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The Mediterranean fever (MEFV) gene codes for protein pyrin, which is among the modulators of inflammasome activity in innate immune cells. It was suggested that there is a relation between MEFV variations and inflammatory diseases. The aim of this study was to investigate MEFV gene variations in the patients with primary dysmenorrhea. The prevalence of common MEFV gene variations (M694V, M680I, V726A, E148Q and R202Q) was investigated in 145 young women with primary dysmenorrhea and 135 unrelated healthy controls. MEFV gene variations were genotyped using PCR-based RFLP assay. Number of childbirth and marriage were significantly lower in the study group than the controls, respectvely (p < 0.001, p = 0.001). Family history was statistically higher in the patient group (p < 0.001). In total, MEFV genotype and allele frequencies were significantly higher in patients than controls, respectively (p = 0.008 and p = 0.005, respectively). It was found that MEFV gene E148Q allele was more common in patient group (p = 0.039). MEFV R202Q A allele was higher in the patients than the controls (p = 0.045). A significant association was observed when the patients were compared with the controls according to R202Q variant AA versus GG+GA genotypes (p=0.020). Our findings suggest that MEFV variations may be a risk factor for patients with dysmenorrhea in a Turkish cohort. There are very few studies in the literature regarding the relationship between pathological variants of MEFV and dysmenorrhea disease. The common MEFV mutations/variants were evaluated in primary dysmenorrhea patients. Family history was statistically higher in the patient group (p <.001). MEFV gene variations were found 52 (35.9%) in patients and 29 (21.5%2) in controls. MEFV gene allele frequency was significantly higher in-patient group than control (p =.005). [ABSTRACT FROM AUTHOR]

Background Menstrual cycle irregularities and anovulation have been found to occur with increased frequency in women who deviate considerably from normal weight. Ovulation abnormalities may also be caused by fluctuations in weight, such as being overweight, obese, or underweight, which are hypothesized to disrupt the energy balance. Objectives The aim of this study was to find out the association between menstrual patterns and body mass index (BMI) among students of selected health science university. Materials and Methods A descriptive research study was conducted among 222 university students at a selected health science university in Mangalore. The samples were selected by using simple random sampling techniques. A demographic proforma, self-reported menstrual pattern questionnaire, and anthropometric measurements like height and weight were measured. BMI was calculated by using the standardized formula, BMI= (weight [kg]/height [m 2 ]) by the World Health Organization for the Asian population based on the revised consensus guidelines for India. Students who are aged between 17 and 25 years, unmarried female students who are studying under Yenepoya (deemed to be university), attained menarche, and who are willing to participate in the study were included in the study. Results From this study, it can be considered that the mean age of menarche was 12.49 ± 0.51years. Most 68.5% students reported dysmenorrhea. It is the most common menstrual disorder among our study subjects. Of the total subjects, 38.3% cases had oligomenorrhea, which was the next most common menstrual disorder. The majority of the subjects has a normal BMI, with a mean of 21.02 kg/m 2. There is a significant association between dysmenorrhea, oligomenorrhea, and polymenorrhagia with BMI status of university students at 0.05 level significance. Conclusion Lifestyle modification and nutritional counselling for female students could alleviate menstrual problems. It will not only improve the girls' current health, sense of well-being, and overall quality of life but may also lower her risks for future disease and ill health after proper advice about diet and exercise. Menstrual irregularities are mostly neglected by the society due to unawareness regarding the irregular menstrual pattern and their problems. [ABSTRACT FROM AUTHOR]

Purpose: To provide technical guidance on applying catheter-directed and needle-directed ethanol sclerotherapy for endometriomas and present the results of these sclerotherapy methods. Materials and Methods: From January 2015 to March 2021, the results of the patients with symptomatic ovarian endometriomas who underwent needle-directed or catheter-directed sclerotherapy were evaluated, retrospectively. The decision to apply which sclerotherapy technique was made during the procedure for each patient considering the following factors: cyst size, cyst location, cyst viscosity, and tissue rigidity. Results: Both needle-directed (n = 34 cysts) and catheter-directed (n = 34 cysts) sclerotherapy techniques were effective, with a 100% technical success rate and a 97% clinical success rate. In two of 34 cysts (6%) treated with needle-directed sclerotherapy, recurrence was detected and successfully retreated with catheter-directed sclerotherapy. Significant reductions in cyst size, pain, and serum cancer antigen 125 levels (p < 0.05) were noted. Serum anti-Müllerian hormone levels remained unaffected, indicating preserved ovarian reserve (p > 0.05). Among those treated for infertility, the pregnancy rate was 54% (n = 6/11). The mean ± SD cyst size decline was greater in catheter-directed sclerotherapy than needle-directed sclerotherapy (5.5 ± 3.1 cm vs. 4.0 ± 2.1 cm, p < 0.05). However, the pretreatment cyst volumes were considerably higher in catheter-directed sclerotherapy group (202.0 ± 233.5 mL vs. 78.8 ± 59.7 mL, p < 0.05) and were associated with significant post-treatment volume decrease (p < 0.05). Conclusion: The choice between catheter-directed and needle-directed ethanol sclerotherapy should be determined during the procedure, with a preference for catheter-directed sclerotherapy when feasible. Crucial factors in making this decision include cyst size, cyst location, cyst viscosity, and tissue rigidity. Level of evidence Level 3, non-controlled retrospective cohort study. [ABSTRACT FROM AUTHOR]

Introduction: Cesarean scar endometriosis is a rare form of extra-pelvic endometriosis. The aim of the study was to investigate the clinical and surgical outcomes of patients with cesarean scar endometriosis. Methods: We collected the clinical, surgical, and follow-up data of patients diagnosed with cesarean scar endometriosis who attended Kartal Lütfi Kırdar Research and Training Hospital, Istanbul, from April 2019 to May 2022. Results: There were 34 patients with a median age of 32.5 (range: 26-45). All cesarean scar endometriosis was located in the corners of the Pfannenstiel incision: 18 (52.9%) on the left and 16 (47.1%) on the right corners, respectively. Follow-up examination over 32 months revealed that five patients had a recurrence. The median volume of the CSE was 2467.51 mm³ (range: 635.97-56013.3). The mean size on ultrasonography was 26.1 mm. There was a significant improvement in the postoperative VAS scores for dysmenorrhea, non-cyclic pelvic pain, and dyspareunia. Discussion and Conclusion: This study indicates that surgical excision is the preferred and effective treatment. Postoperative VAS scores for dyspareunia, dysmenorrhea, and non-cyclic pelvic pain were dramatically decreased after surgical treatment. [ABSTRACT FROM AUTHOR]

Objective was to present detailed menstrual cramps information in normally ovulatory versus anovulatory cycles from a single-cycle cohort study during the SARS-CoV-2 Pandemic. Secondly, we reviewed the literature for cohort studies documenting both menstrual cramps and ovulation. Participants and Methods: The Menstruation and Ovulation Study 2 recruited 108 women ages 19– 35 years to a prospective, observational single-cycle study, recording cramps daily (0– 4 scale) in the Menstrual Cycle Diary© and assessing normal ovulation (luteal length ≥ 10 days) by the validated Quantitative Basal Temperature© (Mean Temperature Method). We searched databases for « primary dysmenorrhea » / » menstrual cramps »; « menstrual cycles »; « anovulation », finding four valid publications. Results: In 75 women/cycles during the Pandemic, mean age was 28.5, body mass index 23.5, and higher education (16 years); 40 normally ovulatory and 35 anovulatory cycles had similar lengths (29.5– 30.0 days), respectively (P= 0.571). However, anovulatory cycles recorded significantly worse menstrual cramps versus normally ovulatory cycles; anovulatory median intensity was 1.9 versus 1.6, and Cramp Score was 8 versus 6 in normally ovulatory cycles (P=0.017). Four publications in 273 women (991 cycles) showed cramps in both anovulatory and ovulatory cycles; three were in adolescent/young adult women, one of which documented a significantly greater percentage of cramps in ovulatory cycles. The 694 cycles in premenopausal women (20– 41 years) showed similar percentages of symptomatic cramps in cycles of both ovulatory types. Meta-analysis documented significantly higher cramp prevalence in ovulatory cycles (OR 2.10; 95% CI 1.31, 3.37; P=0.002). Conclusion: This is the first documentation of more intense and frequent cramps in anovulatory cycles. However, meta-analysis showing the presence of symptomatic cramps in both ovulatory and anovulatory cycles documented they were twice as prevalent in ovulatory menstrual cycles. Plain Language Summary: "Worse Menstrual Cramps in Anovulatory Cycles". Medicine has long believed that menstrual cramps only occur in ovulatory menstrual cycles that release an egg and have high progesterone levels that decrease before the next period. The notion was that dropping progesterone levels triggered release of prostaglandins that cause the pain and uterus muscle contractions of menstrual cramps. This research studied 75 community women aged 19– 35 years for a single cycle during COVID-19. Forty women had normally ovulatory cycles and 35 had anovulatory cycles with a similar mean cycle length of 29.7 days. Women in both groups were similar in age, weight, education and other reproductive characteristics. Women recorded Menstrual Cycle Diary© daily experiences for cramp presence and intensity (scored 0– 4). Ovulation was documented by daily first morning temperatures analyzed by the valid Quantitative Basal Temperature© method. Results showed menstrual cramps occurred in both normally ovulatory and anovulatory cycles. Surprisingly, anovulatory compared with ovulatory cycles had cramps that lasted longer (4 rather than 3 days), were more intense (1.9 versus 1.6) and with significantly higher Cramp Scores (of 8 versus 6). We also found four other published studies showing cramps occurred in both anovulatory and ovulatory cycles. A meta-analysis of these, however, showed that cramps were twice as frequent in ovulatory cycles. These results matter because they stimulate the search for more accurate understandings of why menstrual cramps occur. They will likely stimulate more effective therapies for the rare, intense menstrual cramps that currently are not effectively treated by anti-inflammatory medicines such as ibuprofen. [ABSTRACT FROM AUTHOR]

Graphene-based warm uterus acupoint paste (GWUAP) is an emerging non-drug alternative therapy for the treatment of primary dysmenorrhea (PD), but the underlying mechanism is still unclear. SD female rats were randomly divided into control group, model group and treatment group to explore the mechanism of GWUAP in the treatment of PD. Combined with 16S rDNA and fecal metabolomics, the diversity of microbiota and metabolites in each group was comprehensively evaluated. In this study, GWUAP reduced the torsion score of PD model rats, improved the pathological morphology of uterine tissue, reduced the pathological damage score of uterine tissue, and reversed the expression levels of inflammatory factors, pain factors and sex hormones. The 16 S rDNA sequencing of fecal samples showed that the abundance of Lactobacillus in the intestinal flora of the model group decreased and the abundance of Romboutsia increased, while the abundance of Lactobacillus in the intestinal flora of the treatment group increased and the abundance of Romboutsia decreased, which improved the imbalance of flora diversity in PD rats. In addition, 32 metabolites related to therapeutic effects were identified by metabolomics of fecal samples. Moreover, there is a close correlation between fecal microbiota and metabolites. Therefore, the mechanism of GWUAP in the treatment of PD remains to be further studied. [ABSTRACT FROM AUTHOR]

Background: Drawing on the principles of wrist-ankle acupuncture (WAA), our research team has developed a portable device for WAA point compression, termed the acupressure wrist-ankle strap (AWA). The current study aims to evaluate the efficacy of the AWA in alleviating pain associated with primary dysmenorrhea. Methods: A single-blind, randomized clinical trial was conducted from April 1, 2019, to December 31, 2019. 78 participants with primary dysmenorrhea were recruited from Shanghai University of Traditional Chinese Medicine. All participants were treated on the first day of menstruation for 30 min. Participants in the AWA group used the AWA, the internal side of which is equipped with a tip compression component, while participants in the non-acupressure wristankle acupuncture(NAWA)group used the NAWA, with the inside tip pressing parts removed. The main outcome was the difference in visual analogue scale (VAS) score between baseline and 30 minutes after randomization. Results: A total of 78 participants aged 18 to 30 years were included in the intention-to-treat analyses. The VAS scores (mean [standard deviation]) in the AWA group were significantly lower than those in the NAWA group at each time point of intervention (5 minutes: 95% CI, [-1.27 to -0.68], p < 0.001; 10 minutes: 95% CI, [-2.34 to -1.51], p < 0.001; 30 minutes: 95% CI, [-3.74 to -2.72], p < 0.001). In the AWA group, 16 participants reported "obvious relief" of dysmenorrhea pain while 23 did not; the average onset time of analgesia they reported were (21.50 ± 3.65) min, while no subjects in NAWA group reported obvious pain relief. The pain threshold (mean [standard deviation]) at SP9 of both sides in AWA group decreased significantly after intervention that in NAWA group (Left: 95% CI, [-5.02 to -1.81], p < 0.001; Right: 95% CI, [-7.67 to -4.24], p < 0.001). There was no significant change in the temperature at CV4 in either group (95% CI, [-0.63 to -0.66], p = 0.970). Conclusion: This trial substantiates our hypothesis that the AWA provides immediate analgesic effects. The AWA represents an effective and safe noninvasive physical therapy option, which patients can self-administer to alleviate abdominal pain [ABSTRACT FROM AUTHOR]

Introduction: Electroacupuncture (EA) has been applied in dysmenorrhea and has shown good efficacy. The mechanisms of EA are associated with autonomic nervous system adjustments and neuroendocrine regulation. Laser acupuncture (LA), however, has been widely investigated for its noninvasiveness. However, it remains uncertain whether LA is as effective as EA. This study aimed to compare EA and LA head to head in dysmenorrhea. Methods: A crossover, randomized clinical trial was conducted. EA or LA was applied to selected acupuncture points. Participants were randomized into two sequence treatment groups who received either EA or LA twice per week in luteal phase for 3 months followed by 2-month washout, then shifted to other groups (sequence 1: EA > LA; sequence 2: LA > EA). Outcome measures were heart rate variability (HRV), prostaglandins (PGs), pain, and quality-of-life (QoL) assessment (QoL-SF12). We also compared the effect of EA and LA in low and high LF/HF (low frequency/high frequency) status. Results: Totally, 43 participants completed all treatments. Both EA and LA significantly improved HRV activity and were effective in reducing pain (Visual Analog Scale [VAS]; EA: p < 0.001 and LA: p = 0.010) and improving QoL (SF12: EA: p < 0.001, LA, p = 0.017); although without intergroup difference. EA reduced PGs significantly (p < 0.001; δ p = 0.068). In low LF/HF, EA had stronger effects than LA in increasing parasympathetic tone in respect of percentage of successive RR intervals that differ by more than 50 ms (pNN50; p = 0.053) and very low-frequency band (VLF; p = 0.035). Conclusion: There is no significant difference between EA and LA in improving autonomic nervous system dysfunction, pain, and QoL in dysmenorrhea. EA is prominent in PGs changing and preserving vagus tone in low LF/HF; yet LA is noninvasive for those who have needle phobia. Whether LA is equivalent with EA and the mechanism warrants further study. Clinical trial identification number: NCT04178226. [ABSTRACT FROM AUTHOR]

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]

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. PCOS is characterized by the presence of polycystic ovaries, menstrual dysfunction, infertility, and biochemical and clinical hyperandrogenism. The objective of this study was to evaluate the serum vitamin D Level and Insulin Resistance in Obese Adolescents with polycystic ovary syndrome (PCOS). The study was a cross-sectional study conducted among 94 PCOS women of reproductive age coming to the Department of Endocrinology & Metabolism of Bangabandhu Sheikh Mujib Medical University (BSMMU). The women with polycystic ovary syndrome were considered as the study population. Among the participants, around 91% had vitamin D deficiency and 4% had vitamin D insufficiency, no participants had a sufficiency. Among PCOS patients underweight was 42.10%, Healthy Weight 45.27%, pre-obese 9.63%, and obese 3.0%. Regarding fasting insulin levels (<20uIU/ml) among 14.9% of PCOS. In the comparison of clinical characteristics of the participants, less than half (37.2%) had painful menstruation and 67% had hirsutism. Adolescent girls with PCOS are mostly vitamin D deficient and the rate of obesity is also high. The results of this study brought the true picture of insulin resistance and metabolic syndrome among different phenotypes of women with PCOS in Bangladesh, very likely contributing to a better understanding of the management of PCOS, and patients will benefit individually in their management. Estimation of vitamin D levels & and examination the obesity may help the clinician to manage obesity cases with PCOS adolescents more efficiently. [ABSTRACT FROM AUTHOR]

Background: The prevalence of Müllerian anomalies (MA) among patients with congenital solitary functioning kidney (SFK) is not well defined. A delay in diagnosis of obstructive MA can increase the risk of poor clinical outcomes. This study describes the prevalence of MA in patients with congenital SFK. Methods: A retrospective review was performed of patients within the Nationwide Children's Hospital system with ICD9 or ICD10 diagnostic codes for congenital SFK defined as either unilateral renal agenesis (URA) or multicystic dysplastic kidney (MCDK) and confirmed by chart review. Patients with complex urogenital pathology were excluded. Renal anomaly, MA, reason for and type of pelvic evaluation, and age of diagnosis of anomalies were evaluated. Results: Congenital SFK occurred in 431 girls due to URA (209) or MCDK (222). Pelvic evaluation, most commonly by ultrasound for evaluation of abdominal pain or dysmenorrhea, occurred in 115 patients leading to MA diagnosis in 60 instances. Among 221 patients ages 10 years and older, 104 underwent pelvic evaluation and 52 were diagnosed with an MA of which 20 were obstructive. Isolated uterine or combined uterine and vaginal anomalies were the most common MA. MA were five-fold more common in patients with URA compared to MCDK. In 75% of patients, the SFK was diagnosed prior to the MA. Conclusions: The prevalence of MA in patients with congenital SFK was 24% among those age 10 years or older, and 38% were obstructive. This justifies routine screening pelvic ultrasound in girls with congenital SFK to improve early diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Accessory cavitated uterine malformation (ACUM) is a relatively recent term used to describe a noncommunicating, accessory uterine cavity. ACUM have been published under different terms ranging from juvenile cystic adenomyosis to "uterus‐like mass". The objective of this study was to systematically identify all cases of ACUM and definitions described in the literature, regardless of label, and identify morphological, epidemiological, and clinical characteristics as well as management, while also highlighting knowledge gaps. Material and methods: A systematic literature search of three databases was performed, reviewing all records of cystic myometrial lesions. Cases that fitted common definitions for ACUM were included and clinical and imaging characteristics were documented in detail. This work was registered to PROSPERO and reporting followed PRISMA guidelines for scoping reviews. Results: A total of 53 articles were included, comprising 115 cases that met the minimal criteria for ACUM. The median age at onset of symptoms was 17 years, presenting with dysmenorrhea soon after menarche. A total of 19 women were parous. On ultrasound, ACUM appears as unilocular myometrial cysts, usually with ground‐glass content. Hemorrhagic content is also observed on magnetic resonance imaging (MRI), with high signal intensity on both T2 and T1‐weighted images. Ninety‐five (83%) cases were managed surgically, with a trend towards primary nonsurgical options. Although no adverse outcomes were reported, long‐term follow‐up on subsequent fertility and pregnancy was rare. Conclusions: Despite its increasing recognition as a clinical entity, ACUM often remains underdiagnosed as it shares similarities with other myometrial masses. We propose a unified terminology and definition for ACUM based on the data in this review. ACUM presents as a cavitated lesion, surrounded by a myometrial mantle, in continuity with the anterolateral uterine wall and located beneath the insertion of the round ligament and the interstitial portion of the fallopian tube. In contrast to other uterine abnormalities, a normal uterine cavity is visualized. Future studies are needed, using a clear definition for ACUM, and prospectively investigating management strategies, including long‐term follow‐up of patient‐reported symptoms, fertility, and pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Primary Dysmenorrhoea (PD) is a common disorder in both young and adult females which is characterised by cramps that start immediately before or at the beginning of menstruation in the lower abdomen and are spasmodic and painful in nature, without any pelvic pathology. PD has a serious detrimental effect on quality of life and productivity in terms of health. Need of the Study: To the best of author's knowledge, there is no specific scale meant to extensively assess the overall physical, social, psychological and nutritional status of females with PD and evaluate the quality of life, therefore, a comprehensive tool is required to resolve these issues and capture a comprehensive overview of the typical distress encountered during menstruation. Aim: To develop the items and domains, estimate its content and concurrent validity as well as assess intra-rater and testretest reliability of the scale, which comprehensively assesses physical, social, psychological and nutritional status of females with PD and determine their quality of life. Materials and Methods: The present study is a cross-sectional study, that will be conducted at General Outpatient Department (OPD), Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar Deemed to be University, Mullana, Ambala, Haryana, India from April 2023 to March 2024. It consists of three phases. First phase comprises of the scale development procedure which includes generation of domains and items. Second phase is to validate the scale. This phase includes content validation through Delphi method as well as evaluation of criterion (concurrent) validity. Third phase consists of assessing intra-rater and testretest reliability of the scale. [ABSTRACT FROM AUTHOR]

Objective: Premenstrual syndrome (PMS) is a common condition among women during their menstrual cycle. PMS can negatively affect a woman's daily life and function. Nurses, as an important and substantial segment of healthcare staff, are affected by the demanding environment of work place. Since PMS, as a prevalent counterproductive condition, has not been studied in this population in Iran, we assessed the prevalence of PMS and its associated factors among nurses aged 23 to 49 in teaching hospitals of the Tehran province of Iran. Material and Methods: In this cross-sectional study from April 2021 to January 2022, 280 participants from teaching hospitals were enrolled. Simple random sampling was used to determine the sample size of the study. Two validated questionnaires and a data gathering sheet were used to collect information. The premenstrual symptoms screening tool was used to determine PMS severity and the Copenhagen Psychosocial Questionnaire to evaluate the associated job demands. Demographic data and work-related data included: night shift, shift type, monthly COVID-19 care and gynecologic and past medical history were gathered. Then data were analyzed using logistic regression analysis, chi-square and t-test. Results: The severity of PMS was: mild (42.5%); moderate (30%); and severe (27.5%). Regular menstruation and dysmenorrhea were reported by 84.6% and 72.3%, respectively. Moderate to severe PMS was associated with: monthly COVID shift (p=0.02); emotional (p<0.01) and quantitative (p<0.01) demands; regular caffeine intake (p=0.01); education level (p=0.005); regular exercise (p=0.003); regular fiber intake (p=0.08); and irregular menstrual cycles (p=0.007). In logistic regression only quantitative (p=0.003) and emotional (p=0.018) job demands were significant. Conclusion: Results showed that the prevalence of PMS was high among Iranian nurses and was associated with quantitative and emotional job demands. We suggest further studies focusing on preventative and effective interventions to diminish the consequences of PMS in this population. We also suggest investigating the practical application of the findings of this study for healthcare professionals and policymakers. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Does linzagolix administered orally once daily for up to 3 months at a dose of 75 mg alone or 200 mg in combination with add-back therapy (ABT) (1.0 mg estradiol; 0.5 mg norethindrone acetate, also known as norethisterone acetate [NETA]) demonstrate better efficacy than placebo in the management of endometriosis-related dysmenorrhea and non-menstrual pelvic pain? SUMMARY ANSWER Combining 200 mg linzagolix with ABT was found to significantly reduce dysmenorrhea and non-menstrual pelvic pain at 3 months of therapy, while a daily dose of 75 mg linzagolix yielded a significant decrease only in dysmenorrhea at 3 months. WHAT IS KNOWN ALREADY? A previously published Phase 2, dose-finding study reported that at a dose of 200 mg daily, linzagolix promotes full suppression of estradiol secretion to serum levels below 20 pg/ml and noted that the addition of ABT may be needed to manage hypoestrogenic side effects. At lower doses (75 mg and 100 mg/day), linzagolix maintains estradiol values within the target range of 20–60 pg/ml, which could be ideal to alleviate symptoms linked to endometriosis. STUDY DESIGN, SIZE, DURATION EDELWEISS 3 was a multicenter, prospective, randomized, placebo-controlled, double-blind, double-dummy Phase 3 study to evaluate the safety and efficacy of linzagolix for the treatment of moderate-to-severe endometriosis-associated pain. Treatment was administered orally once daily for up to 6 months. PARTICIPANTS/MATERIALS, SETTING, METHODS In the EDELWEISS 3 trial, 486 subjects with moderate-to-severe endometriosis-associated pain were randomized at a 1:1:1 ratio to one of the three study groups: placebo, 75 mg linzagolix alone or 200 mg linzagolix in association with ABT. Pain was measured daily on a verbal rating scale and recorded in an electronic diary. MAIN RESULTS AND THE ROLE OF CHANCE At 3 months, the daily 200 mg linzagolix dose with ABT met the primary efficacy objective, showing clinically meaningful and statistically significant reductions in dysmenorrhea and non-menstrual pelvic pain, with stable or decreased use of analgesics. The proportion of responders for dysmenorrhea in the 200 mg linzagolix with ABT group was 72.9% compared with 23.5% in the placebo group (P  < 0.001), while the rates of responders for non-menstrual pelvic pain were 47.3% and 30.9% (P  = 0.007), respectively. The 75 mg linzagolix daily dose demonstrated a clinically meaningful and statistically significant reduction in dysmenorrhea versus placebo at 3 months. The proportion of responders for dysmenorrhea in the 75 mg linzagolix group was 44.0% compared with 23.5% in the placebo group (P  < 0.001). Although the 75 mg dose showed a trend toward reduction in non-menstrual pelvic pain at 3 months relative to the placebo, it was not statistically significant (P  = 0.279). Significant improvements in dyschezia and overall pelvic pain were observed in both linzagolix groups when compared to placebo. Small improvements in dyspareunia scores were observed in both linzagolix groups but they were not significant. In both groups, hypoestrogenic effects were mild, with low rates of hot flushes and bone density loss of <1%. A daily dose of 200 mg linzagolix with ABT or 75 mg linzagolix alone was found to significantly reduce dysmenorrhea and non-menstrual pelvic pain also at 6 months of therapy. LIMITATIONS, REASONS FOR CAUTION Efficacy was compared between linzagolix groups and placebo; however, it would be useful to have results from comparative studies with estro-progestogens or progestogens. It will be important to ascertain whether gonadotropin-releasing hormone antagonists have significant benefits over traditional first-line medications. WIDER IMPLICATIONS OF THE FINDINGS Linzagolix administered orally once daily at a dose of 200 mg in combination with add-back therapy (ABT) demonstrated better efficacy and safety than placebo in the management of moderate-to-severe endometriosis-associated pain. The quality of life was improved and the risks of bone loss and vasomotor symptoms were minimized due to the ABT. The 75 mg dose alone could be suitable for chronic treatment of endometriosis-associated pain without the need for concomitant hormonal ABT, but further research is needed to confirm this. If confirmed, it would offer a viable option for women who do not want to wish to have ABT or for whom it is contraindicated. STUDY FUNDING/COMPETING INTEREST(S) Funding for the EDELWEISS 3 study was provided by ObsEva (Geneva, Switzerland). Analysis of data and manuscript writing were partially supported by ObsEva (Geneva, Switzerland), Theramex (London, UK) and Kissei (Japan) and grant 5/4/150/5 was awarded to M.-M.D. by FNRS. J.D. was a member of the scientific advisory board of ObsEva until August 2022, a member of the scientific advisory board of PregLem, and received personal fees from Gedeon Richter, ObsEva and Theramex. J.D. received consulting fees, speakers' fees, and travel support from Gedeon Richter, Obseva and Theramex, which was paid to their institution. C.B. has received fees from Theramex, Gedeon Richter, and Myovant, and travel support from Gedeon Richter—all funds went to the University of Oxford. He was a member of the data monitoring board supervising the current study, and served at an advisory board for endometriosis studies of Myovant. H.T. has received grants from Abbvie and was past president of ASRM. F.C.H. has received fees from Gedeon Richter and Theramex. O.D. received fees for lectures from Gedeon Richter and ObsEva and research grants for clinical studies from Preglem and ObsEva independent from the current study. A.H. has received grants from NIHR, UKRI, CSO, Wellbeing of Women, and Roche Diagnostics; he has received fees from Theramex. A.H.'s institution has received honoraria for consultancy from Roche Diagnostics, Gesynta, and Joii. M.P. has nothing to declare. F.P. has received fees from Theramex. S.P.R. has been a member of the scientific advisory board of Gedeon Richter and received fees from Gedeon Richter. A.P. and M.B. are employees of Theramex. E.B. was an employee of ObsEva, sponsor chair of the data monitoring board supervising the current study, and has been working as a consultant for Theramex since December 2022; she owns stock options in ObsEva. M.-M.D. has received fees and travel support from Gedeon Richter and Theramex. TRIAL REGISTRATION NUMBER NCT 03992846. TRIAL REGISTRATION DATE 20 June 2019. DATE OF FIRST PATIENT'S ENROLLMENT 13 June 2019. [ABSTRACT FROM AUTHOR]

• A meta-analysis of conservative treatment of DIE with DNG drugs. • DNG can effectively relieve the pain symptoms related to DIE without resorting to surgical treatment. • DNG showed significantly reducing the size of the lesions when used in the conservative treatment of DIE. To systematically review and conduct a meta-analysis to assess the effectiveness of dienogest (DNG) in the prolonged conservative drug management of deep infiltrating endometriosis (DIE). The findings from this study are intended to serve as a valuable reference for clinical decision-making regarding medication in the context of DIE. Following the PRISMA Statement, we searched EMBASE, PubMed, The Cochrane Library, Web of Science, and Medline databases for relevant literature published in the public domain from the date of establishment of the database until October 2023. Subsequently, all English publications on clinical studies using DNG for the treatment of DIE were included. Studies involving surgical intervention or drug therapy for postoperative recurrence were excluded. All literature included in the review underwent risk assessment of bias. Two evaluators independently screened the publications, conducted a quality assessment of each article and extracted data. We used Revman 5.4 for the meta-analysis of the included literature. Our final analysis consisted of five clinical studies, involving a total of 256 patients. We found that there were significant improvements in the following indicators post-medication as compared to levels before taking the medication: dysmenorrhea (MD = 4.24, 95 % CI: 2.92–5.56, P < 0.00001), non-menstrual pelvic pain (MD = 3.11, 95 % CI: 2.34–3.88, P < 0.00001), dyspareunia (MD = 1.93, 95 % CI: 1.50–2.37, P < 0.00001), dyschezia (MD = 2.48, 95 % CI: 1.83–3.12, P < 0.00001), and rectosigmoid nodule size (MD = 0.32, 95 % CI: 0.18–0.46, P < 0.00001). Compared with pre-medication levels, the following indicators were significantly worse: headache (RR = 0.03, 95 % CI: 0.00–0.23, P = 0.0006), decreased libido (RR = 0.08, 95 % CI: 0.01–0.62, P = 0.02); and there was no significant improvement in dysuria (P > 0.05). DNG showed efficacy in relieving pain-related symptoms and significantly reducing the size of the lesions when used in the drug conservative treatment of DIE. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Obstetrics & Gynecology is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Obstetrics & Gynecology is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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: Dysmenorrhea often occurs in adolescent girls and disrupts their daily activities. Dysmenorrhea occurs 1-2 years after menarche, with an average age of 12.8 years. One way to reduce dysmenorrhea is to use plants, such as ginger and citronella oil. Purpose: This study aimed to determine the effectiveness of ginger and citronella oil on dysmenorrhea in adolescent girls. Methods: This research was quasi-experimental with a one-group pretest-posttest design approach. The sample consisted of 68 adolescent girls from SMPN 14 Tasikmalaya city who were experiencing dysmenorrhea with moderate pain intensity. Purposive sampling was used. The results of this study were obtained using the Numeric Rating Scale (NRS) and then analyzed using the Wilcoxon signed-rank test. Results: The research results showed that the average dysmenorrhea score before being administered ginger and citronella oil to adolescent girls was 4.6, and after the intervention, it was 3.69 out of ten. The statistical-test results showed that ginger and citronella oil were effective for dysmenorrhea in adolescent girls (p = 0.000). Conclusion: This study concluded that there is a difference in the average dysmenorrhea score before and after administering ginger and citronella oil to adolescent girls. Therefore, adolescent girls can use ginger and citronella oil to reduce dysmenorrhea. Implications for Nursing: Integrating complementary ginger and citronella oil therapy into nursing or midwifery services is necessary to reduce dysmenorrhea. This innovation can be a reference source to provide care and minimize chemical-drug use. [ABSTRACT FROM AUTHOR]

Robert's uterus is a rare Müllerian duct anomaly (MDA) characterized by complete asymmetric septum dividing uterine cavity into two non‐communicating parts. This study offers insights into diagnosing and management of this condition in a young patient, and a systematic literature review. The review included 19 studies from 2013 to 2023. 11.4% of women reported a history of miscarriage and 5.7% primary infertility. Dysmenorrhea was the most frequent symptom (54.3%), and 14.3% of patients had a coexisting endometriosis. The surgical interventions most commonly combine laparoscopic and hysteroscopic techniques. Robert's uterus requires heightened clinical awareness for early diagnosis, particularly in young women. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Acupuncture & Tuina Science is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: The aim of this article is to present our experience with minimally-invasive treatment for nulliparous patients with pelvic venous congestion syndrome (PVCS) with special attention to anatomical considerations, procedural and clinical outcome. Materials and Methods: In this retrospective, monocentric study, 21 patients with PVCS treated from January 2014 to June 2023 were included. The preprocedural imaging evaluation of PVCS was based on color Doppler ultrasound, contrast-enhanced CT and/or MRI. In all cases insufficient ovarian veins and/or internal iliac branches were occluded with coils and sclerosant. Procedural and clinical outcomes were measured 30 and 90 days after the procedure. Results: Average duration of pelvic pain was 44.8 ± 54.2 months (from 6 to 200) with the mean VAS-recorded pain intensity of 8.5 ± 1.1 (range from 7 to 10 where 0 was "no pain" and 10 "worst pain possible"). Most common symptoms included dysmenorrhea, dyspareunia and dysuria. Complete embolization was observed in in all cases. Targeted vessels included left ovarian vein (13/21, 62%), both ovarian veins (7/21, 33%) and left pudendal with left ovarian (1/21, 5%). Residual PVCS was noted in 1 patient. Mean VAS at 90-days after the procedure was 2.4 ± 1.4 (range from 0 to 6, p < 0.001). Nineteen patients (90%) were satisfied with the clinical outcome (13 "very satisfied", 6 "satisfied") and reported improvement in quality of life. Two patients (9.5%) reported to be "neutral" as the VAS reduction was less than 50%. Conclusion: Our study confirms that endovascular coil embolization is safe and effective in treatment of nulliparous patients with PVCS that provides very high rate of clinical success and overall satisfaction. [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]

Objectives: The reproductive health of girls is the key to the health of the future generation. This research aimed to evaluate girls' menstrual patterns and their dependence on some nongenetic determinants influencing the reproductive health of adolescent girls. Matwerial and Methods: The cross-sectional descriptive study was conducted among 417 high school adolescent girls. The questionnaire included items concerning socioeconomic status, components of lifestyle, academic performance, age at menarche and menstrual patterns of girls. Results: The mean age at menarche was 12.4±0.9 years. The mean duration of the menstrual cycle was 27.6±3.6 days with the mean duration of bleeding 4.7±1,1 days. The irregular cycle was experienced by 1/4 of girls, dysmenorrhea and menstruation-related symptoms have been mentioned by 40.5% of girls. Only 23% of girls consulted a physician concerning dysmenorrhea and menstruation-related symptoms. Results have shown statistically significant impact of family size, family income, academic performance, nutritional habits, sleep, etc. on the cycle regularity and dysmenorrhea. Conclusion: The menstrual patterns of the majority of girls were in a range of normal values. The prevalence of irregular cycles, the prevalence of dysmenorrhea and menstruation-related symptoms were lower as compared to other studies. Nevertheless, around half of girls, who mentioned dysmenorrhea and menstruation-related symptoms, were not serious about these symptoms. Some socioeconomic factors and components of lifestyle (family size, family income, nutrition, sleep) have been shown to influence the cycle regularity and dysmenorrhea. Hence, these findings highlight the need to enlarge the knowledge concerning reproductive health and healthy lifestyle among adolescent girls. [ABSTRACT FROM AUTHOR]

Congenital malformations of the female genital organs are rare anomalies and their incidence is estimated to be up to 7% in the general population. Müllerian ducts abnormalities are one of the causes of infertility and occur in approximately 16% of women with recurrent miscarriages. Sex development disorders are diagnosed at different stages of the patient's life depending on the accompanying ailments. Alarming signs of genital malformations include primary amenorrhea or dysmenorrhea, dyspareunia, and periodic abdominal pain. [ABSTRACT FROM AUTHOR]

IntroductionPartnership is an important resource in dealing with endometriosis related chronic pain. Hence, our objective was to assess partnership in the context of endometriosis and its symptoms, considering the perspectives of both individuals involved.MethodsThe study was designed as a multi-center matched case–control study in Switzerland, Germany and Austria. Altogether 381 women with surgically/histologically confirmed endometriosis and 381 control women, 250 male partners of endometriosis-affected women and 229 of control women were evaluated. Partnership quality, partnership happiness, separation thoughts, and areas of conflict were evaluated through the Partnership Questionnaire and a validated list of conflict areas.ResultsQuality of partnership was rated as high by 60.1% of the women with endometriosis and 66.7% of the control women, as well as by 45.8 and 50.2% of their respective partners. Women with endometriosis mentioned separation thoughts, mostly related to sexual satisfaction, more often (34.9%/28.3%) and experienced more partnership-related conflicts than control women. Chronic pain, dyspareunia, dissatisfaction with sexuality, fatigue, and infertility were significantly associated with partnership conflicts. Fatigue and infertility but not pain experiences were related to lower partnership quality. Male partners in both groups reported separation thoughts equally often. In men, a high intensity of pain experienced by their partner was associated with reduced partnership happiness.ConclusionGiven the significance of partnership in dealing with chronic diseases and the connection between symptoms of endometriosis and a decrease in partnership quality, it is essential to incorporate strategies that alleviate the negative impacts on relationships for both partners into medical support.Clinical trial registrationidentifier NCT 02511626.

Background: Endometriosis is a chronic gynecologic disease that is dependent on estrogen and is associated with the existence of endometrial glands and stroma outside the uterus. It has been demonstrated that dienogest significantly and fairly effectively alleviates endometriosis-related symptoms such as dysmenorrhea and irregular menstruation. Material and Methods: This was a randomized, prospective, comparative, open-label study. For 12 weeks, Group A (n=30) received Dienogest 2 mg OD while Group B (n=30) received Medroxyprogesterone acetate (MPA) 10 mg BD. The patients were assessed at 4, 8, and 12 weeks to observe the VAS Score for dysmenorrhea, number of patients having dysmenorrhea, number of patients having irregular menstrual cycles. Adverse drug reactions (ADRs) were recorded for safety assessment. Results: After 12 weeks, VAS score & number of patients experiencing dysmenorrhea decreased in both groups significantly. Dienogest depicted better response than MPA in the reduction of VAS score (95.99% versus 84.91%; p-value=0.048) & reduction in the number of patients having dysmenorrhea after 12 weeks (6.67% versus 26.67%; p-value=0.038) and the difference was statistically significant. MPA group had a greater number of ADRs. Conclusion: Dienogest is significantly more effective than MPA, especially for dysmenorrhea. Dienogest shows better tolerability than MPA.

Background: Hemoglobin (HGB) was the most important factors which could cause dysmenorrhea in women. Metals exposure and hemoglobin level in dysmenorrhea female was unclear. We aimed to explore the associations of multi-metal exposure and HGB level in female college students with dysmenorrhea. Methods: 253 female students who had dysmenorrhea was included in our study. The Last Absolute Shrinkage and Selection Operator (LASSO) regression, generalized linear model (GLM), and Bayesian Kernel Machine Regression (BKMR) models were used to explore the associations of multi-metal exposure and HGB levels in female college students with dysmenorrhea. Results: GLM results showed that plasma Fe, Ni and Rb was positively associated with HGB and plasma Co was negatively associated with HGB. In menarche age ≤13 years old group, plasma Co and Rb only was negatively and positively associated with HGB level, respectively, and plasma Ni had positive association with HGB level in menarche age >13 years old group. BKMR results showed the reverse U-shaped relationship between the five metals mixture (Co, Fe, Ni, Cu and Rb) and HGB levels in overall and menarche age ≤13 years old group. However, there were positive association between the five metals mixture and HGB levels in menarche age >13 years old group. Conclusion: Our present study revealed that metals (Fe, Ni, Co, Rb, Cu) mixture exposure could effect HGB levels in female college students with dysmenorrhea. And the relationships were different during different menarche age in female college students.