Treatment Of Dysmenorrhea Research Articles

Phytotherapy and Medicinal Plants in the Treatment of Dysmenorrhea: A Systematic Review Study in Iranian Ethnobotanical Documents

Dysmenorrhea is an unusual pain in the abdomen during menstruation. Women experience pain in the lowerabdomen and uterus during menstruation, but if the pain is too much to stop daily activities, it is calleddysmenorrhea or painful menstruation. Chemical treatments for dysmenorrhea are usually associated withside effects. Gastrointestinal problems, nausea, blurred vision, headache, and dizziness are some of theside effects of medications used to treat dysmenorrhea. Today, the use of herbal remedies and traditionalmedicine has become common. In this systematic review study, the most important medicinal plantsmentioned for dysmenorrhea in Iranian ethnobotanical documents were extracted and reported. In thisreview study, keywords such as dysmenorrhea, medicinal plants, ethnobotany, identification of medicinalplants, region and Iran from databases including ISI ,Web of Science, PubMed, Scopus, ISC, Magiran andGoogle Scholar to review articles and Resources used. Based on the obtained results, medicinal plantsFoeniculum vulgare Mill, Juniperus communis, Origanum vulgare, Salvia sclarea L., Urtica dioica L.,Anthemis cotula L., Carthamus lanatus L., Silybum marianum [L.] Gaerth., Anthriscus cerefolium L[Hoffm.], Vitex pseudonegundo, Parietaria judaica L., Achillea biebersteinii Afanasiev., Equisetum arvenseL., Phoeniculum vulgare Mill. daenensis Celak., Peganum harmala L., Trifolium repens L., Salix aegyptiacaL., Nepeta fassenii, Cicer kermanenses, Teucrium pollium L., Achillea santolina, Cuminum cyminum,Valeriana officinalis, Salvia macrosiphon, Achillea eriophora, which are medicinal plants. They are used indifferent regions of Iran to treat dysmenorrhea.

Associations Between Dysmenorrhea Symptom-Based Phenotypes and Vaginal Microbiome: A Pilot Study.

Dysmenorrhea is highly prevalent; it places women at risk for other chronic pain conditions. There is a high degree of individual variability in menstrual pain severity, the number of painful sites, and co-occurring gastrointestinal symptoms. Distinct dysmenorrhea symptom-based phenotypes were previously identified, but the biological underpinnings of these phenotypes are less known. One underexplored contributor is the vaginal microbiome. The vaginal microbiota differs significantly among reproductive-age women and may modulate as well as amplify reproductive tract inflammation, which may contribute to dysmenorrhea symptoms. The objective of this study was to examine associations between dysmenorrhea symptom-based phenotypes and vaginal microbiome compositions on- and off-menses. We conducted a prospective, longitudinal, pilot study of 20 women (aged 15-24 years) grouped into three dysmenorrhea symptom-based phenotypes: "mild localized pain," "severe localized pain," and "severe multiple pain and gastrointestinal symptoms." Over one menstrual cycle, participants provided vaginal swabs when they were on- and off-menses. We assayed the vaginal microbiome using 16S rRNA gene sequencing. Permutational multivariate analysis of variance tests were used to compare microbiome compositions across phenotypes, with heat maps generated to visualize the relative abundance of bacterial taxa. The vaginal microbiome compositions (n = 40) were different across the three phenotypes. After separating the on-menses (n = 20) and off-menses (n = 20) specimens, the statistically significant difference was seen on-menses, but not off-menses. Compared to the "mild localized pain" phenotype, participants in the "multiple severe symptoms" phenotype had a lower lactobacilli level and a higher abundance of Prevotella, Atopobium, and Gardnerella when on-menses. We also observed trends of differences across phenotypes in vaginal microbiome change from off- to on-menses. The study provides proof-of-concept data to support larger studies on associations between dysmenorrhea symptom-based phenotypes and vaginal microbiome that might lead to new intervention targets and/or biomarkers for dysmenorrhea. This line of research has the potential to inform precision dysmenorrhea treatment that can improve women's quality of life.

Efficacy and safety of Chinese herbal footbaths for the treatment of dysmenorrhea: Protocol for a systematic review and meta-analysis.

BackgroundChinese herbal footbaths are an external therapy of traditional Chinese medicine that has been widely used to treat dysmenorrhea. This review aims to systematically evaluate its efficacy and safety for the treatment of dysmenorrhea.MethodsDatabases of PubMed, EMBASE, Cochrane Library, CIHAHL, Web of Science, Chinese National Knowledge Infrastructure(CNKI), Chinese Scientific Journals Database (VIP), Wanfang Database, China Biomedical Literature Database(CBM), and Chinese Biomedical Literature Service System (SinoMed) will be searched from the inception to September 30, 2020. The eligible randomized controlled trials (RCTs) will be identified and included. The primary outcomes include pain intensity measured by validated scales of visual analog scale, numeric rating scale, and response rate of symptom reduction. The secondary outcomes are scores on validated pain questionnaires, quality of life measured by SF-36 or other validated scales, and adverse events. Study selection, data extraction, and assessment of bias risk will be conducted by two reviewers independently. RevMan software (V.5.3.5) will be utilized to perform data synthesis. Subgroup and sensitivity analysis will be performed when necessary. The strength of the evidence will be evaluated with the Grading of Recommendations Assessment, Development and Evaluation System.ResultsA high-quality synthesis of current evidence of Chinese herbal footbaths for patients with dysmenorrhea will be provided in this study.ConclusionThis systematic review will provide evidence of whether Chinese herbal footbaths are an effective and safe intervention for the treatment of dysmenorrhea.Systematic review registrationPROSPERO CRD42020188256.

A Comprehensive Mini-Review of Curcumae Radix: Ethnopharmacology, Phytochemistry, and Pharmacology

Curcumae Radix is an efficacious ingredient with various medicinal properties empirically used in traditional Chinese medicine (TCM) formula for the treatment of cancer, depression, chest pain, dysmenorrhea, epilepsy, and jaundice. However, either phytochemical or pharmacological information of Curcumae Radix underlying its traditionally medicinal uses is rarely summarized and systematically analyzed. To provide evidence for clinical trials, a comprehensive literature review has been prepared of the phytochemicals, and ethnopharmacological and pharmacological mechanisms of this herb. The review approach consisted of searching several web-based scientific databases, including PubMed, Web of Science, and Elsevier. The keywords included “Curcumae Radix,” “ Curcuma wenyujin,” “ Curcuma longa,” “ Curcuma kwangsiensis,” and “ Curcuma phaeocaulis.” Based on the proposed criteria, 57 articles were evaluated in detail. The accumulated data indicate that Curcumae Radix contains a number of bioactive phytochemicals, mainly sesquiterpenes, diarylheptanoids, and diarylpentanoids, which account for a variety of medicinal values, such as anticancer, anti-inflammation, anti-hepatic fibrosis, and antioxidant. A wide range of apoptotic proteins, cell adhesion molecules, inflammatory cytokines, and enzymic and nonenzymic antioxidants could be modulated by either Curcumae Radix or its bioactive compounds, thus underpinning a fundamental understanding for the pharmacological effects of this herb. This review highlights the therapeutic potential of Curcumae Radix to progress the development of versatile adjuvants or therapeutic agents in the future.

PENGARUH TEKNIK RELAKSASI OTOT PROGRESIF TERHADAP PENURUNAN SKALA NYERI MENSTRUASI (DISMENORE) PADA REMAJA PUTRI DI DESA PULAU JAMBU

during menstruation or dysmenorrhea is often complained by teenage girls who have entered puberty as an uncomfortable sensation such as pain in the abdomen, cramps and pain in the waist that can interfere with daily activities. One of the non-pharmacological treatments for dysmenorrhea is progressive muscle relaxation techniques, which are very suitable for reducing dysmenorrhea pain. Purpose: This study was to determine the effect of progressive muscle relaxation techniques on the scale of menstrual pain (dysmenorrhea) in young women in Pulau Jambu village, the working area of the Kuok Community Health Center in 2020. Methods: This type of research uses a quasi-experimental method with a non-equivalent pretest-posttest plan. The sampling technique used purposive sampling with a sample size of 30 people. The data collection tool used was an observation sheet using the Numeric Rating Scale (NRS) pain scale. Data processing used univariate and bivariate analysis with the Wilcoxon Signed Rank Test with the SPSS 17 program. Results: this study shows that progressive muscle relaxation techniques have an influence on the scale of dysmenorrhea in young women in Pulau Jambu village, the working area of the Kuok Health Center in 2020 with a p value of 0.000. (

Bioactive constituents and the molecular mechanism of Curcumae Rhizoma in the treatment of primary dysmenorrhea based on network pharmacology and molecular docking

BackgroundCurcumae Rhizoma (CR) has a clinical efficacy in activating blood circulation to dissipate blood stasis and has been used for the clinical treatment of qi stagnation and blood stasis (QSBS) primary dysmenorrhea for many years. However, its molecular mechanism is unknown. ObjectiveThe present study aimed to demonstrate the multicomponent, multitarget and multipathway regulatory molecular mechanisms of CR in the treatment of QSBS primary dysmenorrhea. MethodsObservations of pathological changes in uterine tissues and biochemical assays were used to confirm that a rat model was successfully established and that CR was effective in the treatment of QSBS primary dysmenorrhea. The main active components of CR in rat plasma were identified and screened by ultra-performance liquid chromatography-quadrupole/time-of-flight mass spectrometry (UPLC-Q/TOF-MS). The component-target-disease network and protein-protein interaction (PPI) network of CR were constructed by a network pharmacology approach. Then, we performed Gene Ontology (GO) functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Molecular docking was adopted to verify the interactions between the core components and targets of CR to confirm the accuracy of the network pharmacology prediction results. Furthermore, we evaluated the bioactive constituents of CR and molecular mechanism of by which CR promote blood circulation and remove blood stasis via platelet tests in vivo and in vitro and Western blot analysis. ResultsThe results of HE staining and biochemical assays of PGF2α, TXB2 and Ca2+ showed that CR was effective in the treatment of QSBS primary dysmenorrhea. A total of 36 active components were identified in CR, and 329 common targets were obtained and used to construct the networks. Of these, 14 core components and 10 core targets of CR in the treatment of primary dysmenorrhea were identified. The GO and KEGG enrichment analyses revealed that the common targets were involved in multiple signaling pathways, including the calcium, cAMP, MAPK, and PI3K-Akt signaling pathways, as well as platelet activation, which is closely related to platelet aggregation. The molecular docking results showed that the 14 core components and 10 core targets could bind spontaneously. Two core targets (MAPK1 and CCR5) and 7 core components (Isoprocurcumenol, Curcumadione, Epiprocurcumenol, (+)-Curdione, Neocurdione, Procurcumenol, and 13-Hydroxygermacrone) were closely related to CR in the treatment of primary dysmenorrhea. Furthermore, the in vivo platelet test showed that CR clearly inhibited platelet aggregation. Five core components ((+)-Curdione, Neocurdione, Isoprocurcumenol, Curcumadione and Procurcumenol) obviously inhibited platelet aggregation in vitro. In addition, based on the relationships among the signaling pathways, we confirmed that CR can effectively inhibit the expression of MAPK and PI3K-Akt signaling pathway-related proteins and decrease the protein expression levels of ERK, JNK, MAPK, PI3K, AKT and CCR5, thereby inhibiting platelet aggregation. ConclusionThis study demonstrated the bioactive constituents and mechanisms of CR in promoting blood circulation and removing blood stasis and its multicomponent, multitarget and multipathway treatment characteristics in primary dysmenorrhea. The results provide theoretical evidence for the development and utilization of CR.

Effect of Moxibustion Therapy on Intensity of Primary Dysmenorrhea in Adolescents Girl at Cimahi Negeri 2 Junior High School

Based on the data from the World Health Organisation (WHO), primary dysmenorrhea is prevalent among 55-75% adolescent girls and women of reproductive age. Threequarters of these women experienced mild-moderate dysmenorrhea. One of the non-pharmacological treatments for dysmenorrhea is moxibustion therapy. The heat from moxa is able to stimulate sensory nerve cells around the acupoints and can affect the endocrine system to release endorphins and also inhibit pain impulses in spinal cord. This research design was quasi-experiment with non-equivalent control group design, using non-probability with purposive sampling technique, which obtained 54 samples consisting of 27 in each intervention and control groups. Mean was used in univariate analysis and t-dependent also t-independent tests was used in bivariate analysis. This research occured at Cimahi Negeri 2 Junior High School. In the intervention group the therapy was given in one-time, 1 inch above the 9 acupoints within 15 minutes long, while in the control group no intervention was given. The results of the study proved the differences in the mean pain scale values of primary dysmenorrhea in the intervention group and the control group (p-value = 0.000) so that there is an effect of moxibustion therapy on the intensity of primary dysmenorrhea in adolescents. Moxibustion therapy can be recommended to be applied as a non-pharmacological action to treat dysmenorrhea and can be done independently.
 
 Keywords: Acupoints, Moxibustion Therapy, Primary Dysmenorrhea

Efficacy of Ginger in the Treatment of Primary Dysmenorrhea: A Systematic Review and Meta-analysis.

It has been evidenced that very few systematic reviews have examined the effectiveness of ginger for pain duration and its severity among women with primary dysmenorrhea. This meta-analysis was therefore performed to methodically incorporate and significantly evaluate randomized controlled ginger studies for the treatment of primary dysmenorrhea. The literature was searched using PubMed, Embase, Ovid, ClinicalKey, Medline, and electronic database. We have analyzed clinical trials by comparing ginger with placebo and non-steroidal anti-inflammatory drugs in women with primary dysmenorrhea. The primary outcomes assessed in our meta-analysis were pain severity and pain duration. Secondary outcomes were change in bleeding, side effects of the drug, and rate of satisfaction. We have screened a total of 638 studies, out of which narrative synthesis was formulated for eight studies. We have performed a meta-analysis of five trials examining ginger with placebo and other two randomized controlled trials comparing ginger with a non-steroidal anti-inflammatory drug (NSAID); it seems to be more helpful for relieving menstrual pain than a placebo (mean difference [MD] = 2.67, 95% CI = 3.51-1.84, P = 0.0001, I2 = 86%), although it was found that ginger and NSAIDs were equally effective in pain severity (risk ratios [RR] = 1.15, 95% CI = 0.53-2.52, P = 0.72, I2 =77%). We have not observed any significant difference between ginger and placebo on pain duration among primary dysmenorrheic women (MD = -2.22, 95% CI = -7.62-3.18, P = 0.42, I2 = 56%). Accessible information proposes that oral ginger can be a compelling treatment for primary dysmenorrhea. This meta-analysis strongly supports the requirement for high methodological quality consistency for upcoming trials.

Efficacy of cyclic and extended regimens of ethinylestradiol 0.02mg -levonorgestrel 0.09mg for dysmenorrhea: A placebo-controlled, double-blind, randomized trial.

PurposeWe aimed to evaluate the efficacy and safety of 28‐day Cyclic and 84‐day Extended regimens of NPC‐16 (ethinylestradiol 0.02 mg plus levonorgestrel 0.09 mg) in patients with dysmenorrhea.MethodsThis was a placebo‐controlled, double‐blind, randomized trial conducted in Japan. A total of 251 primary and secondary dysmenorrhea patients were randomly assigned to the NPC‐16‐Cyclic group, NPC‐16‐Extended group, or the Placebo group. The primary end point was a comparison of the efficacy and safety of the Cyclic and Extended NPC‐16 regimen for the treatment of dysmenorrhea relative to the Placebo.Main findingsSignificantly greater reductions in total dysmenorrhea score and visual analog scale score were observed in the Cyclic and Extended groups compared with the Placebo group. Compared with the Cyclic regimen as a secondary end point, the Extended regimen exhibited greater efficacy in the treatment of dysmenorrhea over the course of the study period, particularly in patients with severe dysmenorrhea. The incidence of adverse drug reactions (ADRs) was significantly higher in the Cyclic and Extended groups than in the Placebo group.ConclusionThe Cyclic and Extended regimens of NPC‐16 significantly reduced dysmenorrhea severity compared to placebo. The Extended regimen was superior to cyclic regimen in reducing the dysmenorrhea.

Mechanism of Danggui Sini Decoction in treatment of primary dysmenorrhea based on network pharmacology and molecular docking

Network pharmacology, molecular docking and in vivo experiments were used to explore the pharmacodynamic basis and potential mechanism of Danggui Sini Decoction in the treatment of primary dysmenorrhea(PD). The chemical constituents of Danggui(Angelicae Sinensis Radix), Guizhi(Cinnamomi Ramulus), Tongcao(Tetrapanacis Medulla), Baishao(Paeoniae Radix Alba), Xixin(Asari Radix et Rhizoma), Gancao(Glycyrrhizae Radix et Rhizoma), and Dazao(Jujubae Fructus) from Danggui Sini Decoction were retrieved through TCMSP(Traditional Chinese Medicine Systems Pharmacology Database), and the action targets of Danggui Sini Decoction were collected through DrugBank. "Primary dysmenorrhea" and "dysmenorrhea" were used as the key words to search the corresponding targets in the GeneCards, OMIM and TTD databases, and then the intersection targets of Danggui Sini Decoction and the primary dysmenorrhea targets were taken for reverse screening to obtain the corresponding active ingredients. Cytoscape 3.6.1 software was used to construct a traditional Chinese medicine-compound-target-disease network; STRING database was used to build a protein-protein interaction(PPI) network; Gene ontology(GO) function enrichment analysis and Kyoto encyclopedia of genes and genomes(KEGG) pathway enrichment analysis were conducted by using DAVID database. The action mechanism of the intersection targets were then predicted, and a histogram chart and bubble chart were drawn for visualization. Then the top five targets in the PPI network were used for docking with the most compounds. In animal experiments, Sprague Dawley(SD) female rats were used to establish a primary dysmenorrhea model by intraperitoneal injection of diethylstilbestrol once a day. A total of 60 SD female rats were randomly divided into 6 groups, namely control group, model group, Danggui Sini Decoction low(1.5 g·kg~(-1)), medium(3.0 g·kg~(-1)), high(6.0 g·kg~(-1)) dose groups, and ibuprofen(20 mg·kg~(-1)) positive control group, with 10 rats in each group. From day 4, except for the control group, rats in the other groups were given intragastric administration of corresponding drugs, and the control group received intragastric administration of normal saline for 7 consecutive days. The number of writhing before and after the administration, the ute-rine contraction inhibition rate and the uterine index after administration were observed, and ELISA assay was used to detect the levels of prostaglandin-endoperoxide synthase 2(PTGS2) and vascular endothelial growth factor A(VEGFA) in the tissues of each group as well as the levels of serum inflammatory factors interleukin 1(IL-1), interleukin 6(IL-6), and tumor necrosis factor-alpha(TNF-α). According to network analysis, 7 Chinese medicines contained 114 active ingredients, 149 targets, and 30 common target genes with PD were obtained. The key targets included VEGFA, IL6, PTGS2, TNF, etc.; GO function enrichment analysis showed a total of 399 terms(P<0.05) were obtained, 353 of which were biological process(BP) terms, 21 were cell composition(CC) terms, and 25 were molecular function(MF) terms. In KEGG pathway enrichment analysis, 14 signaling pathways were obtained, 3 of which were related to inflammation, namely arachidonic acid metabolism, MAPK signaling pathway and NOD-like receptor signaling pathway. The compounds in Danggui Sini Decoction can play a therapeutic role in the treatment of PD by acting on VEGFA, IL-6, PTGS2, TNF and other targets to regulate arachidonic acid and inflammatory signaling pathways.

SURVEY ON CHARACTERISTICS CLINICAL OF DYSMENORRHEA AND THE NEED FOR TREATMENT WITH TRADITIONAL MEDICINE OF FEMALE STUDENTS OF HUE UNIVERSITY OF MEDICINE AND PHARMACY

Background: Dysmenorrhea is understood as a woman suffering from menstrual pain. Dysmenorrhea is often manifested with symptoms such as abdominal pain, back pain, vomiting, nausea, diarrhea, dizziness,... it not only causes physical pain for the patient, expensive treatment, but also greatly affects the quality of life. Objective: To stduy characteristics of dysmenorrhea and the need for treatment with traditional medicine of female students of Hue university of medicine and pharmacy. Materials and method: A crosssectional descriptive study was conducted in 409 female students from 8 academic majors at Hue University of Medicine and Pharmacy. Students were instructed and completed a self-administered questionnaire, using the Cox Retrospective Symptom Scale (RSS –Cox) to assess menstrual symptoms, using the VAS pain severity scale to assess the level of pain. Result: The rate of dysmenorrhea among female students of Hue University of Medicine and Pharmacy was 88.8%. Moderate pain (according to VAS) accounts for 51.8%, mild pain 30.3% and severe pain 17.9%. The average RSS-Cox1 score was 16.7 ± 10.6 and the RSS-Cox 2 score was 13.0 ± 9.5. According to traditional medicine, Excess accounts for 65.3%, Deficiency 47.9%, Heat 3.0% and Cold 51.8%. In clinical type, the pattern of stagnation of cold-dampness accounts for 38.3%, stagnation of Qi and blood stasis 30.9%, deficiency of Qi and blood 18.7% deficiency of the liver and kidney 10.5%. The proportion of students who need for treatment with traditional medicine is 14.9%, acupress massage and moxibustion are the two methods with the highest demand for treatment. Conclusion: The rate of dysmenorrhea among female students at Hue University of Medicine and Pharmacy is high, most of them have moderate pain, and menstrual-related symptoms appear more often with quite severe levels. According to traditional medicine, most of them have the manifestations of Excess and Cold, corresponding to stagnation of cold-dampness and stagnation of Qi and blood stasis are higher than the others. Demand for treatment of dysmenorrhea with traditional medicine is relatively low, most of them need treatment with acupress massage and moxibustion methods. Key words: dysmenorrhea, the need for treatment, female students, Hue university of medicine and pharmacy

Research on Quality Markers of Guizhi Fuling Prescription for Endometriosis Treatment Based on Gray Correlation Analysis Strategy.

Guizhi Fuling prescription (GFP), a prestigious prescription of traditional Chinese medicine (TCM) recorded in “Jingui Yaolue,” was composed of five Chinese medicines, including Moutan Cortex, Paeoniae Radix Alba, Persicae Semen, Poria Cocos, and Cinnamomi Ramulus. It was used for the treatment of endometriosis, primary dysmenorrhea, and blood stasis for centuries. However, its Quality Markers of treating endometriosis have not been clearly elucidated. In this study, a rapid ultraperformance liquid chromatography/quadrupole time-of-flight tandem mass spectrometry (UPLC/Q-TOF-MS/MS) method was established for Quality Markers investigation on GFP, and a total of 50 potentially bioactive constituents including triterpenoids, paeoniflorin and its derivatives, phenolic acids, and other species were identified based on their retention time, fragmentation pattern, and accurately measured mass value. Furthermore, regularity of recipe composition and gray correlation analysis revealed that all of the characteristic peaks contributed to the treatment of endometriosis. The relative correlation degrees were greater than 0.6. Among them, peaks 1 and 10, which were most closely correlated to the endometriosis, were identified as amygdalin and cinnamic acid. Finally, all of the active ingredients were molecularly docked with proteins associated with endometriosis by Schrodinger method. Among them, amygdalin, cinnamic acid, paeonol, gallic acid, and paeoniflorin had the lower binding energies. It was proposed that these constituents could be directed at Quality Markers for GFP. Thus, the integrated approach describing for revealing Quality Markers of GFP could be expected to provide a method for quality evaluation.

Untargeted metabolomics reveals the synergistic mechanisms of Yuanhu Zhitong oral liquid in the treatment of primary dysmenorrhea

Primary dysmenorrhea is a prevalent gynecological disorder that severely affects the quality of life in women. Yuanhu Zhitong oral liquid (YZOL) is a standardized herbal preparation frequently used in clinical practice and is a promising alternative therapy for primary dysmenorrhea. The findings of previous studies show that YZOL exhibits significant analgesic and spasmolytic effects, however, the involved mechanism remains unclear. Herein, we performed an untargeted plasma metabolomic analysis on a mouse model of oxytocin-induced primary dysmenorrhea to investigate the underlying mechanism of YZOL. We used multivariate and pathway-driven analyses to uncover the treatment targets linked with YZOL therapy and verified the possible mechanisms through biochemical assays. Therefore, we identified 47 plasma biomarkers primarily associated with sphingolipid metabolism, amino acid metabolism, arachidonic acid metabolism, and biosynthesis of steroid hormone as well as primary bile acid. We established that the analgesic effect of YZOL on primary dysmenorrhea relies on multiple constituents that act on multiple targets in multiple pathways. Our correlation analysis showed significant correlations between the biomarkers and biochemical indicators, which is of considerable significance in elucidating the YZOL mechanisms. Moreover, we identified some novel prospective biomarkers linked to primary dysmenorrhea, including bile acids. Collectively, these data provide new insights into the mechanism of YZOL and provide evidence for the analgesic effect of YZOL in the treatment of primary dysmenorrhea.

Pulsed high-intensity laser therapy versus low level laser therapy in the management of primary dysmenorrhea.

[Purpose] To determine the effect of pulsed high intensity laser therapy (HILT) versus low level laser therapy (LLLT) in the treatment of primary dysmenorrhea. [Participants and Methods] This was a randomized clinical trial that included 30 females diagnosed with primary dysmenorrhea who were assigned randomly into two groups of equal numbers. The treatment was three sessions every cycle for three consecutive cycles, where group (A) received pulsed HILT and group (B) received LLLT. All participants were evaluated before and after treatment sessions by visual analogue scale (VAS) and at the end of treatment by pain relief scale (PRS). [Results] The results showed a significant decrease in the severity of pain in the two groups. Comparison between the two groups showed a statistically non-significant difference in the severity of pain and pain alleviation at the end of the treatment course. [Conclusion] Both pulsed HILT and LLLT are effective in the treatment of primary dysmenorrhea, with no significant differences between the two modalities.

Conventional and Alternative Management of Dysmenorrhea – A Narrative Review

Introduction: Dysmenorrhea also known as painful menstruation is a public health problem with high prevalence among adolescents. It is defined as a severe, painful, cramping sensation within the lower abdomen occurring just before, during or few days after menstruation starts. Dysmenorrhea can negatively affect a woman's quality of life and interfere with daily activities. The two categories of dysmenorrhea are primary and secondary. Dysmenorrhea occurring in the absence of any pathological condition of the pelvis is known as primary dysmenorrhea while dysmenorrhea occurring in the presence of pathological condition of the pelvis is called secondary dysmenorrhea. Aim of review: The purpose of this review is to present a general overview of the types, epidemiology, diagnosis and available treatment options of both primary and secondary dysmenorrhea. Methods: PubMed, Google Scholar and Medline search engines (2000 to 2021) were used to conduct searches of relevant articles on dysmenorrhea. Citation lists of publications, including studies for randomized controlled trials (RCTs) and review articles were searched. Conclusion: Although prevalence is difficult to determine, dysmenorrhea may affect as high as 90% of menstruating women. Risk factors for dysmenorrhea may include smoking, early menarche, nulliparity, and family history. Analgesics and oral contraceptives are the mainstay of treatment for primary dysmenorrhea. Complementary and alternative treatments options such as herbal medicines, exercise and diet are also available. Addressing the underlying pathology of secondary dysmenorrhea is the main stay for its management.

Samomedikacija primarne dismenoreje kod studentkinja medicine u Srbiji

Introduction: Primary dysmenorrhea is a common disorder in women, with a significant impact on quality of life. Aim: The objective of this academic study was to investigate the severity of dysmenorrhea in female students of the Faculty of Medicine in Novi Sad, to estimate the self-medication prevalence of primary dysmenorrhea, to identify the most commonly used conventional, herbal, homeopathic remedies and manner of their usage, as well as non-pharmacological measures in the treatment of primary dysmenorrhea. Material and Methods: This study was performed on a random sample of 100 respondents from different departments of the Faculty of Medicine in Novi Sad, from December 1st to December 15th, 2016. The data were obtained by using a standardized questionnaire. Results: The sample included 59 female medical students and 41 female students of the other study groups. Most of the respondents had medium expressed symptoms due to dysmenorrhea (48.0%). The most common symptoms were cramps and pain in the lower abdomen, anxiety, and appetite changes. 11% of respondents were absent from classes at the university minimum one day of each menstrual cycle, because of dysmenorrhea. 66% of respondents used drugs due to symptoms of dysmenorrhea. The most commonly used group of drugs were non-steroid anti-inflammatory drugs (75.76%), primarily ibuprofen (53.03%), and diclofenac (10.61%). Self-medication prevalence was 48.48%. Conclusion: According to the results of this study, dysmenorrhea symptoms significantly impact the quality of life.

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

Ethnopharmacological relevanceAkebiae Fructus, a Tujia minority folk medicine and a well-known traditional Chinese medicine for soothing the liver, regulating Qi, promoting blood circulation and relieving pain, is widely used in the treatment of primary dysmenorrhea. However, little is known about its underlying mechanism. Aim of the studyTo explore the effect of Akebiae Fructus on primary dysmenorrhea model induced by estradiol benzoate and oxytocin, and to provide better understanding of the mechanism of Akebiae Fructus for primary dysmenorrhea treatment. Materials and methodsThe primary dysmenorrhea mouse model was used in this study. Except for the control group and the normal administration group, the mice of other groups were subcutaneously injected with estradiol benzoate (10 mg/kg/d) for 10 consecutive days. From the 5th day of the ten-day model period, the positive control groups were given 0.075 g/kg ibuprofen and 7.5 g/kg Leonurus granule, the drug groups were given 0.2 g/kg, 0.4 g/kg, 0.8 g/kg Akebiae Fructus extract, the normal administration group was given 0.8 g/kg Akebiae Fructus extract, and the same volume saline was given in the control group. On the tenth day, oxytocin (10 U/kg) was peritoneally injected after estradiol benzoate injected 1 h. After the oxytocin injection, writhing behavior was observed for 30 min. Then the uterine tissue was collected to measure the level of PGF2α and PGE2, and for histological analysis and transcriptomics analysis. Meanwhile, plasma and urine samples were collected for metabolomic analysis. ResultsAkebiae Fructus inhibited the writhing, decreased the PGF2α level and ameliorated the morphological changes. 32 potential metabolic biomarkers in plasma and 17 in urine were found for primary dysmenorrhea, and after Akebiae Fructus treatment, 25 metabolites in plasma and 14 in urine were restored. These altered metabolites were mainly involved in lipid, amino acid and organic acid metabolism. For the transcriptomic study, a total of 2244 differentially expressed genes (1346 up-regulated and 898 down-regulated) were obtained between the control and model group, and 148 differentially expressed genes (DEGs) were found related with Akebiae Fructus treatment of primary dysmenorrhea. Correlation analysis was carried out based on the transcriptomic and metabolomic data. 5 differentially expressed genes (Plpp3, Sgpp2, Arg1, Adcy8, Ak5) were found related with the enrichment metabolic pathways. The mechanism by which Akebiae Fructus ameliorates primary dysmenorrhea may account for the regulation of the gene expression to control the key enzymes in the sphingolipid metabolism, arginine and proline metabolism, glycerophospholipid metabolism and purine metabolism, inhibiting the abnormal secretion of PGF2α, alleviating the uterine contraction and reducing inflammation and pain. ConclusionsAkebiae Fructus could effectively alleviate the symptoms of primary dysmenorrhea, regulate metabolic disorders, and control the related gene expression in primary dysmenorrhea. The study may provide clues for further study of Akebiae Fructus treatment on primary dysmenorrhea.

Chemical composition and uterine smooth muscle relaxant activity of essential oils from 10 kinds of blood-activating and stasis-resolving Chinese medicinal herbs

Ethnopharmacological relevanceDysmenorrhea is one of the most common gynecological problems among menstruating females. Blood-activating and stasis-resolving herbs (BASRHs) have been employed to be the first choice for treating dysmenorrhea in China. Especially, the essential oils of some BASRHs have been confirmed to play important roles in the treatment of dysmenorrhea, but the constituents and uterine smooth muscle relaxant activity of some commonly used BASRH essential oils have not been fully assessed, and whether there are differences in the constituents and anti-dysmenorrhea effect among BASRH essential oils has not been evaluated. Aim of the studyThis study aims to systematically investigate the chemical constituents of 10 BASRH essential oils and assess their uterine smooth muscle relaxant activity and the preliminary mechanism of the most effective essential oil. Materials and methodsThe chemical constituents of 10 BASRH essential oils were analyzed by Gas Chromatography-Mass Spectrometer. A rat model of dysmenorrhea in vitro was established to investigate the uterine smooth muscle relaxant activity of 10 kinds of essential oils. Rat isolated uterus strips were given different dose of 10 kinds of essential oils (0.04, 0.08, 0.16 mg/mL). The contractile responses were recorded with Power Lab recording system, and contractile tension, contractile frequency, and contractile activity were evaluated. The preliminary mechanism of the essential oil of the rhizomes of Curcuma phaeocaulis Valeton (CPEO) was assessed using a rat model of dysmenorrhea in vivo and in vitro, and rats were given the CPEO (15, 30, and 60 mg/kg) by gavage. The level of Ca2+ in uterine tissue of rats was determined by methyl thyme phenol blue colorimetric and Bradford methods. The effects of CPEO on extracellular Ca2+ influx and intracellular Ca2+ release were evaluated using the isolated uterus. ResultsThe results of Gas Chromatography-Mass Spectrometer analysis showed that more than 81 components (content: 1% max appearance) were identified. The main components of the 10 BASRH essential oils were found to be monoterpenoids, sesquiterpenoids, diterpenoids, aromatics, aliphatics, and phthalides. The study of in vitro smooth muscle relaxant activity demonstrated that all the essential oils except the essential oil of the roots of Cyathula officinalis K.C.Kuan markedly decrease the contractile activity, tension, and frequency (P < 0.05 or P < 0.01). Among these oils, CPEO has the most pronounced effect. Further in vivo studies indicated that CPEO can significantly decrease the level of Ca2+ in uterine tissue when compared with the model group (P < 0.05 or P < 0.01). In vitro studies indicated that CPEO can inhibit the extracellular Ca2+ influx and intracellular Ca2+ release in favor of uterine relaxation. ConclusionsBASRH essential oils play an important role in inhibiting uterine smooth muscle contractions, and sesquiterpenoids and phthalides in BASRH essential oils are important active compounds for relaxing uterine smooth muscle. CPEO is a favorable candidate for developing anti-dysmenorrhea drugs.

Hormonal Contraceptive Treatment May Reduce the Risk of Fibromyalgia in Women with Dysmenorrhea: A Cohort Study.

Dysmenorrhea is the most common gynecological disorder for women in the reproductive age. Study has indicated that dysmenorrhea might be a general risk factor of chronic pelvic pain and even chronic non-pelvic pain, such as fibromyalgia. We used the Longitudinal Health Insurance Database 2000 from the Taiwan National Health Research Institutes Database to investigate whether women with dysmenorrhea have a higher risk of fibromyalgia and whether treatment of dysmenorrhea reduced the risk of fibromyalgia. The dysmenorrhea cohort was matched with a non-dysmenorrhea cohort at a 1:1 ratio based on gender, age, and the year of entry study by frequency matching. Multivariable Cox proportional hazard regression models were used to assess the risk of fibromyalgia, with controlling for potential confounding variables such as age, comorbidities, and medication use. After controlling confounding variables, results revealed that women with dysmenorrhea have a significantly higher risk of fibromyalgia than women without dysmenorrhea. However, only treatment of dysmenorrhea with hormonal contraceptives reduce the risk of fibromyalgia. These results indicated that dysmenorrhea may be a risk factor of fibromyalgia, whereas personalized medicine for treatment of dysmenorrhea may be the key to reduce the risk of fibromyalgia. Future studies are needed to identify the causes and prevention strategies in detail.

The Therapeutic Effect of Ge-Gen Decoction on a Rat Model of Primary Dysmenorrhea: Label-Free Quantitative Proteomics and Bioinformatic Analyses.

Ge-Gen decoction (GGD) is widely used for the treatment of primary dysmenorrhea (PD) in China. However, the mechanisms that underlie this effect are unclear. We investigated the protective mechanism of GGD in a rat model of PD using label-free quantitative proteomics. The model was established by the administration of estradiol benzoate and oxytocin. Thirty rats were divided into three groups (ten rats/group): a control group (normal rats), a model group (PD rats), and a treatment group (PD rats treated with GGD). The serum levels of prostaglandin E2 (PGE2) and prostaglandin F2α (PGF2α) were measured by ELISA. Nanohigh-performance liquid chromatography-tandem mass spectrometry (nano-HPLC-MS/MS) was used to identify differentially expressed proteins (DEPs), and bioinformatics was used to investigate the protein function. Proteomic data were validated by western blot analysis. Oxytocin-induced writhing responses and abnormal serum levels of PGE2 and PGF2α were reversed following the administration of GGD. A total of 379 DEPs were identified; 276 were identified between the control group and the model group, 144 were identified between the model group and the treatment group, and 41 were identified as DEPs that were common to all groups. Bioinformatics revealed that the DEPs between the control group and the model group were mainly associated with cellular component biogenesis and binding processes. The DEPs between the model group and the treatment group were mainly involved in the protein binding and metabolic process. The expression levels of HSP90AB1 and the phosphorylation levels of ERK, JNK, and P-p38 in the uteri of rats in the three groups were consistent with the proteomic findings; MAP kinases (ERK, JNK, and p38) are known to be involved in the production of inflammatory cytokines and oxytocin signaling while HSP90AB1 is known to be associated with estrogen signaling. Collectively, these data indicate that GGD may exert its protective function on PD by regulating the inflammatory response and signaling pathways associated with oxytocin and estrogen.