Search

The effects of the menstrual cycle in women with and without primary dysmenorrhea on phase-related postural sensory organization are controversial. This study was carried out to examine postural sensory organization in three phases of the menstrual cycle in women with and without primary dysmenorrhea and to evaluate whether there is a difference between women with/without primary dysmenorrhea in this regard. Women aged 18–30 years were divided into two groups as primary dysmenorrhea group (PDG, n = 14) and control group (CG, n = 15). Computerized dynamic posturography were applied to the participants on the follicular, ovulation, and luteal phases of the menstrual cycle. Outcome measures were antero-posterior and medio-lateral Sensory Organization Test (SOT–somatosensory, vestibular and visual scores) and Limits of Stability test (LoS). The findings obtained were analyzed with the two-factor ANOVA, paired samples t test, and independent samples t test. In the PDG, follicular phase antero-posterior somatosensory scores were lower compared to luteal phase (p = 0.002). Follicular phase antero-posterior and medio-lateral vestibular scores were lower than ovulation (p = 0.003, p = 0.004, respectively) and luteal (p = 0.005, p = 0.001, respectively) phases. Follicular phase LoS scores were lower than ovulation (p = 0.001) and luteal (p = 0.002) phases. In the CG, ovulation phase antero-posterior somatosensory scores were lower than follicular phase (p = 0.003). Follicular phase LoS scores were lower than ovulation phase (p = 0.002). The PDG had lower follicular phase antero-posterior somatosensory (p = 0.019), vestibular (p = 0.031), and medio-lateral somatosensory (p = 0.019) scores than those of the CG. The PDG had lower luteal phase antero-posterior somatosensory scores than those of the CG (p = 0.029). The PDG showed lower follicular phase LoS scores than those of the CG (p = 0.009). This study revealed that primary dysmenorrhea impairs postural sensory organization. Decreased sensory organization may predispose women to injury. The risk of injury should be investigated and necessary precautions should be taken. • Primary dysmenorrhea may impair sensory organization. • Limits of stability were lower in those with primary dysmenorrhea. • Sensory organization may be affected in all phases of menstruation in dysmenorrhea. • Decreased sensory organization and postural control may predispose women to injury. [ABSTRACT FROM AUTHOR]

Primary dysmenorrhea (PD) is a common gynecological condition causing depression. Acupuncture is an effective option for PD management but its effects on PD-associated depression remain unclear. A retrospective cohort study involving 35,099 propensity score-matched pairs of acupuncture users and non-users with PD was conducted using data from Taiwan's Longitudinal Generation Tracking Database 2000. Cox proportional hazard models were used to estimate depression risk, and bioinformatics analyses were performed to uncover underlying molecular mechanisms. The risk of developing depression was reduced by 64 % in acupuncture users compared with non-acupuncture users during the 19-year follow-up period. The decrease was dose-dependent. Bioinformatics analyses identified 34 co-expressed targets for acupuncture, PD, and depression; and eight hub genes (coding for interleukin 6 and 1B, tumor necrosis factor, albumin, vascular endothelial growth factor A, C-reactive protein, prostaglandin-endoperoxide synthase 2, and brain-derived neurotrophic factor) potentially involved in the therapeutic effects of acupuncture. Several molecular pathways were found to be involved, including cytokine-cytokine receptor interaction, neuroactive ligand-receptor interaction, cyclic adenosine 3′,5′-monophosphate signaling pathway, mitogen-activated protein kinase signaling pathway, serotonergic synapse, and estrogen signaling pathway. Bias in the selection of participants could have been introduced as a consequence of the retrospective nature of the study. Data were derived from a single national database, and acupuncture treatment details were unavailable. Acupuncture may protect against the development of depression in patients with PD. This study provides insight into the potential molecular mechanisms underlying the therapeutic effects of acupuncture in PD management and depression prevention. • A large cohort study compares acupuncture users and non-users with primary dysmenorrhea, showing reduced depression risk. • A dose-dependent decrease in depression risk with increasing use of acupuncture treatment was observed. • Study uncovers acupuncture's mechanisms on primary dysmenorrhea and depression: immune, neuromodulatory, and signaling paths. [ABSTRACT FROM AUTHOR]

The Liangfu formula, as described in 'Liangfang Jiye', is well-known for its efficacy in treating stomach pain, abdominal pain, and dysmenorrhea. This research aimed to investigate the pharmacokinetics and tissue distribution of 5-hydroxy-7-(4-hydroxy-3-methoxyphenyl)-1-phenyl-3-heptanone (DPHA), Galangin, Kaempferide, 5-Hydroxy-1,7-diphenyl-3-heptanone (DPHC), α-Cyperone, and Nootkatone in vivo using an LC-MS/MS method. The method successfully separated the six active components and internal standards (Chrysin and Yakuchinone-A) on an XB-C18 column with a mobile phase of 0.2 ‰ formic acid water-acetonitrile. It demonstrated good linearity with a correlation coefficient (r2) ≥ 0.9911 and a lower limit of quantification (LLOQ) of 5–80 ng/mL for the different components. Precision, accuracy, matrix effects, and recovery rates were within acceptable ranges. Pharmacokinetic analysis revealed significant differences in parameters between primary dysmenorrhea (PD) and normal rats (especially AUC, T max, and CL z /F). Tissue distribution showed that the six active components of the herbal pair Alpinia officinarum Hance- Cyperus rotundus L. (HPAC) extract was primarily distributed in the liver, lung, and kidney. This study offers valuable insights into the potential mechanisms of action and drug development for treating PD. • A sensitive and reliable LC-MS/MS method was developed and validated. • 6 bioactive compounds from LFHP were quantified in rat plasma and tissues. • The pharmacokinetic behavior of the analytes was altered in PD rats. • The six analytes were mainly distributed in liver, lung and kidney. [ABSTRACT FROM AUTHOR]

Objectives: Primary dysmenorrhea (PD), as the most common complaint among students, is also one of the public problems worldwide. Prevalence and risk factors of PD were variant between studies; as the main population, no meta-analysis for PD has hitherto been conducted in students.Methods: We searched the published literature in PubMed, Embase, the Cochrane Library, Web of Science, National Knowledge Infrastructure, WANFANG, and VIP database. After screening and assessing the quality of studies, data from eligible studies were extracted for meta-analysis via the R language.Results: A total of 96 studies published from 1991 to 2021 with 78 068 students were included, the mean age of participants was 19.4, and 79.9% were university students. The pooled overall prevalence of PD was 66.1% (95% confidence interval [CI] 63.4-68.9), and 31.1% (CI 28.1-34.3), 25.7% (CI 23.4-28.0), and 8.3% of students (CI 7.4-9.3) reported mild, moderate, and severe PD, respectively. Besides, the prevalence of PD was estimated at 58.8% (CI 54.3-63.7) before 2010, but ascended to 68.5% (CI 65.5-71.6) after 2010 and rose to 71.5% (CI 65.8-76.6) in 2015 to 2021. About risk factors for PD, underweight, skipping breakfast, poor sleep quality, staying up late, lack of physical exercise, exposure to cold and eating cold or spicy foods during menstruation, dietary bias, prefer snacks, family history of dysmenorrhea, irregular menstrual cycle, heavy stress, negative emotion during menstruation, and anxiety were significantly related to PD.Conclusions: The overall prevalence of PD among students was 66.1% and had a rising tendency in the last 10 years. Our findings helped understand the current prevalence and improve the administration of PD among students. [ABSTRACT FROM AUTHOR]

Objective: Primary dysmenorrhea (PD) is a chronic health condition that affects primarily young women and interferes with daily activities, causes loss of work productivity, and reduces quality of life. Transcutaneous electrical nerve stimulation (TENS) is a complementary and alternative therapy used to reduce pain related to PD. The purpose of this meta-analysis study was to evaluate the effectiveness of TENS in the treatment of pain in women with PD.Methods: A search of the English literature in the Cochrane Library, MEDLINE (EBSCO), Physiotherapy Evidence Database (PEDro), CINAHL (EBSCO), PUBMED, OVID, Science Direct, Scopus, Academic Search Complete databases was conducted using combinations of the following search terms: 'primary dysmenorrhea', 'pain', 'transcutaneous electrical nerve stimulation', 'TENS', and 'electrical stimulation'. All content from database inception through April 2020 was included in the search.Results: The initial search strategy based on date range and language yielded 571 relevant records and 4 of them were about both TENS and PD. A total of 260 patients were enrolled in the included studies. In all of the included studies, the comparison intervention consisted of sham TENS. The primary outcome of interest was pain intensity. Our analysis indicated that TENS was statistically more effective than sham TENS in reducing PD-related pain (SMD=1.384; 95% CI=0.505, 2.262; p = 0.002).Conclusion: TENS is a safe and well-tolerated electrophysical therapy that may be effective for relieving pain in PD. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the presence of anovulation in adolescents with primary dysmenorrhea (PD). Prospective cohort study. Hacettepe University Children's Hospital, Adolescent Medicine outpatient clinic between September 2018 and September 2019. 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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

To explore the clinical effect differences of moxibustion with different doses on primary dysmenorrhea with cold congelation and blood stasis type. A total of 60 patients of primary dysmenorrhea were randomized into an intensified dose group and a conventional dose group. All of the patients were treated with moxibustion. In the intensified dose group, the treatment was given three times daily (once every morning, afternoon and at bedtime successively) and during the trial, 1 case was dropped out and 29 cases were included in the statistical analysis finally. In the conventional dose group, the treatment was given once daily and 1 case was dropped out during trial and 29 cases were included in the statistical analysis. The score of visual analogue scale (VAS) at the worst painful time point, the score of dysmenorrhea symptoms and recurrence rate were observed and compared before and after treatment in the patients between the two groups. The clinical therapeutic effects were observed in the two groups too. VAS difference value (D-value) and dysmenorrhea symptoms D-valuebefore and after treatment in the intensified dose group were higher than those in the conventional dose group respectively (both P < 0.05). The recurrence rate was 14.29% in the intensified dose group, lower than 42.31% in the conventional dose group, with the statistical significance (P < 0.05). The total clinical effective rate was 96.55% in the intensified dose group, higher than 89.66% in the conventional dose group, with the statistical significance (P < 0.05). Compared with the conventional dose moxibustion, moxibustion with intensified dose achieves satisfactory therapeutic effect on primary dysmenorrhea of cold congelation and blood stasis type. This therapy is low in recurrent rate and convenient in manipulation, thus it deserves to be promoted in clinical application. [ABSTRACT FROM AUTHOR]

To explore whether or not the changes in body surface resistance at yuan- source points of three yin meridians of foot can specifically responds the onset of primary dysmenorrhea (PD) in females of menstrual period and the before and after, so as to provide the evidence for acupoint selection in clinic. A total of 90 cases of PD were recruited in a PD group and 90 healthy female undergraduates were recruited in a normal group. The yuan -source of points of three yin meridians of foot were selected, i.e. Tàibái (太白SP3), Tàichōng (太冲LR3) and Tàixī (太溪KI3). The acupoints for control were Xuèhăi (血海SP10), the non-special acupoint, Xuánzhōng (悬钟GB39), the acupoint not on the relevant meridian, as well as a non-meridian point. Successively, before menstruation, on Day 1 during menstruation and on Day 3 after menstruation, the body surface resistance at the above-mentioned test sites was detected in the participants of two groups each day. The resistance imbalance degree (RID) of the bilateral acupoints was taken as the outcome indicator. The observation lasted one menstrual cycle. (1) Intra-group comparison: at LR3, the RID was lower on Day 1 during menstruation than that before menstruation significantly in the normal group (P ≤ 0.05). There was no significant change in RID at the same time points, but RID on Day 3 after menstruation was lower significantly than that before menstruation in the PD group (P ≤ 0.05). At SP3, KI3, SP10, GB39 and sham acupoint, there were no significant differences in RID among different time points within the same group (all P > 0.05). (2) Inter-group comparison: there were no significant differences in RID among different time points at the same point. (all P > 0.05). RID at yuan -source points of three yin meridians of foot cannot specifically respond to PD. However, at LR3, before and after menstruation, RID changes are different between PD patients and healthy female undergraduates, which needs a further study in the future. [ABSTRACT FROM AUTHOR]

Background: The effects of the menstrual cycle and primary dysmenorrhea (PD) on phase-related cognitive and physical functions are controversial. This study was carried out to examine whether women with PD showed a different physical function or dual-tasking response than women without PD at times other than menstruation.Methods: Women with or without PD were recruited for the study. Individuals assessed on the first day of the menstruation and the day they reported themselves as well being (feeling good day-FGD). Zebris © FDM Type Force Platform was used to evaluate postural stability. Individuals have were asked to perform to a 3-step balance test protocol; the first session: comfortable upright standing; the second session: standing with a motor task; the third session: standing with a cognitive task (counting backward). Correctly calculated numbers were also recorded.Results: The number of correct answers given by individuals during the cognitive dual-task was similar on the first day of menstruation and FGD (p > 0.05). In the control group, no difference was observed between the first days of menstruation and the evaluations on FGD days with dual-task (p > 0.05). In individuals with PD, there was no difference between the measurements at different times (p > 0.05). However, in the assessment with the motor dual-task on the first day of menstruation; postural sway increased (p < 0,05). In FDG measurement; distortion in postural stability was observed with the cognitive task (p < 0,05). In the assessments performed on the first day of menstruation, there was no difference in any parameters between the groups (p > 0.05). In the measurements made on FGD day with the cognitive task; there was a difference between the groups (p < 0,05). Individuals with PD had higher postural sway.Significance: This study showed that the primary dysmenorrhea is not only a problem for females during menstruation, primary dysmenorrhea causes impaired ability of the individual to perform dual-tasking and continuously affects postural stability. [ABSTRACT FROM AUTHOR]

This study aimed to clarify the resting-state cerebral blood flow alteration patterns induced by primary dysmenorrhea, investigate the relationships between cerebral blood flow alterations and clinical parameters of patients with primary dysmenorrhea, and explore whether brain regions with abnormal cerebral blood flow also feature functional connectivity changes. Arterial spin labeling imaging and clinical parameters were acquired in 42 patients with primary dysmenorrhea and 41 healthy controls during their menstrual phases. Differences in cerebral blood flow were compared between the two groups, and the clusters with significant group differences were selected as the regions of interest for further statistical analyses. Compared to healthy controls, patients with primary dysmenorrhea exhibited increased cerebral blood flow in the bilateral precuneus, left posterior cingulate cortex, and right rolandic operculum. Among patients with primary dysmenorrhea, we identified a negative correlation between the cerebral blood flow in the right rolandic operculum and the visual analogue score for anxiety, and greater correlation between the functional connectivity in the precuneus/posterior cingulate cortex and the right middle cingulate cortex, and between the right rolandic operculum and the left inferior parietal lobule and the bilateral postcentral gyrus. Cerebral blood flow abnormalities associated with primary dysmenorrhea were mainly concentrated in the areas comprising the default mode network in primary dysmenorrhea patients, which could be involved in the central mechanism of primary dysmenorrhea. Cerebral blood flow alteration in the rolandic operculum may underlie an anxiety-induced compulsive tendency in patients with primary dysmenorrhea. Investigating the enhanced connectivity among various pain-related brain regions could improve understanding of the onset and development of primary dysmenorrhea. • The application of ASL and ASL FC is very limited in pain research, especially PDM. • PDM patients showed altered CBF predominately located in the core region of DMN. • The rolandic operculum may be implicated in the onset of obsessive-compulsive disorder. • Aberrant CBF and its connectivity might explain the central mechanism of PDM. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to synthesize the epidemiological findings for the associations between dysmenorrhea, including primary dysmenorrhea and endometriosis-associated dysmenorrhea and any chronic pain conditions, including chronic pelvic pain, and chronic nonpelvic pain.Data Sources: The data sources included PubMed, Embase, and CINAHL from inception to December 2019.Study Eligibility Criteria: The study criteria included observational population-based studies in which the relationship between dysmenorrhea and the presence or severity of chronic pain was examined.Study Appraisal and Synthesis Methods: Each study was double coded and evaluated for bias based on the modified Newcastle and Ottawa Scale. Random-effect meta-analyses were conducted to quantify the associations between dysmenorrhea and the presence of chronic pelvic and nonpelvic pain.Results: Out of 9452 records, 32 studies were included, with 14 reporting associations between dysmenorrhea and chronic pelvic pain, and 20 for dysmenorrhea and chronic nonpelvic pain. Primary dysmenorrhea and endometriosis-associated dysmenorrhea were examined in 7 studies, respectively. More than 30% of the studies were categorized as poor quality, 56% as moderate, and 12.5% as high. Dysmenorrhea was positively associated with both the presence and severity of chronic pelvic and nonpelvic pain conditions. Based on 6689 women from 8 studies, those with chronic pelvic pain had 2.43 (95% confidence interval, 1.98-2.99, I2, 42%) times the odds of having dysmenorrhea compared with those without. Based on 3750 women from 11 studies, those with chronic nonpelvic pain had 2.62 (95% confidence interval, 1.84-3.72, I2, 72%) times the odds of having dysmenorrhea compared with those without. Overall, dysmenorrhea was associated with 2.50 (95% confidence interval, 2.02-3.10) times the odds of chronic pain, which did not differ by chronic pelvic vs chronic nonpelvic pain, community vs clinical populations, or different geographical regions.Conclusions: Dysmenorrhea may be a general risk factor for chronic pain, although whether primary dysmenorrhea increases the risk for chronic pain is unclear. Given that adolescence is a sensitive period for neurodevelopment, elucidating the role of primary dysmenorrhea in pain chronicity in future longitudinal studies is important for preventing both chronic pelvic and nonpelvic pain. [ABSTRACT FROM AUTHOR]

Objectives: This systematic review aimed to evaluate the efficacy and safety of Tao-Hong Siwu Tang (TST) for the treatment of primary dysmenorrhea.Methods: We searched four English databases (MEDLINE, EMBASE, Allied and Complementary Medicine Database, and Cochrane Central Register of Controlled Trials [CENTRAL, Cochrane Library]), three Chinese databases (China National Knowledge Infrastructure, Wanfang, and Chinese Science and Technology Periodical Database), two Korean databases (Oriental Medicine Advanced Searching Integrated System and Korean traditional Knowledge Portal), and one Japanese database (Citation Information by NII). All randomized controlled trials (RCTs) using TST or modified TST (MTST) were included. Three independent reviewers extracted the data, assessed the risk of bias according to the Cochrane criteria, and performed a meta-analysis.Results: A total of 85 possibly relevant articles were identified, and five trials met our inclusion criteria. The meta-analysis showed a favorable effect of MTST compared to non-steroidal anti-inflammatory drugs (NSAIDs) (n = 486, risk ratio [RR] = 1.53, 95% confidence interval [95% CI] = 1.37-1.72, I2 = 39%). Among the included trials, one RCT showed superior effects of MTST on primary dysmenorrhea recurrence rate compared to NSAIDs (n = 246, RR = 0.31, 95% CI = 0.15-0.63, P = 0.001). Another RCT revealed a beneficial impact of oral contraceptives (OCs) used in combination with TST compared to OCs alone (n = 60, RR = 1.35, 95% CI = 1.02-1.79, P = 0.04).Conclusion: This systematic review and meta-analysis provides moderate quality evidence for the superiority of MTST over NSAIDs as well as that of TST plus OCs over OCs in the treatment of primary dysmenorrhea. [ABSTRACT FROM AUTHOR]

Introduction: Primary dysmenorrhea (PD) is a common gynecological disorder that usually begins in adolescence, and affects patients' daily activities and quality of life. Non-steroidal anti-inflammatory drugs (NSAIDS) are considered the first-line treatment, and hormonal contraceptives are also recommended for PD, but both are prone to side-effects. The Chinese herbal formula Siwutang (SWT) and its derivative formulas are a common treatment for PD in China. This review assessed the efficacy and safety of SWT for the treatment of PD.Methods: PubMed, EmBase, Cochrane CENTRAL, CNKI, Wanfang and CBM were searched. We included randomized controlled trials (RCTs) that investigated SWT for PD, compared with no intervention, placebo, or conventional Western medicine. The outcome measurements included pain intensity measured by visual analogue scale (VAS) or other validated scales, the Cox Menstrual Symptom Scale (CMSS), quality of life, response rate and adverse events. The Cochrane Collaboration's tool was used to assess the risk of bias. RevMan V.5.3 was used for data synthesis and meta-analysis. Risk ratio (RR) with 95 % confidence intervals (CIs) or mean difference (MD) with 95 % CIs was calculated for dichotomous data or continuous data, respectively. Heterogeneity among studies was evaluated using both a chi-square test and an I2 test.Results: A total of 38 RCTs involving 3982 participants were identified. The methodological quality of the included trials was generally poor. Moreover, the results for SWT compared with placebo were unclear, as there was only 1 RCT. SWT improved pain intensity measured by VAS (3 RCTs, n = 220, MD:-2.61, 95 % CI:-3.72 to -1.51) when compared with conventional medicine, and these results were statistically significant. The meta-analysis showed the superior effect of SWT (including derivative formulas) on response rate (35 RCTs, n = 3,695, RR: 1.28, 95 % CI: 1.22-1.34) with medium heterogeneity (I2 = 48 %). Both original SWT and its derivative formula XFSWT had a higher response rate than conventional medicine (23 RCTs, n = 2,493, RR: 1.28, 95 % CI: 1.23-1.33) (11 RCTs, n = 1,076, RR: 1.36, 95 % CI: 1.20-1.53). These results were statistically significant. No trial reported on quality of life or CMSS. Adverse events were reported by 5 studies, and meta-analysis showed SWT may be safer than conventional medicine in terms of the incidence of adverse events (3 RCTs, n = 236, RR: 0.17, 95 % CI: 0.07-0.38, I2 = 0%).Conclusion: In conclusion, the included trials showed favorable effects of SWT for treating primary dysmenorrhea when compared with conventional medicine. SWT may be safer than conventional medicine, but insufficient data was reported. The level of evidence is low because of the high risk of bias. Thus, further well-designed clinical trials with large sample sizes are warranted.Registration Number: CRD42019136230 in PROSPERO 2019. [ABSTRACT FROM AUTHOR]

The professor Wei-hua ZHANG's experiences in treatment of primary dysmenorrhea with "warming-unblocking needling method" was introduced in this paper. Prof. Zhang believes that obstruction is the crucial in pathogenesis of primary dysmenorrhea no matter of the excess or the deficiency syndrome. Warming and unblocking principle is the essential in treatment. Hence, an unique therapeutic method is innovated, named warming-unblocking needling method, including three-layer and two-direction warming needling technique at Sānyīnjiāo (三阴交 SP6), two-layer rotating warming- unblocking technique at Zhōngjí (中极 CV3) and one-layer and two-direction warming needling technique at Cìliáo (次髎 BL32). In this set of needling procedure, acupoint is viewed as a three-dimensional hierarchical structure. A layered and multidirectional needling technique is adopted at main acupoints to enhance the sensations of diqi and to generate heat effect in the local. Additionally, moxibustion is combined to intensify warming and unblocking effect. Simultaneously, the supplementary acupoints are used in response to symptoms. All of the acupoints coordinately warm up the uterus, promote meridian circulation and stop pain. Hence, this therapeutic method achieves relatively excellent effect and deserves to be promoted in practice. [ABSTRACT FROM AUTHOR]

To examine prevalence and risk factors associated with primary dysmenorrhea among Chinese female university students in Hunan province, China. A cross-sectional study. Female university students in Changsha city, Hunan province, China. Four thousand six hundred six female individuals selected using a multistage cluster random sampling method. A self-administered questionnaire, which included sociodemographic information, lifestyle habits, emotional characteristics, and menstruation pattern, was used to collect data. Information about menarche, body mass index, cycle length and regularity, primary dysmenorrhea, physical exercise, depression, and anxiety. 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. 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. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy, safety, and clinically recommended dose of dienogest (DNG; 0.5 mg/d, 1 mg/d, and 2 mg/d) in the treatment of primary dysmenorrhea.Design: A phase II, randomized, double-blind, multicenter, placebo-controlled study.Setting: Twenty study sites.Patients: A total of 235 patients with primary dysmenorrhea.Intervention(s): Patients were randomized to receive orally a placebo, DNG (0.5 mg/d, 1 mg/d, or 2 mg/d) or ethinylestradiol 0.02 mg/drospirenone 3 mg (an open-label reference drug) for 12 weeks.Main Outcome Measure(s): The primary endpoint was the change from baseline in the dysmenorrhea score at week 12 of treatment. The secondary endpoint was the change from baseline in the visual analogue scale at week 12 of treatment. Subjects were assessed for lower abdominal pain and/or low back pain.Results: All DNG arms were superior to the placebo arm in terms of the change from baseline in the dysmenorrhea score. The results suggest an equal or greater effect of DNG 1 and 2 mg/d in relieving pain, when compared to the reference drug. In the safety profile of DNG, including irregular uterine bleeding, there was no obvious difference among the doses of DNG. A significant decrease in the serum estradiol concentration compared to that in the placebo arm was not observed in the DNG 1 mg/d arm but was observed in the DNG 2 mg/d arm.Conclusion(s): The results suggest that DNG at a dose of 1 mg/d is an effective and well-tolerated treatment for primary dysmenorrhea.Trial Registration: JapicCTI-152977 (en). [ABSTRACT FROM AUTHOR]

Ding-kun-dan (DKD), as one of well-known traditional Chinese medicine (TCM), is considered as an effective prescription to regulate menstruation, benefit Qi and nourish the blood. Previous studies had showed that DKD could improve sex hormone levels, insulin resistance, metabolism abnormalities and regulate immunity in animal models with polycystic ovary syndrome or endometriosis, however, little study conducted to reveal its clinical efficacy in Primary Dysmenorrhea (PD). To compare the effect of Ding-kun-dan (DKD) with Marvelon on relief of symptoms and change of serum pain-related factors in patients with primary dysmenorrhea. 136 patients with primary dysmenorrhea were randomly assigned to the DKD group (n = 73, take one tablet per day from 5th day of the menstrual cycle for 10 days every 28 days) and the Marvelon group (n = 63, take one tablet per day from 5th day of the menstrual cycle for 21 days every 28 days), the therapeutic effects were analyzed through evaluating the change of VAS scores, CMSS scores and the level of PGF 2a , PGE 2 , PGF 2a /PGE 2 and NO during the 12 weeks intervention. Both DKD and Marvelon could effectively relief pain and other associated symptoms at each visit (Baseline, 4th week, 8th week and 12th week). Although Marvelon was significantly superior to DKD in reducing VAS scores, the total CMSS, CMSS severity and duration scores at each posttreatment follow-up (P < 0.01), VAS scores in the DKD group decreased significantly over time while scores in the COC group only dropped rapidly after the first two months of treatment. Efficacy gap between two interventions continuously narrowed over time and the efficacy of DKD became non-inferior at the 12th week compared to that of Marvelon (the difference between groups, – 0.78%; 95% confidence interval (CI), −13.67%–12.75%; non-inferiority margin, 15%). DKD group had better efficacy on mild pain compared to that of the COC group with no statistical difference (75% VS 61.9%, P > 0.05). DKD and Marvelon could effectively reduce PGF 2a , PGE 2 and higher PGF 2a /PGE 2 in patients with PD. There was no statistical difference in the level of PGF 2a , PGE 2 , PGF 2a /PGE 2 and NO between DKD and Marvelon group at each follow-up. No serious adverse effect was observed. Ding-kun-dan is another available, effective and safe method for patients with primary dysmenorrhea to choose, especially for those who are suffered from mild pain and/or contraindicated to hormonal agents. [Display omitted] [ABSTRACT FROM AUTHOR]

The plant Ainsliaea fragrans Champ. (A. fragrans) named "Xingxiang Tuerfeng", is a traditional herb with a long history of therapeutic practice in southern China in the treatment of gynecological diseases. The anti-inflammatory extract of Ainsliaea fragrans Champ. (AF-ext) exhibited anti-primary dysmenorrhea (PD) activity in oxytocin-induced mice. This study aimed to unravel the underlying mechanisms of AF-ext on PD by the integrative approach of network pharmacology and experimental verification. First, the therapeutic targets of AF-ext are predicted using network pharmacology and molecular docking methods. Second, activity screening and immunoblotting methods were used for target validation. Then, the therapeutic effect of AF-ext on PD was evaluated using oxytocin-induced mice and uterine strips model. AF-p1, and AF-p2, the active ingredients of AF-ext, showed inhibitory effects on COX1/2 and EGFR, and all five active components showed antagonistic activity on TRPV1. AF-ext (25, 50, 100 mg/kg) could significantly reduce the number of writhing times and prolong writhing latencies in a dose-dependent manner. AF-ext inhibited spasmolytic activity in uterine strips induced by oxytocin and Ca2+ stimulation. AF-ext inhibited NF-κB/COX-2/PG pathway and activation of the NLRP3 inflammasome in PD mice. It significantly downregulated the PD-induced overexpression of p-p65/p65, p-IκBα, and COX-2 by inhibiting the NF-κB pathway. Moreover, the overexpression of NLRP3, p20/pro-Caspase 1, and p17/pro-IL-1β was greatly downregulated. AF-ext demonstrated anti-inflammatory, analgesic, and spasmolytic activity in the treatment of PD. It inhibited the NF-κB/COX-2/PG pathway and NLRP3 inflammasome activation in PD mice with a multi-target approach. [Display omitted] [ABSTRACT FROM AUTHOR]

To study the effectiveness of performing Zumba exercise on the severity and duration of pain in patients with primary dysmenorrhea. Randomized controlled trial. Cairo University gynecology Hospital and Bahgat gym and fitness center. Ninety-eight women diagnosed with primary dysmenorrhea. 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. 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. 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). 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. [ABSTRACT FROM AUTHOR]

Highlights • Combine 1H NMR, RP-UPLC–MS and HILIC-UPLC–MS on metabonomics platform. • Several novel biomarkers for primary dysmenorrheal were revealed. • Elucidate the mechanism and metabolic pathway of Guizhi Fuling capsule in the treatment of primary dysmenorrhea. Abstract Guizhi Fuling capsule (GFC) was an important traditional Chinese herbal medicine used for the treatment of primary dysmenorrheal (PD). The aim of this study was to evaluate the anti-dysmenorrheal effect of GFC on dysmenorrheal rats induced by oxytocin and to investigate its mechanism of action. An integrative urinary metabolomic study based on 1H NMR and UPLC–MS was used to investigate the therapeutic effect of GFC on PD rats. In addition, in order to obtain more potential biomarkers and to investigate the global urine metabolic profile associated with PD, we combined the characteristics of RP-UPLC–MS with HILIC-UPLC–MS on metabolomic platform to find non-polar and polar metabolites. Finally, a total of 36 potential biomarkers were identified as being primarily involved in the TCA cycle, gluconeogenesis, glycolysis, pentose phosphate pathway, lipid metabolism, energy metabolism, amino acid metabolism and intestinal flora metabolism, and PD could influence the balance of many of these metabolic pathways in vivo. Furthermore, these results also suggested that the GFC had therapeutic effects on PD rats via the regulation of multiple metabolic pathways. In conclusion, the variations in potential biomarkers revealed the therapeutic mechanism of GFC, and these potential biomarkers were both significant for early diagnosis and predicting PD. [ABSTRACT FROM AUTHOR]

• The ACC-neurotransmitter levels have imbalanced changes in PDM patients in only the menstrual phase. • There were significant correlations between ACC-GABA+ and ACC-Glx levels in PDM patients in only the menstrual phase. • The imbalances in the ACC-neurotransmitter levels may have a neurochemical association with depression and painful catastrophic symptoms in PDM. The neural pathophysiology underlying primary dysmenorrhea (PDM), which leads to poor mode and changes in central pain modulatory systems, remains largely unknown. The objective of this study was to investigate the changes in glutamate/glutamine (Glx) and gamma-aminobutyric acid (GABA+) levels within anterior cingulate cortex (ACC), and their associations with clinical indicators in PDM women. Using 3 T proton magnetic resonance spectroscopy (1H-MRS), we acquired and compared ACC-Glx and ACC-GABA+ levels in PDMs (N = 41) and age- and education-matched healthy controls (HCs) (N = 39) during both the menstrual and periovulatory phases, and between menstrual and periovulatory phases within each group. Total creatine (Cr referencing) level was used as an endogenous reference. The correlations of ACC-neurotransmitter levels with clinical characteristics and the correlations of ACC-Glx with ACC-GABA+ levels in the two groups were analyzed. Compared to HCs or the periovulatory phase, PDMs exhibited significantly increased ACC-Glx levels (p < 0.05) during the menstrual phase. Positive correlations between GABA+ and Glx levels (r = 0.385, p = 0.025) were found in PDMs during the menstrual phase. ACC-GABA+ levels were associated with self-rating distress scale (SDS) scores (GABA+/Cr: r = 0.369, p = 0.045) and pain catastrophizing scale (PCS) scores (GABA+/Cr: r = 0.373, p = 0.042) in PDM group in only the menstrual phase. Our study represents the first report of ACC-GABA+/Glx imbalances in PDMs during the menstrual phase, which may underlie the mechanisms mediating depression and painful catastrophic symptoms. [ABSTRACT FROM AUTHOR]

• This network meta-analysis evaluated the relative efficacy and safety of different Chinese herbal medicines for women with primary dysmenorrhea. • Of the seven Chinese herbal medicines evaluated, overall Siwu decoction and Wenjing decoction were the most effective for alleviating pain and other dysmenorrhea symptoms. • No serious adverse events from Chinese herbal medicine were observed. Primary dysmenorrhea (PD) is a common gynecological complaint among adolescents and young women. Chinese herbal medicines (CHMs) have been widely used for PD treatment in China. However, the relative advantages of different CHM regimens remain uncertain. This systematic review aimed to compare the efficacy and safety of different CHMs for the treatment of PD using network meta-analysis. We searched PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), and Chinese BioMedical Literature Database (CBM) from their inception to December 17, 2022. Randomized controlled trials (RCTs) comparing CHM or Chinese patent drugs with Prostaglandin Synthetase Inhibitors (PGSIs) were included. Risk of bias was assessed using the Cochrane risk of bias tool. A frequentist framework network meta-analysis was performed using R (4.2.2). A total of 54 RCTs with 5,345 PD patients were included. Compared with PGSIs, Danggui Sini decoction (mean difference [MD] = -5.92, 95% confidence interval [CI] -8.64 to -3.20) and Xiangfu Siwu Decoction (MD = -4.63, 95%CI -8.37 to -0.89) reduced pain significantly.; Danggui Sini decoction (risk ratio[RR] = 1.31, 95%CI 1.12 to 1.53), Danggui shaoyao san (RR = 1.23, 95%CI 1.05 to 1.44), Siwu decoction (RR = 1.32, 95%CI 1.17 to 1.47), Taohong Siwu Decoction (RR = 1.35, 95%CI 1.14 to 1.61), and Wenjing decoction (RR = 1.33, 95%CI 1.19 to 1.52) showed significantly higher overall response rates, and Wenjing decoction could significantly reduce TCM syndrome scores (MD = -4.14, 95%CI -6.84 to -1.44), compared with PGSIs. No serious adverse events were observed. Siwu decoction and Wenjing decoction ranked as the top treatment options in terms of all outcomes of interest (P-score ranking). CHMs were associated with improved overall response rate, pain reduction, and alleviation of symptoms compared to conventional treatments for patients with PD, and no serious adverse events were observed. However, the confidence in the conclusions is limited because of the lack of high-quality trials. [ABSTRACT FROM AUTHOR]

Abstract Aim To evaluate the short-term effectiveness of connective tissue manipulation (CTM) for relieving menstrual pain and symptoms in primary dysmenorrhea (PD). Methods Forty-four women with PD were randomly assigned to treatment (n = 21) or control group (n = 23). While the control group was given only advising, the treatment group additionally received CTM. The primary outcome was the menstrual pain intensity by Visual Analogue Scale. Secondary outcomes included the number of pain medications, menstrual pain catastrophizing by Pain Catastrophizing Scale (PCS), menstrual symptoms by Menstrual Symptom Questionnaire (MSQ) and menstrual attitude by Menstrual Attitude Questionnaire (MAQ). Results Compared with the control group, CTM group showed statistically significant improvement in pain, medication use, PCS, MSQ (p = 0.001) and in the perception of menstruation as a natural event (p = 0.029). However, no significant differences were detected between groups for some aspects of MAQ (p > 0.05). Conclusions CTM seems to be an effective approach in the short-term in PD. [ABSTRACT FROM AUTHOR]

Abstract Background Primary dysmenorrhea is a cyclic cramp in pelvic which interferes with daily activity. This study determined the effect of Cinnamon on relieving dysmenorrhea. Methods This is a randomized, double-blind clinical trial. The intervention group received Cinnamon (capsules contained 1000 mg cinnamon) and the control group received placebo (capsules contained 1000 mg starch) during the first 72 h of menstruation for two cycles continuously. The Visual Analogue Scale was used to determine the severity of pain. The subjects were followed up for two cycles. Descriptive statistics, Independent T test, analysis of variance (ANOVA) with repeated measures were used for continuous quantitative variables. Mann-Whitney and Chi-square tests were used for nominal and ordinal qualitative variables. Results The results showed the mean intensity of dysmenorrhea significantly decreased over time in both groups (time: P < 0.001) and this reduction was significantly different over time between two groups (time*group: P = 0.02). There is significantly more reduction in the intervention group. Also the pain reduction in the intervention group was significantly lower than the placebo group after the first treatment (P = 0.001) and the second treatment (P = 0.002) compared to before treatment. Conclusions Cinnamon can reduce the intensity of primary dysmenorrhea. This aromatic spice for relive of primary dysmenorrhea is recommended. [ABSTRACT FROM AUTHOR]

Objective: Primary dysmenorrhea is one of the most commonly reported disorders for women that have unfavorable effects on patient's quality of life. Based on the evidences that suggest the anti-inflammatory and analgesic properties of chlorella, this double-blind, randomized, placebo controlled clinical trial aimed to evaluate the effects of Chlorella supplementation on the severity of menstrual pain in a group of young women with primary dysmenorrhea.Study Design: In this clinical trial, 44 girls with primary dysmenorrhea were randomly divided into intervention and control groups. Patients in the intervention group received 1500 mg/day of chlorella as 5 soft gel and the control group received placebo soft gels for eight weeks. Menstrual and food information were collected using a previously validated and published questionnaire. Anthropometric measurements and biochemical parameters including prostaglandin E2 (PGE2), ProstaglandinF2a (PGF2a), high-sensitivity C-reactive protein (hs-CRP) and malondialdehyde (MDA) were assessed at baseline and end of week eight.Results: In chlorella supplemented group the PGE2, PGF2a, hs-CRP and MDA decreased significantly (P < 0.05). The severity and duration of dysmenorrheal pain were significantly reduced in the intervention group compared to the control group (p < 0.05). Systemic symptoms of dysmenorrhea (fatigue, headache, nausea, vomiting, lack of energy) decreased in the chlorella group (p < 0.05). The mean of menstrual characteristics, anthropometric indices and daily energy and macronutrient intake in both intervention and control groups were not changed significantly.Conclusion: This study showed that chlorella supplementation could decrease the severity of pain and systemic symptoms and improve serum levels of prostaglandins, inflammatory and oxidative markers in women with primary dysmenorrhea. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance Compound Muniziqi granule (CMG) is usually used as a traditional Uighur medicine to treat acne, chloasma, skin inflammation, primary dysmenorrhea (PDM), and menopausal syndrome. However, there are no sufficient data to support the clinic uses of CMG in PDM. Aim of the study This work aims to examine the effect of CMG as a treatment for PDM and reveal its possible therapeutic mechanism. Materials and methods In vivo and in vitro mouse PDM models were utilized in this study. The mouse uterine contraction was induced by oxytocin after progynova or estradiol benzoate pretreatment. CMG, alkaloid extracts from seeds of Peganum harmala (AEP), and 10% and 95% ethanol extracts from seeds of Nigella glandulifera (EEN10 and EEN95) were given to mice in three doses by gavage. The writhing times within 30 min after oxytocin treatment were recorded to evaluate the analgesic effect, and the glutathione peroxidase (GSH-Px), malondialdehyde (MDA), 6-keto-prostaglandin F 1α (6-k-PGF 1α ), prostaglandin F 2α (PGF 2α ), thromboxane B2 (TXB 2 ), and nitric oxide (NO) levels in uterine tissues and PGF 2α and MDA in serum were determined. The effects (contractile curve) of CMG, AEP, EEN10, and EEN95 on uterus contraction induced by oxytocin in isolated mouse uterus were recorded. Results In contrast to the control group, CMG, AEP, N10, and N95 could display analgesic activities dose dependently by reducing the writhing response of the PDM model mice. CMG, AEP, EEN10, and EEN95 could also remarkably decrease the level of PGF 2α , 6-k-PGF 1α , TXB 2 , NO and MDA in uterine tissues and PGF 2α and MDA in serum, whereas the activity of GSH-Px in uterine tissues was increased. Furthermore, CMG, AEP, EEN10, and EEN95 could significantly inhibit the frequency and amplitude of isolated uterus induced by oxytocin in a concentration-dependent manner. Conclusions CMG exhibited a significant protective effect on experimental PDM. The mechanisms are probably associated with abating lipid peroxidation and over-inflammatory reaction, and alleviating the contraction of isolated mouse uterus. The seeds of P. harmala and N. glandulifera in the CMG may play an important role in exerting protective effects on PDM. This study provides pre-clinic proof to the use of CMG in clinical practice of PDM. [ABSTRACT FROM AUTHOR]

Background: Primary dysmenorrhea (PDM) is one of the most common gynaecological disorders among women, which seriously affects women's life quality due to its high incidence rate. Guizhi Fuling capsule (GZFLC), a well-known traditional Chinese medical prescription, has been widely used to treat gynecological blood stasis syndromes such as PDM. However, its mechanisms of action and combination were still unknown.Purpose: The aim of this study was to develop a pharmacokinetic-pharmacodynamic (PK-PD) model to assess time-concentration-effect relationships for anti-dysmenorrhea effect of GZFLC and provide better understanding for mechanisms of action and combination of GZFLC.Study Design and Methods: The PDM rats model was induced by oxytocin exposure following estradiol benzoate pretreatment. Gallic acid (GA), amygdalin (AMY), albiflorin (ALB), prunasin (PA) and cinnamic acid (CA) were evaluated as bioactive ingredients for investigating PK processes. GA, AMY, ALB and PA exhibited appropriate PK parameters and were selected as the PK markers to map the anti-dysmenorrhea effect of GZFLC. A PK-PD model was established on the basis of GA, AMY, ALB and PA plasma concentrations vs. the values of two ratios (PGE2/PGF2α and 6-Keto-PGF1α/TXB2), by a two-compartment PK model with a simple Emax model to explain the time delay between the drug plasma concentrations of PK markers and the anti-dysmenorrhea effect.Results: The PDM rat model has been successfully established. Compared with the normal treated group, the bioactive ingredients in PDM treated group exhibited significant changing trends of PK behaviors, such as better absorption and distribution, slower elimination and delays in reaching the maximum concentration (Tmax). The analysis of PK-PD parameters indicated that the active metabolites and prototypes of bioactive ingredients in GZFLC were inclined to regulate the activity of prostacyclin synthetase and thromboxane synthetase to control the production of TXA2 and PGI2 so as to treat PDM. As the main effective medicinal materials for the treatment of PDM in GZFLC prescription Persicae Semen, Moutan Cortex and Paeonia lactiflora Pall, Persicae Semen played the most important role, while the role of Paeonia lactiflora Pall was the weakest.Conclusion: The PK-PD model results provided scientific basis for clarifying compatibility mechanisms of GZFLC prescription and a better understanding for biosynthetic mechanisms of four prostaglandins (PGE2, PGF2α, 6-Keto-PGF1α and TXB2) in the treatment of PDM by GZFLC. Investigations on the relationship between the effects and the bioactive ingredients are of benefit to explore the mechanisms of action and combination for traditional Chinese medical prescriptions (TCP) and facilitate the development of future clinical applications of TCP. [ABSTRACT FROM AUTHOR]

Although nonsteroidal antiinflammatory drugs can alleviate menstrual pain, about 18% of women with dysmenorrhea are unresponsive, leaving them and their physicians to pursue less well-studied strategies. The goal of this review is to provide a background for treating menstrual pain when first-line options fail. Research on menstrual pain and failure of similar drugs in the antiplatelet category suggested potential mechanisms underlying nonsteroidal antiinflammatory drug resistance. Based on these mechanisms, alternative options may be helpful for refractory cases. This review also identifies key pathways in need of further study to optimize menstrual pain treatment. [ABSTRACT FROM AUTHOR]

Some studies suggest that women with primary dysmenorrhea have distinct emotional or personality features. For example, they might exaggerate their responses to external stimuli, such as to intensity-increasing auditory stimuli. Fifteen women with primary dysmenorrhea and 15 healthy women were invited to undergo tests of the intensity dependence of auditory evoked potentials (IDAEP), the Functional and Emotional Measure of Dysmenorrhea, and the Plutchik-van Praag Depression Inventory. Study participants with dysmenorrhea showed higher Functional and Emotional scale scores and stronger IDAEP. Regarding the IDAEP generation, the source inversion of N1 and P2 disclosed the activated bilateral superior temporal gyri, medial and superior prefrontal gyri in all participants, and additionally, the middle frontal gyri in dysmenorrhea patients. We report a pronounced IDAEP in primary dysmenorrhea, which indicates the decreased cerebral serotonergic innervations and points to increased activations in the prefrontal and frontal areas in the disorder.Perspective: Using an IDAEP technique, the authors found decreased serotonergic innervation and altered cerebral activation in women with primary dysmenorrhea, which might offer some pharmacotherapeutic clues for the disorder. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate effect of specially designed yoga program on the menstrual pain, physical fitness, and quality of life (QOL) of non-athlete women with primary dysmenorrhea (PD) aged 18–22 years. Thirty-four volunteers were randomly assigned into control and yoga groups. Menstrual pain, physical fitness, and QOL were evaluated at baseline and at the end of the 12-week study period. The yoga group was asked to practice yoga for 30 min per day, twice a week, for 12 weeks at home, while the control group did not receive any form of exercise over the study period. There were significant improve in menstrual pain, physical fitness, and QOL in the yoga group more than the control group. Therefore, this specially designed yoga program may be a possible complementary treatment for PD. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance The twigs and bark of Cinnamomum cassia Presl (Lauraceae) are widely used in traditional Chinese medicine in the treatment of tumor, abdominal pain, dysmenorrhea, digestive system disease and inflammatory diseases. The aim of this study was to determine the inhibitory effect of the essential oil from the twigs of Cinnamomum cassia Presl (EOCC) on uterine contraction in vitro and in vivo. Materials and methods The Institute of Cancer Research (ICR) mouse uterine contraction was induced by oxytocin (OT) exposure following estradiol benzoate pretreatment. Mice were given the EOCC (60, 30, and 15 mg/kg) by gavage. The level of prostaglandin F 2α (PGF 2α ) in uterine tissue were determined according to specification of enzyme linked immunosorbent assay (ELISA) kit. Uterine tissue was collected for histopathological analysis (H&E). Myosin light chain 20 (MLC20), phosphorylation of myosin light chain 20 (p-MLC20) and cyclooxygenase-2 (COX-2) proteins in uterine tissue were assessed by Western Blot. Mouse isolated uterus strips were mounted in tissue organ baths containing Locke's solution. The contractile responses were recorded with Power Lab recording system. The effect of the EOCC on uterine contraction induced by OT, PGF 2α , and acetylcholine (Ach) was observed. Myometrial cells were exposed to OT (7 μM) to induce Ca 2+ release, and the effect of the EOCC (100, 50, and 25 μg/ml) on intracellular Ca 2+ was analysed with fluorometry imaging. Results In vivo study demonstrated that the EOCC significantly reduced OT-induced writhing responses with a maximal inhibition of 66.5%. It also decreased the level of PGF 2α in OT-induced mice uterine tissue. Moreover, Western blot analysis showed that COX-2 and p-MLC20 expressions in uterine tissue of dysmenorrhea mice were significantly reduced. EOCC inhibited spontaneous uterus contractions in a dose-dependent manner, and the concentration of the EOCC giving 50% of maximal contraction (IC 50 ) value was 61.3 μg/ml. The IC 50 values of the EOCC on OT, PGF 2α , and Ach-induced contractions were 113.0 μg/ml, 94.7 μg/ml, and 61.5 μg/ml, respectively. Further in vitro studies indicated that the EOCC could restrain intracellular Ca 2+ levels in favour of uterine relaxation. Conclusion Both in vivo and in vitro results suggest that the EOCC possesses significant spasmolytic effect on uterine contraction. Thus, the EOCC yields a possible therapeutic choice for the prevention and treatment of primary dysmenorrhea. [ABSTRACT FROM AUTHOR]

Objective This meta-analysis investigates the effect of aromatherapy massage on pain in primary dysmenorrhea. Methods Randomized controlled trials were searched by keywords in several databases (Pubmed, ISI Web of Sciences, and Google Scholar). Six randomized controlled trials that included 362 participants with primary dysmenorrhea, comparing abdominal aromatherapy massage (n = 184) with massage with placebo oils (n = 178), were analyzed in the meta-analysis. The change in the visual analogue scale (VAS) pain score from the first menstruation cycle to the second cycle at the first menstruation day was used as the primary outcome. Results Aromatherapy massage with essential oils was superior to massage with placebo oils (standardized mean difference = −1.06 [95% CI: −1.55 to −0.55]). Conclusion Abdominal aromatherapy massage with essential oils is an effective complementary method to relieve pain in primary dysmenorrhea. [ABSTRACT FROM AUTHOR]

Guizhi Fuling Wan (GFW) is one of the most widely known traditional Chinese medicine (TCM) formulations that has long been used in China for the treatment of primary dysmenorrhea (PD). However, the quality of evidence is limited and there are few studies on specific TCM syndromes of GFW for PD. To evaluate the efficacy and safety of GFW on PD patients with the heat-burning blood-stasis syndrome. This was a randomized, double-blinded, placebo-controlled trial. Eligible patients were recruited and randomly assigned to one of two groups to receive GFW or the placebo twice daily for three menstrual cycles with a 3-month follow-up. The primary outcome was the baseline-to-month 6 change in pain intensity measured by a Visual Analog Scale (VAS). The secondary outcomes included the changes in the Cox Menstrual Symptom Scale (CMSS), the Self-rating Anxiety Scale (SAS), the Self-rating Depression Scale (SDS), and the TCM syndrome scale from baseline to month 6. Additionally, adverse effect was assessed. A total of 353 patients were screened for eligibility and 128 were randomly assigned, of whom 121 completed all treatments and follow-ups. In both the full analysis (FAS) and the per-protocol analysis (PPS), the VAS score of pain intensity decreased significantly more in the GFW group than in the placebo group from baseline to month 6 (P < 0.01). Similarly, the decrease in CMSS, SAS and TCM syndrome scores was greater in the GFW group compared with the placebo group (P < 0.01). There were no differences in SDS scores between the two groups (P > 0.05). In addition, no serious adverse events were observed. Our findings revealed that GFW significantly alleviated the severity of menstrual pain in PD patients with the heat-burning blood-stasis syndrome without significant adverse effects. [Display omitted] [ABSTRACT FROM AUTHOR]

Pharmacological agents, such as non-steroidal anti-inflammatory drugs (NSAIDs), and non-pharmacological techniques, including acupuncture and aromatherapy, are commonly used for the management of abdominal pain in patients with primary dysmenorrhea. Essential rose oil obtained from Rosa Mill (RDM) is often used in aromatherapy for the treatment of many diseases. This study was aimed at using visual analog scale (VAS) pain scores and total analgesic consumption to evaluate the effects of adding RDM essential oil inhalation to the standard treatment (NSAID) of primary dysmenorrhea. In this prospective randomized controlled clinical trial, 86 patients were randomized into groups R and C. The patients in group C only used standard analgesics (50 mg diclofenac sodium enteric film tablets). In group R, patients used both standard analgesics and RDM inhalation aromatherapy. A 10-point VAS was used to determine the pain values of the patients and was recorded as pre-treatment (VAS-0) and post-treatment (VAS-60). The analgesic consumption by the patients was recorded for 24 h. In both groups, there was a significant decrease in VAS scores after treatment. The VAS-60 scores in group R were significantly lower than those in group C (2 [1–4] vs. 5 [2–5], respectively; P = 0.013). Analgesic consumption in group R was significantly lower than in group C (50 [50–100] mg vs. 100 [50–100] mg, respectively; p = 0.003). Inhalational rose oil aromatherapy is a good self-treatment option for primary dysmenorrhea. [ABSTRACT FROM AUTHOR]

Background: Acupuncture and moxibustion have promising effects in managing primary dysmenorrhea. However, some evidence from clinical trials remains controversial due to methodological flaws in study designs that involve acupuncture and its related modalities and require urgent attention and dialogue.Methods: Allied and Complementary Medicine Database (AMED), Cochrane Library, Excerpta Medica database (EMBASE), PubMed, Web of Sciences, Chinese Biological Medicine (CBM), China National Knowledge Infrastructure (CNKI), VIP Database for Chinese Technical Periodicals (VIP), and Wanfang database were searched from their inception to July 2021. Data were extracted based on the types of study design, primary outcome measures, adverse events (AEs), and participants' subjective views.Results: Most studies (n = 282, 93 %) were published in Chinese and 21 (7 %) in English. Among these, there were 209 (69 %) randomized controlled trials (RCTs), 39 (13 %) non-randomized controlled trials (nRCTs), 30 (10 %) case-series reports, 15 (5 %) cohort studies, and 10 (3 %) case reports. The most frequent reported outcome was pain, followed by emotion, sleeping quality, quality of life, skin temperature, changes in brain function, uterine and ovarian blood flow, and reproductive endocrine level. AEs were reported in 37 studies with mild events, and all recovered without actions taken; 31 trials reported no AEs; 235 failed to report any AEs. One RCT found that the satisfaction rate of the intervention group was statistically significantly higher than the control group.Conclusion: Clinical studies on acupuncture and its related modalities face methodological challenges and require urgent attention. RCT with blinding and sham control might be the gold standard trial design. However, it may not be the most suitable research method for these modalities. We recommend using pragmatic RCTs in this field, where trial protocol registration on the trial registry platforms and detailed safety reporting should be mandatory. [ABSTRACT FROM AUTHOR]

Music medicine and dark chocolate may be potentially effective in helping reduce pain and anxiety in primary dysmenorrhea (PD). The aim of the study was to determine the effects of music medicine and dark chocolate on primary dysmenorrhea related pain intensity and anxiety level in young women. This was was a non-blinded, three-parallel group randomized controlled trial. The study included 18–25-year-old nulliparous nursing students with PD having a regular menstruation cycle and a Visual Analog Scale (VAS) severity of menstrual pain of 5 and over during the previous 6 months. Ninety nursing students were randomly allocated into one of the three groups; dark chocolate, music, or control. The study was completed with 84 nursing students because some participants did not want to continue the study and used analgesics. In the first month, 84 students (chocolate: 30, music: 25, control: 29) completed the State-Trait Anxiety Inventory (STAI). In the second month, menstrual pain intensity and state anxiety were measured on the first day of menstruation using VAS and STAI, respectively, on 84 students. The dark chocolate group had dark chocolate for three days before menstruation and on the first day of menstruation in the third month. The music group listened to a song for the same four days. The pain scores and state anxiety were measured in all groups after the interventions. Mean menstrual pain intensity and mean anxiety level in the dark chocolate and music group decreased significantly after the intervention. No significant difference was observed in the control group. The difference between menstrual pain intensity and anxiety levels of the groups was tested by analysis of variance, and the standardized effect size calculated at 95% confidence level, and α = 0.05 was 0.35 and 0.42, respectively. Both dark chocolate and music medicine significantly reduced menstrual pain and anxiety in young women with primary dysmenorrhea. Further research is needed to draw stronger conclusions on their impact on controlling menstrual pain and anxiety in primary dysmenorrhea as a nursing intervention. clinicaltrials.gov. (Clinical Trial registration number: NCT04911673). [ABSTRACT FROM AUTHOR]

We reviewed the available evidence for SP6 (Sanyinjiao) acupressure for the relief of primary dysmenorrhea (PD) symptoms, as well as patients' experiences of this intervention. We searched six relevant databases and gray literature for publications dated up to March 2016. The search yielded 72 potential studies. Six of these studies, contributing a total of 461 participants, were included in this review. The primary outcome was pain intensity. Studies with significant homogeneity were pooled for meta-analysis. Qualitative data and quantitative data not suitable for meta-analysis were presented as a narrative synthesis. The Cochrane criteria demonstrated that the included studies were generally of low quality with a high risk of bias. SP6 acupressure delivered by trained personnel significantly decreased pain intensity immediately after the intervention (effect size = −0.718; CI = −0.951 to −0.585; p = 0.000), and pain relief remained up to 3 h after the intervention (effect size = −0.979; CI = −1.296 to 0.662; p = 0.000). However, patient-administered intervention required multiple monthly cycles to effect pain reduction. SP6 acupressure appears to be effective when delivered by trained personnel for some PD symptoms. Findings suggest that self-administered acupressure shows promise for the alleviation of PD symptoms. High-quality research is needed before conclusive recommendations are proposed. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance Guizhi Fuling formula, a well-known Chinese herbal formula recorded in the Eastern Han Dynasty, is composed of Cinnamomum cassia (L.) J.Presl (Cassia bark), Poria cocos (Schw.) Wolf (Poria), Paeonia suffruticosa andrews (Moutan Cortex), Paeonia lactiflora Pall (Herbaceous peony), and Amygdalus persica L.(Persicae Semen). It has clinical efficacy of activating blood circulation to dissipate blood stasis and is commonly used for the treatment of primary dysmenorrhea. However, its therapeutic mechanism has not been clearly elucidated. The aim of this study is to reveal molecular mechanisms of action using in vivo and in vitro experimental models. Material and methods The ICR mouse uterine contraction was induced by oxytocin exposure following estradiol benzoate pretreatment. Mice were given GZFLC (0.54, 1.08 g/kg) by gavage. The levels of NO, PGF 2α and Ca 2+ in uterine tissue were determined according to instructions. Cyclooxygenase-2 (COX-2) and oxytocin receptor (OTR) proteins in uterine tissue were assessed by Western Blot. Mouse isolated uterus strips were mounted in tissue organ baths containing Locke's solution. The contractile responses were recorded with Power Lab recording system. The effect of GZFLC on spontaneous uterine contraction, and uterine contraction induced by oxytocin, PGF 2α was observed. Myometrial cells were exposed to oxytocin (5 U/L) to induce calcium release, and the effect of GZFLC and its components (PL, PGG, CA) on intracellular Ca 2+ was analyzed with fluorometry imaging. Results In vivo study demonstrated that GZFLC significantly reduced oxytocin-induced writhing responses with a maximal inhibition of 55%. It also decreased the levels of NO, PGF 2α and Ca 2+ in oxytocin-induced mice uterine tissue. Moreover, Western blot analysis showed that COX-2 and OTR expressions in uterine tissue of dysmenorrhea mice were significantly reduced. GZFLC inhibited spontaneous uterus contractions in a dose-dependent manner, and the IC 50 value was 0.99 mg/ml. The IC 50 values of GZFLC on PGF 2α , oxytocin-induced contractions were 1.45 mg/ml, 3.53 mg/ml, respectively. Further in vitro studies indicated that GZFLC and its components (PL, PGG, CA) could restrain intracellular calcium levels in favour of uteri relaxation. Conclusions Both in vivo and in vitro results indicated that GZFLC possessed a significant spasmolytic effect on uterine tetanic contraction. The present study provides in vivo and in vitro experimental evidence to support the use of GZFLC for the clinical treatment of primary dysmenorrheal (PD). [ABSTRACT FROM AUTHOR]

Background and objectives Primary dysmenorrhea refers to painful menstrual cramps without an organic cause and is one of the most common problems for women during reproductive ages. Given the high prevalence of primary dysmenorrhea and its undesirable effects on the quality of life, and also given the evidence on the analgesic properties of peppermint capsules, the present study was conducted to investigate the effect of these capsules on the severity of primary dysmenorrhea in female students living in the dormitories of North Khorasan University of Shirvan, Iran in 2014–2015. Materials and method This double-blind clinical trial was conducted on 102 eligible female students (aged 18–25) living in the dormitories of North Khorasan University of Shirvan from August 2014 to February 2015. The study subjects were initially matched in terms of the reported severity of primary dysmenorrhea and then divided into a peppermint capsule group (46 students) and a placebo group (44 students). The treatment group received three 330 mg peppermint capsules per day, and the placebo group received three identical placebo capsules containing starch, which were taken from the first to the third day of their menstrual cycle with identical administrations. The severity of pain was measured and compared before the intervention and over two successive cycles based on a visual analogue scale (0–10 cm). The data obtained was analyzed in SPSS-17 using the independent t -test and the ANOVA at the significance level of P < 0.05 . Results No significant differences were observed between the two groups in the mean duration and severity of pain before the intervention. After the intervention, a significant difference was observed between the groups in the severity of pain (P < 0.05), but no significant differences were observed in the duration of pain. Discussion Peppermint capsules appear to be capable of reducing the severity of primary dysmenorrhea through certain analgesic mechanisms. Further studies are recommended to be conducted in order to confirm the use of peppermint in the relief of primary dysmenorrhea. [ABSTRACT FROM AUTHOR]

Objective This study aimed to evaluate the effects of rose essential oil on primary dysmenorrhea. Methods One hundred patients were randomly divided into two groups; Group D received diclofenac sodium (75 mg/im) and Group A administered diclofenac sodium with aromatherapy (2% rose essential oil). The visual analog scale (VAS) scores in all subjects at baseline, 10th min, and 30th min were recorded. Results When the two groups were compared before and after the treatment, there were significant decreases in VAS values at the 10 min and 30 min compared to baseline values in both groups (p < 0.001). However, the 30th min mean VAS value in Group D was higher than in Group A (p = 0.019). Conclusion The present study suggests that aromatherapy with rose essential oil, which is a nonpharmacologic treatment method, as an adjuvant to conventional treatment methods may be beneficial for pain relief in individuals with primary dysmenorrhea. [ABSTRACT FROM AUTHOR]

Study Objective To evaluate the efficacy of continuous norethisterone acetate (NET-A), 5 mg (group N) vs cyclical combined oral contraceptive pill (COC) consisting of drospirenone 3 mg/ethinyl estradiol 20 μg pills (group P) in treating dysmenorrhea in young adult women. Design, Setting, and Participants This prospective, open-label, nonrandomized study included 38 Jordanian patients: 20 patients in group N and 18 patients in group P. Interventions Continuous NET-A 5 mg daily or cyclical COC. Main Outcome Measures Pain scores, adverse effects, analgesic use, school absence, and cost. Results Thirty-eight patients used NET-A or COC for 6 months. All participants had almost the same starting levels of visual analogue scale (VAS) scores. Both drugs were similar in suppressing dysmenorrhea at the 3-month follow-up visit; VAS score mean (±SD) in group N and P were 1.30 ± 1.22 and 1.28 ± 0.83 ( P = .22), respectively, and after 6 months, with mean VAS scores (±SD) of 1.30 ± 1.22 and 1.28 ± 0.83, respectively ( P = .95). The cost of the treatment in the N group was much less than in the P group. Participants in the N group were less likely to use pain killers: 20% and 44% in the N and P groups, respectively ( P = .006) in the first month and only 5% and 17% ( P = .019) in the N and P groups, respectively, at the 3-month follow-up, and none of them used any analgesics at the 6-month follow-up. Conclusion A continuous NET-A regimen is a well tolerated, effective, and inexpensive option for dysmenorrhea treatment and was as good as COC. [ABSTRACT FROM AUTHOR]

Study Objective To evaluate the effectiveness and safety of the combination of N -palmitoylethanolamine (PEA) and transpolydatin vs placebo in the treatment of primary dysmenorrhea in adolescents and young women. Design, Setting, and Participants Randomized treatment and follow-up of 220 cases of primary dysmenorrhea in the Department of Medicine and Health Sciences, Institute of Gynecology and Obstetrics, University of Molise, Italy. Methods Between February 2013 and February 2014, we treated 220 young women aged 16 to 24 years who had primary dysmenorrhea: 110 patients were treated with the oral combination of PEA-transpolydatin: 400 mg + 40 mg (1 tablet a day for 10 days from the 24th day of cycle) and 110 patients with placebo (1 tablet a day for 10 days from the 24th day of cycle). A follow-up was performed after treatment, and all girls were seen at this time. A 10-point visual analog scale was used to measure the improvement of pelvic pain. For categorical variables, the χ 2 test and analysis of variance were performed to value the significance of differences between groups. A value of P < .05 was considered statistically significant. Results An improvement of pelvic pain was seen in 98.18% (95% confidence interval 97.64% to 98.60%) of cases in group 1 vs 56.36% (95% confidence interval 48.62% to 63.81%) in group 2 ( P < .001). The combination of PEA and transpolydatin was more effective than placebo ( P < .001). Conclusion The combination of PEA and transpolydatin shows promise as a valid adjuvant therapy in the medical treatment of primary dysmenorrhea in adolescents and young women. [ABSTRACT FROM AUTHOR]

Guizhi-Fuling capsule (GZFL), a well-known herbal remedy, has been widely used to treat primary dysmenorrhea (PD). Hence, systematic identifying multiple active ingredients and the involved mechanism is essential and urgently needed for GZFL. Aim of the study : This study was planned to assess the pharmacokinetics of GZFL in rats, and identify whether these GZFL-derived absorbed components (ACs) contribute to the efficacy of source herbs and relevant mechanism. The in vivo pharmacokinetic profile of 11 phytochemicals and 13 metabolites in healthy and PD rats were evaluated using liquid chromatography with mass spectrometry (LC-MS/MS). Whereafter, the introduced contribution strategy assessed ACs' effect (doses = their contents in GZFL) in PD rats with the mechanism. The pharmacokinetic profiles of prototypes and metabolites differed in healthy and PD rats. As a main proxy of GZFL, 11ACs exerted an anti-PD effect (improvement of indexes for writhing latency, writhing time, PGF 2α /PGE 2 , TXB 2 /6-keto-PGF 1α and β-EP) by regulating PI3K-Akt/ERK pathway. As a paradigmatic example, 11ACs contributed an average of 113.55% to GZFL in terms of anti-PD efficacy, providing an approach to rapidly, accurately and consistently identify the bioactive components and their pathway from herbs. [Display omitted] • Pharmacokinetics of phytochemicals and metabolites was explored in healthy/PD rats. • 11compounds (doses = content in herbs) exerted average ∼113.55% anti-PD effects. • PI3K-AkT/ERK participated in ACs-showing anti-PD efficacy, validated by agonists. • The dose and contribution strategy can become paradigmatic for multi-herbs study. [ABSTRACT FROM AUTHOR]

• The efficacy of Danggui Shaoyao San in treating primary dysmenorrhea rats was observed. • A total of 23 biomarkers related to metabolic abnormalities in primary dysmenorrhea rats were revealed. • The key metabolic mechanism of Danggui Shaoyao San on the amelioration of primary dysmenorrhea was firstly investigated. Danggui Shaoyao San (DSS) is a well-known prescription for relieving primary dysmenorrhea (PD) of women in China. However, its pharmacological mechanism has not been thoroughly uncovered. Here, an integrative UPLC-Q-TOF-MS-based serum metabolomics approach coupled with multivariate data analysis has been proposed to investigate the effects and mechanism of DSS on estradiol benzoate and oxytocin-induced PD rats. 31 potential biomarkers of PD were screened and identified, mainly involving phenylalanine, tyrosine and tryptophan biosynthesis, glycerophospholipid metabolism, primary bile acid biosynthesis, and the occurrence of PD could destroy biological homeostasis in vivo by monitoring these pathways. After DSS treatment, 18 identified different metabolites were restored to the nomal state in varying degrees and could be potential biomarkers contributing to the treatment of DSS. These findings implyed that DSS exhibited a therapeutic effect on PD rats through regulating multiple abnormal pathways. Of note, this study discovered some potential biomarkers related to PD for the first time, such as L-tyrosine, glycocholic acid, citric acid, palmitoylcarnitine, cholesterol. It preliminarily proved the pathophysiology of PD and action mechanisms of DSS on PD, and provided a novel insight into the effectiveness of DSS on PD. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of a physiotherapy program for relieving symptoms of primary dysmenorrhea among Mexican women.Study Design: This was a single-center, prospective, experimental, parallel group, randomized controlled trial. This cross-sectional study was performed at the Universidad Politécnica de Pachuca, Hidalgo, Mexico. Female patients with primary dysmenorrhea, age of 18-22 years; pain intensity from 4 to 10cm on a Visual Analogue Scale (VAS); and sedentary lifestyle were included. The patients were then randomized to receive a physiotherapy program for three months or to no intervention program. The physiotherapy program consisted of overall stretching, specific stretches, Kegel exercises, jogging, and relaxation exercises. Patient evaluations of symptomatology and pain intensity were recorded basally and throughout for three menstrual periods. The data were entered into a computerized database for descriptive and inferential statistical analyses.Results: A per-protocol population of eighty three women with a mean age of 20.2±1.8 years underwent the physiotherapy program, and seventy seven participants with a mean age of 20.4±1.2 years received no treatment. The participant assessments of pain on the VAS during the second and the third menstrual cycles demonstrated a significant reduction in the treatment group (p<0.05) compared with the control group.Conclusions: The results showed that strengthening, stretching and muscle relaxation techniques, in addition to jogging, are effective for reducing dysmenorrheic symptoms when they are regularly performed. [ABSTRACT FROM AUTHOR]

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

Objectives Study was planned to evaluate the efficacy and safety of lornoxicam in moderate to severe menstrual pain due to primary dysmenorrhea. Study design This doubled blind, double dummy, randomized, comparable study of lornoxciam versus ibuprofen was conducted at Sir Takhtsinghji General Hospital, Bhavnagar, Gujarat, India. Total 57 primary dysmenorrhea participants having mean age ± standard deviation (SD) of 19.2 ± 2.08 were analyzed. The participants were randomly allocated to either lornoxicam 8 mg or ibuprofen 400 mg two times a day for maximum of three days on two consecutive menstrual periods. The different medication was taken on each cycle. The analgesic efficacy was compared by a total area under pain relief score to 4 and 8 h, pain intensity difference, sum of pain intensity difference to 4 and 8 h, peak pain intensity difference to 4 and 8 h, peak pain relief to 4 and 8 h, total medication consumption, rescue medication and participant global evaluation. Adverse effects were recorded in both groups. Results In both treatments, efficacy parameters were significantly reduced at measured time points as compared to baseline. No significant difference was observed between lornoxicam and ibuprofen in terms of efficacy parameters: total area under pain relief to 4 h (8.0 ± 2.6 vs 8.3 ± 2.7), total area under pain relief to 8 h (22.4 ± 4.6 vs 23.0 ± 4.4), sum of pain intensity difference to 4 h (−5.7 ± 1.9 vs −6.0 ± 2.0), sum of pain intensity difference to 8 h (−17.5 ± 3.3 vs −17.8 ± 3.5), peak pain relief to 4 h (3.4 ± 0.8 vs 3.5 ± 0.8), peak pain relief to 8 h (3.9 ± 0.5 vs 3.9 ± 0.4), peak pain intensity difference to 4 h (−2.6 ± 0.7 vs −2.7 ± 0.7), peak pain intensity difference to 8 h (−3.3 ± 0.6 vs −3.3 ± 0.6). Total medication consumption, a requirement of rescue medication and global evaluation of efficacy were comparable in both groups. The incidence of adverse effect was also similar in both groups. Conclusions Lornoxicam appears to be a new therapeutic agent for the treatment of primary dysmenorrhea. [ABSTRACT FROM AUTHOR]

Background Primary dysmenorrhea refers to painful menstrual cramps without pelvic pathology. The condition is highly prevalent among women and exerts negative effects on their quality of life. Considering the evidence for anti-inflammatory properties of Boron, the present study aimed to determine the effects of Boron supplementation on the severity and duration of menstrual pain in female university students. Methods This triple-blind randomized clinical trial study recruited 113 university students. The participants were matched for the severity and duration of dysmenorrhea and randomly allocated into the case and control groups (n = 58 and 55, respectively). The case group consumed 10 mg/day Boron from two days before the menstrual flow until its third day. The control group received placebo capsules (similar to those distributed among the cases). All subjects were asked to take the capsules for two consecutive menstrual cycles. Pain severity (measured on a visual analog scale) and duration (in hours) were measured at baseline and during the two cycles. Results The two groups had no significant differences in the severity and duration of pain at baseline. After the intervention, however, the severity and duration of pain were significantly lower in the case group than in the control group (P < 0.05). Conclusion Based on our findings, Boron supplementation can reduce the severity and duration of menstrual pain through exerting anti-inflammatory effects. In order to clarify the effects of Boron on dysmenorrhea, future studies are required to measure the levels of hormones and inflammatory biomarkers. [ABSTRACT FROM AUTHOR]

Abstract: Question: In women with primary dysmenorrhoea, what is the effect of physiotherapeutic interventions compared to control (either no treatment or placebo/sham) on pain and quality of life? Design: Systematic review of randomised trials with meta-analysis. Participants: Women with primary dysmenorrhea. Intervention: Any form of physiotherapy treatment. Outcome measures: The primary outcome was menstrual pain intensity and the secondary outcome was quality of life. Results: The search yielded 222 citations. Of these, 11 were eligible randomised trials and were included in the review. Meta-analysis revealed statistically significant reductions in pain severity on a 0–10 scale from acupuncture (weighted mean difference 2.3, 95% CI 1.6 to 2.9) and acupressure (weighted mean difference 1.4, 95% CI 0.8 to 1.9), when compared to a control group receiving no treatment. However, these are likely to be placebo effects because when the control groups in acupuncture/acupressure trials received a sham instead of no treatment, pain severity did not significantly differ between the groups. Significant reductions in pain intensity on a 0–10 scale were noted in individual trials of heat (by 1.8, 95% CI 0.9 to 2.7), transcutaneous electrical nerve stimulation (2.3, 95% CI 0.03 to 4.2), and yoga (3.2, 95% CI 2.2 to 4.2). Meta-analysis of two trials of spinal manipulation showed no significant reduction in pain. None of the included studies measured quality of life. Conclusion: Physiotherapists could consider using heat, transcutaneous electrical nerve stimulation, and yoga in the management of primary dysmenorrhea. While benefits were also identified for acupuncture and acupressure in no-treatment controlled trials, the absence of significant effects in sham-controlled trials suggests these effects are mainly attributable to placebo effects. [Kannan P, Claydon LS (2014) Some physiotherapy treatments may relieve menstrual pain in women with primary dysmenorrhea: a systematic review. Journal of Physiotherapy 60: 13–21] [Copyright &y& Elsevier]