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Dysmenorrhea, or painful uterine contractions during menstruation in women, is a common condition. It may affect up to 90% of patients in a doctor's office. Depending on the severity of symptoms, it may cause discomfort or prevent normal functioning in everyday life. Some women do not realize that this is not a normal symptom during menstruation. Unfortunately, lack of exercise, smoking, or drinking alcohol only increases the symptoms. A medical history and physical examination of the patient are important steps in finding the cause. Primary dysmenorrhea is primarily associated with the pathogenesis of prostaglandins and leukotrienes, which generate inflammation and pain. However, it has nothing to do with pelvic pathology. It usually first appears in young women during puberty, up to 24 months after their first period. If the history and physical examination are not clear about the primary cause of pain, a secondary cause should be considered. For this purpose, a transvaginal ultrasound examination should be performed. The most common secondary pathology is endometriosis. In the treatment of primary and secondary diseases, physical exercises and warm compresses are beneficial, which women are often unaware of. First-line pharmacological treatment may include NSAIDs or combined oral estrogen-progestogen hormonal therapy. The purpose of this review is to provide knowledge about the symptoms, risk factors, diagnosis, and treatment of dysmenorrhea.

The aim of this systematic review was to identify the current state of knowledge on the association between susceptibility genes associated with this disorder and the lifestyle of patients (including diet, habits and stress levels). It also highlighted the advances made in this field of study, from a constructive point of view, and pointed out the perspectives for research into this disorder. Dysmenorrhoea, as a primary and secondary disorder, is one of the main causes of partial or total disability in the life cycle of women, both in reproductive age and later. It is recognised as a painful and disabling disorder which, depending on the cultural context, may or may not be cured by medical care, physiotherapy and the use of pain-relieving drugs, from an unknown aetiology (primary dysmenorrhoea) or concomitantly to surgical intervention (secondary dysmenorrhoea). Lifestyle, habits and diet have been identified as related to the intensity of pain and the disability it causes (active or passive use of cigarettes, consumption of alcohol, etc.), and genes related to the interpretation of pain generated by the patient from the morphology of the hypothalamus and the associative function of pain (BNDF Val66Met polymorphism) have been identified, as well as alterations in cytokines (in primary dysmenorrhoea), prostaglandins and an influence of the Cyp1A1 gene (in passive smokers). The study perspective is usually non-integrative and limited to the site studied, as well as to professional, laboratory, imaging (gynaecological and genetic) and/or molecular resources, which can only in a few cases be of an integral approach. Limitations are compounded by the fact that not all the populations studied are usually educated about menstruation, which also limits compatibility and comparability among studies.

The World Health Organization estimates dysmenorrhea as the most important cause of a chronic pelvic pain. Its prevalence among adolescents and young women ranges from 40 % to 90 %, and varies, depending on age, country of residence and population density of the area. Primary dysmenorrhea is responsible for reducing the quality of life, absenteeism in the workplace or at school, refusing to participate in community and sporting events, changing of pain perception and sleep disturbance. There is evidence of its relationship with an early menarche, a family history, a length of the menstrual cycle, bad habits, poor sleep hygiene, an unbalanced diet, sedentary lifestyle and obesity. Characteristic features of a personality contribute in a certain way, making women prone to neuroticism and pain catastrophizing to be more at risk of developing dysmenorrhea. Irritable bowel syndrome, musculoskeletal pain and interstitial cystitis often accompany dysmenorrhea and respond to its treatment positively. Despite the proven validity of nonsteroidal anti­inflammatory drugs treatment there are resistant forms of menstrual pain, those make a search for alternative therapy relevant.

Abstract Background The unicornuate uterus is caused by abnormal or failed development of one Müllerian duct. Unicornuate uteri with functioning non-communicating rudimentary horns are susceptible to many gynaecologic and obstetric complications such as hematometra, endometriosis and ectopic pregnancy and thus surgical resection is usually recommended.. Case presentation We report a rare case of a unicornuate right uterus with rudimentary non-communicating (functional) cavitary left horn (class U4a) in a 17-year-old girl who was diagnosed with VACTERL association. She was presented to our centre with 3 years history of secondary sever dysmenorrhea. Pelvic magnetic resonance imaging revealed a normal uterus on the right side, a 7 × 8 cm left endometrioma, a tortuous dilated fluid-filled structure in the left hemipelvis, mostly represented left-sided hematosalpinx, and a well-defined lesion with thick enhancing wall in the left hemipelvis measuring 6.7 × 5.7 × 5.6 cm with a similar enhancement to the uterus in the right. She underwent laparotomy that showed a right unicornuate uterus with a normal cervix and a rudimentary non-communicating distended left horn. In addition, there was a left endometrioma and left hematosalpinx. Resection of the left communicating horn, left salpingectomy and left ovarian cystectomy were performed. The right tube and both ovaries were preserved. At 9-months follow up, the patient had a regular period and the pain subsided completely. Conclusion We report yet the second case of VACTERL association and unicornuate uterus with non-communicating functional rudimentary horn, in hope of expanding the knowledge of a rare occurrence. This case also highlights the importance of considering the diagnosis of Müllerian duct anomalies in patients with a history of other anomalies, and/or history of early-age secondary dysmenorrhea.

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]

Endometriosis affects a significant proportion of teenagers. Published studies suggest that laparoscopically confirmed endometriosis could be found in over 60% of adolescent girls undergoing laparoscopic investigation for pain, in 75% of girls with chronic pelvic pain resistant to treatment and in 70% of girls with dysmenorrhea and in approximately 50% of girls with chronic pelvic pain not necessarily resistant to treatment. Both early and advanced forms, including deep endometriosis have been reported to be present in teenagers. It has recently been claimed that deep endometriosis has its roots in teenage years. Risk factors include obstructive mullerian anomalies, family history, early menarche and early onset dysmenorrhea. Both surgical and medical treatment approaches are used for treatment in this age group, but care should be taken when treatment with GnRHa and progestins is being considered due to their potential impact on bone formation. Further studies are urgently needed to determine whether early diagnosis and treatment of teenage endometriosis lead to better long term outcomes or simply increase number of interventions without preventing progression of the disease. [ABSTRACT FROM AUTHOR]

Objective Interstitial cystitis/bladder pain syndrome ( IC/ BPS) is a chronic disabling condition of the urological system. Many gynecological conditions are reported to be associated with IC/ BPS. This study presents epidemiological evidence of a possible association between dysmenorrhea and IC/ BPS, using population-based data. Design A case-control study. Setting Taiwan. Sample The study sample was retrieved from Taiwan's Longitudinal Health Insurance Database 2000, i.e. 291 women aged 18-45 years with a diagnosis of IC/ BPS between January 2000 and December 2010 (cases) and 873 randomly selected controls matched on age and index date of ambulatory care visit. We used logistic regression conditioned on age to calculate the odds ratio of cases having a prior diagnosis of dysmenorrhea relative to controls. Results Prior dysmenorrhea was found in 87 (29.9%) cases and in 163 (18.7%) of the controls. Conditional logistic regression showed a crude odds ratio of 1.86 (95% confidence interval 1.37-2.52, p < 0.001) for prior dysmenorrhea among cases vs. controls. The adjusted odds ratio was 1.59 (95% confidence interval 1.13-2.23, p = 0.007) after adjusting for medical co-morbidities. Conclusion This population-based study found that there is an association between IC/ BPS and prior dysmenorrhea. [ABSTRACT FROM AUTHOR]

Dysmenorrhea is the most common gynecologic complaint among adolescent females. Dysmenorrhea in adolescents is usually primary, and is associated with normal ovulatory cycles and with no pelvic pathology. In approximately 10% of adolescents with severe dysmenorrheic symptoms, pelvic abnormalities such as endometriosis or uterine anomalies may be found. Potent prostaglandins and leukotrienes play an important role in generating the symptoms of dysmenorrhea. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common pharmacologic treatment for dysmenorrhea. A loading dose of NSAIDs (typically twice the regular dose) should be used as initial treatment for dysmenorrhea in adolescents, followed by a regular dose until symptoms abate. Adolescents with symptoms that do not respond to treatment with NSAIDs for three menstrual periods should be offered hormonal treatment such as combined estrogen/progestin oral contraceptive pills for three menstrual cycles. Adolescents with dysmenorrhea who do not respond to this treatment should be evaluated for secondary causes of dysmenorrhea. The adolescent care provider's role is to explain the pathophysiology of dysmenorrhea to every adolescent female, address any concern that the patient has about her menstrual period, and review effective treatment options for dysmenorrhea with the patient. [ABSTRACT FROM AUTHOR]

Many women are familiar with the experience of dysmenorrhea, which can contribute to significant physical and emotional distress and life disruption. However, women may not seek professional expertise in their attempt to alleviate this condition. It is important to assess the beliefs and experiences of all women with dysmenorrhea, including adolescents, as early in gynecologic care as possible. This article reviews the management of primary dysmenorrhea. Midwives can provide valuable assistance to women in their explorations of the variety of treatment options available for the relief of dysmenorrhea, including lifestyle changes, complementary and alternative approaches, analgesics, and hormones. [Copyright &y& Elsevier]

Endometriosis is a common gynecological disease that causes marked physical and emotional distress in lives of women, resulting in dysmenorrhea, pain, or both throughout the menstrual cycle in over 96% of cases. A multiple case study design (N = 5) was employed to investigate the use of thermal biofeedback in the treatment of pain associated with endometriosis. The majority of participants (4 out of 5) were able to demonstrate mastery over hand temperature through thermal biofeedback. Of those participants, significant reductions in various aspects of pain were observed by the end of the study; one had a significant increase in Life Control; two had reductions in Pain Severity; three had a decrease in Affective Distress; and all 4 demonstrated reduction in Life Interference, as measured by the West Haven-Yale Multidimensional Pain Inventory. This is a preliminary study with a small sample size and without a control sample; hence, the results are considered only as suggestive of the potential use of biofeedback therapy in alleviating pain and associated symptomatology related to endometriosis. Further research is warranted. [ABSTRACT FROM AUTHOR]