Prevalence, risk factors, and management practices of primary dysmenorrhea among young females

Effects of Therapeutic Taping on Clinical Symptoms of Students with Primary Dysmenorrhea

STUDY OBJECTIVES

Primary dysmenorrhea (PD) is a prevalent gynecologic condition affecting young females, characterized by cyclic, cramping pelvic pain with no organic pathology. It can significantly impact their quality of life and academic performance. This study aimed to determine the effect of therapeutic taping on the clinical symptoms, quality of life, and academic performance of students with PD.

DESIGN

This was a single-blind, parallel design, randomized controlled trial.

SETTING

The study was conducted from May to September 2023 at a girls' hostel in Islamabad, Pakistan.

PARTICIPANTS

Women aged 18-25 years with PD and pain severity rated 4 or higher on a visual analogue scale (VAS) were recruited. Those with other health conditions and having an allergy to Kinesio tape (KT) were excluded from the study.

INTERVENTION

A total of 66 women completed the study. They were randomly assigned to 3 groups: experimental (KT), sham tape (ST), and control group (CG). KT was applied to the suprapubic and sacral regions using the ligament technique in the KT group and without stretch in the ST group. Assessments were taken at baseline and on the 8th and 12th weeks.

MAIN OUTCOME MEASURES

The study tools were the VAS, Menstrual Symptom Questionnaire, health-related quality of life questionnaire (SF-36), and Academic Performance Questionnaire. Data analysis was done using SPSS-25.

RESULTS

The participants' mean age (years) was 22.04 ± 2.13 (KT), 22.35 ± 3.11 (ST), and 23 ± 2.52 (CG). Between-group analysis showed a statistically significant difference in the VAS (P < .05) and Menstrual Symptom Questionnaire (P < .01) scores after the 12th week of intervention, the difference in the Academic Performance Questionnaire score was statistically significant (P < .01) on the 8th and 12th weeks. Similarly, the SF-36 score was significantly different for both the physical (P < .001) and mental (P < .05) component summary between the intervention groups.

CONCLUSION

KT is an effective intervention option for pain reduction, menstrual symptom relief, and improved academic performance for individuals with PD.

I'm tired of pretending that nothing's wrong: A mixed-methods study of financial barriers for individuals living with primary dysmenorrhea

BACKGROUND

Primary dysmenorrhea (PD), or pain in the abdomen experienced during menstruation, remains under-recognised, leading to poorer financial outcomes for those affected.

AIM

The current study aimed to explore individual perspectives of financial burden relating to PD, while also examining the impact of biopsychosocial factors on reported financial barriers.

METHOD

Participants completed an online survey between May and July 2019 measuring pain, symptoms of depression, anxiety, and stress, fatigue, perceived social support, sociodemographic information, days of work or school missed, and number of GP or specialist visits due to pain per year. Open-ended questions relating to financial impact of PD and suggested workplace supports were included in a two-year follow-up survey. Template thematic analysis was conducted, and themes were then entered as outcome measures in binary logistic regression models, using biopsychosocial variables as predictors.

RESULTS

Australian women who experienced PD, measured by a numeric rating scale for period pain, were recruited (n = 140). Three themes were developed: Burden of Healthcare and Financial Disempowerment, Reduced Workplace Participation and Stigma and Prejudice. Pain (OR = 1.568, 95 % CI = 1.195-2.058), fatigue (OR = 1.050, 95 % CI = 1.013-1.089) and perceived family support (OR = 0.715, 95 % CI = 0.522-0.980) significantly predicted Stigma and Prejudice.

CONCLUSION

Increased pain or fatigue severity and reduced perceived family support may be associated with Stigma and Prejudice as a financial barrier for those with PD. Improved recognition of the impact of PD at a governmental level may help to address stigma, thus reducing the financial burden for those affected and society as a whole.

Guideline No. 345: Primary Dysmenorrhea

OBJECTIVE

This guideline reviews the investigation and treatment of primary dysmenorrhea.

TARGET POPULATION

Individuals experiencing menstrual pain for which no underlying cause has been identified.

BENEFITS, HARMS, AND COSTS

Primary dysmenorrhea is common and frequently undertreated, despite effective therapy being widely available at a minimal cost. Treatment of primary dysmenorrhea has the potential to improve quality of life and decrease time away from school or work.

EVIDENCE

Published clinical trials, randomized controlled trials, observational studies, population studies, and systematic review articles indexed in PubMed and the Cochrane database were identified using search the terms "dysmenorrhea" and "menstrual pain." This search builds on the previous review (January 2005 to March 2016), including new literature between March 2016 and December 2024.

VALIDATION METHODS

The author rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).

INTENDED AUDIENCE

Primary care providers, pediatricians, and obstetrician/gynaecologists.

SOCIAL MEDIA ABSTRACT

Although menstrual pain is commonly experienced by women and adolescents, it is often undertreated or unfairly dismissed. If left untreated, persistent menstrual pain may develop into a chronic pain syndrome. Treatment includes non-steroidal anti-inflammatory drugs and hormonal contraceptives and can be provided without the need for pelvic examinations; treatment should not be delayed pending a definitive diagnosis. Effective treatments are available and do not require a pelvic examination or invasive procedures.

SUMMARY STATEMENTS

RECOMMENDATIONS.

Comparison of safety signals for ibuprofen in children and adults: A real-world pharmacovigilance analysis

Ibuprofen is commonly used as an over-the-counter antipyretic and analgesic. However, children, as vulnerable population, are frequently excluded from pre-market clinical trials. Furthermore, there is a lack of post-marketing safety study. This study aims to evaluate the adverse events (AEs) associated with ibuprofen in both children and adults in real-world practice. The data was obtained from the Adverse Drug Reaction Monitoring Center of Henan Province, covering the period from January 1, 2010 to December 31, 2023. A disproportionality analysis was conducted using the reporting odds ratio (ROR) and the proportional reporting ratio (PRR) to detect risk signals associated with ibuprofen in children (0-17 years) and adults (≥18 years). A total of 1399 reports were recorded for children, while 9813 reports were documented for adults. Ibuprofen-related AEs were primarily associated with gastrointestinal disorders, nervous system disorders and skin and subcutaneous tissue disorders in both children and adults. Rash and pruritus were reported more frequently among children. AEs of gastrointestinal disorders were reported more frequently among adults. White blood cell count decreased (ROR = 12.72, PRR = 12.63) has been proposed as a new AE signal in children. Headache (ROR = 1.26, PRR = 1.26) and dizziness (ROR = 2.11, PRR = 2.04) were identified only in male adults, whereas abdominal discomfort (ROR = 1.25, PRR = 1.24) and rash pruritic (ROR = 2.16, PRR = 2.16) were observed solely in female adults. The toxicity profile of ibuprofen in children and adults exhibited distinct characteristics. Clinicians should provide active monitor based on these characteristic, especially white blood cell count decreased in children.

Cryotherapy Is Effective in Nulliparous Women with Primary Dysmenorrhea: A Randomized Controlled Trial

Primary dysmenorrhea is a prevalent condition causing severe menstrual pain in nulliparous women, negatively impacting daily functioning and well-being. This randomized controlled trial investigated the efficacy of cryotherapy in alleviating pain and enhancing secondary outcomes such as sleep quality, quality of life, and physical activity. Fifty-eight nulliparous women were randomly assigned to a cryotherapy group or a control group. Pain intensity was measured using the Numeric Rating Scale, whereas secondary outcomes were evaluated with the Pittsburgh Sleep Quality Index, World Health Organization Quality of Life-Brief Version, and the International Physical Activity Questionnaire. Socioeconomic factors, including household income, education, and occupation, were also assessed. Cryotherapy significantly reduced pain intensity from a baseline of 7.1 ± 1.4 to 1.8 ± 1.7 (p < 0.001) compared with a modest reduction in the control group (5.9 ± 1.9-5.4 ± 2.1). Sleep quality improved more in the cryotherapy group (6.90 ± 3.0 to 5.03 ± 2.5) than in the control group (6.88 ± 3.6 to 5.68 ± 2.8). However, no statistically significant changes were observed in the quality of life or physical activity levels, likely because menstrual pain alone may not sufficiently influence these domains, which are affected by broader psychosocial and behavioral factors. These findings demonstrate that cryotherapy is a simple, cost-effective intervention for managing primary dysmenorrhea, providing substantial pain relief and modest improvements in sleep quality. Further research is recommended to evaluate its long-term benefits and potential for broader applications in menstrual health management.

Vitamin D for primary dysmenorrhea and endometriosis-related pain - A systematic review of registered RCTs

OBJECTIVE

This systematic review investigates the potential role of vitamin D supplement in alleviating pain associated with primary dysmenorrhea or endometriosis by analysing registered randomised controlled trials (RCTs).

METHODS

We comprehensively searched the WHO International Clinical Trials Registry Platform to identify registered RCTs that assessed the effects of vitamin D supplement on pain outcomes in people with primary dysmenorrhea or endometriosis. The primary outcomes of interest were pain severity/intensity, pain duration, pain medication usage and pain-related outcome measurements.

RESULTS

Seven registered RCTs were included in this systematic review. These RCTs had diverse doses and treatment durations of vitamin D supplement used as intervention. They also had either high or some concerns of risk of bias, according to Cochrane risk of bias version 2 assessment. Substantial heterogeneities were generally observed across the seven RCTs. When measured using a validated tool visual analogue scale (VAS), pain severity was significantly lower at the end of treatment when compared with placebo (mean difference MD -1.12, 95% confidence interval [-2.16, -0.07], I2=81%, 5 studies, n = 308). This significant difference was observed in the primary dysmenorrhea RCTs, but not the endometriosis RCTs.

CONCLUSION

This systematic review identified vitamin D may reduce pain associated with primary dysmenorrhea, though a low certainty of evidence was available. Future studies that use standardised doses and treatment duration in accordance with the latest clinical practice guidelines are needed to explore any potential benefits vitamin D may have for people with these conditions.

Management practices of primary dysmenorrhea among female high school students in Nekemte town, East Wallaga Zone, Western Oromia, Ethiopia: a cross-sectional study

BACKGROUND

Primary dysmenorrhea is a common gynecological condition characterized by recurring, cramp-like abdominal pain before or during menstruation in the absence of pelvic disease. Despite its high prevalence, management practices remain unstudied, particularly among adolescent students. This study examined pharmacological and nonpharmacological management strategies for primary dysmenorrhea among female high school students in Nekemte town, Ethiopia.

OBJECTIVES

To assess the management practices for primary dysmenorrhea among high school students in Nekemte town, East Wallaga, Western Oromia, Ethiopia.

METHODS

This institutional-based cross-sectional study was conducted from November 6 to December 6, 2024, among 422 female high school students who experienced primary dysmenorrhea. The participants were selected via a multistage stratified sampling technique. The data were collected via a structured questionnaire and analyzed via SPSS version 25. A paired t-test was used to assess differences in pain scores before and after the interventions, whereas multiple linear regression was used to evaluate the effectiveness of nonpharmacological methods.

RESULTS

Among the participants, 80.1% utilized nonpharmacological management, including drinking tea (20.2%), drinking ginger tea (15.8%), and sleeping (16.7%). Diclofenac (53.1%) was the most commonly used pharmacological treatment. Tukey post hoc analysis revealed that ibuprofen (n = 13, M = 3.54, SD = 2.22) significantly reduced pain scores more than diclofenac did (n = 26, M = 1.65, SD = 1.70). A paired t-test revealed a significant reduction in pain scores after both pharmacological (p < 0.001) and nonpharmacological (p < 0.001) interventions. Multiple linear regression indicated that sports (p = 0.040) and hot baths (p = 0.026) significantly reduced pain scores.

CONCLUSION

Many students rely on self-medication for their management of primary dysmenorrhea. Moreover, both pharmacological and nonpharmacological interventions were associated with reducing pain, with sports and hot baths showing significant benefits. Greater awareness and education on safe and effective pain management strategies are recommended. Schools and healthcare providers should collaborate to promote evidence-based dysmenorrhea management practices.

Validation and psychometric analysis of the Spanish version of the menstrual attitude questionnaire

PROBLEM

In Spanish, there is no instrument available to assess the symptoms associated with the menstrual cycle.

BACKGROUND

The evaluation of menstrual attitudes is clinically important, particularly for women who experience discomfort or pain during their menstrual cycle.

AIM

To validate and analyse the psychometric properties of the Menstrual Attitude Questionnaire (MAQ) in a Spanish population.

METHODS

Adaptation and translation of the MAQ into Spanish, and cross-validation with data collected between March 2023 and March 2024 from 800 women (age 18-57 years).

FINDINGS

The first factor analysis showed that six items did not load on any factor, so they were excluded from the analysis (Items 9, 17, 18, 24, 28 and 29). Once these items had been eliminated, the exploratory factor analysis showed that four factors could be extracted: performance, positivity, anticipation and subjectivity.

DISCUSSION

Statistical analysis revealed that the proposed Spanish version of the MAQ consists of four factors. This implies a reduction of one factor compared with the original MAQ, resulting from the merging of two sections: 'Menstruation as an annoying event' and 'Menstruation as a natural event'. Both components of the questionnaire refer to the 'identity' or meaning that women attribute to their menstruation.

CONCLUSIONS

The Spanish version of the MAQ consists of four factors and 29 items, explaining most of the variability in the data. The Spanish version of the MAQ demonstrates good internal consistency and, therefore, represents a valuable tool for healthcare professionals who work daily with women with menstrual symptoms.

Psychological and cultural correlates of illness conception and menopausal symptoms: a cross-sectional and longitudinal comparative study of Mosuo, Yi, and Han women

Objective

This study explores the differences in menopausal symptoms, illness conception, and health-seeking behaviors among Mosuo, Yi, and Han women in China, analyzes the key factors behind these differences, and conducts a longitudinal comparison.

Methods

This study collected data from Mosuo, Yi, and Han women in Yongning Township, Ninglang County, Yunnan Province, through a questionnaire survey. The instruments included the Kupperman Menopause Index (KMI), Depression-Anxiety-Stress Scale (DASS), Self-Rating Scale of Illness Conception and Health Seeking Behavior (SSICHSB) and General Self-Efficacy Scale (GSES). First, descriptive statistical analysis was conducted on the demographic characteristics and various indicators of the sample. Chi-square tests and one-way ANOVA were used to examine the differences in KMI and SSICHSB among the different ethnic groups. The KMI was used to assess menopausal symptoms, and multiple linear regression analysis was employed to identify the main factors influencing menopausal symptoms. A longitudinal comparison of data from 2012 and 2020 was performed to analyze the dynamic changes in KMI and SSICHSB of Mosuo and Han women.

Results

The regression analysis identified stress, anxiety, and dysmenorrhea experience as risk factors, while self-efficacy served as a protective factor influencing menopausal symptoms. Both the menopausal symptoms and the scores for concerns and fears about illness among Mosuo women significantly decreased in 2020 compared to 2012 (p = 0.040, p = 0.010).

Conclusion

The results provide an important basis for the development of culturally sensitive health interventions. Future public health strategies should consider cultural, social, and physiological factors to provide more effective health support and interventions for women from different ethnic groups.

Efficacy and safety of abhal (Juniperus communis L). on pain intensity, uterine artery doppler flow, and quality of life in primary dysmenorrhea: A double-blind, randomized controlled trial

ETHNOPHARMACOLOGY RELEVANCE

Incorporating ancient wisdom from Unani Medicine, this study delves into the therapeutic efficacy of Juniperus communis L. in primary dysmenorrhea. By seamlessly merging traditional knowledge with modern scientific evaluation, this research illuminates Juniperus communis L. (Juniper) potential. This study stands as a testament to the value of exploring ethnopharmacological insights and bridging the gap between ancient healing traditions and evidence-based medicine.

AIM OF THE STUDY

To assess the efficacy and safety of Juniper berry compared to mefenamic acid in menstrual cramps and its associated symptoms, and overall quality of life in women with PD. Additionally, the study aimed to explore the impact of these interventions on uterine blood flow using Doppler evaluation.

MATERIALS AND METHODS

This was a double-blind, standard-controlled study conducted on 62 participants aged 18-35 years. They were randomly assigned to receive either two capsules (750 mg) of Juniper berry or 250 mg mefenamic acid thrice daily from day 1 to day 3 of menstruation, spanning two menstrual cycles. Primary outcomes were measured using the Visual Analogue Scale (VAS) for pain intensity and the Numerical Rating Scale (NRS) for systemic symptoms. Pelvic Doppler flow indices and responses to the SF-12 questionnaire were analyzed as secondary outcomes.

RESULTS

After the intervention in cycle 2, both the juniper and standard groups exhibited a significant reduction in mean VAS scores from 8.1 ± 1.3 to 2.87 ± 1.17 and 8.1 ± 1.13 to 3.61 ± 1.14, respectively (p = 0.012). Intergroup comparisons revealed no statistically significant differences in systemic symptoms at baseline, and cycle 2 (C2) follow-up (p > 0.05). Similarly, there were no significant differences in the SF-12 questionnaire scores at baseline, C2, and C4 (p > 0.05). However, intragroup comparisons for VAS, NRS, and SF-12 in both groups showed significant differences at C2 and C4 compared to the baseline (p < 0.001). In the juniper group, intergroup and intragroup comparisons indicated a small effect size for the right uterine artery (Rt UtA) RI and SD at C3 compared to C1 (0.2 and 0.33). Left UtA-PI and RI also demonstrated a medium effect size (0.482 and 0.501), respectively, between C3 and C1.

CONCLUSION

Juniper demonstrated significant efficacy and safety in reducing menstrual cramps, and its associated symptoms and improving health-related quality of life. Further, changes in pelvic uterine artery flow indices were also observed.

Exploratory Ultrasound Analysis of the Diaphragm and Respiratory Capacity in Women with Primary Dysmenorrhea: A Cross-Sectional Observational Study

Primary dysmenorrhea (PD) is a common gynecological condition characterized by menstrual pain without underlying pelvic pathology. It has been linked to functional and structural changes in the core musculature, but limited evidence exists regarding its association with diaphragmatic and respiratory mechanics. This study aimed to elaborate on these potential associations by assessing the diaphragmatic structure and respiratory function in women with PD compared to healthy controls, utilizing ultrasound imaging, spirometry and respiratory pressure measurements.

METHODS

An observational, cross-sectional study was conducted with 44 female participants (22 with PD and 22 healthy controls). Diaphragmatic structure was evaluated through ultrasound, measuring the intercostal distance, diaphragmatic thickness, and diaphragmatic excursion at rest and during maximum voluntary contraction. Spirometric assessments included forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and the FVC/FEV1 ratio, along with measurements of maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP). Group differences were analyzed using Student's t-test and effect sizes were reported with Cohen's d.

RESULTS

No significant differences were observed between the groups in diaphragmatic thickness, diaphragmatic excursion, or global respiratory capacity (p > 0.05). However, women with PD presented a significant reduction in the left intercostal distance both at rest (p = 0.035, d = 0.56) and during contraction (p = 0.039, d = 0.54). No other significant group differences were detected.

CONCLUSIONS

While primary dysmenorrhea does not appear to affect overall diaphragmatic function or respiratory capacity, it is associated with subtle localized changes in the left intercostal dynamics. These findings suggest a potential compensatory mechanical adaptation rather than global respiratory dysfunction. Further longitudinal studies with larger sample sizes are needed to explore the clinical significance of these findings.

Primary dysmenorrhea and its associated factors among female high school students in Nekemte town, East Wallaga Zone, Western Oromia, Ethiopia: a cross-sectional study

BACKGROUND

Primary dysmenorrhea is a common gynecological problem characterized by recurrent, periodical, and cramping pain in the lower abdomen that occurs before or during menstruation, usually without pelvic disease. Its magnitude has not been well studied; some of the associated factors are inconclusive. Therefore, the goal of this study was to fill gaps on the magnitude, and associated factors of primary dysmenorrhea among female high school students in Nekemte town.

OBJECTIVES

To assess the magnitude of primary dysmenorrhea, its associated factors among high school students in Nekemte town, East Wallaga, Western Oromia, Ethiopia, 2023.

METHODS

An institutional-based cross-sectional study was conducted among high school students in Nekemte town from June 05 to 19, 2023. The calculated total sample size was 534, and data were collected from four governmental high schools and one private high school that were selected by multistage stratified sampling. The collected data were entered into Epi Info version 3.1 and analyzed using SPSS version 25. Binary and multivariable logistic regressions were used to find associations between dependent and independent variables.

RESULTS

The magnitude of primary dysmenorrhea was 68.4% (95% CI = 64.3%, 72.0%). Anxiety (AOR = 2.41, 95% CI = 1.31, 4.43), family history of primary dysmenorrhea (AOR = 4.64, 95% CI = 2.74, 7.86), sexual intercourse (AOR = 0.34, 95% CI = 0.21, 0.55), drinking tea <4 cups per day (AOR = 0.38, 95% CI = 0.22, 0.60), and physical activity (AOR = 0.06, 95% CI = 0.03, 0.11) were factors associated with primary dysmenorrhea.

CONCLUSION

The magnitude of primary dysmenorrhea was high among high school students in the study area. Sexual intercourse, physical activity, drinking tea, anxiety, and family history of primary dysmenorrhea were significantly associated with primary dysmenorrhea.

Study on the influencing factors of primary dysmenorrhea in female college students: Systematic review and meta-analysis

BACKGROUND

The influencing factors of primary dysmenorrhea in female college students were analyzed through meta-analysis to provide the corresponding basis for its prevention and treatment.

METHODS

The databases, including China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, VIP database, China Biology Medicine Disc, Pubmed, Embase, Cochrane library, and Web of science were searched for the literature on the influencing factors of primary dysmenorrhea in female college students was retrieved from the science database from the establishment of the database to July 17, 2023. The Newcastle-Ottawa Quality Scale was used to score the quality of cohort and case-control studies included in the study. The cross-sectional studies were scored by the Agency for Healthcare Research and Quality. Two researchers independently screened the literature, and if there was no consensus, the third party would make a judgment on whether to include the literature. The extracted content included the first author, publication year, country, study type, sample size, and influencing factors. Stata17.0 software was used for meta-analysis.

RESULTS

A total of 23 studies were included, with a total sample size of 18,080 cases. Current evidence shows that the prevalence of primary dysmenorrhea in female college students is 70.3% (95%CI: 62.7-77.9%), and the combined odd ratio values (95%CI) of the main influencing factors are: family history of dysmenorrhea 2.116 (1.613-2.776), early age at menarche 2.200 (1.392-3.477), irregular menstrual cycle 1.662 (1.166-2.367), drinking cold drinks 1.717 (1.220-2.417), high caffeine intake 2.082 (1.379-3.144), stress 1.895 (1.515-2.282), medical specialty 1.827 (1.365-2.445), and adequate sleep 0.328 (0.232-0.463).

CONCLUSION

The prevalence of primary dysmenorrhea is high in female college students, and adequate sleep is a protective factor for primary dysmenorrhea. Family history of dysmenorrhea, early age at menarche, irregular menstrual cycle, drinking cold drinks, high caffeine intake, stress, and medical specialty were all risk factors.

Relationship between menstrual cycle and cognitive function in women with primary dysmenorrhea

Background/aim

To evaluate the relationship between the change in pain intensity over days of the menstrual cycle and cognitive function in females with primary dysmenorrhea.

Materials and methods

One hundred thirty-four females with primary dysmenorrhea who were admitted to our hospital from January 2021 to November 2023 were assessed. Of these participants, 46 individuals who subjectively stated that their cognitive function was affected, for whom neurology consultation was requested, and for whom patient data were available, were included in the study.

Results

A significant decrease was seen in phonemic and semantic fluency on day 3 of menstruation (p < 0.001 and p < 0.001, respectively). A significant decrease was observed in the forward and backward digit span (DGS) scores on day 3 of menstruation (p < 0.001 and p < 0.001, respectively). A significant decrease was seen in the forward and backward DGS scores on the most painful day of menstruation (p < 0.001 and p < 0.001, respectively). A significant decrease in the logical memory subtest Wechsler Memory Scale revised scores on the most painful day of menstruation (p < 0.001).

Conclusion

Consistent with the literature, strong evidence was found showing a negative correlation between dysmenorrhea and cognitive function. Future prospective, larger sample-size studies comparing cognitive function in females with and without dysmenorrhea at various stages of the menstrual cycle are needed.

Dysmenorrhea and Occupational Factors: Korea Nurses' Health Study

Aim: To examine the prevalence of dysmenorrhea in the predominantly female nursing profession and investigate the role of occupational characteristics in dysmenorrhea. Background: Studies on working women have mostly examined the effects of dysmenorrhea symptoms on work performance, as opposed to shedding light on the association between work-related characteristics and dysmenorrhea. Methods: In this cross-sectional study, we used data obtained from survey 9 of the Korea Nurses' Health Study. The participants were female nurses of childbearing age. Statistical analysis included descriptive statistics and multivariable logistic regression. Results: Data from 6697 participants were analyzed. Of the total sample, 47.3% had dysmenorrhea. After adjusting for confounders to examine the relationship between occupational characteristics and dysmenorrhea, the odds for dysmenorrhea were 1.230 times higher among women who lifted heavy objects at least six times a day compared to those who did not engage in heavy lifting (95% confidence interval: 1.028-1.473) and 1.042 times higher among women with higher physical fatigue (odds ratio: 1.042, 95% confidence interval: 1.023-1.061). Conclusion: The findings clarify the potential for reducing dysmenorrhea through the improvement of work environment factors. Thus, this study may prove useful for developing educational programs and policies that aim to alleviate dysmenorrhea among working women, including nurses. Implications for Nursing Management: Nursing managers and health policymakers need to understand the factors influencing dysmenorrhea and minimize female nurses' physical burden by implementing appropriate nurse-patient ratios and improving their work environment.

Prevalence and risk factors of primary dysmenorrhoea among medical students: a cross-sectional survey in Indonesia

OBJECTIVES

This study aimed to assess the prevalence and associated risk factors of primary dysmenorrhoea among medical students in Indonesia.

DESIGN

A web-based survey was conducted among 630 medical students across Indonesia, selected based on specific inclusion criteria. Dysmenorrhoea prevalence, severity and associated risk factors were assessed using a self-reported questionnaire. To analyse the data, univariate and multiple binary logistic regression analyses were performed. A significance level of 5% (p<0.05) was used for both types of analyses to determine the statistical significance of the observed associations.

SETTING AND PARTICIPANTS

Indonesia (2021: n=630 female medical students).

OUTCOMES

The primary outcome is primary dysmenorrhoea, defined as painful menses without previous diagnosis of pelvic pathology. The severity of dysmenorrhoea was measured using the Verbal Multidimensional Scoring System. Independent variables include socio-demographic characteristics, menstrual history and other identified associated risk factors.

RESULTS

Of the 630 Indonesian medical students surveyed, a large proportion (91.27%) reported experiencing dysmenorrhoea, with 52.35% experiencing moderate-to-severe pain. Family history of dysmenorrhoea emerged as a significant predictor for both occurrence (OR 3.76; 95% CI 1.89 to 7.45) and severity (OR 1.47; 95% CI 1.04 to 2.06). Dysmenorrhoea severity was positively associated with cycle length (OR 1.57; 95% CI 1.01 to 2.43), whereas higher body mass index (BMI) (OR 0.94; 95% CI 0.90 to 0.98) and being Indonesian of foreign descent (OR 0.46; 95% CI 0.27 to 0.84) were negatively associated with moderate-to-severe dysmenorrhoea.

CONCLUSIONS

Dysmenorrhoea is prevalent among Indonesian medical students, with family history, BMI, cycle length and race significantly associated with its occurrence or severity. These findings underscore the need for further research on more diverse populations to enhance awareness and address this prevalent gynaecological concern effectively.

Dysmenorrhea and Its Impact on Patients' Quality of Life-A Cross-Sectional Study

Background: Dysmenorrhea is a common condition that may have negative effects on social life, couples' relationships and professional activities. The objectives of this study were to evaluate the prevalence, risk factors and characteristics of dysmenorrhea and its impact on patients' quality of life using a specific self-questionnaire named "DysmenQoL questionnaire". We also checked the validity and reliability of this questionnaire in our population. Methods: We conducted a cross-sectional study that included 504 participants of reproductive age between 18 and 45 years of age. The data were collected with an original form divided into three sections. The last section (DysmenQoL questionnaire) included 20 statements scored from 1 ("never") to 5 ("every time") that evaluates the effects of menstrual pain on health and feelings, daily activities, relationships and professional activity. We calculated the sum of the scores for each statement and we called it the "DysmenQoL score". Results: The prevalence of dysmenorrhea was 83.7%. The presence of dysmenorrhea was statistically significant associated with the degree of menstrual bleeding (p = 0.017), the presence of infertility (p = 0.034) and dyspareunia (p = 0.002), but also with the presence of premenstrual syndrome and a family history of dysmenorrhea (p < 0.001). Among the participants with dysmenorrhea, 73.9% considered that this symptom affected their quality of life, and this was correlated with pain intensity and the DysmenQoL score (p < 0.001). A significant difference regarding the DysmenQoL score depending on the pain intensity, frequency and duration of dysmenorrhea and the methods used to reduce the pain was observed. Conclusions: Dysmenorrhea had a high prevalence among the participants included in the study, and its presence was associated with a series of risk factors. Most women considered that dysmenorrhea affected their quality of life. The DysmenQoL questionnaire proved to be a reliable and valid method for evaluating the impact of dysmenorrhea on quality of life.

Comparisons of pharmacokinetics and tissue distribution of six major bioactive components of the herbal pair Alpinia officinarum-Cyperus rotundus in normal and primary dysmenorrhea rats

The Liangfu formula, as described in 'Liangfang Jiye', is well-known for its efficacy in treating stomach pain, abdominal pain, and dysmenorrhea. This research aimed to investigate the pharmacokinetics and tissue distribution of 5-hydroxy-7-(4-hydroxy-3-methoxyphenyl)-1-phenyl-3-heptanone (DPHA), Galangin, Kaempferide, 5-Hydroxy-1,7-diphenyl-3-heptanone (DPHC), α-Cyperone, and Nootkatone in vivo using an LC-MS/MS method. The method successfully separated the six active components and internal standards (Chrysin and Yakuchinone-A) on an XB-C18 column with a mobile phase of 0.2 ‰ formic acid water-acetonitrile. It demonstrated good linearity with a correlation coefficient (r2) ≥ 0.9911 and a lower limit of quantification (LLOQ) of 5-80 ng/mL for the different components. Precision, accuracy, matrix effects, and recovery rates were within acceptable ranges. Pharmacokinetic analysis revealed significant differences in parameters between primary dysmenorrhea (PD) and normal rats (especially AUC, Tmax, and CLz/F). Tissue distribution showed that the six active components of the herbal pair Alpinia officinarum Hance-Cyperus rotundus L. (HPAC) extract was primarily distributed in the liver, lung, and kidney. This study offers valuable insights into the potential mechanisms of action and drug development for treating PD.

Productivity loss due to polycystic ovary syndrome and its relationship to race, mental health and healthcare delivery indices

Objective

To study the impact of polycystic ovary syndrome (PCOS) on work-related impairments and explore relationships with race, mental health, and healthcare delivery indices.

Design

A cross-sectional internet-based survey.

Setting

North American women with PCOS between August 2022 and October 2022.

Patients

Individuals with a self-reported diagnosis of PCOS.

Interventions

Not applicable.

Main Outcome Measures

The primary outcome was missed work because of PCOS. The secondary outcomes included leave from work, impacts on the quality of work, and feelings of being held back at work because of PCOS.

Results

Of 1,105 respondents, 1,058 reported having PCOS diagnosed by a physician. Of this group, 50.4% reported missing work because of PCOS, 72% felt that PCOS impacted the quality of their work, and 51.5% felt held back at work by PCOS. Multivariate analyses revealed that missing work because of PCOS was independently associated with black race, lack of insurance, requiring multiple doctors for a PCOS diagnosis, needing ≥3 doctors for current care, decreased satisfaction with care, and symptoms of anxiety and depression.

Conclusions

Polycystic ovary syndrome significantly impacts employment-related productivity. Factors such as race, mental health, and healthcare delivery appear to play a crucial role in the extent of this impact.

Efficacy of acupuncture-related therapy in the treatment of primary dysmenorrhea: A network meta-analysis of randomized controlled trials

Objectives

In order to compare and rank the most effective acupuncture therapy for primary dysmenorrhea and provide evidence-based medical support for clinical treatment of this disease.

Methods

A comprehensive search was conducted on China National Knowledge Infrastructure (CNKI), Wanfang Database, Information Chinese Journal Service Platform (VIP), China Biomedical Literature Service System (SinoMed), PubMed, Web of Science, Embase, and Cochrane Library databases from their inception to May 1, 2023. The Cochrane Collaboration Risk of Bias Tool was used to evaluate bias risk, and the GeMTC package of Stata 15.1 software and R 4.3.1 software was used to perform network Meta-analysis.

Results

70 studies were included, including 5772 patients with primary dysmenorrhea, involving 25 kinds of acupuncture techniques commonly used in clinic. The quality of the included literature was low, most of them did not mention the registration information of clinical trial centers, and the specific sample size estimation method was unclear. Some literature did not explain the specific random method, distribution concealment and blindness, so there was a certain publication bias and small sample effect. Results showed that for improving the clinical effective rate, the top three treatments were salt-separated moxibustion, massotherapy + acupoint patching, acupuncture + heat-sensitive moxibustion. In terms of reducing the visual analogue scale(VAS), the top three treatments were massotherapy + acupoint patching, acupuncture + acupoint patching and warm acupuncture. In terms of alleviating cox menstrual symptom scale (CMSS), the top three treatments were acupuncture + acupoint patching, acupoint patching and point embedding. In relieving TCM symptom score, the top three treatments were acupoint patching + heat-sensitive moxibustion, acupoint patching and moxibustion.

Conclusion

Different acupuncture therapies have more advantages than oral analgesics in improving the clinical effective rate, reducing VAS score, reducing CMSS score, and alleviating TCM symptom score. Among them, massage therapy + acupoint patching, acupuncture + acupoint patching and acupoint patching may be the best solutions for the treatment of primary dysmenorrhea. However, more large-sample, multi-center and high-quality randomized controlled trials are needed to demonstrate.

To explore the mechanism of acupoint application in the treatment of primary dysmenorrhea by 16S rDNA sequencing and metabolomics

Graphene-based warm uterus acupoint paste (GWUAP) is an emerging non-drug alternative therapy for the treatment of primary dysmenorrhea (PD), but the underlying mechanism is still unclear. SD female rats were randomly divided into control group, model group and treatment group to explore the mechanism of GWUAP in the treatment of PD. Combined with 16S rDNA and fecal metabolomics, the diversity of microbiota and metabolites in each group was comprehensively evaluated. In this study, GWUAP reduced the torsion score of PD model rats, improved the pathological morphology of uterine tissue, reduced the pathological damage score of uterine tissue, and reversed the expression levels of inflammatory factors, pain factors and sex hormones. The 16 S rDNA sequencing of fecal samples showed that the abundance of Lactobacillus in the intestinal flora of the model group decreased and the abundance of Romboutsia increased, while the abundance of Lactobacillus in the intestinal flora of the treatment group increased and the abundance of Romboutsia decreased, which improved the imbalance of flora diversity in PD rats. In addition, 32 metabolites related to therapeutic effects were identified by metabolomics of fecal samples. Moreover, there is a close correlation between fecal microbiota and metabolites. Therefore, the mechanism of GWUAP in the treatment of PD remains to be further studied.

A comprehensive investigation of biopsychosocial determinants influencing primary dysmenorrhea among university students

Dysmenorrhea, characterized by pain and related symptoms, significantly impacts women's quality of life in work and education, prompting a comprehensive evaluation of associated factors. The objective of this study was to utilize structural equation modeling (SEM) to analyze and assess the biopsychosocial factors influencing dysmenorrhea among university students. Three hundred and thirty-nine university students were included in this cross-sectional descriptive study. Data were collected using the Participant Information Form, the Beck Anxiety Scale (BAS), the Beck Depression Scale (BDS), the Multidimensional Scale of Perceived Social Support (MSPSS), the Adverse Childhood Experiences Scale (ACES), the Pain Catastrophizing Scale (PCS) and the Visual Analogue Scale (VAS). It was determined that the variables of pain onset (t = 3.24, p < .05) and age at menarche (t = -2.16, p < .05) showed a significant relationship with the model. The variables of the PCS (t = 16.87, p < .001), BDS (t = 3.06, p < .05), and BAS (t = 5.13, p < .001) showed a significant relationship with the model. Social factors in the model were examined, and a family history of dysmenorrhea and the ACES variables did not contribute significantly to the model (p > .05). The study indicates primary dysmenorrhea influenced by biological and psychological factors. Nurses should conduct holistic assessments and provide comprehensive care for affected women.

Evaluation of Electromagnetic Therapy in the Treatment of Severe Dysmenorrhea in Young Women of Basrah

INTRODUCTION

Primary dysmenorrhea (PD) is a public disease of young female worldwide, it affects their daily performances. Severe recurrent uterine cramps are the main complaints in 90% of adolescents and 50% of reproductive-age females. This study aimed to evaluate the use of magnetic field therapy in the treatment of severe dysmenorrhea grade 3 and provide an encouraging goal to continue daily work without pain.

METHODS

Two hundred and fifty female patients were recruited in this study from gynecological clinics in Basrah, southern Iraq. All had severe dysmenorrhea, patients were subjected to a questionnaire form, Visual Analog Scale, and verbal multidimensional scoring system to determine the pain intensity and grade of dysmenorrhea. Only 38 young females had severe dysmenorrhea grade 3 with ages ranging from 16 to 28 years with a mean age of 22.04 ± 1.43 years and body mass index 23.81 ± 1.94, patients subjected to electromagnetic field therapy (EMFT), two sessions per week for 20 min each for 6 weeks. Three categories were assessed, working ability, associated symptoms, and drugs used. Data were collected and statistically analyzed using SPSS version 22.

RESULTS

The present study showed statistically significant progress (P < 0.05) in reducing pain, rare physical and mental complaints, and improved working ability with no need for drugs in majority of patients.

CONCLUSION

EMFT has better results than other methods in relieving pain and symptoms of dysmenorrhea with a settled lifestyle.

Role of stress and physical activity on primary dysmenorrhea: A cross-sectional study

The initial physiological change in adolescent girls is the onset of menstruation. The most prevalent challenge they face regarding menstruation is primary dysmenorrhea, characterized by persistent or intermittent pelvic pain in the lower abdomen. The aim of this study was to investigate the influences of stress levels and physical activities on primary dysmenorrhea. A cross-sectional was conducted in Cirebon, Indonesia, in 2023 included young women who had never given birth (nullipara), aged 17-25 years old, had menstruated, and had no history of smoking and alcohol. The data were collected using a set of questionnaires consisting of the Numeric Rating Scale (NRS) to determine primary dysmenorrhea pain, the Depression Anxiety Stress Scales 42 (DASS 42) to determine the level of stress and the International Physical Activity Questionnaire (IPAQ) to determine physical activity. Pearson's correlation test was used to assess the correlation between the variables (stress levels, physical activity, and dysmenorrhea). A total of 150 young women were included in the study. Moderate stress levels (23.3%) and high physical activity (90.7%) were the most prevalent category observed among studied participants. Approximately 42% of them experienced mild dysmenorrhea pain. Our analysis indicated that stress levels and physical activities had strong positive and negative correlations with dysmenorrhea pain levels, with r=0.782 and r=-0.748, respectively, with both had p<0.001. This highlights that controlling stress could be beneficial in preventing dysmenorrhea pain among young women.

Feasibility Study on Menstrual Cycles With Fitbit Device (FEMFIT): Prospective Observational Cohort Study

BACKGROUND

Despite its importance to women's reproductive health and its impact on women's daily lives, the menstrual cycle, its regulation, and its impact on health remain poorly understood. As conventional clinical trials rely on infrequent in-person assessments, digital studies with wearable devices enable the collection of longitudinal subjective and objective measures.

OBJECTIVE

The study aims to explore the technical feasibility of collecting combined wearable and digital questionnaire data and its potential for gaining biological insights into the menstrual cycle.

METHODS

This prospective observational cohort study was conducted online over 12 weeks. A total of 42 cisgender women were recruited by their local gynecologist in Berlin, Germany, and given a Fitbit Inspire 2 device and access to a study app with digital questionnaires. Statistical analysis included descriptive statistics on user behavior and retention, as well as a comparative analysis of symptoms from the digital questionnaires with metrics from the sensor devices at different phases of the menstrual cycle.

RESULTS

The average time spent in the study was 63.3 (SD 33.0) days with 9 of the 42 individuals dropping out within 2 weeks of the start of the study. We collected partial data from 114 ovulatory cycles, encompassing 33 participants, and obtained complete data from a total of 50 cycles. Participants reported a total of 2468 symptoms in the daily questionnaires administered during the luteal phase and menses. Despite difficulties with data completeness, the combined questionnaire and sensor data collection was technically feasible and provided interesting biological insights. We observed an increased heart rate in the mid and end luteal phase compared with menses and participants with severe premenstrual syndrome walked substantially fewer steps (average daily steps 10,283, SD 6277) during the luteal phase and menses compared with participants with no or low premenstrual syndrome (mean 11,694, SD 6458).

CONCLUSIONS

We demonstrate the feasibility of using an app-based approach to collect combined wearable device and questionnaire data on menstrual cycles. Dropouts in the early weeks of the study indicated that engagement efforts would need to be improved for larger studies. Despite the challenges of collecting wearable data on consecutive days, the data collected provided valuable biological insights, suggesting that the use of questionnaires in conjunction with wearable data may provide a more complete understanding of the menstrual cycle and its impact on daily life. The biological findings should motivate further research into understanding the relationship between the menstrual cycle and objective physiological measurements from sensor devices.

Perceptions, Beliefs, and Experiences about the Menstrual Cycle and Menstruation among Young Women: A Qualitative Approach

The experience of menstruation is often associated with negative connotations and gender stereotypes, which results in making it invisible. This research aimed to explore the perceptions, beliefs, and knowledge of young Spanish women regarding the menstrual cycle and menstruation and their impact on their lives. The study delves into their understanding, menstrual management practices, the types of menstrual products employed, and their experiences related to menstrual health. Qualitative methodology was used with discussion groups as a data collection technique. The participants comprised 45 young Spanish women, aged between 18 and 23, hailing from both rural and urban areas. The majority were university students, with some engaged in part-time work, and one participant working full-time. While many experienced menstrual pain ranging from mild to debilitating, a normalization of this pain often led them to forego seeking specialist assistance. Disposable menstrual products (DMPs) are the most used by participants, despite limited awareness of their absorption capacity. Regarding reusable menstrual products (RMPs), menstrual cup users emphasized comfort but expressed a need for proper training. Negative menstruation experiences could evoke fear and difficulties, underscoring the importance of providing comprehensive menstrual health education encompassing both theoretical and practical components.

The Effect of Fenugreek on the Severity of Dysmenorrhea: A Systematic Review and Meta-analysis

INTRODUCTION

Dysmenorrhea is the most common periodic pain, which affects more than 50% of women with regular menstruation. Fenugreek is one of the medicinal plants with analgesic properties. This study aimed to determine the effect of fenugreek application in the severity of dysmenorrhea and its side effects in women with dysmenorrhea. PICO: Population: women with dysmenorrhea; Intervention: fenugreek; Comparison: control groups; and Outcome: reduction in the severity of dysmenorrhea and its side effects.

METHODS

English database (PubMed, Cochrane Library, Scopus, and Web of Science) and Persian database [SID (Scientific Information Database) and Magiran] were used for research until February 11, 2023, using the keywords "Dysmenorrhea [Mesh]," "Foenum [Mesh]," "fenugreek [Mesh]," and "Trigonella [Mesh]." The reference list of the selected articles was also checked. The quality assessment was conducted through the Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0. The RevMan 5.3 software was used to analyze and report the data of the entered studies. Meta-analysis results were reported with the standardized mean difference (95% confidence interval). A subgroup analysis was performed based on the type of control groups. The quality of evidence was assessed using the GRADE approach.

RESULTS

After removing duplicates and ineligible cases, four articles were included in the systematic review out of the 1526 records obtained. The results showed that the pain intensity caused by primary dysmenorrhea decreased with fenugreek compared to placebo (pooled result SMD: -2.21; 95% CI: -3.26 to -1.17; Z: 4.17; p <0.001). There was no significant difference between fenugreek with mefenamic acid (SMD: 0.05; 95% CI: -0.57 to 0.67; Z: 0.17; p = 0.86) and fenugreek with Chandrasura churna (SMD: 0.06; 95% CI: -0.56 to 0.68; Z: 0.19; p = 0.85). Bias, in terms of incomplete outcome data and selective reporting, was low risk in all studies, and the available evidence was low quality according to the GRADE approach.

CONCLUSION

The results showed that the effect of fenugreek on pain intensity in dysmenorrhea is highly uncertain. The true effect is likely to be substantially different from the estimate of effect. Regarding the importance of the health and quality of life of women of reproductive age and the low quality of evidence of the studies, clinical trials with stronger methodology are suggested in this field.

[Holistic treatment of endometriosis]

BACKGROUND

The pain phenomena caused by endometriosis are manifold. In addition to nociceptive pain there is also a nociplastic reaction with central sensitization. Atypical symptoms, such as acyclic lower abdominal pain, radiating pain, nonspecific bladder and intestinal complaints or even depression increasingly occur in addition to the classical cyclic complaints, such as severe dysmenorrhea, cyclic lower abdominal pain, dyspareunia, dysuria and dyschezia. Due to the diffuse range of symptoms, affected patients often consult not just gynecologists but also specialists from other disciplines (internal medicine, gastroenterology, orthopedics, pain therapy, psychology etc.).

OBJECTIVE

The complexity of endometriosis is presented. The resulting approaches to multimodal interdisciplinary holistic treatment are described.

RESULTS

Interdisciplinary concepts should be involved in the optimal treatment of endometriosis patients along with hormonal and surgical treatment, mostly under the supervision of a gynecologist and pain management, dietary changes, psychological support and physiotherapeutic management should also be included. This article provides an overview of possible treatment strategies for chronic symptomatic endometriosis.

CONCLUSION

Based on multimodal treatment strategies and regarding the complex pathophysiological alterations of this disease, the complex complaints that significantly impair the quality of life of endometriosis patients can be greatly improved.

Repurposing of Bryophyllum pinnatum for dysmenorrhea treatment: a systematic scoping review and case series

Dysmenorrhea affects women throughout their reproductive years but there has been a lack of effective and well-tolerated treatment options. Pain symptoms mainly result from inflammatory processes and increased contractile activity in the myometrium. The reported use of Bryophyllum pinnatum preparations against inflammation and pain in ethnomedicine as well as current pharmacological data on their inhibition of myometrial contractility led us to hypothesize that this medicinal plant might be a new treatment option for dysmenorrhea. In the first part of the present work, clinical, in vivo, and in vitro studies on the anti-nociceptive and anti-inflammatory, as well as on myometrium relaxing properties of B. pinnatum are reviewed. In the second part, cases of five women with dysmenorrhea who were tentatively treated with a B. pinnatum product are described. The review revealed thirty-three experimental in vivo and in vitro studies, but no clinical study, reporting anti-nociceptive and anti-inflammatory effects of B. pinnatum extracts and compounds in a wide range of conditions. Moreover, sixteen publications on smooth muscle contractility revealed relaxing effects. The latter consisted of clinical evidence, as well as of in vivo and in vitro data. The evidence reviewed therefore provided a rational basis for the use of B. pinnatum in the treatment of dysmenorrhea. We subsequently set out to tentatively treat patients with a well-tolerated B. pinnatum product that is registered (without indication) and commonly used in obstetrics and gynecology in Switzerland. All five treated patients reported a reduction in pain symptoms and 4 out of 5 indicated a reduced intake of painkillers during menstruation. Taken together, the reviewed information on the pharmacological properties and clinical evidence of B. pinnatum extracts and compounds as well as the outcomes of all five patients in the case series support our hypothesis in favor of B. pinnatum as a new, well-tolerated therapeutic approach for dysmenorrhea. Prospective clinical studies are urgently needed.

Reasons for Not Seeking Healthcare Among Students with Dysmenorrhea: A Qualitative Study

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.

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

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

Knowledge Mapping of Primary Dysmenorrhea: Hotspots, Knowledge Structure, and Theme Trends

Purpose

The global incidence of primary dysmenorrhea is continuously increasing, and understanding its research trends is crucial for effective pain management and women's health. Therefore, this study aims to perform a comprehensive bibliometric analysis of primary dysmenorrhea research to identify hotspots, explore emerging trends, and provide valuable insights for future research endeavors.

Material and Methods

All of the relevant studies on primary dysmenorrhea in the Web of Science™ Core Collection database were searched for bibliometric analysis. Biclustering analysis using gCLUTO software was performed to identify research hotspots. Social network analysis with Ucinet was employed to reveal knowledge structure. Evolutionary analysis using SciMAT was utilized to predict thematic trends.

Results

A total of 903 papers were analyzed, indicating a gradual increase in research on primary dysmenorrhea in recent years, with the scope of research expanding and diversifying. We identified seven hotspots, three treatment nodes, and four thematic trends. Research hotspots focused on epidemiological studies, adolescent primary dysmenorrhea, drug and non-drug treatments. Within the realm of treatments, we have identified three treatment nodes: acupuncture, acupressure, and ibuprofen. The evolution of research has witnessed a shift from traditional epidemiological studies toward a more diverse research landscape. Adolescent primary dysmenorrhea is expected to remain a prominent research topic while dietary supplements and lifestyle are predicted to gain more attention. An emerging theme is the study of variation and polymorphism of circadian rhythm genes concerning primary dysmenorrhea.

Conclusion

This bibliometric analysis provides valuable insights into the current state of research on primary dysmenorrhea, offering a clearer understanding of the field's landscape. The identified hotspots, knowledge structure, and thematic trends can serve as valuable references for future investigations in this area. The research holds significant scientific importance and innovative value in elucidating the mechanisms of primary dysmenorrhea and finding more effective treatment approaches.

Efficacy of Connective Tissue Therapy and Abdominal Stretching Exercises in Individuals With Primary Dysmenorrhea: A Review

Dysmenorrhea is a menstrual disorder characterized by painful uterine cramps that occur during menstruation. There are two types of dysmenorrhea, primary and secondary. It affects 45-95% of all menstruating women worldwide. The prevalence in India is approximately 75%. Primary dysmenorrhea diagnosis is based on the patient's medical history and physical examination. If the history of start and duration of lower abdominal discomfort suggests secondary dysmenorrhoea or if the dysmenorrhoea does not respond to medical treatment, a pelvic examination is necessary to evaluate dysmenorrhoea. Because of the increasingly large number of women who are impacted by primary dysmenorrhea, it should be a public health concern that authorities must address. Abdominal stretching is a very simple, efficient, and risk-free workout. Some of the benefits of stretching exercises for dysmenorrhea include increased elasticity and strength of the spine and pelvic muscles and reduction in pain. The knee-to-chest exercise in combination with hydrocollator packs has a significant effect in improving the pain and the monthly irregularities in primary menstrual pain. Massage of connective tissue is a form of cutaneous stimulation that tries to stimulate the connective tissue's mechanical receptors. Connective tissue massage studies for treating a range of dysfunctions usually indicate that patients treated with this modality get pain alleviation and even complete remission.

Prevalence, Management, and Impact of Dysmenorrhea on the Lives of Nurse and Midwife Trainees in Northern Ghana

Background

Dysmenorrhea is the most common gynecological problem affecting the majority of female students in the nursing profession today. They often experience severe pain that is not only incapacitating but also has a significant impact on their day-to-day college life, academic, and clinical performance.

Aim

This study was conducted to assess the prevalence, management, and impact of dysmenorrhea on the lives of nurse and midwife trainees in northern Ghana.

Methods

A descriptive cross-sectional design with a quantitative approach to data collection was employed to collect data from nurse and midwife trainees in three colleges of nursing and/or midwifery in the northern region of Ghana. A proportionate stratified random sampling technique was used to recruit 303 respondents for the study. After gaining permission from various institutions, data were collected by using a structured questionnaire from 13th September to 28th October, 2022. Stata (special edition) for Windows version 17.0 was used for the statistical analyses.

Results

The study revealed a high prevalence of dysmenorrhea among female nursing students (66.7% and 95% CI: 0.611-0.720). More than half of the respondents (67.3%) experienced loss of appetite for food. The most common site of most intense pain was the pelvis and lower abdomen (98.0%). A greater proportion of students (65.8%) used antispastic drugs to reduce pain. The respondents' concentration in the classroom was greatly affected (77.2%) as well as normal physical activities (58.4%). A multivariable logistic regression analysis revealed that the odds of dysmenorrhea are 2.67 times higher when the duration of menstruation is 4-5 days (AOR = 1.82, 95% CI = 1.13-6.28, and p = 0.024) than a duration of 1-3 days. Having urinary tract infections was associated with 3.56 times higher odds of dysmenorrhea (AOR = 3.56, 95% CI = 0.98-12.86, and p = 0.053). Again, the odds of dysmenorrhea were also four times higher among respondents with a family history of the same condition (AOR = 4.05, 95% CI = 2.16-7.61, and p = 0.001).

Conclusion

The current study revealed a high prevalence of dysmenorrhea among nurse and midwife trainees in the northern part of Ghana. The majority of the respondent experienced loss of appetite and intense pain in the pelvis and lower abdomen, and their concentration during lectures was also significantly affected. The most predominant nonpharmacological method used for reducing the pain was sleep and the application of warm objects on the abdomen.

Effect of Lumbar Spine Mobility and Postural Alignment on Menstrual Pain in Young Women

(1) Background: Studies indicate that 45 to 95% of women suffer from painful periods. Despite frequent incidence, the problem is still underestimated. Menstruation-related ailments often correlate with high absenteeism at school and work, as well as limitation of social and scientific activity. The aim of this study was to assess the relationship between the size of the curvature, the mobility of the spine in the sagittal plane, and menstrual pain in young women. (2) Methods: The analysis included 224 women aged 18-26, mean of 21.56 ± 1.95, studying at the College of Medical Sciences of the University of Rzeszów. For this purpose, the measurement of the anterior-posterior curvature of the spine with a gravitational inclinometer, the Schober test and the authors' questionnaire related to menstruation were used. (3) Results: The data analysis demonstrated a significant difference between the group with menstrual pain (MP) and the control group without pain (CG), where the angle of the lumbar sacral transition (p = 0.034), thoracolumbar transition (p = 0.044) and lumbar lordosis (p = 0.006) were statistically significantly lower in MP compared to CG. There were no significant differences in the measurement of the so-called smartphone hump and between the mobility of the lumbar spine and menstrual pain in any of the groups. (4) Conclusions: Women with menstrual pain are characterized by reduced lumbar lordosis and thoracic kyphosis, while sagittal mobility of the spine does not affect pain.

Experiences of dysmenorrhea and its treatment among allistic and autistic menstruators: a thematic analysis

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.

Oral contraceptive pills shortage in Lebanon amidst the economic collapse: a nationwide exploratory study

BACKGROUND

The political instability, economic crisis, and devaluation of the national currency left Lebanese females suffering from a scarcity of oral contraceptive pills (OCPs). Therefore, we aimed to identify the incidence of OCPs shortage in Lebanon and its impact on women's sexual and reproductive health, as well as physical and psychological well-being.

METHODS

Community pharmacies were selected randomly across Lebanon, using a stratified sampling approach, where female clients asking for OCPs were interviewed using a standardized data collection form.

RESULTS

A total of 440 females were interviewed. More than three-quarters of the participants (76.4%) reported not finding their preferred OCPs brands, almost 40% were affected by the increased prices, and 28.4% declared stockpiling OCPs. More than half of the participants using OCPs for pregnancy prevention reported adopting alternative traditional contraceptive methods (55.3%). Unplanned pregnancy was reported by 9.5% of participants, where 75% of them disclosed intentional abortion while the remaining (25%) reported experiencing a spontaneous miscarriage. Other consequences of OCPs shortage included mood disturbances (52.3%), dysregulation of menses (49.7%), dysmenorrhea (21.1%), weight gain (19.6%), acne (15.7%), and hirsutism (12.5%). Of the participants taking OCPs for birth control, 48.6% reported a reduced frequency of sexual intercourse, which led to conflicts with their partners (46%) and a decreased libido (26.7%).

CONCLUSIONS

OCPs shortage has seriously and negatively exposed women to various undesirable consequences including unplanned pregnancy and dysregulation of menses. Therefore, there is an urgent need to bring the attention of healthcare authorities to support the national pharmaceutical industry in manufacturing affordable OCPs generics to meet women's reproductive health demands.

Severity of Menstrual Pain Is Associated with Nutritional Intake and Lifestyle Habits

Recently, the employment rate of women in Japan has steadily increased. Approximately 80% of women experience menstrual pain and premenstrual syndrome (PMS). These symptoms decrease a woman's quality of life and her work productivity, leading to an economic loss. This cross-sectional study of 321 healthy Japanese women aged 20-39 years aimed to clarify the lifestyle-related factors or nutrient intake that might cause menstrual pain. The participants underwent body composition measurements and completed meal survey sheets and lifestyle questionnaires, including menstrual status, exercise, sleep and breakfast consumption. Based on the questionnaire results, participants were divided into two groups according to the severity of menstrual pain, namely, heavy and light. Chi-square and Wilcoxon signed-rank sum tests were used to compare the severity of menstrual pain in the two groups. In the heavy group, the intake of animal proteins, including fish, vitamin D and vitamin B12, was significantly lower (p < 0.05), as was the frequency of breakfast consumption and bathing (p < 0.05). The rate of PMS symptoms was significantly higher in the heavy group (p < 0.05). This study suggests that a lack of animal protein, the accompanying vitamins and fatty acids, and the frequency of breakfast or bathing are associated with the severity of menstrual pain.

The experiences of menstrual symptom changes among international students studying in China during the acculturation period: A phenomenology study

Objectives

Menstruation is a normal physiological phenomenon among female which could be influenced by the process of acculturation. Few studies have explored the experience of menstrual symptom changes among international female students studying in China. Therefore, this paper aims to summarize international female students' experiences of menstrual symptom changes when they were studying in China and interpret these changes through considering the influence of acculturation on their social and academic lives.

Methods

We used a descriptive phenomenology approach. Structured in-depth face-to-face interviews were conducted between May and November 2019 among ten international female students studying in one Province located in south central China. Participants were those who reported having experienced menstrual symptom changes during the acculturation period, which was defined as the first six months of living in China. All interviews were audio-recorded, transcribed verbatim, and analyzed using NVivo 11.0 with the guidance of Colaizzi's seven-step method.

Results

The international female students' experiences of menstrual symptom changes were summarized and grouped into five main categories and 13 subcategories. The main categories include: 1) demonstration of menstrual symptom changes, 2) challenges of maintaining menstrual function in the new setting, 3) coping styles to take care of menstrual health, 4) consequences of the menstrual symptom changes, and 5) culture-based attitude toward menstruation.

Conclusions

International female students reported experiences of menstrual symptom changes, including somatic and psychological symptoms during the acculturation period. Culture barriers, academic stress, and sleep patterns are common factors influencing their menstrual symptom changes. More culturally-tailored interventions should be explored to improve the menstrual health of international female students in China.

Auricular therapy for primary dysmenorrhea: A protocol for systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Primary dysmenorrhea (PD) is a common problem among women. It is defined as any degree of perceived cramping pain during menstruation without any evident pathology. Auricular therapy (AT), a widely used alternative medical treatment method as part of traditional Chinese acupuncture, lacks reliable evidence to support its safety and effectiveness for PD. We aimed to conduct a meta-analysis to investigate the efficacy and safety of AT in PD and to investigate possible factors impacting the particular efficacy of AT in PD by meta-regression.

METHODS

This protocol followed the PRISMA guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. The following 9 sources will be searched for randomized control trials of AT for PD: the Cochrane Central Register of Controlled Trials, PubMed, Medline, Embase, Web of Science, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure, Chinese Science and Technology Periodicals (VIP) database and WanFang Database from inception to January 1, 2023. Primary outcomes include visual rating scales and clinical efficacy rates, while secondary outcomes include endocrine hormone indicators related to PD and adverse events. Two reviewers will work independently on study selection, data extraction, and coding, including the risk of bias assessment in the included studies. While conducting a meta-analysis, Review Manager version 5.3 will be employed. Otherwise, a descriptive analysis will be performed. The results will be displayed as a risk ratio with 95% confidence intervals for dichotomous data as well as weight mean difference or standardized mean difference with 95% confidence intervals for continuous data.

RESULTS

This study's protocol will investigate the efficacy and safety of AT in the treatment of PD in a systematic way.

CONCLUSION

This systematic evaluation will objectively and systematically assess the efficacy and safety of AT in PD based on the available evidence, as well as provides clinicians with evidence to support the treatment of the disease.

Stroke Risk in Young Women with Primary Dysmenorrhea: A Propensity-Score-Matched Retrospective Cohort Study

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.

The Sprint-Interval Exercise Using a Spinning Bike Improves Physical Fitness and Ameliorates Primary Dysmenorrhea Symptoms Through Hormone and Inflammation Modulations: A Randomized Controlled Trial

Dysmenorrhea with high prevalence has been categorized as primary dysmenorrhea (PD) and secondary dysmenorrhea due to differences in pathogenesis. A significant number of reproductive females suffering from monthly menstruation have to deal with negative impacts on their quality of life, work/study productivity, activities, and social relationships. In addition to medical treatment, exercise has been recognized as a complementary and alternative strategy for disease prevention, alleviation, and rehabilitation. This study aimed to investigate the potential effects of exercise on the severity of primary dysmenorrhea, physiological modulation, and physical fitness. Participants consisted of university students who were enrolled in the study and divided into a non-PD (Control) and a PD group based on recruiting criteria, the latter being randomly assigned to either an untreated dysmenorrhea group or a dysmenorrhea group that underwent 10 weeks of high intensity interval training (HIIT) exercise (Dysmen and DysmenHIIT, respectively). The DysmenHIIT group used spinning bikes and the training intensity was validated by heart rate monitors and BORG rating of perceived exertion. Forms containing participant information (premenstrual symptoms, menstrual distress, and a Short Form McGill Pain Questionnaire) as well as physical fitness, biochemical variables, hormone and prostaglandin (PGE2 and PGF2α) levels were assessed before and after the exercise intervention. After intervention, premenstrual symptoms (anger, anxiety, depression, activity level, fatigue, etc.), menstrual distress symptoms (cramps, aches, swelling, etc.), and pain severity were shown to be significantly mitigated, possibly through hormone (estradiol, prolactin, progesterone, and cortisol) modulation. Furthermore, high-sensitivity C-reactive protein (HsCRP), PGE2 and PGF2α levels were also down-regulated, resulting in the amelioration of uterine contraction and inflammation. Participants' physical fitness, including cardiovascular endurance and explosive force, was significantly improved after HIIT. The 10-week HIIT spinning bike exercise used in this study could be employed as a potential and complementary treatment for PD symptoms alleviation and considered as part of an educational health plan for promoting women's health. However, the effects of HIIT utilizing different exercise methods and accounting for different age populations and secondary PD warrant further investigation.

The relation between body mass index and primary dysmenorrhea: A systematic review and meta-analysis

INTRODUCTION

The relation between body mass index (BMI) categories and the occurrence of primary dysmenorrhea has been investigated, but the results of these studies are inconsistent and controversial. The aim of our study was to systematically review the literature and investigate the association between each category of BMI and the occurrence of primary dysmenorrhea.

MATERIAL AND METHODS

We conducted a systematic review and meta-analysis of observational studies related to BMI and primary dysmenorrhea. Eleven databases-PubMed, Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), Chinese Biomedical Literature Database (CBM), and Wanfang database-were systematically searched from inception to March 2022. We used the 11 items recommended by the Agency for Healthcare Research and Quality to assess the quality of included studies. The Q test and the I2 test were used to evaluate the heterogeneity among studies. Odds ratios (OR) and their 95% confidence intervals (CI) were pooled by fixed-effects models or random-effects models. Stata software version 16.0 was used to complete the statistical analyses.

RESULTS

A total of 4181 articles were collected from the database, and 12 studies were included based on inclusion and exclusion criteria. A total of 29 647 participants were included in the study, with a mean baseline age of 17-45 years. All included literature was published between 2017 and 2021 and was conducted in six countries. Eleven included studies were of medium quality and one included study was of high quality. Being underweight may be related to the occurrence of primary dysmenorrhea (12 studies, n = 6545, OR 1.43, 95% CI 1.18-1.73). Being overweight (12 studies, n = 3098) and obesity (four studies, n = 94) may not be associated with the development of primary dysmenorrhea.

CONCLUSIONS

Being underweight may increase the risk of the occurrence of primary dysmenorrhea, whereas overweight and obesity might not be associated with primary dysmenorrhea. Due to the limitations of the meta-analysis, more studies are needed to investigate the relation between each category of BMI and the occurrence of primary dysmenorrhea. To maintain a balanced diet and an appropriate lifestyle is beneficial for people to have the normal category of BMI and live a healthy life, which may play a role in preventing the occurrence of primary dysmenorrhea.

Myofascial Pain Syndrome in Women with Primary Dysmenorrhea: A Case-Control Study

There is limited information on myofascial trigger points (MTrPs) and specific symptoms of chronic pelvic pain and, more specifically, dysmenorrhea. The objective of this study was to determine whether patients suffering from primary dysmenorrhea present alterations in mechanosensitivity and pain patterns, and greater presence of MTrPs in the abdominal and pelvic floor muscles. A case-control study was carried out with a total sample of 84 participants distributed based on primary dysmenorrhea and contraceptive treatment. The sample was divided into four groups each comprising 21 women. Data on pain, quality of life, and productivity and work absenteeism were collected; three assessments were made in different phases of the menstrual cycle, to report data on pressure pain threshold, MTrP presence, and referred pain areas. One-way ANOVA tests showed statistically significant differences (p < 0.01) between the groups, for the Physical Health domain and the total score of the SF-12 questionnaire, and for all the domains of the McGill questionnaire; but no significant differences were found in the data from the WPAI-GH questionnaire. Statistically significant data (p < 0.01) were found for mechanosensitivity in the abdominal area and limbs, but not for the lumbar assessment, within the group, with very few significant intergroup differences. The frequency of active MTrPs is higher in the groups of women with primary dysmenorrhea and during the menstrual phase, with the prevalence of myofascial trigger points of the iliococcygeus muscle being especially high in all examination groups (>50%) and higher than 70% in women with primary dysmenorrhea, in the menstrual phase, and the internal obturator muscle (100%) in the menstrual phase. Referred pain areas of the pelvic floor muscles increase in women with primary dysmenorrhea.

Electroacupuncture Treatment for Primary Dysmenorrhea: A Review of Randomized Controlled Trials

To evaluate the effectiveness of electroacupuncture treatment for primary dysmenorrhea (PD), a literature review of a randomized controlled trials (RCTs) was performed where electroacupuncture was used as a treatment intervention in patients diagnosed with PD. Relevant clinical studies (N = 226) were retrieved from multiple databases according to the study inclusion/exclusion criteria, and interventions and outcomes were analyzed. As a result of the review, there were 6 RCTs which met the criteria. In all 4 studies that measured pain indicators (visual analog scales), electroacupuncture showed significantly positive changes. In addition, positive changes were observed in most indicators (MMDQ, PGF2a, PGE2, 6-keto PGF1, TXB2, clinical efficacy score, uterine arterial blood flow parameters, and blood viscosity). 2 studies showed that electroacupuncture had a stronger therapeutic effect than NSAIDs. No major side effects were reported. Electroacupuncture may be an effective and safe treatment for PD however, further RCTs are required.

Curative Effect of Heat-sensitive Moxibustion on Primary Dysmenorrhea: A Meta-Analysis

Background

Primary dysmenorrhea (PD) refers to functional dysmenorrhea, typically characterized by cyclical, pronounced lower abdominal pain and seriously affects a woman's work and quality of life. Some studies have reported that heat-sensitive moxibustion (HSM) is expected to alleviate the clinical symptoms. This systematic review aimed to evaluate the current evidence regarding the efficacy and safety of HSM on PD.

Methods

7 databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wan Fang Data Knowledge Service Platform (Wan Fang Data), and China Science and Technology Journal Database (VIP) were searched for clinical randomized controlled trials. Meanwhile, Revman 5.3 software was used to evaluate the methodological quality of the included literature. The confidence interval (CI) of either relative risk or mean difference was set to 95%. Besides, the heterogeneity of the research results is tested by I².

Results

19 studies were ultimately included in this meta-analysis. All of them were declared as random controlled trials. 18 studies reported the total effective rate of the test group and the control group, which was significantly higher (RR: 0.92; 95% CI: 0.85,0.99; P=0.031 < 0.05) than the control group. It is demonstrated that the VAS score of the test group, totally 9 studies included, was significantly lower (SMD: −0.98; 95% CI: −1.15, −0.81; P < 0.001). The meta-analysis of 6 studies showed the symptom score of the test group was significantly lower (SMD: −0.67; 95% CI: −0.87, −0.47; P < 0.001). There were the CMSS results of 3 studies which were significantly lower (SMD: −0.88; 95% CI: −1.13, −0.62; P < 0.001). Combined with the results of subgroup analysis, compared with the control group, the test group had advantages in the VAS score, symptom score, and CMSS score.

Conclusions

The result has revealed the effectiveness and feasibility of HSM in treating PD, especially in improving the total effective rate and reducing the VAS score, symptom score, and CMSS score.

Integrated Serum Pharmacochemistry, Metabolomics, and Network Pharmacology to Reveal the Material Basis and Mechanism of Danggui Shaoyao San in the Treatment of Primary Dysmenorrhea

Danggui Shaoyao San (DSS), a well-known formula, has been successfully applied in treating primary dysmenorrhea (PD) in China. However, its material basis and mechanism are still unrevealed. This current research aims to reveal the material basis and mechanism of DSS in treating PD by an integrative approach of serum pharmacochemistry, metabolomics, and network pharmacology. The results showed that DSS markedly relieved the physiological and pathological symptoms of PD as confirmed by the improvement of writhing behavior, inhibition of uterine edema, callback of clinical biochemical indexes, and metabolic profiles. Furthermore, a metabolomic analysis demonstrated that the therapeutic effect of DSS was attributed to the modulation of arachidonic acid metabolism, pentose and glucuronate interconversions, and phenylalanine metabolism. Meanwhile, 23 blood ingredients were identified after the oral administration of DSS. By analyzing the correlation coefficient of the identified biomarkers and blood components, active compounds closely associated with core metabolic pathways were extracted. Taking these active compounds as a basis, network pharmacology prediction was executed. It was found that active components of DSS including alisol B,23-acetate, chlorogenic acid, levistilide A, cianidanol, senkyunolide A, atractylenolide II, and sedanolide, were germane to steroid hormone biosynthesis, arachidonic acid metabolism, sphingolipid signaling pathway, etc. Interestingly, PTGS2 and PTGS1 related to the arachidonic acid metabolism may be pivotal targets of DSS. The current study proved that the integration of serum pharmacochemistry, metabolomics, and network pharmacology, was a powerful approach to investigate the material basis and the molecular mechanisms of DSS, and provided a solid basis for DSS application.

Dysmenorrhea in adolescents

Studies show that between 41% and 91.5% of young women, school-aged and university-aged, are affected by dysmenorrhea. Primary dysmenorrhea, which is caused by the production of prostaglandins, is defined as cramping pain in the lower abdomen and/or pelvis occurring just before or during menstruation, in the absence of other diseases such as endometriosis, and typically lasting 1-3 days and with a negative physical examination. Secondary dysmenorrhea presents with similar signs and symptoms but is a result of underlying pelvic pathology, for example endometriosis or uterine fibroids. Dysmenorrhea most typically presents as abdominal cramping; however, it can also present with headaches, nausea, vomiting or other generalized symptoms. The diagnosis is mainly clinical, but other tests such as a pelvic examination, a pregnancy test and STI screening may be helpful in ruling out other sources of pain. Although the mainstay of treatment for dysmenorrhea is NSAIDs and hormonal therapy, lifestyle changes and complementary/alternative medicine can also be helpful approaches. Lifestyle changes include aerobic exercise and stretching, while complementary alternative medicine include peppermint, cinnamon, ginger and other herbs and supplements. Finally, endometriosis must be considered as a potential cause for secondary dysmenorrhea and would warrant a prompt referral to gynecology.

Assessing the pharmaceutical care provision to suspected COVID-19 patients in community pharmacies: a simulated patient study

BACKGROUND

In the wake of COVID-19, community pharmacists (CP) were called upon to free up healthcare providers to treat more serious conditions and alleviate overcrowded healthcare centers. CPs were placed under tremendous pressure, where many patients primarily sought their health advice. This situation raised concerns about the preparedness of CPs in facing these challenges. Therefore, this study aimed to assess the appropriateness of pharmaceutical care provided by CPs to patients with suspected COVID-19 and to investigate their communication skills.

METHODS

A simulated patient (SP) study was conducted among randomly selected community pharmacies in Beirut, Lebanon. Each pharmacy was visited by the SP who complained of fever and loss of smell sensation. Interactions between the attending pharmacist and the suspected COVID-19 patient were documented directly after each visit in a standardized data collection form.

RESULTS

More than half of the CPs (56%) did not retrieve any relevant information to assess the patient's condition. While pharmacists' responses were limited to one to two recommendations, with the majority recommending the patient to perform the PCR test (90%). Inappropriate recommendations made by the CPs included mainly the confirmation that the patient had COVID-19 without prior testing (9%), and prescribing either an antimicrobial drug (5%) or dietary supplements (20%), claiming that the latter are essential to boost the patient's immunity. As for the pharmacist-patient communication skills, the mean total score was 2.25 ± 0.79 (out of 4), displaying nonoptimal and ineffective communication.

CONCLUSION

An unsatisfactory and suboptimal provision of pharmaceutical care to a suspected COVID-19 case was evident. This may be a public health threat, particularly for developing countries that lack an efficient and unified healthcare system. The findings should alert health authorities to support and guide community pharmacists in assisting suspected COVID-19 patients.