COMPLEMENTARY MEDICINE AND QUALITY OF LIFE IN GYNAECOLOGICAL PATIENTS WITH DYSMENORRHEA

Background Dysmenorrhea is a major gynaecological complaint among females who have reached menarche. It is one of the major causes of absenteeism of females from schools and at the workplaces resulting in loss of productive working hours and work efficiency. Owing to socioeconomic and cultural differences, females from different backgrounds perceive and manage dysmenorrhea differently. Little is known about the use of complementary and alternative medicines (CAM) in the management of this condition by females in senior high schools in Ghana. Thus, this study sought to assess the use of CAM in the management of dysmenorrhea among female students in two senior high schools in Ghana. Methods A school-based cross-sectional study using a quantitative approach was conducted on a total of 478 female students attending Archbishop Porter Girl's Secondary School and Mporhor Senior High School. Information on the sociodemographic characteristics, lay representations of dysmenorrhea, pain intensity and severity, quality of life, self-management, and the use of CAM in the management of dysmenorrhea were obtained. The data were analysed using SPSS. Results 79.3% of the students used some form of CAM to manage dysmenorrhea. Of CAM users, 32% were utilizing mind-body medicine such as endurance and relaxation, 31% used the whole and alternative medicine such as the hot water therapy, 15% used biological-based medicine such as herbal products, and 22% used the manipulative and body-based systems such as exercises. Various CAM methods and products were perceived to be effective in relieving the pain and discomfort associated with dysmenorrhea in about 90% of the participants who used them. Significant associations were reported for pain severity and quality of life (QoL). Conclusions This study has demonstrated that the female students experiencing dysmenorrhea employ various CAM remedies in its management. Therefore, there is the need for education on the right management of dysmenorrhea to ensure that safe and efficacious CAM products and methods are used by adolescent female students.

Dysmenorrhoea is the occurrence of painful menstrual cramps of uterine origin and is a very common gynaecological complaint with negative effect on a sufferer's quality of life. Medical therapy for dysmenorrhoea includes oral contraceptive pills (OCP) and nonsteroidal anti-inflammatory drugs (NSAIDs) which both act by suppressing prostaglandin levels. While these treatments are very successful there is still a 20 to 25% failure rate and surgery has been an option for such cases. Uterine nerve ablation (UNA) and presacral neurectomy (PSN) are two surgical treatments that have become increasingly utilised in recent years due to advances in laparoscopic procedures. These procedures both interrupt the majority of the cervical sensory pain nerve fibres. Observational studies have supported the use of these procedures for primary dysmenorrhoea. However, both operations only partially interrupt the cervical sensory nerve fibres in the pelvic area and, therefore, this type of surgery may not always benefit women with dysmenorrhoea. To assess the effectiveness of surgical interruption of pelvic nerve pathways as treatment for primary and secondary dysmenorrhoea, and to determine the most effective surgical treatment. We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (searched 9 June 2004), CENTRAL (The Cochrane Library Issue 2, 2004), MEDLINE (1966 to Nov 2003), EMBASE (1980 to Nov 2003), and CINAHL (1982 to Oct 2003). Attempts were also made to identify trials from the metaRegister of Controlled Trials and the citation lists of review articles and included trials. In most cases the first or corresponding author of each included trial was contacted for additional information. The inclusion criteria were randomised comparisons of surgical techniques of interruption of the pelvic nerve pathways (using both open and laparoscopic procedures) for the treatment of primary and secondary dysmenorrhoea. The main outcome measures were pain relief and adverse effects. Eleven randomised controlled trials (RCTs) were identified that initially appeared to fulfil the inclusion criteria for this review. Two trials were subsequently excluded (Garcia Leon 2003; Sutton 1991). Of the remaining nine trials, eight were included in the meta-analysis. The results of one trial were included in the text of the review for discussion because the data were not available in a form that allowed them to be combined in the meta-analysis. Five trials investigated laparoscopic uterine nerve ablation (LUNA), two trials laparoscopic presacral neurectomy (LPSN) and two open presacral neurectomy (PSN). For the treatment of primary dysmenorrhoea there was some evidence of the effectiveness of laparoscopic uterine nerve ablation (LUNA) when compared to a control or no treatment. The comparison between LUNA and laparoscopic presacral neurectomy (LPSN) for primary dysmenorrhoea showed no significant difference in pain relief in the short term; however, long-term LPSN was shown to be significantly more effective than LUNA. For the treatment of secondary dysmenorrhoea six identified RCTs addressed endometriosis and one included women with uterine myomas. The treatment of LUNA combined with surgical treatment of endometrial implants versus surgical treatment of endometriosis alone showed that the addition of LUNA did not aid pain relief. For PSN combined with endometriosis treatment versus endometriosis treatment alone there was an overall difference in pain relief although the data suggests this may be specific to laparoscopy and for midline abdominal pain only. Adverse events were significantly more common for presacral neurectomy; however, the majority were complications such as constipation, which may spontaneously improve. There is insufficient evidence to recommend the use of nerve interruption in the management of dysmenorrhoea, regardless of cause. Future methodologically sound and sufficiently powered RCTs should be undertaken.

Epigenetic mechanisms, which cannot be explained by genotypic changes, but reveal the phenotype formation differences of genes, take part in the whole cellular process throughout our life. Recent advances in today’s rapidly evolving technology have shown that erroneous epigenetic regulations can contribute to serious biological consequences and diseases in human. Human is the smallest model of the universe with its memory, which is processed into DNA codes within the cell, which is the smallest building block. All the phenomena we see as causal relationships in the human body are a reflection of “balance and harmony” relationship. We can see the intersection point of the quadruplet body (human body, energy body, electrical body, and energy channels) as a homeostatic system that produces continuous “balance and harmony” for the coordination of the inheritance DNA. As known, therapeutic approaches that are called as holistic or complementary medicine mainly target to the causes underlying basis of the diseases by using natural therapeutic agents and methods. Thus, it is primarily aimed to protect physiological mechanisms of the body. Also, such therapeutic methods allow medicine to avoid possible side effects of the modern therapeutic approaches. Probably, these are benefits of holistic or complementary medicine methods. On the other hand, many complementary and alternate medicine methods are commonly available, reasonable, and regularly used in many countries. And, these therapies are maintained by practical evidence on protection and efficacy. A growing amount of scientific clinical studies nowadays maintain the usage of definite these therapies. The Remember Regeneration Therapy Method (RTM) is a holistic medicine that describes the anatomical and physiological aspects of physiopathological changes in quadruplet body structures (QBSs), which is unique treatment system where phytotherapy is at its center and integrated with traditional and complementary applications. In the RTM model, diseases are seen as the reflection of epigenetic changes in the phenotype resulting from the gene-environment mismatch. The treatment strategy is based on the recovery of health by essentially improving the deteriorating structures. Considering that many of the epigenetic changes that cause disease can potentially be reversed, it has been clinically observed that epigenetic changes and irregularities improved when appropriate treatment protocols were applied, as in the RTM model. In conclusion, the main aim of this review is to introduce a new model of diagnosis and treatment to medical literature and to demonstrate the efficacy of RTM, which has been characterized by clinical experience (nearly 130,000 individuals suffering from several disorders) over a long period (approximately 25 years) and the reviewing of previous scientific knowledge.

Because acne vulgaris has a chronic course, can cause cosmetic problems, and negatively affects the psychosocial functionality and quality of life of patients, patients with acne vulgaris can frequently resort to complementary medicine practices. This study aimed to examine the frequency of complementary medicine use in patients diagnosed with acne vulgaris, the methods they used, the reasons for practicing these methods, and the factors affecting these practices. In this descriptive cross-sectional study, 400 (81.4%) of 491 patients aged ≥13 years who were diagnosed with acne vulgaris and treated at the dermatology outpatient clinic at Konya Numune Hospital between February and October 2020 were enrolled. A survey consisting of 37 questions was administered to patients in face-to-face interviews. Permission to conduct the study was obtained from the Faculty of Medicine Local Ethics Committee. The mean age of the patients was 20.0 ± 5.17, and 60% of the patients were women. It was stated by 87% of the patients that they used complementary medicine methods for the treatment of acne vulgaris. The first 3 methods used, in order of frequency, were topical herbal remedies at a rate of 61%, herbal medicines at 23.5%, and cupping/leeches at 2.5%. Complementary medicine use was significantly higher among the patients aged 19 to 25 and among the single patients. While practicing complementary medicine treatments, 33.5% also used the treatment given by their doctor simultaneously. It was determined that the physicians of 73.5% of the patients did not question their use of complementary medicine when prescribing treatment. In our study, it was determined that 87% of patients with acne vulgaris used complementary and alternative medicine (CAM) methods, and the majority of these patients were young. These treatment methods may affect the treatments that their physicians will recommend. Therefore, to prevent ill-advised practices, patients should be informed about the CAM methods they use when planning their treatment. Considering the possible side effects of CAM practices, physicians need to be aware that acne vulgaris patients frequently use CAM methods and improve themselves in raising the desired awareness on this issue.

Primary dysmenorrhea (PD) affects a large number of female university students, diminishing their quality of life and hindering academic performance, representing a significant cause of absenteeism. The purpose of our study was to determine how nursing students experienced restrictions as a result of primary dysmenorrhea. A qualitative exploratory study was conducted among 33 nursing students with primary dysmenorrhea. A purposeful sampling strategy was applied. Data were collected from five focus groups (two sessions each) and the field notes of 10 researchers. A video meeting platform was used to conduct the focus groups. A thematic inductive analysis was performed. Thirty-three female nursing students participated in the study with a mean age of 22.72 (SD 3.46) years. Three broad themes emerged: (a) restrictions on daily activities and sports; (b) academic restrictions, and (c) restrictions on social and sexual relationships. The students described restrictions in performing everyday activities, such as carrying weight, and shopping. Some students even gave up the practice of sports and were absent from classes at the university, and from clinical practices at the hospital. The pain affected their ability to maintain and create new social relationships. Primary dysmenorrhea caused restrictions in the personal, social and academic life of the nursing students.

BackgroundPostmenopausal women are interested in using complementary and alternative medicine because of their menopausal symptoms and the side effects of chemical medications and hormone therapy. Therefore, this study aimed to investigate the relationship between the use of complementary medicine (CAM) and menopausal symptoms among postmenopausal women.MethodsThis cross-sectional study was conducted among 288 postmenopausal women who were referred to health centers in Kerman, southeastern Iran, from 2020 to 2021. Data were collected using a demographic questionnaire, the CAM questionnaire, and the Menopause Rating Scale (MRS).ResultsThe mean score for the menopausal symptoms of the participants was 8.73 ± 6.11. Only 28.8% of the participants had no/little symptoms. About 65.3% of the participants used at least one type of CAM in the previous year. The most commonly used types of CAM were nutritional supplements, prayer, and medicinal herbs. A significant association was found between the use of medicinal herbs, dry cupping, relaxation and meditation, prayer, and menopausal symptoms. Women experiencing menopausal symptoms used more CAM methods than those without menopausal symptoms (Odds ratio = 2.25, 95% confidence interval = 1.33–3.80).ConclusionThe study results indicated that the severity of menopausal symptoms and scores in somatic-vegetative and urogenital domains were higher in CAM users compared to non-CAM users. But there was no significant difference in the psychological domain between CAM and non-CAM users. Based on the results, it is suggested that more research be done in different communities with different healthcare systems to find out how complementary and alternative medicine affects menopausal symptoms in women.

Primary dysmenorrhea is considered to be one of the most common gynecological complaints, affecting women's daily activities and social life. The severity of dysmenorrhea varies among women, and its management is of high importance for them. Given that non-steroidal anti-inflammatory drugs (NSAIDs), the established treatment for dysmenorrhea, are associated with many adverse events, alternative therapeutic options are under evaluation. Emerging evidence correlates management of dysmenorrhea with micronutrients, especially vitamins. The aim of this narrative review is to highlight and provide evidence of the potential benefits of vitamins for the management of dysmenorrhea. The articles were searched on PubMed, Scopus and Google Scholar. The searching process was based on keywords, such as "primary dysmenorrhea", "vitamins", "supplementation", "vitamin D", "vitamin E" and others. Our search focused on data derived from clinical trials, published only during the last decade (older articles were excluded). In this review, 13 clinical trials were investigated. Most of them supported the anti-inflammatory, antioxidant and analgesic properties of vitamins. Particularly, vitamins D and E revealed a desirable effect on dysmenorrhea relief Conclusion: Despite the scarcity and heterogeneity of related research, the studies indicate a role of vitamins for the management of primary dysmenorrhea, proposing that they should be considered as alternative therapeutic candidates for clinical use. Nevertheless, this correlation warrants further research.

Yoga and Quality of Life in Women with Primary Dysmenorrhea: A Systematic Review.

Breast cancer is a common form of cancer in women. In Taiwan, breast cancer ranks as the second highest incidence of all cancers and is the fourth leading cause of cancer death for women. Being diagnosed and living with breast cancer involves a series of stressful life events that impact on many aspects of women’s quality of life (QOL). Consequently, many women with breast cancer have developed particular coping strategies and used complementary and alternative medicine (CAM) to enhance their QOL and well being. While research has shown that cultural and contextual factors affect QOL in women with breast cancer, it is unclear how well personal and environmental variables, specifically treatment-related stressors, coping, and CAM use, predict QOL in Taiwanese women with breast cancer. The overall purpose of this study was to identify the predictors of QOL and to explore the role of CAM use in Taiwanese women with breast cancer. A mixed methods two-phased study was used. The study was underpinned by the pragmatist paradigm, and employed a sequenced combination of quantitative approach followed by qualitative inquiry. The complementarity approach was chosen to enhance, enrich and illustrate the results from one method with the results from the other method. Phase One used a predictive survey to identify the relationships between QOL and its hypothesised predictors in a convenience sample of outpatients from a large general hospital in eastern Taiwan. The survey data were collected by face-to-face interviews using structured instruments that comprised: a demographic profile sheet; and five scales, including symptom distress, anxiety and depression, internal health locus of control, use of coping strategies, and QOL; as well as number of individual items in relation to CAM use. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Cancer (EORTC QLQ-C30) was used to measure the QOL. It is composed of five functioning scales, a single scale for global QOL, three symptom scales, and six individual symptom items. A number of multiple regression analyses were undertaken to identify the significant predictors of each of the EORTC QLQ-C30 scales. A total of 240 women were invited to participate in study. The overall response rate was 81.7% (n = 196), which is considered statistically high. The majority of respondents were high school educated, married, Buddhists, not currently employed, and with a mean age of 53 years. The average time since diagnosis was 28 months. Most women were diagnosed with Stage II breast cancer, and had had a mastectomy with no recurrence of the disease. Approximately 74% of the women reported that they were CAM users before and/or after their diagnosis. The women’s perceived QOL was predicted by several independent variables. A combination of the independent predictive QOL variables explained 5.7% to 43.8% of the variance. In particular, symptom distress, anxiety and depression were the most influential variables in the prediction of QOL. Additionally, the use of coping strategies, such as planning coping, denial, humour, venting, and self-distraction, made statistically significant contributions to the prediction of various aspects of QOL. Phase Two of the study used a qualitative exploratory design to describe the role of CAM use in the context of Taiwanese women’s health needs and perceived QOL, from the perspective of women with breast cancer. Various perceptions were integrated and further illustrated the women’s use of CAM. Three major domains were identified: women’s reasons for CAM use; influences on decision making regarding CAM; and effects of CAM use. Within these three domains, eight major categories emerged: dealing with emerging health problems through CAM use; regaining balance in life; fighting cancer to enhance health; family and friends’ influence; communication with health care professionals; beliefs about CAM; living a normal life through using CAM; and building strong social networks. This study supports the stress and coping model proposed by Lazarus and Folkman, that indicated that people use particular coping strategies in response to the situation and context; and these, may affect their adaptation. The findings suggest that the use of certain coping strategies and CAM use may be integrated within the conventional biomedical treatments to help improve breast cancer patients’ well being. Understanding CAM use in women with breast cancer may inform clinical practice and assist health professionals to provide compassionate and comprehensive cancer care, and thus support women in making informed treatment decisions.

Aim: Healthcare professionals will set an example to society with their behaviors about Traditional and Complementary Medicine usage. We aimed to investigate and compare the knowledge and attitudes of society and physicians about Traditional and Complementary Medicine to create an infrastructure for medical training. Methods: In this cross-sectional descriptive study "Turkish Version of Complementary, Alternative and Conventional Medicine Attitude Scale" was used for data collection. Results: A total of 392 physicians and 438 citizens participated in the study. Among all participants, 36.9% had used a Traditional and Complementary Medicine method before and the most used method was phytotherapy. There was a significant difference between groups in terms of the level of knowledge. Surprisingly no significant difference was found between physicians and the public in the "Dissatisfaction with Modern Medicine" subgroup. Conclusion: Although there were differences in the level of knowledge between the public and physicians, it was seen that the behavioral patterns were similar to each other. This situation suggests that physicians are also influenced by the society they live in, rather than scientific data, in their decisions about Traditional and Complementary Medicine. Being as a role model to the public, physicians are responsible for providing evidence-based answers to questions about Traditional and Complementary Medicine and should receive adequate training about methods. Keywords: complementary medicine, therapeutic use, evidence-based practice, knowledge, physicians

IntroductionDysmenorrhea is one of the most common gynecologic disorders that affects women’s quality of life and social activities. Lifestyle, eating behaviors, and general health are essential to the management of menstrual symptoms. This study was conducted to examine the relationship between lifestyle and primary dysmenorrhea in students at Sari University of Medical Sciences in 2015 in order to facilitate the performance of lifestyle-improving interventions among young women.MethodsThis study was conducted on 250 students with and without primary dysmenorrhea at Sari University of Medical Sciences in 2015. Data were collected using personal-social and lifestyle questionnaires (addressing nutrition, physical activity, stress, social relationships, improper health behaviors, and self-care). The data were analyzed by SPSS software, version 18, using the independent-samples t-test, the chi-squared test, and logistic regression analysis.ResultsGiven the scores obtained on the lifestyle questionnaire, significant differences were observed between the groups with and without dysmenorrhea in terms of eating behavior (p=0.008), physical activity (p=0.011), stress (p=0.041), and social relationships (p=0.000). No differences were observed in terms of self-care (p=0.115) and smoking, drinking, and drug use (p=0.355). According to the logistic regression analysis, age (OR=1.208, p=0.014), physical activity (OR=1.008, p=0.040) and social relationship (OR=0.952, p=0.002) were different in the two groups, but there was no statistical differences in their eating behavior, self-care, and stress.ConclusionTo prevent and reduce the incidence of primary dysmenorrhea, knowledge and awareness should be raised in young women through proper lifestyle education and health promotion measures.

Background Dysmenorrhea, defined as menstrual pain, is one of the common chronic pelvic pain problems associated with mussculoskeletal symptoms. 1 Dysmenorrhea is considered as a lower abdominal or pelvic pain appears just before and/or during menstruation and lasts about 2448 hours.2 It is a common condition with prevalence rates between 50% and 91% in women. The daily life of women with menstrual pain can be adversely affected by pain and pain accompanying symptoms.3 It is seen that these effects are mostly on the quality of life (QoL) of individuals. In addition, physical activity of individuals may be restricted due to menstrual pain.4 Objectives The aim of this study was to determine the relationship between quality of life, physical activity level and the severity of menstrual pain in Turkish women. Methods 336 female cases aged over 18 years and with menstrual pain complaint in the majority of menstrual cycles were included in the present study. Menstrual pain severity was assessed by 0-10 point Visual Analogue Scale.5 Physical activity level was assessed by the “International Physical Activity Questionnaire-Short Form” and the score was expressed in Metabolic Equivalent Task minutes per week. Total score of the short form included walking, moderate level activity and duration (minutes) and frequency (days) of sufficiently active. The quality of life of was assessed by the “Nottingham Health Profile”. It consists of six parts: pain, physical activity, energy, sleep, social isolation and emotional reaction. The maximum score on any section is 100. The higher the score on any section the greater the number and severity of perceived problems in that area. Normality testing was performed on all data. Spearmans correlation was performed to identify correlation between menstrual pain score and other measures. Results The average age and body mass index of 336 participants were 223 years and 21,42,8 kg/m2, respectively. There was a significant correlation between quality of life and menstrual pain severity (r=0.350; p:0.006). There was no significant correlation between physical activity level and menstrual pain severity (p>0.05). Conclusion Based on the results of the present study, quality of life seems to be related with menstrual pain. On the other hand, no relationship was identified between the physical activity level and menstrual pain. In order to determine the exact relationship, further studies with larger samples and with more varied levels of physical activity are needed.

1. Paula J. Adams Hillard, MD* 1. *Professor, Department of Obstetrics & Gynecology and of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio After completing this article, readers should be able to: 1. Recognize the prevalence of dysmenorrhea in adolescents and its common results. 2. Describe a menstrual history that is most consistent with primary dysmenorrhea. 3. List the mediators of uterine pain and contractions believed to be involved in the pathophysiology of primary dysmenorrhea. 4. Recommend the appropriate evaluation and management of primary dysmenorrhea, including the appropriate choice and dosing of both over-the-counter and prescription medications. 5. Recognize patients who should be referred for evaluation of possible causes of secondary dysmenorrhea. A 15½-year-old girl came to the office with complaints of the recent onset of painful menstrual periods. She experienced her first menstrual period at the age of 13 years and except for an occasional mildly uncomfortable menstrual period, had not experienced significant pain until recently. She reported regular monthly menses, although she did not write down the dates. She described additional symptoms that also had not been present previously, including headache, loose stools, and breast tenderness. She has tried several over-the-counter medications, including acetaminophen, without significant relief. She has missed 3 days of school in the last 6 weeks because of these complaints. She is otherwise healthy, having no major illnesses, no history of surgeries, and no other genitourinary complaints. There is no family history of endometriosis; severe dysmenorrhea; menorrhagia; irregular periods; infertility; uterine fibroids; or breast, ovarian, colon, or uterine cancer. Her mother recalled that she had been prescribed oral contraceptives at the age of 16 years to alleviate her severe menstrual cramps. When spoken with privately, having been assured confidentiality, the girl denied sexual activity or abuse. She was doing well in school, making As and Bs, and felt that the relationship with her parents and one sister were good. She reported that she experienced crampy midline lower abdominal pain that began with the …

Patients living with a permanent ostomy encounter many physical, psychological, and social challenges due to the loss of function of a part of their body. Today, as the use of alternative therapies increases, some of these patients are seeking complementary medicine to relieve the symptoms and complications of their disease. Therefore, the present study aimed to determine the use of, reasons for, and satisfaction with the complementary medicine among patients living with a permanent ostomy. This descriptive cross-sectional study was conducted on 100 patients living with a permanent ostomy who were referred to ostomy clinics in southeastern Iran. The census method was used for sampling. The research tool included a complementary medicine questionnaire. SPSS-25 was used for data analysis. The results showed that in physical methods, most of the participants used herbal medicines (83%), aromatherapy (79%), vitamin supplements (76%), and diet (66%). In mental methods, most of the participants used prayer/recourse/vow (91%) and music therapy (75%) (every day to several times a year). People with university education (p < 0.001), higher incomes (p = 0.002), and history of addiction (p = 0.048) used more methods of complementary medicine. Fifty-three point four of the participants used herbal medicines to reduce physical complications, 46.6% used them to improve anxiety and stress induced by ostomy, and between 66 and 80% was completely satisfied with the use of various types of complementary medicine. The study results showed that the frequency of complementary medicine use among patients living with a permanent ostomy varied from a few days to several years. Considering the use of complementary medicine by these patients, educational programs, and interventions are necessary to increase the general awareness of ostomy patients about the types of complementary and alternative medicine (CAM) and the effects of these methods.

A Role for Government: An Observation on Federal Healthcare Efforts in Prevention