women with PD, >18 years old, with menstrual pain greater than or equal to four points in the Numerical Rating Scale. Participants will be randomized into three groups (active TENS, placebo TENS, and educational booklet). Participants allocated to the active TENS group will receive electrical stimulation (F = 100 Hz, pulse duration = 200 μs, for 30 min). In contrast, the placebo TENS group will receive placebo stimulation (same parameters, but for only 30 s, and then the current will be ramped off over a 15-s time frame) for three consecutive months during menstruation. Participants allocated to the educational booklet group will receive instructions about health promotion and education actions related to PD. A blinded assessor will evaluate the pain intensity (Numerical Rating Scale), presenteeism (Stanford Presenteeism Scale), Health-Related Quality of Life (Short-Form 6 dimensions and SF-36), and health costs of menstrual pain. This is the first study to propose a health economic evaluation while assessing the benefits of using TENS to treat PD symptoms. It is hypothesized that active TENS will be more effective than placebo TENS or the educational booklet in improving clinical outcomes in the short-, medium- and long-term. The study will also provide information about the cost-effectiveness of TENS, which can be used by policy makers to improve PD care in public and private health systems.
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Affiliation(s)
- Jéssica Cordeiro Rodrigues
- Women’s Health Research Laboratory (LAMU), Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Mariana Arias Avila
- Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Patricia Driusso
- Women’s Health Research Laboratory (LAMU), Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, SP, Brazil
- * E-mail:
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Armour M, Hyman MS, Al-Dabbas M, Parry K, Ferfolja T, Curry C, MacMillan F, Smith CA, Holmes K. Menstrual Health Literacy and Management Strategies in Young Women in Australia: A National Online Survey of Young Women Aged 13-25 Years. J Pediatr Adolesc Gynecol 2021; 34:135-143. [PMID: 33188935 DOI: 10.1016/j.jpag.2020.11.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/17/2020] [Accepted: 11/06/2020] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE To explore key aspects of menstrual health literacy and menstrual management in young women at school or in tertiary education. DESIGN Cross-sectional online survey. SETTING Australia-wide. PARTICIPANTS A total of 4202 adolescent and young women (13-25 years of age; median age 17 years), having reached menarche, living in Australia and currently attending school (n = 2421) or tertiary education (n = 1781). INTERVENTIONS Online survey hosted by Qualtrics between November 2017 and January 2018. Data were collected on contraceptive use, management strategies, sources of information, and knowledge of menstruation. MAIN OUTCOME MEASURES Information on prevalence and effectiveness of different management strategies, health-seeking behavior, knowledge about menstruation, and common menstrual disorders such as endometriosis. RESULTS The majority of young women did not seek medical advice for their menstrual symptoms, but used information from the Internet (50%) and engaged in self-management, most commonly with over-the-counter medications such as paracetamol (51%) or ibuprofen (52%). Oral contraceptive use was relatively common (35%), and mostly for reduction of menstrual pain (58%). Despite having significant dysmenorrhea, approximately one-half of the participants (51%) thought that their period was normal. Women with higher pain scores were more likely to rate their period as "abnormal" (P < .0001) but not more likely to consult a doctor (P = .13). Only 53% of those at school had heard of endometriosis. CONCLUSION Self-management of menstrual symptoms is common, but a significant minority of women are underdosing or choosing ineffective methods. Most women do not seek medical advice even when symptoms are severe, and cannot identify symptoms suggestive of secondary dysmenorrhea. Improved education on menstruation is vital.
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Affiliation(s)
- Mike Armour
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia; Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia.
| | - Mikayla S Hyman
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia; Department of Sociology/Anthropology, Middlebury College, Middlebury, Vermont
| | - Mahmoud Al-Dabbas
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Kelly Parry
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Tania Ferfolja
- Centre for Educational Research, Western Sydney University, Penrith, NSW, Australia
| | - Christina Curry
- Centre for Educational Research, Western Sydney University, Penrith, NSW, Australia
| | - Freya MacMillan
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia; School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Caroline A Smith
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia; Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Kathryn Holmes
- Centre for Educational Research, Western Sydney University, Penrith, NSW, Australia
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Abstract
BACKGROUND Dysmenorrhea is a prevalent pain condition among women and a risk factor for other chronic pain conditions. Individuals vary in dysmenorrhea pain severity, the number of painful sites, and co-occurring gastrointestinal symptoms. Three dysmenorrhea symptom-based phenotypes were previously identified using latent class analysis; however, there is a need to validate these in an independent sample, so they can be used in mechanistic and interventional research. There is also a need to further characterize dysmenorrhea symptom-based phenotypes in terms of demographic, clinical, and psychobehavioral characteristics so they can be used to inform precision dysmenorrhea treatment. OBJECTIVES The study objectives were to (a) determine whether the same dysmenorrhea symptom-based phenotypes would be found in a new sample; (b) determine whether including demographic, clinical, and psychobehavioral covariates in latent class analyses would change individuals' phenotype memberships; and (c) investigate relationships between dysmenorrhea symptom-based phenotypes and demographic, clinical, and psychobehavioral characteristics. METHODS This cross-sectional survey study included 678 women (aged 14-42 years) with dysmenorrhea. Participants reported dysmenorrhea symptom severity, demographic, clinical (comorbid chronic pain and gynecological conditions), and psychobehavioral characteristics (perceived stress, anxiety, depression, sleep disturbance, and pain catastrophizing). We used latent class analysis to identify symptom-based phenotypes. We compared analyses with and without covariates (i.e., demographic, clinical, and psychobehavioral characteristics) to determine if individuals' phenotype memberships changed. We then examined associations between phenotypes and demographic, clinical, and psychobehavioral characteristics. RESULTS We reproduced three dysmenorrhea symptom-based phenotypes: the "mild localized pain" phenotype (characterized by mild abdominal cramps), the "severe localized pain" phenotype (characterized by severe abdominal cramps), and the "multiple severe symptoms" phenotype (characterized by severe pain at multiple locations and gastrointestinal symptoms). Analyses with and without covariates had little effect on individuals' phenotype membership. Race, comorbid chronic pain condition, endometriosis, and pain catastrophizing were significantly associated with the dysmenorrhea phenotypes. DISCUSSION Findings provide a foundation to further study mechanisms of dysmenorrhea symptom heterogeneity and develop dysmenorrhea precision treatments. The three dysmenorrhea symptom-based phenotypes were validated in a second sample. Demographic, clinical, and psychobehavioral factors were associated with dysmenorrhea symptom-based phenotypes.
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Living with Restrictions. The Perspective of Nursing Students with Primary Dysmenorrhea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228527. [PMID: 33212985 PMCID: PMC7698483 DOI: 10.3390/ijerph17228527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 12/30/2022]
Abstract
Primary dysmenorrhea (PD) affects a large number of female university students, diminishing their quality of life and hindering academic performance, representing a significant cause of absenteeism. The purpose of our study was to determine how nursing students experienced restrictions as a result of primary dysmenorrhea. A qualitative exploratory study was conducted among 33 nursing students with primary dysmenorrhea. A purposeful sampling strategy was applied. Data were collected from five focus groups (two sessions each) and the field notes of 10 researchers. A video meeting platform was used to conduct the focus groups. A thematic inductive analysis was performed. Thirty-three female nursing students participated in the study with a mean age of 22.72 (SD 3.46) years. Three broad themes emerged: (a) restrictions on daily activities and sports; (b) academic restrictions, and (c) restrictions on social and sexual relationships. The students described restrictions in performing everyday activities, such as carrying weight, and shopping. Some students even gave up the practice of sports and were absent from classes at the university, and from clinical practices at the hospital. The pain affected their ability to maintain and create new social relationships. Primary dysmenorrhea caused restrictions in the personal, social and academic life of the nursing students.
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Ramos-Pichardo JD, Ortega-Galán ÁM, Iglesias-López MT, Abreu-Sánchez A, Fernández-Martínez E. Why Do Some Spanish Nursing Students with Menstrual Pain Fail to Consult Healthcare Professionals? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218173. [PMID: 33167417 PMCID: PMC7663954 DOI: 10.3390/ijerph17218173] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 12/22/2022]
Abstract
Dysmenorrhea is a problem that affects a large percentage of young women worldwide. Alarmingly, the majority of these women choose to self-medicate rather than consult a healthcare professional, despite the risks involved. The present study aimed to explore the reasons why undergraduate nursing students do not consult health care professionals regarding their menstrual pain. A qualitative study was conducted using an open question: "Why didn't you consult a healthcare professional?" within the context of a research project on primary dysmenorrhea among nursing students at the University of Huelva, Spain. The responses of 202 women were analyzed using content analysis. Three categories were identified: assessment of the pain experienced, expectations, and experiences of professional care and selfcare. We found a striking normalization of the problem; notably, students downplayed the importance of the problem, considering that it was not worth consulting a physician. Furthermore, there was a notable degree of self-medication using non-steroidal anti-inflammatories (NSAIDs). These results may be useful for orienting policies to raise social awareness of this problem and for designing health education strategies aimed at women with primary dysmenorrhea.
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Affiliation(s)
- Juan Diego Ramos-Pichardo
- Department of Nursing, University of Huelva, 21071 Huelva, Spain; (J.D.R.-P.); (Á.M.O.-G.); (A.A.-S.)
| | - Ángela María Ortega-Galán
- Department of Nursing, University of Huelva, 21071 Huelva, Spain; (J.D.R.-P.); (Á.M.O.-G.); (A.A.-S.)
| | - María Teresa Iglesias-López
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Crta. Pozuelo-Majadahonda km 1800, Pozuelo de Alarcón, 28223 Madrid, Spain;
| | - Ana Abreu-Sánchez
- Department of Nursing, University of Huelva, 21071 Huelva, Spain; (J.D.R.-P.); (Á.M.O.-G.); (A.A.-S.)
| | - Elia Fernández-Martínez
- Department of Nursing, University of Huelva, 21071 Huelva, Spain; (J.D.R.-P.); (Á.M.O.-G.); (A.A.-S.)
- Correspondence:
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Fernández-Martínez E, Fernández-Villa T, Amezcua-Prieto C, Suárez-Varela MM, Mateos-Campos R, Ayán-Pérez C, Molina de la Torre AJ, Ortíz-Moncada R, Almaraz A, Blázquez Abellán G, Delgado-Rodríguez M, Alonso-Molero J, Martínez-Ruíz V, Llopis-Morales A, Valero Juan LF, Cancela Carral JM, Martín-Peláez S, Alguacil J. Menstrual Problems and Lifestyle among Spanish University Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207425. [PMID: 33053847 PMCID: PMC7599672 DOI: 10.3390/ijerph17207425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022]
Abstract
Menstrual problems affect many young women worldwide, conditioning both their academic performance and quality of life. This study sought to analyse the prevalence of menstrual problems and their possible relationship with lifestyle among Spanish university women, as part of a research project (UniHcos Project) involving a cohort of 11 Spanish universities with 7208 university students. A descriptive analysis was performed using the bivariate chi-square test and the Student’s t-test together with a binary logistic regression, in which the dependent variable was ‘suffering from menstrual problems’. Menstrual problems were identified in 23.8% of the students, representing women who paid more visits to the doctor and to emergency rooms, and who consumed more painkillers and contraceptives. In relation to dietary preferences, menstrual problems were 1.39 (CI 95% 1.22–1.61; p = 0.000) times more likely among women classified as high-risk alcohol users according to the AUDIT questionnaire, and 1.187 (CI 95% 1.029–1.370; p = 0.019) times greater among those who consumed sweets daily, 1.592 (CI 95% 1.113–2.276; p = 0.011) times more frequent among those who eat fish daily, and 1.199 (CI 95% 1.004–1.432; p = 0.045) times greater among those who were dieting. Menstrual problems affect many college students and potentially modifiable lifestyle variables exist which may influence their prevalence. It would be interesting to develop programmes to promote women’s health in the university context.
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Affiliation(s)
- Elia Fernández-Martínez
- Department of Nursing, University of Huelva, 21071 Huelva, Spain
- Correspondence: (E.F.-M.); (T.F.-V.)
| | - Tania Fernández-Villa
- Research Group on Gene-Environment Interactions and Health (GIIGAS)/Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain;
- Correspondence: (E.F.-M.); (T.F.-V.)
| | - Carmen Amezcua-Prieto
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (C.A.-P.); (V.M.-R.); (S.M.-P.)
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain
- Biosanitary Research Institute ibs., 18014 Granada, Spain
| | - María Morales Suárez-Varela
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain
- Area of Preventive Medicine and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Legal Medicine, School of Pharmacy, University of Valencia, 46100 Valencia, Spain; (M.M.S.-V.); (A.L.-M.)
| | - Ramona Mateos-Campos
- Preventive Medicine and Public Health, University of Salamanca, 37007 Salamanca, Spain; (R.M.-C.); (L.F.V.J.)
| | | | - Antonio José Molina de la Torre
- Research Group on Gene-Environment Interactions and Health (GIIGAS)/Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain;
| | - Rocío Ortíz-Moncada
- Area of Preventive Medicine and Public Health, Food and Nutrition Research Group, University of Alicante, 03550 Alicante, Spain;
| | - Ana Almaraz
- Preventive Medicine and Public Health, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain;
| | - Gemma Blázquez Abellán
- Departament of Medical Sciences, Faculty of Pharmacy, University of Castilla-La Mancha, 02071 Albacete, Spain;
| | - Miguel Delgado-Rodríguez
- Department of Preventive Medicine and Public Health, University of Jaen, 23071 Jaén, Spain;
- CIBERESP, Institute of Health Carlos III, Ministry of Health, 28029 Madrid, Spain
| | - Jéssica Alonso-Molero
- CIBERESP, Institute of Health Carlos III, Ministry of Health, 28029 Madrid, Spain
- University of Cantabria–IDIVAL, 39011 Santander, Spain;
| | - Virginia Martínez-Ruíz
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (C.A.-P.); (V.M.-R.); (S.M.-P.)
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain
- Biosanitary Research Institute ibs., 18014 Granada, Spain
| | - Agustín Llopis-Morales
- Area of Preventive Medicine and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Legal Medicine, School of Pharmacy, University of Valencia, 46100 Valencia, Spain; (M.M.S.-V.); (A.L.-M.)
| | - Luis Félix Valero Juan
- Preventive Medicine and Public Health, University of Salamanca, 37007 Salamanca, Spain; (R.M.-C.); (L.F.V.J.)
| | - José Mª Cancela Carral
- Galicia Sur Health Research Institute (IIS Galicia Sur), Sergas-UVIGO, HealthyFit Research Group, Faculty of Education and Sport Sciences, University of Vigo, 36310 Pontevedra, Spain;
| | - Sandra Martín-Peláez
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (C.A.-P.); (V.M.-R.); (S.M.-P.)
- Biosanitary Research Institute ibs., 18014 Granada, Spain
| | - Juan Alguacil
- CIBERESP, Institute of Health Carlos III, Ministry of Health, 28029 Madrid, Spain
- Natural Resources, Health and Environment Research Center (RENSMA), University of Huelva, 21071 Huelva, Spain;
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Mellado BH, Pilger TL, Poli Neto OB, Rosa E Silva JC, Nogueira AA, do Vale Brandão C, Candido Dos Reis FJ. Daily life attitudes of women with moderate or severe chronic pelvic pain. A qualitative study. Eur J Obstet Gynecol Reprod Biol 2020; 254:109-113. [PMID: 32950889 DOI: 10.1016/j.ejogrb.2020.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/28/2020] [Accepted: 09/04/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE How a woman copes with the pain might play a significant role in the management of chronic pelvic pain. This study aimed to understand the attitudes adopted by women with chronic pelvic pain (CPP) to deal with daily life problems caused by the illness. STUDY DESIGN We conducted a qualitative study including 58 women diagnosed with chronic pelvic pain regardless of the cause. To collect the data, we used semi-structured interviews with the key question: "How do you handle the pain in your daily life?". The interviews were audio-recorded and transcribed. We conducted a qualitative thematic analysis of transcribed texts following the sequence: 1) initial reading; 2) preliminary identification of codes; 3) identification of themes; 4) review of themes; 5) nominating the themes in categories; 6) final study synthesis. The analysis was performed with the aid of the RQDA package in the R environment. RESULTS Daily life attitudes varied from submission to the pain to positive coping. We identified five major categories: 1) shaping life by pain; 2) isolating from social contact; 3) avoiding sexual relationship; 4) seeking pain relief; 5) seeking positive strategies. Positive strategies were more frequent in older women. CONCLUSION Women with chronic pelvic pain adopted a broad spectrum of attitudes to deal with the pain in daily life. The depth understanding of patient perspectives has the potential to improve the multidisciplinary care of this debilitating condition.
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Affiliation(s)
- Bruna Helena Mellado
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine - University of São Paulo, Brazil
| | - Taynara Louisi Pilger
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine - University of São Paulo, Brazil
| | - Omero Benedicto Poli Neto
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine - University of São Paulo, Brazil
| | - Julio Cesar Rosa E Silva
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine - University of São Paulo, Brazil
| | - Antonio Alberto Nogueira
- Department of Gynecology and Obstetrics of Ribeirão Preto School of Medicine - University of São Paulo, Brazil
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Fernández-Martínez E, Abreu-Sánchez A, Pérez-Corrales J, Ruiz-Castillo J, Velarde-García JF, Palacios-Ceña D. Living with Pain and Looking for a Safe Environment: A Qualitative Study among Nursing Students with Dysmenorrhea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6670. [PMID: 32933209 PMCID: PMC7558082 DOI: 10.3390/ijerph17186670] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022]
Abstract
Dysmenorrhea refers to chronic pain associated with menstruation that is often accompanied by other symptoms. Primary dysmenorrhea (PD) occurs without any associated pelvic disease. Nonetheless, it may negatively affect women's quality of life. Among university students, dysmenorrhea decreases academic performance and is a cause of absenteeism. The purposes of our study were to describe how nursing students experienced PD and the changes affecting their body and mood. A qualitative case study was performed among 33 nursing students with PD. Data were collected through five focus groups (with two sessions each) and 10 researchers' field notes. We used a video meeting platform to conduct the focus groups. A thematic analysis was performed, and the Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative Research guidelines were followed. Three main themes emerged from the data: (a) living with dysmenorrhea, with two subthemes: menstruation and pain; (b) body changes and mood swings; and (c) seeking a safe environment, with three subthemes: safe environment, unsafe environment, and key safety aspects. Students considered menstruation to be negative and limiting, causing physical and mood changes, making them feel less attractive, and conditioning their way of dressing and relating.
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Affiliation(s)
- Elia Fernández-Martínez
- Department of Nursing, University of Huelva, Avenida Tres de Marzo s/n, 21071 Huelva, Spain; (E.F.-M.); (A.A.-S.); (J.R.-C.)
| | - Ana Abreu-Sánchez
- Department of Nursing, University of Huelva, Avenida Tres de Marzo s/n, 21071 Huelva, Spain; (E.F.-M.); (A.A.-S.); (J.R.-C.)
| | - Jorge Pérez-Corrales
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Avenida Atenas s/n, 28922 Alcorcón, Spain;
| | - Javier Ruiz-Castillo
- Department of Nursing, University of Huelva, Avenida Tres de Marzo s/n, 21071 Huelva, Spain; (E.F.-M.); (A.A.-S.); (J.R.-C.)
| | - Juan Francisco Velarde-García
- Department of Nursing, Red Cross College, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Autónoma de Madrid, Calle Reina Victoria 28, 28003 Madrid, Spain;
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Avenida Atenas s/n, 28922 Alcorcón, Spain;
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Interference and Impact of Dysmenorrhea on the Life of Spanish Nursing Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186473. [PMID: 32899505 PMCID: PMC7559731 DOI: 10.3390/ijerph17186473] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/30/2020] [Accepted: 09/03/2020] [Indexed: 12/14/2022]
Abstract
Dysmenorrhea is a cause of absenteeism in universities which, in the context of nursing studies, may affect mandatory attendance. Moreover, presenteeism is associated with medication errors, patient falls, and a reduced quality of patient care. This study sought to identify the degree of interference of dysmenorrhea on daily life and its impact on academic performance among Spanish nursing students, and to explore the reasons for presenteeism. A cross-sectional descriptive study was conducted on 261 nursing students. Data were collected using a self-administered questionnaire. The chi square tests, chi-square linear trend, Student's t-test, one-way analysis of variance of polynomial contrasts, and post hoc tests for the bi-variate analysis were used to compare the participants' responses regarding their type of dysmenorrhea and pain intensity. In addition, a multivariate regression was performed to predict absenteeism. The answers to the open questions were analyzed using thematic content analysis techniques. We observed 62.8% of absenteeism and 92.7% of presenteeism due to dysmenorrhea. Absenteeism was observed to be 3.079 (confidence interval (CI): 95%1.724-5.499; p < 0.001) times more likely among women with severe menstrual pain, 2.513 (CI 95%1.314-4.807; p = 0.005) times more in those suffering from menstrual nausea and 1.936 (CI 95%1.098-3.411; p = 0.022) times more frequent in those suffering from diarrhea. The reasons for presenteeism were grouped into five categories: the pain was bearable, it is not a reason to be absent, others don't consider it a reason to be absent, responsibility and guilt, and academic consequences. Dysmenorrhea can have a significant impact on academic performance. The concern among students about the academic repercussions and even feelings of guilt and incomprehension from others leads to high rates of presenteeism with potentially negative consequences for patient care.
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Abreu-Sánchez A, Parra-Fernández ML, Onieva-Zafra MD, Fernández-Martínez E. Perception of Menstrual Normality and Abnormality in Spanish Female Nursing Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6432. [PMID: 32899383 PMCID: PMC7504309 DOI: 10.3390/ijerph17176432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 12/17/2022]
Abstract
Menstrual problems are usually taboo; and often, some, such as dysmenorrhea, are presumed normal. This study seeks to compare the menstrual characteristics and symptoms of female university students reporting self-perceived normality concerning their cycles and menstruation with those who perceive their menstruation as being abnormal. A cross-sectional descriptive study was conducted among 270 nursing students using a self-report questionnaire that included sociodemographic and gynecological issues, together with Visual Analog Scale, the Andersch and Milsom Scale, and the Spanish version of the EuroQol-5 Dimension (EuroQol-5D) to measure self-perceived health status. A bivariate analysis was performed using the chi-square test, linear trend chi-square, and Student's t-test, and a multivariate analysis of stepwise binary logistic regression was performed to predict the perception of cycle abnormality. In total, 77.4% of participants displayed normality; however, in self-reporting of menstrual characteristics, 67.4% identified alterations. Young women suffering from menstrual dizziness were 1.997 (CI95% = 1.010-3.950; p = 0.047) more likely to manifest abnormal menstruation, 4.518 (CI95% = 1.239-16.477; p = 0.022) more likely if they suffered from Grade 3 menstrual pain, and 2.851 (CI95% = 1.399-5.809; p = 0.004) more likely if they perceived that menstruation interfered with their daily lives. Many menstrual changes and symptoms are still considered normal, making it difficult to identify and address these issues. Therefore, it is necessary to develop health policies and strategies to improve menstrual health literacy for increased knowledge and earlier diagnosis.
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Affiliation(s)
| | - María Laura Parra-Fernández
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La-Mancha, Ciudad Real, 13071 Ciudad Real, Spain; (M.L.P.-F.); (M.D.O.-Z.)
| | - María Dolores Onieva-Zafra
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La-Mancha, Ciudad Real, 13071 Ciudad Real, Spain; (M.L.P.-F.); (M.D.O.-Z.)
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Allyn K, Evans S, Seidman LC, Payne LA. "Tomorrow, I'll Be Fine": Impacts and coping mechanisms in adolescents and young adults with primary dysmenorrhoea. J Adv Nurs 2020; 76:2637-2647. [PMID: 32761654 DOI: 10.1111/jan.14460] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/13/2020] [Accepted: 06/01/2020] [Indexed: 12/30/2022]
Abstract
AIMS To understand the experiences of adolescents and young adults with primary dysmenorrhoea through the lens of structured frameworks extant in contemporary pain literature. DESIGN Descriptive qualitative study. METHODS Thirty-nine adolescents and young adults (ages 16-24 years) with primary dysmenorrhoea participated in semi-structured in-person interviews. Transcripts of the interviews were analysed using deductive thematic analysis from November 2018 to April 2019. RESULTS Two overarching themes, each with subthemes, were identified. The first theme, primary dysmenorrhoea impacts the whole person, contained the following subthemes: biological, social, and psychological. The second theme, coping mechanisms of women with primary dysmenorrhoea, contained the following subthemes: primary, secondary, and passive coping. CONCLUSION Women experience several primary dysmenorrhoea-related impacts on their biological, social, and psychological functioning. Women employ a variety of coping mechanisms to manage their primary dysmenorrhoea pain. IMPACT This study emphasizes the significant effects of primary dysmenorrhoea on nearly every aspect of women's lives and contributes to an understanding of the ways women cope with this pain. The findings of this study underscore the need for continued consideration of primary dysmenorrhoea as a debilitating pain process as well as the need for additional interventions to help women manage this condition.
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Affiliation(s)
| | - Subhadra Evans
- School of Psychology, Deakin University, Geelong, Vic., Australia
| | | | - Laura A Payne
- McLean Hospital, Belmont, MA, USA.,Harvard Medical School, Boston, MA, USA
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Chen CX, Murphy T, Ofner S, Yahng L, Krombach P, LaPradd M, Bakoyannis G, Carpenter JS. Development and Testing of the Dysmenorrhea Symptom Interference (DSI) Scale. West J Nurs Res 2020; 43:364-373. [PMID: 32680445 DOI: 10.1177/0193945920942252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dysmenorrhea affects most reproductive-age women and increases the risk of future pain. To evaluate dysmenorrhea interventions, validated outcome measures are needed. In this two-phase study, we developed and tested the dysmenorrhea symptom interference scale. During the scale-development phase (n = 30), we created a nine-item scale based on qualitative data from cognitive interviews. During the scale-testing phase (n = 686), we evaluated reliability, validity, and responsiveness to change. The scale measures how dysmenorrhea symptoms interfere with physical, mental, and social activities. Internal consistency was strong with Cronbach's α > 0.9. Test-retest reliability was acceptable (r = 0.8). The scale showed satisfactory content validity, construct validity (supported by confirmatory factor analysis), concurrent validity, and responsiveness to change. The minimally important difference was 0.3 points on a scale with a possible total score ranging from 1 to 5. This new psychometrically sound scale can be used in research and clinical practice to facilitate the measurement and management of dysmenorrhea.
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Affiliation(s)
- Chen X Chen
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Tabitha Murphy
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Susan Ofner
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lilian Yahng
- Indiana University Center for Survey Research, Bloomington, IN, USA
| | - Peter Krombach
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Michelle LaPradd
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Giorgos Bakoyannis
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
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50
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Jones J, Hughes M, Pauling J, Gooberman-Hill R, Moore AJ. What narrative devices do people with systemic sclerosis use to describe the experience of pain from digital ulcers: a multicentre focus group study at UK scleroderma centres. BMJ Open 2020; 10:e037568. [PMID: 32532783 PMCID: PMC7295424 DOI: 10.1136/bmjopen-2020-037568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Digital ulcers (DUs) are a common complication in systemic sclerosis (SSc). No existing studies have specifically reported on the qualitative patient experience of DU pain, and our current patient-reported outcome measure (PROM) does not capture the multifaceted painful experience of SSc-DU. Our aim was to examine the patient experience of SSc-DU pain. DESIGN Focus groups with people diagnosed with SSc who had experienced DUs were conducted using a topic guide developed by people with SSc, experts in SSc and experienced qualitative researchers. Focus groups were continued until data saturation had been reached. The focus groups were audio recorded, transcribed verbatim, anonymised and analysed using inductive thematic analysis. Our current study is an integration of the data from these focus groups to specifically examine the patient experience of DU pain. SETTING Three specialist scleroderma units across the UK (Bath, Manchester and London). PARTICIPANTS Four focus groups were undertaken; 29 adults (20 women, 9 men) with SSc and a spectrum of historical DUs participated. We included participants with a diverse demographic (including ethnic) background and disease-related characteristics. RESULTS Five narrative devices were identified, which encompass how people describe the pain from SSc-DUs: 'Words to express DU-associated pain', 'Descriptions of physical and psychological reactions to pain', 'Comparisons with other painful events', 'Descriptions of factors that exacerbate pain' and 'Descriptions of strategies for coping with the pain'. CONCLUSION The experience of SSc-DU pain leads to the use of graphic language and rich description by participants in the focus group setting. Existing SSc-DU outcomes do not adequately capture the patient experiences of SSc-DU pain. Our findings further highlight the multifaceted nature of SSc-DUs and will hopefully support the development of a novel PROM to assess the severity and impact of SSc-DUs.
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Affiliation(s)
- Jennifer Jones
- Health Sciences, University of Leicester, Leicester, UK
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Hughes
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John Pauling
- Department Pharmacy and Pharmacology, University of Bath, Bath, UK
- Rheumatology Department, Royal National Hospital For Rheumatic Diseases NHS Foundation Trust, Bath, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Andrew J Moore
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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