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Aim: In April 2020, the Japanese government introduced a Specific Medical Fee for managing secondary dysmenorrhea (SD). This initiative provided financial incentives to medical facilities that provide appropriate management of SD with hormonal therapies. We aimed to assess how this policy affects the management processes and outcomes of patients with SD. Methods: Using a large Japanese administrative claims database, we identified outpatient visits of patients diagnosed with SD from April 2018 to March 2022. We used an interrupted time‐series analysis and defined before April 2020 as the pre‐introduction period and after April 2020 as the post‐introduction period. Outcomes were the monthly proportions of outpatient visits due to SD and hormonal therapy among women in the database and the proportions of outpatient visits for hormonal therapy and continuous outpatient visits among patients with SD. Results: We identified 815 477 outpatient visits of patients diagnosed with SD during the pre‐introduction period and 920 183 outpatient visits during the post‐introduction period. There were significant upward slope changes after the introduction of financial incentives in the outpatient visits due to SD (+0.29% yearly; 95% confidence interval, +0.20% to +0.38%) and hormonal therapies (+0.038% yearly; 95% confidence interval, +0.030% to +0.045%) among the women in the database. Similarly, a significant level change was observed after the introduction of continuous outpatient visits among patients with SD (+2.68% monthly; 95% confidence interval, +0.87% to +4.49%). Conclusions: Government‐issued financial incentives were associated with an increase in the number of patients diagnosed with SD, hormonal therapies, and continuous outpatient visits. [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate the effect of physical activity, body mass index (BMI), and levels of prostaglandins (PGF2α) urine on the occurrence of dysmenorrhea in adolescents. Methods: A total of 128 female students included in the study. The study was conducted from January to March 2023 using a cross‐sectional design. This study utilized the Menstrual Symptom Questionnaire (MSQ) and gynecological examination with ultrasonography. The urinary prostaglandin (PGF2α) was measured using the enzyme linked immuno sorbent assay (ELISA). Data were analyzed using the chi‐square test and logistic regression test. Results: The age range of the participants included in the study was 14–17, with a mean age of 15.85 ± 0.65. There was an correlation between physical activity, BMI, and urinary prostaglandin (PGF2α) levels with the incidence of dysmenorrhea in adolescents (p < 0.001). In multivariate analysis, it revealed that underweight, and had a high urinary prostaglandin significant correlated to primary dysmenorrhea with odds ratio 4.78 (95% confidence interval [CI] 1.98–11.54) and 4.88 (95% CI 1.98–12.08), respectively. High physical activity and overweight was not associated with incidence of dysmenorrhea in adolescents. Conclusion: This study provides valuable insights into the correlation between physical activity, BMI, and levels of prostaglandins (PGF2α) in urine. A high level of urinary prostaglandin was found to be the most influential factor in the incidence of primary dysmenorrhea in adolescents. By addressing factors associated with dysmenorrhea in adolescents, healthcare professionals can potentially enhance well‐being by reducing menstrual pain and encouraging a healthy lifestyle to prevent dysmenorrhea. [ABSTRACT FROM AUTHOR]

The Women's Health Care Committee was established in 2010 with the goal of improving women's health. In the current academic year, there are six subcommittees focusing on conducting the following surveys: (1) the current status of pregnancy‐associated breast cancer in Japan; (2) surgery for disorders of sex development; (3) diagnosis and treatment of premenstrual syndrome and premenstrual dysphoric disorder; (4) obstetrics and gynecology‐based treatment for patients with eating disorders in Japan; (5) multi‐drug‐resistant bacterial infections in the field of obstetrics and gynecology; and (6) changing the methodology of the treatment of dysmenorrhea and continuing medical education. The activities of each subcommittee are described below. This report is based on the Japanese version of the annual report (Acta Obst Gynaec Jpn 2023;75(6):662–86). [ABSTRACT FROM AUTHOR]

Aim: This study utilized a descriptive and relational design to determine the relationship between young women's experiences of premenstrual syndrome (PMS) and dysmenorrhea with internalized misogyny. Methods: A total of 487 individuals were accessed. Data were collected through the "Personal Information Form" prepared by the researchers, the "Functional and Emotional Measure of Dysmenorrhea" the "Premenstrual Syndrome Scale," and the "Internalized Misogyny Scale." Results: The internalized misogyny scale mean score had significant effects on the functional and emotional measure of dysmenorrhea mean score (p < 0.05). The internalized misogyny scale mean score was found to have a statistically significant effect on the premenstrual syndrome scale (p < 0.05). Conclusions: This study found that young women's internalized misogyny was highly correlated with PMS and dysmenorrhea, and increased internalized misogyny also increased the severity of PMS and dysmenorrhea in young women. [ABSTRACT FROM AUTHOR]

Aim: To compare the therapeutic efficacy of ultrasound‐guided high‐intensity focused ultrasound (USgHIFU) in the treatment of adenomyosis with different signal intensity (SI) on T2‐weighted images (T2WI). Methods: A total of 299 adenomyosis patients who underwent HIFU and completed a one‐year follow‐up were retrospectively reviewed. Based on the SI values of adenomyosis relative to myometrium and endometrium on T2WI MRI, the patients were classified into three groups: the hypointense adenomyosis (Hypo‐AM) group, the isointense adenomyosis (Iso‐AM) group, and the hyperintense adenomyosis (Hyper‐AM) group. The non‐perfused volume ratio (NPVr) and relief of dysmenorrhea were used to assess the therapeutic efficacy. Optimal cutpoints (CPs) of NPVr were determined using the postoperative dysmenorrhea score as an anchor. Logistic regression analysis was used to test the relationship between the NPVr and SI. Results: The clinical effectiveness rate was significantly lower in the Hyper‐AM group than in the Hypo‐AM and Iso‐AM groups (P < 0.05 for both). The NPVr in the Hypo‐AM and Iso‐AM groups were significantly higher than that in the Hyper‐AM group (P < 0.05 for both). The optimal CP was 54.0% for NPVr. Logistic regression analysis showed that the SI on T2WI was an effect factor for NPVr (P < 0.05), and the probability of NPVr ≥54.0% decreased continuously as the SI of adenomyosis increased. Conclusions: The NPVr of 54.0% has a clinically significant impact on dysmenorrhea scores in patients. The efficiency of the Hypo‐AM and Iso‐AM was better than that of the Hyper‐AM. [ABSTRACT FROM AUTHOR]

Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) is a rare malformation that not only causes severe menstrual cramps shortly after menarche but can also lead to endometriosis and infection in the future. We report a case of OHVIRA successfully managed by vaginoscopic excision of the vaginal septum. A 12‐year‐old virgin girl presented to our hospital with dysmenorrhea and lower abdominal pain. OHVIRA was diagnosed using magnetic resonance imaging. Vaginoscopic surgery was performed for drainage of hematocolpos and excision of the vaginal septum. Vaginoscopic excision of the vaginal septum was performed using a resectoscope, without a vaginal speculum. The procedure was completed safely without injuring the hymen. This is the first case report of successful excision of the vaginal septum by vaginoscopic surgery for OHVIRA in Japan. Vaginoscopic excision may be one of the effective options for the treatment of vaginal obstruction. [ABSTRACT FROM AUTHOR]

Imaging and histological changes occurring in adenomyosis due to pregnancy are unclear. A 38‐year‐old nulliparous woman presented with dysmenorrhea and infertility. Pelvic magnetic resonance imaging (MRI) showed diffuse‐type adenomyosis. Following pregnancy by in vitro fertilization, she was hospitalized at 23 weeks of gestation due to fetal growth restriction and subsequently diagnosed with preeclampsia. A second MRI performed due to an elevated inflammatory response at 31 weeks of gestation detected no obvious degenerative findings. An emergency cesarean section was performed at 33 weeks of gestation because of nonreassuring fetal status. On postpartum day 2, she showed uterine tenderness with a dramatically elevated inflammatory response. A third MRI showed cyst‐like degenerations with hemorrhagic changes without abscess. By postpartum day 7, she was quickly relieved and discharged from the hospital. A fourth MRI at postpartum month 4 confirmed the disappearance of degenerations. This is the first report of imaging findings of early postpartum degeneration of adenomyosis. [ABSTRACT FROM AUTHOR]

Background: Adolescent endometriosis is a special type of endometriosis. Its diagnosis is often delayed. This study aimed to share the treatment experience of adolescent endometriosis and analyze the clinical manifestation, clinical stage, and risk factors of postoperative recurrence in China. Methods: Eighty‐nine cases of adolescent endometriosis over 7 years in a single institution were reviewed. Demographic, clinical outcome measures were collected. Result: The cumulative incidence rates of postoperative recurrence at years 1, 2, 3, 4, and 5 were 13.2%, 15.09%, 16.98%, 20.75%, and 20.75%, respectively. The risk factors associated with postoperative recurrence were disease stage, number of lesions, and height. In multivariate analysis, the independent risk factors of postoperative recurrence were height (RR: 1.132, 95% CI: 1.018–1.260) and the number of pelvic lesions (three or more, RR: 4.202, 95% CI: 1.013–17.433). Conclusion: Taller patients and those who had multiple lesion sites (≥3) should receive more attention, because they have a higher possibility of relapse after surgery than their counterparts. This finding can guide the postoperative treatment of adolescent patients with endometrioma. [ABSTRACT FROM AUTHOR]

The Women's Health Care Committee was instituted in 2010 with the goal of improving women's health. In the current academic year, there are 6 subcommittees focusing on conducting the following surveys: (1) Current status of pregnancy‐associated breast cancer in Japan; (2) Surgery for disorders of sex development; (3) Diagnosis and treatment of premenstrual syndrome and premenstrual dysphoric disorder; (4) Obstetrics and gynecology‐based treatment for patients with eating disorders in Japan; (5) Multi‐drug‐resistant bacterial infections in the field of obstetrics and gynecology; and (6) Changing methodology of treatment of dysmenorrhea and continuing medical education. The activities of each subcommittee are detailed below. This report is based on the Japanese version of the annual report (Acta Obst Gynaec Jpn 2022;74(6): XXX–XXX). [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate the oleoylethanolamide (OEA) effects on oxidative stress and inflammatory factors in girls with primary dysmenorrhea. Methods: This double‐blind, placebo‐controlled clinical trial was done on population consisted of female students who had dysmenorrhea pain based on the visual analogue scale (VAS) questionnaire. Patients were randomly allocated to groups consuming a capsule containing 125 mg of OEA per day (n = 22) or placebo (n = 22) for 2 months. The severity of the pain, total antioxidant capacity (TAC), malondialdehyde (MDA), C‐reactive protein (CRP), and tumor necrosis factor alpha (TNF‐α) were measured at the beginning and the end of the study. In this study, SPSS software was used to analyze the data. Results: According to the results, oral supplementation with OEA for 60 days significantly increased TAC (p = 0.022) and decreased the menstrual pain (p = 0.040), MDA (p = 0.011), CRP (p = 0.01), and TNF‐α (p = 0.038) compared to the placebo group. Also, intragroup changes were statistically significant on the mean of pain (p = 0.042), TAC (p = 0.032), MDA (p = 0.023), CRP (p = 0.027), and TNF‐α (p = 0.029) at the end of the study in the intervention group. Changes in the studied factors at the end of the study compared to the beginning of the study in the placebo group were not statistically significant. Conclusion: Considering the reducing effects of OEA on menstrual pain, using of this supplement can be introduced as an alternative medicine to reduce the use of anti‐inflammatory drugs. [ABSTRACT FROM AUTHOR]

Adenomyosis is a common disease that affects many premenopausal women. Two patients with adenomyosis, aged 51 and 42 years, presented with dysmenorrhea and increased menstrual volume. They refused laparoscopy or laparotomy surgery and were not eligible for the levonorgestrel‐releasing intrauterine system (LNG‐IUS). The first patient underwent endometrial ablation and subcutaneous etonogestrel (ENG)‐releasing implant placement at the same time. Her symptoms of dysmenorrhea and heavy menstruation improved significantly. When serum follicle‐stimulating hormone (FSH) and estradiol (E2) levels suggested menopause, the ENG‐releasing implant was removed. However, her abdominal pain recurred and was relieved by medication. For the second patient, an ENG‐releasing implant was placed first, and her dysmenorrhea and heavy menstrual volume were relieved. However, the bleeding pattern changed from regular bleeding to prolonged bleeding, which troubled the patient. Endometrial ablation was performed 4 months later to solve the problem. Both patients had improved symptoms and were satisfied with the treatment. For patients with adenomyosis who refuse surgery and are not candidates for the use of LNG‐IUS, an ENG‐releasing implant combined with endometrial ablation may be an effective alternative. [ABSTRACT FROM AUTHOR]

Aim: The levonorgestrel‐releasing intrauterine (LNG‐IUS) system is an effective primary treatment for adenomyosis; however, it has high expulsion rates. We aimed to modify the system—allowing affixion to the myometrium—and evaluate the expulsion rate, effectiveness, and side effects in patients with adenomyosis and heavy menstrual bleeding. Methods: This study included patients with adenomyosis and heavy menstrual bleeding who underwent implantation of: a modified LNG‐IUS (experimental group, n = 47); and the original system after gonadotropin‐releasing hormone agonist treatment (control group, n = 47), between January 2014 and April 2016. Results: In the experimental group, two device expulsions occurred 12–18 months postimplantation. In the remaining 45 patients, the system was safely removed after the 60‐month validity period, and no extrauterine device movement or infection occurred. In the control group, downward displacement and expulsion of the device occurred in eight (17%) patients within 60 months. The 5‐year total expulsion rates were 4.3% and 17.0% in the experimental and control groups, respectively (p = 0.045). There were significant changes in the pretreatment severity of dysmenorrhea, menstrual volume, uterine volume (cm3), and hemoglobin level in each group compared with after 1 year (p < 0.01 in all groups). The severity of dysmenorrhea, menstrual volume, uterine volume, and hemoglobin level after 1 year were similar between the two groups (p > 0.05 in all groups). Conclusions: Use of the modified LNG‐IUS is a safe, cost‐effective, and simple method for reducing the downward movement and expulsion rate in patients with adenomyosis and heavy menstrual bleeding. [ABSTRACT FROM AUTHOR]

Aim: Prior research has primarily focused on static pain assessment, largely ignoring the dynamic nature of pain over time. We used a novel assessment tool for characterizing pain duration, frequency, and amplitude in women with dysmenorrhea and evaluated how these metrics were affected by naproxen treatment. Methods: Dysmenorrheic women (n = 25) rated their menstrual pain by squeezing a pressure bulb proportional to the magnitude of their pain. To evaluate whether bulb squeezing was affected by naproxen, we compared parameters before and after naproxen. We also analyzed the correlation between pain relief on a numerical rating scale to changes in bulb squeezing parameters. Random bulb‐squeezing activity in pain‐free participants (n = 14) was used as a control for nonspecific effects or bias. Results: In dysmenorrheic women, naproxen reduced the duration of the squeezing during a painful bout, the number of painful bouts and bout intensity. Before naproxen, the correlation between these bulb squeeze parameters and self‐reported pain on numeric rating scale was not significant (R2 = 0.12, p = 0.304); however, there was a significant correlation between changes in bulb squeeze activity and self‐reported pain relief after naproxen (R2= 0.55, p < 0.001). Conclusion: Our study demonstrates a convenient technique for continuous pain assessment, capturing three different dimensions: duration, frequency, and magnitude. Naproxen may act by reducing the duration and frequency of episodic pain in addition to reducing the severity. After further validation, these methods could be used for other pain conditions for deeper phenotyping and assessing novel treatments. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the clinical efficacy and safety of laparoscopic adenomyomectomy combined with intraoperative replacement of levonorgestrel‐releasing intrauterine system (LNG‐IUS) in the treatment of symptomatic adenomyosis. Methods: This is a case‐series study in a university medical center. A total of 52 patients with symptomatic adenomyosis were treated by laparoscopic adenomyomectomy combined with intraoperative replacement of LNG‐IUS from January 2015 to July 2018. Visual analog scale, menstrual flow and uterine volume were compared before and after the surgery (3, 12 and 24 months). Meanwhile, LNG‐IUS‐induced adverse reactions (e.g. irregular vaginal bleeding, amenorrhea, expulsion, and perforation) were also recorded. Results: All operations were successfully completed via laparoscopy without conversion to laparotomy. No severe complications were noted during the surgical procedure or follow‐up period. The mean postoperative visual analog scale and menstrual flow scores and the volume of the uterus were significantly decreased (all P < 0.001) at 3, 12, and 24 months postoperatively, compared with preoperative scores. The clinical effective rates among the patients with dysmenorrhea were 98%, 96% and 96% at 3, 12 and 24 months after the operation, respectively. And the clinical effectiveness rate of menorrhagia was 97.6%, 95.2% and 95.2% at 3, 12 and 24 months after treatment, respectively. Among all related adverse reactions, amenorrhea was the most common (n = 12, 23.1%). There was one case of LNG‐IUS perforation (1.9%) and two cases of expulsion (3.8%). Conclusion: Laparoscopic adenomyomectomy combined with intraoperative replacement of LNG‐IUS is a novel and effective conservative surgical procedure for symptomatic adenomyosis treatment. [ABSTRACT FROM AUTHOR]

Aim: The purpose is to investigate pain perception during transvaginal four‐dimensional hysterosalpingo‐contrast sonography (TV 4D‐HyCoSy) and factors influencing pain severity. Methods: This was a retrospective study included 340 women who underwent TV 4D‐HyCoSy examination from January 2016 to October 2017. The factors were recorded, including age, childbearing history, infertility type, history of pelvic inflammation, pelvic surgery, history of uterine manipulation, history of ectopic pregnancy, atropine delivery mode, uterine position, uterine malformation, uterine lesion, fibroid, intrauterine adhesion, polycystic ovary, endometrial implantation cyst, dysmenorrhea score, the degree of patency of fallopian tube and contrast agents dosage. Pain was evaluated during and after TV 4D‐HyCoSy. The time point of peak pain was evaluated and the influencing factors of moderate/severe pain were analyzed. Results: The highest pain occurred at contrast instillation. The independent influencing factors of moderate/severe pain were age (P = 0.021), dysmenorrhea score (P = 0.003) and tubal patency (P < 0.001). Further analysis showed that age affected the pain score when TV 4D‐HyCoSy started and the peak pain occurred. Dysmenorrhea score and tubal patency affect the pain score at most time points. Conclusion: Age, dysmenorrhea score and tubal patency are factors influencing the severity of pain during TV 4D‐HyCoSy. [ABSTRACT FROM AUTHOR]

Aim: To describe the characteristics, management and outcomes of a cohort of young people with dysmenorrhea presenting to a tertiary adolescent gynecology service, managed primarily with medical interventions. Methods: A retrospective cohort study was conducted at the Royal Children's Hospital in Melbourne, Australia. Data were collected from medical records of patients presenting with dysmenorrhea and/or pelvic pain. Results: Of 154 patients, mean age of presentation was 15.7 years (SD = 2.2) and mean duration of pain was 14.9 months (SD = 10.8). Regular cycles were reported by 64.5%, and heavy menstrual bleeding (HMB) in 67.8%. Patients self‐reporting HMB reported less pain on the day prior to menses than those not reporting HMB (P < 0.005). At follow‐up, therapeutic interventions included nonsteroidal anti‐inflammatory drugs, tranexamic acid and cyclic or continuous combined oral contraceptive pills. Laparoscopies were undertaken in 12 (8.1%) patients, with normal findings in 8 (66.7%). Secondary dysmenorrhea was identified in 10 patients: of these, endometriosis was identified in one patient and unilateral obstructive Müllerian anomalies in six. Overall, 92.2% of patients had improvement in symptoms after treatment. Conclusion: Laparoscopy and endometriosis rates in patients presenting to a tertiary center were lower than previously reported, with most patients achieving symptom improvement without laparoscopy. [ABSTRACT FROM AUTHOR]

Aim: Hypertensive disorders of pregnancy (HDP) are serious conditions that occur in 5–10% of pregnancies. Maternal factors, such as maternal age, obesity, and renal disease, have been described as risk factors. In order to extract the background lifestyle and gynecological characteristics for HDP, we conducted a prospective cohort study. Methods: Pregnant participants were administered a questionnaire on characteristics, menstrual abnormalities and lifestyle factors. The women were followed individually until 1‐month postpartum. We used medical records to examine the relationship between menstrual abnormalities and the onset of HDP. Results: We collected data from 193 pregnant women, and excluding 3 who had miscarriage, examined the records of 190. A total of 26 patients developed HDP, of which 10 had early‐onset HDP and 16 had late‐onset HDP. Although there was no significant association between HDP and dysmenorrhea just prior to pregnancy, there was a significant increase in the incidence of HDP in patients who experienced dysmenorrhea around the age of 20 years (odds ratio 4.362 [95% CI 1.61–11.81]). Conclusion: We found that patients with a history of dysmenorrhea around the age of 20 years have a significantly higher risk of developing HDP. Although dysmenorrhea in young adulthood is ameliorated, it may become apparent as a perinatal disease when a physical load such as pregnancy is applied. [ABSTRACT FROM AUTHOR]

Aim: Tokishakuyakusan (TSS) is representative of popular Kampo medicines for Japanese women to treat dysmenorrhea, irregular menstruation and menopause. Current hormonal treatments and low‐dose oral contraceptives (OCs) used as a first‐choice drug for primary symptoms, however, have a high incidence of adverse events without improving patients' satisfaction. We evaluated the efficacy of TSS as additional treatment on the quality of life (QOL) of patients taking OCs with reduced therapeutic satisfaction. Methods: Twelve patients treated with OCs for endometriosis were enrolled. TSS (7.5 g/day) in combination with OCs were given for three menstrual cycles. The main outcome was the degree of QOL assessed using the Endometriosis Health Profile‐30 (EHP‐30). Secondary outcomes were the Menstrual Distress Questionnaire (MDQ), patient's satisfaction using a Likert scale and cold feeling‐visual analogue scale (VAS). Results: In EHP‐30, significant changes by TSS with OCs in each menstrual cycle were not found, although the scores for pain and emotional well‐being tended to decrease. In MDQ, water retention in the premenstrual phase was improved. With regard to cold feeling‐VAS, 61.6 mm at pretreatment decreased to 31.3 mm at the endpoint. Average Likert scale values after TSS treatment declined from 4.3 to 2.6. Cold feeling and patient's satisfaction have improved. Conclusion: Although the influence of TSS add‐on therapy on QOL was moderate, possible improvement of cold feeling and menstruation‐related symptoms was suggested. [ABSTRACT FROM AUTHOR]

Aims: To compare the efficacy of gonadotropin‐releasing hormone agonist (GnRH‐a) and GnRH‐a + levonorgestrel‐releasing intrauterine system (LNG‐IUS) after adenomyomectomy for improved adenomyosis‐associated symptoms. Methods: Overall, 193 patients with adenomyosis included in this study were categorized into three groups: adenomyomectomy (n = 57, group 1), adenomyomectomy + GnRH‐a (n = 83, group 2) and adenomyomectomy + GnRH‐a + LNG‐IUS (n = 53, group 3). Visual Analog Scale (VAS) scores and uterine volumes were determined to evaluate the severity of adenomyosis. Dysmenorrhea improvement and uterine volume were the main outcomes. Results: The VAS scores of all patients reduced from 7.3 (6.0, 8.5) to 0 (0, 0.6) at the 6 months after surgery, which were significantly higher in group 1 compared to other groups (P < 0.05). In groups 1, 2 and 3, there were 14, 7 and 4 patients, respectively, who suffered dysmenorrhea recurrence. The mean recurrent‐free‐survival (RFS) was 51.6 ± 2.4, 58.0 ± 1.2 and 58.3 ± 1.0 months, respectively, which was significantly shorter in group 1 (P < 0.05). The dysmenorrhea recurrences were 26.3%, 6.1%, 5.9% in groups 1, 2 and 3, respectively, at the 36 months, which was significantly higher in group 1 (P < 0.01). Significantly decreased uterine volumes were observed in all patients from 222.2 (147.6, 350.4) to 77.0 (65.9, 94.1) mL (P < 0.05) at the 6 month after surgery. Conclusion: Treatment GnRH‐a and LNG‐IUS after surgery could significantly reduce the recurrence and prolong the RFS. It seemed that the use of LNG‐IUS was beneficial for a lower recurrence in long‐term follow‐up. [ABSTRACT FROM AUTHOR]

Aim: To investigate the safety and efficacy of dienogest (DNG), a progestational 19‐norsteroid, administered for 52 weeks in patients with primary and secondary dysmenorrhea. Methods: A total of 147 patients with dysmenorrhea received 1 mg of DNG orally each day for 52 weeks. The dose could be increased to 2 mg/day at or after Week 12 according to the investigator's determination. The primary safety endpoint was evaluation of adverse events, and the secondary safety endpoint was evaluation of adverse drug reactions. The number of days and severity of genital bleeding were assessed according to records in the patients' diary. Lower abdominal pain and/or low back pain because of dysmenorrhea were assessed according to the dysmenorrhea score. Results: The most frequent adverse drug reaction was irregular uterine bleeding (94.6%). Most subjects completed the 52‐week administration. Genital bleeding was more likely to occur in subjects with secondary dysmenorrhea than in those with primary dysmenorrhea, and in subjects with "uterine myoma or adenomyosis" than in those with "endometriosis alone." In any of the categorizations, there tended to be fewer days with genital bleeding as the treatment period increased in length, and most of the genital bleeding cases were mild. The change from baseline in the dysmenorrhea score (mean ± standard deviation [SD]) was −3.7 ± 1.6 at Week 24 of treatment and −4.0 ± 1.3 at Week 52. Conclusion: This study showed favorable tolerability of the long‐term use of DNG to patients with dysmenorrhea and a sustainable pain relief effect. [ABSTRACT FROM AUTHOR]

Aim: To report the reproductive results and symptomatic relief of patients with adenomyosis who attempted to conceive after ultrasound‐guided radiofrequency ablation (RFA). Methods: Of 182 consecutive patients with adenomyosis who had undergone RFA, only 81 patients were eligible for this study. Pregnancy outcomes, postoperative complications, preoperative and postoperative pictorial blood loss assessment chart scores, and pain scores were evaluated. Results: Of these 81 patients, 74 were infertile and seven were single at the time of RFA. The mean age at the time of operation was 35.8 years. The mean duration from the time of RFA to conception was 18.9 months (range, 2–72 months). Fifty‐nine patients tried natural conception, while 22 patients attempted conception with assisted reproductive techniques. Twenty‐nine (35.8%) patients achieved 39 pregnancies. Except for the 23 patients who did not actively try to conceive and who inevitably or arbitrarily discontinued pregnancy attempts, the pregnancy success rate reached 50%. Twenty‐two (84.6%) of the 29 patients delivered 24 (66.7%) live babies (nine vaginal deliveries and 15 cesarean sections). Twelve (33.3%) pregnancies ended in spontaneous abortions. No uterine ruptures occurred. Paired sample t‐tests revealed that preoperative pictorial blood loss assessment chart and pain scores were significantly (P < 0.05) different from the postoperative scores at 1‐, 3‐ and 6‐months. Conclusion: RFA could be considered a minimally‐invasive treatment option for patients with adenomyosis who desire to maintain fertility and alleviate symptoms. [ABSTRACT FROM AUTHOR]

We report the case of a 29‐year‐old woman with deep infiltrating endometriosis who underwent robotic nerve‐sparing surgery for resection of all visible lesions infiltrating pelvic and extrapelvic sites. Painful symptoms included severe dysmenorrhea, menstrual dyschezia and stranguria, with no improvement in response to hormonal treatment. The location on physical examination of a painful retrocervical nodule was identified by magnetic resonance imaging to be infiltrating the right parametrium/paracervix. During surgery, this nodule was recognized as an important retrocervical/rectovaginal lesion infiltrating the pelvic floor (i.e. levator ani and coccygeus), and was histopathologically confirmed as endometriosis infiltrating the skeletal pelvic floor muscles. A Pubmed search of the MEDLINE database in March (2019) found no publication reporting histopathologic confirmation of endometriosis infiltrating the pelvic floor muscles. [ABSTRACT FROM AUTHOR]

Aim: Previous studies have revealed that loss of cell apical‐basal polarity contributed to the early stages of tumorigenesis. Adenomyosis involves a down‐growth and aberrant implantation of the endometrial basalis into the myometrium. This study discovered aberrant expression of polarity protein Scribble (Scrib) and Crumbs homologue 3 protein (CRB3) in epithelial cells of diffuse adenomyosis. Methods: This was a case‐controlled study, including 39 patients with histologic evidence of adenomyosis, and 48 patients with carcinoma in situ of the uterine cervix without adenomyosis or endometriosis as control. Adenomyotic foci, eutopic endometrium of adenomyotic patients as well as normal endometrium were collected. Reverse Transcription Polymerase Chain Reaction (RT‐PCR), Immunoreactivity, confocal microscopy and immune electron microscopy were conducted to evaluate Scribble expression and localization of Scribble and CRB3. Results: Scrib was screen out as an abnormally expressed polarity protein in adenomyotic eutopic endometrium (ADM‐EU) at messenger RNA (mRNA) level. The ADM‐EU and adenomyotic ectopic endometrium showed a significantly decreased expression of Scrib compared with normal endometrium (all P‐values <0.05). Scrib decreased significantly in ADM‐EU than normal endometrium only in patients at proliferative phase and with severe dysmenorrhea (P‐values <0.01, P‐values <0.001 respectively). In ADM‐EU, Scrib expression significantly lowered in patients with severe dysmenorrhea than mild dysmenorrhea (P‐values <0.05). Aberrant redistribution of CRB3 from apical to basal lateral membrane portion was also detected in experiments by confocal microscopy immune electron microscopy (all P‐values <0.01). Conclusion: Basolateral polarity protein Scrib was found decreased significantly in endometrial cells of adenomyosis at mRNA and protein level, compared with normal endometrium. Menstrual phase and severity of dysmenorrhea has an impact on Scrib expression. Scrib decrease was accompanied by aberrant redistribution of CRB3 from apical to basal lateral membrane portion. [ABSTRACT FROM AUTHOR]

Aim: To evaluate various adverse symptoms during short‐term use of ulipristal acetate in women with uterine myomas (n = 90), adenomyosis (n = 3) or both (n = 7). Methods: One hundred premenopausal women who received ulipristal acetate for 4–12 weeks during 2016 to 2017 were selected. The medical records were reviewed and the following information was collected; adverse symptoms during medication, presence of menorrhagia or menstrual cramps, blood hemoglobin and liver function test. Adverse symptoms were recorded in the medical records as a checklist form including 76 specific progestin‐related symptoms. Results: Overall, the most frequent adverse symptom was amenorrhea (43%), followed by weight gain (29%), fatigue (27%), abdominal discomfort (21%), decreased menstrual flow (19%) and dizziness (18%). In 89 symptomatic women (with heavy menstrual bleeding and/or menstrual cramping pain and/or anemia), the most frequent adverse symptom was weight gain (27%) and fatigue (27%), followed by abdominal discomfort (21%), dry eye (18%), facial flushing (17%), dizziness (17%), headache (17%) and increased vaginal discharge (15%). Fourteen women stopped the medication due to unwanted adverse symptoms. Of this discontinuation group, major complaint was fatigue (50%), followed by weight gain (36%) and breast discomfort (35.7%). Conclusion: Adverse symptoms were common and discontinuation rate was somewhat higher during short‐term course of ulipristal acetate. Information about incidence of various adverse symptoms should be given to women who willing to take ulipristal acetate. [ABSTRACT FROM AUTHOR]

Aim: It is commonly thought that laparoscopic surgery leads to faster postoperative recovery for its low invasiveness. We evaluated postoperative quality of life (QOL) after laparoscopic myomectomy (LM) by using the Euro‐QOL 5 dimension (EQ‐5D) score and analyzed its relationship to surgical factors. Methods: Between 2014 and 2016, 541 patients underwent LM at our institution. We included 86 patients in the final analysis (16% response rate) who replied to the EQ‐5D questionnaire, in order to investigate postoperative QOL. We evaluated patients' EQ‐5D score before the operation and on the 3rd, 7th, 14th, 21st and 28th postoperative day (POD). We investigated the degree of correlation between the EQ‐5D score and four surgical characteristics (operation time, intraoperative bleeding, number of resected myomas and weight of specimen). We examined correlation between EQ‐5D scores and chief complaints such as hypermenorrhea, dysmenorrhea, other pain, myoma enlargement, palpable tumor and desire for childbearing. We also examined correlation between EQ‐5D scores and other factors such as patient's age, infertility, history of abdominal surgery, marriage and body mass index. Results: Full recovery, defined as an EQ‐5D score of 1.0, was reported 2.3% of patients by POD3, 18.6% by POD7, 58.1% by POD14, 73.3% by POD21 and 86.0% by POD28. Longer duration of operation correlated weakly with poor recovery on POD3. Intraoperative bleeding, number of resected myomas and weight of the specimen did not significantly influence EQ‐5D score. There was no correlation between chief complaints or other factors mentioned above and EQ‐5D score. Conclusions: More than a half of the patients undergoing LM included in our study reported full recovery of QOL after 2 weeks. The time to recover QOL was slightly influenced by the operation time. However, when LM was finished without any complications, postoperative QOL eventually seemed to improve regardless of the surgical characteristics such as operation time, intraoperative bleeding, number of resected myomas and weight of specimen. [ABSTRACT FROM AUTHOR]

Aims: Dydrogesterone is a retro‐progesterone preparation widely used for over a half century. We sought to evaluate the efficacy and safety of dydrogesterone in Japanese women with dysmenorrhea. Methods: This study was conducted as an open‐label, single‐arm, multicenter study. One dydrogesterone 5‐mg tablet (Duphaston) was administered orally twice daily for 21 days from the 5th to 25th day of each menstrual cycle. A total of 44 (safety analysis) and 31 patients (efficacy analysis) were enrolled. Total dysmenorrhea score, dysmenorrhea subscale scores, dysmenorrhea visual analog scale, severity of menstruation‐related lower abdominal pain, low back pain, headache, and nausea/vomiting, basal body temperature, and serum estradiol and progesterone levels were evaluated. Results: Baseline of the total dysmenorrhea score was 4.61, which went down over time following the administration of dydrogesterone, and the decrease was statistically significant at and after 2nd cycle of menstruation. Mean change from baseline at the final evaluation point was −1.84 (P < 0.001). Severity of menstruation‐related lower abdominal pain, low back pain, headache, and nausea/vomiting, in the evaluated menstruation cycles tended to decrease over time. Basal body temperature showed a biphasic pattern in 70% at baseline, 50% in 2nd menstruation cycle, and 61% in 5th menstruation cycle, and at least half of the patients may have had ovulation during the treatment. Incidence of adverse drug reactions was 31.8%, and the most common adverse event was metrorrhagia. Conclusion: Dydrogesterone is efficacious, safe, and clinically beneficial in patients with dysmenorrhea, thereby indicating that dydrogesterone can be considered as a treatment option for patients with dysmenorrhea. [ABSTRACT FROM AUTHOR]

Aim: The primary aim of this study was to investigate the pain characteristics, academic performance and participation in sports and social activities among students with primary dysmenorrhea (PD) who have different pain intensities and to compare dysmenorrhea‐related life impact with pain‐free students. Methods: The present study was conducted on 471 university students with and without PD. Based on Visual Analog Scale score, participants were categorized into four groups: no‐pain (n = 60), mild pain (n = 83), moderate pain (n = 165) and severe pain (n = 163). Data on the pain characteristics, impact of dysmenorrhea on university absence, class concentration, participation in sports and social activities were obtained and analyzed with the Kruskal–Wallis, Mann–Whitney U and chi‐square tests. Results: University absence, loss of class concentration and the impact on sports and social activities were higher in severe pain group than in no‐pain, mild and moderate pain groups (P < 0.001). There were statistically significant differences in the duration of pain, the pattern of pain and the day when maximum pain is perceived among mild, moderate and severe pain groups (P < 0.05). Conclusion: The results of the present study present that PD negatively influences academic performance and participation in sports and social activities. Furthermore, pain characteristics differed among the patients with mild, moderate and severe pain. There is a need for further studies that improve treatment options for PD in order to minimize the influence of pain on academic performance and social activities. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Menorrhagia and dysmenorrhea are common symptoms. Uterine adenomyosis is one of the causes of menorrhagia and dysmenorrhea. These symptoms often decrease the quality of life in women. Microwave endometrial ablation (MEA) is a recently developed procedure that enables endometrial ablation. Dienogest has long been used to suppress endometrium development and reduce adenomyosis‐related dysmenorrhea. However, some cases could be resistant to dienogest. In this study, we evaluated the efficacy of a combination of MEA and postoperative dienogest in reducing adenomyosis‐related dysmenorrhea and menorrhagia. Methods: Ten patients with hormone treatment‐resistant symptomatic adenomyosis underwent MEA and were administered oral dienogest after the procedure. The primary endpoints were reduction in pain recurrence and anemia. The secondary endpoint was a change in the adenomyosis lesion and its symptomatic recurrence. Results: Statistically significant improvements were seen in the visual analog scale score and hemoglobin levels in women post‐treatment. The difference in myometrial thickness pre‐ and post‐MEA was statistically significant. There were no cases of symptomatic recurrence. Conclusion: The combination of MEA and postoperative dienogest is useful for treating uterine adenomyosis with menorrhagia and dysmenorrhea. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To identify the association between primary dysmenorrhea (PD) and body mass index (BMI). Methods: This cross sectional study was conducted on 370 female students (aged 18–25 years) of Immam Abdulrahman Bin Faisal University Dammam, from March 2016 till March 2017. Pretested dysmenorrhea questionnaire was filled by the students. Weight and heights of the subjects were measured, and BMI was calculated. Based on BMI, subjects were divided into four groups (underweight [UW], normal weight, overweight and obese [OB]). Subjects were also categorized into mild, moderate and severe dysmenorrhic groups based on numeric pain relating scale. SPSS version 20.0 was used to analyze the data. Results: This study showed that 85.7% of the students were suffering from PD, out of which 12.7% had mild, 65.6% had moderate and 8.4% had severe dysmenorrhea. In total, 54.5% of the students mentioned that dysmenorrhea interferes with their daily activities. Whereas 55.8% of the students mentioned that they got pain relief by using non‐steroidal anti‐inflammatory drugs. Pair wise comparison of dysmenorrhea between different BMI groups showed a statistically significant difference in the frequency of moderate and severe dysmenorrhea between UW and OB subjects (P values 0.003 and 0.06) respectively, indicating that UW females are at a higher risk of having PD. Conclusion: This study indicates a higher prevalence of moderate and severe dysmenorrhea in UW as compared to the OB subjects. We recommend further studies to explore the underlying pathophysiological mechanisms responsible for this association. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Adenomyosis is a common gynecological disorder that causes dysmenorrhea, hypermenorrhea and metrorrhagia. Previously, we reported that 24 weeks of dienogest treatment is highly effective for pain in symptomatic adenomyosis. Up to present, there is no report that describes treatment of adenomyosis with long‐term dienogest administration for more than 2 years. In this retrospective cohort study, we investigated the course of long‐term dienogest treatment in patients with symptomatic adenomyosis. Methods: This is a retrospective cohort study. Dienogest was continuously administered at a dose of 2 mg daily for patients with symptomatic adenomyosis. The outcome of long‐term administration of dienogest was investigated, and the characteristics of patients were compared between discontinued cases and long‐term administration cases. Results: Two patients were excluded from this study because of transfer to another hospital or discontinuation due to infertility treatment. Twelve of 18 patients (66.7%) received dienogest until menopause or for a period of >80 months. Four cases (22.2%) discontinued dienogest treatment because of severe metrorrhagia. In the discontinued cases because of severe metrorrhagia, the pain score for dysmenorrhea and serum CA125 level at baseline significantly elevated, and the hemoglobin level at baseline and the frequency of type 2 adenomyosis significantly decreased, compared to those with long‐term use. Moreover, long‐term dienogest use did not decrease the serum estradiol level. Conclusion: Our report suggests that dienogest is tolerable for long‐term use until menopause and can be an alternative treatment option in some patients, especially those with type 2 adenomyosis, to avoid hysterectomy. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To evaluate the surgical outcomes of both approach methods (laparoscopy vs laparotomy) and to suggest the proper surgical approach according to type of uterine adenomyosis (focal vs diffuse). Methods: We retrospectively analyzed 224 cases of uterine adenomyomectomy, 116 laparotomic and 108 laparoscopic, performed between July 2011 and June 2016 by a single surgeon (Y. S. K.). In all 224 cases, the surgeon had used transient occlusion of the uterine artery (TOUA). Surgical outcomes included weight of specimen, operating time, estimated blood loss and intraoperative injury to other organs. Postoperative clinical outcomes included symptom improvement (dysmenorrhea, menorrhagia and others) and recurrence. Results: All patients in the laparoscopic group had been diagnosed with focal uterine adenomyosis, and most in the laparotomic group (85.3%) had been diagnosed with diffuse type. The largest lesion diameters were 6.48 cm in the laparotomic group and 4.34 cm in the laparotomic group. Operation time and estimated blood loss were 116.12 min and 222.67 mL in the laparotomic group and 75.09 min, respectively, and 155.33 mL in the laparoscopic group. There was no case of laparotomic conversion in patients with laparoscopic adenomyomectomy. Conclusion: Conservative surgery is effective to reduce the symptoms of adenomyosis regardless of approach method. For near‐complete excision of adenomyosis, the diffuse type is recommended to be treated with laparotomic adenomyomectomy, and focal lesions less than 5 cm can be treated with laparoscopic conservative surgery. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To examine the prevalence and factors correlated with primary dysmenorrhea in young female subjects. Methods: Cross‐sectional research was conducted among 1305 female university students aged 19–25 years. The following measurements were taken: height, body mass, waist circumference, hip circumference, the length of index and ring finger. A questionnaire was used to obtain information on menstrual pains, the characteristics of the menstrual cycles (regularity, duration), the number of the days of menstrual bleeding, age at menarche, overall health and socio‐economic status of the subjects. Results: The prevalence of primary dysmenorrhea (PD) in the group was 64.85%, of which 69.60% reported mild pain, and 30.40% moderate and severe pain. PD occurs more frequently both in women with excess and insufficient level of abdominal adiposity. PD occurred more frequently in women who experience first menstruation at earlier age than in women with average and late age at menarche. The prevalence of PD grew along with mother's education and fell along with father's education. Painful menstruations occurred most commonly in women from large families. The impact of the age at menarche and the presence of abnormal body mass and abnormal level of abdominal adiposity on the prevalence of painful menstruation was also confirmed by the results of logistic regression analysis. The risk of PD is the highest in women whose finger 4 is longer than finger 2. Conclusion: The results suggest that healthy body mass and lack of abdominal obesity may reduce the risk of PD. [ABSTRACT FROM AUTHOR]

Aim Premenstrual syndrome (PMS) is characterized by physical, cognitive, and behavioral symptoms that occur cyclically, from several days to 2 weeks before menses, which resolve either quickly or during the early days of menstruation. The aim of this study was to determine the factors associated with the severity of PMS in Iranian college students. Methods The cross-sectional study was performed among 298 college students (aged 18-35 years) with PMS, of whom, 271 college students completed the Iranian version of the Premenstrual Symptoms Screening Tool questionnaire to determine the severity of PMS. Factors associated with PMS severity were identified using linear regression analysis with a stepwise method. Results Factors associated with severity of PMS were age (years), family income (low vs high income), marital status (unmarried vs married), and familial history of dysmenorrhea or PMS after adjustment for dysmenorrheal severity with β (95% confidence interval) of 0.31 (0.45-0.57), 11.6 (1.2-23.54), 3.2 (0.4-5.2), and 2.22 (0.04-4.4), respectively. Conclusion In this study, factors associated with severity of PMS were age, marital status, family income, and familial history of PMS. We observed that some outcomes were consistent with some previously reported results, which indicates the need for further studies. [ABSTRACT FROM AUTHOR]

Aim To compare ormeloxifene with combined oral contraceptive (COC) in abnormal uterine bleeding (AUB) due to leiomyoma (AUB-L). Methods Fifty women with AUB-L were randomized after informed consent and institute ethics clearance. Group I (n = 25) was given ormeloxifene (a SERM i.e. selective estrogen receptor modulator) 60 mg twice per week and group II (n = 25) was given COC (ethinyl estradiol 30 μg with desogestrel 150 μg) on days 1-21 for 6 months. Menstrual blood loss was assessed on pictorial blood loss assessment chart (PBAC) score and leiomyoma volume was assessed on ultrasound. Fibroids were classified according to FIGO-PALM-COEIN classification for AUB where leiomyomas were further sub-classified as types 0 to 8 according to their location. Follow up was done at 1, 3, 6 and 9 months. Results Mean PBAC score reduced by 81% with ormeloxifene (group I) compared with 43.8% for COC (group II). After 6 months, 18 patients (72%) in group I had PBAC score in the non-menorrhagic range (<100) compared with only two (8%) in group II. In group I, PBAC score in FIGO-PALM-COEIN leiomyoma types 2, 3, 4, 5, 6 reduced by 90.2%, 82.5%, 93.3%, 56.4% and 100%, respectively and 14 (56%) developed amenorrhea; compared with reduction of 64%, 27.5%, 25.9% in types 4, 5 and 6, respectively in group II. Dysmenorrhea visual analog scale score decreased in both groups. Mean leiomyoma volume increased in both groups: by 25.7% with ormeloxifene versus 16.9% with COC; only grade 2 leiomyoma in group I reduced by 44%. One patient in group II with grade 2 leiomyoma discontinued treatment at 3 months. Seven patients (28%) developed ovarian cyst in group I with no other major adverse effect in either group. Conclusion Ormeloxifene with its convenient twice-weekly dosage schedule was effective in treating AUB-L, with 72% of patients responding to 6-month treatment compared with 8% with COC, even though leiomyoma volume increased insignificantly with both ormeloxifene and COCs. [ABSTRACT FROM AUTHOR]

Aim Conventional microwave endometrial ablation (MEA) can be insufficient to control menorrhagia resulting from adenomyosis. We compared the standard single ablation technique with multiple MEA - repeating ablation three times in the same region - in patients with adenomyosis and menorrhagia. Material and Methods We performed single MEA in 18 patients and multiple MEA in seven patients between 2007 and 2013. We compared the efficacy of single and multiple MEA using a visual analog scale (VAS) for menorrhagia, dysmenorrhea, and patient satisfaction. We also evaluated the incidence of menorrhagia recurrence, amenorrhea, and procedure complications in relation to patients' clinical factors. Results VAS scores for improved menorrhagia and patient satisfaction were significantly higher in the multiple MEA group than in the single MEA group; however, the operative time was longer in the multiple-treatment group. There were no statistical differences between groups in hemoglobin levels, VAS improvement for dysmenorrhea, menorrhagia recurrence, frequency of complications, or amenorrhea rate. Conclusion Multiple MEA successfully controls menorrhagia from adenomyosis and achieves a higher satisfaction rate than single MEA. [ABSTRACT FROM AUTHOR]

Aim A combined oral contraceptive containing ethinylestradiol 20 µg plus drospirenone 3 mg (EE20 + DRSP) in a 24/4 regimen has been shown to alleviate the symptoms of premenstrual syndrome and premenstrual dysphoric disorder. This study was conducted to evaluate the efficacy of EE20 + DRSP in Japanese patients with premenstrual symptoms. Material and Methods A multicenter, prospective, open-label, single-arm, phase IV study was performed in Japanese women with dysmenorrhea and premenstrual symptoms. They were treated with EE20 + DRSP to alleviate the symptoms of dysmenorrhea for six treatment cycles. Premenstrual symptoms were evaluated using a Premenstrual Symptoms Questionnaire at baseline and after three and six cycles of EE20 + DRSP. The degree of dysmenorrhea was also evaluated using a visual analog scale at baseline and after one, three, and six cycles of EE20 + DRSP. Results Forty-eight patients were treated with EE20 + DRSP. Most of the premenstrual symptoms were alleviated significantly by three and six cycles of EE20 + DRSP treatment. EE20 + DRSP treatment significantly improved the severity of premenstrual symptoms. We also confirmed the effectiveness of EE20 + DRSP for the treatment for dysmenorrhea. Conclusion This study showed that EE20 + DRSP could be a useful treatment strategy for premenstrual symptoms in Japanese women. [ABSTRACT FROM AUTHOR]

Aim This study aimed to determine the feasibility and safety of adenomyomectomy with transient occlusion of uterine arteries ( TOUA) in patients with symptomatic diffuse uterine adenomyosis. Material and Methods Twenty-six patients with symptomatic diffuse uterine adenomyosis underwent adenomyomectomy with TOUA by a single surgeon at Ulsan University Hospital between May 2011 and September 2012. Surgical outcomes included operative time, intraoperative injury to blood vessels, nerves, and pelvic organs and operative blood loss. We assessed the degree of improvement in dysmenorrhea and menorrhagia at the 4-month follow-up after completion of adjuvant gonadotrophin-releasing hormone agonist. Results The mean age of patients was 37.73 years (range, 27-49 years). The mean total surgical time was 95.0 min (range, 60-145 min; SD, 34.49). The mean estimated blood loss was 191.54 mL (range, 80-400 mL; SD, 110.91) and there were no cases of injury to the uterine arteries or pelvic nerves. The mean time of TOUA was 9.79 min (range, 6-16 min; SD, 2.74). The mean duration of hospital stay was 5.65 days (range, 4-7 days; SD, 0.85). There were no major complications requiring reoperation or readministration during the mean follow-up period of 13.5 months. At the 7-month follow-up after adenomyomectomy with TOUA, complete remission of dysmenorrhea and menorrhagia was observed in 94.4% and 100% of patients, respectively. Conclusions Adenomyomectomy with TOUA could be a safe and effective surgical method in women with symptomatic diffuse uterine adenomyosis to preserve fertility. [ABSTRACT FROM AUTHOR]

Aims A population-based cross-sectional study design was used to study the effects of symptoms of various gynecological morbidities ( GM) on health-related quality of life ( HRQo L) of women, residents of squatter settlements of Karachi, Pakistan. Material and Methods This cross-sectional study was conducted in squatter settlements of Karachi from September 2012 to August 2013, with 1002 married, non-pregnant women. After obtaining written informed consent from every participant, a structured questionnaire was used to collect information about symptoms of GM and their effect on four domains of HRQo L (physical, social, functional and financial domains). Results Of 1002 women who participated in the study, 578 reported suffering from one or more symptoms of GM. The most commonly reported symptoms were foul-smelling vaginal discharge, dysmenorrhea and uterovaginal prolapse while the least reported symptom was post-coital bleeding. Symptoms of GM were found to have a negative impact on HRQo L. Approximately one-third of women with the symptoms of GM reported having negative influences on the physical, financial and functional domains of HRQo L with social domain being comparatively less affected. Compared to other symptoms, dysmenorrhea and uterovaginal prolapse were reported to be mostly associated with poor HRQo L of women. Conclusion The concept of HRQo L has been kept marginal and inconspicuous by clinicians. In order to achieve the psychosocial satisfaction of the patient, the focus needs to be diverted to all domains of HRQo L. [ABSTRACT FROM AUTHOR]

Aim The aim of this case-control study was to compare the efficacy of ethinyl estradiol/drospirenone and Fructus agni casti in women with severe primary dysmenorrhea measuring uterine artery blood flow via Doppler ultrasonography. Methods A total of 60 women with severe primary dysmenorrhea and 30 healthy women (control) were included in this study. Thirty patients were treated with ethinyl estradiol 0.03 mg/drospirenone (group 1) and another 30 were treated with Fructus agni casti (group 2) during three menstrual cycles. Before and at the end of third month of therapy visual analog scale ( VAS) scores, pulsatility index ( PI), resistance index ( RI) of uterine artery were recorded before and after receiving therapy on the first day of the menstrual cycle. Results Mean PI and RI values in patients with severe primary dysmenorrhea were significantly higher than in the control groups on the first day of the menstrual cycle ( P < 0.0001). Mean PI and RI values were significantly lower after the treatment in both groups compared to before values ( P < 0.001 for both). After using the drugs for three menstrual cycles, VAS scores were significantly dropped in both groups compared to before treatment values ( P < 0.0001 for both); however, there were no significant differences in terms of Doppler findings between group 1 and 2. Conclusion The effectiveness of Fructus agni casti was similar to that of ethinyl estradiol/drospirenone in patients with primary dysmenorrhea. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to determine the frequency of various symptoms and their associated characteristics in women with adenomyosis who underwent hysterectomy, and to determine which symptoms are likely to go with which others in these patients. Material and Methods In 2007, 1697 consecutive patients underwent hysterectomy in our hospital. Among them, 734 (43.3%) were histologically confirmed to have adenomyosis, and 710 of them were premenopausal. The medical charts of all 734 patients were retrieved, and their demographic, clinical information and postoperative findings were recorded. We used the Verbal Descriptor Scale to measure the preoperative severity of dysmenorrhea. The Apriori Algorithm was used for mining the association of different symptoms. Results Among the 710 premenopausal patients, only 4.5% of them had no symptoms. Dysmenorrhea was the most common complaint, occurring in 81.7% of patients. Dysmenorrhea co-occurred most frequently with menorrhagia. The presence of adhesion, presence of endometriosis, complaint of menorrhagia, longer duration of disease, gravidity, palpable pain during pelvic examination, and diffuse adenomyosis were positively associated with the severity of dysmenorrhea. Age, severity of dysmenorrhea, and complaint of metrorrhagia were positively associated with the risk of menorrhagia. Conclusions Dysmenorrhea is the most common complaint in women with adenomyosis, which often goes with that of menorrhagia. Adenomyosis often co-occurs with endometriosis and leiomyomas. Various factors are associated with the risk of having different symptoms. [ABSTRACT FROM AUTHOR]

Aim We aimed to investigate the relation between mutations and polymorphisms playing roles in the onset of clinical findings of Familial Mediterranean Fever ( FMF) and clinical phenotypic reflections manifesting with painful episodes, such as dysmenorrhea. Material and Methods A total of 1000 female patients who had not responded well to non-steroidal anti-inflammatory drugs in the menstrual period, and who had presented to the emergency room with the complaint of recurrent pain episodes were included in the study. All the patients were Turkish women living in Istanbul. In this study, the mutations most frequently seen in the Mediterranean Fever Gene ( MEFV), namely M694V, E148Q, M680I(G/C), V726A, P369S, R761H, A744S, M694I, K695R, F479L, M680I(G/A), and I692del were examined using the DNA sequence analysis following DNA isolation. Results The number of individuals who had a mutation in at least one allele for FMF was 511 out of 1000 patients. Of these 511 patients, homozygous mutations were found in 21% ( n = 109), compound heterozygous mutations were found in 27% ( n = 136), and heterozygous mutations were found in 52% ( n = 266). The most frequent homozygous genotype seen in our study population was M694V/M694V. The most common compound heterozygote genotypes were M694V/M680I, M694V/V726A, M694V/E148Q, and M680I/V726A; and 11.7% ( n = 60) of the families in whom mutations were found had consanguinity. Conclusion Women who present to the emergency room with the complaint of dysmenorrhea that is irresponsive to non-steroidal anti-inflammatory drugs may have several types of MEFV mutations that are responsible for FMF. [ABSTRACT FROM AUTHOR]

Aim: To confirm the difference in the expression of endothelial nitric oxide synthase in the normal endometrium and myometrium of women who have leiomyoma or adenomyosis compared with controls, and its correlation with the pathogenesis of menorrhagia or dysmenorrhea in patients with uterine leiomyoma. Methods: Fifty-one hysterectomized patients were divided into three groups: (i) patients with leiomyoma ( n = 24); (ii) those with adenomyosis ( n = 19); and (iii) the control group ( n = 8). The expression of endothelial nitric oxide synthase was confirmed on immunohistochemistry and analyzed using an evaluation nomogram. Results: The expression of endothelial nitric oxide synthase was significantly higher in the leiomyoma group and the adenomyosis group as compared with the control group. In the subgroup analysis of leiomyoma depending on symptoms (menorrhagia or dysmenorrhea or both), the expression of endothelial nitric oxide synthase was significantly higher in the symptomatic subgroup than the asymptomatic subgroup (endometrium P = 0.0029, myometrium P = 0.0276). Conclusions: Based on the findings that the expression of endothelial nitric oxide synthase was significantly higher in the uterus with leiomyoma or adenomyosis, it can therefore be inferred that nitric oxide might have a pathological effect on the uterus with the above diseases. In particular, it is also presumed that endothelial nitric oxide synthase is closely associated with menorrhagia and dysmenorrhea. [ABSTRACT FROM AUTHOR]

Aim: This study assessed the effectiveness of blended essential oils on menstrual cramps for outpatients with primary dysmenorrhea and explored the analgesic ingredients in the essential oils. Material and Methods: A randomized, double-blind clinical trial was conducted. Forty-eight outpatients were diagnosed with primary dysmenorrhea by a gynecologist and had 10-point numeric rating scales that were more than 5. The patients were randomly assigned to an essential oil group ( n = 24) and a synthetic fragrance group ( n = 24). Essential oils blended with lavender ( Lavandula officinalis), clary sage ( Salvia sclarea) and marjoram ( Origanum majorana) in a 2:1:1 ratio was diluted in unscented cream at 3% concentration for the essential oil group. All outpatients used the cream daily to massage their lower abdomen from the end of the last menstruation continuing to the beginning of the next menstruation. Results: Both the numeric rating scale and the verbal rating scale significantly decreased ( P < 0.001) after one menstrual cycle intervention in the two groups. The duration of pain was significantly reduced from 2.4 to 1.8 days after aromatherapy intervention in the essential oil group. Conclusion: Aromatic oil massage provided relief for outpatients with primary dysmenorrhea and reduced the duration of menstrual pain in the essential oil group. The blended essential oils contain four key analgesic components that amount to as much as 79.29%; these analgesic constitutes are linalyl acetate, linalool, eucalyptol, and β-caryophyllene. This study suggests that this blended formula can serve as a reference for alternative and complementary medicine on primary dysmenorrhea. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to compare the effectiveness and safety of sublingual misoprostol with i.v. oxytocin infusion administered after delivery in reducing blood loss at cesarean section in Nigeria. Materials and Methods: One hundred women with term singleton pregnancy undergoing elective or emergency cesarean section under spinal anesthesia in Nigeria were randomly allocated to receive either misoprostol 400 mg sublingually or i.v. infusion of 20 units oxytocin soon after delivery of the baby. Estimated blood loss at surgery and within the first 4 h post-operation were measured in both groups. Results: No significant difference was found in mean blood loss between the oxytocin and misoprostol groups. Similarly, no significant difference occurred between preoperative and postoperative hematocrit levels in both groups. The need for additional oxytocin was similar in both groups. There was significantly less blood loss in the first 4 h after surgery in the misoprostol group than in the oxytocin group (58.2 20.7 vs 80.5, 26.8; P-value = 0.02). The incidence of adverse effects like shivering/pyrexia was significantly higher in the misoprostol group than in the oxytocin group (27/50 vs 1/50, P < 0.001). Conclusion: Sublingual misoprostolwas as effective as i.v. oxytocin infusion in reducing blood loss at cesarean section. It offers several advantages over oxytocin, including long shelf life, stability at room temperature, and noral administration, which make it a suitable uterotonic agent in low-resource areas. [ABSTRACT FROM AUTHOR]

Emerging evidence suggests that adenomyosis, like endometriosis, may also be an epigenetic disease. In this study, we evaluated the effect of valproic acid (VPA) in ICR mice with adenomyosis, induced by neonatal dosing with tamoxifen. For all mice, we evaluated the bodyweight and the response to thermal stimuli by hotplate and tail-flick tests 4, 8, and 12 weeks after dosing, respectively, and then treated mice with low- and high-dose of VPA, progesterone (P4), P4 + VPA, or vehicle only. Three weeks after treatment, both bodyweight and thermal response tests were evaluated again before sacrifice, and the depth of myometrial infiltration was evaluated. We found that: (i) the induction of adenomyosis resulted in progressive generalized hyperalgesia as measured by hotplate and tail-flick tests, along with decreased bodyweight; (ii) treatment with VPA, P4, or a combination was efficacious in improving generalized hyperalgesia; and (iii) drug treatment appeared to reduce the myometrial infiltration, but the difference did not reach statistical significance. Thus, VPA seems to be a promising therapeutics for treating adenomyosis, as reported recently in some case series in humans. [ABSTRACT FROM AUTHOR]

To estimate the prevalence of dysmenorrhea in Iranian women and investigate associated risk factors. In a cross-sectional study in Tehran, Iran in 2007, 381 women (81% response rate, age 16-56 years) were selected through a stratified random sample of 22 different districts and completed a questionnaire about dysmenorrhea. Descriptive statistics, spearman rank correlation statistic, and ordinal logistic regression models were used. Confounding and effect-modification were explored for each association. The prevalence of no, mild, moderate, and severe menstrual pain was 10%, 41%, 28%, and 22%, respectively. Older age and high intake of fruits and vegetables were protective factors for menstrual pain while women with family history of dysmenorrhea, higher stress and depression tended to have more severe pain. Body mass index, parity, smoking, and physical activity were not significantly associated with dysmenorrhea after controlling for potential confounding factors and effect modifiers. Menstrual pain is a common complaint in Iranian women. The inverse association between fruit and vegetable intake and dysmenorrhea, and reduction of stress and depression need to be further explored and considered in terms of recommendation to reduce dysmenorrhea. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to assess the long-term effectiveness and safety of hysteroscopic rollerball endometrial ablation as a surgical management of adenomyosis with menorrhagia and/or dysmenorrhea. We compared the results of patients who underwent pretreatment with gonadotropin-releasing hormone (GnRH) agonist with the results of those who did not. Methods: A retrospective study included 190 adenomyotic patients who suffered from menorrhagia and/or dysmenorrhea and underwent hysteroscopic rollerball endometrial ablation. Main outcome measures were rates of successful operation, complications, improvement of abnormal uterine bleeding and pelvic pain after the surgery. Results: The majority of the patients (142, 74.7%) underwent hysteroscopic rollerball endometrial ablation during the early proliferative phase of the menstrual cycle. The rest were operated on after GnRH agonist pretreatment for 6-8 weeks. Ablations were successfully performed on all patients in a day surgery setting. The average operation time was 36.3 ± 7.1 min. The mean glycine deficit was 583.4 ± 247.3 mL. The ablation in the no-pretreatment group took a significantly longer time and had more glycine absorption compared to the GnRH agonist pretreatment group ( P < 0.0001). Mean postoperative follow-up duration was five years (range 1-10 years). A total of 187 patients (98.4%) who had undergone hysteroscopic endometrial ablation reported decreased bleeding: amenorrhea in 58 (30.5%), hypomenorrhea in 78 (41.1%), and eumenorrhea in 51 (26.8%) patients. Three patients (1.6%) underwent hysterectomy due to symptoms recurrence. A total of 165 (86.8%) patients with dysmenorrhea reported either reduced or no dysmenorrhea. There was no significant difference in the efficacy of hysteroscopic rollerball endometrial ablation between patients who underwent pretreatment with GnRH agonists and those who did not. No major complications related to the procedure were reported. Conclusions: Hysteroscopic rollerball endometrial ablation as a surgical management of menorrhagia and dysmenorrhea that develops in patients with adenomyosis is an effective and safe procedure. It can reduce the need for the unnecessary major surgery of hysterectomy. [ABSTRACT FROM AUTHOR]

Aim: To explore and compare the features of menstruation, perception and management of menstrual pain between two cohorts of Australian and Chinese women. Methods: A pilot comparison study was carried out using modified valid menstrual questionnaires. The study included 120 Australian women and 122 Chinese women aged from 18 to 45 years with primary dysmenorrhea. Results: Australian women rated menstrual pain as more intense than Chinese women (8.5 ± 1.5 on a 10-point pain scale vs 7.3 ± 1.8, P < 0.001), duration of pain was 36% longer (3.0 ± 2.5 vs 2.2 ± 0.9 days, P = 0.002) and menarche commenced earlier (12.7 ± 1.5 vs 14.2 ± 1.4 years, P < 0.001). The mean reported menstrual interval was also shorter (29.2 ± 5.3 vs 30.52 ± 3.7, P = 0.020) with heavier overall menstrual flow ( P = 0.002) and fewer clots in menstrual blood (83% vs 95.8%, P = 0.001). There was no significant difference in duration of menstruation (5.2 ± 1.3 vs 5.4 ± 1.1 days; P = 0.180). Correlations were found between earlier menarche and increased intensity of menstrual pain ( r = −0.16, P = 0.011), and between heavier menstrual flow and increased intensity of menstrual pain ( r = 0.19, P = 0.003). Conclusion: Evidence from this pilot study suggested that the clinical menstrual presentations in the cohorts of Australian and Chinese women were different. Although the findings are preliminary, evaluating ethnic differences in menstruation and experimental menstrual pain models may not only provide some information about underlying mechanisms but may also predict or explain group differences. [ABSTRACT FROM AUTHOR]

Aim: To test the efficacy of heat- and steam-generating (HSG) sheets for the relief of symptoms of primary dysmenorrhea in young women. Materials & Methods: Thirty-four female university students were enrolled in this study. HSG sheets generate moist heat to keep the attached body area at 38.5 °C for 8 h. Subjects attached the HSG sheet to the lower abdominal or lumbar region for 5 to 8 h once a day on the first, second and third days of menstruation. Subjects documented symptoms of dysmenorrhea (abdominal pain, lumbago and lumbar dullness) on a self-recording form using a 4-score scale of 0 (mild) to 3 (severe) just before applying and after removing the HSG sheet. Either a small (54 cm [ABSTRACT FROM AUTHOR]

Aim: To determine the frequency of dysmenorrhea and its associated symptoms amongst a number of adolescent female students and to investigate the possible association between daily dairy product intake and dysmenorrhea. Methods: A self-assessment questionnaire was completed by 127 female university students aged between 19 and 24 years. Participants gave information that included demographics, the nature, type, and severity of pain associated with menstruation if any, management used to relieve dysmenorrhea, associated symptoms, and a general assessment of dietary intake of dairy products. Results: The prevalence of primary dysmenorrhea in the population studied was 87.4% with the majority of the participants' pain symptoms beginning a few days before and continuing through the first two days of menstruation. Forty-six percent of students were found to have severe dysmenorrhea. Abdominal bloating was the most frequently expressed symptom associated with dysmenorrhea amongst the population studied. Dysmenorrhea and associated symptoms were found in significantly fewer female students who consumed three or four servings of dairy products per day as compared to participants who consumed no dairy products. Conclusion: Primary dysmenorrhea is common in young women. This study helps us to better understand the relationship between low dietary intake of dairy products and the risk of dysmenorrhea. [ABSTRACT FROM AUTHOR]