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Congenital uterine anomalies are an uncommon type of female genital malformations caused by abnormal development of müllerian ducts during embryogenesis. Patients with an obstructive uterine anomaly have a higher risk of developing gynecological and obstetric complications that may present at menarche or later in life. We present a case of severe dysmenorrhea in a young teenager caused by obstructive hematometra in a noncommunicating horn of the unicornuate uterus. A differential diagnosis of a possible anomaly was made using 2-dimensional pelvic ultrasonography, which was later confirmed using MRI that revealed an anomalous uterine cavity with a single left-sided cornua communicating with the cervix and a distended right-sided rudimentary horn. She underwent a right salpingectomy with rudimentary horn excision, which was successfully managed laparoscopically. This case emphasizes the importance of physicians being cognizant in identifying patients with uterine anomaly to provide appropriate treatment and prevent adverse reproductive outcomes.

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., По оценкам Всемирной организации здравоохранения, дисменорея является наиболее важной причиной хронической тазовой боли. Ее распространенность среди подростков и молодых женщин колеблется от 40 до 90 % и варьирует в зависимости от возраста, страны проживания и густоты населенности местности. Первичная дисменорея ответственна за снижение качества жизни, отсутствие на работе или в школе, отказ от участия в общественных и спортивных мероприятиях, изменение восприятия боли и нарушения сна. Имеются данные о ее взаимосвязи с ранним менархе, отягощенным семейным анамнезом, длительностью менструального цикла, вредными привычками, плохой гигиеной сна, несбалансированным питанием, малоподвижным образом жизни и ожирением. Определенную лепту вносят характерологические особенности личности, делая женщин, склонных к невротизации и катастрофизации боли, более подверженными риску развития дисменореи. Синдром раздраженного кишечника, мышечно­скелетная боль и интерстициальный цистит часто сопутствуют дисменорее и положительно реагируют на ее лечение. Несмотря на доказанную обоснованность терапии нестероидными противовоспалительными препаратами, встречаются резистентные формы менструальной боли, что делает актуальными поиски альтернативных методов лечения., За оцінками Всесвітньої організації охорони здоров'я, дисменорея є найважливішою причиною хронічного тазового болю. Її поширеність серед підлітків і молодих жінок коливається від 40 % до 90 % і варіює залежно від віку, країни проживання та густоти населеності місцевості. Первинна дисменорея відповідальна за зниження якості життя, відсутність на роботі або в школі, відмову від участі в громадських та спортивних заходах, зміну сприйняття болю і порушення сну. Є дані про її взаємозв’язок з раннім менархе, обтяженим сімейним анамнезом, тривалістю менструального циклу, шкідливими звичками, поганою гігієною сну, незбалансованим харчуванням, малорухливим способом життя й ожирінням. Певну лепту вносять характерологічні особливості особистості, роблячи жінок, схильних до невротизації й катастрофізації болю, більш схильними до ризику розвитку дисменореї. Синдром подразненого кишечника, м’язово­скелетний біль та інтерстиціальний цистит часто супроводжують дисменорею і позитивно реагують на її лікування. Незважаючи на доведену обґрунтованість терапії нестероїдними протизапальними препаратами, зустрічаються резистентні форми менструального болю, що робить актуальними пошуки альтернативних методів лікування.

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.

Secondary dysmenorrhea is frequently associated with dyspareunia. When the diagnostic workup is negative, its clinical management could be complex and a cause for concerned for the patient. We reported a case of a young woman who suffered from dyspareunia, dysmenorrhea and chronic pelvic pain. After symptoms progression and pharmacological therapy unresponsiveness, the gynaecologist referred the patient to an osteopath for the functional evaluation of the abdominal pevic area. The examination revealed the presence of pelvic, lumbosacral, and sacrococcygeal dysfunctions which, once treated, significatively reduced the severity of dysmenorrhea and dyspareunia. A multidisciplinary approach might be considered in case of suspected functional impairment. This should be carefully evaluated, considering the previous trauma history and the somatic dysfunctions on abdominal-pelvic fascia.

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

Background Although dysmenorrhea is not a life-threatening condition, it can cause a substantial burden on individuals and communities. There is no data on the prevalence of dysmenorrhea in Kuwait. This study aimed to estimate the prevalence of dysmenorrhea among female public high-school students in Kuwait and investigate factors associated with dysmenorrhea. Methods A cross-sectional study using multistage cluster sampling with probability proportional to size method was conducted on 763 twelfth grade female public high-school students (aged 16–21 years). We used face-to-face interview with a structured questionnaire to collect data on dysmenorrhea and presumed risk factors. Weight and height of the students were measured using appropriate weight and height scales in a standardized manner. The association between dysmenorrhea and potential risk factors was assessed using multiple logistic regression. Results The one-year prevalence of dysmenorrhea was found to be 85.6% (95%CI: 83.1–88.1%). Of the participants with dysmenorrhea, 26% visited a public or a private clinic for their pain and 4.1% were hospitalized for their menstrual pain. Furthermore, 58.2% of students with dysmenorrhea missed at least one school day and 13.9% missed at least one exam. Age of menarche (p-value = 0.005), regularity and flow of the menstrual period (p-value = 0.025, p-value = 0.009; respectively), and drinking coffee (p-value = 0.004) were significantly associated with dysmenorrhea in multivariable analysis. Conclusion Dysmenorrhea seems to be highly prevalent among female high-school students in Kuwait, resembling that of high-income countries. Because of the scale of the problem, utilizing school nurses to reassure and manage students with primary dysmenorrhea and referring suspected cases of secondary dysmenorrhea is recommended.

Background. Primary dysmenorrhea, defined as painful menstrual cramps originating in the uterus without underlying pathology, is a gynecological disease that affects quality of life and school success. Our goal was to determine the effect of anterior uterocervical angle on primary dysmenorrhea and disease severity. Methods. A total of 200 virgin adolescents, 16 to 20 years of age, were included in the study. The Andersch and Milsom scale was used to determine dysmenorrhea severity. Those with pathologies causing secondary dysmenorrhea were excluded from the study. Study subjects were grouped based on severity of pain. Demographic characteristics and uterocervical ultrasonographic measurements were compared among groups. Results. Of the 200 participants enrolled in the study, 50 were healthy controls and 150 had primary dysmenorrhea. Those with primary dysmenorrhea had a significant family history of primary dysmenorrhea compared with controls (P<0.001). Age (P=0.668), body mass index (P=0.898), menarche age (P=0.915), and length of menstrual cycles (P=0.740) were similar in all groups. The uterine corpus longitudinal axis, uterine corpus transverse axis, and uterine cervix longitudinal axis were also similar (P=0.359, P=0.279, and P=0.369, resp.). The mean uterocervical angle was 146.8 ± 6.0 in controls and 143.3 ± 7.3 in those with mild pain with no significant difference between the groups. In those with moderate pain, the mean uterocervical angle was 121.2 ± 7.3 compared with 101 ± 9.2 in those with severe pain, which was a significant difference. Additionally, there was also a significant difference in the uterocervical angle among those with mild, moderate, and severe pain (P<0.001). Conclusion. Our results indicate that a narrower anterior uterocervical angle is associated with primary dysmenorrhea and disease severity.

Menstrual disorders and abnormal uterine bleeding are common concerns of young women. Complaints include menses that are: too painful (dysmenorrhea), absent or occur irregularly (amenorrhea or oligoamenorrhea), or prolonged and heavy (menorrhagia, or excessive uterine bleeding). In providing optimal reproductive care, the medical provider must be able to distinguish between normal developmental patterns or symptoms requiring education and reassurance from pathologic conditions requiring prompt assessment and treatment. This article discusses the normal menstrual patterns seen in adolescent females and provides an evaluation and management approach to primary and secondary dysmenorrhea.

Unicornuate uterus with a rudimentary horn is a rare congenital Müllerian anomaly, which may lead to many obstetrical and gynaecological complications. This pathology occurs in approximately 1/100 000 women. A rudimentary horn forms due to insufficient development of the Müllerian duct. The diagnosis of this anomaly is usually delayed, as it remains asymptomatic until adolescence and its main symptom is dysmenorrhea.

We evaluated the effect of acupuncture on NSAID resistant dysmenorrhea related pain [measured according to Visual Analogue Scale (VAS)] in 15 consecutive patients. Pain was measured at baseline (T1), mid treatment (T2), end of treatment (T3) and 3 (T4) and 6 months (T5) after the end of treatment. Substantial reduction of pain and NSAID assumption was observed in 13 of 15 patients (87%). Pain intensity was significantly reduced with respect to baseline (average VAS = 8.5), by 64, 72, 60 or 53% at T2, T3, T4 or T5. Greater reduction of pain was observed for primary as compared with secondary dysmenorrhea. Average pain duration at baseline (2.6 days) was significantly reduced by 62, 69, 54 or 54% at T2, T3, T4 or T5. Average NSAID use was significantly reduced by 63, 74, 58 or 58% at T2, T3, T4 or T5, respectively, and ceased totally in 7 patients, still asymptomatic 6 months after treatment. Our findings suggest that acupuncture may be indicated to treat dysmenorrhea related pain, in particular in those subjects in whom NSAID or oral contraceptives are contraindicated or refused.

To study the frequency of problems related to menstruation in adolescent girls in urban region of Ukraine. Study includes 532 adolescent girls in the age group 15–17 years who had had menarche for at least one year at the time of study.It was detected that almost 20% of girls have irregular menstruation. Dysmenorrhea occurs in almost 62% of cases, harmonious development at age 15–17 years had less than 50% of girls.So general practitioners, pediatricians, adolescent gynecologists should be more active in diagnosis of dysmenorrhea at adolescence girl. One of the main preventive measures for adolescence girl’s management of dysmenorrhea is lifestyle modification, smoking cessation and exercises., Выполненное исследование изучало частоту проблем, связанных с менструацией, у проживающих в городских регионах Украины девушек-подростков. В исследование вошли 532 девочки-подростка в возрасте 15–17 лет, у которых были менструации в течение как минимум одного года до момента включения в исследование.Обнаружено, что почти 20% девушек имеют нерегулярные менструации. Дисменорея встречалась в почти 62% случаев, гармоничное развитие в возрасте 15–17 лет наблюдалось менее чем у 50% девочек.В связи с этим отмечено, что врачи общей практики, педиатры, подростковые гинекологи должны быть более активны в диагностике дисменореи у девочек-подростков. Одними из основных профилактических мер подростковой дисменореи являются изменение образа жизни, отказ от курения и физическая активность., Виконане дослідження вивчало частоту пов'язаних із менструацією проблем у дівчат-підлітків, які проживають у міських регіонах України. У дослідження увійшли 532 дівчинки-підлітка віком 15–17 років, у яких були менструації протягом щонайменше одного року до моменту включення в дослідження.Виявлено, що близько 20% дівчат мають нерегулярні менструації. Дисменорея зустрічалася у майже 62% випадків, гармонійний розвиток у віці 15–17 років спостерігався менш ніж у 50% дівчаток.У зв'язку з цим відзначено, що лікарі загальної практики, педіатри, підліткові гінекологи повинні бути активнішими в діагностиці дисменореї у дівчаток-підлітків. Одними з основних профілактичних заходів підліткової дисменореї є зміна способу життя, відмова від паління і фізична активність.

Dysmenorrhea is the most common gynecologic complaint among adolescents/young adults. Dysmenorrhea is usually primary and is associated with normal ovulatory cycles and with no pelvic pathology. Potent prostaglandins and potent leukotrienes play an important role in generating primary dysmenorrhea symptoms. Adolescents/young adults with severe dysmenorrhea symptoms may have pelvic abnormalities, such as endometriosis or uterine anomalies (secondary dysmenorrhea).This review provides an update on treatments and management strategies of dysmenorrhea in adolescents/young adults. Medical literature articles were retrieved using a Medline search on primary and secondary dysmenorrhea. Original articles from peer-reviewed journals were selected based on relevance.Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) is the preferred initial treatment for dysmenorrhea in nonsexually active adolescents/young adults. Adolescents/young adults with symptoms that do not respond to NSAIDs for three menstrual periods should be offered hormonal treatment, such as combined estrogen and progestin oral contraceptive pills (OCPs), for three menstrual cycles. If dysmenorrhea does not improve within 6 months of NSAIDs and OCPs, a laparoscopy is indicated to look for endometriosis, which is the most common reason for secondary dysmenorrhea.

This study aimed to evaluate the effects of noninvasive acupoint stimulation therapy with middle-frequency electrical waves on dysmenorrhea in young women.This randomized controlled trial enrolled 66 gynecology patients who had primary dysmenorrhea, which was defined as painful menstruation without pelvic pathology (secondary dysmenorrhea). Pathology was ruled out by gynecological ultrasound examination and serum concentration of CA-125. Subjects were randomly assigned to an experimental group (n=34) and control group (n=32). Main outcome measures included McGill Questionnaire Short-form and numerical rating scale for pain intensity. Acupuncture-like trancutaneous electrical nerve stimulation (AL-TENS) of middle-frequency (1000 Hz-10,000 Hz) was applied at Hegu (LI4) and Sanyinjiao (SP6) points in the experimental group twice weekly for 8 weeks; the control group received AL-TENS on nonacupoints. Pre- and postintervention results were recorded.Prior to AL-TENS intervention, no significant differences were found in pain scale and pain intensity between experimental and control groups. After AL-TENS intervention, average total pain score in the experimental group was significantly lower than in the control group (experimental group 2.9±1.2, control group 5.4±2.2; p0.001). Significant differences were observed between experimental and control groups in average change in pain scores between pre- and postintervention (experimental group 4.5±1.9, control group 1.39±2.0; p0.001). Pain severity at postintervention was also significantly different between groups (p0.001).Noninvasive electro-acupuncture stimulation therapy with middle-frequency electric waves applied at both Hegu (LI4) and Sanyinjiao (SP6) acupoints mitigates pain in dysmenorrhea.

To evaluate the effect on menstrual pain in women with primary and secondary dysmenorrhea of a novel 'frameless' intrauterine drug delivery system (IUS), FibroPlant-levonorgestrel (LNG) (Contrel Research, Belgium), releasing 14 microg of LNG per day. An ancillary objective was to evaluate the effect of the new IUS on menstrual blood loss.An open label, non-comparative ongoing pilot study. Eighteen insertions were performed in women between 16 and 52 years of age by the first author. Four insertions were performed in nulligravid women. Eight women were categorized as having primary dysmenorrhea and 10 as having secondary dysmenorrhea. Twelve women complained of heavy bleeding. Three women had significant fibroids and three were suspected to have adenomyosis.The trial covers a period from a minimum of 3 months up to 33 months. By the end of August 2001, 12 recruited women had at least 12 months' follow-up and six had between 3 months and 1 year. All women reported much reduced pain, or no pain at all, and strongly reduced bleeding which started as soon as 1 month after insertion of the FibroPlant-LNG IUS. There was one exception; this woman had significant fibroids. She reported much reduced bleeding but this was not as pronounced as in the other women in the study. All women are continuing to use the method.The results of this preliminary study suggest that the FibroPlant-LNG IUS, releasing 14 microg ofLNG per day, is a safe and effective method for the treatment of primary and secondary dysmenorrhea. The absence ofa frame is particularly advantageous in these women. Of significant added importance is the high effectiveness in reducing menstrual bleeding, a symptom often present in women with menstrual pain complaints, and the fact that the system provides effective contraception. The low daily release rate of LNG from the FibroPlant-LNG IUS results in a virtual absence of hormonal side-effects.

In two Norwegian industrial companies 234 women of menstruating age were examined by the industrial nurse with regard to menstrual complaints. Every second woman experienced pain, 23% had consulted a doctor previously, about 30% had to stay in bed, and about 30% had been absent from work recently due to dysmenorrhea. Although pain was prevalent in all age groups, there were age-specific differences in other complaints, such as headache and depression, which were more frequent among the older women. In a selected group of 32 women with severe complaints, the history and gynecological examination indicated secondary dysmenorrhea in only a few cases. Hormonal assays and endometrial biopsy indicated anovulatory cycles in 4 out of 12 women, in spite of dysmenorrhea.

Severe dysmenorrhea following sterilization may be due to the presence of a noncommunicating horn of a bicornuate uterus. Ultrasound examination should be made before a functional basis is considered for such pain.

A case of endometriosis of the bladder after cesarean section, presenting as secondary dysmenorrhea, is described. The clinical features and treatment of vesical endometriosis are discussed.