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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.

Introduction: In Indonesia, the incidence of dysmenorrhea is 64.25% consisting of primary dysmenorrhea amounted to 54.89% and secondary dysmenorrhea of 9.36%. Some women experienced menstrual pain or cramps, also known as dysmenorrhea. The purpose of this research was to find out the effect of abdominal massage effleurage on decreasing the pain scale of primary dysmenorrhea. Method: Systematic review using the database: Google Scholar. The search results that meet the criteria were then analyzed for articles. Result: Primary dysmenorrhea pain could be relieved by massage techniques such as abdominal effleurage massage. Conclusion: To deal with dysmenorrhea pain, it is advisable for young women not to consume it immediately pharmacological drugs but using massage therapy such as massage effleurage abdomen.

Dysmenorrhea is the cramping, pain and other discomfort associated with menstruation. The incidence of menstrual pain in the world is very high, it is said that because it is estimated that> 50% of women in all countries experience menstrual pain. In Indonesia, the incidence of dysmenorrhea is 64.25% consisting of 54.89% primary dysmenorrhea and 9.36% secondary dysmenorrhea. This study aims to determine the effect of lavender aromatherapy candles on the level of primary dysmenorrhea in female students of SMA Negeri 1 Kotamobagu. This study used a pre-experimental research type, with one group pretest-posttest design. Determination of the sample in this study using non-probability sampling with total sampling technique, where the sample in this study were all female students who experienced primary dysmenorrhea in class XI IPA A and XI IPA B, totaling 24 people. The analysis used was univariate and bivariate, where the relationship test was performed using the Wilcoxon statistical test. The instrument used was the Numeric Rating Scale (NRS). Samples were given lavender aromatherapy candles for 60 minutes when they felt menstrual pain. The results of this study indicate the value of ρ = 0.000, where the value of ρ

Background: Dysmenorrhea can be primary or secondary. The causes of secondary dysmenorrhea are uterine and vaginal anomalies, menstrual outflow obstructions, endometriosis, adenomyosis and uterine ...

Dysmenorrhea is pain during menstruation, usually with felt cramp and concentrated in the lower abdomen. Pain complaints from mild to severe. Based on the causes, dysmenorrhea was divided into two, namely primary and secondary dysmenorrhea. The method to treat dysmenorrhea was used painkillers, take a rest, take a deep breath, calm down, exercise lightly, eat vegetables and fruits, compress the pain parts with hot water. One of nonfarmacology method is use carrot juice. The purpose of this research is to find out carrot juice can reduce primary dysmenorrhea pain on adolescent girls in dorm Poltekkes Kemenkes Pontianak. This research was used the quasy experiment method with a pre and post test without control approach. The sampling technique was used purposive sampling. Data collections conduct from May to June 2019 used the NRS questionnaire, Sheet Procedure for Giving Carrot Juice. Data was analyzed by Wilcoxon test. The research results showed that before be given carrot juice, the middle value of primary dysmenorrhea pain was 6.00. After be given carrot juice, the middle value of primary dysmenorrhea pain was 2.00, which means there is a difference in pain around 4.00 and a value of p = 0,000 (p. 0.05). The conclusion is there are differences in the pain of primary dysmenorrhea before and after be given carrot juice.

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.

Dysmenorrhea is one of the most common diseases in women. Dysmenorrhea is divided into primary dysmenorrhea (PD) and secondary dysmenorrhea (SD) . The prevalence of dysmenorrhea is high. However, there is no unified treatment for dysmenorrhea at home and abroad. In this paper, the relevant literatures of acupuncture and moxibustion for dysmenorrhea in China and Europe in recent years are systematically sorted, analyzed, concluded and summarized. The purpose of this paper is to explore the differences in classification, acupoint selection, treatment methods and needle retention time between China and Europe in the treatment of dysmenorrhea by acupuncture.

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.

Primary dysmenorrhea is a common gynecological disorder among adolescents females without pathological abnormalities. Primary dysmenorrhea usually begins two days before menstruation or during menstruation and lasts up to 48-72 hours. This is due to high levels of prostaglandins that cause contraction in the myometrium. The incidence of dysmenorrhea in Indonesia is 64.25%, which 54.89% has primary dysmenorrhea while 9.36% has secondary dysmenorrhea. In principle there are two therapies for treatment of primary dysmenorrhea that is pharmacological and non-pharmacological. Cow milk is a food that containing high calcium and can be used as one of the non-pharmacological therapy to reduce pain intensity of primary dysmenorrhea. This study aims to determine the influence of cow milk consumption to decrease the pain intensity of primary dysmenorrhea in students of nursing department at SMKN 2 Malang. The research design used was true experiment with pre test-post test with control group design. The sample in this study were 21 people and divided into three groups taken by simple random sampling . The results showed that there was a difference of decrease pain intensity in three groups using One Way Anova test with p value 0.000 (p

Menstrual disorders and abnormal uterine bleeding are common worries of young women. Complaints comprise menses that are: too painful (dysmenorrhea), prolonged and heavy (menorrhagia, or excessive uterine bleeding), or absent or arise irregularly (amenorrhea or oligoamenorrhea). In providing optimal reproductive care, the medical provider should be capable of distinguishing between normal developmental patterns or symptoms necessitating education and reassurance from pathologic conditions needing early evaluation and management. This article discusses the normal menstrual patterns seen in adolescent females and provides treatment and management approach to primary and secondary dysmenorrhea.

Dysmenorrhea becomes on of the most common menstrual problems experienced by teenagers. Dysmenorrhea is divided into primary and secondary dysmenorrhea. Primary dysmenorrhea occurs without pelvic organ pathology. Physical Activity is one factor risk of primary dysmenorrhea. The aim of this study is to determine the association between physical activity with degree of primary dysmenorrhea in young women in The Undergraduate Midwifery Study Program of Medicine Faculty of Brawijaya University Malang. The design of this study is an observational analytical with prospective approach. The sample in this study amounted to 52 people selected by using purposive sampling. This study was conducted during two menstrual cycles. The test result by chi square analysis demonstrated an association between physical activity with the degree of primary dysmenorrhea with p value 0,000 (p

Pediatric surgeons are called upon to evaluate abdominal and pelvic pain in girls of all ages. Dysmenorrhea and adnexal pathology are important to consider in the evaluation and subsequent management of such patients. An understanding of not only the pathology and surgical management but also the long-term implications is absolutely crucial for pediatric surgeons and pediatricians alike. Careful diagnosis and an emerging commitment to ovarian preservation define treatment for pediatric dysmenorrhea and adnexal pathology. In this review, we discuss primary and secondary dysmenorrhea as well as adnexal pathology that may present in pediatric patients.

Mullerian duct malformations represent a miscellaneous group of congenital anomalies that result from the arrested development, abnormal formation or incomplete fusion of the paramesonephric ducts. Congenital Mullerian abnormalities usually present at adolescent age with menstrual irregulari¬ty, dysmenorrhea, infertility and recurrent pregnancy loss. The Unicornuate uterus is a rare uterine malformation which usually features a rudimentary accessory horn with or without functioning endometrium. We are presenting a case of perimenopausal multiparous patient who had history of secondary dysmenorrhea diagnosed with endometrioma on imaging studies, but on laparotomy incidentally found to have Unicornuate uterus with functioning noncommunicating rudimentary horn leading to hematometra and hematosalpinx. The objective of this clinical case report is to highlight this rare Mullerian malformation as a differential diagnosis of secondary dysmenorrhea, chronic pelvic pain or adnexal mass in perimenopausal age group females.

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.

Dysmenorrhea is a menstrual disorder that is often experienced by young women. Dysmenorrhoea is characterized by lower abdominal pain and may be accompanied by other symptoms. The incidence of dysmenorrhea in Indonesia consists of primary dysmenorrhea 54.89% and secondary dysmenorrhea 9.36%. Dysmenorrhea can have a negative impact on young women, namely disruption in teaching and learning activities so that it will affect academic or academic achievement. This study is to describe the degree of dysmenorrhea and the efforts to overcome it in the Darussalam Al-Hafidz Islamic Boarding School, Jambi City. This type of quantitative research with a descriptive design. Respondents who have experienced dysmenorrhea as many as 31 respondents were sampled in this study.The data collection technique was done by filling out a questionnaire. The data is presented in a frequency distribution table. The results of the study most of the respondents experienced a degree of mild pain dysmenorrhea as many as 80.6% of respondents, most of the efforts to treat dysmenorrhea by non-pharmacological means by applying balsam or lotion as much as 71.0%. Most of the respondents experienced mild pain dysmenorrhea and Most of the efforts to treat dysmenorrhea are non-pharmacological by applying balsam or lotion

Unlike many conditions in medicine, the classification of painful menstruation into primary and secondary dysmenorrhea is not based on the temporal appearance of symptoms or the condition, as it is in primary and secondary amenorrhea, or primary and secondary infertility. The taxonomy of primary and secondary dysmenorrhea is based upon the absence or presence (respectively) of clinically identifiable causes. In both cases, a great deal is known about the pathophysiology underlying the development of menstrual pain. It is, therefore, not an issue of a lack of identifiable causation; it is the lack of clinically identifiable processes that drive the assignment.

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.

espanolLa dismenorrea primaria es el sintoma mas comun asociado a la menstruacion y se puede clasificar en dismenorrea primaria, que es el dolor pelvico asociado a la menstruacion en ausencia de patologia pelvica subyacente, y en dismenorrea secundaria, que es cuando se puede atribuir la sintomatologia a alguna patologia pelvica de fondo. La prevalencia de esta patologia es altamente subestimada y varia ampliamente. El proceso patologico no se ha entendido de manera completa, pero segun investigaciones es el resultado del aumento de produccion de prostaglandinas y leucotrienos, con el resultante incremento de la actividad miometrial. El diagnostico se basa principalmente en una historia clinica exhaustiva y un examen fisico dirigido, aunque la respuesta al tratamiento tambien corrobora el diagnostico. El principal objetivo del tratamiento de la dismenorrea es la reduccion del dolor y mejorar la funcionalidad de las pacientes, siendo la primera linea los antiinflamatorios no esteroideos y la terapia hormonal. EnglishPrimary dysmenorrhea is the most common symptom associated with menstruation and can be classified into primary dysmenorrhea, which is the pelvic pain associated with menstruation in the absence of an underlying pelvic pathology, and in secondary dysmenorrhea, which is when the symptomatology can be attributed to an underlying pelvic pathology. The prevalence of this pathology is highly underestimated and varies widely. The pathological process has not been fully understood, but according to research it is the result of increased production of prostaglandins and leukotrienes, with the resulting increase in myometrial activity. The diagnosis is mainly based on a thorough medical history and a targeted physical examination, although the response to treatment also corroborates the diagnosis. The main objective of treatment of dysmenorrhea is to reduce pain and improve the functionality of patients, being the first line treatment the nonsteroidal anti-inflammatory drugs and hormonal therapy.

Context: Dysmenorrhea is the most common gynecological complaint in Iran but the true prevalence of it is not clear yet. This study is aimed to estimate the overall prevalence of dysmenorrhea in Iran. Evidence Acquisition: International and national electronic databases including PubMed, ISI, Ovid, Scopus, Science Direct, SID, MagIran and IranMedex were searched up to January 2016. All studies, in which the prevalence of dysmenorrhea in Iran had been reported, were included in this meta-analysis. Eligible studies were reviewed, and data was extracted onto a standard data sheet. A Meta-analysis was done by a random-effects model with a 95% confidence interval (CI). Results: Twenty-five studies were assessed involving an overall of 9,677 participants, of which 6,748 had primary dysmenorrhea and 280 had secondary dysmenorrhea. The overall prevalence of primary and secondary dysmenorrhea was 0.71 (95% CI: 0.65, 0.77) and 0.18 (95% CI: 0.03, 0.32), respectively. Conclusions: Primary dysmenorrhea is a common problem in Iran however, there are only a few studies regarding secondary dysmenorrhea prevalence. Moreover, there is a significant variation between the results of the studies on the primary dysmenorrhea prevalence. Therefore, further evidence-based data on national studies is needed to estimate the exact estimation of dysmenorrhea prevalence in Iran.

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.

Purpose: To provide a case study for the discussion, diagnosis, management, and comprehensive plan of care for primary dysmenorrhea, secondary dysmenorrhea, and dyspareunia for the advanced practice registered nurse (APRN) working in primary care. Data sources: Selected text, research, clinical articles, and personal communication with expert APRNs. Conclusions: Three of the most commonly presenting women's health related conditions include primary dysmenorrhea, secondary dysmenorrhea, and dyspareunia. These conditions can present a challenge in developing an accurate differential diagnosis and appropriate plan of care. This article presents the reader with a detailed case study that provides an analysis of each potential differential diagnosis with rationale. A recommended diagnostic and therapeutic plan of care is included for the reader's review. Implications for practice: If left untreated, primary dysmenorrhea, secondary dysmenorrhea, and dyspareunia can result in pain, suffering, and impaired fertility and sexual function. Patients frequently experience symptoms for months to years prior to accurate diagnosis.

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.

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.

Primary dysmenorrhea, secondary dysmenorrhea, and cyclic pelvic pain syndromes represent a special subset of CPP. Although more common and no less debilitating, these conditions are better understood, more easily diagnosed, and more successfully treated than chronic pain states. It should be the expectation of both the physician and the patient that successful resolution of these complaints is possible.

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.

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.

Transvaginal ultrasound has proven to be an excellent diagnostic tool for evaluation of the endometrial lining of the uterus. This case report describes a focal echogenic foci visualized within the endometrial lining that was shown by pathologic examination to be immature calcified chorionic villi.

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.

In a group of 129 dysmenorrheics, of whom 84 suffered from primary dysmenorrhea, and 45 from secondary dysmenorrhea, treatment by special exercises was followed by definite relief in 84.5 per cent of the cases. In many instances, the beneficial effect lasted for at least twenty-months, which was the limit of the follow-up period in this investigation. Within the subgroup of those afflicted with primary dysmenorrhea, the percentage of alleviation was 89.3.

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.