Significant Increase in Depression in Women With Primary Dysmenorrhea: A Systematic Review and Cumulative Analysis

Association between primary dysmenorrhoea on quality of life, mental health and academic performance among medical students in Indonesia: a cross-sectional study

OBJECTIVES

To investigate the association between primary dysmenorrhoea and quality of life, mental health and academic performance among medical students in Indonesia.

DESIGN

A cross-sectional study using an online survey was conducted among Indonesian medical students. Primary dysmenorrhoea occurrence and severity, as well as their associations with quality of life, mental health and academic performance, were assessed using validated questionnaires. The associations of dysmenorrhoea occurrence and severity were analysed alongside other potential independent variables, including age, region, stage of study and parental income. Statistical analyses included χ2 tests, t-tests and multiple regression models to adjust for confounders (p<0.05).

SETTING AND PARTICIPANTS

Indonesia (June-July 2021: n=630 medical students).

OUTCOMES

The primary outcomes were quality of life, mental health and academic performance, assessed as dependent variables. Quality of life was measured using the Quality of Life Scale, mental health was assessed through depression and stress scores from the Depression Anxiety Stress Scales-42; and academic performance was evaluated through concentration and activity disruption, absenteeism and cum laude grade point average (GPA). The independent variables were primary dysmenorrhoea occurrence and severity, categorised as mild or moderate-to-severe using the Verbal Multidimensional Scoring System.

RESULTS

Primary dysmenorrhoea was significantly associated with reduced quality of life, mental health challenges and academic disruptions. Students with dysmenorrhoea had significantly lower Quality of Life scores (-1.82, 95% CI: -2.63 to -1.02; p<0.001), with moderate-to-severe pain linked to an even more significant reduction (-2.09, 95% CI: -2.54 to -1.63; p<0.001). Dysmenorrhoea occurrence was significantly associated with depression (OR 2.16, 95% CI: 1.23 to 3.81; p=0.007), while severity was associated with both depression (OR 2.07, 95% CI: 1.47 to 2.92; p<0.001) and stress (OR 1.82, 95% CI: 1.26 to 2.62; p<0.001). Dysmenorrhoea occurrence and severity significantly disrupted concentration (OR 12.92, 95% CI: 6.14 to 27.22; p<0.001 and OR 7.24, 95% CI: 4.68 to 11.19; p<0.001, respectively), activities (OR 34.95, 95% CI: 4.77 to 256.16; p<0.001 and OR 6.92, 95% CI: 4.63 to 10.36; p<0.001) and absenteeism (OR 12.10, 95% CI: 1.65 to 88.83; p=0.014 and OR 5.65, 95% CI: 3.32 to 9.63; p<0.001). Cum laude GPA was not significantly associated.

CONCLUSIONS

Primary dysmenorrhoea is significantly associated with the quality of life, mental health and academic performance of medical students in Indonesia. Addressing its implications can enhance student well-being and academic outcomes.

Current Status of Depression in Patients with Endometriosis and Rheumatoid Arthritis

BACKGROUND

Endometriosis often causes chronic pain and fertility issues, exacerbating the risk of depression and complicating conditions like rheumatoid arthritis, which further impacts quality of life. This study aimed to explore the detection rate of depression in patients with endometriosis and rheumatoid arthritis by using different diagnostic criteria, and to analyze the occurrence and influencing factors.

METHOD

A total of 108 patients with endometriosis combined with rheumatoid arthritis in the First Hospital of Lanzhou University from July 2021 to July 2023 were selected as samples. The internationally accepted Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), the new depression assessment tool Hamilton Depression Scale (HAMD), and the Self-rating Depression Scale (SDS) were used to detect the incidence of depression in patients with endometriosis and rheumatoid arthritis. On the basis of the DSM-5 results, patients with concurrent depression were categorized into the observation group, and those without depression were categorized into the control group. The patients' clinical data were collected, and the impact factors were analyzed through binary logistic regression.

RESULTS

DSM-5 detected 20 patients with depression, with a detection rate of 18.52%. HAMD detected 21 patients with depression, with a detection rate of 19.44%. SDS detected 18 patients with depression, with a detection rate of 16.67%. The difference in the detection rate of depression in patients with endometriosis combined with rheumatoid arthritis among the three methods was not statistically significant (p = 0.865). Binary logistic regression analysis showed that dysmenorrhea (odds ratio (OR) = 3.589, p = 0.005), dyspareunia (OR = 2.964, p = 0.012), Visual Analog Scale score (OR = 2.545, p = 0.001), Disease Activity Score-28 score (OR = 3.828, p = 0.004), Pittsburgh Sleep Quality Index score (OR = 3.942, p = 0.004), and Health Assessment Questionnaire-Disability Index score (OR = 3.527, p = 0.008) were significant influencing factors for depression.

CONCLUSION

DSM-5, HAMD, and SDS can be used to detect depression in patients with endometriosis and rheumatoid arthritis as effective tools for depression screening. Dysmenorrhea, dyspareunia, Visual Analog Scale (VAS), Rheumatoid arthritis disease activity (DAS28), Pittsburgh Sleep Quality Index (PSQI), and Health Assessment Questionnaire-Disability Index (HAQ-DI) are influencing factors of depression in these patients.

Deciphering the genetic interplay between depression and dysmenorrhea: a Mendelian randomization study

BACKGROUND

This study aims to explore the link between depression and dysmenorrhea by using an integrated and innovative approach that combines genomic, transcriptomic, and protein interaction data/information from various resources.

METHODS

A two-sample, bidirectional, and multivariate Mendelian randomization (MR) approach was applied to determine causality between dysmenorrhea and depression. Genome-wide association study (GWAS) data were used to identify genetic variants associated with both dysmenorrhea and depression, followed by colocalization analysis of shared genetic influences. Expression quantitative trait locus (eQTL) data were analyzed from public databases to pinpoint target genes in relevant tissues. Additionally, a protein-protein interaction (PPI) network was constructed using the STRING database to analyze interactions among identified proteins.

RESULTS

MR analysis confirmed a significant causal effect of depression on dysmenorrhea ['odds ratio' (95% confidence interval) = 1.51 (1.19, 1.91), P = 7.26 × 10-4]. Conversely, no evidence was found to support a causal effect of dysmenorrhea on depression (P = .74). Genetic analysis, using GWAS and eQTL data, identified single-nucleotide polymorphisms in several genes, including GRK4, TRAIP, and RNF123, indicating that depression may impact reproductive function through these genetic pathways, with a detailed picture presented by way of analysis in the PPI network. Colocalization analysis highlighted rs34341246(RBMS3) as a potential shared causal variant.

CONCLUSIONS

This study suggests that depression significantly affects dysmenorrhea and identifies key genes and proteins involved in this interaction. The findings underline the need for integrated clinical and public health approaches that screen for depression among women presenting with dysmenorrhea and suggest new targeted preventive strategies.

Prevalence of Primary Dysmenorrhea and Its Effect on the Quality of Life Among Female Students at Umm Al-Qura University

Introduction Primary dysmenorrhea is a common menstrual disorder causing significant physical and emotional discomfort, particularly among young women. This study aimed to determine the prevalence of primary dysmenorrhea, its associated symptoms, and its impact on the quality of life among female students at Umm Al-Qura University in Saudi Arabia. Methodology A cross-sectional study was conducted among 620 female students aged 18-30 using a validated, self-reported questionnaire. Data collected included demographic information, menstrual history, dysmenorrhea characteristics, and quality of life measured by the Short Form Health Survey-12 (SF-12). The confidence interval (CI) was maintained at 95%, and a p-value of <0.05 was selected as the statistically significant level in all tests. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 27 (Released 2020; IBM Corp., Armonk, New York). Results The prevalence of primary dysmenorrhea was 83.7%. Of the participants, 51.1% reported moderate pain, while 32.6% experienced severe pain (pain score 8-10). Premenstrual syndrome was reported by 71.8%. Pain significantly impacted physical functioning, with 75.5% reporting decreased productivity due to menstrual pain, and 76.3% noted emotional problems. Family history of menstrual pain was present in 53.2% of the participants, and BMI had no significant correlation with pain severity. Conclusions Primary dysmenorrhea significantly affects the quality of life and academic performance of female students. Effective management strategies and increased awareness are essential to reduce its impact on young women's lives.

Validation of the Working Ability, Location, Intensity, Days of Pain and Dysmenorrhea (WaLIDD) Scale in Arabic-Speaking Young Female Adults

Background

Dysmenorrhea, characterized by painful menstrual cramps, significantly impacts the well-being of women globally. Despite its prevalence and adverse effects, dysmenorrhea is often underdiagnosed and inadequately treated. This study aims to validate the Arabic version of the Working ability, Location, Intensity, Days of pain, and Dysmenorrhea (WaLIDD) scale among Lebanese female university students aged 18-45.

Methods

This cross-sectional study, involving 729 participants, utilized a translated WaLIDD scale and the Depression, Anxiety, and Stress Scales (DASS-8).

Results

Confirmatory Factor Analysis (CFA) confirmed the one-factor structure of the WaLIDD scale, demonstrating excellent fit indices, with good internal reliability. Concurrent validity analysis revealed significant associations between higher WaLIDD scores and elevated levels of depression, anxiety, and stress. The prevalence of dysmenorrhea in the study was estimated at 7.3%.

Conclusion

The study underscores the importance of the WaLIDD scale as a reliable and valid tool for assessing dysmenorrhea among Arabic-speaking populations. The successful validation of the Arabic version facilitates its application in Lebanon and potentially other Arab regions, providing a universal tool to predict and assess dysmenorrhea and its impact. Further research is encouraged to explore the scale's applicability in clinical settings and tailor interventions for improved women's well-being.

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.

Efficacy of progressive muscle relaxation technique in primary dysmenorrhea: A randomized controlled trial

OBJECTIVE

To examine the effects of Jacobson's Progressive Muscle Relaxation Technique (JPMRT) on menstrual pain and symptoms, anxiety, quality of life (QoL), social activity, and work/school performance in primary dysmenorrhea (PD).

MATERIALS AND METHODS

Women with PD were randomly divided into two groups as relaxation and control groups. JPMRT was applied three times a week from the estimated date of ovulation to the onset of the next menstruation. No treatment was performed in the control group. Pain intensity, menstrual symptoms, anxiety, impacts on QoL, social activity, and work/school performance were assessed before and after the interventions.

RESULTS

After the interventions, there was a further decrease in menstrual pain intensity, menstrual symptoms, anxiety level, the impact of QoL, and the work/school performance scores in the relaxation group than in the control group (p < 0.05).

CONCLUSION

JPMRT might be used as an alternative method in the treatment of PD.

More than Cramps in Scrubs: Exploring Dysmenorrhea among Women Healthcare Workers

Though understudied, dysmenorrhea, a painful cramping sensation occurring near and during menses, is the most prevalent gynecological disorder among women of reproductive age, affecting 50-90% of the global population. Contributing factors of this disorder include poor medical assessment, lack of consciousness, gender bias, moderate to high levels of stress, and depression and anxiety. Among school students and healthcare trainees, dysmenorrhea contributes to short-term absenteeism, lower productivity, creativity, and job performance. Among medical trainees, dysmenorrhea has been found to impact daily activities to a disabling degree in nearly one third of instances, resulting in difficulties in relationships and even self-isolation. Dysmenorrhea further produces substantial global economic losses and higher healthcare costs. To begin to alleviate the extensive issue of dysmenorrhea, we must increase awareness to fully understand its prevalence, risk factors, and potential for effective, affordable, and accessible treatments. Concurrently, our clinical environment must adopt a standard description and assessment tool to prevent, measure, and monitor dysmenorrhea, while on a global scale, we must develop and widely disseminate nationwide labor regulations that address the workforce impact due to the effects of dysmenorrhea.

Acupuncture's long-term impact on depression prevention in primary dysmenorrhea: A 19-year follow-up of a Taiwan cohort with neuroimmune insights

BACKGROUND

Primary dysmenorrhea (PD) is a common gynecological condition causing depression. Acupuncture is an effective option for PD management but its effects on PD-associated depression remain unclear.

METHODS

A retrospective cohort study involving 35,099 propensity score-matched pairs of acupuncture users and non-users with PD was conducted using data from Taiwan's Longitudinal Generation Tracking Database 2000. Cox proportional hazard models were used to estimate depression risk, and bioinformatics analyses were performed to uncover underlying molecular mechanisms.

RESULTS

The risk of developing depression was reduced by 64 % in acupuncture users compared with non-acupuncture users during the 19-year follow-up period. The decrease was dose-dependent. Bioinformatics analyses identified 34 co-expressed targets for acupuncture, PD, and depression; and eight hub genes (coding for interleukin 6 and 1B, tumor necrosis factor, albumin, vascular endothelial growth factor A, C-reactive protein, prostaglandin-endoperoxide synthase 2, and brain-derived neurotrophic factor) potentially involved in the therapeutic effects of acupuncture. Several molecular pathways were found to be involved, including cytokine-cytokine receptor interaction, neuroactive ligand-receptor interaction, cyclic adenosine 3',5'-monophosphate signaling pathway, mitogen-activated protein kinase signaling pathway, serotonergic synapse, and estrogen signaling pathway.

LIMITATIONS

Bias in the selection of participants could have been introduced as a consequence of the retrospective nature of the study. Data were derived from a single national database, and acupuncture treatment details were unavailable.

CONCLUSION

Acupuncture may protect against the development of depression in patients with PD. This study provides insight into the potential molecular mechanisms underlying the therapeutic effects of acupuncture in PD management and depression prevention.

Patient prognosis and prediction model for taking Kampo formulas in dysmenorrhea: An observational study

Two representative Kampo formulas, keishibukuryogan and tokishakuyakusan, are frequently prescribed for patients with dysmenorrhea. We previously constructed a model that could predict which of these 2 formulas was most suitable, which is based on 4 subjective symptoms and 3 objective signs. To evaluate the prognosis of patients with dysmenorrhea using the established prediction model and assess the treatment outcomes between those treated in accordance with the prediction model and those who received various other treatments. In this retrospective, observational study, we included patients with menstrual pain who visited the Kampo Clinic at the Keio University Hospital for the first time between October 2014 and December 2020. These patients were monitored over a 90-day follow-up period. Participants were categorized into 2 groups: model-accordance and various-options. The progression of visual analogue scale (VAS) values was evaluated by determining the slopes from regression analysis between these 2 groups, with changes corroborated by the medical records. The study comprised 57 patients: 37 in the model-accordance group and 20 in the various-options group. Notably, the various-options group reported a significantly higher number of subjective symptoms (P = .03). The VAS value showed a decline, as indicated by the negative slope value of the regression line, across both groups - irrespective of their classification. There were no significant differences in the occurrence of adverse events between the 2 groups. The prognosis of patients with dysmenorrhea and the incidence of adverse events remained consistent, regardless of whether the treatment approach was in accordance with the prediction model or varied. Further studies are warranted to assess the prognosis when Kampo formulas are chosen based on the prediction model in the various-options population.

Clinical Observation on Auricular Acupressure for Primary Dysmenorrhea: A Study Protocol for a Randomized Clinical Trial

Purpose

The objective of this study is to evaluate the immediate and time-dependent effects of AA in treating PD and assess its safety.

Methods/Design

This study is a randomized, single-blinded, controlled trial that will enroll 92 patients in a 1:1 allocation ratio. Patients will be assigned to either the treatment group (n=46) or the control group (n=46). During the first menstrual period, the treatment group will receive AA treatment, while the control group will receive sham AA treatment for 7 days. The second menstrual period will serve as the follow-up period. The primary outcome measure is the Visual Analog Scale (VAS) score 30 min after the first treatment. Secondary outcome measures include the VAS score immediately after the first treatment, onset time of analgesic effect, duration of pain, extra dosing rate of ibuprofen, and change of the Menstrual Distress Questionnaire (MDQ) score. The outcomes will be assessed at baseline, during the intervention period, and during the follow-up period.

Conclusion

The study results will provide evidence on the efficacy and safety of AA in managing PD by analyzing its immediate effect, time-effect relationship, and reduction of painkiller use.

Trial Registration

Chinese Clinical Trial Registry (ChiCTR2300069741).

The efficacy and safety of transcutaneous auricular vagus nerve stimulation in the treatment of depressive disorder: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Transcutaneous auricular vagus nerve stimulation (taVNS) is used for treating depression but the efficacy and safety have not been well assessed. This study was conducted to evaluate the efficacy and safety of taVNS in depression.

METHODS

The retrieval databases included English databases of PubMed, Web of Science, Embase, the Cochrane Library and PsycINFO, and Chinese databases of CNKI, Wanfang, VIP and Sino Med, and the retrieval period was from their inception to November 10, 2022. The clinical trial registers (ClinicalTrials.gov and Chinese Clinical Trial Registry) were also searched. Standardized mean difference and the risk ratio were used as the effect indicator and the effect size was represented by the 95 % confidence interval. Revised Cochrane risk-of-bias tool for randomized trials and the Grades of Recommendation, Assessment, Development and Evaluation system were used to assess the risk of bias and quality of evidence respectively.

RESULTS

Totally, 12 studies of 838 participants were included. taVNS could significantly improve depression and reduce Hamilton Depression Scale scores. Low to very low evidence showed that taVNS had higher response rates than sham-taVMS and comparable response rates compared to antidepressants (ATD) and that taVNS combined with ATD had comparable efficacy to ATD with fewer side effects.

LIMITATIONS

The number of studies in subgroups was small and the evidence quality was low to very low.

CONCLUSIONS

taVNS is an effective and safe method for alleviating depression scores and had a comparable response rate to ATD.

Bibliometric Analysis of Global Research Landscape and Hotspots on Dysmenorrhea: Where are We Now?

Purpose

Dysmenorrhea is the most common gynecological condition among women of childbearing age and remains a challenging public health issue. This study aimed to visualize profiles and hotspots in dysmenorrhea research through a bibliometric analysis to deepen the understanding of knowledge in this field.

Methods

Articles and reviews on dysmenorrhea published from 2000 to 2021 were collected. We summarized standard bibliometric indicators. Publications were systematically assessed in terms of country, institution, author, journal, reference, and keywords using Citespace, VOSviewer, Bibliometric, and an online platform. Besides, correlation analyses of country-specific characteristics and bibliometric indicators were performed.

Results

3407 publications were included. Dysmenorrhea-related publications have been increasing steadily annually. China and the United States were the most productive and academically influential countries, respectively. Correlation analysis revealed that economic power is an essential factor influencing scientific activity. However, collaboration in dysmenorrhea research remained weak. Natl Yang Ming Univ and Vercellini P were the most productive institution and influential author, respectively. A significant proportion of dysmenorrhea research was published in high-impact journals and it was explored at a multidisciplinary level. Current research topics focus on two primary areas: (1) pathophysiology, such as pathogenesis, oxidative stress, and functional connectivity, and (2) public health impacts, such as quality of life, burden, depression, and exercise.

Conclusion

Dysmenorrhea research has received extensive attention from scholars and is rapidly evolving. Improved collaboration and interdisciplinary exploration may advance this field. Public health research and pathophysiological exploration of dysmenorrhea are current research hotspots and may also be a focus of research in the coming years.

Dysmenorrhoea: Can Medicinal Cannabis Bring New Hope for a Collective Group of Women Suffering in Pain, Globally?

Dysmenorrhoea effects up to 90% of women of reproductive age, with medical management options including over-the-counter analgesia or hormonal contraception. There has been a recent surge in medicinal cannabis research and its analgesic properties. This paper aims to critically investigate the current research of medicinal cannabis for pain relief and to discuss its potential application to treat dysmenorrhoea. Relevant keywords, including medicinal cannabis, pain, cannabinoids, tetrahydrocannabinol, dysmenorrhoea, and clinical trial, have been searched in the PubMed, EMBASE, MEDLINE, Google Scholar, Cochrane Library (Wiley) databases and a clinical trial website (clinicaltrials.gov). To identify the relevant studies for this paper, 84 papers were reviewed and 20 were discarded as irrelevant. This review critically evaluated cannabis-based medicines and their mechanism and properties in relation to pain relief. It also tabulated all clinical trials carried out investigating medicinal cannabis for pain relief and highlighted the side effects. In addition, the safety and toxicology of medicinal cannabis and barriers to use are highlighted. Two-thirds of the clinical trials summarised confirmed positive analgesic outcomes, with major side effects reported as nausea, drowsiness, and dry mouth. In conclusion, medicinal cannabis has promising applications in the management of dysmenorrhoea. The global medical cannabis market size was valued at USD 11.0 billion in 2021 and is expected to expand at a compound annual growth rate (CAGR) of 21.06% from 2022 to 2030. This will encourage academic as well as the pharmaceutical and medical device industries to study the application of medical cannabis in unmet clinical disorders.

Metabonomic Study of the Effect of Dingkundan Intervention Comparing with Oral Contraceptives on Primary Dysmenorrhea Using the UPLC-MS Technique

Primary dysmenorrhea (PD) is a prevalent problem in gynecologic clinics among adolescents and women of reproductive age. Several therapy modalities, including traditional Chinese medicine, are deemed adequate (TCM) and have been in practice for a long time. In China, Dingkundan (DKD), a multicomponent gynecological treatment, has been used to treat PD for centuries. However, the fundamental process remains poorly understood. Comparing plasma samples acquired from DKD-treated and oral contraceptive- (OC-) treated subjects, we performed an integrated plasma metabonomic analysis utilizing the UPLC-MS technology to study the therapeutic mechanisms of DKD in PD patients. Thirty possible biomarkers and metabolic pathways were discovered, primarily steroid hormone production, glycerophospholipid metabolism, and bile secretion. The results suggested that DKD may have therapeutic benefits for PD patients via modulation of various metabolic pathways. This study is envisaged to provide detailed metabolite information regarding the etiology of PD, an assessment of the efficacy of DKD, and a comparison of DKD and OC.

COVID-19-Associated Mental Health Impact on Menstrual Function Aspects: Dysmenorrhea and Premenstrual Syndrome, and Genitourinary Tract Health: A Cross Sectional Study among Jordanian Medical Students

The physiology of reproduction is affected by psychological distress through neuroendocrine pathways. Historically, COVID-19 is one of the most stressful events with devastating consequences. This research aims to investigate the relationship between dysmenorrhea, PMS, and reproductive tract health on one hand, and COVID-19-related anxiety, depression, and stress on the other among medical students in Jordan. Medical students were invited through teaching platforms and social media to complete an online survey. SPSS software was used to analyze data. A total of 385 medical students participated in this research. Hence, 49.9% of the study population reported severe dysmenorrhea during COVID-19 compared to 36.9% before COVID-19 (p = 0.000). Dysmenorrhea was significantly associated with disruptions of sport and daily activities during COVID-19 (p = 0.015 and p = 0.002, respectively). The prevalence of PMS components, e.g., mastalgia, fatigue, headache, palpitation, and emotional and sleep disturbances, was raised during COVID-19 compared with before (p < 0.05). Symptoms of genitourinary tract infections, such as lower abdominal pain, vaginal discharge, genitalia rash/ulcers and itching, and urgency, were significantly increased after COVID-19 (p < 0.05). Positive Pearson correlations between COVID-19-associated mental health disorders and dysmenorrhea severity, PMS, and genital tract health abnormalities were observed (p < 0.05). The multiple linear regression model revealed that dysmenorrhea severity, PMS symptoms like palpitation, and genitourinary symptoms like lower abdominal pain and urgency were associated with worsening of depression, while dysuria was associated with a protective effect against depression. Moreover, it was observed that dysmenorrhea severity, PMS symptoms, such as headache and palpitation, and urinary urgency were associated with aggravation of anxiety. However, food craving and dysuria were protective against anxiety. Finally, dysmenorrhea severity, PMS symptoms of headache and palpitation, lower abdominal pain, and urgency were related to worsening of stress, whereas the premenstrual symptom of breast pain was a protective factor against stress. This work showed that COVID-19 pandemic-related psychological distress and menstrual, premenstrual, and genitourinary symptoms are closely related. Further future work is required to evaluate the long lasting-effects of the pandemic on mental health and the physiology of reproduction.

Quality of Life in Japanese Patients with Dysmenorrhea or Endometriosis-Associated Pelvic Pain Treated with Extended Regimen Ethinylestradiol/Drospirenone in a Real-World Setting: A Prospective Observational Study

INTRODUCTION

Dysmenorrhea and endometriosis are common gynecologic disorders among women of reproductive age that significantly impact health-related quality of life (HRQL) as well as productivity. Although there are treatment options listed in Japanese guidelines, a gap remains in unmet medical needs for maximizing treatment outcome. The extended regimen of ethinylestradiol and drospirenone (EE/DRSP) (taken daily for up to 120 consecutive days) has been available in Japan for treating dysmenorrhea and/or endometriosis-associated pain since 2016. Yet, the effectiveness of its usage on HRQL has not been investigated elsewhere to date. Therefore, in this study, we aim to observe changes in HRQL of Japanese women treated with an extended regimen of EE/DRSP for dysmenorrhea and/or endometriosis-associated pain.

METHODS

As part of a 2-year post-marketing surveillance study, women with dysmenorrhea or endometriosis-associated pelvic pain were prescribed extended EE/DRSP during routine clinical practice. Data were collected 1 month before and 3 and 6 months after initiating treatment. Primary outcomes were the Menstrual Distress Questionnaire (MDQ) (before, during, and after menstruation) in patients with dysmenorrhea, and the Endometriosis Impact Scale (EIS) and European Quality of Life 5-dimensions 5-level instrument (EQ-5D-5L) in patients with endometriosis.

RESULTS

The study cohort included 315 patients (mean age 28.9 years) with dysmenorrhea and 262 patients (mean age 31.3 years) with endometriosis. Mean MDQ total scores before and during menstruation decreased significantly after 6 months with extended EE/DRSP; there was no improvement in after-menstruation MDQ score. Mean EIS domain scores improved significantly by 6 months, with improvement in most EIS individual item scores. Mean EQ-5D-5L scores increased slightly during 6 months of treatment.

CONCLUSIONS

Extended EE/DRSP treatment improved HRQL outcomes in Japanese women with dysmenorrhea or endometriosis-associated pelvic pain.

TRIAL REGISTRATION

Registered at ClinicalTrials.gov (NCT03126747) on June 2017.