Search

Study Objective The aim of the study was to examine the effect of heavy menstrual bleeding (HMB) and dysmenorrhea on daily activity and quality of life (QoL) in young women engaged in demanding activities. Design Cross-sectional study. Participants A total of 422 Israeli women soldiers in combat and non-combat roles. Interventions Participants were asked to provide consent and to complete study questionnaires. Main Outcome Measures A pictorial bleeding assessment chart (PBAC), visual analog scale (VAS), verbal multidimensional scoring system for assessment of dysmenorrhea, and approved Hebrew-translated age-appropriate Pediatric Quality of Life Inventory (PedsQL). Results HMB (PBAC >100) and severe HMB (PBAC >185) were demonstrated in 181 (50%) and 96 (26%) participants, respectively. A high PBAC score was recorded in 20% who answered “no” or “unknown” in the questionnaire on having HMB. Mild, moderate, and severe dysmenorrhea were demonstrated in 80 (21.5%), 115 (31%), and 142 (38%) participants, respectively. The prevalence of HMB and dysmenorrhea was similar in soldiers in combat and non-combat roles. Diagnosis of HMB was related to the lower fitness-for-service score, history of bleeding, and dysmenorrhea. Daily activity and QoL were both affected by the severity of HMB and dysmenorrhea. Conclusion Underdiagnosis of HMB and dysmenorrhea results from a combination of unawareness from the women's side and inattention from the system. In an era of female empowerment, each woman should be at the optimal physiological and psychological level to start her career; thus, addressing the menstrual burden and providing effective treatment is needed in the military scenario and other settings with demanding activities.

STUDY OBJECTIVE: To characterize typical menstrual characteristics in a large sample of secondary school girls, as well as knowledge of typical (ie, normal) menstruation, endometriosis awareness, and educational needs. To establish whether self-reported atypical period symptoms indicate menstrual characteristics suggesting the need for further clinical review for a specialist opinion. DESIGN: Cross-sectional survey. SETTING: Secondary schools in West Midlands, England. PARTICIPANTS: A total of 442 girls, aged 15-19 years. INTERVENTIONS AND MAIN OUTCOME MEASURES: The questionnaire determined demographic characteristics, age at menarche, menstrual cycle patterns and experiences, awareness of endometriosis, and preferences for learning about it. RESULTS: Period pain was common (94%), with pain reported as moderate/severe (86%). Girls reported missing school due to their menstrual periods (23%), mainly because of pain. Most believed their period was typical (63%); however, 27% were unsure, and 30% did not know whether it was regular. Self-report of atypical periods was associated with symptoms suggesting need for clinical review and with consulting a doctor [χ²(2) = 36.272, P < .001)]. Only 8% could describe endometriosis, although 86% wanted to learn more about it. CONCLUSION: Most secondary school girls report dysmenorrhea. Although most girls reporting atypical periods had seen a doctor, more than one-fourth did not know whether their period was typical or regular. The majority do not have knowledge of endometriosis, contrasting with adolescents' familiarity with other common chronic conditions such as diabetes and epilepsy. We suggest menstrual health education (MHE) to improve knowledge of typical menstruation and pain treatment, aiding earlier identification of problematic period symptoms that might indicate underlying pathology.

Study Objective This study aimed to evaluate the presence of anovulation in adolescents with primary dysmenorrhea (PD). Design Prospective cohort study. Setting Hacettepe University Children's Hospital, Adolescent Medicine outpatient clinic between September 2018 and September 2019. Participants Healthy female adolescents (between 11 and 18 years of age), with regular menstruation with a score of 1-3 according to the Numerical Rating Scale (NRS) and grade 0 (no limitation for daily activities, no analgesic need and systemic symptoms) according to the Verbal Multidimensional Scoring System (VBSS) were recruited as a control group. The participants who met the diagnostic criteria for PD with an NRS score ≥4, had analgesic need in at least the last 3 menstrual cycles, had defined moderate-to-severe PD according to VMSS (Grade 2-3), and had analgesic need every time were accepted as the PD group. Intervention and Main Outcome Measures For the determination of ovulation, suprapubic pelvic ultrasound and luteal SP levels were used. The first day of menstruation (DOM) was accepted as the first day of the menstrual cycle. The participants were called to the outpatient clinic for a total of 3 visits during 1 cycle; the first visit was for the suprapubic pelvic ultrasound imaging on the 12th-18th DOM, the second visit was for the first SP level measurement on the 21st-24th DOM, and the third visit was for the second SP level measurement on the 28th-31st DOM, if the next expected menstruation has not started yet. Participants’ anthropometric measurements, menstrual history, family history of dysmenorrhea, and additional symptoms accompanying pain were recorded. Results Anovulatory cycle rates according to 2 different references for SP threshold values (3 and 5 ng/mL) were 31.7% and 36.6% in the PD group, and 44.4% and 55.6% in the control group, respectively (P = .250, P = .095). In the PD group, NRS scores were similar for the ovulatory and anovulatory cycles for both SP threshold values (P = .320, P = .205). When the reference value for SP threshold was accepted as ≥5 ng/mL, the NRS score was significantly higher in the ovulatory group (P = .0017). When the distribution percentages of SP levels were evaluated among all participants, the median value was 5.5 ng/mL. Conclusion Contrary to classical information, anovulatory cycles are not rare in PD patients, and pain severity is at the same level in these cycles. The pathogenesis of PD in adolescents requires further study.

Study Objective This study describes menstrual dysfunction and treatment among adolescent and young adult (AYA) females with congenital heart disease (CHD). Design Data collected from a 1-time survey completed by AYA females (and mothers if AYA unable). Setting Participants were recruited from pediatric cardiology clinics. Participants Female AYA with CHD, aged 14-21 years (N = 114). Interventions None. Main Outcome Measures The questionnaire assessed sexual and reproductive health (SRH) concerns, behaviors, and management. Outcome measures were self-reported menstrual complaints, use of over-the-counter (OTC) pain relief medications for dysmenorrhea, reported visits with a clinician for a menstrual problem, and reported use of hormones for menstrual problems or birth control. Results Mean age was 17.0 years (SD = 2.2). The majority of participants (83%) reported 1 or more menstrual complaints (67.5% cramping, 42.1% irregular menses, 46.5% heavy periods), and 88% reported any history of taking OTC medications for pain relief. Increased menstrual complaints were not associated with level of cardiac complexity, reported transplantation, or reported use of hormonal contraception. However, 32% of participants reported use of hormonal contraception for menstrual dysfunction. Combined oral contraceptive pills (COCs) were the most common; 2 of these women carried contraindications to estrogen. Conclusions A large majority of AYA females with CHD reported menstrual dysfunction. Use of OTC medication for menstrual pain and inappropriate use of estrogen creates concerns that menstrual disorders may be unaddressed or addressed inappropriately. Thus, gynecological needs of adolescents with CHD may need to be specifically targeted by providers who feel comfortable with this population and their complex needs.

Endometriosis is the most common cause of secondary dysmenorrhea among adolescents. Data on postoperative symptoms of the disease in adolescents are limited. In this study we aimed to describe the clinical characteristics and postoperative symptoms of adolescent endometriosis in our center.Retrospective cohort study.Tertiary care institution.Eighty-five adolescents with surgically confirmed endometriosis, age younger than 19 years, were included.None.Clinical characteristics including demographic factors, pelvic symptoms, and changes of pelvic pain after surgery.Of 11,236 patients with endometriosis who received surgical treatment between January 2008 and January 2018 in our department, 85 adolescents (85/11,236; 0.76%) were included. The mean age at the time of surgery was 16.3 (±2.4) years and pelvic pain was the main symptoms which occurred in 73/85 (85.9%). Forty-four of the 85 patients (51.8%) had associated genital malformations. The patients with genital malformations tended to present with a younger age at the time of surgery (15.1 ± 2.4 vs 17.6 ± 1.7 years; P .001) and a shorter duration of symptoms to time of surgery (1.5 ± 1.3 vs 2.3 ± 2.1 years; P = .033). The median follow-up time was 56 months (range, 24-140 months) after surgery, and the pelvic pain had disappeared in 41.7% of patients, improved in 38.3% of patients, and had no change or worsened in 20.0% patients.Pelvic pain was the main symptom in adolescents with endometriosis and was greatly improved after surgery. It should also be noted that genital malformation might be an important factor in younger adolescents with endometriosis.

Study Objective To study the presentation of dysmenorrhea and endometriosis in transmasculine adolescents and review their treatment outcomes. Design A retrospective review. Setting Boston Children's Hospital. Participants Transmasculine persons younger than 26 years old who were diagnosed with dysmenorrhea and treated between January 1, 2000 and March 1, 2020. Interventions Not applicable. Main Outcome Measures An electronic medical record review of the clinical characteristics, transition-related care, and treatment outcomes. Results Dysmenorrhea was diagnosed in 35 transmasculine persons. Mean age was 14.9 years ± 1.9 years. Twenty-nine (82.9%) were diagnosed after social transition. Twenty-three of 35 (65.7%) were first treated with combined oral contraceptives, but 14/23 (61%) discontinued or transitioned to alternative therapy. Twelve patients with dysmenorrhea alone initiated testosterone treatment, and 4/12 (33.3%) experienced persistent symptoms. Seven of 35 patients with dysmenorrhea (20.0%) were laparoscopically evaluated for endometriosis, and it was confirmed in all seven. Six had stage I disease, and one had stage II. Three of the 7 (42.9%) were diagnosed after social transition, with one diagnosed 20 months after initiating testosterone treatment. Their endometriosis was treated with combined oral contraceptives, danazol, or progestins; four experienced suboptimal response during treatment with these therapies alone. Two of those with suboptimal response subsequently resolved their dysmenorrhea when using testosterone. Five patients with endometriosis initiated testosterone treatment, and of the 5 (40%) experienced persistent symptomatology with combined testosterone and progestin therapies. Conclusion To our knowledge, this is the first study to characterize endometriosis in transmasculine persons. Evaluation for endometriosis was underutilized in transmasculine persons with dysmenorrhea, despite those who underwent laparoscopic evaluation and had disease confirmation. Although testosterone treatment can resolve symptoms in some, others might require additional suppression. Endometriosis should be considered in transmasculine persons with symptoms even when they are using testosterone.

Study Objective To explore the prevalence and impact of dysmenorrhea, pelvic pain and menstrual symptoms on young women at school or in tertiary education. Design and Setting Cross-sectional online survey in Australia. Participants A total of 4202 adolescent and young women (13-25 years of age; median age 17 years), having reached menarche, living in Australia and currently attending school (n = 2421) or tertiary education (n = 1781). Interventions Online survey hosted by Qualtrics between November 2017 to January 2018. Data were collected on sociodemographic data, menstrual cycle characteristics, dysmenorrhea, pelvic pain, and educational and social impact. Main Outcome Measures Information on menstrual and pelvic pain impact, academic absenteeism and presenteeism, impact on non-academic activities and interactions with teaching staff. Results and Conclusions Dysmenorrhea was reported by 92% of respondents. Dysmenorrhea was moderate (median 6.0 on a 0-10 numeric rating scale) and pain severity stayed relatively constant with age [rs(3804) = 0.012, P = .477]. Noncyclical pelvic pain at least once a month was reported by 55%. Both absenteeism and presenteeism related to menstruation were common. Just under half of women reported missing at least one class/lecture in the previous three menstrual cycles. The majority of young women at school (77%) and in tertiary education (70%) reported problems with classroom concentration during menstruation. Higher menstrual pain scores were strongly correlated with increased absenteeism and reduced classroom performance at both school and in tertiary education. Despite the negative impact on academic performance the majority of young women at school (60%) or tertiary education (83%) would not speak to teaching staff about menstruation.

Study Objective To identify and examine the key areas of need and explore the experiences of adolescent girls with heavy menstrual bleeding and/or dysmenorrhea. Design and Setting Qualitative interview study using semi-structured interviews. Gynaecology outpatient clinic at The Royal Children's Hospital, Melbourne, Australia. Participants Adolescent girls (12-18 years; mean age, 14.8 ± 1.5 years) presenting with heavy menstrual bleeding and/or dysmenorrhea at the clinic (N = 30). Interventions and Main Outcome Measures In-depth semi-structured interviews were conducted between May and August 2018. Interview data were thematically analyzed using a grounded theory approach. Themes covered experiences and unmet needs of adolescent girls with heavy menstrual bleeding and/or dysmenorrhea. Results A total of 12 themes were identified, and covered the impact of symptoms, experiences, and/or unmet needs of these adolescents. Key themes highlighting experiences and unmet needs related to (1) coordination of healthcare, (2) day-to-day coping, (3) school, and (4) information surrounding menstrual issues. From these themes, 7 unmet needs emerged and were organized under 3 key areas of need: (1) treatment, management, and care, (2) improvements in the school environment, and (3) menstrual health as a gendered issue. Conclusion Menstrual concerns can have a profound physical and psychosocial impact on adolescents. Effective school-based menstrual education programs may be key in reducing stigma, fear, and shame surrounding menstruation, in teaching positive management strategies and in encouraging adolescents to seek help for their menstrual concerns.

Study Objective To provide insight into the unmet needs of parents of adolescents with heavy menstrual bleeding or dysmenorrhea, in the context of their daughters’ menstrual concerns. Design Qualitative interview study using semi-structured interviews. Setting Gynecology outpatient clinic at The Royal Children's Hospital, Melbourne, Australia. Participants Parents of adolescent girls with heavy menstrual bleeding or dysmenorrhea recruited from an adolescent gynecology clinic between May and August 2018. Interventions In depth, semi-structured interviews with 24 parents whose daughters had heavy menstrual bleeding or dysmenorrhea. Data were analyzed using a grounded theory approach. Main Outcome Measures Themes derived from interview transcripts about the supportive care needs of parents. Results Thirteen themes emerged in the interviews across 4 areas of need: (1) experiences with healthcare, (2) informational needs, (3) support and acceptance, and (4) financial impacts. Across the interviews, parents identified a need for greater awareness and education among parents and daughters, health professionals, and the broader community. Conclusion This research confirmed that parents play a significant role in daughters’ menstrual health care and have a series of unmet needs. Strategies and interventions specifically targeting these parents may be warranted.

Endometriosis is the leading pathologic cause of dysmenorrhea and chronic pelvic pain among adolescents. The appearance of endometriosis in adolescents may be different from that in female adults, resulting in delayed recognition and intervention. This article addresses the epidemiology, pathophysiology, clinical presentation, diagnosis, and management of endometriosis in the adolescent.

Exposure to adverse childhood experiences (ACEs) has been associated with poor health outcomes, including chronic pain. However, little is known about the potential impact on the development of pelvic pain in adolescents and young adults. This systematic review was conducted to explore the association between ACEs and dysmenorrhea, pelvic pain, and dyspareunia in adolescents and young adults.Medline, Embase, and PsycNET were searched, using keywords related to childhood adversity, dysmenorrhea, pelvic pain, and dyspareunia.Of the 566 articles identified, 19 studies were included. There was an association between the number and severity of ACEs and the risk of dysmenorrhea. Sexual abuse and posttraumatic stress disorder appeared to be associated with dysmenorrhea, pelvic pain, and dyspareunia, but it was unclear whether this relationship was mediated by poorer mental health. No association was found for immigration and bullying, and findings were inconsistent regarding female genital mutilation, parental separation, and parental death.Future research should include longitudinal follow-up and use validated tools to assess childhood adversity. A greater understanding of the risk of ACEs among adolescents and young adults with dysmenorrhea, chronic pelvic pain, and dyspareunia could provide insight into the development of these conditions.

To evaluate the impact of nitrous oxide on patient-reported pain for placement of intrauterine systems (IUSs) in adolescents STUDY DESIGN: : Prospective observational study SETTING: : IUS placement in an ambulatory clinic compared with placement with nitrous oxide in a hospital-based sedation unit PARTICIPANTS: : English-speaking adolescents aged 12 to 20 presenting to a pediatric and adolescent gynecologist with a medical indication for IUS placement MAIN OUTCOME MEASURES: : Patient-reported procedural pain measured on a visual analog scale 2 minutes post IUS insertion procedure. Secondary outcome measurement of likelihood of recommending an IUS to a peer.Seventy-four patients agreed to participate. Forty-five patients underwent IUS placement in the clinic. Controlling for age, history of dysmenorrhea, and body mass index, a significant time (change in reported pain scores pre- vs post IUS insertion) by treatment (nitrous oxide vs standard of care) interaction was observed for patient-reported pain (b = -29.32 mm, P0.01). Patients receiving nitrous oxide were more likely to recommend an intrauterine placement than patients who received the current standard of care for pain management (b = 0.47, P = 0.02) after controlling for age, baseline pain score, and dysmenorrhea history.Patient-reported pain was attenuated for patients who received nitrous oxide relative to those who received standard IUS placement. Patient-reported satisfaction was higher for patients who received nitrous oxide relative to those who received standard IUS placement.

Study Objective To study the effectiveness of performing Zumba exercise on the severity and duration of pain in patients with primary dysmenorrhea. Design Randomized controlled trial. Setting Cairo University gynecology Hospital and Bahgat gym and fitness center. Participants Ninety-eight women diagnosed with primary dysmenorrhea. Interventions Study participants were divided randomly into 2 equal groups: group I included women who engaged in Zumba exercise for 60 minutes twice weekly for 8 weeks, and group II was a control group with no intervention. Main Outcome Measures The primary outcome was the menstrual pain intensity measured using the visual analogue scale scores at 4 and 8 weeks after starting Zumba exercise. The secondary outcome was the difference in the duration of pain in both groups. Results Both groups were homogeneous regarding the baseline demographic characteristics. The severity of primary dysmenorrhea at the beginning of the study was not significantly different between the 2 groups. Menstrual pain intensity was significantly decreased in the Zumba group after 4 and 8 weeks of Zumba compared with the control group (mean difference, −2.94 [95% confidence interval, −3.39 to −2.48] and −3.79 [95% confidence interval, −4.16 to −3.43], respectively; P = .001). Also, the duration of pain was shorter in the Zumba group compared with the control group at 8 weeks (4.92 ± 1.90 vs 9.10 ± 2.92 hours, respectively; P = .001). Conclusion The Zumba intervention can reduce the severity and duration of menstrual pain thus suggesting that regularly performing Zumba might be a possible complementary treatment for primary dysmenorrhea.

OBJECTIVE: To evaluate rates of presumptive anovulation in eumenorrheic adolescents and young adults with moderate to severe primary dysmenorrhea and those without primary dysmenorrhea. PARTICIPANTS: Thirty-nine adolescents and young adults (ages 16–24) with primary dysmenorrhea and 52 age-matched controls. DESIGN: Participants completed luteinizing hormone surge ovulation predictor test kits. Anovulatory cycles were defined by never receiving a positive result prior to the next menstrual period; participants were grouped as anovulatory if they experienced at least one anovulatory cycle during study participation. Participants rated daily level of menstrual pain on a 0–10 numeric rating scale. SETTING: A university-based clinical research laboratory. RESULTS: One hundred and sixty-eight cycles were monitored, 29.8% of which were anovulatory (37.1% vs. 17.5% of cycles in control and dysmenorrhea groups respectively). During study participation, control girls were significantly more likely to have had at least one anovulatory cycle than were girls with primary dysmenorrhea (44.2% vs. 17.9% of participants respectively, p.05). CONCLUSION: Data support previous findings of increased rates of ovulation in primary dysmenorrhea. However, menstruation following anovulatory cycles can be as painful as menstruation following ovulatory cycles. These data support the idea that regular menses do not necessarily indicate that a normal ovulatory cycle has occurred. Previous implications that ovulation is necessary for the development of substantial menstrual pain are incomplete.

Study Objective To examine prevalence and risk factors associated with primary dysmenorrhea among Chinese female university students in Hunan province, China. Design A cross-sectional study. Setting Female university students in Changsha city, Hunan province, China. Participants Four thousand six hundred six female individuals selected using a multistage cluster random sampling method. Interventions A self-administered questionnaire, which included sociodemographic information, lifestyle habits, emotional characteristics, and menstruation pattern, was used to collect data. Main Outcome Measures Information about menarche, body mass index, cycle length and regularity, primary dysmenorrhea, physical exercise, depression, and anxiety. Results The prevalence of primary dysmenorrhea was 41.7% (1921/4606) among Chinese female university students. Multivariate binary logistic regression indicated that being a minority (odds ratio [OR], 1.335; 95% confidence interval [CI], 1.083-1.646), underweight (OR, 1.249; 95% CI, 1.08-1.42), annual household income less than 80,000 CNY (OR, 1.169; 95% CI, 1.018-1.342), maternal history of dysmenorrhea (OR, 2.553; 95% CI, 2.236-2.915), age at menarche younger than 12 years (OR, 1.161; 95% CI, 1.013-1.329), irregular menstrual cycle (OR, 1.216; 95% CI, 1.063-1.391), and skipping breakfast (OR, 1.294; 95% CI, 1.124-1.490) were associated risk factors of primary dysmenorrhea. Conclusion The prevalence of primary dysmenorrhea among Chinese university students is relatively high. Various risk factors were identified that associated with primary dysmenorrhea. More effort and attention should therefore be directed toward this health problem in China.

Background and Objective Adolescent girls perceive menstruation as a negative experience, which can affect adolescents’ physical and mental health. The aims of this study were to describe the menstrual knowledge, attitudes, and behaviors of adolescent girls in China and to examine their association with psychological stress. Design, Setting, Participants, Interventions, and Main Outcome Measures A cross-sectional study was conducted among 1349 adolescent girls aged 11-14 years in Changsha, China. Participants anonymously completed questionnaires that assessed sociodemographic characteristics, menstrual knowledge and attitudes, dysmenorrhea self-care behaviors, and perceived stress. One-way analysis of variance and Pearson r correlation and multiple linear regression analyses were conducted to examine the differences and associations among variables. Results The mean age of menarche was 11.70 (±0.82) years. A total of 1053/1349 (78.1%) of girls had a knowledge of menstruation before menarche and their mothers were the main source 931/1349 (69.0%) of their knowledge. More than half (53.4%) of adolescent girls experienced different degrees of dysmenorrhea. The mother's education, family monthly income, family type, and the girls' age, grade, menstrual status, age at menarche, sanitary napkin change frequency, menstrual restrictions, and dysmenorrhea influenced menstrual knowledge, attitudes, and practice. Psychological stress was affected by age, grade, age at menarche, sanitary napkin change frequency, menstrual restrictions, dysmenorrhea, and menstrual knowledge, attitudes, and practices. Conclusion Psychological stress management during menstruation should be a focus of health education programs for adolescent girls. During adolescence, health care providers should not only pay attention to the physical changes of adolescence girls, but also provide stress management skills to help them cope with menstrual-related concerns.

Study Objective This study aims to determine the results of a cognitive-behavioral approach in a dysmenorrhea support program that covers the symptoms, acquaintance, and attitudes toward menstruation of university students who had primary dysmenorrhea. Design and Setting This randomized controlled, prospective, experimental study was carried out in a nursing school using a pretest-posttest design. Participants A total of 682 female nursing students and 584 volunteers from the 2017-2018 academic year participated in a study of the prevalence of primary dysmenorrhea (94.0%). Study subjects were first-year female nursing students who scored severe on a visual analog scale for primary dysmenorrhea. As a result of the analysis, 80 female nursing students were assigned to study and control groups. A total of 60 students, 29 in the study group and 31 in the control group, completed the study. Intervention The study group participated in a 6-session cognitive-behavioral approach in a dysmenorrhea support program. No intervention was administered to the control group. The control group and the study group were followed by using data collection forms during three menstrual cycles. Outcome Measures The Participant Introductory Form (PIF), Dysmenorrhea Follow-up Form (DFF), Dysmenorrhea Information Form (DIF), Functional and Emotional Dysmenorrhea Scale (FEDS), Visual Analog Scale (VAS), and Menstrual Attitude Questionnaire (MAQ) were used to measure outcomes. Results In the case of primary dysmenorrhea, the use of nonpharmacological methods was higher in the study group than in the control group. In the third cycle, although the rate of analgesics use was 20.7% in the study group, it was 50% in the control group. Primary dysmenorrhea symptoms, pain levels, and analgesic use decreased. No change was observed in the attitude toward menstruation. Conclusion A cost-effective, reliable, cognitive-behavioral approach−based dysmenorrhea support program can be used to relieve symptoms, decrease the use of analgesics, and increase knowledge about primary dysmenorrhea.

Although adolescent pregnancy and birth rates have been declining since the early 1990s, the rate of intrauterine device (IUD) use in adolescents remain low. IUDs are a highly effective contraceptive method with a failure rate of less than 1%. There are currently 5 IUDs available and marketed in the United States: the nonhormonal copper-containing IUD (Paragard Copper T380A; Ortho-McNeil) and 4 hormonal levonorgestrel-releasing intrauterine systems (LNG-IUDs). IUDs can be used in adolescents, and the LNG-IUD has many noncontraceptive benefits including the treatment of heavy menstrual bleeding, dysmenorrhea, pelvic pain/endometriosis, and endometrial hyperplasia/endometrial cancer. In addition, the LNG-IUD is an effective tool for suppression of menses.

Study Objective To evaluate the prevalence of pain symptoms suggestive of endometriosis among adolescent girls aged 15-19 years. Design Cross-sectional study. Setting University hospital. Participants Adolescent girls aged 15-19 years attending elementary school, high school, or vocational institute at 3 cities in Southwest Finland in 2010-2011. Interventions The school nurses distributed a detailed questionnaire to 2582 girls who were attending school at the time of the study. Completion of the questionnaire was voluntary and anonymous. Main Outcome Measures Prevalence and severity of dysmenorrhea, acyclic abdominal pain, dyspareunia, dyschezia, and dysuria. Severity was evaluated with an 11-point numerical rating scale (NRS). Results A total of 1103 eligible answers were analyzed. The prevalence of dysmenorrhea was 68% (738/1092) with mean NRS of 7.0 (SD = 2.0). Acyclic abdominal pain, dyspareunia, dyschezia, and dysuria were less frequent (19% [207/1085], 12% [53/458], 8% [87/1088] and 5% [50/1084], respectively). The prevalence of severe dysmenorrhea (NRS 8-10) was 33% (355/1089). Severe dysmenorrhea was associated with increased risk of concurrent acyclic abdominal pain (odds ratio [OR] = 2.7; 95% confidence interval [CI], 2.0-3.6), dyschezia (OR = 2.5; 95% CI, 1.6-3.9), and regular absenteeism from school or hobbies (OR = 10.0; 95% CI, 4.2-23.6). Using different criteria, 2%-10% (21-106/1103) of all girls could be identified as having symptoms suggestive of endometriosis. Five percent of girls (n = 53/1103) had severe dysmenorrhea, used oral contraceptive pills, and reported inadequate relief from pain medication. Conclusion One-third (355/1089) of 15- to 19-year-old girls had severe menstrual pain and 14% (49/355) of them were regularly absent from school or hobbies. Five percent of all teenage girls (53/1103) were poor responders to conventional therapy for primary dysmenorrhea.

Adolescents with special needs have unique reproductive health care needs related to their physical and cognitive issues. This review discusses some of the most common concerns that are encountered in clinical practice, as the clinician will partner with the adolescent and her family to guide her through the pubertal transition and to help navigate the risks and rights of reproduction. Families often seek anticipatory guidance before menarche on menstrual hygiene, abuse risk and sexuality and can be reassured that most teens with special needs do very well with menstruation. The clinician needs to evaluate the teenager's reproductive knowledge as well her risk for abuse and coercion and her ability to consent to sexual activity, if she requests contraception. Menstrual management is mostly based on the impact of the menstrual cycles on the teenager's life and activities. The adolescents may have a decreased ability to tolerate menses or pain, or experience changes in seizure pattern or altered mood. Hormonal treatment is often used to assist with menstrual hygiene, cyclical mood changes or dysmenorrhea. The goal of treatment can be complete amenorrhea, alleviate pain or regulate and decrease menstrual flow. The unique risks and benefits of hormonal treatment for this special population are highlighted.

Study Objective To demonstrate that adenomyosis is a rare cause of dysmenorrhea or chronic pelvic pain (CPP) in the adolescent population that can be identified with magnetic resonance imaging (MRI) and to report resolution of adenomyosis by MRI after a course of hormonal suppression in 4 adolescents. Design, Setting, and Participants Retrospective case series of 4 adolescents with adenomyosis on pelvic MRI at Texas Children's Hospital. Interventions Continuous oral contraceptive (COC) therapy or leuprolide acetate. Main Outcome Measures Lesions on pelvic MRI after treatment. Methods We reviewed medical records of 4 adolescents with CPP and adenomyosis on T2-weighted pelvic MRI. All patients had initial diagnostic pelvic MRI and then definitive hormonal intervention. Repeat imaging was obtained after a symptom-free interval. Results Patient ages ranged from 12 to 16 years. One patient had resolution of symptoms with COC therapy. MRI performed 3 years later showed no adenomyosis. Three patients failed COC therapy. All were symptomatically improved after therapy with a gonadotropin-releasing hormone agonist. Follow-up MRI performed at intervals between 6 months and 3 years showed resolution of adenomyosis. Conclusion MRI can raise suspicion for the diagnosis of adenomyosis in adolescents with refractory CPP. Subsequent MRI can show regression of lesions after symptom resolution with hormonal therapy.

Study Objective The study sought to gain an in-depth understanding of primary dysmenorrhea management and coping strategies for dysmenorrhea among adolescents and young adults who were in school. Design The study adopted a qualitative exploratory approach using a descriptive phenomenology to explore the phenomenon of interest. Setting The study was conducted in two educational institutions in Accra, Ghana: a Senior High School (SHS) and a University. Participants and Data Collection Sixteen participants were purposively recruited (8 SHS and 8 University students) through snowball sampling. Individual interviews were conducted in English, audio-taped, transcribed and analysed using content analysis procedures. Informed consent was obtained from all participants and rigor was ensured through prolonged engagement and member checking. Results Participants employed both pharmacologic (orthodox and herbal) and nonpharmacologic approaches such as warm compress, exercise, and water and diet therapy for their dysmenorrhea. Students' dysmenorrhea was managed at the school clinic and the hospital. Health professionals demonstrated negative attitudes towards dysmenorrhea management. Students coped with dysmenorrhea by planning activities before the onset of pain, receiving social and spiritual support, and developing a mind-set to bear pain. Conclusions Individualized approaches should be employed to enhance dysmenorrhea management. Health professionals should be educated on dysmenorrhea to improve their attitude and skills for dysmenorrhea management.

To establish the prevalence and impact on quality of life of dysmenorrhea among young adult Jordanian females.Cross-sectional study based on quantitative self-reported anonymous questionnaire.University-based study.A total of 272 female medical students (aged 19-25 years).None.Self-reports of menstruation-related pain symptoms and methods of dealing with them.Of study subjects 152/272 (55.8%) participants had moderate and severe dysmenorrhea. Of them, 55.8% had a family history of severe dysmenorrhea compared with 33.1% of those without dysmenorrhea (χ2 = 13.40, df = 1, P.001). There was strong association between severity of dysmenorrhea and poor university attendance (χ(2) = 45.35, df = 2, P.001), poor social activities (χ2 = 32.06, df = 2, P.001), poor relationships with family (χ2 = 18.46, df = 2, P.001) and friends (χ2 = 19.14, df = 2, P.001), and poor sport activities (χ2 = 12.15, df = 2, P = .002). Dysmenorrhea worsens during examination periods in 50% of cases. The most common pain symptom was low back pain (60.2%). Body mass index, family monthly income and early age at menarche had no correlation with the occurrence of dysmenorrhea. Of those with dysmenorrhea, 69.4% were using analgesics. Mothers were the main source of information regarding menstruation.Dysmenorrhea is highly prevalent among young adult Jordanian females and seems to negatively affect quality of life, particularly as related to university attendance and performance and social relationships.

Study Objectives To assess the effectiveness of fennel on primary dysmenorrhea symptoms and menorrheal duration. Design Clinical trial study. Setting Islamic Azad University, Toyserkan. Participants 80 female students were randomly divided in to two groups of intervention (n = 40) and control (n = 40). Interventions The intervention group was given one soft capsule Fennel (30 mg) every 4 hours, 3 days before menstruation till the 5th day and continued for 3 months. The control group received no medication. Main Outcome Measures The severity of samples pain was graded using a visual analogue scale. 5 standard questionnaires include of Visual analog scale pain (VAS), McGill pain questionnaire, the range of stress about dysmenorrheal (VASA), Perceived stress scale, Well being scale were filled out in intervals of before, during and after fennel capsule uptake. Data were analyzed by SPSS 17 software. P Results The mean of nausea intensity and weakness decreased to 1.93, and 2.88 after 3 months, whereas they were 2.37, 6.65 in control group which indicated a significant difference. Reduce the duration of menstrual period, a significant difference was found after two and three months of use. Concern in terms of quality and feelings of well-being after 1 and 3 months, was observed significant difference compared with before using. Conclusion Considering the safety of herbal medicines, this drug can use to relieve dysmenorrheal signs and menstrual duration.

Objectives: This is a controlled, prospective study which compares the effects of a low-dose heat patch for self-medication on the reduction of pain symptoms in dysmenorrhea. Methods: The sample group included female sophomore students studying at a university in Istanbul, Turkey, between 2007 and 2008. These female participants completed the Dysmenorrhea Identification Form to determine the sample group, and a total of 193 female students possessed the eligible criteria. The research control group consisted of 66 patients, the analgesia group consisted of 61, and the heat patch group consisted of 66. The control group did not use any treatments, while the self-medication group used analgesic medication (single dose), and the heat patch group applied a heat patch on the lower abdomen, against the skin, for an application period of 2 menstrual cycles. Using a visual analog scale (VAS), the pain severity was recorded at the baseline, after 4 hours of intervention, and after 8 hours of intervention. The data were examined using ANOVA. Results: There were significant differences between the groups in terms of pain severity after 8 hours of application (P ! .001). All groups had similar pain levels at baseline and during the fourth and eighth hours, with no significant differences between the groups during the first and the second menstrual cycles (P O .05). Conclusion: The authors conclude that the heat patch is an effective method for reducing dysmenorrhea.

To examine the relationship between primary dysmenorrhea and symptoms of depression and anxiety among adolescent female students in Tbilisi, Georgia.A case-control study.Tbilisi, Georgia.Four hundred twenty-four postmenarcheal girls aged 14-20 years (a subset of a larger study involving 2561 girls).The data was gathered in 2011 by the use of a questionnaire prepared for the purpose of this study, completed anonymously. Menstrual pattern, depression and anxiety level were evaluated in both groups; continuous and categorical variables were compared by Pearson chi-square test. Depressive symptoms were determined by a self-reporting scale (Beck Depression Inventory); anxiety was determined using Taylor Manifest Anxiety Scale (TMAS) and Spielberger State-Trait Anxiety Inventory (STAI).Differences in mental health between two groups.Patients with primary dysmenorrhea (PD) had significantly higher scores of depression than the control subjects: moderate depression, 15.9% in PD patients vs 6.2% in control subjects and severe depression, 1.8% vs 0% (P.003, LR 0.001). High anxiety (TMAS) was also more prevalent in adolescents with primary dysmenorrhea (44% vs 9.9%; P.001, LR0.001). STAI scores were also significantly higher in these patients than in healthy women (68.9% vs 25.0%; P.001, LR0.001).Primary dysmenorrhea is strongly linked with positive scores for depression and anxiety. Because of this association, attention should be given to effective mental health screening in these patients; psychological support may be necessary during their treatment and follow-up.

Background Membranous dysmenorrhea is a rare entity. It involves the sloughing of the endometrium in 1 cylindrical or membranous piece, retaining the shape of the uterine cavity. Herein, we report the first case of spontaneous membranous dysmenorrhea in an adolescent girl. Case A 17-year-old girl was admitted to the emergency clinic with severe painful menstrual bleeding and passage of tissue via the vagina. Bloody endometrial tissue resembling the endometrial cavity expulsed from the vagina was seen on inspection. The pathologic diagnosis of the mass was membranous dysmenorrhea. Summary and Conclusion To our knowledge, this is the first case of the spontaneous occurrence of membranous dysmenorrhea. The relationship between membranous dysmenorrhea and endogenous or exogenous progesterone should be investigated further. A review of the literature on membranous dysmenorrhea is presented.

Introduction Primary dysmenorrhea occurs in as many as 50% of postmenarche women and is characterized by a particularly intense pain that is localized in the abdominal inferior quadrants and radiates to the inner thigh. This study assessed the effectiveness of Achillea millefolium on relief of primary dysmenorrhea. Materials and Methods The clinical trial was conducted at Islamic Azad, Toyserkan Branch in western Iran from July 10 to November 18, 2013. It consisted of female students from the university who had primary dysmenorrhea. The subjects were randomly divided into 2 equal groups and were given either placebo or A millefolium in teabag form for 3 days in 2 menstruation cycles. They graded the severity of their pain by using a visual analog scale. Results The severity of pain in the 2 groups was compared using t test. The mean change in pain score in the A millefolium group was significantly greater than that in the placebo group at 1 month ( P = .001) and 2 months ( P Conclusion A millefolium is effective in minimizing the pain severity in primary dysmenorrhea.

Study Objective To determine the SCUBE1 levels in adolescents with primary dysmenorrhea. Design A prospective cross-sectional study. Setting A university hospital outpatient clinic, Rize, Turkey. Participants A total of 40 adolescent girls, 15 on menses and 25 not on menses. Interventions and Main Outcome Measures Demographic features and menstrual history of the participants were assessed and blood samples were obtained for detecting the platelet volume, platelet counts, and SCUBE1 levels of the participants. Results No difference was detected between the 2 groups in mean platelet volume, platelet count, and SCUBE1 levels. Conclusion Future trials are required to investigate the relation between SCUBE1 levels and primary dysmenorrhea.

Study Objective In the literature about primary dysmenorrhea (PD), either a pain gradient has been studied just in women with PD or pain was assessed as a binary variable (presence or absence). Accordingly, we decided to carry out a study in young women to determine possible factors associated with intense pain. Design A cross-sectional observational study. Setting A Spanish University in 2016. Participants A total of 306 women, aged 18-30 years. Interventions A questionnaire was filled in by the participants to assess associated factors with dysmenorrhoea. Main Outcome Measures Our outcome measure was the Andersch and Milsom scale (grade from 0 to 3). Definition: grade 0 (menstruation is not painful and daily activity is unaffected), grade 1 (menstruation is painful but seldom inhibits normal activity, analgesics are seldom required, and mild pain), grade 2 (daily activity affected, analgesics required and give relief so that absence from work or school is unusual, and moderate pain), and grade 3 (activity clearly inhibited, poor effect of analgesics, vegetative symptoms and severe pain). Results Factors significantly associated with more extreme pain: a higher menstrual flow (odds ratio [OR], 2.11; P Conclusion We determined factors associated with extreme pain in PD in a novel way. Further studies are required to corroborate our results.

Background Developmental anomalies of the Mullerian duct system are some of the most intriguing and challenging disorders that gynecologists and surgeons encounter in their practice. Case We report on a 16-year-old adolescent girl with regular menstrual cycles, who presented with recurrent cyclical abdominal pain for which she had undergone 2 unsuccessful surgeries. When correctly diagnosed with the rare condition of “Robert's uterus,” she underwent successful metroplasty and is completely asymptomatic at 2-year follow-up. Summary and Conclusion To avoid inappropriate management, gynecologists and surgeons should be aware of this rare entity while evaluating cases of severe dysmenorrhoea in previously normal menstruating young girls.

Objective Describe the experience that girls with Rett syndrome have with menstruation including menstrual hygiene, dysmenorrhea, premenstrual syndrome (PMS), and attempts at treatment. Design Anonymous web-based survey. Setting Convenience sample recruited from Rett syndrome LISTSERV in July of 2009. Participants Mothers of girls with Rett syndrome between the ages of 10–25 who have had at least one menses. Main Outcome Measures Prevalence, frequency, and severity of dysmenorrhea and PMS; hygiene concerns; and treatments attempts and perceived effectiveness. Results Dysmenorrhea and PMS are common problems among young women with Rett syndrome. Despite their frequency and severity they do not routinely limit activities. Multiple treatment attempts are common. Hormonal contraception is used mostly for menstrual cycle control with oral contraceptive pills the most commonly used method. Conclusions Young women with Rett syndrome have standard symptoms of dysmenorrhea and PMS as well as autism spectrum specific PMS symptoms. Hormonal contraception is commonly used for menstrual management.

Objectives This study aims to determine whether adolescent girls with severe dysmenorrhea (SD) have different psychological characteristics from their peers. Study design Cross-sectional survey (SMASH 02). Settings Nationally representative sample of adolescents attending post-mandatory education. Participants N = 7548, of whom 3340 were females, aged 16-20 years. Intervention Self-administered, anonymous survey consisted of 565 items on 4 main topics: sociodemographic determinants of health, health status, health behaviors, and health care use. Outcomes Body image variables, mental health, and associated variables like sexual abuse and health perceptions. Bivariate analysis and binomial logistic regression controlling for explanatory variables were performed. Results 12.4% (95% confidence interval [CI]: 11.0-14) declared SD. Compared to their peers, subjects with SD were more likely to report depressive symptoms (adjusted odds ratio [AOR]: 1.73; 95% CI: 1.38-2.15), have a higher gynecological age (AOR: 1.13; 95% CI: 1.05-1.20), and attend vocational school (AOR: 1.33; 95% CI: 1.00-1.76). Moreover, the proportion of those reporting dissatisfaction with their body appearance was higher (AOR: 1.50; 95% CI: 1.02-2.22). Conclusion Patients with SD not only show a different profile from their peers in terms of their mental health academic track and gynecological age, but they are also more dissatisfied with their body appearance. Clinicians should pay particular attention to patients with SD and offer them a global evaluation, bearing in mind what factors can be associated with SD.