Intensity Of Menstrual Pain Research Articles

Effect of Reflexotherapy on Controlling Primary Dysmenorrhea among Faculty Nursing Students

Primary dysmenorrhea is the most common gynecologic disorder among female adolescents, with a prevalence of 60% to 93%. It leads to several problems in the personal and social life of the female adolescents. Adverse effects of medical treatments and its failure rate of 20-25% have caused many females to seek other complementary and alternative methods for the management of primary dysmenorrhea. Reflexotherapy is one of such methods. So, the aim of this study was to determine the effect of reflexotherapy on controlling primary dysmenorrhea among Faculty Nursing Students. The study was conducted at Faculty Nursing, Tanta University. The total number of study sample was 120 female students from the second year of Faculty Nursing Students who fulfilling the inclusive criteria. Four tools were used for the collection of data: Tool I: Sociodemographic and menstrual history structured interview schedule. Tool II, Visual Analog Scale (VAS). Tool III, Modified McGill Pain Questionnaire Short form (MPQ-SF). Tool IV, Physiological and behavioral responses to pain sheet. The results of this study revealed that after the application of reflexotherapy, the intensity of menstrual pain had a significant decrease among the study group compared to the control group 1st ,2nd and 3rd months post intervention, as well as the intensity of sensory and affective menstrual pain descriptors. In addition the physiological and behavioral responses to menstrual pain were significantly improved. Therefore, the study recommended that reflexotherapy can be used in the management of primary dysmenorrhea and menstruation-related symptoms as this method is noninvasive, easy to perform, and free from the potentially adverse effects of analgesics.

The Influence of Dark Chocolate to Reduce Menstrual Pain in Primary Dysmenorhea

Chocolate contains copper which used by the body to synthesize collagen and neurotransmitters called endorphins. Endorphin hormone would be a analgesic and natural sedative so as to reduce the intensity of pain such as menstruation pain. Dark chocolate contains more cocoa, making it the best choice to get the health benefits. The purpose of this study was to investigated the influence of dark chocolate on reducing mentrual pain in primary dysmenorhea. Thestudy used a quasy-experimental research design to approach non-equivalent control group design. The research was conducted in August 2014 until September 2014 at the University of Muhammadiyah Malang. Acted as research sample, 40 students with dismenorhea primary were taken by purposive sampling technique which was divided into treatment group and control group. The independent variable of this study was the provision of dark chocolate and the intensity of menstrual pain on the student with primary dismenorhea became the dependent variable. Data was analyzed by independent t test. The results of the analysis using an independent t test be obtained significant in value (p) less than alpha (0.000<0.05). Dark chocolate influential on decreasing menstrual pain in primary dysmenorhea.

Can self-care by means of contact needles gently applied to the skin relieve menstrual pain?

The efficacy of complementary and alternative medicine to relieve menstrual pain so far has lacked adequate evidence. We conducted a randomized, placebo-controlled, double-blind, comparative study in order to evaluate the efficacy of self-care by application of contact needles for menstrual pain relief. 19 women who experienced menstrual pain were randomly assigned to a contact needle or placebo needle group. Participants were allowed to settle contact or placebo needles on acupuncture points (BL37, BL55, and BL56) in their lower extremities on the first and second days of 4 menstrual cycles. The primary objective was the change in menstrual pain intensity, which was compared between the groups. In the 14 participants (contact needle group: n=8, placebo needle group: n=6) who completed the study, the mean change in menstrual pain was assessed by using a 100-mm Visual Analogue Scale: −17.31 mm in the contact needle group and -18.83 mm in the placebo needle group. There was no intergroup difference (p=0.87, Cohen’s d=0.09). Our findings suggest that self-care by contact needle therapy relieves menstrual pain. However, given that its effect on menstrual pain was equivalent to that of self-care by placebo needle therapy, the pain relief observed in this study is likely to have been due to non-specific effects, such as placebo effects and acupressure effects.

The role of treatment timing and mode of stimulation in the treatment of primary dysmenorrhea with acupuncture: An exploratory randomised controlled trial.

ObjectivesWe examined the effect of changing treatment timing and the use of manual, electro acupuncture on the symptoms of primary dysmenorrhea.MethodsA randomised controlled trial was performed with four arms, low frequency manual acupuncture (LF-MA), high frequency manual acupuncture (HF-MA), low frequency electro acupuncture (LF-EA) and high frequency electro acupuncture (HF-EA). A manualised trial protocol was used to allow differentiation and individualized treatment over three months. A total of 74 women were randomly assigned to one of the four groups (LF-MA n = 19, HF-MA n = 18, LF-EA n = 18, HF-EA n = 19). Twelve treatments were performed over three menstrual cycles, either once per week (LF groups) or three times in the week prior to menses (HF groups). All groups received a treatment in the first 48 hours of menses. The primary outcome was the reduction in peak menstrual pain at 12 months from trial entry.ResultsDuring the treatment period and nine month follow-up all groups showed statistically significant (p < .001) reductions in peak and average menstrual pain compared to baseline but there were no differences between groups (p > 0.05). Health related quality of life increased significantly in six domains in groups having high frequency of treatment compared to two domains in low frequency groups. Manual acupuncture groups required less analgesic medication than electro-acupuncture groups (p = 0.02). HF-MA was most effective in reducing secondary menstrual symptoms compared to both–EA groups (p<0.05).ConclusionAcupuncture treatment reduced menstrual pain intensity and duration after three months of treatment and this was sustained for up to one year after trial entry. The effect of changing mode of stimulation or frequency of treatment on menstrual pain was not significant. This may be due to a lack of power. The role of acupuncture stimulation on menstrual pain needs to be investigated in appropriately powered randomised controlled trials.

COMPARISON OF EFFECTS OF ABDOMINAL STRETCHING EXERCISE AND COLD COMPRESS THERAPY ON MENSTRUAL PAIN INTENSITY IN TEENAGE GIRLS

Background: Pain during menstruation is not uncommon, especially in young women, which has an impact on their life activities.&#x0D; Objective: To examine the effect of abdominal stretching exercise and cold compress therapy on decreasing intensity of menstrual pain in teenage girls.&#x0D; Design: A quasi-experimental study with two group comparison pretest-posttest design at SMK Bakti Indonesia Medika, Indonesia. There were 46 respondents selected in this study by consecutive sampling that consisted of 23 samples in the abdominal stretching exercise group and 23 samples in the cold compress group. The menstrual pain was measured using VAS (visual analog scale). Data were analyzed using Mann-Whitney, Chi-Square, and Wilcoxon test.&#x0D; Results: Findings showed that the mean of menstrual pain before intervention in the abdominal stretching exercise was 7.04 and in the cold compress therapy was 6.74 with p-value 0.211 (&lt;0.05), which indicated that there was no mean difference of pain between both groups. However, after intervention, the menstrual pain was reduced from 7.04 to 1.91 (5.09 difference) in the abdominal stretching exercise group; and from 6.74 to 5.52 (1.22 difference) in the cold compress group with p-value 0.000 (&lt;0.05), which indicated that there was statistically significant difference of menstrual pain before and after intervention, both abdominal stretching exercise and cold compress therapy.&#x0D; Conclusion: There were statistically significant effects of abdominal stretching exercise and cold compress therapy on menstrual pain in teenage girls. The abdominal stretching exercise is more effective than cold compress therapy in reducing menstrual pain intensity. Thus, it is suggested that abdominal stretching exercise can be an alternative choice of management of dysmenorrhea in teenage girls, and can be a part of subject in the education as non-pharmacological medicine.

Acupuncture Point Injection of Vitamin K1 to Treat Severe Primary Dysmenorrhea: Case Series at a Women’s Health Service in Bologna

Introduction and Aim: Vitamin K acupuncture point injection is an effective and safe menstrual pain treatment derived from Traditional Chinese Medicine, commonly used in some Chinese hospitals. This case series investigated the effectiveness and safety of vitamin K acupuncture point injection on menstrual pain in patients with severe primary dysmenorrhea at a regional public health clinic at Bologna, Italy. Methods: From September 2006 to July 2010, 24 women were enrolled and treated during their first day of menstrual pain with an injection of 1 ml of solution containing 5 mg of vitamin K1 in an acupuncture point San Yin Jiao/Spleen 6 (SP6) bilaterally on the inside of each lower leg above the ankle. Results: Treatment was well tolerated and no major adverse events were reported. Pain relief was observed starting from 2 minutes after treatment and within 30 minutes. All treated women but one (96%) reported a substantial pain reduction (p < 0.001). During the six post-treatment follow-up cycles, a trend toward a reduction of menstrual distress evaluated by the Cox Pain Intensity and Duration Scales was documented. Women reported fewer daily life restrictions and consumption of fewer analgesic tablets when compared to what they reported at the pre-treatment cycle. Conclusions: The results of this case series indicate that in primary dysmenorrhea a single vitamin K1 injection in the SP6 acupuncture point has an immediate pain-relieving effect and may ameliorate menstrual pain intensity and duration in post-treatment follow-up cycles.

Efek Minyak Esensial Lavender Dibandingkan dengan Minyak Esensial Jahe terhadap Intensitas Nyeri Menstruasi pada Remaja

Background: Menstrual pain is the pain in the abdomen which is perceived before or during menstruation, that even when the menstrual pain is heavily painful, the sufferers leave their activities. Research in 2011 showed that the rate of occurrence of primary menstrual pain in Indonesian adolescences was about 54.89%. Various therapies have been used to cure the pain, both pharmacologically and nonpharmacologically. Pharmacologically, it is done by the usage of NSAID, and non-pharmacologically is done by using essential oil.Objective: To know about the effects of lavender essential oil compared to ginger essential oil toward the intensity of menstrual pain in the adolescences of SHS 1 Muncar.Method: True experimental design, with randomized pretest posttest design plan. Time of data retrieval was August-September 2014 in SMA 1 Muncar, Banyuwangi, East Java. Population in this research were female adolescences in class of X and XI, with the amount of 260 students, with samples’ amount of 30 for each treatment group. The sampling technique was simple random sampling. The dependent variable are the giving of lavender and ginger essential oils, meanwhile the independent variable are the reduction of the intensity of menstrual pain. Instrument which was used was Numerical Rating Scale. The data analysis used the Wilcoxon and Mann-Whitney Test.Result and Discussion: The intensity of pain before and after intervention of essential oil of lavender and ginger are 5,47±1,19 vs 2,93±1,53, P=0,00 and 5,40±0,96 vs 2,93±1,43, P=0,00, respectively. Comparison of the effects essential oil of lavender and ginger have P &gt;0,05.Conclusion: Both lavender essential oil and ginger essential oil are effective in reducing the intensity of menstrual pain in adolescences. Keywords: Menstrual pain, Essential oils, Lavender, Ginger, Adolescences

Effects of a Yoga Program on Menstrual Cramps and Menstrual Distress in Undergraduate Students with Primary Dysmenorrhea: A Single-Blind, Randomized Controlled Trial.

To investigate the effects of a yoga program on menstrual cramps and menstrual distress in undergraduate students with primary dysmenorrhea. Single-blind, randomized controlled trial. 40 randomly selected undergraduate nursing students, with 20 each assigned to an exercise or a control group. The participants engaged in a yoga program for 60 minutes once a week for 12 weeks. The program consisted of physical exercise combined with relaxation and meditation. Menstrual cramps and menstrual distress levels were measured by using the Visual Analogue Scale for Pain and the Menstrual Distress Questionnaire, respectively. Data were analyzed by using the Kolmogorov-Smirnov and Shapiro-Wilk normality tests, t-test, chi-square test, logistic regression analysis, and multivariate analysis of variance (SPSS program). Menstrual pain intensity (group difference, -0.94; 95% confidence interval [CI], -1.47 to -0.42; p = 0.001) and menstrual distress (group difference, -1.13; 95% CI, -1.43 to -0.82; p < 0.0001) scores decreased significantly in the experimental group compared with the control group. These findings indicate that yoga interventions may reduce menstrual cramps and menstrual distress in female undergraduate students with primary dysmenorrhea.

Effects of Calcium-Vitamin D and Calcium-Alone on Pain Intensity and Menstrual Blood Loss in Women with Primary Dysmenorrhea: A Randomized Controlled Trial.

There is limited evidence on effectiveness of calcium and vitamin D on dysmenorrhea. The authors aimed to determine the effect of combined calcium-vitamin D and calcium-alone on pain intensity and menstrual blood loss in women with primary dysmenorrhea. A randomized double-blind trial. Dormitories of Tabriz University of Medical Sciences. 85 students with moderate or severe primary dysmenorrhea. Participants were randomized into three groups: receiving one tablet/day of 1000 mg calcium + 5000 IU vitamin D3, calcium-alone 1000 mg, or matched placebo, from 15th cycle day until menstrual pain disappearance in the following cycle, for three cycles. Pain intensity and menstrual blood loss were assessed one cycle before, three cycles under, and one cycle following intervention using 10-cm visual analog scale and pictorial blood loss assessment chart, respectively. The groups were compared using repeated measures ANOVA. Time after intervention and interaction of time with group had no significant effects on the outcomes. Compared to the placebo group, mean pain intensity was lower in the both calcium-vitamin D (adjusted difference -0.7, 95% confidence interval -1.6 to 0.3) and calcium-alone (-1.6, -2.6 to -0.6) groups, but the difference was statistically significant only in the calcium-alone group. Menstrual blood loss was not significantly different in the either calcium-vitamin D (-4.7, -21.9 to 12.4) or calcium-alone (-0.4, -17.4 to 16.4) groups compared to placebo. Intake of the calcium-alone was effective in reducing menstrual pain intensity. The results could not indicate significant effects of calcium-vitamin D on the pain or any of the interventions on menstrual blood loss. This study was approved by the Ethics committee of Tabriz University of Medical Sciences (code 92145) and registered at the Iranian Registry of Clinical Trials with IRCT201402043706N21.

Clinical efficacy of Trigonella foenum graecum (Fenugreek) and dry cupping therapy on intensity of pain in patients with primary dysmenorrhea.

To determine the effificacy and safety of fenugreek seed and dry cupping on intensity of pain in primary dysmenorrhea. Sixty patients with primary dysmenorrhea were enrolled in this prospective, open-labeled, randomized, standard-controlled study, conducted in the National Institute of Unani Medicine Hospital between February 2010 and April 2011. In group A (20 cases), 3 g powder of fenugreek seed (3 capsules, 1 g each) was given orally twice daily from day 1 to 3 of menstrual cycle. Group B (20 cases) received the same dose of fenugreek seed as group A along with dry cupping therapy [two 4.2-cm and one 2.5-cm cups (internal diameter)], which was applied below the umbilicus for 15 min on day 1 and day 3 of menstrual cycle for 3 consecutive months. The control group C (20 cases) was given mefenamic acid, 500 mg twice daily, on the same protocol. The reduction in menstrual pain intensity was measured with well validated Visual Analogue Scale and safety of fenugreek seed was evaluated by clinical examination and laboratory investigations. Baseline characteristics and biochemical parameters were comparable and homogenous among all groups (P>0.05). The percentage reduction in lower abdominal pain was 66.89%, 66.49%, and 62.88% in A, B and C groups respectively at the end of the treatment. No adverse drug effects were noticed. The fenugreek seed and dry cupping are effificacious, safe, cost effective, and well tolerated.

Myoma-associated pain frequency and intensity: a retrospective evaluation of 1548 myoma patients

ObjectiveTo analyze the possible relation between symptoms (especially pain) reported by myoma patients and objective features of their myomas as determined by ultrasound. Specifically: (1) What is the frequency and intensity of myoma-related pain? (2) Does the pain intensity depend on the number, size, or location of the myomas? (3) Is there any correlation between premenstrual pain, menstrual pain, and pain during sexual intercourse? Study designA retrospective analysis of data from a patient questionnaire and ultrasound exams, collected from February 2009 until January 2013 at the myoma clinic of a university hospital in a large European city. The study analyzed data from 1548 myoma patients. Patients completed a 0–10 Likert scale questionnaire about their symptoms. The number, size, and location of myomas were determined from ultrasound exams. ResultsThe three most frequent symptoms reported were hypermenorrhea, dysmenorrhea, and premenstrual pain. There was no statistically significant relationship between premenstrual pain or pain during sexual intercourse on the one hand and the number, size, or location of myomas on the other hand. For women with severe dysmenorrhea (Likert-scale scores of 8–10), submucosal myomas were significantly more frequent than all other myoma locations (p=0.01). Severe dysmenorrhea (Likert-scale scores of 8–10) was reported by a significantly (p<0.001) greater portion of the women whose largest myoma had a largest diameter of <5cm than by the women whose largest myoma had a diameter ≥5cm. The number of myomas did not have a significant influence on the dysmenorrhea intensity. The three types of pain (premenstrual, menstrual, and/or during sexual intercourse) had moderate pairwise correlations (ρ values from 0.304 to 0.542) that were all statistically highly significant (p<0.001). ConclusionMyoma-associated pain is, alongside hypermenorrhea, the most frequent problem reported by the affected patients. Unlike premenstrual pain and pain during sexual intercourse, the intensity of menstrual pain is clearly dependent on the location and size of the largest myoma. Further research is needed to better understand the degree to which the pain reported by the patients is due to features of the myomas versus other possible factors.

Effects of Flexibility in Coping with Menstrual Pain on Depressive Symptoms.

Coping flexibility refers to the ability to discontinue an ineffective coping strategy and replace it with a more effective alternative. The coping flexibility hypothesis (CFH) predicts that more flexible coping will produce more adaptive outcomes. This study tested CFH validity among young Japanese women with menstrual pain. A total of 186 college students, who reported menstrual pain as being the most frequent pain they suffered over the past year, completed questionnaires related to coping flexibility and strategies for dealing with menstrual pain. Additionally, they reported on later depressive symptoms experienced during menstruation. A hierarchical multiple regression analysis showed that menstrual pain coping flexibility was significantly associated with reduced depressive symptoms during menstruation, even after controlling for the effects of menstrual pain intensity and coping strategies. Thus, the CFH was supported by the data obtained from menstrual pain sufferers in college.

Menstrual pain and quality of life in women with primary dysmenorrhea: Rationale, design, and interventions of a randomized controlled trial of effects of a treadmill-based exercise intervention

Dysmenorrhea in the absence of pelvic abnormality is termed primary dysmenorrhea (PD). The health burden and social and economic costs of PD are high as it is reported to be the leading cause of recurrent absenteeism from school or work in adolescent girls and young adults. The belief that exercise works for relieving symptoms in women with PD is based on anecdotal evidence and non-experimental studies. There is very limited evidence from randomized controlled trials (RCTs) to support the use of exercise to reduce the intensity of menstrual pain. The objective of this study is to evaluate the effectiveness of exercise to reduce intensity of pain and improve quality of life in women with PD. We describe the study design of a single-blind (assessor), prospective, two-arm RCT, and the participant characteristics of the 70 women recruited in the age-group 18 to 43years. The primary outcome of the study is pain intensity. The secondary outcomes of the study are quality of life, functional limitation, sleep, global improvement with treatment, and protocol adherence. The outcomes assessments are done at first menstrual period (baseline, Week 0), 2nd menstrual period (Week 4) and at two additional time points (Week 16 and Week 28) during the trial.The results of the study will provide physiotherapists, medical practitioners, and researchers as well as the women who have PD with new insights, knowledge, and evidence about the use of exercise to manage pain in women with PD.

Research of Herb-Partitioned Moxibustion for Primary Dysmenorrhea Patients Based on the LC-MS Metabonomics.

Objective. To explore the efficacy and mechanism of primary dysmenorrhea patients were treated with herb-partitioned moxibustion through metabonomics. Methods. 20 patients with primary dysmenorrhea were randomized into two groups, separately treated with herb-partitioned moxibustion at CV8 (shenque) and acupuncture at SP6 (sanyinjiao). After three menstrual cycles' treatment, the intensity of menstrual pain using VAS and the changes of metabolites of plasma using LC-MS were observed. Results. The VAS of two groups decreased with different descending range. Herb-partitioned moxibustion upregulated 20α-dihydroprogesterone, pregnenolone, prostaglandin E2 and γ-aminobutyric acid and downregulated the content of estrone and prostaglandin H2, while acupuncture upregulated pregnenolone and 20α-dihydroprogesterone and downregulated 2-methoxyestradiol-3-methylether, 15-hydroxyeicosatrienoic acid and 6-keto-prostaglandin. Discussion. It was effective in relieving the abdominal pain by these two therapies. Herb-partitioned moxibustion is superior to acupuncture for primary dysmenorrhea, which could be related to regulating the endocrine hormone.

Women with dysmenorrhoea are hypersensitive to experimentally induced forearm ischaemia during painful menstruation and during the pain-free follicular phase.

Monthly primary dysmenorrhoeic pain is associated with increased sensitivity to painful stimuli, particularly in deep tissue. We investigated whether women with dysmenorrhoea, compared with controls, have increased sensitivity to experimentally induced deep-tissue muscle ischaemia in a body area distant from that of referred menstrual pain. The sub-maximal effort tourniquet test was used to induce forearm ischaemia in 11 women with severe dysmenorrhoea and in nine control women both during menstruation and in the follicular phase of the menstrual cycle. Von Frey hair assessments confirmed the presence of experimental ischaemia. Women rated the intensity of menstrual and ischaemic pain on a 100-mm visual analogue scale. Women with dysmenorrhoea [mean (SD): 68 (20) mm] reported significantly greater menstrual pain compared with controls [mean (SD): 2 (6) mm; p = 0.0001] during the menstruation phase. They also rated their forearm ischaemic pain as significantly greater than the controls during the menstruation [dysmenorrhoeics vs. controls mean (SD): 58 (19) mm vs. 31 (21) mm, p < 0.01] and follicular [dysmenorrhoeics vs. controls mean (SD): 60 (18) mm vs. 40 (14) mm, p < 0.01] phases of the menstrual cycle. These data show that compared with controls, women who experience severe recurrent dysmenorrhoea have deep-tissue hyperalgesia to ischaemic pain in muscles outside of the referred area of menstrual pain both during the painful menstruation phase and pain-free follicular phase. These findings suggest the presence of long-lasting changes in muscle pain sensitivity in women with dysmenorrhoea. Our findings that dysmenorrhoeic women are hyperalgesic to a clinically relevant, deep-muscle ischaemic pain in areas outside of referred menstrual pain confirm other studies showing long-lasting changes in pain sensitivity outside of the painful period during menstruation.

An Investigation of the Relationship between Pelvic Pain and Density of Nerve Fibers in Peritoneal Lesions of Endometriosis

Purpose Endometriosis is a gynecological disease often characterized by severe pelvic pain, including perimenstrual and intermenstrual pain and dyspareunia. Sensory nerve fibers within peritoneal lesions have previously been shown to contribute to generation of pain in endometriosis; however, their association with different types of pelvic pain is currently uncertain. Methods Peritoneal endometriotic lesions (n = 30) were sectioned and stained immunohistochemically with protein gene product 9.5 (PGP 9.5; pan-neuronal marker), neuropeptide Y (NPY; sympathetic), vasoactive intestinal polypeptide (VIP; parasympathetic), substance P (SP; sensory) and nerve growth factor (NGF) to identify nerve fibers and neurotrophin levels. Densities were assessed within stroma of the lesions and in the adjacent peritoneum. Pelvic pain scores were obtained using a visual analogue scale (VAS), and correlation analysis was performed. Results Increased density of nerve fibers was observed within the stroma of lesions. NGF expression was significantly increased in glandular epithelium, compared with stromal regions (p = 0.026) and correlated inversely with menstrual pain scores (p = 0.05). Sympathetic nerve fiber density (NPY) in stroma showed a significant positive correlation with intensity of menstrual pain (p = 0.04). Parasympathetic nerve fiber density (VIP) also showed a strong trend toward a positive correlation with menstrual pain intensity (p = 0.056). Conclusions There is increased neurogenesis in the stromal region. Innervation of lesions correlates to intensity of menstrual pain. NGF in glandular epithelium may promote growth of nerve fibers into the core of lesions; however, the inverse correlation between NGF expression in glandular epithelium and menstrual pain indicates that mechanisms of pain generation in endometriosis are complex.

Some physiotherapy treatments may relieve menstrual pain in women with primary dysmenorrhea: a systematic review.

In women with primary dysmenorrhoea, what is the effect of physiotherapeutic interventions compared to control (either no treatment or placebo/sham) on pain and quality of life? Systematic review of randomised trials with meta-analysis. Women with primary dysmenorrhea. Any form of physiotherapy treatment. The primary outcome was menstrual pain intensity and the secondary outcome was quality of life. The search yielded 222 citations. Of these, 11 were eligible randomised trials and were included in the review. Meta-analysis revealed statistically significant reductions in pain severity on a 0-10 scale from acupuncture (weighted mean difference 2.3, 95% CI 1.6 to 2.9) and acupressure (weighted mean difference 1.4, 95% CI 0.8 to 1.9), when compared to a control group receiving no treatment. However, these are likely to be placebo effects because when the control groups in acupuncture/acupressure trials received a sham instead of no treatment, pain severity did not significantly differ between the groups. Significant reductions in pain intensity on a 0-10 scale were noted in individual trials of heat (by 1.8, 95% CI 0.9 to 2.7), transcutaneous electrical nerve stimulation (2.3, 95% CI 0.03 to 4.2), and yoga (3.2, 95% CI 2.2 to 4.2). Meta-analysis of two trials of spinal manipulation showed no significant reduction in pain. None of the included studies measured quality of life. Physiotherapists could consider using heat, transcutaneous electrical nerve stimulation, and yoga in the management of primary dysmenorrhea. While benefits were also identified for acupuncture and acupressure in no-treatment controlled trials, the absence of significant effects in sham-controlled trials suggests these effects are mainly attributable to placebo effects.

Intensity of menstrual pain and estimated angle of uterine flexion

To assess the impact of ultrasound-estimated uterus position on the intensity of pelvic pain. Descriptive analytical study. Tertiary university gynecology unit. 181 consecutive patients with pelvic pain. Each woman underwent physical examination, transvaginal sonography and filled self-administered questionnaires on pain using a 10-cm visual analog scale (VAS). Visual analog scale score of menstrual pain, intermenstrual pain and dyspareunia was related to uterine version (ante- or retroversion) and the angle of uterine flexion (actual angle between cervix and uterine body) evaluated by transvaginal sonography. Estimated uterine version was not associated with the intensity of any type of pain. The estimated angle of flexion was higher in retroverted than in anteverted uteri (182.3° ± 50.3° vs. 142.3° ± 24.2°, p < 0.0001). Intensity of menstrual pain was lowest with flexion between 150° and 210° (4.9 ± 3.1) (p = 0.002), intermediate with flexion <150° (6.3 ± 2.8) and highest with flexion ≥210° (7.9 ± 2.3). Severe menstrual pain was more prevalent with flexion ≥210° (77.7%) than between 150° and 210° (31.4%; p = 0.0008) or <150° (45.2%; p = 0.005). The intensity of intermenstrual pain and dyspareunia were not associated with the angle of flexion. In multiple regression analysis, the angle of flexion was independently related only to the intensity of menstrual pain (r = 0.272; p = 0.002). In women with pelvic pain, ultrasound-estimated uterine flexion represents an independent risk for intense menstrual pain.

The 24-h progression of menstrual pain in women with primary dysmenorrhea when given diclofenac potassium: a randomized, double-blinded, placebo-controlled crossover study

Primary dysmenorrhea, which refers to painful, spasmodic cramping in the lower abdomen just before/or during menstruation, is the most common gynecological complaint in women of reproductive age. Non-steroidal anti-inflammatory drugs have been prescribed as the first-line therapy for pain relief from dysmenorrhea. We aimed to investigate the efficacy of the daily recommended dose (150 mg) of diclofenac potassium, administered at set intervals across the first 24 h of menstruation, in treating severe menstrual pain in 24 women with severe primary dysmenorrhea. In a randomized, placebo-controlled, double-blind cross-over study, women rated their menstrual pain intensity on a 100-mm visual analog scale across set time intervals over a 24-h period. Menstrual pain intensity was significantly reduced after taking the first capsule of diclofenac, and remained consistently lower (P < 0.0001), compared with initial pain intensity, in the morning (before treatment), throughout the day, evening, and into the next morning. Also, women rated their pain intensity as significantly lower (P < 0.001) at each time point across the 24-h time interval of the cycle when receiving diclofenac compared with the cycle when they received placebo. No woman required rescue medication when taking diclofenac potassium compared with six women taking rescue medications during the placebo trial. When taking only placebo, women rated their menstrual pain intensity as persistently severe across the first 24 h of menstruation. These results show that the recommended daily dose of diclofenac potassium, in three 50 mg doses across the day and evening, offers effective menstrual pain relief across 24 h, compared with placebo, in women with severe primary dysmenorrhea.

Relationship between Dysmenorrhea and Posttraumatic Stress Disorder in Japanese High School Students 9 Months after the Great East Japan Earthquake

Study ObjectiveTo determine the relationship between dysmenorrhea and posttraumatic stress disorder (PTSD) among Japanese adolescent girls 9 months after the Great East Japan Earthquake. DesignCross-sectional study. SettingTwo high schools in Sendai, the largest city in northeastern Japan. Participants1489 female adolescents aged between 15 and 18 years. Main Outcome MeasuresImpact of Event Scale-Revised (IES-R), intensity of menstrual pain. ResultsThe intensity of menstrual pain increased according to the comorbidity of PTSD (P < .001). The IES-R subscale and total scores significantly increased according to the severity of menstrual pain. ConclusionsThis study showed a significant association between natural disaster-induced PTSD and the severity of dysmenorrhea.