Omega-3 long chain polyunsaturated fatty acids as a potential treatment for reducing dysmenorrhoea pain: Systematic literature review and meta-analysis

AIM

This systematic literature review with meta-analysis aimed to determine the effect of omega-3 long chain polyunsaturated fatty acids on prostaglandin levels and pain severity in women with dysmenorrhoea and identify adverse side effects.

METHODS

A literature search was conducted in Embase, Scopus, Web of Science, MEDLINE complete, CINAHL and AMED databases (PROSPERO CRD42022340371). Included studies provided omega-3 long chain polyunsaturated fatty acids compared to a control in women with dysmenorrhoea and reported pain and/or prostaglandin levels. A random effects meta-analysis with Cohen's d effect size (95% confidence interval) was performed in SPPS for studies that reported pain outcomes. Study quality was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist.

RESULTS

Twelve studies (n = 881 dysmenorrhoeal women) of predominantly neutral quality (83%) were included that provided daily supplementation of 300-1800 mg omega-3 long chain polyunsaturated fatty acids over 2 or 3 months. Meta-analysis (n = 8 studies) showed a large effect of omega-3 long chain polyunsaturated fatty acids (d = -1.020, 95% confidence interval -1.53 to -0.51) at reducing dysmenorrhoea pain. No studies measured prostaglandin levels, 86% of studies measuring analgesic use showed a reduction with omega-3 long chain polyunsaturated fatty acids and few studies reported mild adverse side effects in individual participants.

CONCLUSIONS

Findings suggest that daily supplementation of 300-1800 mg omega-3 long chain polyunsaturated fatty acids over 2-3 months are generally well tolerated and reduces pain and analgesic use in women with dysmenorrhoea. However, the neutral quality of research is limited by methodological issues and the mechanism of action remains to be determined.

Cannabis sativa L. roots from Northeast Brazil reduce abdominal contortions in a mouse model of primary dysmenorrhea

ETHNOPHARMACOLOGICAL RELEVANCE

Although the root of Cannabis sativa L. has been mentioned in some regions, such as the Vale do São Francisco, for its potential traditional medicinal use as an anti-inflammatory, anti-asthmatic, and against gastrointestinal diseases, it has received little exploration and discussion.

AIM OF THE STUDY

This study aimed to perform a chemical analysis of an aqueous extract of Cannabis sativa roots (AqECsR) and evaluate its pharmacological effects against uterine disorders, in vivo and ex vivo, in rodents.

MATERIALS AND METHODS

The roots were provided by the Brazilian Federal Police, and the freeze-dried extract was used for the chemical analysis of the AqECsR by high performance liquid chromatography coupled with mass spectrometry (HPLC-MS). The sample was subsequently used in three doses for pharmacological assays (12.5, 25, and 50 mg/kg), which included the spasmolytic activity test and the primary dysmenorrhea test. The primary dysmenorrhea test aimed to verify the effect of AqECsR on induced abdominal contortions in female mice in vivo and to perform a morphometric analysis of the organs. Association tests at subtherapeutic doses of AqECsR with antidysmenorrheic drugs were also performed.

RESULTS

The data obtained by HPLC-MS suggested the presence of four substances: cannabisativine, anhydrocannabisativine, feruloyltyramine, and p-coumaroyltyramine. In the pharmacological assays, the AqECsR showed no spasmolytic effect. However, in the antidysmenorrheal activity test, AqECsR demonstrated a significant in vivo effect of reducing oxytocin-induced abdominal contortions. Morphometric analysis of the uterus showed no significant organ enlargement effect, and the association of AqECsR with subtherapeutic doses of three drugs used in antidysmenorrheal therapy (mefenamic acid, scopolamine, and nifedipine) showed an effect in reducing abdominal contortions.

CONCLUSIONS

In conclusion, AqECsR contains four chemical compounds and exhibits an antidysmenorrheic effect both alone and in association with drugs, reducing abdominal contortions in female mice without generating organ enlargement in the animals. Further studies are needed to prove the mechanism of action by which AqECsR promotes its effect on primary dysmenorrhea and to explore its associations.

Carvacrol-Loaded Nanoemulsion Promotes Tocolytic and Anti-Dysmenorrhea Effects in Rodents

INTRODUCTION

Carvacrol is a phenolic constituent of essential oils that has antinociceptive, anti-inflammatory, and antioxidant activities.

METHOD

This study aimed to evaluate the in vitro spasmolytic and in vivo anti-dysmenorrhea potential of a nanoemulsion-containing carvacrol (nanoCARV).

RESULTS

In isolated rat uterus, nanoCARV reduced spontaneous contractions (pEC50 = 3.91 ± 0.25) and relaxed preparations pre-contracted with oxytocin (pEC50 = 3.78 ± 0.2), carbachol (pEC50 = 4.15 ± 0.4), prostaglandin F2α (pEC50 = 3.00 ± 0.36), and KCl (pEC50 = 3.98 ± 0.32). The investigation of the mechanism of action revealed significant differences (p < 0.05) between the pEC50 values of nanoCARV in the absence or presence of aminophylline or tetraethylammonium. In a primary dysmenorrhea model, treatment with nanoCARV reduced the number of oxytocin-induced abdominal writhes.

CONCLUSIONS

These data indicate that the anti-dysmenorrhea effect of nanoCARV may be related to the relaxation of uterine smooth muscle, with participation of the cAMP signaling pathway and potassium channels.

Multigenerational endometriosis : consequence of fetal exposure to diethylstilbestrol ?

BACKGROUND

Endometriosis, which affects 10-15 % of women of reproductive age, is an estrogen-driven condition influenced by environmental and genetic factors. Exposition to estrogen-like endocrine-disrupting chemicals (EDCs) has been reported to contribute to the fetal origin of this disease.

CASE PRESENTATION

We report here an informative family in which all prenatally DES-exposed daughters and subsequent granddaughters presented endometriosis, whereas the unexposed first daughter and her progeny presented no gynecological disorders. Moreover, the only post-pubertal great-granddaughter, who presents chronic dysmenorrhea that remains resistant to conventional therapy, is at risk of developing endometriosis. The mother (I-2) was prescribed DES (30 mg/day for 3 months) to inhibit lactation after each delivery.

CONCLUSIONS

Although a direct causal link between the grandmother's treatment with DES and the development of endometriosis in possibly three exposed generations remains speculative, this report strengthens the suspicion that fetal exposition to DES contributes to the pathogenesis of adult diseases, such as endometriosis. It also highlights a multigenerational and likely transgenerational effect of EDCs.

Taking Call

Telehealth proves to be more than just a stopgap in providing support to patients.

Paeonol alleviates primary dysmenorrhea in mice via activating CB2R in the uterus

BACKGROUND AND PURPOSE

Primary dysmenorrhea is the most common gynaecologic problem in menstruating women and is characterized by spasmodic uterine contraction and pain symptoms associated with inflammatory disturbances. Paeonol is an active phytochemical component that has shown anti-inflammatory and analgesic effects in several animal models. The aim of this study was to explore whether paeonol is effective against dysmenorrhea and to investigate the potential mechanism of cannabinoid receptor signalling.

EXPERIMENTAL APPROACH

Dysmenorrhea was established by injecting oestradiol benzoate into female mice. The effects of paeonol on writhing time and latency, uterine pathology and inflammatory mediators were explored. Isolated uterine smooth muscle was used to evaluate the direct effect of paeonol on uterine contraction.

KEY RESULTS

The oral administration of paeonol reduced dysmenorrhea pain and PGE2 and TNF-α expression in the uterine tissues of mice, and paeonol was found to be distributed in lesions of the uterus. Paeonol almost completely inhibited oxytocin-, high potassium- and Ca²⁺-induced contractions in isolated uteri. Antagonists of CB2R (AM630) and the MAPK pathway (U0126), but not of CB1R (AM251), reversed the inhibitory effect of paeonol on uterine contraction. Paeonol significantly blocked L-type Ca²⁺ channels and calcium influx in uterine smooth muscle cells via CB2R. Molecular docking results showed that paeonol fits well with the binding site of CB2R.

CONCLUSIONS AND IMPLICATIONS

Paeonol partially acts through CB2R to restrain calcium influx and uterine contraction to alleviate dysmenorrhea in mice. These results suggest that paeonol has therapeutic potential for the treatment of dysmenorrhea.

An experimental study of the anti-dysmenorrhea effect of Chinese herbal medicines used in Jin Gui Yao Lue

ETHNOPHARMACOLOGICAL RELEVANCE

Dang-Gui-Shao-Yao-San () and Gui-Zhi-Fu-Ling-Tang () and among the herbal medicines commonly used to treat primary dysmenorrhea with proven record of effectiveness.

AIM OF THIS STUDY

This study aims to assess the effectiveness of herbal medicines on relieving primary dysmenorrhea in a murine model and to delineate a plausible mechanism.

MATERIALS AND METHODS

Herbal medicines in the form of pills (Wan) or capsules, including Gui-Zhi-Fu-Ling capsule, Gui-Zhi-Fu-Ling-Wan, Jia-Wei-Xiao-Yao-Wan, and Shao-Fu-Zhu-Yu capsule were purchased from local drug stores in Nanjing. Dang-Gui-Shao-Yao-San filled from a local hospital. The identity of the drugs was validated by HPLC profiling. Female ICR mice were used for an induced dysmenorrhea model. The severity of dysmenorrhea was evaluated and scored, the motor coordination and balance affected by induced dysmenorrhea was assessed by a Rotarod test. Uterine inflammation and edema were examined after histological and immunohistochemical staining. The effect of the drugs on COX2 activity was evaluated enzymatically.

RESULTS

The Chinese herbal medicines at dosages relevant to recommended uses in humans relieved painful responses, including abdominal wall contraction, pelvic twisting and/or rear limb stretching. The treatment also improved motor coordination, extending the time staying on a rotating rod from 2.64 ± 0.38 min of oxytocin-induced group to 8.59 ± 1.45 (DGSYs), 9.50 ± 1.47 (GZFLc), 8.04 ± 1.87 (GZFLw), 9.91 ± 1.62 (JWXYw), and 8.20 ± 1.35 min (SFZYc), respectively. H&E staining showed that treatment with ibuprofen or Chinese herbal medicines markedly decreased edema and inflammatory cell infiltration in uterine tissues. The treatment did not significantly affect pattern of COX2 staining. In an in vitro enzymatic assay, the Chinese herbal medicines showed strong inhibitory activity against cyclooxygenase-2. The aqueous extracts from P. lactiflora or P. suffruticosa, two of the common components in the formulae tested, also showed anti-dysmenorrhea activity in the rotarod assay.

CONCLUSION

The study demonstrates that traditionally used Chinese herbal medicines are effective against induced-dysmenorrhea. These herbal medicines relieve dysmenorrhea symptoms likely though inhibition of cyclooxygenase activity.

Soy-based infant formula feeding and menstrual pain in a cohort of women aged 23-35 years

STUDY QUESTION

Is soy formula feeding during infancy associated with menstrual pain in reproductive-age women?

SUMMARY ANSWER

Our data suggest that soy formula feeding during infancy is associated with several indicators of severe menstrual pain in reproductive-age women.

WHAT IS KNOWN ALREADY

A prior study observed greater severity of menstrual pain in young women who as infants participated in feeding studies and were assigned to soy-based formula feeding.

STUDY DESIGN, SIZE, DURATION

We used data from the Study of Environment, Lifestyle & Fibroids (SELF), a cohort of 1696 African-American women ages 23-35 years at enrollment.

PARTICIPANTS/MATERIALS, SETTINGS, METHODS

Data on infant soy formula feeding was ascertained by self-administered questionnaire for 1553 participants, with 89% of participants receiving assistance from their mothers. Information on menstrual pain indicators was collected by web- and telephone-interview. We estimated the relative risk (RR) and 95% confidence interval (CI) using log-binomial regression, or log-multinomial regression, adjusting for participant age and maternal education.

MAIN RESULTS AND THE ROLE OF CHANCE

Women ever fed soy formula as infants were more likely than unexposed women to report ever use of hormonal contraception for menstrual pain (RR 1.4, CI: 1.1-1.9) and moderate/severe menstrual discomfort/pain with 'most periods', but not 'every period', during early adulthood (ages 18-22 when not using hormonal contraception) (RR 1.5, CI: 1.1-2.0).

LIMITATIONS, REASONS FOR CAUTION

We relied on retrospective recall to ascertain infant exposure to soy formula feeding and data on menstrual pain indicators.

WIDER IMPLICATIONS OF THE FINDINGS

Our observations add to the growing body of literature from animal and human studies on the reproductive health consequences of early-life exposure to soy formula.

STUDY FUNDING/COMPETING INTEREST(S)

This research was supported by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences and, in part, by funds allocated for health research by the American Recovery and Reinvestment Act. This research was also supported by grant K99NR017191 (KU). None of the authors has a conflict of interest.

TRIAL REGISTRATION NUMBER

Not applicable.

Mechanism of penehyclidine hydrochloride on a dysmenorrhea rat model

Primary dysmenorrhea affects the quality of life in young women, particularly school and work performance. This study investigated the mechanisms of penehyclidine hydrochloride (PHC) efficacy on a rat model of primary dysmenorrhea. The model was induced by injecting both estradiol benzoate and oxytocin. Different doses of PHC were administrated intraperitoneally following estradiol benzoate administration. Writhing scores were assessed, and pathological changes of the uterus were observed via hematoxylin and eosin staining. Western blot and real-time PCR were used to evaluate the expression level of the M₃ receptor, both TLR₃ and TLR₄ in uterine tissue, and the level of Ca²⁺ was measured in uterine tissues. Writhing scores significantly decreased in the PHC treatment group compared to model, and PHC alleviated the occurrence of edema or necrosis in the uteri compared to model group. PHC can decrease the M₃ receptor, TLR₃ , TLR₄ expression, and the Ca²⁺ level compared to the model group. PHC is a potential candidate for the future treatment of primary dysmenorrhea due to its ability to attenuate muscarinic receptors and TLRs. Preclinical Research & Development.

Extracts of compound Muniziqi granule suppressed uterus contraction and ameliorated oxytocin-induced primary dysmenorrhea

ETHNOPHARMACOLOGICAL RELEVANCE

Compound Muniziqi granule (CMG) is usually used as a traditional Uighur medicine to treat acne, chloasma, skin inflammation, primary dysmenorrhea (PDM), and menopausal syndrome. However, there are no sufficient data to support the clinic uses of CMG in PDM.

AIM OF THE STUDY

This work aims to examine the effect of CMG as a treatment for PDM and reveal its possible therapeutic mechanism.

MATERIALS AND METHODS

In vivo and in vitro mouse PDM models were utilized in this study. The mouse uterine contraction was induced by oxytocin after progynova or estradiol benzoate pretreatment. CMG, alkaloid extracts from seeds of Peganum harmala (AEP), and 10% and 95% ethanol extracts from seeds of Nigella glandulifera (EEN10 and EEN95) were given to mice in three doses by gavage. The writhing times within 30 min after oxytocin treatment were recorded to evaluate the analgesic effect, and the glutathione peroxidase (GSH-Px), malondialdehyde (MDA), 6-keto-prostaglandin F_1α (6-k-PGF_1α), prostaglandin F_2α (PGF_2α), thromboxane B2 (TXB₂), and nitric oxide (NO) levels in uterine tissues and PGF_2α and MDA in serum were determined. The effects (contractile curve) of CMG, AEP, EEN10, and EEN95 on uterus contraction induced by oxytocin in isolated mouse uterus were recorded.

RESULTS

In contrast to the control group, CMG, AEP, N10, and N95 could display analgesic activities dose dependently by reducing the writhing response of the PDM model mice. CMG, AEP, EEN10, and EEN95 could also remarkably decrease the level of PGF_2α, 6-k-PGF_1α, TXB₂, NO and MDA in uterine tissues and PGF_2α and MDA in serum, whereas the activity of GSH-Px in uterine tissues was increased. Furthermore, CMG, AEP, EEN10, and EEN95 could significantly inhibit the frequency and amplitude of isolated uterus induced by oxytocin in a concentration-dependent manner.

CONCLUSIONS

CMG exhibited a significant protective effect on experimental PDM. The mechanisms are probably associated with abating lipid peroxidation and over-inflammatory reaction, and alleviating the contraction of isolated mouse uterus. The seeds of P. harmala and N. glandulifera in the CMG may play an important role in exerting protective effects on PDM. This study provides pre-clinic proof to the use of CMG in clinical practice of PDM.

Comparisons of pharmacokinetic and tissue distribution profile of four major bioactive components after oral administration of Xiang-Fu-Si-Wu Decoction effective fraction in normal and dysmenorrheal symptom rats

ETHNOPHARMACOLOGICAL RELEVANCE

Xiang-Fu-Si-Wu Decoction (XFSWD) has been widely used to treat primary dysmenorrhea in clinical practice for hundreds of years and shown great efficacy. One fraction of XFSWD, which was an elution product by macroporous adsorption resin from aqueous extract solution with 60% ethanol (XFSWE), showed great analgesic effect. The present study was conducted to investigate the possible pharmacokinetic and tissue distribution profiles of four major bioactive constituents (berberine, protopine, tetrahydrocoptisine and tetrahydropalmatine) after oral administration of XFSWE in dysmenorrheal symptom rats, and to compare the difference between normal and dysmenorrheal symptom rats.

MATERIALS AND METHODS

Estradiol benzoate and oxytocin were used to produce dysmenorrheal symptom rat model. The experimental period was seven days. At the final day of experimental period, both normal and dysmenorrheal symptom rats were orally administrated with XFSWE, and then the blood and tissues samples were collected at different time points. Berberine, protopine, tetrahydrocoptisine and tetrahydropalmatine in blood and tissue samples were determined by LC-MS/MS. Pharmacokinetic parameters were calculated from the plasma concentration-time data using non-compartmental methods. The differences of pharmacokinetic parameters among groups were tested by one-way analysis of variance (ANOVA).

RESULTS

There were statistically significant differences (P<0.05) in Cmax, Tmax, AUC(0-t), AUC(0-∞), MRT(0-t), MRT(0-∞) and CL/F between normal and dysmenorrheal symptom rats that orally administered with same dosage of XFSWE. In tissue distribution study, the results showed that the overall trend was C(Spleen)>C(Liver)>C(Kidney)>C(Uterus)>C(Heart)>C(Lung)>C(Ovary)>C(Brain)>C(Thymus), C(M-60 min)>C(M-120 min)>C(M-30 min)>C(C-60 min)>C(C-120 min)>C(C-30 min). The contents of protopine in liver, spleen and uterus were more than that in other tissues of dysmenorrheal symptom rats. Compared to normal rats, partial contents of the compounds in dysmenorrheal symptom rats׳ tissues at different time points had significant difference (P<0.05).

CONCLUSIONS

This study was the first report about pharmacokinetic and tissue distribution investigation in dysmenorrheal symptom animals. The results indicated that berberine, protopine, tetrahydrocoptisine and tetrahydropalmatine have higher uptake and slower elimination in the rats with dysmenorrheal syndrome, which suggests that the rate and extent of drug metabolism were altered in dysmenorrheal syndrome rats. And the results also demonstrated that berberine, protopine and tetrahydropalmatine in normal and dysmenorrheal symptom rats had obvious differences in some organs and time points, suggesting that the blood flow and perfusion rate of the organ were altered in dysmenorrheal symptom animals.

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.

Decidual cast after discontinuation of oral contraceptives use in a young girl

BACKGROUND

The differential diagnosis of tissue passed per vagina in a young girl includes aborted pregnancy, rhabdomyosarcoma, polyp, and very rarely decidual cast.

CASE

A 10-year-old girl using oral contraceptives for menorrhagia presented with a decidual cast after discontinuing the drug. Symptoms disappeared during clinical follow-up without any intervention.

CONCLUSIONS

Decidual cast formation is an unusual entity of unknown origin. It's generally seen during treatment with variable contraceptives. This is the first case described with desogestrel and it occurred after discontinuing treatment.

Evaluation of the anti-inflammatory and analgesic properties of individual and combined extracts from Commiphora myrrha, and Boswellia carterii

AIM OF THE STUDY

The Chinese herbs of myrrh and frankincense are often combined for treating some inflammatory pain diseases with synergistic therapeutic effects. In this study, we investigated the effects of individual herbal extracts and combined extract on anti-inflammatory and analgesic activities in vivo and analyzed the potential bioactive components from the combination extract by ultra-performance liquid chromatography coupled with mass spectrum (UPLC-MS/MS).

MATERIALS AND METHODS

The anti-inflammatory activities were investigated by utilizing the paw edema mice induced by formalin and carrageenan. In addition, we determined the levels of PGE(2) and nitrite in the edema paw. The analgesic activity was examined against oxytocin-induced dysmenorrhea in mice. The effects of the administration of dolantin or indomethacin were also studied for references. The components in combination extract (CWE) were analyzed by UPLC-MS/MS.

RESULTS

The results showed that myrrh water extract (MWE) and the combined extract (CWE) at the 3.9 g/kg, and 5.2 g/kg showed inhibition of formalin-induced paw edema with inhibition rate of 30.44%, and 23.50%, respectively. The PGE(2) production was inhibited significantly by all samples (P<0.01 or P<0.05). CWE showed stronger suppression on carrageenan-induced mice paw edema at 2 and 3h after administration of drugs. The inhibitory effect of CWE on nitrite production was between that of MWE and water extract of frankincense (FWE) at 5.2 g/kg. The dysmenorrhea mice test showed MWE could remarkably reduce the writhing times (P<0.05) and prolong the latency period, while FWE showed no obvious effects on the writhing times. CWE significantly reduced the writhing times and prolong the latency period (P<0.01).

CONCLUSION

These results demonstrated MWE, FWE, and CWE exhibited significant anti-inflammatory and analgesic activities. The findings suggest that CWE may be therapeutically more useful for mitigating inflammatory pain than individual herbal extract. In addition, 12 potential active compounds were identified from CWE. These data may support the fact the traditional application of this combined extract in treating various diseases associated with inflammatory pain.

[Effect of acupuncture on Cx43 knock-out mice dysmenorrhea response]

OBJECTIVE

To observe the effect of acupuncture on dysmenorrhea response of Cx43 knock out mice.

METHODS

Two-months-old heterozygote [Cx43(+/-)] type and wild type [Cx43(+/+)] female mice (20 mice/type) were allocated into normal group, model group, acupuncture group and Yimucao Gao (Extractum Leonuri Inspissatum) group randomly. Dysmenorrheal model was established by feeding the mouse with diethylstilbestrol (2 mg/g) once daily for 12 days. Ocytocin (i. p. 2 U/kg) was injected on the 12th day 1 h later after the feeding. Acupuncture of "Sanyinjiao" (SP 6) and "Diji" (SP 8) was given to mice of acupuncture group, once daily for 5 days from the 7th day on after modeling. The latency of body-writhing and the writhing number were measured. Ocytocin receptor (Oct-R) mRNA and vasopressin receptor (Vas-R) mRNA expression in the uterus tissue was detected by using reverse transcription polymerase chain reaction (RT-PCR) technique, and Oct-R expression was detected with immunohistochemistry after fixating and sectioning the uterus tissue.

RESULTS

In comparison with their individual normal group, the latency of body-writhing of model groups in Cx43 (+/+) and Cx43 (+/-) mice shortened considerably, while the writhing number increased significantly (P<0.01). Compared with the corresponding model group, the writhing latencies of acupuncture and Yimucao Gao groups in Cx43 (+/+) mice and that of Yimucao Gao group in Cx43 (+/-) mice increased remarkably, and the writhing numbers of acupuncture and Yimucao Gao groups in Cx43 (+/+) mice and that of Yimucao Gao group in Cx43 (+/-) mice reduced markedly (P<0.05). In Cx43 (+/+) and Cx43 (+/-) mice, compared with their individual normal group, Oct-R and Vas-R mRNA expressions and Oct-R expression in model group were upregulated obviously (P<0.05). Compared with the corresponding model group, Oct-R and Vas-R mRNA expressions and Oct-R expression of acupuncture and Yimucao Gao groups in Cx43 (+/+) mice, and those of Yimucao Gao group in Cx43 (+/-) mice were down-regulated significantly (P<0.05). No significant differences were found between acupuncture and corresponding model groups in Cx43 (+/-) mice in the above-mentioned indexes (P>0.05).

CONCLUSION

Acupuncture can inhibit diethylstilbestrol + ocytocin induced body writhing response in Cx43 (+/+) mice rather than in Cx43 (+/-) mice, which is closely related to its effects in down-regulating Oct-R mRNA, Vas-R mRNA and Oct-R expression.

Adverse effects of phytoestrogens on reproductive health: a report of three cases

BACKGROUND

Phytoestrogens have been thought to have favorable effects on women's health and perhaps in offsetting cancers. The possible adverse effects of phytoestrogens have not been evaluated.

CASES

Abnormal uterine bleeding with endometrial pathology in three women was found to be related to a high intake of soy products. The first woman had postmenopausal bleeding with uterine polyp, proliferative endometrium and a growing leiomyoma. The second woman presented with severe dysmenorrhea, abnormal uterine bleeding, endometriosis and uterine leiomyoma not responding to treatment. The third woman with severe dysmenorrhea, abnormal uterine bleeding, endometriosis and uterine leiomyomata presented with secondary infertility. All three women improved after withdrawal of soy from their diet.

CONCLUSION

Additional information on phytoestrogens is necessary to ascertain their safety before they can be routinely used as supplements.

[Reproductive effects of occupational exposure to mercury on female workers in China: a meta-analysis]

OBJECTIVE

To analyze and evaluate the reproductive effects of occupational exposure to mercury among female workers and to identify relative sensitive indicators.

METHODS

Documents on the relations of occupational exposure to mercury and reproductive effects on female workers were collected through computer and manually that were published in Chinese language during 1989-2006. After strict selection, homogeneity test and integrated analysis for the abstracted data of the eligible studies were conducted using Review Manager Statistic Software. Combined RR value was used as the index for total effect on each project for Meta-analysis.

RESULTS

In total, 14 original research papers were included (totally 2148 subjects and 2044 controls). When comparing to the controls, the occupational exposure to mercury was significantly associated with longer menstrual period (RR = 1.82, 95% CI: 1.45-2.30), menstrual cycle delay (RR = 2.03, 95% CI: 1.74-2.37) and the changes of menstrual blood volume (RR = 2.06, 95% CI: 1.47-2.09), dysmenorrhea (RR = 2.14, 95% CI: 1.54-2.99), pregnancy-induced hypertension (RR = 2.17, 95% CI: 1.32-3.57), stillbirths (RR = 2.54, 95% CI: 1.41-4.56) and low birth weight (RR = 3.39, 95% CI: 1.38-8.33)/birth defect (RR = 2.67, 95% CI: 1.55-4.60) of their offspring (P < 0.05).

CONCLUSION

Occupational exposure to mercury could cause dysfunction of the menstrual period, menstrual cycle, menstrual blood volume, as well as dysmenorrhea for female workers being exposed to mercury and inducing adverse reproductive outcomes, including pregnancy-induced hypertension, stillbirth, low birth weight and birth defects of their offspring.

[The effect of cadmium pollution on reproductive health in females]

OBJECTIVE

To study the relationship between cadmium pollution and its adverse effects on female reproductive health status in people living in cadmium polluted area in Zhenghe, Fujian provinces.

METHODS

Data through laboratory studies on reproductive health of female residents in Cd-pollution area were studied and compared with those in control areas in Zhenghe.

RESULTS

Both prevalence rates of abnormal menstrual cycle and dysmenorrhea in unmarried women in Cd-pollution area (19.1% vs. 42.6%) were significantly higher than those in control area (5.7% vs. 18.9%) and the rates of sterility in married women in Cd-pollution area (6.3%) were significantly higher than those in control area (1.1%). During the first two pregnancies, rates of queasiness, disgorgement, spontaneous abortion and stillbirth in married women in polluted area were 44.7%, 31.7%, 10.27% and 4.23%, significantly higher than those 26.5%, 17.8%, 2.85% and 1.05% in control area, with significant differences (P < 0.05). Results from cumulative odds model analysis showed that: living in Cd-pollution area was a possible risk factor related to female reproductive health (OR = 2.072), after the other risk factors being under control.

CONCLUSION

The female reproductive health status of people residing in the cadmium polluted area had already been deteriorated.

[Assessment of the clinical efficacy and safety of epinastine plus pseudoephedrine vs loratadine plus pseudoephedrine in perennial allergic rhinitis]

BACKGROUND

Several drugs for the treatment of perennial allergic rhinitis and its symptoms have been investigated since some years ago. These drugs are: steroidal-type immunoregulators, immunotherapy and antihistamines. Because of first generation of the last ones originated several side effects, pharmacological research was oriented to the search of formulas with the same of higher efficacy, but with fewer effects on central nervous system.

OBJECTIVE

To compare the efficacy and safety of epinastine 10 mg plus pseudoephedrine 120 mg vs loratadine 5 mg plus pseudoephedrine 120 mg, twice a day, in the treatment of perennial allergic rhinitis.

MATERIAL AND METHODS

A comparative, random, open, prospective, longitudinal and multicenter study was made in 62 patients with an average age of 26.17 +/- 9.75 years (13-56 years) with diagnosis of perennial allergic rhinitis, who attended to external consultation of the different departments of allergy of the participant institutions. All patients were submitted to: complete clinical history, physical exploration, measurement of vital signs, nasal exploration, qualification of allergic symptoms and record of daily symptoms. Moreover, washout during a week and pharmacological treatment was given during two weeks. Symptoms referred by patient and findings of physical exploration during the different visits, as well as rhinoscopic findings, were assessed by a scale of five parameters of rhinitis. Tolerance grade of drugs was assessed based on frequency and severity of side effects.

RESULTS

According to the basal clinical assessment symptoms qualification of patients of groups of epinastine and loratadine was of 9.12 +/- 2.78 and 7.90 +/- 2.7, respectively. Seven side effects appeared: three cases of somnolence, one of sickness and one of anxiety in patients of group of loratadine and one case of somnolence and one of dysmenorrhea in the subjects of group of epinestine. Although it did not have statistically significant difference, it is clinically important for patients. Frequency of side effects was higher in the loratadine group.

CONCLUSION

Both drugs are efficient for the treatment of perennial allergic rhinitis.

Effects of metallic mercury on the perimenstrual symptoms and menstrual outcomes of exposed workers

BACKGROUND

Mercury is an important environmental and industrial pollutant and its effect on perimenstrual symptoms and menstrual outcomes is unclear.

METHODS

A retrospective epidemiological investigation was conducted on 296 female workers exposed to mercury vapor and 394 female workers from food processing plants. Both groups included women of 18-44 years of age currently working since last at least 1 year when studied. Women who were currently pregnant, using oral contraceptives (Ocs), an intrauterine device (IUD), and steroid hormones were excluded.

RESULTS

The air concentration of mercury in the workplace ranged from 0.001-0.200 mg/m(3). The prevalence of abdominal pain in the exposed group was significantly higher than that in the control group (odds ratio (OR) = 1.47, 95% CI is 1.03-2.11). The prevalence of dysmenorrhea in the exposed group was significantly higher than that in the control group (OR = 1.66, 95% CI is 1.07-2.59).

CONCLUSIONS

An increased prevalence of abnormal menstruation was found in mercury-exposed workers in China. Dysmenorrhea may be a useful biomarker for assessing female exposure to mercury occupationally. These observations suggest that further studies and preventive measures are warranted.

Adolescent compliance and side effects with Quick Start initiation of oral contraceptive pills

Adolescents' compliance with use of oral contraceptive pills has been described in the literature. The purpose of this study was to compare traditional Sunday Start to a same day (Quick Start) approach. A retrospective study of patients 22 years of age and younger was performed comparing compliance at 3 months and 12 months and side effects. The groups were divided into Quick Start (N = 77, 40%) and Sunday Start (N = 116, 60%). One hundred twenty-five (65%) patients were compliant at 3 months; 68 patients (35%) were compliant at 12 months. Quick Start users were more likely to comply at 3 months (72% vs. 56%, p = 0.059), especially if they were Caucasian (80% vs. 65%, p = 0.007), with dysmenorrhea (86% vs. 62%, p = 0.006), nulligravid (77% vs. 58%, p = 0.008), or nulliparous (73% vs. 59%, p = 0.038). There was no difference in side effects. There was no significant difference at 1 year in compliance or side effects. Findings suggest better compliance in adolescents at 3 months with the Quick Start approach while maintaining side effect profile.

Imaging of membranous dysmenorrhea

Membranous dysmenorrhea is an unusual clinical entity. It is characterized by the expulsion of huge fragments of endometrium during the menses, favored by hormonal abnormality or drug intake. This report describes a case with clinical, US, and MRI findings before the expulsion. Differential diagnoses are discussed.

Timing of pain and bleeding after mifepristone-induced abortion

Previous studies of medical abortion with mifepristone and a prostaglandin have reported percentages of subjects who experience cramping and/or bleeding relative to prostaglandin use. This is the first analysis of cramping and bleeding onset patterns in subjects treated with low-dose (200 mg) mifepristone and 800 microg vaginal misoprostol at 24, 48, or 72 h after mifepristone. We analyzed the cramping and bleeding onset patterns in subjects up to 8 weeks pregnant who used 800 microg vaginal misoprostol at 24, 48, or 72 h after 200 mg of oral mifepristone. We collected data from subjects' symptom diaries and divided symptom onset into 3 categories: before misoprostol use, 0--12 h following misoprostol, and more than 12 h after misoprostol. Of the 2,302 subjects, cramping and bleeding onset data were available for 2,030 (88%) and 2,123 (92%), respectively. Across all groups, 230 (11%) experienced cramping and 445 (21%) experienced bleeding before misoprostol use. There was a significantly higher percentage of subjects who experienced early cramping and/or early bleeding between the three treatment groups, and this was related to the interval between mifepristone and misoprostol. In the 12 h following misoprostol administration, cramping and bleeding patterns were similar in the three groups. The longer subjects waited to insert misoprostol, the more likely they were to experience early cramping and/or bleeding. After misoprostol insertion, cramping and bleeding patterns are similar regardless of treatment group. Patients and providers cannot rely on symptom onset to predict treatment success.

An integrated analysis of vaginal bleeding patterns in clinical trials of Implanon

The vaginal bleeding patterns observed during the use of the single-rod progestin-only implant, Implanon, compared with those seen during the use of the six-capsule implant, Norplant, have been analyzed. The acceptability of these bleeding patterns was also assessed. An integrated analysis of 13 different trials was done, studying reference periods (RP) of 90 days. These trials included totals of 1716 Implanon users and 689 Norplant users. There were statistically significant lower mean values over RP 2-8 the range over RP 2-8 is presented) for Implanon, for the number of bleeding-spotting days (15.9-19.3 vs 19.4-21.6; p = 0.0169), the number of bleeding days (7.5-10.0 vs. 11.7-13.1; p < 0.001), and the number of bleeding-spotting episodes (2.2-2.7 vs. 3.1-3.3; p < 0.0001). The bleeding patterns of Implanon users appeared to be more variable than those observed with Norplant: Implanon users had more amenorrhea, and slightly more infrequent bleeding, frequent bleeding, and prolonged bleeding than Norplant users. The difference was only statistically significant for amenorrhea (17.9%-24.8% with Implanon compared with 2.0%-7.0% for Norplant over RP 2-8). There were no statistically significant differences in the acceptability of the two products as indicated by the discontinuation rates, which were 30.2% and 0.9% in Europe and Southeast Asia, respectively, for Implanon, and 22.5% and 1.4%, respectively, in the two regions, for Norplant. The individual bleeding pattern was not predictable. However, in general, it can be stated that women initially without bleeding or with infrequent bleeding have only a small chance of becoming frequent bleeders, and vice versa. Dysmenorrhea clearly improved during use of both Implanon and Norplant. Neither Implanon nor Norplant caused anemia.

Retreatment with nafarelin for recurrent endometriosis symptoms: efficacy, safety, and bone mineral density

OBJECTIVE

To assess the efficacy, safety, and effect on bone mineral density of a 3-month course of retreatment with intranasal nafarelin acetate for recurrent symptoms of endometriosis.

DESIGN

Multicenter, open-label, nonrandomized clinical trial.

SETTING

Eleven hospital-based and private practices.

PATIENT(S)

Thirty-six women with endometriosis symptoms recurring after 3 or 6 months of treatment with nafarelin.

INTERVENTION(S)

Nasal nafarelin 200 micrograms twice daily for 3 months.

MAIN OUTCOME MEASURE(S)

Assessments for dysmenorrhea, dyspareunia, pelvic pain, tenderness, and induration. Measurement of bone mineral density of the lumbar spine.

RESULT(S)

Improvements from admission to the end of retreatment were significant for dysmenorrhea, pelvic pain, tenderness, induration, and dyspareunia. Three months after retreatment ended, mean symptom scores for dysmenorrhea and pelvic tenderness, although worse than at the end of retreatment, were still significantly better than scores at admission. Mean bone mineral density 3 months after retreatment was 0.56% lower than before retreatment and 1.94% lower than before initial treatment.

CONCLUSION(S)

Three-month nafarelin retreatment for recurrent endometriosis symptoms was effective and safe.

A three-year clinical investigation into efficacy, cycle control and tolerability of a new low-dose monophasic oral contraceptive containing gestodene

This long-term, open-label multicenter study investigated the clinical efficacy and tolerability of a monophasic oral contraceptive containing 20 micrograms ethinylestradiol and 75 micrograms gestodene. A total of 670 women between the ages of 18 and 45 years received the trial preparation over a 3-year period, giving 19,095 evaluable cycles. Of the 670 participants in the study, 75% completed at least 24 cycles with the trial preparation and 46% remained in the study for the full 3 years. One pregnancy occurred during the study which was considered by the investigator to be the result of misuse of the drug, giving an uncorrected Pearl Index of 0.07. Cycle control with the trial preparation was good, especially in women who did not miss any pills. By cycle 3, only 10.2% of women who had not missed pills reported intermenstrual bleeding (scanty or medium/excessive bleeding) and this decreased to 2.3% by cycle 36. The preparation was well tolerated, with a low incidence of unprompted adverse events. There were no clinically significant changes in mean body weight or blood pressure. Over the 3 years of the study, 10% of women withdrew from the study for reasons related mostly to mild adverse events. Results from this study demonstrate that the trial preparation is a reliable and well-tolerated oral contraceptive that provides good cycle control.

Membranous dysmenorrhea: the forgotten entity

BACKGROUND

Membranous dysmenorrhea involves the spontaneous slough of the endometrium in one cylindrical or membranous piece that retains the shape of the uterine cavity. Because this entity is rarely mentioned in the medical literature, the purpose of this report is to describe two such cases.

CASES

An 18-year-old nullipara with regular menstrual cycles presented with membranous dysmenorrhea after taking the contraceptive Gynera (Gestodene 0.075 mg, ethinyl estradiol 0.030 mg). Symptoms disappeared when the medication was discontinued. The second patient, a 26-year-old woman, gravida 1, para 1, was on a 10-day monthly regimen of Provera (medroxyprogesterone acetate) 2.5 mg/day for dysfunctional uterine bleeding. When the Provera dose was increased to 10 mg/day, the symptoms disappeared.

CONCLUSION

Membranous dysmenorrhea is "a disease of theories" with various recommended medications. When this condition is caused by iatrogenic treatment, the best approach is to discontinue the offending drug or change its dosage.

[Effects of mercury exposure on reproduction in female workers]

Reproductive hazards in 704 female workers exposed to low-level metallic mercury and 583 controls were investigated. Females exposed to low-level mercury for a long term mainly manifested dysmenorrhoea, and the incidence of dysmenorrhoea increased with exposure dose, suggesting a dose-response relationship. At a level over 0.06 mg/m3 of mercury, incidence of hypomenorrhea significantly increased, and in general, at a level below 0.06 mg/m3, menstrual cycles, quantity and duration of menstrual flow did not change significantly. Differences in incidences of preterm delivery, spontaneous abortion, fetal death, still birth, and complications of pregnancy between the group exposed to 0.06-0.1 mg/m3 of mercury and the control group did not reach a significant level. Incidences of birth defect, neonatal asphyxia, neonatal death, infant infection, low birth weight, retardation on physical and mental development in offsprings of the exposed females were not significantly higher than in those of controls.

Menstrual function in workers exposed to toluene

Rates of menstrual disorders were studied in 231 female production workers with high exposure to toluene (mean 88 (range 50-150 ppm) in a factory manufacturing audio speakers and compared with a control group of 58 female production workers in other departments in the same factory who had little or no exposure to toluene (0-25 ppm). An external community control group of 187 working class women under routine care at public maternal and child health centres were also studied. Detailed menstrual and reproductive histories were obtained by personal interview using a structured questionnaire. The rates for dysfunctional uterine bleeding (cycle irregularity and prolonged or heavy menstrual bleeding) were similar in all groups. Dysmenorrhoea seemed to occur more often in the women highly exposed to toluene compared with women at maternal and child health centres, but not compared with factory controls with low exposure to toluene. There was no evidence that dysfunctional uterine bleeding was likely to result from exposure to toluene. It is uncertain whether dysmenorrhoea was associated specifically with exposure to toluene, as other behavioural and work related factors may also result in dysmenorrhoea.

Clinical experience with triphasic oral contraceptive (Triquilar) in 527 women in China

From October 1987 to May 1989, a total number of 527 women completed a total of 6,291 treatment cycles in 6 centers in China for the study of a triphasic oral contraceptive - Triquilar. The mean age of subjects was 30.21 +/- 2.84 years. There were 7 pregnancies during the study period. Among them, five were patient failures because of missed pill or incorrect intake; one had taken barbiturates along with Triquilar. Only one woman became pregnant in the 11th treatment cycle without any reason being found. In most cases, menstrual flow decreased and dysmenorrhea improved as treatment continued. Of the total treatment cycles, the incidence of missed withdrawal bleeding was 0.25%, spotting 0.97%, and breakthrough bleeding 0.48%. Nausea and vomiting was the most common side effect and accounted for 6.4% of the total treatment cycles. This was followed by breast tenderness (3.7%), dizziness (2.4%) and headache (1.6%). Most of the side effects occurred during the first few cycles and were alleviated later. By the end of one year, the total dropout was 64 cases. The reasons for discontinuing treatment were: pregnancy 1.33 (per hundred women), menstrual disturbances 0.76, side effects 3.80, other medical reasons 2.09, and personal reasons 4.18. The results confirm that Triquilar is an effective oral contraceptive with good cycle control and low incidence of side effects. No serious reaction has been reported. It has been well accepted by the Chinese women. However, due to the low dosage of steroids, it is of utmost importance to avoid errors in its use.(ABSTRACT TRUNCATED AT 250 WORDS)

Hormonal and cytopathological changes in vaginal and cervical smears from women undergoing chemotherapy for extragenital malignant diseases

The effects of various chemotherapeutic drugs on the squamous epithelium of the cervicovaginal tissues were investigated in a test group of 74 and a control group of 44 women with advanced extragenital malignancy. The cytological findings were as follows: (A) cytohormonal changes reflecting estrogenic withdrawal in pre- and postmenopausal women, (B) reversible cytopathological changes reflecting a cytotoxic reaction, and (C) absence of premalignant and malignant changes.

Contraception with levonorgestrel, 0.15 mg, and ethinyl estradiol, 0.03 mg. Clinical studies in Latin America

Levonorgestrel, 0.15 mg, and ethinyl estradiol, 0.03 mg, an ultra-low-dose oral contraceptive product, was studied in Latin America. In total, 1,206 sexually active, fertile women in their reproductive years were followed through 9,736 cycles. Only one of eight pregnancies was attributed to failure of the medication, resulting in a corrected Pearl index of 0.13. Very good cycle regulation was achieved, with an acceptably low rate of intermenstrual bleeding. The medication was discontinued for medical reasons in only 5% of the patients. Apart from a mild case of thrombophlebitis, there were no major side effects. These studies show that this combination oral contraceptive provides effective contraception with a very low incidence of side effects.

Difficulties in taking care of business: women addicts as mothers

This paper is devoted to a discussion of women addicts as mothers. Women who are addicted while pregnant begin their careers as mothers with extreme guilt and a sense of initial failure. Heroin becomes a mechanism for coping with the routine difficulties of childraising. Children can also act as a controlling force on their mother's addiction if she has the option to perform her mothering duties in an otherwise "normal" fashion. If the woman is being supported adequately and can be available for her children, it is possible to combine addiction and mothering. Often, however, the woman has to work outside the home (usually in criminal pursuits) and the general chaos of her life greatly impinges on her ability to fulfill her mothering duties. Children are occasionally mistreated, sometimes neglected physically, and often neglected psychologically by a mother who is frequently absent. Addicted mothers feel extreme guilt and remorse over this neglect, and often take stock of their situation when their roles as a mother is threatened; the children are being taken away physically or growing up and she is losing them to time. The woman addict most often wants "out" of the heroin life when her children and her role as mother--her last remaining option--are in jeopardy.