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Adenomyosis is a chronic, hormone-related disease characterized by the presence of the endometrial glands and stroma within the myometrium. This condition can manifest in various features, focal or diffuse adenomyosis or as an adenomyoma, and it may involve different uterine walls (posterior, anterior, and/or lateral walls). The disease can also be classified into different degrees, as mild, moderate and severe, which can be associated with more intense symptoms, although this correlation is not always directly proportional. In fact, adenomyosis can be asymptomatic in about a third of cases or it can significantly impact patients' quality of life through painful symptoms, such as dysmenorrhea and dyspareunia, abnormal uterine bleeding—particularly heavy menstrual bleeding—and potential effects on fertility. Historically, adenomyosis has been considered a disease primarily affecting premenopausal women over the age of 40, often multiparous, because the diagnosis was traditionally based on surgical reports from hysterectomies performed after the completion of reproductive desire. Data on the presence of adenomyosis in adolescent patients remain limited. However, in recent years, advancements in noninvasive diagnostic tools and increased awareness of this pathology have enabled earlier diagnoses. The disease appears to have an early onset during adolescence, with a tendency to progress in terms of extent and severity over time. Adenomyosis often coexists with endometriosis, which also has an early onset. Therefore, it is important, when diagnosing adenomyosis, to also screen for concomitant endometriosis, especially deep endometriosis in the posterior compartment. The aim of this narrative review is to investigate the prevalence of different types and degrees of adenomyosis in younger patients, assess the associated symptoms, and describe the most appropriate diagnostic procedures for effective therapeutic management and follow-up, with the goal of improving the quality of life for these young women. [ABSTRACT FROM AUTHOR]

Background: Dysmenorrhea and premenstrual syndrome (PMS) are common disorders in the Mexican population, but these are usually underdiagnosed and under-treated, impacting women's quality of life. Adequate health habits have been reported as precursors of decreasing dysmenorrhea symptoms. However, few studies assess their impact on PMS. Aim: This study aims to evaluate dysmenorrhea and premenstrual syndrome in association with health habits in the Mexican population. Methods: To assess the impact of health habits on menstruation symptoms a validated survey was conducted in 1679 adult females aged ≥18 years. The survey collected data on participants' dysmenorrhea, PMS, and their health habits. Results: The analysis showed that physical activity duration, changes in eating habits (increases in salty or sugary foods) during menstruation, and oversleeping habits predict increases in dysmenorrhea and PMS. In contrast, an active sexual life, relaxing physical activity, and adequate sleep hours during menstruation seem to decrease the symptoms. Conclusions: We conclude that adequate health habits and addressing early gynecological conditions might regulate dysmenorrhea and PMS. [ABSTRACT FROM AUTHOR]

Background/Objectives: Adenomyosis is a debilitating gynecologic condition that affects both multiparous older women and nulliparous younger women, inducing a variety of symptoms such as dysmenorrhea, menorrhagia, and infertility. Thermal ablation techniques are new procedures that have been proposed for the treatment of adenomyosis. They include high-intensity focused ultrasound (HIFU), percutaneous microwave ablation (PMWA), and radiofrequency ablation (RFA). Because thermal ablation techniques are minimally invasive or noninvasive, fertility is not impaired while symptoms improve. In addition, hospital stays and financial costs are generally reduced, increasing the interest in these alternative management options. Methods: In this narrative review, we conducted a thorough literature search of PubMed/Medline from the database inception to September 2022. In our search, we focused on noninvasive treatment methods such as HIFU ablation, RFA ablation, and PMWA as well as adenomyosis-specific terms and noninvasive techniques (ultrasonography, ultrasound, or magnetic resonance imaging). The queries were a combination of MeSH terms and keywords. The search was limited to the English language. Abstracts were screened according to their content, and relevant articles were selected. Results: Overall, the results showed that the above-mentioned ablation techniques are effective and safe in providing adenomyosis treatment. Lesion size and uterus volume are reduced, leading to considerable symptom alleviation with all three methods. Positive results concerning safety and fertility preservation have been described as well. Conclusions: Nonetheless, more research is required in this field to compare the efficacy and safety of different ablation techniques with traditional therapies. Such research will help improve these procedures and their associated decision-making processes. [ABSTRACT FROM AUTHOR]

Background: Dysmenorrhea is a common condition that may have negative effects on social life, couples' relationships and professional activities. The objectives of this study were to evaluate the prevalence, risk factors and characteristics of dysmenorrhea and its impact on patients' quality of life using a specific self-questionnaire named "DysmenQoL questionnaire". We also checked the validity and reliability of this questionnaire in our population. Methods: We conducted a cross-sectional study that included 504 participants of reproductive age between 18 and 45 years of age. The data were collected with an original form divided into three sections. The last section (DysmenQoL questionnaire) included 20 statements scored from 1 ("never") to 5 ("every time") that evaluates the effects of menstrual pain on health and feelings, daily activities, relationships and professional activity. We calculated the sum of the scores for each statement and we called it the "DysmenQoL score". Results: The prevalence of dysmenorrhea was 83.7%. The presence of dysmenorrhea was statistically significant associated with the degree of menstrual bleeding (p = 0.017), the presence of infertility (p = 0.034) and dyspareunia (p = 0.002), but also with the presence of premenstrual syndrome and a family history of dysmenorrhea (p < 0.001). Among the participants with dysmenorrhea, 73.9% considered that this symptom affected their quality of life, and this was correlated with pain intensity and the DysmenQoL score (p < 0.001). A significant difference regarding the DysmenQoL score depending on the pain intensity, frequency and duration of dysmenorrhea and the methods used to reduce the pain was observed. Conclusions: Dysmenorrhea had a high prevalence among the participants included in the study, and its presence was associated with a series of risk factors. Most women considered that dysmenorrhea affected their quality of life. The DysmenQoL questionnaire proved to be a reliable and valid method for evaluating the impact of dysmenorrhea on quality of life. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study explored the potential of Hinoki aromatherapy to induce biomarkers of dysmenorrhea relief through working memory. Structural magnetic resonance imaging and magnetoencephalography (MEG) were used to examine their effects on neurophysiological responses to a visual working memory (VWM) test. Behavioral performance was measured to understand its effects on the overall working memory. Methods: Twenty-four healthy participants completed the VWM task during nonmenstruation and menstruation. Behavioral (accuracy and reaction time) and neurophysiological (event-related fields, source estimation, and permutation t-test on source data) measures were assessed without and with Hinoki aromatherapy. Results: A significant difference in the ratio of accuracy to reaction time was found without and with aromatherapy in participants with dysmenorrhea, suggesting that aromatherapy may improve working memory performance in this population. MEG analysis revealed high temporal resolution of evoked latency and intensity during the VWM task. Source localization of the activation aimed to identify brain areas involved in dysmenorrhea. Aromatherapy reduced signals in these areas, which may also contribute to reducing dysmenorrhea-related visual signals. Conclusions: Based on these findings, Hinoki aromatherapy may be a promising treatment option for alleviating dysmenorrhea and improving related symptoms by reducing activity in brain pain processing regions. These regions include the left entorhinal cortex, inferior temporal gyrus, primary visual cortex, retrosplenial cortex, and presubiculum. Furthermore, decreased activity in these areas with aromatherapy suggests that they could be used as biomarkers of dysmenorrhea relief. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the effectiveness of 8-week exercise programs (aerobic, stretching, and aerobic plus stretching) in improving menstrual characteristics in female adolescents in Saudi Arabia. Methods: In this quasi-experimental study, seventy-eight healthy female adolescents aged 12–18 from secondary and high schools in Riyadh participated. Participants were divided into three groups and subjected to different types of exercises (aerobic, stretching, and aerobic plus stretching) for 20–30 min, three times a week. Menstrual pain, stress, and attitudes were assessed using the Numerical Rating Scale, Adolescent Stress Questionnaire Short Version, and Adolescent Menstrual Attitude Questionnaire, respectively. Assessments were conducted before the intervention and after the third menstrual period post-intervention. Results: The aerobic exercise group experienced a significant reduction in the mean length of the menstrual cycle (p = 0.025). The aerobic plus stretching group had the most significant reduction in mean menstrual pain scores (p < 0.0001). Stress scores were significantly reduced in the stretching group (p < 0.0001). Conclusion: We conclude that combining aerobic and stretching exercises significantly reduces menstrual pain, while aerobic exercise decreases menstrual cycle length and pain. [ABSTRACT FROM AUTHOR]

Dysmenorrhea treatment with 0.5 mg dienogest tablets twice daily (1 mg/day) has proven useful, but its effect on premenstrual disorders has not yet been evaluated. This study aimed to evaluate the efficacy of 0.5 mg dienogest tablets in relieving premenstrual syndrome (PMS)-like symptoms during the treatment of dysmenorrhea in comparison with that of continuous low-dose estrogen–progestin (LEP/COC) drospirenone/ethinylestradiol combination, which is considered effective in treating premenstrual dysphoric disorder. During the standard course of dysmenorrhea treatment with dienogest or LEP/COC, PMS-like symptoms were scored based on patients' reports, and the treatment effects were compared. As a result, the dienogest group experienced a significant improvement in PMS-like symptoms compared with the LEP/COC group over the 6-month study period (p < 0.01). Furthermore, dienogest was more effective in providing relief from PMS-like symptoms, with 89.7% of patients reporting a complete resolution of PMS-like symptoms at 6 months, compared with 47.1% in the LEP/COC group (p < 0.01). These results indicate that dienogest is effective in relieving PMS-like symptoms, similar to LEP/COC. Further studies are needed to determine whether 0.5 mg dienogest tablets, which are only available in Japan, are effective in treating premenstrual disorders diagnosed via standard methods. [ABSTRACT FROM AUTHOR]

Gestrinone (R-2323), or ethylnorgestrienone, is a synthetic steroid of the 19-nortestosterone group more commonly used as an oral, intravaginal, or subcutaneous implant for the treatment of endometriosis, contraception, and estrogen-dependent conditions such as hypermenorrhea, premenstrual dysphoria, and intense menstrual cramps. This review aims to reevaluate the routes, doses, and applicability proposed for using gestrinone, including its use in new conditions such as menopause, lipedema, and sarcopenia. Here, we present the possible application of gestrinone as a long-acting therapeutic possibility through hormonal implants and the benefits and potential risks. Available evidence on the safety of doses and routes is limited. Gestrinone appears to be effective compared to other progestins and may have some advantages in the treatment of estrogen-dependent pathologies. Future research must evaluate gestrinone's long-term safety and potential therapeutic indications. [ABSTRACT FROM AUTHOR]

Menstruation-related symptoms in young women are associated with lifestyle factors such as stress. This study aimed to examine menstrual conditions, menstruation-related symptoms, and types of stress in Japanese female students from their first to second years of university and the association between menstruation-related symptoms and stress levels. This prospective longitudinal cohort study utilized a self-reported web survey with the Menstrual Distress Questionnaire (MDQ) at three timepoints (2, 8, and 14 months) following admission and continuing into the second year. Data from 33 out of 102 students, who were followed throughout the study period, were used for analysis. Results indicated a trend towards changes in menstrual regularity, with the lowest (48.5%) at timepoint 1 and the highest (72.7%) at timepoint 3, and significant changes in perceived bleeding amount. Stress related to study and academic performance was consistently highest, with significant differences across timepoints. Intra-menstrual MDQ scores were highest at timepoint 1, with significant variations in impaired concentration severity across timepoints. Significant correlations were found between the MDQ scores and stress related to health and personality at all timepoints, and to future prospects, friendships, study, and academic performance at different timepoints. In short, stress related to academic performance, along with a strong correlation between MDQ scores and specific stress types, such as health and personality, was observed across all timepoints. This implies the need to provide new students with health education regarding menstruation and stress management before specific timepoints. [ABSTRACT FROM AUTHOR]

Headache and visceral pain are common clinical painful conditions, which often co-exist in the same patients. Numbers relative to their co-occurrence suggest possible common pathophysiological mechanisms. The aim of the present narrative review is to describe the most frequent headache and visceral pain associations and to discuss the possible underlying mechanisms of the associations and their diagnostic and therapeutic implications based on the most recent evidence from the international literature. The conditions addressed are as follows: visceral pain from the cardiovascular, gastrointestinal, and urogenital areas and primary headache conditions such as migraine and tension-type headache. The most frequent comorbidities involve the following: cardiac ischemic pain and migraine (possible shared mechanism of endothelial dysfunction, oxidative stress, and genetic and hormonal factors), functional gastrointestinal disorders, particularly IBS and both migraine and tension-type headache, primary or secondary dysmenorrhea and migraine, and painful bladder syndrome and headache (possible shared mechanisms of peripheral and central sensitization processes). The data also show that the various visceral pain–headache associations are characterized by more than a simple sum of symptoms from each condition but often involve complex interactions with the frequent enhancement of symptoms from both, which is crucial for diagnostic and treatment purposes. [ABSTRACT FROM AUTHOR]

Cardiovascular disease is a leading cause of death worldwide, affecting the quality of life of patients. The management of cardiovascular disease faces challenges in integrating clinical practice with updated diagnostic methods and treatment. Artificial intelligence shows promise as a diagnostic tool for cardiac disease, but it is limited without the support of clinicians. The article also discusses various diagnostic and treatment approaches for specific heart pathologies, such as noninvasive diagnostic methods and minimally invasive intervention techniques. The use of artificial intelligence and innovative prosthetic heart valve devices are also explored. The article concludes by emphasizing the importance of combining clinical examination, symptom identification, laboratory tests, and appropriate diagnostic examinations with the potential benefits of artificial intelligence in diagnosing severe heart disease. [Extracted from the article]

Background/Objectives: Adenomyosis is a benign condition characterized by the presence of endometrial tissue within the myometrium. Despite surgery being a valuable approach, medical options are considered as the first-line approach and have been investigated in the treatment of adenomyosis, although strong evidence in favor of these is still lacking. This study aims to gather all available data and determine the effectiveness of the aforementioned medical options in patients with associated pain and not currently seeking pregnancy, both in comparison to placebo and to one another. Methods: For this study, PubMed and EMBASE were used as data sources, searched up to January 2024. A systematic review and meta-analysis were performed in accordance to guidelines from the Cochrane Collaboration. The primary outcomes investigated were changes in dysmenorrhea, quantified by means of VAS scores, HMB in terms of number of bleeding days, and changes in uterine volume determined at ultrasound. Twelve eligible studies were selected. Results: The results highlighted that dienogest yields a reduction in dysmenorrhea that is significantly superior to that of the rest of the medical treatments investigated (p-value of <0.0002). On the other hand, GnRH agonists seem to play a more prominent role in reducing uterine volume (p-value of 0.003). While it was not possible to determine which medical treatment better decreased the number of bleeding days, it was observed that COC performed significantly worse than the other treatments studied (p-value of 0.02). Conclusions: While this meta-analysis provides valuable insights in the comparative efficacy of different treatments, the paucity of relevant studies on the topic might impact the reliability of some of the conclusions drawn. [ABSTRACT FROM AUTHOR]

The purpose of this article is to review the effects of four commonly consumed beverage types—sugar-sweetened beverages (SSBs), caffeinated beverages, green tea, and alcohol—on five common benign gynecological conditions: uterine fibroids, endometriosis, polycystic ovary syndrome (PCOS), anovulatory infertility, and primary dysmenorrhea (PD). Here we outline a plethora of research, highlighting studies that demonstrate possible associations between beverage intake and increased risk of certain gynecological conditions—such as SSBs and dysmenorrhea—as well as studies that demonstrate a possible protective effect of beverage against risk of gynecological condition—such as green tea and uterine fibroids. This review aims to help inform the diet choices of those with the aforementioned conditions and give those with uteruses autonomy over their lifestyle decisions. [ABSTRACT FROM AUTHOR]

Background: Endometriosis is a multifaceted gynecological condition that poses diagnostic challenges and affects a significant number of women worldwide, leading to pain, infertility, and a reduction in patient quality of life (QoL). Traditional diagnostic methods, such as the revised American Society for Reproductive Medicine (r-ASRM) classification, have limitations, particularly in preoperative settings. The Numerical Multi-Scoring System of Endometriosis (NMS-E) has been proposed to address these shortcomings by providing a comprehensive preoperative diagnostic tool that integrates findings from pelvic examinations and transvaginal ultrasonography. Methods: This retrospective study aims to validate the effectiveness of the NMS-E in predicting surgical outcomes and correlating with the severity of endometriosis. Data from 111 patients at Nippon Medical School Hospital were analyzed to determine the correlation between NMS-E scores, including E-score—a severity indicator—traditional scoring systems, surgical duration, blood loss, and clinical symptoms. This study also examined the need to refine parameters for deep endometriosis within the NMS-E to enhance its predictive accuracy for disease severity. Results: The mean age of the patient cohort was 35.1 years, with the majority experiencing symptoms such as dysmenorrhea, dyspareunia, and chronic pelvic pain. A statistically significant positive correlation was observed between the NMS-E's E-score and the severity of endometriosis, particularly in predicting surgical duration (Spearman correlation coefficient: 0.724, p < 0.01) and blood loss (coefficient: 0.400, p < 0.01). The NMS-E E-score also correlated strongly with the r-ASRM scores (coefficient: 0.758, p < 0.01), exhibiting a slightly more excellent predictive value for surgical duration than the r-ASRM scores alone. Refinements in the methodology for scoring endometriotic nodules in uterine conditions improved the predictive accuracy for surgical duration (coefficient: 0.752, p < 0.01). Conclusions: Our findings suggest that the NMS-E represents a valuable preoperative diagnostic tool for endometriosis, effectively correlating with the disease's severity and surgical outcomes. Incorporating the NMS-E into clinical practice could significantly enhance the management of endometriosis by addressing current diagnostic limitations and guiding surgical planning. [ABSTRACT FROM AUTHOR]

Background: There are many reports about variations in the menstrual cycle after infection with SARS-CoV-2 or vaccination against it. However, data on SARS-CoV-2 infection or vaccination-related changes in menstruation-associated endometriosis-typical symptoms such as dysmenorrhea, dyspareunia, dyschezia, dysuria, and bloating are rare or missing. Methods: This retrospective study was performed as an online survey among employees and students at the University Hospital Ulm, Germany. Changes regarding the presence of mentioned symptoms and after immunization (vaccination and/or infection) were evaluated with the McNemar Test. Additionally, the risk factors associated with these changes and associations between a subjectively perceived general change in menstruation and changes in the symptoms were evaluated. Results: A total of 1589 respondents were included in the final analysis. Less than 4% of respondents reported the occurrence of new symptoms that they had not experienced before immunization. Overall, there was a significant reduction in the presence of dysmenorrhea, back pain, dyschezia, bloating, and dyspareunia after immunization against coronavirus (p < 0.001). Only 2.3% of all participants reported to have been diagnosed with endometriosis. Factors associated with changes in endometriosis-typical symptoms following immunization were body mass index, age, endometriosis, and thyroid disease. Conclusions: Our results provide unique data about a reduction in the incidence of endometriosis-associated symptoms as dysmenorrhea, dyschezia, and dyspareunia after immunization against COVID-19. [ABSTRACT FROM AUTHOR]

Adenomyosis (ADM) is a multifaceted uterine pathology characterized by the ectopic infiltration of endometrial tissue into the myometrium, affecting approximately 20% of women in the reproductive age group seeking gynecological care. This condition manifests as a range of debilitating symptoms, including dysmenorrhea, menorrhagia, impaired fertility, and heightened susceptibility to miscarriage and obstetric complications. Substantial research has been dedicated to exploring its underlying molecular mechanisms and developing non-invasive precision medical therapies. ADM is primarily characterized by a dysregulation in sex steroid hormone homeostasis, particularly estrogen and progesterone. However, emerging evidence suggests that additional endocrine mediators and disruptors may play contributory roles in the etiology of ADM. Genetic and epigenetic alterations of endocrine signaling pathways have been implicated as prevailing mechanisms underlying the development and progression of the disease. The present review aims to provide an updated and comprehensive overview of the current understanding of the pathophysiology of ADM, with a particular emphasis on the dysregulated hormonal milieu and the potential involvement of endocrine disruptors. By elucidating these intricate molecular mechanisms, this review seeks to pave the way for novel research directions in the development of targeted therapeutic strategies for ADM management. [ABSTRACT FROM AUTHOR]

Accurate diagnosis of Müllerian duct anomalies (MDA) remains a clinical challenge even by direct surgical inspection. Although obstetrical complications are more frequent in women with MDA, some subtypes allow normal reproduction, further delaying the diagnosis. Unicornuate uterus with a rudimentary non-communicating functioning horn is a rare form of MDA, susceptible to many gynecologic and obstetric complications such as miscarriages, premature birth, hematosalpinx, endometriosis, and chronic pelvic pain. We present an entire case pictorial assay including preoperative imaging as well as the surgical correction of the uterine anomaly and the associated complication of an occult unicornuate right uterus with rudimentary non-communicating functioning left horn (Class U4aC0V0/ European Society of Human Reproduction and Embryology/European Society of Gastrointestinal Endoscopy Classification) and its natural evolution following a previous incomplete surgical treatment. The patient had an emergency left adnexectomy for hematosalpinx and ovarian endometrioma at her local county hospital. After five years, the patient presented with severe dysmenorrhea and abdominal endometriosis due to blocked retrograde menstruation from a rudimentary, non-communicating functioning horn. Surgical treatment with the resection of the rudimentary uterine horn, together with the abdominal wall endometriosis lesions, was carried out with good outcomes. [ABSTRACT FROM AUTHOR]

Background: Plant-based remedies have been used since antiquity to treat menstrual-related diseases (MD). From the late nineteenth to the early to mid-twentieth century, Italian folk remedies to treat "women's diseases" were documented in a vast corpus of literature sources. Aim: The purpose of this paper is to bring to light the plant-based treatments utilized by Italian folk medicine to heal clinical manifestations of premenstrual syndrome (PMS), dysmenorrhea, amenorrhea and menstrual disorders in an attempt to discuss these remedies from a modern pharmacological point of view. Moreover, we compare the medical applications described by Hippocrates with those utilized by Italian folk medicine to check if they result from a sort of continuity of use by over two thousand years. Results: Out of the 54 plants employed in Italian folk medicine, 25 (46.3%) were already documented in the pharmacopoeia of the Corpus Hippocraticum for treating MD. Subsequently, a detailed search of scientific data banks such as Medline and Scopus was undertaken to uncover recent results concerning bioactivities of the plant extracts to treat MD. About 26% of the plants used by Italian folk medicine, nowadays, have undergone human trials to assess their actual efficacy. At the same time, about 41% of these herbal remedies come back to in different countries. Conclusions: Active principles extracted from plants used by Italian folk healers could be a promising source of knowledge and represent strength candidates for future drug discovery for the management of MD. [ABSTRACT FROM AUTHOR]

It is unclear whether clinical background differs between endometriosis in adolescent patients with obstructive Müllerian anomalies and those without anomalies. The aim of the study is to identify the difference in clinical characteristics of endometriosis in patients with or without obstructive Müllerian anomalies. The study involved 12 patients aged under 24 years old who underwent primary surgery for obstructive Müllerian anomalies and 31 patients aged under 24 years old who underwent surgery for ovarian endometrioma. A total of 6 out of 12 cases with obstructive Müllerian anomalies developed endometriosis (4 Herlyn–Werner–Wunderlich syndrome, 2 non-communicating functional uterine horn, 2 cervical aplasia). The age at surgery was significantly younger in endometriosis with obstructive Müllerian anomalies, compared with those without obstructive Müllerian anomalies (17.8 ± 4.4 vs. 23.1 ± 1.3, p = 0.0007). The rate of endometrioma was 50.0% and the rate of hydrosalpinx was significantly higher (66.7% vs. 0%, p = 0.0002) in the group of obstructive Müllerian anomalies. The recurrence rate of endometriosis was 20.0% in the group of anomalies and 25.9% in the group of those without anomalies. Adolescent patients with obstructive Müllerian anomalies more easily developed endometriosis and co-occurred with higher rate of hematosalipinx. [ABSTRACT FROM AUTHOR]

The experience of menstruation is often associated with negative connotations and gender stereotypes, which results in making it invisible. This research aimed to explore the perceptions, beliefs, and knowledge of young Spanish women regarding the menstrual cycle and menstruation and their impact on their lives. The study delves into their understanding, menstrual management practices, the types of menstrual products employed, and their experiences related to menstrual health. Qualitative methodology was used with discussion groups as a data collection technique. The participants comprised 45 young Spanish women, aged between 18 and 23, hailing from both rural and urban areas. The majority were university students, with some engaged in part-time work, and one participant working full-time. While many experienced menstrual pain ranging from mild to debilitating, a normalization of this pain often led them to forego seeking specialist assistance. Disposable menstrual products (DMPs) are the most used by participants, despite limited awareness of their absorption capacity. Regarding reusable menstrual products (RMPs), menstrual cup users emphasized comfort but expressed a need for proper training. Negative menstruation experiences could evoke fear and difficulties, underscoring the importance of providing comprehensive menstrual health education encompassing both theoretical and practical components. [ABSTRACT FROM AUTHOR]

Premenstrual syndrome is characterized by pain and related symptoms that negatively affect women's quality of life. Our aim was to evaluate the safety and effectiveness of a specific oral fixed dose combination of naproxen 220 mg + paracetamol 300 mg + pamabrom 25 mg in tablet form. A prospective, open-label, multicenter, uncontrolled, observational post-marketing study was conducted from December 2017 to December 2019 consisting of 270 women over 18. The primary outcome was the number and severity of adverse effects. Secondary outcomes were pain intensity, number and intensity of other premenstrual symptoms, and the proportion of patients with a pain score reduction of at least 50%. The mean age of participants was 28.9 ± 8.8 years. We found that 8 women (3%) experienced adverse events, namely headache (5/8), gastritis (2/8) dyspepsia (1/8), diarrhea (1/8), and nausea (1/8). In three of the eight women, the study was discontinued due to adverse effects. Pain intensity was reduced (−4.5, 95%CI; −5, −4, p < 0.001). The proportion of patients with pain reduction of at least 50% was 70.7%. The study results suggest that the combination of drugs used in this formulation is safe and effective for premenstrual symptoms. [ABSTRACT FROM AUTHOR]

In recent years, photobiomodulation (PBM) has attracted widespread attention for the treatment of various causes of pain and inflammation. Primary dysmenorrhea (PD) is a common gynecological condition characterized by severe menstrual pain, and the limited effectiveness and side effects of conventional treatments have highlighted the urgent need to develop and identify new adjunct therapeutic strategies. The present study from the perspective of light morphology aimed to bypass the heat risk limitation and evaluate the efficacy and safety of pulsed 630 nm PBM therapy for reducing pain associated with PD. The pulse light parameters were designed according to the transmittance of red light. In this randomized, cross-over design, sham-controlled study, 46 women with PD were included and randomly assigned to either pulsed 630 nm light therapy or white light sham control therapy. The intervention lasted for 20 min per day and was administered for 7 consecutive days before and during menstruation. The results showed that the pulsed 630 nm PBM treatment demonstrated a significant reduction in pain levels compared to the placebo treatment (p < 0.001), with 55.00% of active treatment participants experiencing a pain intensity differential concentration exceeding 50.00%. Moreover, participants reported an improved quality of life during the active treatment phase and generally preferred it as a more effective method for relieving PD. No adverse events or side effects were reported throughout the trial. Based on the results, pulsed 630 nm LED therapy showed significant relief of menstrual pain compared to white light placebo treatment and improved quality of life under certain circumstances. Therefore, this study proposes that pulsed red light PBM therapy may be a promising approach for future clinical treatment of PD. [ABSTRACT FROM AUTHOR]

A growing number of women of reproductive age experience menstrual disorders. The menstrual cycle is considerably influenced by dietary habits, physical activity, and the use of stimulants. The main aim of this study was to assess women's knowledge about the menstrual cycle and the influence of diet and lifestyle factors on menstrual symptoms, and to identify dietary models that may alleviate or exacerbate menstrual distress. A total of 505 young women participated in the study. Nearly 90% of the respondents reported at least one menstrual disorder, mostly dysmenorrhea (70.7%), whereas secondary amenorrhea was least frequently reported (13.8%) (p = 0.002). In the study population, dysmenorrhea/menstrual distress was linked with higher consumption frequency of certain food groups. Women with severe dysmenorrhea consumed refined cereal products, processed meat, sugar, and water significantly more frequently than women with moderate menstrual pain. In turn, sweetened dairy products, animal fats, and fruit were consumed more frequently by women with low intensity of menstrual pain (mild pain). Significant differences in knowledge about the menstrual cycle and physiological changes in the body were observed between the compared dietary models. [ABSTRACT FROM AUTHOR]

Background and Objective: Primary dysmenorrhea (PD) is one of the most common clinical disorders in women of reproductive age. Our aim was to examine whether a twice-weekly thirty-minute Aviva exercise intervention could result in improvements in pain level and body awareness in patients with PD. Materials and Methods: In our prospective observational trial, the observation period included two consecutive menstrual cycles and the period of the next menstrual bleeding. The first menstrual bleeding period was the first measurement time (T1), the second was the second measurement time (T2), and the third was the third measurement time (T3) in a total of 78 volunteers. The primary endpoint was the change in the level of menstrual pain according to the Numeric Rating Scale (NRS) questionnaire between the intervention group (IG) and the control group (CG) at T1, T2, and T3. In this study, the secondary outcomes were the differences between the IG and CG regarding the different subscales of the Hungarian version of the Body Awareness Questionnaire (BAQ-H) at T1, T2, and T3; the Borg scale results of the IG; and adherence to the intervention. Statistical tests such as independent-sample t-tests, chi-square tests, Pearson's linear correlation coefficient, and repeated-measure ANCOVA were used for the analyses. Results: In total, 78 volunteers were enrolled: 40 persons in the IG and 38 in the CG. There was a significant change in the level of menstruation pain according to the NRS questionnaire between the IG and CG (p < 0.001). There was no significant difference between the IG and CG regarding the different subscales of the BAQ-H. Only in the case of the "Note responses or changes in body process" subscale of the BAQ-H was there a trend-like effect from the Aviva exercises (p = 0.086). Conclusions: The Aviva exercise could contribute to pain relief from PD. Regarding body awareness, no significant difference was found between the two groups. Due to the short detection period and prospective observational design, our results are preliminary and need to be confirmed in larger clinical trials. [ABSTRACT FROM AUTHOR]

Peony pollen contains multiple nutrients and components and has been used as a traditional Chinese medicine with a long history, but the effect of the treatment of primary dysmenorrhea remains to be clarified. The aim of this study is to investigate the therapeutic effect of peony pollen on primary dysmenorrhea mice and the potential mechanism. A uterus contraction model in vitro and primary dysmenorrhea mice were used to evaluate the treatment effect of peony pollen on primary dysmenorrhea. The primary dysmenorrhea mice were treated with 62.5 mg/kg, 125 mg/kg, or 250 mg/kg of peony pollen, and the writhing response, latency period, histopathological changes in the uterus, prostaglandin E2 (PGE2) and prostaglandin F2α (PGF2α) levels, and infiltration of neutrophils and macrophages were investigated. Protein expression of interleukin 1 β (IL-1β), interleukin 6 (IL-6), NOD-like receptor thermal protein domain associated protein 3 (NLRP3), cyclooxygenase-2 (COX-2), microsomal prostaglandin-E synthase 1 (mPGEs-1), BCL2-Associated X (Bax), B-cell lymphoma-2 (BCL-2), caspase-3, and cleaved caspase-3 were detected by Western blot, and the oxidative stress related marker malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and reactive oxygen species (ROS) were evaluated. Peony pollen could attenuate spontaneous or oxytocin-induced uterus contractions in vitro. Moreover, peony pollen decreased the writhing times, prolonged the writhing latency, and reduced the pathological damage of uterine tissues. Furthermore, the inflammatory cell infiltration and the protein expression of IL-1β, IL-6, and NLRP3 were decreased. The COX-2/PGE2 pathway was inhibited; oxidative stress and apoptosis in the uterus also improved in the uterus of primary dysmenorrhea mice. Peony pollen exerts a positive effect on primary dysmenorrhea by inhibiting the inflammatory response and modulating oxidative stress and apoptosis by regulating the COX-2/PGE2 pathway. [ABSTRACT FROM AUTHOR]

Background: Primary dysmenorrhea (PD) is one of the most common diseases in women of reproductive age. Our aim was to examine whether a twice-weekly thirty-minute exercise intervention could result in a difference in the pulsatility index (PI) of the uterine arteries (UAs) and level of menstrual pain in patients with PD. Methods: In our prospective observational trial, the observation period included one spontaneous menstrual cycle and the consecutive time of the next menstruation of all participants, aged 18–44, with no extensive sports experience. In total, 73 volunteers were enrolled: 38 persons in the intervention group (IG) and 35 in the control group (CG). The intervention program was accompanied by music, performed in groups under the supervision of a qualified instructor in Hungary. The primary outcome was the difference between the IG and CG regarding the PI values of UAs at the 1st and the 2nd ultrasound (US) Doppler flowmetry. The secondary outcome was the difference between the IG and CG regarding the PI of UAs and menstrual pain measured by using the Numeric Rating Scale and adherence to the intervention. Statistical tests such as an independent-samples t-test, chi-square test, Mann–Whitney test and analysis of covariance (ANCOVA) were used during the analyses. Results: Examining the mean of the PI of UAs in the IG and the CG at the 1st and the 2nd US measurement, a significant difference was found in the change in the measured value (Z = −2.545; p = 0.011). The IG showed a significantly higher increase in the mean of the PI of UAs (Median = 0.825) than the CG (Median = 0.130). The difference in the PI of the UAs of the IG and the CG is not related to the level of pain in any group (p = 0.336) and not related to the whole sample (p = 0.354); furthermore, the level of pain did not significantly differ between the two groups. Conclusions: Our study is the first to document the significant effects of mild-to-moderate exercise training on the change in the PI of the UAs in individuals with PD. The IG had a reduced blood flow due to circulatory redistribution after exercise. The level of menstrual pain of primary dysmenorrhea patients is independent of the level of blood circulation regarding the PI of the UAs. Randomized controlled studies with more participants and a longer research period are needed to confirm our findings regarding the association between regular exercise and the PI of UAs. The study was registered at clinicaltrials.gov: NCT04618172. [ABSTRACT FROM AUTHOR]

Introduction: Urinary tract endometriosis (UTE), a rare manifestation, encompasses bladder and ureteral involvement. Surgical intervention is commonly recommended for UTE, though the optimal surgical approach remains a subject of debate. This study aims to report our centre's experience with UTE. Methods: We conducted a retrospective cohort study of 55 patients who underwent surgical treatment for UTE at a single tertiary centre over a 10-year period (2012–2022). Patient data, including demographics, symptoms, intraoperative findings, and complications, were collected from medical records. Data were statistically analysed, and correlations were explored. Results: The study population had a mean age of 37.11 years, with dysmenorrhea (89.1%) being the most common symptom. Bladder endometriosis was present in 27 cases, ureteral endometriosis in 25, and mixed-location in 3. Laparoscopy was the primary surgical approach, with multidisciplinary teams involving urologists. There were six patients with postoperative complications, and there were six (10.9%) recurrences of endometriosis. A positive correlation was found between age and recurrence, but no significant predictors of recurrence were identified in our analysis. Conclusions: Laparoscopic treatment of urinary endometriosis is safe and effective. Multidisciplinary collaboration plays a pivotal role in addressing this challenging condition. [ABSTRACT FROM AUTHOR]

Background: Endometrial proliferative lesions (EPL) usually refer to endometrial hyperplasia (EH) and endometrial cancer (EC). Among patients with premenopausal EPL who wish to preserve their fertility, only those with EH and early-stage EC have the possibility to undergo fertility preservation therapy. However, there is currently a lack of specific and reliable screening criteria and models for identifying these patients. Methods: This study utilized a retrospective diagnostic study design. The training set included medical record information that met the criteria between August 2017 and October 2022, while the validation set consisted of medical record information that met the criteria from November 2022 to May 2023. The endometrial pathological test served as the gold standard. The serum anti-Mullerian hormone (AMH) level before endometrial sampling and a regression model were employed to predict EPL. Results: The study included a total of 1209 patients with PCOS (1119 in the control group and 90 in the endometrial proliferative lesion group) and 5366 women without PCOS (5249 in the control group and 117 in the proliferative lesion group). In the case of PCOS patients aged 20–39 years, the most effective screening threshold for AMH was found to be a serum AMH level of ≤5.39 ng/mL. The model used for this group was logit(p) = −2.562 − 0.430 × AMH + 0.127 × BMI + 1.512 × hypertension + 0.956 × diabetes −1.145 × regular menstruation. On the other hand, for non-PCOS women aged 20–39 years, the optimal screening threshold for AMH was determined to be a serum AMH value of ≤2.18 ng/mL. The model used for this group was logit(p) = −3.778 − 0.823 × AMH + 0.176 × BMI + 2.660 × diabetes −1.527 × regular menstruation −1.117 × dysmenorrhea. It is important to note that all of these findings have successfully passed internal verification. Conclusion: For PCOS and non-PCOS women aged 20–39 years, the serum AMH test and related multiple regression models were obtained for the warning of EPL. [ABSTRACT FROM AUTHOR]

This ethnobiological study addresses the complicated relationship between the Dard ethnic group and their natural environment in the Gurez region of the Kashmir Valley. The study documents their traditional knowledge of the use of plant species for medicinal and culinary purposes. A total of 87 plant species from 41 different families were cataloged, with the Asteraceae family (15 species) and the Lamiaceae family (12 species) being the most commonly used. These plants were found to be used to treat 20 different ailments, with menstrual cramps being the most common (12 species). The fidelity values for these plants ranged from 11.10 to 71.42, demonstrating their importance in traditional medicine. In addition, 17 plant species were found to be useful for gastronomic purposes, with Juglans regia being the most valuable (use value of 0.73). The study also evaluated the conservation status of these plants and found that seven of them are considered critically endangered, ten endangered, and four endangered according to the IUCN classification. This study offers insights into the Dard people's deep connection to their natural environment and has significant implications for policy formulation, cultural conservation, and sustainable use of endemic species, as well as potential applications in pharmaceutical research for therapeutic compounds. [ABSTRACT FROM AUTHOR]

Endometriosis affects approximately 10% of premenopausal women worldwide. Despite its impact on quality of life, the delay in diagnosing this chronic disease is well known. Many patients with endometriosis report having suffered from dysmenorrhea and chronic pelvic pain in adolescence or at a young age. However, this painful symptom is often highly underestimated and considered a normal and transient symptom in young women. The real prevalence of endometriosis in adolescence remains uncertain. Some authors recently described at least one ultrasound feature of endometriosis in 13.3% of a general population of adolescent girls, which increased to 35.3% in young girls with severe dysmenorrhea. Dysmenorrhea is classified as primary dysmenorrhea or secondary dysmenorrhea. Primary dysmenorrhea is defined as a menstrual pain without organic disease, while secondary dysmenorrhea is defined as a menstrual pain associated with organic pelvic pathology. Since endometriosis represents the main cause of secondary dysmenorrhea in adolescents and young women, it is important to determine whether the patient has primary dysmenorrhea or additional suggestive symptoms related to endometriosis. Endometriosis in adolescent patients is a challenging problem with clinical and pathological differences compared with its presentation in premenopausal women. Adolescents and young women with dysmenorrhea and painful symptoms that suggest endometriosis should be referred to dedicated endometriosis centers for an early diagnosis and appropriate medical and surgical management. This paper aims to describe the role of dysmenorrhea in adolescents and the management of these young patients to confirm or exclude endometriosis. [ABSTRACT FROM AUTHOR]

The use of medicinal plants to treat inflammatory conditions and painful processes has attracted the attention of scientists and health professionals due to the evidence that natural products can promote significant therapeutic benefits associated with fewer adverse effects compared to conventional anti-inflammatory drugs. The genus Plectranthus is composed of various plants with pharmacological potential, which are used to treat various diseases in traditional communities worldwide. The present study systematically reviewed Plectranthus species with anti-inflammatory and analgesic potential. To this end, a systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The search was conducted on the following databases: PubMed, ScienceDirect, SciVerse Scopus, and Web of Science. Different combinations of search terms were used to ensure more excellent article coverage. After the selection, a total of 45 articles were included in this review. This study identified twelve Plectranthus species indicated for the treatment of different inflammatory conditions, such as wounds, fever, bronchitis, abscess, asthma, hepatitis, labyrinthitis, tonsillitis, and uterine inflammation. The indications for pain conditions included headache, sore throat, heartburn, menstrual cramp, colic, toothache, stomachache, migraine, chest pain, abdominal pain, local pain, labor pain, and recurring pain. Among the listed species, ten plants were found to be used according to traditional knowledge, although only four of them have been experimentally studied. When assessing the methodological quality of preclinical in vivo assays, most items presented a risk of bias. The SR results revealed the existence of different Plectranthus species used to treat inflammation and pain. The results of this systematic review indicate that Plectranthus species have the potential to be used in the treatment of diseases with an inflammatory component, as well as in the management of pain. However, given the risk of biases, the experimental analysis of these species through preclinical testing is crucial for their safe and effective use. [ABSTRACT FROM AUTHOR]

Endometriosis is a gynecological disorder prevalent in women of reproductive age. The primary symptoms include dysmenorrhea, irregular menstruation, and infertility. However, the pathogenesis of endometriosis remains unclear. With the advent of high-throughput technologies, various omics experiments have been conducted to identify genes related to the pathophysiology of endometriosis. This review highlights the molecular mechanisms underlying endometriosis using omics. When genes identified in omics experiments were compared with endometriosis disease genes identified in independent studies, the number of overlapping genes was moderate. However, the characteristics of these genes were found to be equivalent when functional gene set enrichment analysis was performed using gene ontology and biological pathway information. These findings indicate that omics technology provides invaluable information regarding the pathophysiology of endometriosis. Moreover, the functional characteristics revealed using enrichment analysis provide important clues for discovering endometriosis disease genes in future research. [ABSTRACT FROM AUTHOR]

Adenomyosis is a commonly diagnosed benign condition characterized by the presence of ectopic endometrial glands within the underlying myometrium. The most common presenting signs and symptoms are abnormal uterine bleeding, chronic pelvic pain, and infertility. The clinical relevance of this condition is evident in both medical and surgical care. Histopathology and imaging studies are used for the diagnosis and classification of adenomyosis, which are hallmarks of the advancement of our ability to diagnose adenomyosis. Importantly, the diagnosis and classification of adenomyosis lacks standardization due to the nature of imaging techniques, features of adenomyosis, and the clinical spectrum of adenomyosis. We reviewed the literature to summarize the available classification systems for adenomyosis and highlight the different imaging approaches and histologic criteria used in diagnosis. Despite the high prevalence of the disease, there is no clear consensus on one classification system. We provide a review of some of the classification systems available and discuss their strengths and limitations. [ABSTRACT FROM AUTHOR]

The effect of Pilates on dysmenorrhea has been little studied. The purpose of this study was to evaluate the effect of Pilates on menstrual pain and symptoms, premenstrual syndrome, and risk factors of dysmenorrhea. Thirty young women with primary dysmenorrhea were randomly assigned into a Pilates group (PG; n = 15) and a waitlist control group (CG; n = 15). The Pilates was performed twice a week for 12 weeks. Menstrual pain and symptoms were measured by visual analogue scale (VAS) and the Cox menstrual symptom scale (CMSS), respectively. Premenstrual syndrome was assessed using the premenstrual symptoms screening tool (PSST). Additionally, back flexibility, hip muscle strength, sleep duration and quality, perceived stress, state-trait anxiety, and depression were evaluated. The VAS, CMSS severity and frequency, and PSST symptoms and functional impairments decreased in the PG compared to the CG (p < 0.001 or p < 0.01) with large effect sizes. Back flexibility and the strength of hip flexors, hip extensors, and hip abductors significantly increased in the PG compared to the CG (all p < 0.01) with large effect sizes. Sleep quality (p < 0.01) and stress (p < 0.05) improved in the PG. Sleep duration, anxiety, and depression did not change in either group. In conclusion, the 12-week Pilates intervention ameliorates dysmenorrhea, partly mediated by improved physical function and sleep quality. [ABSTRACT FROM AUTHOR]

Objectives: Are other pain symptoms in addition to dysmenorrhea, dyspareunia, dyschezia, dysuria, and chronic pelvic pain correlated to endometriosis and suitable for a clinical prediction model? Methods: We conducted a prospective study from 2016 to 2022, including a total of 269 women with numerous pain symptoms and other parameters. All women filled out two questionnaires and were examined by palpation and transvaginal ultrasound (TVUS). In cases of suspected deep endometriosis, magnetic resonance imaging (MRI) was performed. After the operation, endometriosis was diagnosed by histological examination. Results: All in all, 30 significant parameters and 6 significant numeric rating scale (NRS) scores associated with endometriosis could be identified: 7 pain adjectives, 8 endometriosis-associated pain symptoms, 5 pain localizations, 6 parameters from the PainDETECT, consumption of analgesics, and allergies. Furthermore, longer pain duration (before, during, and after menstruation) was observed in women with endometriosis compared to women without endometriosis (34.0% vs. 12.3%, respectively). Although no specific pain for endometriosis could be identified for all women, a subgroup with endometriosis reported radiating pain to the thighs/legs in contrast to a lower number of women without endometriosis (33.9% vs. 15.2%, respectively). Furthermore, a subgroup of women with endometriosis suffered from dysuria compared to patients without endometriosis (32.2% vs. 4.3%, respectively). Remarkably, the numbers of significant parameters were significantly higher in women with endometriosis compared to women without endometriosis (14.10 ± 4.2 vs. 7.75 ± 5.8, respectively). A decision tree was developed, resulting in 0.904 sensitivity, 0.750 specificity, 0.874 positive predictive values (PPV), 0.802 negative predictive values (NPV), 28.235 odds ratio (OR), and 4.423 relative risks (RR). The PPV of 0.874 is comparable to the positive prediction of endometriosis by the clinicians of 0.86 (177/205). Conclusions: The presented predictive model will enable a non-invasive diagnosis of endometriosis and can also be used by both patients and clinicians for surveillance of the disease before and after surgery. In cases of positivety, as evaluated by the questionnaire, patients can then seek advice again. Similarly, patients without an operation but with medical therapy can be monitored with the questionnaire. [ABSTRACT FROM AUTHOR]

Dysmenorrhea causes pain and inconvenience during menstruation. In addition to medication, natural compounds are widely used to relieve various types of pain. In this study, we aimed to assess the effects of vitamin D (vit. D) supplementation in relieving the symptoms of primary dysmenorrhea. A comprehensive systematic database search of randomized controlled trials (RCTs) was performed. Oral forms of vit. D supplementation were included and compared with a placebo or standard care. The degree of dysmenorrhea pain was measured with a visual analogue scale or numerical rating scale. Outcomes were compared using the standardized mean difference (SMD) and 95% confidence intervals (CIs) in a meta-analysis. RCTs were assessed using the Cochrane risk-of-bias v2 (RoB 2) tool. The meta-analysis included 8 randomized controlled trials involving 695 participants. The results of the quantitative analysis showed a significantly lower degree of pain in the vit. D versus placebo in those with dysmenorrhea (SMD: −1.404, 95% CI: −2.078 to −0.731). The results of subgroup analysis revealed that pain lessened when the average weekly dose of vit. D was over 50,000 IU, in which dysmenorrhea was relieved regardless of whether vit. D was administered for more or less than 70 days and in any dose interval. The results revealed that vit. D treatment substantially reduced the pain level in the primary dysmenorrhea population. We concluded that vit. D supplementation is an alternative treatment for relieving the pain symptoms of dysmenorrhea. [ABSTRACT FROM AUTHOR]

Primary dysmenorrhea is a common menstrual disorder that significantly impacts women's quality of life, productivity, and healthcare utilization. In this randomized, double-blinded, placebo-controlled trial, sixty women with primary dysmenorrhea were randomly divided into two groups with thirty participants each, and were allocated either turmeric–boswellia–sesame formulation (treatment) or placebo. The participants were advised to take two softgels of 500 mg as a single dose of allocated study intervention (total dose 1000 mg) when their menstrual pain reached 5 or more on a numerical rating scale (NRS). Menstrual cramp pain intensity and relief were evaluated every 30 min post-dose until 6 h. Results indicated a promising role of turmeric–boswellia–sesame formulation for menstrual pain relief compared to the placebo. The mean total pain relief (TOTPAR) of the treatment group (18.9 ± 0.56) was found to be 12.6 times better than the placebo group (1.5 ± 0.39). The NRS analysis showed that there was a statistically significant difference in pain intensity between the treatment and placebo groups (p < 0.001) at every timepoint. Additionally, the sum of pain intensity difference at 6 h (SPID6) of the treatment group (34.32 ± 1.41) showed a significant difference (p < 0.0001) and was 20.19 times better when compared to placebo (1.7 ± 0.56). Based on the study results, the turmeric–boswellia–sesame formulation exhibited remarkable menstrual pain relief as compared to the placebo. [ABSTRACT FROM AUTHOR]

Background: Primary dysmenorrhea is considered to be one of the most common gynecological complaints, affecting women's daily activities and social life. The severity of dysmenorrhea varies among women, and its management is of high importance for them. Given that non-steroidal anti-inflammatory drugs (NSAIDs), the established treatment for dysmenorrhea, are associated with many adverse events, alternative therapeutic options are under evaluation. Emerging evidence correlates management of dysmenorrhea with micronutrients, especially vitamins. Purpose: The aim of this narrative review is to highlight and provide evidence of the potential benefits of vitamins for the management of dysmenorrhea. Methods: The articles were searched on PubMed, Scopus and Google Scholar. The searching process was based on keywords, such as "primary dysmenorrhea", "vitamins", "supplementation", "vitamin D", "vitamin E" and others. Our search focused on data derived from clinical trials, published only during the last decade (older articles were excluded). Results: In this review, 13 clinical trials were investigated. Most of them supported the anti-inflammatory, antioxidant and analgesic properties of vitamins. Particularly, vitamins D and E revealed a desirable effect on dysmenorrhea relief Conclusion: Despite the scarcity and heterogeneity of related research, the studies indicate a role of vitamins for the management of primary dysmenorrhea, proposing that they should be considered as alternative therapeutic candidates for clinical use. Nevertheless, this correlation warrants further research. [ABSTRACT FROM AUTHOR]

Background: Adhesions after endometriosis resection are frequent and the most common causes for chronic pain and secondary infertility. Primary results of our randomized controlled trial (RCT) on adhesion prevention after deep infiltrating endometriosis (DIE) resection using the gel barrier 4DryField® PH showed 85% adhesion reduction in second-look surgeries. Secondary endpoint data on fertility and pain development were collected during 12-month follow-ups. Methods: This RCT comprised 50 patients. Preoperatively and after 1, 6 and 12 months, pain scores for cycle-independent pelvic pain, dysmenorrhea, dyspareunia, dyschezia, and dysuria, as well as the number of pregnancies, were recorded,. Results: The pregnancy rate in the intervention group was significantly higher (p < 0.05). Pain development was also improved: after 12 months, all 5 subscores were lower in the intervention group and improvements were more pronounced, most prominently concerning cycle-independent pelvic pain and dysmenorrhea, the two subcategories with the highest preoperative scores and, therefore, the highest relevance for the patients. Cycle-independent pelvic pain even recurred in the control group, while barrier application prevented this. Conclusions: Considering the known causal link between adhesions and pain, it is apparent that the favourable outcomes in the intervention group are linked to effective adhesion prevention. The significant increase in pregnancies is remarkable. [ABSTRACT FROM AUTHOR]

Endometriosis-associated pain is an essential factor in deciding surgical indications of endometriosis. However, there is no quantitative method to diagnose the intensity of local pain in endometriosis (especially deep endometriosis). This study aims to examine the clinical significance of the pain score, a preoperative diagnostic scoring system for endometriotic pain that can be performed only with pelvic examination, devised for the above purpose. The data from 131 patients from a previous study were included and evaluated using the pain score. This score measures the pain intensity in each of the seven areas of the uterus and its surroundings via a pelvic examination using a numeric rating scale (NRS) which contains 10 points. The maximum value was then defined as the max pain score. This study investigated the relationship between the pain score and clinical symptoms of endometriosis or endometriotic lesions related to deep endometriosis. The preoperative max pain score was 5.93 ± 2.6, which significantly decreased to 3.08 ± 2.0 postoperatively (p = 7.70 × 10−20). Regarding preoperative pain scores for each area, those of the uterine cervix, pouch of Douglas, and left and right uterosacral ligament areas were high (4.52, 4.04, 3.75, and 3.63, respectively). All scores decreased significantly after surgery (2.02, 1.88, 1.75, and 1.75, respectively). The correlations between the max pain score and dysmenorrhea, dyspareunia, perimenstrual dyschezia (pain with defecation), and chronic pelvic pain were 0.329, 0.453, 0.253, and 0.239, respectively, and were strongest with dyspareunia. Regarding the pain score of each area, the combination of the pain score of the pouch of Douglas area and the VAS score of dyspareunia showed the strongest correlation (0.379). The max pain score in the group with deep endometriosis (endometrial nodules) was 7.07 ± 2.4, which was significantly higher than the 4.97 ± 2.3 score obtained in the group without (p = 1.71 × 10−6). The pain score can indicate the intensity of endometriotic pain, especially dyspareunia. A local high value of this score could suggest the presence of deep endometriosis, depicted as endometriotic nodules at that site. Therefore, this method could help develop surgical strategies for deep endometriosis. [ABSTRACT FROM AUTHOR]

Adenomyosis is a common benign gynecologic condition characterized by ectopic endometrial glands and stroma in the myometrium causing pain (dysmenorrhea) and abnormal uterine bleeding. New interventional techniques have been introduced over recent years. This study evaluates the treatment success and side effects of radiofrequency ablation. An electronic literature search in the PubMed, Scopus, and ScienceDirect databases was carried out on the outcomes of pain reduction and, secondarily, on abnormal uterine bleeding, reintervention, reproductive outcome, imaging outcome, and complications. There was a mean decrease in dysmenorrhea pain scores by −63.4 ± 9.0% at 12 months. Data on other outcome parameters were sparse. No major complications were reported. Radiofrequency ablation represents a promising minimally invasive and organ-preserving treatment in patients with symptomatic adenomyosis. It is associated with clinically meaningful improvement of adenomyosis-related pain in the short term. [ABSTRACT FROM AUTHOR]

Cystic adenomyosis is a rare type of uterine adenomyosis, mainly seen in young women, which is often characterized by severe dysmenorrhea. The quality of life and reproductive function of young women could be affected by misdiagnosis and delayed treatment. At present, there are no universal guidelines and consensus. We report two cases of patients with cystic adenomyosis in juveniles treated with high-intensity focused ultrasound (HIFU) ablation. In the first case, magnetic resonance imaging (MRI) indicated a cystic mass of 2.0 cm × 3.1 cm × 2.4 cm in the uterus. After she underwent HIFU treatment, her pelvic MRI showed a mass of 1.1 × 2.4 cm in size, and her dysmenorrhea symptoms gradually disappeared. In the second case, a pelvic MRI indicated a 5.1 cm × 3.3 cm × 4.7 cm cystic mass in the uterus. After she underwent HIFU and combined four consecutive cycles of GnRH-a treatment, the lesion shrunk 1.2 cm ×1.4 cm × 1.6 cm, without dysmenorrhea. Simultaneously, the report reviewed 14 cases of juvenile cystic adenomyosis over the last ten years. HIFU or HIFU-combined drugs were safe and effective in treating juvenile cystic adenomyosis, but multicenter and prospective studies may be necessary to validate this in the future. [ABSTRACT FROM AUTHOR]

Recently, the employment rate of women in Japan has steadily increased. Approximately 80% of women experience menstrual pain and premenstrual syndrome (PMS). These symptoms decrease a woman's quality of life and her work productivity, leading to an economic loss. This cross-sectional study of 321 healthy Japanese women aged 20–39 years aimed to clarify the lifestyle-related factors or nutrient intake that might cause menstrual pain. The participants underwent body composition measurements and completed meal survey sheets and lifestyle questionnaires, including menstrual status, exercise, sleep and breakfast consumption. Based on the questionnaire results, participants were divided into two groups according to the severity of menstrual pain, namely, heavy and light. Chi-square and Wilcoxon signed-rank sum tests were used to compare the severity of menstrual pain in the two groups. In the heavy group, the intake of animal proteins, including fish, vitamin D and vitamin B12, was significantly lower (p < 0.05), as was the frequency of breakfast consumption and bathing (p < 0.05). The rate of PMS symptoms was significantly higher in the heavy group (p < 0.05). This study suggests that a lack of animal protein, the accompanying vitamins and fatty acids, and the frequency of breakfast or bathing are associated with the severity of menstrual pain. [ABSTRACT FROM AUTHOR]

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is often associated with various other syndromes or conditions including mast cell activation (MCA), dysmenorrhea and endometriosis, postural tachycardia (POTS) and small fiber neuropathy (SFN). The causes of these syndromes and the reason for their frequent association are not yet fully understood. We previously published a comprehensive hypothesis of the ME/CFS pathophysiology that explains the majority of symptoms, findings and chronicity of the disease. We wondered whether some of the identified key pathomechanisms in ME/CFS are also operative in MCA, endometriosis and dysmenorrhea, POTS, decreased cerebral blood flow and SFN, and possibly may provide clues on their causes and frequent co-occurrence. Our analysis indeed provides strong arguments in favor of this assumption, and we conclude that the main pathomechanisms responsible for this association are excessive generation and spillover into the systemic circulation of inflammatory and vasoactive tissue mediators, dysfunctional β2AdR, and the mutual triggering of symptomatology and disease initiation. Overall, vascular dysfunction appears to be a strong common denominator in these linkages. [ABSTRACT FROM AUTHOR]

Education about menstruation is a sensitive topic for young female students; providing appropriate knowledge is essential for maintaining and improving their health. The present study was conducted to collect data corresponding to different factors affecting health among young individuals; the menstrual status, exercise habits, sleep status, and body composition of these individuals as well as the relationships among these factors, were evaluated. Altogether, 200 female students responded to the survey; 129 completed all the physical measurement items. As a case study, face-to-face interviews regarding menstrual symptoms were conducted. Results showed that 49/200 (25%) and 120/200 (60%) participants experienced moderate or severe pain before and during menstruation, respectively. The degree of pain one week before menstruation and during menstruation were significantly positively correlated (r = 0.573, p < 0.01). When analyzed as group data, it was difficult to identify the relationship between menstrual status, exercise habits, and sleep status; these were found to be intricately associated with various factors. The case study analysis confirmed that some individuals experienced physical and psychological symptoms, such as irregular menstrual cycles, premenstrual syndrome, and severe menstrual cramps. [ABSTRACT FROM AUTHOR]

(1) Despite its high prevalence, the diagnostic delay of endometriosis is still estimated to be about 7 years. The objective of the present study is to understand the symptomatology of endometriosis in patients across various countries and to assess whether the severity of symptoms correlates with the diagnosed stage of disease. (2) An international online survey collected self-reported responses from 2964 participants from 59 countries. Finalization of the questionnaire and its distribution was achieved by cooperation with various organizations and centers around the globe. (3) Chronic pain presentation remarkably increased between Stage 1 and 2 (16.2% and 32.2%, respectively). The prevalence of pain only around and during menstruation was negatively correlated to the stage, presenting with 15.4% and 6.9% in Stages 1 and 4, respectively. Atypical presentation of pain was most commonly reported in stage 4 (11.4%). Pain related solely to triggering factors was the most uncommon presentation of pain (3.2%). (4) Characteristics of pain and quality of life tend to differ depending on the reported stage of the endometriosis. Further research may allow a better stage estimation and identification of patients with alarming symptomatic presentation indicative of a progressive stage, even those that are not yet laparoscopically diagnosed. [ABSTRACT FROM AUTHOR]

Background: Diagnostic and treatment delays have caused significant impacts on the physical and emotional well-being of adolescents with endometriosis, though such research is limited. This study aimed to assess the effects of one-year dienogest therapy on the clinical picture, pain patterns, psycho-emotional status, and quality-of-life indicators in adolescents with endometriosis after surgical treatment. Methods: The study enrolled 32 girls aged 13–17 with peritoneal endometriosis to analyze one-year dynamics of the Visual Analog Scale (VAS), McGill Pain Questionnaire, Beck Depression Scale (BDI), Hospital Anxiety and Depression Scale (HADS), Spielberger State-Trait Anxiety Inventory (STAI) and SF-36 quality-of-life survey scores along with clinical and laboratory indicators before surgery and after one-year dienogest therapy. Results. The therapy provided a significant alleviation of endometriosis-associated clinical symptoms, including dysmenorrhea, pelvic pain, gastrointestinal/dysuria symptoms, decreased everyday activity (<0.001), a decrease in anxiety/depression scores (BDI, HADS, STAI), and quality-of-life improvement (<0.001). These effects were accompanied by beneficial dynamics in hormone and inflammatory markers (prolactin, cortisol, testosterone, estradiol, CA-125, neutrophil/lymphocyte ratio; <0.005) within reference ranges. A low body mass index and high C-reactive protein levels were associated with higher VAS scores; a high estradiol level was a factor for anxiety/depression aggravation (<0.05). Conclusions: Dienogest, after surgical treatment, significantly improved quality of life and reduced pain symptoms while showing good tolerability and compliance, and reasoning with timely hormonal therapy in adolescents with endometriosis. [ABSTRACT FROM AUTHOR]

Green tea is harvested from the tea plant Camellia sinensis and is one of the most widely consumed beverages worldwide. It is richer in antioxidants than other forms of tea and has a uniquely high content of polyphenolic compounds known as catechins. Epigallocatechin-3-gallate (EGCG), the major green tea catechin, has been studied for its potential therapeutic role in many disease contexts, including pathologies of the female reproductive system. As both a prooxidant and antioxidant, EGCG can modulate many cellular pathways important to disease pathogenesis and thus has clinical benefits. This review provides a synopsis of the current knowledge on the beneficial effects of green tea in benign gynecological disorders. Green tea alleviates symptom severity in uterine fibroids and improves endometriosis through anti-fibrotic, anti-angiogenic, and pro-apoptotic mechanisms. Additionally, it can reduce uterine contractility and improve the generalized hyperalgesia associated with dysmenorrhea and adenomyosis. Although its role in infertility is controversial, EGCG can be used as a symptomatic treatment for menopause, where it decreases weight gain and osteoporosis, as well as for polycystic ovary syndrome (PCOS). [ABSTRACT FROM AUTHOR]

Background: The early diagnosis of endometriosis in adolescents is not developed. Objective: We aim to conduct clinical, imaging, laparoscopic and histological analyses of peritoneal endometriosis (PE) in adolescents in order to improve early diagnosis. Methods: In total, 134 girls (from menarche to 17 years old) were included in a case–control study: 90 with laparoscopically (LS) confirmed PE, 44 healthy controls underwent full examination and LS was analyzed in the PE group. Results: Patients with PE were characterized with heredity for endometriosis, persistent dysmenorrhea, decreased daily activity, gastrointestinal symptoms, higher LH, estradiol, prolactin and Ca-125 (<0.05 for each). Ultrasound detected PE in 3.3% and MRI in 78.9%. The most essential MRI signs are as follows: hypointense foci, the heterogeneity of the pelvic tissue (paraovarian, parametrial and rectouterine pouch) and sacro-uterine ligaments lesions (<0.05 for each). Adolescents with PE mostly exhibit initial rASRM stages. Red implants correlated with the rASRM score, and sheer implants correlated with pain (VAS score) (<0.05). In 32.2%, foci consisted of fibrous, adipose and muscle tissue; black lesions were more likely to be histologically verified (0.001). Conclusion: Adolescents exhibit mostly initial PE stages, which are associated with greater pain. Persistent dysmenorrhea and detected MRI parameters predict the laparoscopic confirmation of initial PE in adolescents in 84.3% (OR 15.4; <0.01), justifying the early surgical diagnostics and shortening the time delay and suffering of the young patients. [ABSTRACT FROM AUTHOR]

Endometriosis is a chronic disease, in which endometrial-like tissue is found outside the uterine cavity. Lesions are typically located in the true pelvis but can be found, in addition to extragenital endometriosis, in the respiratory system, the diaphragm, the pleura or the pericardium. As the extrauterine endometrial lesions undergo the menstrual cycle, they cause many symptoms, including pain, and besides infertility, they all mostly affect the quality of the patient's life. Pharmacological management of endometriosis significantly increases in importance either as a first-line treatment or as a complementary therapy after surgery. Yet, current research on antagonists of the gonadotropin-releasing hormone (GnRH) has revealed their potential benefits in endometriosis treatment. Their mechanism of action is to down-regulate the hypothalamic–pituitary–gonadal axis and therefore induce a hypoestrogenic state. The resulting reduction of estrogen levels prevents disease progression and diminishes the recurrence rate after surgical removal of endometriosis. The present review summarizes recent reports of the role oral GnRH antagonists have as a significant treatment option for pain reduction in endometriosis patients. [ABSTRACT FROM AUTHOR]