Management Of Dysmenorrhea Research Articles

Management of perimenstrual symptoms among young Taiwanese nursing students

To determine the frequency and distribution of medications used by Taiwanese nursing students for dysmenorrhoea and to investigate potential associations between perimenstrual symptoms and selection of medications. Dysmenorrhoea is a symptom-complex. It is also the leading cause of short-term school absence and is associated with a negative impact on academic and daily activities. The effectiveness of traditional Chinese medicines and Western medications for ameliorating dysmenorrhoea has been well-documented. However, no publications were found to examine the selection of traditional Chinese medicines, Western medications or teas among Taiwanese women for the management of dysmenorrhoea and related symptoms. A descriptive survey. Management of Menstrual Cramps Survey was distributed to a convenience sample of 2758 female nursing students in Southern Taiwan. Content validity and inter-rater reliability were applied to evaluate the measure. The descriptive statistics and chi-square comparisons were calculated where appropriate for each of the items of the questionnaires. Perimenstrual symptoms were statistically significant indicators for the use of any combination of Western medications, traditional Chinese medicines or teas. Data revealed that there were statistically significant association between perimenstrual symptoms and the uses of traditional Chinese medicines (χ(2) = 3·876, df = 1, p = 0·031) or Western medications (χ(2) =( ) 10·171, df = 1, p < 0·01). Panadol and Si-Wu-Tang were the most frequently used medications among Western medicines and traditional Chinese medicines, respectively. However, Western medications were used for a broader spectrum of symptoms than traditional Chinese medicines. The findings have implications for professional nurses, nurse researchers and society. Nurses teach and promote health, which includes the communication of medication-related information. To teach young women in Taiwan about the options available for relief of perimenstrual symptoms is significant.

Dysmenorrhea in a multiethnic population of adolescent Asian girls

Objective To determine the prevalence of dysmenorrhea, its impact, and the treatment-seeking behavior of adolescent Asian girls. Method A cross-sectional study with 1092 girls from 15 public secondary schools and 3 ethnic groups in the Federal Territory of Kuala Lumpur, Malaysia. Results Overall, 74.5% of the girls who had reached menarche had dysmenorrhea; 51.7% of these girls reported that it affected their concentration in class; 50.2% that it restricted their social activities; 21.5% that it caused them to miss school; and 12.0% that it caused poor school performance. Ethnicity and form at school were significantly associated with the poor concentration, absenteeism, and restriction of social and recreational activities attributed to dysmenorrhea. Only 12.0% had consulted a physician, and 53.3% did nothing about their conditions. There were ethnic differences in the prevalence, impact, and management of dysmenorrhea. Conclusion There is a need for culture-specific education regarding menstruation-related conditions in the school curriculum.

Modern management of dysmenorrhoea

AbstractDysmenorrhoea is a common problem for young women and adolescents. Most patients have no underlying pathology and management is therefore aimed at reassurance and symptom relief, although referral may sometimes be necessary where underlying disease is suspected. The authors outline the treatment options available. Copyright © 2009 Wiley Interface Ltd

Self-Care Strategies Used by Taiwanese Adolescents for the Management of Dysmenorrhea

Background: Many adolescent girls experience dysmenorrhea and seek self-care strategies to manage their menstrual discomfort. The purpose of the study was to gain knowledge about self-care strategies used by Taiwanese adolescents for the management of dysmenorrhea.

Repeat STI Screening in Adolescent Obstetric Patients

distress symptoms as well as self-care strategies. Exploratory analyses of possible associations between self-care strategies and dysmenorrhea severity using chi-square and independent-sample Student ttests were performed. Results: The mean score of period pain was 66.18 (SD 5 16.14). Cramps, fatigue, mood swings, backache, and irritability were the most common symptoms of menstrual distress. Participants who sought medical help for their menstrual pain, 18% consulted a western medical doctor, 15% consulted a Chinese medical doctor, and 13% consulted both. Mother was the most important person that the Taiwanese adolescent girls turned to for answers regarding methods for dealing with dysmenorrhoea (68%). The top five priority selfcare strategies used were ‘‘avoid doing intensive exercise’’, ‘‘know clearly which of the uncomfortable areas would occur’’, ‘‘take herbal remedies’’, ‘‘tell my family about my experience of period cramp pain’’, and ‘‘frown and tell others that I am not feeling well’’. The methods perceived as the most effective methods in relieving period pain by 72% of the participants were heat application, pain medication, rest, drinking special drinks, and positioning. There were 28% of the participants did not report any methods which they perceived as effective for their period pain. Conclusions: Self-care strategies used by Taiwanese adolescents were unsatisfactory as indicated by monthly recurrent dysmenorrhea. Cultural factors play a role in self-care of dysmenorrhea among Taiwanese adolescents. Our participants widely used traditional Chinese herbal remedies to manage dysmenorrhea, many with unknown efficacy. The findings of this study highlight the need to develop culturally appropriate and effective health education materials on dysmenorrhea management for Taiwanese adolescents.

Evaluation of Menstrual Pain Management Approaches by Northeastern Anatolian Adolescents

We evaluated approaches taken by Northeastern Turkish adolescents to cope with menstrual pain. The questionnaire was prepared according to the facial pain rating scale and applied to 1,408 female high school students (16.05 ± 1.05 years of age). We investigated the characteristics of dysmenorrhea in adolescents, dysmenorrhea management strategies used by adolescents, and use of medication. We evaluated the relationships among pain duration, severity, and duration of dysmenorrhea experience using the chi-squared test. Dysmenorrhea was considered to be painful menstruation during the past three cycles and was experienced by 81.7% of subjects. It mostly occurred during the past 1-3 years (65.6%). Pain was mostly initiated a day before (38.8%) or at the beginning of (45.8%) menstrual flow and lasted for 1-3 days. It was felt in multiple locations but most commonly in the lower abdomen and lumbar region. Major symptoms associated with dysmenorrhea were sweating, low appetite, headache, distraction, nausea, vomiting, and dizziness, as well as varying degrees of pain severity. Approaches taken to deal with dysmenorrhea were: consulting a health professional (8.9%), medication (46.1%), nonmedicinal activities, and other empirical strategies (24.4%). Medication was recommended mostly by mothers (39.0%) and was taken when pain became unbearable (65.5%). More than one-third of the subjects did not know which drug they took. Major nonpharmacologic measures were: heating pad use (36.5%), sleeping (31.0%), walking (11.3%), and massaging (11.0%). Seeing a physician (p < .001), taking medication (p < .001), and applying empirical strategies to prevent dysmenorrhea (p < .01) were associated with prolonged dysmenorrhea. Medication was associated with shortening pain duration during one menstrual cycle. Except for empirical strategies to prevent dysmenorrhea, all other methods used to prevent dysmenorrhea were related to pain duration and severity. Adolescents should be encouraged to consult a physician and should be prescribed medication in addition to other measures to alleviate menstrual pain and shorten its duration. Moreover, school curriculum should be redesigned to address proper management strategies for adolescent problems. School nurses can also provide consultation services and arrange informative seminars to increase public awareness of this issue.

Dysmenorrhea in adolescents and young adults: from pathophysiology to pharmacological treatments and management strategies

Background: Dysmenorrhea is the most common gynecologic complaint among adolescent and young adult females. Dysmenorrhea is usually primary and is associated with normal ovulatory cycles and with no pelvic pathology. In ∼ 10% of females with severe dysmenorrhea symptoms, pelvic abnormalities such as endometriosis or uterine anomalies may be found. Objective: To review the current knowledge regarding the pathophysiology of dysmenorrhea, as well as review pharmacological treatments and strategies for management of dysmenorrhea in adolescent and young adult females. Methods: Review of original articles on dysmenorrhea that have been published in the medical literature. Results/conclusions: Potent prostaglandins and potent leukotrienes play an important role in generating primary dysmenorrhea symptoms. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most common pharmacologic treatment for dysmenorrhea. A loading dose of NSAIDs (typically twice the regular dose) should be used as initial treatment for dysmenorrhea, followed by a regular dose until symptoms abate. Adolescents and young adults with symptoms that do not respond to treatment with NSAIDs for three menstrual periods should be offered hormonal treatment such as combined estrogen/progestin oral contraceptive pills (OCPs) for three menstrual cycles. If dysmenorrhea does not improve within 6 months of treatment with NSAID and OCPs, a laparoscopy is indicated to look for endometriosis. The goal of pharmacological treatment for endometriosis is to block its abnormal positive feedback loop. The abnormal loop consists of high local levels of estrogen in the lesions, which induce transcription of COX-2 and synthesis of prostaglandin E2. This results in further expression and activity of aromatase and a further increase in estrogen.

Evaluation and Management of Dysmenorrhea in Adolescents

Chronic pelvic pain is defined by the American College of Obstetricians and Gynecologists (ACOG) as noncyclic pelvic pain of at least 3 months duration or cyclic pain of 6-month duration, either of which interferes with one's normal activities of daily living. Dysmenorrhea, or painful menses, is the most common gynecologic complaint among adolescent and young adult females and is the leading cause of recurrent short-term school or work absenteeism. This chapter reviews the assessment, diagnosis, and treatment of some of the most common causes of pelvic pain in adolescents.

Dysmenorrhoea in different settings: Are the rural and urban adolescent girls perceiving and managing the dysmenorrhoea problem differently?

Context:It is well-known that every health problem, not only presents itself with different epidemiological profiles in different population settings, but is also perceived and managed differently. Having knowledge of these variations in its presentations and perceptions in different population settings, for example, in urban and rural settings, will be useful for its successful management.Aim:To study differences in epidemiological profiles, perceptions, socio economic losses, and quality-of-life losses and management of dysmenorrhoea in different settings for effective management.Design and Setting:A comparative cross-sectional study among adolescent school girls (101 girls in urban areas and 79 girls in rural areas) in the district of Karimnagar.Materials and Methods:A cross-sectional survey using a pretested questionnaire was conducted among 180 adolescent girls in urban and rural settings.Statistical Analyses Used:Proportions and X2 test.Results:The prevalence of dysmenorrhoea is 54% (53% in girls in urban areas and 56% in girls in rural areas) (X2 df = 0.1, P = 0.05). Sickness absenteeism (28–48%), socio economic losses, and perceived quality of life losses are more prevalent among girls in urban areas than in girls in rural areas. Girls in rural areas resort to physical labor and other natural methods to obtain relief while the girls in urban areas are mainly depending on medications.Conclusions:Dysmenorrhoea can also be managed effectively by natural methods without resorting to medicines, provided one is psychologically prepared to face it without anxiety.

Managing dysmenorrhoea

AbstractSpecialist Mr Barry Auld answers questions posed by GP Dr Sally Hope on the management of dysmenorrhoea and comments on two case histories. Copyright © 2006 Wiley Interface Ltd

Surgical interruption of pelvic nerve pathways in dysmenorrhea: a systematic review of effectiveness

To assess the effectiveness of surgical interruption of pelvic nerve pathways in primary and secondary dysmenorrhea. Data sources. The Cochrane Menstrual Disorders and Subfertility Group Trials Register (9 June 2004), CENTRAL (The Cochrane Library, Issue 2, 2004), MEDLINE (1966 to Nov. 2003), EMBASE (1980 to Nov. 2003), CINAHL (1982 to Oct. 2003), MetaRegister of Controlled Trials, the citation lists of review articles and included trials, and contact with the corresponding author of each included trial. The inclusion criteria were randomized controlled trials of uterosacral nerve ablation or presacral neurectomy (both open and laparoscopic procedures) for the treatment of dysmenorrhea. The main outcome measures were pain relief and adverse effects. Two reviewers extracted data on characteristics of the study quality and the population, intervention, and outcome independently. Nine randomized controlled trials were included in the systematic review. There were two trials with open presacral neurectomy; all other trials used laparoscopic techniques. For the treatment of primary dysmenorrhea, laparoscopic uterosacral nerve ablation at 12 months was better when compared to a control or no treatment (OR 6.12; 95% CI 1.78-21.03). The comparison of laparoscopic uterosacral nerve ablation with presacral neurectomy for primary dysmenorrhea showed that at 12 months follow-up, presacral neurectomy was more effective (OR 0.10; 95% CI 0.03-0.32). In secondary dysmenorrhea, along with laparoscopic surgical treatment of endometriosis, the addition of laparoscopic uterosacral nerve ablation did not improve the pain relief (OR 0.77; 95% CI 0.43-1.39), while presacral neurectomy did (OR 3.14; 95% CI 1.59-6.21). Adverse events were more common for presacral neurectomy than procedures without presacral neurectomy (OR 14.6; 95% CI 5-42.5). The evidence for nerve interruption in the management of dysmenorrhea is limited. Methodologically sound and sufficiently powered randomized controlled trials are needed.

Management Of Dysmenorrrhoea Among Medical Students

A cross-sectional descriptive study, was carried out among the medical students of the College of Medicine, Ladoke Akintola University of Technology, Osogbo in South-Western Nigeria. Structured questionnaires were used to assess management options of dysmenorrhoea among them. Overwhelming majority decided to live with the condition without seeking medical help from health professionals despite incapacitating effects of the condition. Self-medication is rampant among them. There is need for health education on effective management of dysmenorrhoea to prevent economic and social loss that had been identified with this condition.

Consultation with the Specialist: Dysmenorrhea

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 …

Management of dysmenorrhoea

Accurate diagnosis is important to ensure optimal management of dysmenorrhoea—for women whose dysmenorrhoea does not respond to first line treatments, diagnostic laparoscopy is often useful. Randomised trials have confirmed the effectiveness of a wide and varied array of treatments: conservative approaches including aerobic exercise, topical heat, relaxation therapy, high frequency transcutaneous electrical nerve stimulation (TENS) and timely diagnostic ultrasound; drug treatments including paracetamol and non-steroidal anti-inflammatory drugs, hormonal drug treatments for endometriosis, progestogen drug treatment for unexplained chronic pelvic pain; alternative and newer drug treatments including Vitamin B1, Vitamin E, magnesium, fish oil, toki-shakuyaku-san; surgical treatments including laparoscopic excision and laparoscopic ablation for endometriosis, laparoscopic ovarian cystectomy for endometriomas, the levonorgestrel intrauterine system as a post-operative adjunct for endometriosis, and laparoscopic uterine nerve ablation for primary dysmenorrhoea. The future research agenda has been defined by gaps in randomised trial evidence where data are insufficient or conflicting.

Dysmenorrhoea

Dysmenorrhoea is commonly divided into primary dysmenorrhoea, where pelvic anatomy and ovarian function are normal and there is no co-existent pathology, and secondary dysmenorrhoea where there is an identifiable pathological condition. The true incidence is difficult to establish due to an inconsistency in the definition used and the population studied, but dysmenorrhoea probably affects between 40% and 70% of women of reproductive age, and compromises daily activities in up to 10% of women. It is associated with significant psychological distress, including both anxiety and depression, which may be co-existent, and requires considered, empathetic management by healthcare practitioners. Although the exact pathophysiological mechanisms that underlie the disease are incompletely understood, the pain most likely reflects increased myometrial activity induced by an excessive production of prostaglandin. This is supported by the clearly beneficial effect of non-steroidal anti-inflammatory agents, although optimal management of dysmenorrhoea depends on an understanding of the underlying cause with treatment specifically directed at this. Patients with primary dysmenorrhoea may simply need reassurance and simple analgesics, whereas those with secondary dysmenorrhoea require investigation and treatment of the underlying organic problem. Treatment is generally supportive, however, with adequate symptomatic relief provided for the majority of patients through the single or combined use of non-steroidal anti-inflammatory agents and the combined oral contraceptive pill. Lack of response to these agents increases the likelihood of a secondary cause for dysmenorrhoea prompting further investigations and specifically directed treatment upon diagnosis.

Surgical interruption of pelvic nerve pathways for primary and secondary dysmenorrhoea.

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.

The use of the leukotriene receptor antagonist montelukast (singulair®) in the management of dysmenorrhea in adolescents

PurposePrevious studies have shown an increase in leukotrienes in the uterine tissue as well as in the menstrual flow of adult women with dysmenorrhea. An increase in leukotriene-E4, the major urinary leukotriene, was also reported in adolescent girls with dysmenorrhea, further suggesting a possible involvement of these potent vasoconstrictors and inflammatory mediators in generating dysmenorrhea symptoms. In the present study we examined whether blocking leukotrienes might alleviate symptoms of dysmenorrhea in adolescents. MethodsTwenty-five adolescents (age 16 ± 1 years, 4 ± 1 years post menarche, body mass index 23 ± 1) with dysmenorrhea participated in a randomized, double blind, crossover study. Thirteen girls received one tablet of montelukast (Singulair®, Merck, West Point, PA) 10 mg daily starting on day 21 of the cycle until the last day of the menstrual period for two menstrual cycles, followed by one tablet of placebo (Merck, West Point, PA) daily starting on day 21 of the cycle until the last day of the menstrual period for two additional menstrual cycles. The other 12 girls had a reverse schedule starting with placebo. Participants were instructed to use one or two 200-mg tablets of ibuprofen every 6 h in the event of continuing menstrual symptoms. The Cox Menstrual Symptom Scale was used to assess response to treatment. An intent-to-treat approach was used for data analysis. ResultsTwenty-two girls completed the study. Two girls were noncompliant with the study protocol, and one was withdrawn because of Helicobacter pylori infection. Compared with Cox menstrual score (mean ± SE) before study (46 ± 6), there was no significant change in menstrual symptoms during treatment with placebo (Cox score 42 ± 7) or during treatment with montelukast (Cox score 39 ± 7), and there was no significant difference between montelukast and placebo treatments as well. Likewise, there was no significant difference between the amount of ibuprofen tablets consumed during the menstrual periods before study (4 ± 1), while on placebo (3 ± 1), and while on montelukast (4 ± 1). ConclusionsThis study does not support the use of montelukast, in the current FDA-approved dose (for asthma) and commencing immediately before the menstrual period, for treatment of dysmenorrhea. It remains to be determined in further studies whether a higher dose or a prolonged daily use of montelukast may alleviate symptoms of dysmenorrhea in adolescents.

The use of the leukotriene receptor antagonist singulair (montelukast) in the management of dysmenorrhea in adolescents

Previous studies have shown an increase in leukotrienes in the uterine tissue as well as in the menstrual flow of adult women with dysmenorrhea. An increase in LT-E4, the major urinary leukotriene, was also reported in adolescent girls with dysmenorrhea, further suggesting a possible involvement of these potent vasoconstrictors and inflammatory mediators in generating dysmenorrhea symptoms. In the present study we examined whether blocking leukotrienes might alleviate symptoms of dysmenorrhea in adolescents.

The use of the leukotriene receptor antagonist singulair (montelukast) in the management of dysmenorrhea in adolescents

Previous studies have shown an increase in leukotrienes in the uterine tissue as well as in the menstrual flow of adult women with dysmenorrhea. An increase in LT-E4, the major urinary leukotriene, was also reported in adolescent girls with dysmenorrhea, further suggesting a possible involvement of these potent vasoconstrictors and inflammatory mediators in generating dysmenorrhea symptoms. In the present study we examined whether blocking leukotrienes might alleviate symptoms of dysmenorrhea in adolescents.

Surgical pelvic neuroablation for chronic pelvic pain: a systematic review

Objective To determine, from the best available evidence, the effectiveness of surgical pelvic neuroablative techniques as treatment for primary and secondary dysmenorrhoea. Design Systematic review of randomized controlled trials (RCTs). Subjects Women with primary or secondary dysmenorrhoea. Interventions Surgical neuroablative techniques including uterine nerve ablation and presacral neurectomy. Main outcome measures Pain relief (both short- and long-term) and adverse effects. Results Laparoscopic uterine nerve ablation (LUNA) has been shown by one small study to be effective for primary dysmenorrhoea up to 12 months. A larger study showed no significant difference between LUNA and laparoscopic presacral neurectomy (LPSN) in pain relief for primary dysmenorrhoea up to 6 months, but LPSN was significantly more effective beyond 6 months. For dysmenorrhoea secondary to endometriosis, two trials found no significant difference in pain relief afforded by LUNA plus conservative laparoscopic surgery for endometriosis vs. conservative laparoscopic surgery alone. Presacral neurectomy (PSN) plus conservative surgery for endometriosis at laparotomy vs. conservative surgery for endometriosis at laparotomy showed no significant difference in overall pain relief, although there was a significant difference in relief of midline abdominal pain. Adverse events overall were significantly more common following PSN; these included constipation, urinary urgency, painless labour and one case necessitating a laparotomy for presacral haematoma 2 days after PSN. Conclusions There is insufficient evidence to recommend the use of surgical pelvic neuroablation in the management of dysmenorrhoea, regardless of cause. Further scientifically rigorous RCTs should be undertaken.