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

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.

Nicotine as a female reproductive toxicant-A review

The preceding decades have seen an extensive emergence of the harmful effects of tobacco smoke on systemic health. Among the various compounds of tobacco, nicotine is one of the principal, potentially hazardous, and toxic components which is an oxidant agent that can affect both men's and women's fertility. Nicotine exerts its effect by modulating the expression of transmembrane ligand-gated ion channels called nicotinic acetylcholine receptors. The activities of female reproduction might be disrupted by exposure to nicotine at various sites, such as the ovary or reproductive tract. It's been demonstrated that nicotine might cause oxidative stress, apoptosis, hormonal imbalance, abnormalities in chromosomal segregation, impact oocyte development, and disruption in ovarian morphology and functions. This review paper summarizes the findings and provides an updated overview of the evidence on the harmful effects of nicotine use on women's reproductive health and the resulting detrimental impacts on the body. Additionally, it provides the detailed possible mechanisms involved in impairing reproductive processes like folliculogenesis, oocyte maturation, steroidogenesis, and pregnancy in different animal species.

Influence of tobacco smoking and alcohol drinking on dysmenorrhoea: a cross-sectional analysis of data from the Taiwan Biobank

OBJECTIVES

Dysmenorrhoea, characterised by severe menstrual cramps, affects between 50% and 90% of women of reproductive age and considerably lowers their quality of life.

DESIGN

Cross-sectional study.

SETTING

This study explored the influence of tobacco smoking and alcohol consumption on dysmenorrhoea, using data from the Taiwan Biobank.

PARTICIPANTS

Our analysis involved 8567 individuals and examined the associations between dysmenorrhoea and variables such as alcohol consumption, tobacco smoking, demographic characteristics and lifestyle behaviours through multivariable logistic regression.

RESULTS

The findings reveal a significant association between concurrent alcohol and tobacco use and increased dysmenorrhoea risk, with adjusted ORs suggesting higher risk levels for dual users compared with those who only smoke or drink (adjusted OR (95% CI) both alcohol and tobacco: 3.19 (1.51 to 6.72); only tobacco: 1.21 (0.89 to 1.63); only alcohol: 1.06 (0.53 to 2.13)). Additionally, factors such as higher education level and early menarche were associated with increased dysmenorrhoea risk, whereas regular exercise and multiparity exerted a protective effect against the condition (adjusted OR (95% CI) higher education: 1.43 (1.19 to 1.71); early menarche: 1.37 (1.14 to 1.64); regular exercise: 0.77 (0.64 to 0.93); multiparity: 0.64 (0.52 to 0.77)).

CONCLUSIONS

Our study also highlights the complex interactions between lifestyle factors and dysmenorrhoea, underscoring the need for targeted interventions and lifestyle modifications to mitigate the condition's effects. Future research should employ longitudinal designs for causal inference and to explore the mechanisms underlying the associations observed in this study.

The prevalence and associated risk factors of primary dysmenorrhea among women in Beijing: a cross-sectional study

Primary dysmenorrhea is a common and troublesome gynecological condition. The disease seriously affects the daily life of young and middle-aged women and is a major public health problem. The aim of the research was to conduct an assessment of the prevalence of primary dysmenorrhea and associated factors in Beijing area, and to describe and compare the association between different lifestyles and the degree of dysmenorrhea. We conducted a cross-sectional study at Peking University People's Hospital in the form of an online questionnaire. Out of the total of 516 women who took part in the study, 450 were included in the analysis. The questionnaire consisted of 39 questions that were grouped into three parts. The first concerned characteristics of the study subjects such as age, weight and qualifications. The second part of the questionnaire pertained to the menstruation-related conditions, such as age at menarche, knowledge of menstruation, menstrual cycle, menstrual period, menstrual flow, and so on. In the third part, the women were asked about their lifestyle habits and emotional factors. Dysmenorrhea affected 86.4% of the interviewed women. Significant factors associated with dysmenorrhea were age of menarche (p < 0.001), body mass index (p = 0.023), smoking (p ˂0.001), eating sweet foods frequently (p = 0.042), sedentary time (p = 0.037) and self-esteem (p = 0.043). Chi-square test further found a statistically significant correlation between BMI (p = 0.032), alcohol consumption (p = 0.046), sleep duration (p = 0.006) and the severity of dysmenorrhea. This study shows that the prevalence of dysmenorrhea is high enough for medical workers and public health administrators to pay attention to it. Women with dysmenorrhea were characterized with a family history of dysmenorrhea, early age of menarche, frequent smoking, eating sweet foods frequently, sedentary time, abnormal BMI and low self-esteem. We suggest that it is necessary to pay attention to the related factors of dysmenorrhea.

Dysmenorrhea Among Women Living in Saudi Arabia: Prevalence, Determinants, and Impact

Dysmenorrhea, or painful menstruation, is one of the most prevalent conditions among adolescents and young females globally, significantly affecting academic performance, quality of life, and social interactions. Despite its high prevalence, dysmenorrhea has been rarely investigated in Saudi Arabia, resulting in a scarcity of national data. This study aimed to evaluate the prevalence, severity, and determinants of dysmenorrhea among females in Saudi Arabia. This cross-sectional, questionnaire-based study included 1026 participants recruited from various regions of Saudi Arabia using a convenience sampling technique. Data collection was conducted using a validated, self-administered online questionnaire. Descriptive and inferential statistics were utilized to evaluate the prevalence, severity, and associated symptoms of dysmenorrhea. Additionally, multiple logistic regression was employed to identify the determinants of dysmenorrhea within the sample. The analysis was performed using R software. The prevalence of dysmenorrhea among the sample was 87%, with a mean pain score of 6 ± 2.2. Common menstrual cycle-associated symptoms included mood swings (79%), abdominal bloating (60%), diarrhea (32%), and constipation (26%). Factors associated with an increased risk of dysmenorrhea included Saudi nationality (OR = 1.96, p = 0.032), employment (OR = 1.75, p = 0.034), and a history of gynecological surgeries (OR = 1.81, p = 0.045). Conversely, multiparity was associated with a reduced risk of dysmenorrhea (OR = 0.36, p = 0.046). Dysmenorrhea is highly prevalent among Saudi women and is accompanied by significant menstrual symptoms that adversely affect quality of life. Understanding its determinants and associated symptoms is essential for improving management strategies and mitigating its impact on women's lives.

Dysmenorrhea and Premenstrual Syndrome in Association with Health Habits in the Mexican Population: A Cross-Sectional Study

BACKGROUND

Dysmenorrhea and premenstrual syndrome (PMS) are common disorders in the Mexican population, but these are usually underdiagnosed and under-treated, impacting women's quality of life. Adequate health habits have been reported as precursors of decreasing dysmenorrhea symptoms. However, few studies assess their impact on PMS.

AIM

This study aims to evaluate dysmenorrhea and premenstrual syndrome in association with health habits in the Mexican population.

METHODS

To assess the impact of health habits on menstruation symptoms a validated survey was conducted in 1679 adult females aged ≥18 years. The survey collected data on participants' dysmenorrhea, PMS, and their health habits.

RESULTS

The analysis showed that physical activity duration, changes in eating habits (increases in salty or sugary foods) during menstruation, and oversleeping habits predict increases in dysmenorrhea and PMS. In contrast, an active sexual life, relaxing physical activity, and adequate sleep hours during menstruation seem to decrease the symptoms.

CONCLUSIONS

We conclude that adequate health habits and addressing early gynecological conditions might regulate dysmenorrhea and PMS.

Dysmenorrhea in Polish Adolescent Girls: Impact on Physical, Mental, and Social Well-Being-Results from POLKA 18 Study

Background: Dysmenorrhea, characterised by painful menstrual cramps, is a pressing issue among adolescent girls globally. It significantly impacts their quality of life and has been associated with increased mental health issues and engagement in risky behaviours like smoking. In Poland, there is limited research on menstrual health, emphasising the need for a study to understand dysmenorrhea experiences and their impact on young menstruating individuals. Methods: This research project investigated the effects of dysmenorrhea on quality of life and school attendance, as well as its associations with non-communicable diseases, including mental health among adolescent girls in Poland. Additionally, the study examined risk factors for non-communicable disease development, including high-risk health behaviours and exposure to violence. The study utilised a cross-sectional design, administering self-reported questionnaires in high schools and vocational schools in six voivodeships (regions) in Poland. The analysis was performed using the R language in the Rstudio environment. p-value < 0.05 was considered significant. Results: A significant percentage of respondents experienced heavy menstruation, irregularity, and pain. Adolescents with dysmenorrhea reported higher rates of school absenteeism, mental health issues (such as anxiety and panic attacks), and a higher likelihood of engagement in risk behaviours like smoking and illicit drug use. The study also identified associations between dysmenorrhea and experiences of violence, including sexual abuse and intimate partner violence, as well as links to self-harm and suicidal ideation. Conclusions: These findings contribute to understanding dysmenorrhea among Polish adolescent girls, emphasising the need for tailored interventions and support services. The study underscores the necessity of addressing menstrual health comprehensively, considering its impact on various aspects of young women's lives and promoting their overall well-being.

Evaluation of Abdominal Musculature Thickness, Pelvic Tilt, and Trunk Mobility in Women with Primary Dysmenorrhea: A Cross-Sectional Observational Study

Background: This cross-sectional observational study aimed to investigate differences in abdominal musculature thickness, pelvic tilt, and trunk mobility between women with primary dysmenorrhea (PD) and a control group (CG). Methods: Participants included 44 women (22 with PD and 22 controls) aged over 18, nulliparous, and of reproductive age. Ultrasound imaging was used to measure the thickness of the transverse abdominis (TrA), internal oblique (IO), external oblique (EO), and rectus abdominis (RA) muscles at rest and during contraction. Additionally, anterior pelvic tilt was assessed using the Palpation Meter (PALM), and trunk flexion and extension were measured using an accelerometer (activForce2). Results: Significant differences (p < 0.05) were found in RA and EO muscle thickness, with lower values in the PD group compared to CG. However, there were no significant differences (p > 0.05) in TrA and IO muscle thickness, anterior pelvic tilt, or trunk mobility between groups. Conclusions: These findings contribute to understanding the musculoskeletal factors potentially involved in dysmenorrhea. Further research is needed to explore associations between PD and structural and alignment parameters.

A Narrative Review on the Impact of Smoking on Female Fertility

Understanding the significant impact of preventable factors, such as lifestyle decisions and bad habits like smoking, on female fertility has received a lot of attention. Pervasive smoking among fertile women is a serious public health concern. Smoking has well-documented negative impacts on general health, but it also has significant consequences on fertility. Many women of reproductive age still smoke, despite a wealth of data elucidating the effects of pregnancy and the health of the fetus as a result of prenatal exposure. This review attempts to investigate the consequences of smoking on female fertility, specifically focusing on how it affects the ovaries, oviducts, and uterus through a thorough examination of numerous studies. Important topics such as ovarian reserve, steroidogenesis, ovulation, controlling the menstrual cycle, oviductal function, uterine receptivity, and implantation will receive extra focus.

Systematic replication of smoking disease associations using survey responses and EHR data in the All of Us Research Program

OBJECTIVE

The All of Us Research Program (All of Us) aims to recruit over a million participants to further precision medicine. Essential to the verification of biobanks is a replication of known associations to establish validity. Here, we evaluated how well All of Us data replicated known cigarette smoking associations.

MATERIALS AND METHODS

We defined smoking exposure as follows: (1) an EHR Smoking exposure that used International Classification of Disease codes; (2) participant provided information (PPI) Ever Smoking; and, (3) PPI Current Smoking, both from the lifestyle survey. We performed a phenome-wide association study (PheWAS) for each smoking exposure measurement type. For each, we compared the effect sizes derived from the PheWAS to published meta-analyses that studied cigarette smoking from PubMed. We defined two levels of replication of meta-analyses: (1) nominally replicated: which required agreement of direction of effect size, and (2) fully replicated: which required overlap of confidence intervals.

RESULTS

PheWASes with EHR Smoking, PPI Ever Smoking, and PPI Current Smoking revealed 736, 492, and 639 phenome-wide significant associations, respectively. We identified 165 meta-analyses representing 99 distinct phenotypes that could be matched to EHR phenotypes. At P < .05, 74 were nominally replicated and 55 were fully replicated. At P < 2.68 × 10-5 (Bonferroni threshold), 58 were nominally replicated and 40 were fully replicated.

DISCUSSION

Most phenotypes found in published meta-analyses associated with smoking were nominally replicated in All of Us. Both survey and EHR definitions for smoking produced similar results.

CONCLUSION

This study demonstrated the feasibility of studying common exposures using All of Us data.

Assessment of prevalence, knowledge and health-related practices of dysmenorrhea among Malaysian women in Kuala Lumpur: a cross-sectional survey

BACKGROUND

Menstruation is a natural phenomenon considered an important indicator of women's health, reflecting their endocrine function. Women in low middle income countries face substantial menstrual hygiene management challenges. Data on the knowledge of dysmenorrhea and health-related practices among Malaysian women are scarce. The present study aimed to investigate the prevalence of dysmenorrhea among Malaysian women in Kuala Lumpur and its association with socio-demographic factors, knowledge level, and general practices.

METHOD

A cross-sectional study was carried out among Malaysian women in Kuala Lumpur. A total of 362 unmarried women, nulliparous and aged between 18 and 25 years old, were included in this study. Participants were conveniently recruited through online platforms as well as face to face using a self-administered questionnaire with five sections consisting of demographics, menstrual characteristics, Working ability, Location, Intensity, Days of pain, Dysmenorrhea (WaLIDD) score for diagnosing and assessing the severity of dysmenorrhea as well as an evaluation of respondents' general knowledge and practices towards dysmenorrhea. The collected data were analysed using the SPSS tool, a descriptive statistic was used to report demographic characteristics. Inferential statistics was used to report the differentiation, association, and correlations of the variables.

RESULTS

The prevalence of primary dysmenorrhea was 73.2%. It was found that the majority of the respondents had poor knowledge (60%) and poor practices (61.88%) of dysmenorrhea. The most common preventive practices among the respondents were using dietary supplements, and herbs, taking a rest and exercising. The findings also indicated that dysmenorrhea among the respondents was significantly associated with family history of dysmenorrhea (p = 0.002), monthly income (p = 0.001), and knowledge level (p = 0.001).

CONCLUSION

Dysmenorrhea has a high prevalence among women in Malaysia in Kula Lumpur driven by low knowledge and lack of evidence-based practices among these women. Thus, it is critical for Government and healthcare authorities to promote education related to women health among Malaysian women.

Weight Changes and Unhealthy Weight Control Behaviors Are Associated With Dysmenorrhea in Young Women

BACKGROUND

This study aimed to evaluate the prevalence of dysmenorrhea and to investigate the effect of weight changes or unhealthy weight control behaviors on dysmenorrhea in young Korean women.

METHODS

We used large-scale data of women, aged 14 to 44 years, who participated in the Korean Study of Women's Health-Related Issues. Dysmenorrhea was measured using a visual analog scale and was categorized as none, mild, moderate, and severe according to the severity. Weight changes and unhealthy weight control behaviors (any of the behaviors, fasting/meal skipping, drugs, the use of unapproved dietary supplements, and one-food diets) over the past year were self-reported. We used multinomial logistic regression to investigate the association between weight changes or unhealthy weight control behaviors and dysmenorrhea.

RESULTS

Of the 5,829 young women participating in the study, 5,245 (90.0%) participants experienced dysmenorrhea [2,184 (37.5%) had moderate and 1,358 (23.3%) had severe]. After adjusting for confounders, the odds ratios for moderate and severe dysmenorrhea in participants with weight changes ≥ 3 kg (vs. < 3 kg) were 1.19 (95% confidence interval: 1.05-1.35) and 1.25 (95% confidence interval: 1.08-1.45), respectively. The odds ratios in participants with any unhealthy weight control behaviors were 1.22 (95% confidence interval: 1.04-1.42) and 1.41 (95% confidence interval: 1.19-1.67) for those with moderate and severe dysmenorrhea, respectively.

CONCLUSION

Weight changes (≥ 3 kg) or unhealthy weight control behaviors are common among young women, which may adversely affect dysmenorrhea. Therefore, attention needs to be paid to excessive weight changes and unhealthy weight control behaviors to improve dysmenorrhea in young women.

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSION

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

Prevalence of chronic pelvic pain and primary dysmenorrhea in women of reproductive age in Ecuador

Background

Chronic pelvic pain (CPP) and primary dysmenorrhoea are debilitating conditions that can impair the quality of life of affected women. These conditions are frequently neglected, delaying proper diagnosis and healthcare provision. This study aimed to estimate the prevalence of CPP and primary dysmenorrhoea in Ecuador and identify potential variables associated with their occurrence.

Methods

We conducted a cross-sectional survey in an urban neighbourhood of Quito, the capital of Ecuador. A total of 2397 participants of 14–49 years of age were included. The data were collected through questionnaires administered by trained interviewers.The crude and adjusted prevalence ratios were calculated using a log-binomial regression model. The correlation between pain intensity catastrophising of symptoms were statistically analysed.

Results

The prevalence of CPP and primary dysmenorrhoea was 9.8% and 8.9%, respectively. Irritative urinary symptoms, primary dysmenorrhoea, and underlying mental disorders were associated with CPP, while smoking, irritable bowel syndrome, sleep disturbance, dyspareunia, and mental disorders were associated with primary dysmenorrhoea.

Conclusions

The prevalence of CPP and primary dysmenorrhoea in Ecuador was similar to that in other Latin American countries. Primary dysmenorrhoea is a risk factor of CPP, and less than a quarter of women are undergoing treatment for the condition. Our findings reinforce the importance of healthcare interventions in anticipating the diagnosis of these conditions in women of reproductive age.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01948-y.

Association of fish intake with menstrual pain: A cross-sectional study of the Japan Environment and Children’s Study

The relationship between fish eating habits and menstrual pain is unknown. Elucidating this relationship can inform dietary guidance for reproductive age women with menstrual pain. The aim of this study was to clarify the relationship between fish intake frequency/preference and menstrual pain. This cross-sectional study was conducted at the Miyagi Regional Center as an adjunct study of the Japan Environment and Children’s Study, and 2060 eligible women (mean age, 31.9 years) participated. Fish intake frequency (“< 1 time/week,” “1 time/week,” “2–3 times/week,” or “≥ 4 times/week”), preference (“like,” “neutral,” or “dislike”), and menstrual pain (no/mild or moderate-to-severe) were assessed at 1.5 years after the last delivery through self-administered questionnaires. The association between fish intake frequency/preference and prevalence of moderate-to-severe menstrual pain was evaluated through logistic regression analyses. Our results show that, compared with the “< 1 time/week” (38.0%) group, the “1 time/week” (26.9%), “2–3 times/week” (27.8%), and “≥ 4 times/week” (23.9%) groups showed a lower prevalence of moderate-to-severe menstrual pain (p < 0.01). The prevalence of moderate-to-severe menstrual pain was 27.7%, 27.6%, and 34.4% in the “like,” “neutral,” and “dislike” groups, respectively. Multivariate logistic regression showed that frequent fish intake was associated with a lower prevalence of moderate-to-severe menstrual pain (“1 time/week”: odds ratio [OR] = 0.59; 95% confidence interval [CI], 0.41–0.86, “2–3 times/week”: OR = 0.64; 95% CI, 0.45–0.90 and “≥ 4 times/week”: OR = 0.52; 95% CI, 0.34–0.80; trend p = 0.004). Multivariate logistic regression showed no association between fish preference and moderate-to-severe menstrual pain (“dislike” vs “like”: OR = 1.16; 95% CI, 0.78–1.73). There was a significant negative association between fish intake frequency and menstrual pain. It is suggested that fish intake can reduce or prevent menstrual pain.

The Influence of Lifestyle Variables on Primary Dysmenorrhea: A Cross-Sectional Study

Background

Primary dysmenorrhea is a common and often debilitating, gynaecological condition.

Objective

To investigate the effects of specific lifestyle variables on the prevalence and severity of primary dysmenorrhea.

Materials and Methods

A cross-sectional study of Jordanian women aged between 18-25 years old utilized a questionnaire as the main instrument of the study.

Results

Primary dysmenorrhea was reported by 660 women out of 1988. It was found that approximately two thirds of them were students. Overall, 54.5% of the participants reported severe dysmenorrhea. A statistically significant correlation was found between severe dysmenorrhea and smoking at p value ˂0.001, sleeping less than 7 hours per 24 hours at p = 0.005, holding a university degree at p = 0.032, non-alcohol consumption at p = 0.044, frequent energy, fizzy, tea, coffee drinks and sugar intake. Interestingly, we found that severe dysmenorrhea was statistically significantly associated with women who never eat meat at p ˂0.001, cereals and fish consumers and with those who take less than 3 servings of fruit or none at all per week at p = 0.006. In addition to the previous variables, water intake of less than 1.0 litre a day, irregular cycles, non-OCP use and positive family history were found significantly associated with severe dysmenorrhea. Severe dysmenorrhea was significantly related to working less hours per week, higher stress level and longer bleeding duration at p = 0.021, 0.017 and 0.008, respectively. On the other hand, there was no statistically significant difference found between severe dysmenorrhea and the following variables: age, body mass index (BMI), weekly studying hours and age of menarche.

Conclusion

Primary dysmenorrhea is prevalent in the Jordanian population. To overcome severe dysmenorrhea, women should increase their intake of fish and fresh fruits, drinking water and use of oral contraceptive pills. The study concluded that smoking, frequent sugar intake, fizzy drinks, coffee, tea and energy drinks were associated with severe dysmenorrhea. It is also worth mentioning that alcohol consumption had a positive impact on dysmenorrhea.

Trial Registration

Registered in Clinicaltrial.gov (ID: NCT04583943).

Risk factors for primary dysmenorrhea and the effect of complementary and alternative treatment methods: Sample from Corum, Turkey

OBJECTIVE

Dysmenorrhea is defined as menstrual pain that develops due to uterine menstrual contractions. When the literature is examined, there are a limited number of studies about the frequency of primary dysmenorrhea (PD), influencing factors, and complementary and alternative treatment methods (CAMs) in Turkey. In this study, the aim was to determine the risk factors for PD and the effect of CAM use on PD in female university students.

METHODS

The sample for this descriptive study consisted of 180 female students who met the inclusion criteria and agreed to participate in the study. Data were collected using a questionnaire. Data were evaluated using SPSS v.21 and are presented as frequency, percentage, mean, and standard deviation with Chi-square and Kruskal-Wallis analyses performed.

RESULTS

The prevalence of PD was found to be high in students (83.3%). When the distribution of students is examined according to risk factors affecting dysmenorrhea, the relationships between the history of early menstruation, history of menorrhagia, family history of dysmenorrhea, and the occurrence of dysmenorrhea were found to be statistically significant (P < 0.05). In addition, the relationships between smoking, regular consumption of caffeinated beverages, regular physical activity, and emotional problems with the prevalence of dysmenorrhea were found to be statistically significant (P < 0.05). The mean VAS score of the students was 5.99 ± 2.06. When the distribution of VAS mean scores according to CAM used by the students is examined, the most effective CAM in reducing PD was mind-body techniques (4.20±1.56) (P < 0.05). According to the students' VAS score averages, the most effective mind-body techniques used to reduce PD were applying heat to the abdomen (4.33 ± 1.98) and taking a hot shower (4.61 ± 2.13); the most effective nutritional supplement and healthy lifestyle behavior was omega 3 supplementation (4.20 ± 1.56); and the most effective herbal drink was ginger (4.88 ± 1.61) (P < 0.05).

CONCLUSION

Risk factors for PD included early menarche, menorrhagia, family history of PD, smoking, regular consumption of caffeinated beverages, and emotional problems. The most effective methods to reduce pain in PD were applying heat to the abdomen, taking a hot shower, omega 3 supplements, and ginger.

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

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

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

BACKGROUND

Primary dysmenorrhea (PD) is one of the most common gynecological conditions among young females, which has a significant negative impact on health-related quality of life and productivity. Despite its high prevalence, the evidence is limited regarding the management-seeking practices and its perceived effectiveness among females with PD.

METHODS

This is a cross-sectional study conducted among 550 female students in six universities across Lebanon. The prevalence of PD, associated risk factors, and management-seeking practices were assessed using a self-administered questionnaire.

RESULTS

The prevalence of PD was 80.9%. Most of the females with PD described their menstrual pain as moderate (56%) to severe (34.6%), which significantly affected their daily activities and studying ability (P < 0.001). The major risk factors associated with PD included heavy menstrual flow (adjusted odds ratio [AOR] = 10.28), family history of PD (AOR = 2.52), history of weight loss attempt (AOR = 2.05), and medical specialization (AOR = 1.663). Only 36.9% of females with PD sought formal medical advice. Most dysmenorrheic females (76.4%) received medications for the management of PD, and remarkably none of them took hormonal contraceptives. Drugs commonly used for PD were mefenamic acid (26.2%), ibuprofen (25%), and paracetamol (11.5%), which were administered when the pain started (58.2%). All medications were significantly effective in reducing the pain score (P = 0.001), and most NSAIDs were more potent than paracetamol in managing PD (P = 0.001). However, no significant difference in adverse effects among medications was revealed. Moreover, no superiority of any individual NSAID for pain relief was established. Nevertheless, mefenamic acid was associated with the lowest risk of abdominal pain (OR: 0.03, P = 0.005) and the highest risk of flank pain (OR = 12, P = 0.02).

CONCLUSIONS

Suboptimal management of PD is practiced among university students in Lebanon. Therefore, health care providers should educate dysmenorrheic females to optimize the self-management support of PD. Furthermore, future research is required to investigate females' misconceptions about hormonal contraceptives in the management of PD, aiming to raise awareness and correct misconceptions.

Current Resources for Evidence-Based Practice, November 2020

An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of diversity in the maternity care workforce and commentaries on reviews focused on burnout in midwifery and a cross-national comparison of guidelines for uncomplicated childbirth.