An integrated study of metabolomics and transcriptomics to reveal the anti-primary dysmenorrhea mechanism of Akebiae Fructus

ETHNOPHARMACOLOGICAL RELEVANCE

Akebiae Fructus, a Tujia minority folk medicine and a well-known traditional Chinese medicine for soothing the liver, regulating Qi, promoting blood circulation and relieving pain, is widely used in the treatment of primary dysmenorrhea. However, little is known about its underlying mechanism.

AIM OF THE STUDY

To explore the effect of Akebiae Fructus on primary dysmenorrhea model induced by estradiol benzoate and oxytocin, and to provide better understanding of the mechanism of Akebiae Fructus for primary dysmenorrhea treatment.

MATERIALS AND METHODS

The primary dysmenorrhea mouse model was used in this study. Except for the control group and the normal administration group, the mice of other groups were subcutaneously injected with estradiol benzoate (10 mg/kg/d) for 10 consecutive days. From the 5th day of the ten-day model period, the positive control groups were given 0.075 g/kg ibuprofen and 7.5 g/kg Leonurus granule, the drug groups were given 0.2 g/kg, 0.4 g/kg, 0.8 g/kg Akebiae Fructus extract, the normal administration group was given 0.8 g/kg Akebiae Fructus extract, and the same volume saline was given in the control group. On the tenth day, oxytocin (10 U/kg) was peritoneally injected after estradiol benzoate injected 1 h. After the oxytocin injection, writhing behavior was observed for 30 min. Then the uterine tissue was collected to measure the level of PGF2α and PGE2, and for histological analysis and transcriptomics analysis. Meanwhile, plasma and urine samples were collected for metabolomic analysis.

RESULTS

Akebiae Fructus inhibited the writhing, decreased the PGF2α level and ameliorated the morphological changes. 32 potential metabolic biomarkers in plasma and 17 in urine were found for primary dysmenorrhea, and after Akebiae Fructus treatment, 25 metabolites in plasma and 14 in urine were restored. These altered metabolites were mainly involved in lipid, amino acid and organic acid metabolism. For the transcriptomic study, a total of 2244 differentially expressed genes (1346 up-regulated and 898 down-regulated) were obtained between the control and model group, and 148 differentially expressed genes (DEGs) were found related with Akebiae Fructus treatment of primary dysmenorrhea. Correlation analysis was carried out based on the transcriptomic and metabolomic data. 5 differentially expressed genes (Plpp3, Sgpp2, Arg1, Adcy8, Ak5) were found related with the enrichment metabolic pathways. The mechanism by which Akebiae Fructus ameliorates primary dysmenorrhea may account for the regulation of the gene expression to control the key enzymes in the sphingolipid metabolism, arginine and proline metabolism, glycerophospholipid metabolism and purine metabolism, inhibiting the abnormal secretion of PGF2α, alleviating the uterine contraction and reducing inflammation and pain.

CONCLUSIONS

Akebiae Fructus could effectively alleviate the symptoms of primary dysmenorrhea, regulate metabolic disorders, and control the related gene expression in primary dysmenorrhea. The study may provide clues for further study of Akebiae Fructus treatment on primary dysmenorrhea.

Effect of traditional Chinese medicine formula GeGen decoction on primary dysmenorrhea: A randomized controlled trial study

ETHNOPHARMACOLOGICAL RELEVANCE

GeGen Decoction, a well-known Chinese herbal formula, is widely used in China and other Asian countries to treat gynecological diseases, including primary dysmenorrhea. Pharmacological studies have confirmed that GeGen Decoction is able to inhibit spasmodic contractions of the uterus in vivo and in vitro.

AIM OF THE STUDY

The objective of this study is to examine the efficacy and safety of GeGen Decoction on primary dysmenorrheic patients.

METHODS

This was a randomized, double-blinded, placebo-controlled trial. GeGen Decoction or placebo was administered a week before the expected start of each cycle for three consecutive menstrual periods. Between-group differences in pain intensity were detected by visual analogue scale (VAS). In addition, serum levels of arginine vasopressin (AVP) and estrogen (E) were examined by enzyme-linked immunosorbent assay. Metabolomic analysis was further used to evaluate the influence of GeGen Decoction on the metabolomics of primary dysmenorrheic patients.

RESULTS

A total of 71 primary dysmenorrheic women were recruited and 30 participants met the criteria were randomized into GeGen Decoction or placebo group. After three consecutive menstrual cycles' treatments, the VAS score of the GeGen Decoction group was significantly lower than that of the placebo group. Both serum levels of AVP and E decreased after GeGen Decoction administration, while the placebo seemed to have little effect on either of the index. Moreover, after GeGen Decoction treatment, seven important metabolites were identified by metabolomic analysis compared to the placebo group. No abnormalities in blood biochemical and routine physical examination pre and post GeGen Decoction intervention were observed.

CONCLUSIONS

GeGen Decoction can remarkably relieve the severity of menstrual pain without obvious adverse effects. Its therapeutic effect on primary dysmenorrhea might be related to the regulation of pituitary hypothalamic ovarian hormones, and interfering with the metabolic change.

Low Serum Oxytocin Concentrations Are Associated with Painful Menstruation

Oxytocin-dependent mechanisms are hypothesized to contribute to painful menses, but clinical trials of oxytocin antagonists for dysmenorrhea have had divergent outcomes. In contrast, broader studies have shown that increased systemic oxytocin concentrations are associated with increased pain tolerance and improved psychosocial function. We sought to confirm whether increased serum oxytocin concentrations are associated with menstrual pain and other psychosocial factors. Women with a history of primary dysmenorrhea (n = 19), secondary dysmenorrhea (n = 12), and healthy controls (n = 15) completed pain and psychosocial questionnaires, provided a medical history, and rated their pain during the first 48 h of menses. Serum samples were collected during menses to measure oxytocin concentrations. Oxytocin was significantly lower in participants with a history of primary (704 ± 33 pg/mL; p < 0.001) or secondary (711 ± 66 pg/mL; p < 0.01) dysmenorrhea compared to healthy controls (967 ± 53 pg/mL). Menstrual pain over the past 3 months (r = -0.58; p < 0.001) and during the study visit (r = -0.45; p = 0.002) was negatively correlated with oxytocin concentrations. Pain catastrophizing (r = -0.39), pain behavior (r = -0.32), and pain interference (r = -0.31) were also negatively correlated with oxytocin levels (p's < 0.05). Oxytocin was not significantly correlated with psychosocial factors. Contrary to our hypothesis, women with a history of primary or secondary dysmenorrhea had lower oxytocin concentrations during menses when compared to healthy controls. Lower circulating oxytocin concentrations were also associated with worse menstrual pain and pain-related behavior. When considering the existing literature, low circulating oxytocin may be a sign of dysfunctional endogenous pain modulation.

The impact of circulating 25-hydroxyvitamin and oral cholecalciferol treatment on menstrual pain in dysmenorrheic patients

This study aims to determine Vitamin-D level in patients with primary dysmenorrhea and investigate the effect of Vitamin-D replacement on symptoms. About 100 patients in the 18-30 age group followed-up with primary dysmenorrhea diagnosis were included in this observational study. The pain severity was assessed using the visual analog scale (VAS). 25-hydroxy vitamin D(25(OH)D) levels of the patients were measured and the replacement therapy was applied according to measurement results. The patients were followed for three months in total. At the end of the three-month period, the 25(OH)D level was measured and the VAS score was assessed once more after the therapy. 25(OH)D level was insufficient in 23.0%, deficient in 45.0%, and severely deficient in 32.0% of the patients. It was found that the VAS score increased as the 25(OH)D level decreased (r = -0.320; p = .002). A significant reduction was observed in VAS scores after Vitamin-D treatment in all three groups; the amount of reduction in VAS score was determined to be higher in the patients with severely deficient levels of 25(OH)D, compared to the patients with deficient or insufficient levels (p < .001). A significant and negative correlation was found between Vitamin-D and symptoms associated with dysmenorrhea in our study. The Vitamin-D replacement therapy led to a significant decrease in symptoms.

Moxibustion for pain relief in patients with primary dysmenorrhea: A randomized controlled trial

BACKGROUND

Though moxibustion is frequently used to treat primary dysmenorrhea in China, relevant evidence supporting its effectiveness is still scanty.

METHODS

This study was a pragmatic randomized, conventional drug controlled, open-labeled clinical trial. After initial screen, 152 eligible participants were averagely randomized to receive two different treatment strategies: Moxibustion and conventional drugs. Participants and practitioners were not blinded in this study. The duration of each treatment was 3 months. The primary outcome was pain relief measured by the Visual Analogue Scale. The menstrual pain severity was recorded in a menstrual pain diary.

RESULTS

152 eligible patients were included but only 133 of them eventually completed the whole treatment course. The results showed that the menstrual pain intensity in experimental group and control group was reduced from 6.38±1.28 and 6.41±1.29, respectively, at baseline, to 2.54±1.41 and 2.47±1.29 after treatment. The pain reduction was not significantly different between these two groups (P = 0.76), however; the pain intensity was significantly reduced relative to baseline for each group (P<0.01). Three months after treatment, the effectiveness of moxibustion sustained and started to be superior to the drug's effect (-0.87, 95%CI -1.32 to -0.42, P<0.01). Secondary outcome analyses showed that moxibustion was as effective as drugs in alleviating menstrual pain-related symptoms. The serum levels of pain mediators, such as PGF2α, OT, vWF, β-EP, PGE2, were significantly improved after treatment in both groups (P<0.05). No adverse events were reported in this trial.

CONCLUSIONS

Both moxibustion and conventional drug showed desirable merits in managing menstrual pain, given their treatment effects and economic costs. This study as a pragmatic trial only demonstrates the effectiveness, not the efficacy, of moxibustion for menstrual pain. It can't rule out the effect of psychological factors during treatment process, because no blind procedure or sham control was used due to availability. In clinical practice, moxibustion should be used at the discretion of patients and their physicians.

TRIAL REGISTRATION

ClinialTrials.gov NCT01972906.

Plasma metabolic profiling of normal and dysmenorrhea syndrome rats and the effects of Xiang-Fu-Si-Wu Decoction intervention

CONTEXT

Primary dysmenorrhea (PDM), a common, clinically heterogeneous endocrine disorder affecting young women, is associated with endocrinopathy and metabolic abnormalities. The Xiang-Fu-Si-Wu Decoction (XFSWD) is a traditional Chinese medicine preparation used to treat PDM.

OBJECTIVE

In the current study, a plasma metabonomics method based on the ultra-high-performance liquid chromatography-quantitative time-of-flight-mass spectrometry (UHPLC-Q-TOF-MS) system was employed to examine the mechanism of XFSWD action in PDM.

MATERIALS AND METHODS

Estradiol benzoate (0.01 g/kg/d) and oxytocin (5 mL/kg) were used to create the dysmenorrhea rat model. Based on the chromatographic data of plasma samples at different time-points following oral administration of XFSWD mixed in water (37.8 g crude herbs/kg) on day 7, partial least square (PLS) and discriminate analysis (DA) were applied to visualize group differentiation and marker selection.

RESULTS

Systemic changes occurring in PDM reflect alterations in not only uterus function but also whole-body metabolism. The XFSWD was effective as a therapeutic agent for PDM by reflect metabolic pathway. Prostaglandins and lysophospholipids were identified as two marker types for oxytocin-induced dysmenorrhea syndrome, including LysoPC(18:4), LysoPE(22:2/0:0), LysoPC(17:0), PGJ₂, 11-deoxy-11-methylene-PGD₂, 15-deoxy-δ-12,14-PGJ₂, LysoPC(20:3), etc. Specifically, the concentrations of prostaglandins compounds (PGJ₂, 11-deoxy-11-methylene-PGD₂, 15-deoxy-δ-12,14-PGJ₂) were increased while those of lysophospholipid compounds [lysoPC(18:4), LysoPE(22:2/0:0), LysoPC(17:0)] were decreased to a significant extent (p < 0.05) in dysmenorrheal rats. Upon treatment with the XFSWD at 12 h, the concentrations of lysophospholipids showed no significant differences (P > 0.05) between the model and normal groups. The lysophospholipid levels were restored. Lysophospholipids were the key factors in phospholipid metabolism. Thus, disruption of phospholipids metabolism appears critical for the development of dysmenorrhea. The XFSWD exerted its effects by interfering with the sphingolipid metabolic pathway.

DISCUSSION AND CONCLUSIONS

The metabonomics method presents a promising tool to treat PDM in animal models, and may be applicable for clinical treatment of the human disease in the future.

Vitamin D and PTH status among adolescent and young females with severe dysmenorrhea

OBJECTIVE

To investigate Vitamin D and parathyroid hormone (PTH) status among adolescent and young females with severe and very severe dysmenorrhea.

DESIGN

Cross-sectional study in specific selected sample.

SETTING

One Jordanian university.

PARTICIPANTS

Fifty-six females, ages between 17 and 24 years, with severe and very severe dysmenorrhea were surveyed regarding demographics, pain with menstruation, and dietary intake of dairy products. Plasma Vitamin D, PTH levels were measured.

RESULTS

About 61% of the studied population experience very severe dysmenorrhea. Half of participants had dairy intake less than 1 serving per day. The majority of participants (80%) had insufficient plasma vitamin D and 48% of them had hyperparathyroidism.

CONCLUSION

A high prevalence of vitamin D insufficiency and secondary hyperparathyroidism and/or low dietary calcium intake among adolescent and young adult females who experience severe and very severe dysmenorrhea may negatively affect bone metabolism during achievement of peak bone mass at a young age and adverse bone health at older age.

Evaluation of CA-125 and soluble CD-23 in patients with pelvic endometriosis: a case-control study

OBJECTIVE

To evaluate serum concentrations of CA-125 and soluble CD-23 and to correlate them with clinical symptoms, localization and stage of pelvic endometriosis and histological classification of the disease.

METHODS

Blood samples were collected from 44 women with endometriosis and 58 without endometriosis, during the first three days (1st sample) and during the 7th, 8th and 9th day (2nd sample) of the menstrual cycle. Measurements of CA-125 and soluble CD-23 were performed by ELISA. Mann-Whitney U test was used for age, pain evaluations (visual analog scale) and biomarkers concentrations.

RESULTS

Serum levels of CA125 were higher in endometriosis patients when compared to the control group during both periods of the menstrual cycle evaluated in the study. This marker was also elevated in women with chronic pelvic pain, deep dyspareunia (2nd sample), dysmenorrhea (both samples) and painful defecation during the menstrual flow (2nd sample). CA-125 concentration was higher in advanced stages of the disease in both samples and also in women with ovarian endometrioma. Concerning CD-23, no statistically significant differences were observed between groups.

CONCLUSION

The concentrations of CA-125 were higher in patients with endometriosis than in patients without the disease. No significantly differences were observed for soluble CD-23 levels between groups.

[Effect of massage on hemodynamics parameters of uterine artery and serum prostaglandin in treating patients with primary dysmenorrhea]

OBJECTIVE

To observe the curative effect of massage in the treatment of primary dysmenorrhea (PD), and its effect on hemodynamics parameters of uterine artery and serum prostaglandins.

METHODS

60 PD patients were randomly assigned to the massage group and the control group, 30 in each. Patients in the massage group received massage, while those in the control group orally took ibuprofen sustained release capsule, both for three menstrual cycles. The pain degree was assessed using visual analogue scale (VAS). The hemodynamics parameters of uterine artery [including pulsatility index (PI), resistance index (RI), systolic to diastolic peak ratio (S/D)], the serum levels of prostaglandin F2alpha (PGF2alpha) and PGE2 in the menstruation were detected in the two groups before and after treatment.

RESULTS

There was no statistical difference in each index before treatment between the two groups (P>0.05). Compared with the control group after treatment, the scores of VAS (mm, 33. 17+/-7.93 vs 63.53+/-9.48), PI (2.18+/-0.18 vs 2.74+/-0.23), RI (0.67+/-0.09 vs 0. 86+/-0.27), S/D (5.44+/-0.47 vs 7.56+/-0.28), and serum PGF2a level (ng/L, 28. 10+/-2.41 vs 37.68+/-2.16) were lower and serum PGE, level (ng/L, 29.82+/-2.13 vs 26.43+/-1.42) higher in the massage group, showing statistical difference (P<0.05, P<0.01).

CONCLUSIONS

Massage had favorable therapeutic effect on PD. Its effect might be achieved through improving the blood circulation of uterus, adjusting the abnormal levels of PGF2a and PGE2, thus exerting pain relief effect.

[Effect of electroacupuncture at different acupoints on plasma TXB2 and 6-keto-PGF(1alpha), contents in dysmenorrhea rats]

OBJECTIVE

To observe the effect of electroacupuncture (EA) on plasma thromboxane B2(TXB2) and 6-keto-prostaglandin F1alpha (6-keto-PGF1alpha) levels in dysmenorrhea rats in order to investigate its mechanism underlying relief of primary dysmenorrhea and specificity of acupoint efficacy.

METHODS

Female SD rats with diestrus were randomly divided into saline control (control), model, EA Sanyinjiao (SP 6), EA Xuehai (SP 10), EA Xuanzhong (GB 39) and EA non-acupoint (NAP) groups, with 10 rats in each. Dysmenorrhea model was established by subcutaneous injection of Estradiol Benzoate (0.5 mg/rat on the 1st and 10th day, and 0.2 mg/rat from the 2nd to the 9th day) and intraperitoneal injection of Oxytocin (0.2 mL/rat, 1 h after last injection of Estradiol Benzoate on the 10th day). EA was applied to bilateral SP 6, SP 10, GB 39, and non-acupoint (the mid-point between the Gallbladder and Stomach meridian at the GB 39 level) for 20 min. The latency and score of writhing were recorded for 20 min. Plasma TXB2 and 6-keto-PGF1alpha contents were detected by radioimmunoassay.

RESULTS

Compared with the control group, the latency of writhing in the model group was shortened considerably (P < 0.01), and the writhing score was increased significantly (P < 0.01). In comparison with the model group, the writhing latency was increased significantly only in the EA-SP 6 group (P < 0.05), and the writhing scores in the EA-SP 6, EA-SP 10, EA-GB 39 and EA-NAP groups were reduced remarkably (P < 0.01). Plasma TXB2 content and the ratio of TXB2/6-keto-PGF1alpha. were significantly higher in the model group than in the control group (P < 0.01). Compared to the model group, plasma TXB2 levels and the ratios of TXB2/6-keto-PGF1alpha. in the EA-SP 6, EA-SP 10, EA-GB 39 and EA-NAP groups were downregulated markedly (P < 0.05, P < 0.01), while plasma 6-keto-PGF1alpha was upregulated strikingly only in the EA-SP 6 group (P < 0.05). No significant differences were found among the EA-SP 6, EA-SP 10, EA-GB 39 and EA-NAP groups in the writhing latency and writhing score, plasma TXB2 and 6-keto-PGF1alpha, levels (P > 0.05).

CONCLUSION

EA can relieve pain reaction in dysmenorrhea rats, which may be closely associated with its effects in downregulating plasma TXB2, upregulating plasma 6-keto-PGF1alpha, content, and balancing plasma TXB2/6-keto-PGF1alpha. The effect of EA of SP 6 is relatively better.

[Effect on PGF2alpha in plasma in primary dysmenorrhea treated with eye acupuncture]

OBJECTIVE

To observe the clinical curative effect of primary dysmenorrhea and the content of prostaglandin F2alpha (PGF2alpha) in peripheral blood of menstrual periods treated with eye acupuncture therapy.

METHODS

One hundred and ten cases of primary dysmenorrhea were randomly divided into an eye acupuncture group (60 cases) and a medication group (50 cases). In eye acupuncture group, low energizer area, liver area, kidney area, heart area and spleen area etc. were selected according to the differentiation, and the eye acupuncture therapy was applied. In medication group, Ibuprofen Sustained Release Capsules was taken with oral administration for 300 mg 1-2 days before menses coming or when the symptoms appeared, once every 12 hours, for 3-5 days totally. Three menstrual periods made one session. The content of PGF2alpha in peripheral blood, and the curative effects and recurrence 3 and 6 months after treatment were observed.

RESULTS

After 3 months treatment, compared with the curative effects between both groups, the cured rate was 55.0% (33/60) and the total effective rate was 95.0% (57/60) in eye acupuncture group, which were superior to those of 34.0% (17/50) and 82.0% (41/50) in medication group (both P < 0.05). According to the following-up after 6 menstrual periods, the recurrence rate was 9.1% (3/33), inferior to that of 35.3% (6/11) in medication group. The contents of PGF2alpha in peripheral blood of menstrual periods were all reduced after treatment in two groups (both P < 0.01).

CONCLUSION

The curative effect of primary dysmenorrhea treated with eye acupuncture is favorable, and the lever of PGF2alpha in peripheral blood of menstrual periods is reduced.

[Correlation between blood-stasis tongue figure and platelet activating factor (PAF) and acetyl hydrolase of PAF (PAF-AH) in patients with primary dysmenorrhea]

OBJECTIVE

To explore the pathologic mechanism of blood-stasis tongue figure (BSTF) formation in patients with primary dysmenorrhea.

METHODS

Blood levels of platelet activating factor (PAF) and acetyl hydrolase of PAF (PAF-AH) in 41 patients with primary dysmenorrhea and 20 healthy subjects were detected by enzyme linked immunosorbent assay (ELISA).

RESULTS

The level of PAF in the 22 patients with BSTF was 252. 214 +/- 37. 568 ng/L, which was higher than that in patients without BSTF (19 patients, 212.348 +/- 22.794 ng/L) and healthy subjects (182.126 +/- 18.306 ng/L) respectively, while level of PAF-AH showed an opposite sequence in them, i.e., 3.090 +/- 1.483, 5.382 +/- 1.873, and 5.607 +/- 2.073 ng/L, respectively (P < 0.05). Patients without BSTF showed only a higher level of PAF when compared with that in healthy subjects (P < 0.05). No significant difference in PAF or PAF-AH levels was shown among patients with BDTF of different Chinese medical syndrome types (P > 0.05).

CONCLUSION

PAF level obviously increased and PAF-AH level obviously decreased in primary dysmenorrhea patients of BSTF, suggesting that the imbalance of PAF and PAF-AH was correlated with the pathologic mechanism of the BSTF formation in primary dysmenorrhea patients.

[Randomized controlled study on ear-electroacupuncture treatment of endometriosis-induced dysmenorrhea in patients]

OBJECTIVE

To observe the therapeutic effect of ear-electroacupuncture (Ear-EA) on dysmenorrhea in patients with endometriosis and to explore its underlying mechanism.

METHODS

A total of 80 endometriosis patients were randomly and equally divided into ear-EA group and body-EA group. EA (50 Hz, 0.5-0.8 mA) was applied to auricular points (Uterus, Subcortex, Shenmen, Endocrine, etc.) and body acupoints [Tianshu (ST 25), Qihai (CV 6), Guanyuan (CV 4), Sanyinjiao (SP 6), Diji (SP 8), Uterus (EX-CA 1), etc.] respectively for 30 min, once every other day for 3 months. Dysmenorrhea severity score (DSS) was assessed and plasma prostaglandin (PGE2) and 6-Keto-PGF1alpha levels detected by radioimmunoassay.

RESULTS

Compared with pre-treatment, DSS lowered significantly during the 1st and 2nd menstrual cycle in body-EA group, and during the 1st, 2nd and 3rd menstruation in ear-EA group; and the DSS of ear-EA group during the 3rd menstruation was evidently lower than that of body-EA group (P < 0.05). During the 3rd menstrual onset after the treatment, plasma PGE2 contents in both groups decreased obviously (P < 0.01), and plasma 6-Keto-PGF1alpha, levels increased considerably in comparison with pre-treatment (P < 0.01). Comparison between two groups during the 3rd menstruation showed that plasma PGE2 level of ear-EA group was markedly lower than that of body-EA group, and 6-Keto-PGF1alpha, level of ear-EA group was significantly higher than that of body-EA group (P < 0.05). No significant difference was found between two groups in clinical therapeutic effect (P > 0.05).

CONCLUSION

Both ear-EA and body-EA can effectively relieve endometriosis-induced dysmenorrhea, and the former is superior to the later in reducing pain severity, which may be closely related to their effects in reducing plasma PGE2 and raising 6-Keto-PGF1alpha level.

[Observation on therapeutic effect of acupoint application on dysmenorrhea of excess syndrome and effect on prostaglandins]

OBJECTIVE

To observe therapeutic effect of acupoint application on dysmenorrhea of excess syndrome and its effect on prostaglandins.

METHODS

The patients with primary dysmenorrhea of excess syndrome were randomly divided into an application group and a medication group. The application group of 31 cases were treated with application of Chinese medicine composed of Zhinanxing (Rhizoma Arisaematis), Sanleng (Rhizoma Sparganii), Ezhu (Rhizoma Zedoariae), etc. at Zhongji (CV 3), Guanyuan (CV 4), Qihai (CV 6); and the medication group of 30 cases were treated with oral administration of Tianqi Tongjing Capsules. The scores for the pain degrees and the duration of dysmenorrhea were observed and prostaglandin F2alpha (PGF2alpha) and prostaglandin E2 (PGE2) contents in peripheral blood were determined before and after treatment.

RESULTS

The total effective rate of 93.5% in the application group was significantly better than 73.3% in the medication group (P < 0.05); after treatment, the scores of the symptoms were significantly decreased in the two groups (both P < 0.01), with more obvious improvement in the application group than the medication group (P < 0.01). The PGE2 content was significantly increased, and the PGF2alpha content and PGF2alpha/PGE2 were significantly decreased in the application group (all P < 0.01).

CONCLUSION

Acupoint application has a better therapeutic effect on dysmenorrhea of excess syndrome and has benign regulative action on synthesis of prostaglandins in the patients with primary dysmenorrhea.

[Study on the underlying mechanism of acupuncture in regulating neuroendocrine activity in dysmenorrhea rats]

OBJECTIVE

To observe the influence of acupuncture on neuroendocrine in rats with primary dysmenorrhea, so as to explore its underlying mechanism in relieving dysmenorrhea.

METHODS

Forty female Wistar rats were equal randomized into control, model, acupuncture and Extractum Leonuri Inspissatum (ELI) groups, with 10 cases in each. Primary dysmenorrhea model was established by intragastric perfusion of diethylstilbestrol (3 mg/kg), once daily for 12 days. "Guanyuan" (CV 4), bilateral "Sanyinjiao" (SP 6) and "Diji" (SP 8) were punctured once daily for 7 days. ELI (80 g/kg) was given to rats of ELI group via gastrogavage, once daily for 7 days. On the 12th day, the rats of 4 groups were given with oxytocin (14 U/kg, i.p.) for inducing dysmenorrhea. The latency and incidence rate of writhing within 30 min were observed. The serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and progesterone (P) were detected by radioimmunoassay, and the expression of gonadotropin-releasing hormone (GnRH) mRNA in hypothalamus and ovary, GnRH receptor (GnRH-R) mRNA in pituitary, estrodiol receptor (ER) mRNA and progesterone receptor (PR) mRNA in uterus were determined using RT-PCR.

RESULTS

After modeling, the writhing latency shortened considerably and the writhing times, serum FSH, LH and E2 levels increased apparently, and serum P content decreased markedly (P<0.05). Compared with model group, the writhing times, serum FSH, LH, and E2 contents in acupuncture and ELI groups reduced significantly (P<0.05), while the writhing latency and serum P contents in acupuncture and ELI groups increased remarkably (P<0.05). Compared with control group, hypothalamic GnRH mRNA, ovary GnRH mRNA, pituitary GnRH-R mRNA and uterus ER mRNA expressions in model group were up-regulated significantly, while uterus PR mRNA was down-regulated markedly in model group (P<0.05). In comparison with model group, hypothalamic GnRH mRNA, ovary GnRH mRNA, pituitary GnRH-R mRNA and uterus ER mRNA expressions in acupuncture and ELI groups were suppressed significantly (P<0.05), while uterus PR mRNA expressions in the later two groups were up-regulated obviously (P<0.05).

CONCLUSION

Acupuncture of CV4, SP6 and SP8 can effectively relieve dysmenorrhea in the rat, which may be closely related to its effects in regulating neuroendocrine activities and the related receptor expression of hypothalamus-pituitary-ovary axis.

[Influence of ginger-partitioned moxibustion on serum NO and plasma endothelin-1 contents in patients with primary dysmenorrhea of cold-damp stagnation type]

OBJECTIVE

To explore the mechanism of ginger-partitioned moxibustion in the treatment of cold-damp stagnation type primary dysmenorrhea (PD) patients.

METHODS

A total of 209 PD outpatients of cold-damp stagnation type from 3 hospitals were randomized into moxibustion group (n = 105) who were treated with ginger-partitioned moxibustion, and control group (n = 104) who were asked to take Yueyue Shu Granules (an effective patent drug for PD). Ginger-partitioned moxibustion was applied to Shenque (CV 8) and Guanyuan (CV 4) from the menstrual onset on for the first course and 3 days before the onset for the second and third course, continuously for 3 days. Before and after the treatment, plasma endothelin-1 (ET-1) and serum nitric oxide (NO) contents in those patients (n = 40/group) and normal women (n = 20) experiencing menstrual period were determined by radioimmunoassay and nitrate reductase method.

RESULTS

After the treatment, of the 105 and 104 cases in moxibustion and control groups, 58 and 32 cured, 37 and 33 markedly effective, 5 and 24 effective, 5 and 15 failed, with the effective rates being 95.24% and 85.58% respectively. The therapeutic effect of moxibustion group was significantly better than that of control group (P<0.05). Before treatment, in comparison with normal group, plasma ET-1 contents in both moxibustion and control groups were significantly higher (P<0.01), while serum NO contents in these two groups markedly lower (P<0.01). After the treatment, self-comparison of both moxibustion and control groups showed that plasma ET-1 decreased significantly and serum NO levels in increased considerably (P<0.05, P<0.01), and the therapeutic effect of moxibustion group was markedly superior than that of control group in lowering plasma ET-1 (P<0.01).

CONCLUSION

Ginger-partitioned moxibustion is effective in relieving primary dysmenorrhea patients' abdominal pain, which may be closely associated with its actions in lowering plasma ET-1 level and raising serum NO contents.

Role of leukotrienes in the pathogenesis of dysmenorrhea in adolescent girls

Although dysmenorrhea is a leading cause of gynecologic complaints among adolescents, its pathogenesis is incompletely understood. The purpose of this study was to determine the role of prostaglandins and leukotrienes in the pathogenesis of dysmenorrhea. Twenty patients with dysmenorrhea aged 16.2+/-1.2 years and 20 healthy age-matched controls with eumenorrhea (absence of pain during menstruation) were included in the study. Serial measurements of serum PGF2alpha and urinary LTE4 levels during the menstrual cycle were obtained; serum progesterone was measured and ultrasonographic evaluations were made. LTE4 and PGF2alpha levels decreased on the third day and recovered on the 10th day of the menstrual cycle in both groups. Urinary LTE4 levels were higher in the control group than in the patient group on the 1st, 3rd and 10th days of the cycle (p<0.05 for each). This study suggests that there is a distinct pattern of leukotriene production during the menstrual cycle, but the changes in the systemic level are not responsible for their role in the pathogenesis of dysmenorrhea. Further studies at the local level in the target organ are necessary to elucidate the role of the lipid mediators in the pathogenesis of dysmenorrhea.

[Effects of substance-partitioned moxibustion on plasma beta-EP content in the patient with primary dysmenorrhea of cold-damp stagnation type in the menstrual period]

OBJECTIVE

To probe into the mechanism of substance-partitioned moxibustion in treatment of primary dysmenorrhea (PD) of cold-damp stagnation type.

METHODS

The treatment group (105 cases of PD) were treated with substance-partitioned moxibustion and the control group (104 cases) were treated with Chinese drug Yueyue-shu. Their therapeutic effects were observed. Plasma beta-endorphin contents in menstrual period were determined before and after treatment in 40 patients of each group.

RESULTS

The total effective rate of 95.2% in the substance partitioned moxibustion group was better than 85.6% in the control group (P < 0.05); after treatment, plasma beta-endorphin content significantly increased in the substance-partitioned moxibustion group (P < 0.01).

CONCLUSION

Substance-partitioned moxibustion has obvious therapeutic effect on primary dysmenorrhea of cold-damp stagnation type, which is carried out possibly through regulating the plasma beta-endorphin content as one of the mechanisms.

Reproductive hormones in plasma over the menstrual cycle in primary dysmenorrhea compared with healthy subjects

The pathogenesis of primary dysmenorrhea is still poorly understood. The objective of the present investigation was to study differences in plasma concentrations of reproductive hormones in women with primary dysmenorrhea vs. healthy controls. In a prospective, parallel-group study we determined the plasma concentrations of oxytocin, vasopressin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), 17beta-estradiol (17beta-E2), progesterone and prostaglandin F 2alpha metabolite (15-keto-13,14-dihydro-PGF 2alpha) over one menstrual cycle in eight women with primary dysmenorrhea and eight healthy volunteers. In dysmenorrheic women the plasma concentration of oxytocin was significantly higher at menstruation (p = 0.0084) and that of vasopressin significantly lower at ovulation (p = 0.0281) compared with healthy women. They had also higher FSH levels in the early follicular phase (p = 0.0087) and at menstruation (p = 0.0066) and the 17beta-E2 concentration was higher in the late follicular phase (p = 0.0449). No differences were seen for LH, progesterone and PGF 2alpha metabolite. The differences of oxytocin, vasopressin, FSH and 17beta-E2 concentrations found in plasma suggest an involvement of these hormones in mechanisms of primary dysmenorrhea. These mechanisms seem to be mainly regulated through the hypothalamus and pituitary. The influence of oxytocin on the non-pregnant uterus seems to be more important than earlier believed.

[Influence of Xianglingwan on dysmenorrhea and serum CA125 in treating patients with endometriosis]

OBJECTIVE

To observe the influence of Xianglingwan on dysmenorrhea and serum CA125 in treating patients with endometriosis.

METHOD

A total of 54 patients with endometriosis and without medical complications were random selected. Xianglingwan was administered from the fifth day of the menstrual cycle for 3 weeks every month as a therapeutic course, and three months for a therapeutic period. Pelvic type B ultrasonograph and blood CA125 were detected before and after treatment. Visual analogue scale was admitted to evaluate the dysmenorrhea.

RESULT

The serum CA125 reduced obviously after therapy. There was a significant difference between them (P < 0.01). The symptom of dysmenorrhea also reduced obviously after treatment. There was a significant difference between them (P < 0.05).

CONCLUSION

Xianglingwan can treat edometriosis effectively, and has less adverse reactions, it can also reduce the symptom of dysmenorrheal and the serum CA125.

[Acupuncture at Siguan points for treatment of primary dysmenorrhea]

OBJECTIVE

To observe the therapeutic effect of acupuncture at Siguan points with Qinglong Baizei method on primary dysmenorrhea (PD) and to study the mechanism.

METHODS

One hundred and eighty cases of PD were zandomly divided into group A, group B and group C, 60 cases in each group. Group A were treated by acupuncture at Hegu (LI 4) and Taichong (LR 3) with Qinglong Baiwei method; group B were treated by routine acupuncture with Sanyinjiao (SP 6), Ciliao (BL 32) selected as main points; and group C were treated by oral administration of Yueyueshu Decoction. After treatment of 3 months, the therapeutic effects were analyzed, and changes of hemorrheological indexes and prostaglandin level were observed.

RESULTS

The cured rate and the total effective rate were 75.0% and 100.0% in group A, 60.0% and 95.0% in group B, and 25.0% and 90.0% in group C, respec tively, group A and B being significantly better than group C (P < 0.01). And the analgesic effects within 30 min of treatment in both group A and group B were significantly better than that in group C (P < 0.01), and that in group A was significantly better than that in group B (P < 0.01).

CONCLUSION

Acupuncture at Siguan points with Qinglong Baiwei method has a significant therapeutic effect on primary dysmenorrhea. The possible mechanism is to relieve pain by improving blood circulation and inhibiting production of prostaglandin.

[Effect of tongjingning granule on primary dysmenorrhea]

OBJECTIVE

To study the mechanisms of tongjingning granule (TJN) on primary dysmenorrhea (PD).

METHODS

One hundred and twenty PD patients were treated with TJN, and 40 patients treated with aspirin as controls. The levels of serum estrogen (E2) and progestin (P) content in the luteal metaphase and anaphase (MI/AI) as well as endothelin (ET) and calcitonin gene related peptide (CGRP) in the metaphase and menstrual stage before and after treatment in partial patients were determined.

RESULTS

The therapeutic effect , and the curative markedly-effective rate and improvement rate of main accompanied symptoms of severe and moderate PD patients in the treated group were superior than those in the control group (P < 0.01). The level of E2 and ET were significantly decreased, and the content of P and CGRP were significantly increased in the treated group after treatment respectively (P < 0.01).

CONCLUSION

JTN not only can regulate ovarian hormone, ET and CGRP, but shows advantages in adjusting spirits and emotions, improving homeostasis and consolidating the therapeutic effect.

Evaluation of nitric oxide and homocysteine levels in primary dysmenorrheal women in Taiwan

In this study, we investigated the possible pathophysiological mechanisms in primary dysmenorrhea. The study was undertaken to determine the effect of homocysteine on the nitric oxide (NO) pathway in primary dysmenorrheal women. A total of 94 students from a local nursing college participated. Group 1 consisted of 51 normal subjects with no dysmenorrhea. Group 2 had 43 subjects with dysmenorrheal symptoms. Our results show that serum NO levels in group 2 are higher than those in group 1. However, the serum homocysteine level was lower in group 2. These observations indicate that the NO pathway is involved in the pathophysiological mechanism responsible for the damaging effects of homocysteine on dysmenorrheal women.

A study of serum malondialdehyde and interleukin-6 levels in young women with dysmenorrhea in Taiwan

The purpose of this study was to examine whether the symptoms of dysmenorrhea in young women were related to serum malondialdehyde (MDA) and interleukin-6 (IL-6) levels. Ninety-four non-smoking and non-drinking female subjects without serious disease from a nursing college in Taiwan were divided into two groups. Group 1 consisted of 51 subjects without dysmenorrheal, and Group 2 of 43 subjects with dysmenorrheal symptom. All subjects were provided informed consent. Results showed that the serum levels of MDA and of IL-6 were significantly different between the two groups (P < 0.05) and (P < 0.005), respectively. We conclude that the pathological mechanism of dysmenorrhea is mediated by oxidative stress caused by the action of cytokine.

[Effect of jiawei mojie tablet on plasma oxytocin level in patients with primary dysmenorrhea in menstrual period]

OBJECTIVE

To investigate the therapeutic mechanism of Jiawei Mojie Tablet (JMT) in treating primary dysmenorrhea (PD) by observing its effect on plasma oxytocin (OT) level in patients in menstrual period.

METHODS

Sixty-three patients with PD enrolled in the study were randomly divided into the JMT group (n = 33) and the control Group (n = 30, treated with Yueyueshu Granule) to observe the change of OT level in the menstrual period before and after treatment.

RESULTS

OT level in patients with PD was obviously higher than that in healthy subjects (P < 0.01), and was positively correlated with the degree of pain (r = 0.738, P < 0.01). OT level reduced significantly after treatment (P < 0.01), the reduction was more significant in the JMT group than that in the control group (P < 0.01).

CONCLUSION

JMT could reduce the OT level in menstrual period.

Diet and sex-hormone binding globulin, dysmenorrhea, and premenstrual symptoms

OBJECTIVE

To test the hypothesis that a low-fat, vegetarian diet reduces dysmenorrhea and premenstrual symptoms by its effect on serum sex-hormone binding globulin concentration and estrogen activity.

METHODS

In a crossover design, 33 women followed a low-fat, vegetarian diet for two menstrual cycles. For two additional cycles, they followed their customary diet while taking a supplement placebo pill. Dietary intake, serum sex-hormone binding globulin concentration, body weight, pain duration and intensity, and premenstrual symptoms were assessed during each study phase.

RESULTS

Mean (+/- standard deviation [SD]) serum sex-hormone binding globulin concentration was higher during the diet phase (46.7 +/- 23.6 nmol/L) than during the supplement phase (39.3 +/- 19.8 nmol/L, P < .001). Mean (+/- SD) body weight was lower during the diet (66.1 +/- 11.3 kg) compared with the supplement phase (67.9 +/- 12.1 kg, P < .001). Mean dysmenorrhea duration fell significantly from baseline (3.9 +/- 1.7 days) to diet phase (2.7 +/- 1.9 days) compared with change from baseline to supplement phase (3.6 +/- 1.7 days, P < .01). Pain intensity fell significantly during the diet phase, compared with baseline, for the worst, second-worst, and third-worst days, and mean durations of premenstrual concentration, behavioral change, and water retention symptoms were reduced significantly, compared with the supplement phase.

CONCLUSION

A low-fat vegetarian diet was associated with increased serum sex-hormone binding globulin concentration and reductions in body weight, dysmenorrhea duration and intensity, and premenstrual symptom duration. The symptom effects might be mediated by dietary influences on estrogen activity.

[Clinical observation of forty cases in adolescent dysmenorrhea treated by traditional Chinese medicine]

OBJECTIVE

To observe the therapeutic effect of Tongjing powder (TP) and understand the change in pathophysiology of dysmenorrhea, the blood flow parameters of uterine arteries and hemorheological data before and after the TP administration.

METHODS

The blood of both uterine arteries of patients was examined by color doppler flow imaging. The hemorheological data was examined by conical viscosimeter. The two groups were compared with each other.

RESULTS

Pulsation index (PI), resistance index (RI), systolic peak value/diastolic peak value (A/B value) of dysmenorrhea patients and hemorheological data except erythrocyte sedimentation rate of dysmenorrhea patients were significantly higher than the normal control group. After treating with TP, no difference existed between two groups.

CONCLUSIONS

The blood of dysmenorrhea patients appear to be viscous and adhesive, TP can improve the state of blood circulation and treat the dysmenorrhea effectively.

CTG trinucleotide repeat length and clinical expression in a family with myotonic dystrophy

Unstable expansion of the CTG repeats in the 3' untranslated region encoding a member of the protein kinase family in the q13.3 band on chromosome 19 is a mutation specific for myotonic dystrophy. To examine the correlation between clinical expression and CTG trinucleotide repeat length, we carried out Southern blot analysis in a family with myotonic dystrophy. In this pedigree, the expanded CTG repeats were transmitted maternally. The mother had three female children. The mother had about 200 CTG repeats, and the number of repeats for each child was about 800, 1500 and 1600 in birth order. The mother and the patient with 800 repeats were unaware of muscle weakness or myotonia. Symptoms were present from age 3 years in the patient with 1500 repeats and from birth in the one with 1600 repeats. Although the mother menstruated regularly, the patients with 800 and 1500 repeats both menstruated irregularly, and the one with 1600 repeats has never menstruated. The age of onset and severity of the disease were correlated with the size of the expanded repeats. Endocrinological studies revealed that the basal levels of the gonadotropins, PRL and E2 were within normal range, and a pituitary response to LHRH was observed. These data suggest that the amenorrhea and menstrual irregularities were caused by a suprahypophyseal dysfunction. When expanded CTG repeats are transmitted maternally, abnormal products resulting from the metabolic disturbance in the affected mother may harm the fetus in utero. A heterozygous fetus, who has more CTG repeats, may be unable to metabolize the pathologic products sufficiently and therefore may become more severely affected. This may explain the exclusive maternal transmission of congenital myotonic dystrophy.

Mitogen-induced lymphocyte proliferation and peripheral blood mononuclear cell beta-endorphin concentrations in primary dysmenorrhoea

Dysmenorrhoea is a recurrent painful disease which causes physical and psychological stress. The purpose of the present study was to investigate whether there was a measurable derangement of immune cells and immune responses in women with severe primary dysmenorrhoea. On day 26 of one cycle and on days 1 and 3 of the following cycle we measured polyclonal, mitogen-induced lymphocyte proliferation and beta-endorphin concentration in peripheral blood mononuclear cells obtained from 16 infertile women with normal pelvis, of whom eight had and eight did not have the disorder. In women with dysmenorrhoea, polyclonal mitogen-induced lymphocyte proliferation was lower than in controls on all 3 days considered, but the difference was statistically significant only on day 26 (43,605 +/- 9876 micrograms/ml versus 67,305 +/- 15,249 micrograms/ml; P < 0.01). Monocyte beta-endorphin concentrations in the patients with dysmenorrhoea were significantly elevated on day 3 compared to controls (67.8 +/- 24.3 pg/10(6) cells versus 29.7 +/- 6.9 pg/10(6) cells; P < 0.05). Our results demonstrate that immune responses are modified in patients with primary dysmenorrhoea. These effects are independent of circulating hormone concentrations and are consistent with the role of dysmenorrhoea as a stressful event.

[Effect of nei-yi recipe on plasma beta-endorphin levels during menstrual cycle in women with endometriosis]

In order to investigate the mechanism of Nei-Yi Recipe (NYR) in treatment of endometriosis, we observe the changes of plasma beta-endorphin concentrations in women with endometriosis treated by NYR. It was found that in luteal phase beta-endorphin concentrations in plasma were significantly reduced in moderate and severe dysmenorrhea groups compared with mild and control groups. Moreover, beta-endorphin level in severe dysmenorrhea group was lower in the luteal phase than that in the follicular phase, and it was lower in patients with pelvic pain than that without pelvic pain. In normal women, the contents of beta-endorphin in plasma were not changed during menstrual cycle. It was also found that plasma beta-endorphin levels were significantly increased in luteal phase and follicular phase after treatment by NYR. The therapeutical mechanism of NYR on dysmenorrhea and pelvic pain and enhancement of immune function might be mediated by increase of plasma beta-endorphin levels.

Perimenstrual symptoms in women with diabetes mellitus and the relationship to diabetic control

Four hundred and six insulin-dependent diabetic women completed a Menstrual Health Questionnaire published in Balance. Sixty-seven percent of women experienced changes in blood glucose levels or glycosuria premenstrually and 70% during the menstrual phase. Changes were more common in women who regarded themselves as suffering from premenstrual syndrome. Those experiencing premenstrual craving for sweet foods tended to have higher blood glucose levels or more glycosuria at those times. This may be a consequence of some women indulging their craving. Premenstrual symptoms were not caused by hypoglycaemia. When compared with age-matched non-diabetic women responding to a similar questionnaire, the diabetic women had a later menarche and, among those not on steroidal contraceptives, were more likely to report very irregular menstrual cycles. Among those regarding themselves as sufferers of premenstrual syndrome, diabetic women had less severe premenstrual symptoms than non-diabetic women. When women from these two self-designated premenstrual [corrected] syndrome suffering groups were matched for severity of premenstrual depression, differences still persisted in the severity of some symptoms perimenstrually, raising the possibility that in some way diabetes may alter women's experience of menstrual cycle-related symptoms.

Stimulation of vasopressin release in women with primary dysmenorrhoea and after oral contraceptive treatment--effect on uterine contractility

OBJECTIVE

To study aspects of the aetiology of primary dysmenorrhoea and mechanisms underlying the therapeutic effect in this condition of an oral contraceptive.

INTERVENTION

Intrauterine pressure was recorded before and during infusion of hypertonic saline (5% NaCl, 0.06 ml/kg/min) over 75 min on the first day of bleeding in women with dysmenorrhoea and after 3 weeks of oral contraceptive treatment. Plasma sampling every 15 min of ongoing infusion for the estimation of osmolality, arginine vasopressin, oxytocin and the prostaglandin (PG) F-metabolite, 15-keto-13,14-dihydro-PGF2 alpha.

SUBJECTS

Ten healthy nulliparous women with moderate to severe primary dysmenorrhoea.

MAIN OUTCOME MEASURES

Plasma levels of posterior pituitary hormones and the PGF-metabolite. Total pressure area (TPA) of the recording curve.

RESULTS

In dysmenorrhoea before infusion the plasma concentration of vasopressin was in mean 2.18, oxytocin 5.05 and the PGF-metabolite 321.5 pmol/l, and the TPA 3.8 kPa x 10 min. After oral contraceptive treatment the vasopressin level and the TPA were significantly reduced. At both sessions apart from intensifying the pain, the saline infusion increased vasopressin and oxytocin levels as well as the TPA, whereas the concentration of the PGF-metabolite at both sessions decreased.

CONCLUSION

Confirmation is provided of the elevated secretion of arginine vasopressin and PGF2 alpha, as well as increased uterine activity in primary dysmenorrhoea. The observations are in agreement with the concept that a lowered level of vasopressin and a decreased uterine activity contributes to the beneficial effect of OCs in the condition. Stimulation of the secretion of vasopressin increases the uterine activity and symptoms of primary dysmenorrhoea, but results suggest that this effect does not involve a mechanism of increased PGF-synthesis. The role of oxytocin in dysmenorrhoea can not yet be defined.

[Effects of danggui shaoyao powder on blood rheological indexes and prostaglandin F2 alpha in dysmenorrhea patients]

The results showed that several blood rheological indexes of dysmenorrhea patients were abnormal, the contents of plasma prostaglandin F2 alpha (PGF2 alpha) and menstrual blood PGF2 alpha of the patients were significantly higher than those of the normal women. The abnormal indexes were recovered to normal range after the patients had been treated with Danggui Shaoyao Powder for 3 months. Danggui Shaoyao Powder had better actions of improving the abnormal indexes than Tianqi Dysmenorrhea Capsule did.

Negative correlation of cigarette smoking and dysmenorrhea: reduced prostaglandin synthesis due to beta-endorphin, nicotine, or acrolein antagonism

It is suggested that the mechanism for decreased incidence of dysmenorrhea in female cigarette smokers may lie in the possible inhibition of algesic prostaglandins smoking induced stimulation of beta-endorphin, nicotine, or acrolein.

[The inhibition stage of lipid peroxidation during stress]

Stress is shown to induce at first the generalized inhibition of lipid peroxidation (LPO), and then the activation of LPO. In brain and blood serum of rats subjected to continuous footshock as well as to restraint stress LPO products decreased and superoxide scavenging activity increased during the initial period of stress, after 1 hour of footshock LPO indices nearly reached normal values, and after 2 hours of footshock the accumulation of LPO products and decrease of superoxide scavenging activity were seen. LPO inhibition was accompanied by accumulation of easy oxidizable brain phospholipids and by depletion of brain cholesterol, during LPO activation brain cholesterol content and cholesterol-phospholipid ratio increased. The content of LPO products--fluorescent Schiff bases in blood plasma of women suffering from algomenorrhea at first decreased (O-12 h) and then dramatically increased (12-24 h) after a onset of pain at the beginning of menstruation. The data suggest that the stage of LPO inhibition precedes its activation during stress.

Plasma concentrations of vasopressin and a prostaglandin F2 alpha metabolite in women with primary dysmenorrhoea before and during treatment with a combined oral contraceptive

Oral contraceptives reduce menstrual pain but the interaction with vasopressin and prostaglandin F2 alpha, two uterine stimulants related to the condition, is unknown. Ten women with a history of moderate to severe dysmenorrhoea were studied. Repeated blood samples were taken during a first menstrual cycle without treatment, during the first 21 days of a second cycle when they received an oral contraceptive (150 micrograms levonorgestrel and 30 micrograms ethynyloestradiol) and on the first or second day of the bleeding following hormonal withdrawal. Measurements were made of plasma concentrations of arginine vasopressin, 15-keto-13,14-dihydroprostaglandin F2 alpha, oestradiol-17 beta, progesterone, ethynyloestradiol, levonorgestrel, FSH, LH and prolactin, and serum osmolality was measured. Seven of the women rated their discomfort as moderate to severe on the first two menstruations, but as none or light at the withdrawal bleeding; with the rating scale for degree of pain that was used, this decrease in pain was significant (P less than 0.001). The plasma concentration of vasopressin in these seven women showed significant variation, with the highest concentrations being obtained at the beginning of the two painful menstruations (3.76 +/- 0.76 and 1.75 +/- 0.30 (S.E.M.) pmol/l) and at ovulation in the control cycle (1.91 +/- 0.58 pmol/l). During treatment the concentrations were consistently low, except on the first day of withdrawal bleeding (2.33 +/- 0.35 pmol/l). The concentrations of the prostaglandin F2 alpha metabolite showed less variation, but again the values at withdrawal bleeding (271 +/- 39 pmol/l) were not different from those obtained over the painful menstruations (255 +/- 24 and 217 +/- 25 pmol/l).(ABSTRACT TRUNCATED AT 250 WORDS)

The dynamics of nonsteroidal anti-inflammatory therapy for primary dysmenorrhea

The dynamics of drug therapy are generally discussed in terms of absorption, excretion, and blood levels. These established methods of analyzing the pharmacodynamics frequently fail to determine the more critical tissue concentrations necessary for ultimate drug action. The use of intrauterine pressures to objectively measure uterine response to drug therapy may be used to demonstrate the onset and magnitude of drug action in nonsteroidal anti-inflammatory drug therapy for patients with primary dysmenorrhea. When continuous intrauterine pressure data is combined with plasma drug level sampling, a reflection of the dynamics of these drugs may be possible. Data were studied from 18 patients who participated in a double-blind, placebo-controlled, single-dose crossover study of subjective and objective responses to meclofenamate. The responses in these patients indicated a clear parallel in time response curves between plasma drug level and alterations in uterine contractile activity. The slight time delay between the changes in blood drug level and the onset of changes in uterine activity is hypothesized to represent the time necessary to establish effective tissue levels. Examples of time response curves are illustrated.

Alterations in intrauterine pressure, menstrual fluid prostaglandin F levels, and pain in dysmenorrheic women treated with nimesulide

A double-blind crossover study was carried out to evaluate the therapeutic efficacy of nimesulide and its effects on uterine activity, menstrual fluid prostaglandin F, and pain in women suffering from primary dysmenorrhea. Twenty-three women entered the clinical pharmacologic study. Intrauterine pressure was monitored with a microballoon-tipped catheter on the first day of menstruation. During the maximal pain period (based on monitoring in six patients), nimesulide significantly decreased intrauterine pressure; the measure of pain relief was consistent with decrease of uterine activity. In another six patients, the registration of intrauterine pressure during the submaximal pain period demonstrated that both in the nimesulide- and placebo-treated cycles, the uterine activity was at a lower mean level than that registered during maximal pain. Furthermore, when two 100-mg oral doses of nimesulide were administered to 11 dysmenorrheic women, in double-blind, crossover conditions with placebo as a blank reference, it brought about a reduction of menstrual fluid prostaglandin F2 levels from 382 to 94 ng/mL, (P less than .001). Fourteen women entered a four-cycle, double-blind, crossover therapeutic trial. Each patient was randomly assigned to one of two treatment sequences with nimesulide 200 mg/d PO or placebo. The therapy was judged very effective or good in 22 of 28 cycles treated with nimesulide compared with nine of 27 cycles treated with placebo (P less than .01). The amount of bleeding during the treated cycles did not change, and there were no complaints of untoward signs or symptoms related to the therapies.

Contribution to the pathogenesis of dysmenorrhea

Menstrual blood was collected from five eumenorrheic and seven dysmenorrheic women aged between 20 and 35 years for a period of three cycles each. The levels of prostaglandin F2 alpha (PGF2 alpha), prostaglandin E2 (PGE2), 6-keto-prostaglandin F1 alpha (6-k-PGF1 alpha)-the stable metabolite of prostacyclin (PGI2)-, oestradiol, oestrone, and progesterone were determined radioimmunologically. Both eumenorrheic and dysmenorrheic women showed identical blood losses. The levels of oestradiol excreted by the dysmenorrheic women were markedly elevated as compared to the non-dysmenorrheic subjects (2 p less than 0.05). Oestrone excretion was in the same order of magnitude in all subjects examined. The concentration of progesterone per menstruation was significantly higher in the eumenorrheic women (2 p less than 0.02) than in the dysmenorrheic patients. Menstrual excretion of PGF2 alpha was 2.5 times higher in the dysmenorrheic women compared to the normal subjects (2 p less than 0.05). The levels of PGE2 was identical in both groups. Excretion of 6-k-PGF1 alpha was significantly lower in the dysmenorrheic women than in the eumenorrheic subjects (2 p less than 0.02). The oestradiol/progesterone ratio showed a distinct predominance of oestradiol in the dysmenorrheic patients. PGF2 alpha dominance in the dysmenorrheic patients is expressed by the PGF2 alpha/6-k-PGF1 alpha and the PGF2 alpha/PGE2 ratios. A shift in the oestradiol/progesterone ratio in favour of oestradiol seems to be the underlying pathogenic principle of dysmenorrhea. The oestradiol dominance is associated with a shift in the PGF2 alpha/PGI2 and the PGF2 alpha/PGE2 proportions. Thus, the PGF2 alpha predominance and a simultaneous reduction of PGI2 in uterine tissue seem to be responsible for dysmenorrheic bleeding.

Prostaglandins in menstrual fluid in menorrhagia and dysmenorrhoea

Menstrual fluid was collected in vaginal cups inserted for 2 h during the first 2 days of menstruation and menstrual serum concentrations of prostaglandins PGF2 alpha and PGE2 were measured by radioimmunoassay. In 16 women from whom menstrual fluid was collected on both days, PGF2 alpha and PGE2 concentrations were significantly higher on day 1 than on day 2. The highest concentrations of PGF2 alpha and PGE2 were found in dysmenorrhoeic women on day 1. In non-dysmenorrhoeic women, the amount of PGF2 alpha and PGE2 collected in 2 h correlated directly with total menstrual blood loss. There was no statistically significant difference in the amount of prostaglandins collected in 2 h in pain-free menorrhagic women and dysmenorrhoeic women with normal loss. There was also no significant 9-ketoreductase or 9-hydroxydehydrogenase activity present in menstrual fluid which could suggest PGE2 to PGF2 alpha interconversion.

Diurnal variation of uterine contractility

The diurnal uterine activity in four normal women in the secretory phase of their menstrual cycles and one woman suffering from dysmenorrhea were studied in relation to concomitant hormone levels in blood (progesterone, hGH, prolactin, cortisol, vasopressin, and 15-keto-13,14-dihydro-PGF2 alpha). In the four normal women uterine activity decreased after midnight, unrelated to circulating levels of 15-keto-13,14-dihydro-PGF2 alpha. But during a dysmenorrheic episode the uterine hypercontractility pattern correlated well with levels of the PGF2 alpha-metabolite, indicating a role of endogenous-produced PGF2 alpha in this condition. The results demonstrate a diurnal rhythm, possibly related to the wake-sleep cycle. No simple associations were seen between vasopressin, cortisol, prolactin, hGH, the PGF2 alpha-metabolite, and uterine activity.

Vasopressin and Prostaglandins in Premenstrual Pain and Primary Dysmenorrhea

Both vasopressin and PGF2 alpha are effective uterine stimulants in the non-pregnant human uterus, especially around the onset of menstruation. In order to clarify the relationship of these hormones to menstrual pain, plasma concentrations of vasopressin and two prostaglandin metabolites (15-keto-13,14-dihydro-PGF2 alpha and 11-ketotetranor PGF metabolites) were measured in serial blood samples taken premenstrually and during menstruation. Five women with premenstrual pain gave 7-9 blood samples at intervals of 30 minutes on the day preceding the onset of menstruation. From 5 women with severe primary dysmenorrhea a corresponding series of blood samples were taken during the first day of menstruation. Two groups of 5 women with no symptoms served as controls, either premenstrually or during menstruation. In the women with premenstrual pain the vasopressin concentrations were significantly higher than in the corresponding control group. Even higher and markedly fluctuating vasopressin levels were found in the women with dysmenorrhea who, in general, had more intense pain than the women with premenstrual symptoms. In the group with dysmenorrhea there was also a significant rise in plasma concentration of the PG metabolites. No such increase was seen in the group with premenstrual pain. It is concluded that the pathophysiology of premenstrual pain could imply increased vasopressin secretion. The more severe pain in primary dysmenorrhea seems to be the result of a combined effect of vasopressin and PGF2 alpha.

Effects of naproxen sodium on menstrual prostaglandins and primary dysmenorrhea

Prostaglandins E2 and F2 alpha in the menstrual fluid from 12 patients with primary dysmenorrhea were measured by radioimmunoassay (RIA). Each patient was studied for 3 cycles, using vaginal tampons issued for this study. All tampons were collected individually for prostaglandin extraction and RIA. Severity of dysmenorrhea and clinical response to treatment were evaluated by a scoring method and by the patients' self-assessment. Each patient in this double-blind cross-over study had a control cycle and 2 treatment cycles with naproxen sodium tablets (275 mg) or placebo in random order. The treatment regimen was 2 tablets at the first sign of menses followed by one tablet 4 times daily for 3 days. Nine patients obtained good to excellent relief from naproxen sodium, but no relief from the placebo. Two patients had moderate to good response to both naproxen and placebo, and one patient showed no response. Naproxen therapy but not placebo therapy sharply reduced menstrual prostaglandin F2 alpha and prostaglandin E2 release. There was a positive correlation between menstrual prostaglandin levels and the severity of dysmenorrhea. Symptomatically, naproxen sodium was most effective in alleviating severe menstrual cramps but had little effect on mild cramps. It was also effective in ameliorating many but not all of the subjective symptoms such as dizziness, nausea, and vomiting. Relief of dysmenorrhea was apparent within one hour after the initial dose, attained maximum level in 2 hours, and was maintained throughout therapy.

[Determination of primary prostaglandin (Pgs) and main metabolite of PgF2 alpha in blood plasma for diagnosis of primary dysmenorrhoea]

PGE2, PGF2 alpha, and 13,14-dihydro-15-keto-PGF2 alpha were determined in two-day intervals by means of radio-immuno-assay from plasma of the arm veins of eight women with primary dysmenorrhoea. No evidence could be produced to any rise in plasma concentration of primary prostaglandins and of the main metabolite of PGF2 alpha in the course of one full menstrual cycle. These findings are likely to show that in cases of dysmenorrhoea determination of prostaglandins in peripheral venous blood is unsuitable for verification of high endogenous formation from the endometrium.