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Background: Dysmenorrhea, characterised by painful menstrual cramps, is a pressing issue among adolescent girls globally. It significantly impacts their quality of life and has been associated with increased mental health issues and engagement in risky behaviours like smoking. In Poland, there is limited research on menstrual health, emphasising the need for a study to understand dysmenorrhea experiences and their impact on young menstruating individuals. Methods: This research project investigated the effects of dysmenorrhea on quality of life and school attendance, as well as its associations with non-communicable diseases, including mental health among adolescent girls in Poland. Additionally, the study examined risk factors for non-communicable disease development, including high-risk health behaviours and exposure to violence. The study utilised a cross-sectional design, administering self-reported questionnaires in high schools and vocational schools in six voivodeships (regions) in Poland. The analysis was performed using the R language in the Rstudio environment. p-value < 0.05 was considered significant. Results: A significant percentage of respondents experienced heavy menstruation, irregularity, and pain. Adolescents with dysmenorrhea reported higher rates of school absenteeism, mental health issues (such as anxiety and panic attacks), and a higher likelihood of engagement in risk behaviours like smoking and illicit drug use. The study also identified associations between dysmenorrhea and experiences of violence, including sexual abuse and intimate partner violence, as well as links to self-harm and suicidal ideation. Conclusions: These findings contribute to understanding dysmenorrhea among Polish adolescent girls, emphasising the need for tailored interventions and support services. The study underscores the necessity of addressing menstrual health comprehensively, considering its impact on various aspects of young women's lives and promoting their overall well-being. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to identify and explore the unmet needs of adolescents and young adults living with endometriosis. Design: An open‐ended online survey was conducted, with questions derived from prior research looking at areas of unmet need in healthcare, career and work, financial, information, psychological, social and cultural domains. Setting and Population: Self‐selecting 18‐25 year olds with surgically diagnosed endometriosis (self‐reported) currently living in Australia were included as participants. Methods: Invitation to participate in an open‐ended online survey was shared through the social media of Australian endometriosis organisations and the Royal Women's Hospital, Melbourne. Surveys were analysed qualitatively through template analysis. Main Outcome Measures: Recording of the unmet supportive care needs of this population was carried out. Results: One hundred and thirty‐one respondents fit the eligibility criteria of being aged 18–25 years (median age 23 years). Most were born in Australia (94%), university‐educated (54%) and lived in a metropolitan setting (69%). There was a range of unmet needs that were presented across education, work, healthcare and relationships. Group‐specific challenges were identified: doctors either over‐ or underemphasising future fertility; disrupted sexual and romantic life due to painful sex; managing pain in the classroom and workplace where periods are taboo; and being gender‐queer in gynaecological medical spaces. Conclusions: The increasingly young age at which patients are receiving an endometriosis diagnosis precipitates a shift in patient care. The treatment decisions that are being made must be reflective of the unique needs of the adolescents who carry the burden of the disease. Clinicians are advised to be aware of and discuss needs with their patients. Patient or Public Contribution: The nine open‐ended questions in this survey were developed from data from a preliminary series of interviews with endometriosis patients in a tertiary women's healthcare centre. In asking these data‐informed questions to the online endometriosis community, patients across broader sociocultural demographics and disease states (including less symptomatic endometriosis) have provided a broader understanding of their supportive care needs. [ABSTRACT FROM AUTHOR]

This Perspectives article reflects on findings from our systematic review about adolescent dysmenorrhoea Q, drawing on sociology of diagnosis theory. We consider tensions and uncertainties between presentation with symptoms of dysmenorrhoea and processes of symptom categorisation and diagnosis in adolescents, tracing these through research and clinical guidance, considering possible implications for clinical practice. We argue that challenges in distinguishing between primary and secondary dysmenorrhoea in research translate into challenges in differentiation in clinical practice. We argue that framing this distinction as clear cut and straightforward belies the well-documented challenges in diagnosis of endometriosis, and that not recognising uncertainty and complexity inherent in this task may benefit neither clinicians nor patients. [ABSTRACT FROM AUTHOR]

Copyright of Die Gynäkologie 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.)

Background: A biopsychosocial approach to the understanding of pelvic pain is increasingly acknowledged. However, there is a lack of standardised instruments - or their use - to assess risk factors and their impact on pelvic pain in both clinical and research settings. This review aims to identify validated tools used to assess known contributory factors to pelvic pain, as well as the validated tools to measure the impact of pelvic pain in adolescents and young adults, in order to provide a framework for future standardised, adolescent specific assessment and outcome tools. Methods: Literature searches were performed in MEDLINE, Psyclnfo and PubMed. Search terms included pelvic pain, dysmenorrhoea, endometriosis, adolescent, pain measurement, quality of life, sleep, mental health, coping strategies and traumatic experience. Results: We found validated instruments to assess adverse childhood experiences and coping strategies, both known contributing factors to pelvic pain. The impact of pain was measured through validated tools for health-related quality of life, mental health and sleep. Conclusions: Pelvic pain evaluation in adolescents should include a multi-factorial assessment of contributing factors, such as childhood adversity and coping strategies, and impacts of pelvic pain on quality of life, mental health and sleep, using validated instruments in this age group. Future research should focus on the development of consensus amongst researchers as well as input from young women to establish a standardised international approach to clinical trials involving the investigation and reporting of pelvic pain in adolescents. This would facilitate comparison between studies and contribute to improved quality of care delivered to patients. [ABSTRACT FROM AUTHOR]

Background: Dysmenorrhoea, or period pain, is a prevalent gynaecological condition that can result in functional interference during menstruation. Despite the significant disruption dysmenorrhoea can have on functioning and well-being, medical help-seeking rates are low. Little is known about what factors may predict help-seeking for dysmenorrhoea. Objectives: The current study aimed to test the predictive validity of the Behavioural Model of Health Services Use (BMHSU) for help-seeking behaviour in dysmenorrhoea, whereby help-seeking behaviour was operationalised as having attended to a healthcare professional for dysmenorrhoea-related care. Design: A cross-sectional observational design was used. Methods: Participants (N = 439) completed an online survey, which measured the following eight predictor variables: menstrual pain characteristics, health beliefs, self-efficacy, social support utilisation and satisfaction, perceived healthcare availability, and pain intensity and interference. Participants were also asked to report whether they had ever attended to a healthcare professional for their menstrual pain. Results: The BMHSU accounted for 8% of the variance in help-seeking behaviour. Pain interference and appointment availability were significant predictors of the variance in past help-seeking behaviour, such that those who experienced greater pain interference, and those who perceived greater availability of healthcare appointments were less likely to have visited a healthcare professional for their menstrual pain. The BMHSU had an overall 69% classification accuracy in predicting help-seeking behaviour. Conclusion: Although the BMHSU demonstrated reasonably good model fit, it does not appear to be a particularly robust model for predicting help-seeking behaviour for dysmenorrhoea. Future research should explore whether a refined BMHSU or an alternative theoretical model can provide more useful insight into this behaviour. Better understanding of the determinants of help-seeking behaviour will enable the development of interventions to promote appropriate help-seeking and improve health outcomes for individuals with menstrual pain. Plain language summary: What makes people with period pain seek help? Many people experience common period pain, which can be severe and debilitating. Even though it can make daily life difficult, not many people seek medical help for period pain. The purpose of this study was to find out why people with period pain might or might not go to a doctor for help. We used a theoretical framework called the Behavioural Model of Health Services Use to try to understand this. This framework tells us that predisposing factors like age or health beliefs, enabling factors like family support and access to healthcare, and need factors like severe symptoms, can predict whether someone will go to the doctor. We wanted to test if this way of thinking could accurately predict if someone with period pain had been to see a doctor. We asked people with period pain to fill in an online survey. We asked about things like how painful their periods were, what they believed about their menstrual health, how confident they felt in managing their pain, whether they got support from others, if they thought healthcare was available, and how much the pain affected their lives. We also asked if they had ever gone to a doctor for help with their period pain. We found that these factors were not very accurate in predicting whether people sought help for period pain. The most important predictors were how much the pain affected their lives and whether they believed that healthcare appointments were available to them. If the pain was very disruptive, and if they felt there were free appointments, people were less likely to have gone to see a doctor. This study was the first to use this way of thinking to understand help-seeking for people with period pain. In the future, researchers should test different models to see if they work better for understanding help-seeking behaviour for period pain. It is important to find ways to understand this behaviour to help people seek help for their pain when they need it. [ABSTRACT FROM AUTHOR]

Introduction: Dysmenorrhoea affects many adolescents with significant impacts on education and well-being. In the UK, most of the adolescents who seek care (and many never do), will do so through general practice (primary care). Knowing how best to care for adolescents reporting menstrual pain is an area where UK general practitioners would like better guidance and resources. Methods: This mixed-methods narrative synthesis collates community and specialist evidence from 320 papers about adolescent dysmenorrhoea, with a UK general practice community health perspective. Results: We report a narrative summary of symptoms, cause, consequences and treatments for adolescent dysmenorrhoea. We highlight areas of tension or conflicted evidence relevant to primary care alongside areas of uncertainty and research gaps identified through this synthesis with input from lived experience advisers. Discussion: There is little evidence about primary care management of adolescent dysmenorrhoea or specific resources to support shared-decision making in general practice, although there are evidence-based treatments to offer. Primary care encounters also represent potential opportunities to consider whether the possibility of underlying or associated health conditions contributing to symptoms of dysmenorrhoea, but there is little epidemiological evidence about prevalence from within community health settings to inform this. The areas where there is little or uncertain evidence along the care journey for adolescent dysmenorrhoea, including at the interface between experience and expression of symptoms and potential underlying contributory causes warrant further exploration. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective The aim of this study is to identify and explore the unmet needs of adolescents and young adults living with endometriosis. Design An open‐ended online survey was conducted, with questions derived from prior research looking at areas of unmet need in healthcare, career and work, financial, information, psychological, social and cultural domains. Setting and Population Self‐selecting 18‐25 year olds with surgically diagnosed endometriosis (self‐reported) currently living in Australia were included as participants. Methods Invitation to participate in an open‐ended online survey was shared through the social media of Australian endometriosis organisations and the Royal Women's Hospital, Melbourne. Surveys were analysed qualitatively through template analysis. Main Outcome Measures Recording of the unmet supportive care needs of this population was carried out. Results One hundred and thirty‐one respondents fit the eligibility criteria of being aged 18–25 years (median age 23 years). Most were born in Australia (94%), university‐educated (54%) and lived in a metropolitan setting (69%). There was a range of unmet needs that were presented across education, work, healthcare and relationships. Group‐specific challenges were identified: doctors either over‐ or underemphasising future fertility; disrupted sexual and romantic life due to painful sex; managing pain in the classroom and workplace where periods are taboo; and being gender‐queer in gynaecological medical spaces. Conclusions The increasingly young age at which patients are receiving an endometriosis diagnosis precipitates a shift in patient care. The treatment decisions that are being made must be reflective of the unique needs of the adolescents who carry the burden of the disease. Clinicians are advised to be aware of and discuss needs with their patients. Patient or Public Contribution The nine open‐ended questions in this survey were developed from data from a preliminary series of interviews with endometriosis patients in a tertiary women's healthcare centre. In asking these data‐informed questions to the online endometriosis community, patients across broader sociocultural demographics and disease states (including less symptomatic endometriosis) have provided a broader understanding of their supportive care needs.

Cystic adenomyosis is a rare type of adenomyosis. The main clinical manifestation of uterine cystic adenomyoma is severe dysmenorrhoea, and the condition can be diagnosed by relevant clinical examination. The preferred treatment, with a good prognosis, is lesion resection. The clinical data of a patient with uterine cystic adenomyoma recorded at the Third Hospital of Hebei Medical University are reported herein. A 39-year-old female patient presented with tolerable menstrual pain and aggravated dysmenorrhoea, which she had experienced for 4 years, and menorrhagia, which she had had for approximately 1 year. Ultrasound and tumour marker tests suggested abnormalities, and magnetic resonance imaging confirmed a diagnosis of uterine cystic adenomyoma. A hysteroscopy and intrauterine lesion electrocision were performed, and the results of postoperative pathology tests suggested that the endometriosis cysts had returned to normal after the postoperative intervention. The analysis of the clinical manifestations and diagnosis and treatment of uterine cystic adenomyoma can improve the understanding of the disease and reduce the rates of misdiagnosis and missed diagnoses to ensure early detection with timely diagnosis and treatment.

Background A biopsychosocial approach to the understanding of pelvic pain is increasingly acknowledged. However, there is a lack of standardised instruments – or their use – to assess risk factors and their impact on pelvic pain in both clinical and research settings. This review aims to identify validated tools used to assess known contributory factors to pelvic pain, as well as the validated tools to measure the impact of pelvic pain in adolescents and young adults, in order to provide a framework for future standardised, adolescent specific assessment and outcome tools.Methods Literature searches were performed in MEDLINE, PsycInfo and PubMed. Search terms included pelvic pain, dysmenorrhoea, endometriosis, adolescent, pain measurement, quality of life, sleep, mental health, coping strategies and traumatic experience.Results We found validated instruments to assess adverse childhood experiences and coping strategies, both known contributing factors to pelvic pain. The impact of pain was measured through validated tools for health-related quality of life, mental health and sleep.Conclusions Pelvic pain evaluation in adolescents should include a multi-factorial assessment of contributing factors, such as childhood adversity and coping strategies, and impacts of pelvic pain on quality of life, mental health and sleep, using validated instruments in this age group. Future research should focus on the development of consensus amongst researchers as well as input from young women to establish a standardised international approach to clinical trials involving the investigation and reporting of pelvic pain in adolescents. This would facilitate comparison between studies and contribute to improved quality of care delivered to patients.

Background Aims Materials and Methods Results Conclusions Dysmenorrhoea‐Related Pelvic Pain (DRPP) is a common condition, which may or may not include bladder‐related symptoms. Primary health care practitioners (PHCP) rely heavily on language for diagnosis of DRPP‐related conditions. However, there are no established pain descriptors to assist PHCP to determine whether an individual's DRPP may include a bladder component.To identify differences in the use of pain descriptors in women with DRPP with and without a co‐existing bladder pain component, through an exploratory study of the language of pelvic pain in women.A cross‐sectional online survey of Australian and New Zealand women (n = 750, ages 18–49) who have self‐identified pelvic pain. Free text and predetermined pain descriptors used by women with a self‐perceived bladder pain component (DRPPB+, n = 468) were compared to those without bladder pain (DRPPB−, n = 282). Statistical analysis included Pearson χ2, logistic regression and analysis of variance tests using StataCorp Stata Statistical Software combined with qualitative data from AntConc concordance software.Within free‐form text, bloating (P = 0.014) and pressure (P = 0.031) were used more commonly to describe dysmenorrhoea in women with DRPPB+, while the word excruciating (P < 0.001) was more commonly used by women with DRPPB−. From a pre‐determined list of descriptors, pounding (P < 0.001), tingling (P < 0.001), stabbing (P = 0.010), burning (P = 0.002) and cramping (P = 0.021) were more commonly used by women with DRPPB+, than women with DRPPB−.Systematic patterns of word use should encourage practitioners to further enquire about bladder symptoms that may co‐exist with dysmenorrhoea. Knowledge of these words may be useful in targeting diagnostic and therapeutic interventions. [ABSTRACT FROM AUTHOR]

Vitamin D reduces prostaglandin levels and inflammation, making it a promising treatment option for dysmenorrhoea. However, its effects on pain intensity in different types of dysmenorrhoea remain unclear. We examined whether vitamin D supplementation decreases pain intensity in patients with dysmenorrhoea. The Cochrane Library, Embase, Google Scholar, Medline, and Scopus databases were searched from inception to 30 December 2023. Randomised controlled trials (RCTs) evaluating vitamin D supplementation effects on such patients were included. The primary and secondary outcomes were measured by the changes in pain intensity and rescue analgesic use, respectively. Pooled mean differences and rate ratios were calculated using a random-effect model; trial sequential analysis (TSA) was also performed. Overall, 11 studies involving 687 participants were included. Vitamin D supplementation significantly decreased pain intensity in patients with dysmenorrhoea compared with controls (pooled mean difference, −1.64; 95% confidence interval, −2.27 to −1.00; p < 0.001; CoE, moderate; I2 statistic, 79.43%) and indicated substantial heterogeneity among the included studies. TSA revealed that the current RCTs provide sufficient information. In subgroup analyses, vitamin D supplement reduced primary dysmenorrhoea pain but not secondary dysmenorrhoea pain. In conclusion, although substantial heterogeneity persists, vitamin D supplementation decreased pain intensity in patients with dysmenorrhea, especially in those with primary dysmenorrhoea. [ABSTRACT FROM AUTHOR]

Copyright of Turkiye Klinikleri Journal of Health Sciences / Türkiye Klinikleri Sağlık Bilimleri Dergisi is the property of Turkiye Klinikleri 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.)

Except when surgery is the only option because of organ damage, the presence of suspicious lesions, or the desire to conceive, women with endometriosis-associated pain often face a choice between medical and surgical treatment. In theory, the description of the potential benefits and potential harms of the two alternatives should be standardized, unbiased, and based on strong evidence, enabling the patient to make an informed decision. However, doctor's opinion, intellectual competing interests, local availability of specific services and (mis)information obtained from social media, and online support groups can influence the type of advice given and affect patients' choices. This is compounded by the paucity of robust data from randomized controlled trials, and the anxiety of distressed women who are eager to do anything to alleviate their disabling symptoms. Vulnerable patients are more likely to accept the suggestions of their healthcare provider, which can lead to unbalanced and physician-centred decisions, whether in favour of either medical or surgical treatment. In general, treatments should be symptom-orientated rather than lesion-orientated. Medical and surgical modalities appear to be similarly effective in reducing pain symptoms, with medications generally more successful for severe dysmenorrhoea and surgery more successful for severe deep dyspareunia caused by fibrotic lesions infiltrating the posterior compartment. Oestrogen–progestogen combinations and progestogen monotherapies are generally safe and well tolerated, provided there are no major contraindications. About three-quarters of patients with superficial peritoneal and ovarian endometriosis and two-thirds of those with infiltrating fibrotic lesions are ultimately satisfied with their medical treatment although the remainder may experience side effects, which may result in non-compliance. Surgery for superficial and ovarian endometriosis is usually safe. When fibrotic infiltrating lesions are present, morbidity varies greatly depending on the skill of the individual surgeon, the need for advanced procedures, such as bowel resection and ureteral reimplantation, and the availability of expert colorectal surgeons and urologists working together in a multidisciplinary approach. The generalizability of published results is adequate for medical treatment but very limited for surgery. Moreover, on the one hand, hormonal drugs induce disease remission but do not cure endometriosis, and symptom relapse is expected when the drugs are discontinued; on the other hand, the same drugs should be used after lesion excision, which also does not cure endometriosis, to prevent an overall cumulative symptom and lesion recurrence rate of 10% per postoperative year. Therefore, the real choice may not be between medical treatment and surgery, but between medical treatment alone and surgery plus postoperative medical treatment. The experience of pain in women with endometriosis is a complex phenomenon that is not exclusively based on nociception, although the role of peripheral and central sensitization is not fully understood. In addition, trauma, and especially sexual trauma, and pelvic floor disorders can cause or contribute to symptoms in many individuals with chronic pelvic pain, and healthcare providers should never take for granted that diagnosed or suspected endometriosis is always the real, or the sole, origin of the referred complaints. Alternative treatment modalities are available that can help address most of the additional causes contributing to symptoms. Pain management in women with endometriosis may be more than a choice between medical and surgical treatment and may require comprehensive care by a multidisciplinary team including psychologists, sexologists, physiotherapists, dieticians, and pain therapists. An often missing factor in successful treatment is empathy on the part of healthcare providers. Being heard and understood, receiving simple and clear explanations and honest communication about uncertainties, being invited to share medical decisions after receiving detailed and impartial information, and being reassured that a team member will be available should a major problem arise, can greatly increase trust in doctors and transform a lonely and frustrating experience into a guided and supported journey, during which coping with this chronic disease is gradually learned and eventually accepted. Within this broader scenario, patient-centred medicine is the priority, and whether or when to resort to surgery or choose the medical option remains the prerogative of each individual woman. [ABSTRACT FROM AUTHOR]

This Perspectives article reflects on findings from our systematic review about adolescent dysmenorrhoea Q, drawing on sociology of diagnosis theory. We consider tensions and uncertainties between presentation with symptoms of dysmenorrhoea and processes of symptom categorisation and diagnosis in adolescents, tracing these through research and clinical guidance, considering possible implications for clinical practice. We argue that challenges in distinguishing between primary and secondary dysmenorrhoea in research translate into challenges in differentiation in clinical practice. We argue that framing this distinction as clear cut and straightforward belies the well-documented challenges in diagnosis of endometriosis, and that not recognising uncertainty and complexity inherent in this task may benefit neither clinicians nor patients.

IntroductionDysmenorrhoea affects many adolescents with significant impacts on education and well-being. In the UK, most of the adolescents who seek care (and many never do), will do so through general practice (primary care). Knowing how best to care for adolescents reporting menstrual pain is an area where UK general practitioners would like better guidance and resources.MethodsThis mixed-methods narrative synthesis collates community and specialist evidence from 320 papers about adolescent dysmenorrhoea, with a UK general practice community health perspective.ResultsWe report a narrative summary of symptoms, cause, consequences and treatments for adolescent dysmenorrhoea. We highlight areas of tension or conflicted evidence relevant to primary care alongside areas of uncertainty and research gaps identified through this synthesis with input from lived experience advisersDiscussionThere is little evidence about primary care management of adolescent dysmenorrhoea or specific resources to support shared-decision making in general practice, although there are evidence-based treatments to offer. Primary care encounters also represent potential opportunities to consider whether the possibility of underlying or associated health conditions contributing to symptoms of dysmenorrhoea, but there is little epidemiological evidence about prevalence from within community health settings to inform this. The areas where there is little or uncertain evidence along the care journey for adolescent dysmenorrhoea, including at the interface between experience and expression of symptoms and potential underlying contributory causes warrant further exploration.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPEROFILES/256458_STRATEGY_20210608.pdf, identifier (CRD42021256458).

Complementary therapies for decreasing dysmenorrhoea and factors behind dysmenorrhoea in adolescents is not clear enough. Researchers need information about trends and novelties for the future research topic of complementary therapies and factors related to dysmenorrhoea in adoles-cents. Thus, the purpose of this study was to identify the complementary therapies for decreasing dysmenorrhoea and factors related to dysmenorrhoea in adolescents by analysing network visualisation, overlay visualisation and density visualisation on the topic through bibliometric analysis. The data sources used in this study were based on online searches via https://app.dimensions.ai/. The literature search used the stages following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart. Paper restricted in publications years 2014-2023, focus in the field of health sciences, nursing, public health, clinical sciences and publication type were included as criteria for inclusion in the study. The data were analysed using VOSviewer. After identifying the clusters, the types of complementary therapies that were able to reduce dysmenorrhoea were acupressure, acupuncture, calcium sufficiency, curcumin, yoga, aromatherapy, massage and physical activity. Moreover, factors related to dysmenorrhoea were HIV, reproductive coercion, reproductive health, oxytocin, prolactin, trauma, metformin, anxiety and breast cancer. Moreover, the newest topics that were being widely researched related to adolescent dysmenorrhoea were education, non-suicidal self-injury (NSSI), prolactin and physical activity. On the other hand, topics that were rarely researched related to the topic of adolescent dysmenorrhoea were topics about sexual health, reproductive coercion, inflammation, curcumin and physical activity. Complementary therapies and factors that are still rarely studied offer potential novelty in results in future studies.

Introduction: The emergence of Coronavirus Disease-2019 (COVID-19) caught the world by surprise, leading to a widespread global pandemic that has had profound and distressing effects on various levels. Its impact has been far-reaching, causing severe consequences that continue to unfold. COVID-19 is a multisystem inflammatory disease involving all organs, including the female reproductive system. Aim: To determine the prevalence of COVID-19 among students and compare post-COVID-19 menstrual abnormalities in the home and hospital groups. Materials and Methods: A cross-sectional study was conducted to assess post-COVID-19 menstrual abnormalities among medical students at Department of Obstetrics and Gynaecology, NRI Institute of Medical Sciences, Visakhapatnam, Andhra Pradesh, in southern India from April to December 2022. A total of 600 medical students were approached, and 549 responded, among whom 258 students were reported as COVID-19 positive and 291 reported as COVID-19 negative. After excluding risk factors, 204 COVID-19 positive students were selected as the study population. Data were collected using a prevalidated questionnaire. The COVID-19 study population of 204 (100%) was further stratified into two groups based on the treatment taken at home 162 (79.4%) or in the hospital 42 (20.5%). Chi-square test and Fisher’s-exact tests were used to compare post-COVID-19 menstrual abnormalities, including cycle length abnormalities, Heavy Menstrual Bleeding (HMB), dysmenorrhoea, Premenstrual Syndrome (PMS), and hypomenorrhoea. Results: The prevalence of COVID-19 in the study population was 204, accounting for 37.15% of the total population 204/549. Out of the 204 students, 162 (79.4%) received home treatment, and 42 (20.5%) received hospital treatment. PostCOVID-19 menstrual cycle abnormalities were more prevalent in the hospital group 26/42 (61.9%) than in the home treatment group 76/162 (46.9%). The most common abnormality in both groups was PMS, with a prevalence of 21 (50%) in the hospital group and 38 (23.4%) in the home group. In the home group, 37 (22.8%) experienced longer cycles, 33 (20.3%) had dysmenorrhoea, and 19 (11.7%) had shorter cycles. In the hospital group, 14 (33.3%) had longer cycles, 13 (30.9%) experienced dysmenorrhoea, and 9 (21.4%) had shorter cycles. HMB was reported by 6 (14.2%) in the hospital group and 13 (8%) in the home group, while hypomenorrhoea occurred in 11 (6.7%) in the home group and 5 (11.9%) in the hospital group. A significant association (p=0.001) was found between the COVID-19 treatment groups and PMS. However, for other post-COVID-19 menstrual abnormalities, such as cycle length, dysmenorrhoea, HMB, and hypomenorrhoea, there was no significant association between these abnormalities and COVID-19 treatment groups. Conclusion: Post-COVID-19 menstrual abnormalities were more frequently observed in the hospital group compared to the home group. All post-COVID-19 menstrual irregularities resolved within six months, except for PMS.

Copyright of Magyar Nőorvosok Lapja is the property of Hungarian Society of Obsterics & Gynaecology 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.)

Introduction: Dysmenorrhea, or painful menstruation, affects a substantial portion of women worldwide, with prevalence rates reaching up to 67 to 90% among young women. This condition, characterized by intense lower abdominal cramps and associated symptoms, has a significant impact on women's quality of life. Conventional treatments like non-steroidal anti-inflammatory drugs (NSAIDs) have limitations, leading many to explore alternative therapies such as homeopathy. Objective: This article reviews the effects of homeopathic treatments on dysmenorrhea patients and examines seven studies conducted in this context. Methods: Studies which meet the specific required criteria; involving dysmenorrhea and Homoeopathy and being published in peer-reviewed English-language scientific journals were only included. Various parameters, such as disease intensity scales, the Menstrual Distress Questionnaire (MDQ), the Pain Rating Scale (PRS), the Visual Analogue Scale (VAS), and quality of life (QoL) using the World Health Organization Quality of Life: Brief Version (WHOQOL-BREF) scale, numerical rating scale (NRS), and verbal multidimensional scoring system (VMSS), were evaluated. The results before and after treatment with homoeopathic high dilutions have been compared and summarized. Results: Clinical analysis and statistical data of reviewed studies reveal homeopathic high dilutions as effective for Primary Dysmenorrhea, reducing pain (VAS), improving quality of life (WHOQOL), and demonstrating safety, emphasizing their holistic potential. [ABSTRACT FROM AUTHOR]

Objective: This study examined the prevalence and correlates of depression, anxiety, insomnia, and dysmenorrhea in stressed fingolimod-treated women with multiple sclerosis. Methods: This cross-sectional study recruited female patients diagnosed with multiple sclerosis and high stress scores from Al-Bashir Hospital in Jordan. Depression was assessed by the Patient Health Questionnaire (PHQ-9); anxiety by the Generalized Anxiety Disorder (GAD-7) scale; insomnia by the Insomnia Severity Index (ISI-A) scale; and dysmenorrhea severity by a measure assessing working ability, location, intensity, days of pain, and miscellaneous dysmenorrhea symptoms (WaLIDD). Results: A total of 129 patients were recruited for the study. Severe depression was reported in 55.8%, severe anxiety in 62.0%, severe insomnia in 36.4%, and severe dysmenorrhea in 23.3%. Multivariate analyses revealed that depressive symptoms were associated with dysmenorrhea (OR = 3.55, 95% CI = 1.56–8.12, p = 0.003); anxiety symptoms with "not using dysmenorrhea analgesics" (OR = 2.74, 95% CI = 1.16–6.46, p = 0.02) and dysmenorrhea symptoms (OR = 4.74, 95% CI = 1.94–11.59, p = 0.001); insomnia symptoms with age above 30 years (OR = 4.34, 95% CI = 1.64–11.51, p = 0.003); and dysmenorrhea symptoms with the presence of chronic diseases (OR = 4.21, 95% CI = 1.28–13.92, p = 0.02), anxiety symptoms (OR = 3.03, 95% CI = 1.18–7.73, p = 0.02), and insomnia symptoms (OR = 3.00, 95% CI = 1.18–7.64, p = 0.02). Conclusion: Stressed women with multiple sclerosis in Jordan experience high rates of depression, anxiety, insomnia, and dysmenorrhea. Characteristics related to these conditions may help clinicians to identify those at risk. Longitudinal studies are needed to determine the causal nature of these associations. [ABSTRACT FROM AUTHOR]

Introduction: Endometriosis is a disease of adolescents and women of reproductive age group characterised by the presence of endometrial tissue outside the uterine cavity. It is a typical gynaecological condition that causes symptoms such as dysmenorrhoea, dyspareunia, dyschezia, chronic pelvic pain, irregular uterine bleeding, and infertility. Being a prevalent disease primarily affecting women of reproductive age, this condition significantly reduces the Quality of Life (QoL) with frequent recurrence of symptoms after discontinuation of conservative therapy. Aim: The aim of this study was to investigate the alleviation of Endometriosis-associated Pelvic Pain (EAPP), effective cycle control, and to compare the side effects of continuous dienogest and cyclical dienogest with ethinylestradiol, as well as the improvement in QoL in the two study groups. Materials and Methods: A prospective interventional study was conducted at the Department of Obstetrics and Gynaecology, Medical College Kolkata, West Bengal, India. The study duration was 12 months, from June 2020 to May 2021. Patients attending the Gynaecology Outpatient Department (GOPD) with clinical, sonological, and/or surgical diagnosis of endometriosis were enrolled in the study and divided into two groups of 30 patients each. Group 1 was treated with Dienogest (D) 2 mg, and group 2 received a combination of dienogest 2 mg and Ethinyl Estradiol 30 mcg (D+EE) combination. The Visual Analogue Scale (VAS) was used to define endometriosis-related symptoms. Patient satisfaction in terms of improvement in QoL was measured using a free online calculator based on the 12- item Short Form Health Survey (SF-12), which includes both physical and mental components. Follow-ups were conducted at one, three, and six months. Data were summarised as mean and Standard Deviation (SD) for numerical variables and count and percentages for categorical variables. A p-value

Dysmenorrhea a painful gynecological problem reported by women in their reproductive years, is a common condition and is refers to painful menstruation with severe cramping affecting the lower part of the abdomen caused by excessive prostaglandin production within secretory endometrial cell. Already existing drugs have numerous limitations. The objective of the study is to evaluate the cyclooxygenase inhibitory and radical scavenging potential of Heliotropium indicum L. (Boraginaceae) in the management of dysmenorrhea. The entire dried Heliotropium indicum plant was extracted by successive extraction procedure. Cyclooxygenase assay was carried out using COX-2 Test kit and ABTS assay was also carried out using ABTS Radical cation decoloration assay. HPLC-DAD was used to detect polyphenolic molecules. In cyclooxygenase assay, methanol extract showed highest anti-inflammatory activity with the lowest IC50 of 0.553±0.05 mg/mL when compared with Ibuprofen (IC50 of 0.065±0.00 mg/mL) at 1-0.03125 mg/mL, nhexane and ethyl acetate have IC50 of 0.782±0.01mg/mL and 0.608±0.01mg/mL, respectively. Heliotriopium indicum extract also showed an antioxidative activity when tested with ABTS radical cation decoloration with ethyl acetate having the highest activity (IC50 of 0.315±0.00 mg/mL) when compared with Trolox (IC50 of 0.034±0.00 mg/mL) at 1-0.03125 mg/mL. Tannic acid, naringenin, garlic acid, quercetin, maleic acid and saponin were identified from HPLC-DAD analysis at various concentration. Heliotriopium indicum has the potential to prevent the production of excessive prostaglandin by its ability to inhibit cyclooxygenase-2. Therefore, could be a source of new COX-2 inhibitors. [ABSTRACT FROM AUTHOR]

Introduction: LNG-IUD although used extensively for its non-contraceptive indications like abnormal uterine bleeding (AUB), dysmenorrhoea and fibroid uterus, one of the major drawbacks is the high expulsion rates, especially among adenomyotic and fibroid uterus. Material and Methods: Altius Hospitals, Bangalore have developed a new technique of LNG-IUD fixation, which employs hystero-laparoscopy and usage of a long port closure needle with delayed absorbable sutures. Conclusion: It ensures proper placement and fixation of the LNG-IUD to the uterine cavity, reduces the expulsion rates and has the advantages of being a day care procedure. [ABSTRACT FROM AUTHOR]

Nutcracker syndrome (NCS) is a sporadic syndrome due to the compression of the left renal vein (LRV) between the abdominal aorta and the superior mesenteric artery (SMA). This condition may present with unexplainable pain, hematuria, orthostatic hypotension, proteinuria, or dysfunction of the kidneys. These symptoms would be explained by the fact that if a chronically standing venous congestion is there then there could be the development of gonadal vein and pelvic vein collateral drainage pathways. Doppler USG (ultrasound), cross-sectional and invasive imaging modalities are frequently used for the purpose of diagnosis. Here, in this report, there's a female patient in her mid- 20's. She was asymptomatic since birth and presented with a history of abdominal pain and blood in the urine. USG is not the best modality for describing the findings hence a further contrast-enhanced computed tomography was done which reported an NCS. In all cases of unexplained hematuria, after excluding all differential diagnoses, NCS must be taken into account.

Background: Adenomyosis is a common disorder in women of reproductive age. The gold standard for diagnosis is histopathological examination of hysterectomy specimen. However, only a small percentage of women undergo surgery as treatment is primarily hormonal. Non-invasive methods of diagnosis include transvaginal sonography and magnetic resonance imaging. Patient management in adenomyosis is often based on ultrasonographic diagnosis alone, highlighting the importance of a uniform, reproducible, clinically relevant and validated sonological classification and scoring system. Although a few investigators have proposed classification and scoring system for diagnosis of adenomyosis, none of those have been validated yet. This study aimed to propose and validate a new sonological classification and scoring system for adenomyosis. Methods: This was a prospective observational pilot study. A new sonological classification and scoring system of adenomyosis was proposed based on topography, type, size and extent, which was validated by comparing the sonological reporting with histopathological reporting. The main outcome measures that were measured were rate of agreement (Cohen’s kappa) between the findings of sonologist and pathologist; and diagnostic accuracy of the sonological classification of adenomyosis. Results: This pilot study included 30 women who underwent hysterectomy over a time period of one year with ultrasonographic diagnosis of adenomyosis. The rate of agreement (Cohen’s kappa) between the findings of sonologist and pathologist showed substantial agreement (0.703) for topography and almost perfect agreement for type (0.896), extent (0.892) and size (0.898). Conclusions: Our newly proposed sonological classification and scoring system for adenomyosis is valid and can be used for clinical application in interpersonal communication between clinicians, to prognosticate patients about the disease severity, to assess the candidates for surgical management and in further studies to correlate with symptoms severity and effectiveness of medical therapies.

Vitamin D reduces prostaglandin levels and inflammation, making it a promising treatment option for dysmenorrhoea. However, its effects on pain intensity in different types of dysmenorrhoea remain unclear. We examined whether vitamin D supplementation decreases pain intensity in patients with dysmenorrhoea. The Cochrane Library, Embase, Google Scholar, Medline, and Scopus databases were searched from inception to 30 December 2023. Randomised controlled trials (RCTs) evaluating vitamin D supplementation effects on such patients were included. The primary and secondary outcomes were measured by the changes in pain intensity and rescue analgesic use, respectively. Pooled mean differences and rate ratios were calculated using a random-effect model; trial sequential analysis (TSA) was also performed. Overall, 11 studies involving 687 participants were included. Vitamin D supplementation significantly decreased pain intensity in patients with dysmenorrhoea compared with controls (pooled mean difference, −1.64; 95% confidence interval, −2.27 to −1.00; p < 0.001; CoE, moderate; I2 statistic, 79.43%) and indicated substantial heterogeneity among the included studies. TSA revealed that the current RCTs provide sufficient information. In subgroup analyses, vitamin D supplement reduced primary dysmenorrhoea pain but not secondary dysmenorrhoea pain. In conclusion, although substantial heterogeneity persists, vitamin D supplementation decreased pain intensity in patients with dysmenorrhea, especially in those with primary dysmenorrhoea.

Introduction: Endometriosis is a disease of adolescents and women of reproductive age group characterised by the presence of endometrial tissue outside the uterine cavity. It is a typical gynaecological condition that causes symptoms such as dysmenorrhoea, dyspareunia, dyschezia, chronic pelvic pain, irregular uterine bleeding, and infertility. Being a prevalent disease primarily affecting women of reproductive age, this condition significantly reduces the Quality of Life (QoL) with frequent recurrence of symptoms after discontinuation of conservative therapy. Aim: The aim of this study was to investigate the alleviation of Endometriosis-associated Pelvic Pain (EAPP), effective cycle control, and to compare the side effects of continuous dienogest and cyclical dienogest with ethinylestradiol, as well as the improvement in QoL in the two study groups. Materials and Methods: A prospective interventional study was conducted at the Department of Obstetrics and Gynaecology, Medical College Kolkata, West Bengal, India. The study duration was 12 months, from June 2020 to May 2021. Patients attending the Gynaecology Outpatient Department (GOPD) with clinical, sonological, and/or surgical diagnosis of endometriosis were enrolled in the study and divided into two groups of 30 patients each. Group 1 was treated with Dienogest (D) 2 mg, and group 2 received a combination of dienogest 2 mg and Ethinyl Estradiol 30 mcg (D+EE) combination. The Visual Analogue Scale (VAS) was used to define endometriosis-related symptoms. Patient satisfaction in terms of improvement in QoL was measured using a free online calculator based on the 12-item Short Form Health Survey (SF-12), which includes both physical and mental components. Follow-ups were conducted at one, three, and six months. Data were summarised as mean and Standard Deviation (SD) for numerical variables and count and percentages for categorical variables. A p-value <0.05 was considered statistically significant. Results: A total of 60 patients were enrolled in the study and divided into two groups of 30 patients each. At three and six months, endometriosis-associated pelvic pain significantly decreased in patients receiving Dienogest+Ethinylestradiol (D+EE) compared to patients receiving dienogest alone (p<0.001). The effectiveness in cycle control at three and six months was also higher in the D+EE group (p=0.0098 and 0.0443, respectively). The safety profile was similar in both groups during follow-ups. QoL, as assessed by the Physical Component Score (PCS-12), showed a significant decrease at one, three, and six months with D+EE compared to Dienogest alone (p=0.0135, p=0.0058, and p<0.0001, respectively). The Mental Component Score (MCS-12) at three and six months significantly improved in patients on D+EE (p=0.0101, p<0.0001, respectively). Conclusion: Cyclical D+EE was found to be more effective in the management of pelvic endometriosis compared to continuous dienogest alone, resulting in reduced EAPP, improved cycle control, and enhanced QoL. [ABSTRACT FROM AUTHOR]

Background: Whereas symptomatic endometriosis may affect work performance, the impact of endometriosis in the general community is not known. Aims: The associations between endometriosis and each of sick leave and work ability, were investigated in a large sample of non‐healthcare seeking women. Materials and Methods: This community‐based, cross‐sectional study recruited 6986 women, aged 18–39 years, from three eastern states of Australia between 11 November 2016 and 21 July 2017. Women were identified as having endometriosis if they had undergone a pelvic ultrasound and reported a diagnosis of endometriosis. Working women completed the Work Ability Index. Results: Participants were predominantly of European ancestry (73.1%) and 46.8% were overweight or had obesity. The prevalence of endometriosis was 5.4% (95%CI 4.9–6.0%) with the highest prevalence of 7.7% (95%CI 6.5 to 9.1%) for women aged 35–39 years. Among the 4618 working women, those with endometriosis had significantly more sick days from work (33.6% reported ≥10 days vs 13.5%, overall χ2P < 0.001). Endometriosis was associated with a greater likelihood of poor to moderate work ability, after adjusting for age, body mass index, ethnicity, relationship status, student status, insecure housing, being a carer for another person, parity, ever use of assisted reproductive technologies, and depressed mood (odds ratio 1.90, 95%CI 1.40–2.58, P < 0.001). Conclusions: This study provides new evidence that the negative impact of endometriosis on work attendance and work ability is not limited to women with prevalent symptoms and severe disease, but appears to encompass women across a broader spectrum of this condition in the community. [ABSTRACT FROM AUTHOR]

Women with endometriosis are frequently affected by headache. How many of these have a clear diagnosis of migraine? Are the different forms of migraine related to the phenotypes and/or characteristics of endometriosis? This was a prospective nested case-control study. A consecutive series of 131 women with endometriosis who attended the endometriosis clinic were enrolled and examined for the presence of headache. A headache questionnaire was used to determine the characteristics of the headaches, and the diagnosis of migraine was confirmed by a specialist. The case group included women with endometriosis and a diagnosis of migraine, while the control group included women with only endometriosis. History, symptoms and other comorbidities were collected. A pelvic pain score and associated symptoms were assessed using a visual analogue scale. A diagnosis of migraine was made in 53.4% (70/131) of participants. Pure menstrual migraine was reported by 18.6% (13/70), menstrually related migraine by 45.7% (32/70) and non-menstrual migraine by 35.7% (25/70). Dysmenorrhoea and dysuria were significantly more frequent in patients with endometriosis and migraine than in those without migraine (P = 0.03 and P = 0.01). No difference was found for other variables, including age at diagnosis and duration of endometriosis, endometriosis phenotype, the presence of other autoimmune comorbidities or heavy menstrual bleeding. In most patients with migraine (85.7%) the headache symptoms had started years before the diagnosis of endometriosis. The occurrence of headache in many patients with endometriosis is associated with the presence of different forms of migraine, is related to pain symptoms and often precedes the diagnosis of endometriosis. [ABSTRACT FROM AUTHOR]

Primary aim of this study was to investigate endometriosis characteristics of patients with psychiatric conditions or depression. The secondary aim was to study tolerability of dienogest in this context. This observational case-control study included endometriosis data from patients visiting our clinic from 2015–2021. We collected information from patient charts and in phone interviews based on a structured survey. Patients with surgical confirmed endometriosis were included. 344 patients fulfilled the inclusion criteria: n = 255 no psychiatric disorder, n = 119 any psychiatric disorder and n = 70 depression. Patients with depression (EM-D, p=.018; p=.035) or psychiatric condition (EM-P, p=.020; p=.048) suffered more often from dyspareunia and dyschezia. EM-P patients had more often primary dysmenorrhoea with higher pain scores (p=.045). rASRM stage or localisation of lesions did not differ. EM-D and EM-P patients discontinued dienogest treatment more often related to worsening of mood (p=.001, p=.002). EM-D or EM-P had a higher prevalence of pain symptoms. This could not be attributed to differences in rASRM stage or location of endometriosis lesions. Strong primary dysmenorrhoea might predispose to develop chronic pain-based psychological symptoms. Therefore, early diagnosis and treatment are relevant. Gynaecologist should be aware of the potential impact of dienogest on mood. Women with endometriosis and psychiatric disorders especially have more dyschezia and dyspareunia, independent from rASRM stage, depth of infiltration and localisation of endometriosis lesions. Dienogest has an impact on mood especially in already prone patients. Trial registration: trial registration number: NCT04816357. Date of registration: 22.03.2021, date of enrolment of the first subject: 25.03.2021 [ABSTRACT FROM AUTHOR]

To evaluate quality of life (Qol), pain level and medical consumption before and after uterine botulinum toxin (BT) injections in severe dysmenorrhea, dyspareunia and chronic pelvic pain. This was a before and after study using the database of a pilot study (Open-label non comparative study, on 30 patients, with severe dysmenorrhoea in therapeutic failure) assessing efficacy and cost of uterine injection of BT in women with chronic pelvic pain after failure of conventional treatment (hormonal and analgesics) (CT). Main clinical outcome: Patient Global Impression of Improvement (PGI-I), EuroQol health-related QoL (EQ-5D-5L), EuroQol-visual analogue scale (EQ-VAS), Female Sexual Function Index (FSFI), utility measure of health-related quality of life (also called health state preference values), cost and of health care consumption were collected prospectively and analysed in the two phases (before and after). The two timepoints were 12 months before uterine BT injection, when the patient had been receiving CT, and 12 months after uterine BT injection. Median visual analogue scale scores were significantly improved by BT regarding the patients' main source of pain (31.6 vs 80.55; p < 0.00001). We also noted a significant reduction in the proportion of patients who reported dyspareunia [15 (75%) vs 3 (15%) patients, p = 0.001] and pain during menstruation (p < 0.0001). The PGI-I scale showed a significant increase in the proportion of patients who were satisfied with their treatment after receiving the BT injection. The injection of BT was frequently associated with increase in QoL and a reduction in health care consumption, and cost: 714.82 €+/- €336.43 (BT) versus 1104.16 €+/- €227.37 (CT), which could result in substantial savings approximately (389,34€) per patient. This study revealed the clinical effectiveness of BT injections on dysmenorrhea, chronic pelvic pain as well as reduction of cost and health care consumption, in our population, which is innovative since no standard of treatment exists in this domain. [ABSTRACT FROM AUTHOR]

Is a decrease in dysmenorrhoea after suppressive hormonal therapy a marker of the endometriosis phenotype and of greater disease severity? Retrospective observational cohort study conducted in a French university hospital, between January 2004 and December 2019. Non-pregnant women aged younger than 42 years, who tested for dysmenorrhoea relief after suppressive hormonal therapy before surgery, and who had histological confirmation of endometriosis, were included. The comparisons were carried out according to the results of the suppressive hormonal test. Of the 578 histologically proven endometriosis patients with preoperative pain symptoms, the rate of dysmenorrhoea decrease after suppressive hormonal therapy was 88.2% (n = 510). These patients had a higher incidence of deep infiltrating endometriosis (DIE) intestinal lesions (45.7% [233/510] versus 30.8% [21/68], P = 0.01) and an increased rate of multiple DIE lesions (two or more) (72.8% [287/394] versus 56.4% [22/39], P = 0.02). After multivariate analysis, decrease of dysmenorrhoea after suppressive hormonal therapy remained significantly associated with the severe DIE phenotype (adjusted OR 3.9, 95% CI 2.0 to 7.6, P < 0.001). In women with endometriosis, a decrease of dysmenorrhoea after suppressive hormonal therapy is associated with the DIE phenotype and is a marker of greater severity. [ABSTRACT FROM AUTHOR]

Knowing the population's needs in order to plan measures to reduce emergency department (ED) use is fundamental. The objective of this study was to describe gynaecological ED visits and associated findings in women of reproductive age. This study was a retrospective anonymized chart review analysis of visits to the ED for gynaecological disturbances at the University Hospital of Modena. All consecutive women of reproductive age were included. Women aged <18 years and postmenopausal women were excluded from this study. In total, 461 records were analysed. The median age was 41 (interquartile range 34–46) years. The most common symptom was dysmenorrhoea (42.7 %), followed by heavy menstrual bleeding (33.2 %). The most common gynaecological findings in the ED were adenomyosis (86.1 %), endometriosis (37.1 %) and leiomyomas (13.7 %). Adenomyosis was the most common finding, regardless of age. Endometriosis was more prevalent in women aged <41 years (43.8 % vs 31.2 %; p < 0.05). Meanwhile, adenomyosis and leiomyomas were more prevalent in women aged ≥41 years (81.11 % vs 90.57 % and 7.37 % vs 19.26 %, respectively; p < 0.05). Moreover, potentially life-threatening findings had low prevalence [i.e. haemorrhagic ovarian cyst (0.2 %), tubo-ovarian abscess (0.2 %) and pelvic inflammatory disease (0.4 %)]. In the study setting, chronic pathologies such as adenomyosis, endometriosis and leiomyomas significantly impacted use of the ED. Adenomyosis was the most common pathology, regardless of age. Adenomyosis and leiomyomas were more prevalent in women aged ≥41 years, and endometriosis was more prevalent in women aged <41 years. [ABSTRACT FROM AUTHOR]

Background: Endometriosis is a chronic, often debilitating condition with a current significant delay from symptom onset to diagnosis with much of this in primary care. Methods: A systematic review and meta-analysis of the primary literature was conducted to investigate the accuracy of symptoms, clinical history and first-line non-invasive tests to predict pelvic endometriosis (PROSPERO: CRD42020187543). We searched Medline, Embase, Web of Science and Scopus from conception (1966; 1972; 1997; 2004 respectively) to September 2022 for primary test accuracy studies assessing non-invasive tests against reference standard diagnosis for endometriosis. Two authors independently conducted data extraction and quality assessment. Grading of evidence was performed using a novel visual pentagon model. Meta-analyses of test accuracy was estimated using bivariate random effects models. Results: The 125 included studies (250,574 participants) showed mixed quality. Studies applying non-surgical (database/self-reporting) reference standard had a greater risk of bias. In 98 studies applying surgical reference standard, summary diagnostic odds ratios for endometriosis were: dysmenorrhoea 2.56 (95% confidence interval 1.99-3.29); pelvic pain 2.56 (1.73-3.74); dyschezia 2.05 (1.36-3.10); dyspareunia 2.45 (1.71-3.52); family history of endometriosis 6.79 (4.08-11.3); nulligravidity of 2.01 (1.62-2.50); body mass index (BMI) ≥30kg/m 2 0.37 (0.19-0.68); trans-vaginal ultrasound scan (TVUSS) endometrioma 91.2 (44.0-189); TVUSS invasive endometriosis 26.1 (9.28-73.5); and cancer antigen-125 (CA-125) >35U/mL 16.0 (8.09-31.7). Sensitivity analysis excluding all high-risk studies found concordant results. Conclusions: This meta-analysis collated the performance of non-invasive tests for endometriosis across a comprehensive and geographically varied population. Study quality was mixed, however results were consistent with high-risk studies excluded. These findings will inform future prediction models for triage in primary care.

Abstract Background This study aimed to determine menstrual characteristics and related morbidities among adolescent girls living in Sabah, North Borneo, a less-developed state in Malaysia. Methods Data were obtained from a quantitative survey conducted in three government high schools located in Ranau, Sabah. The participants were adolescent girls who had attained menarche between the ages of 14 and 19. Results Based on the analysis of questionnaires completed by 757 adolescent girls, the mean age at the time of the survey was 17 ± 1.4 years, and the mean menarche age was 12.2 ± 1.1 years. Our data demonstrated that 85.7% of the participants experienced dysmenorrhoea, of which at least 42.1% (mean pain score ± SD: 4.81 ± 0.76, 95% confidence interval (CI) 4.72, 4.90) experienced moderate dysmenorrhoea, and 11.2% (mean pain score ± SD: 7.86 ± 0.94, 95% CI 7.64, 8.08) experienced severe dysmenorrhoea. Over 70% of these girls complained of tiredness, headache, and appetite changes during menses. Conclusions The prevalence of menstrual disorders and related morbidities was high among the girls residing in Sabah. Reproductive health issues in rural and socioeconomically deprived areas remains poorly addressed. The main consequence of neglecting menstrual disorders and their related morbidities is impaired future sexual reproductive health in adults. Thus, addressing adolescent reproductive health issues is crucial, especially for girls living in areas where access to healthcare is difficult. The information gathered from this study can be used to strategize effective interventions to improve adolescents' reproductive health status in rural areas.

Abstract Background It is estimated that between 12 to 25% of women who undergo an endometrial ablation for heavy menstrual bleeding (HMB) are dissatisfied after two years because of recurrent menstrual bleeding and/or cyclical pelvic pain, with around 15% of these women ultimately having a hysterectomy. The insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) immediately after endometrial ablation may inactivate residual untreated endometrium and/or inhibit the regeneration of endometrial tissue. Furthermore, the LNG-IUS may prevent agglutination of the uterine walls preventing intrauterine adhesion formation associated with endometrial ablation. In these ways, insertion of an LNG-IUS immediately after endometrial ablation might prevent subsequent hysterectomies because of persisting uterine bleeding and cyclical pelvic pain or pain that arises de novo. Hence, we evaluate if the combination of endometrial ablation and an LNG-IUS is superior to endometrial ablation alone in terms of reducing subsequent rates of hysterectomy at two years following the initial ablative procedure. Methods/design We perform a multicentre randomised controlled trial in 35 hospitals in the Netherlands. Women with heavy menstrual bleeding, who opt for treatment with endometrial ablation and without contraindication for an LNG-IUS are eligible. After informed consent, participants are randomly allocated to either endometrial ablation plus LNG-IUS or endometrial ablation alone. The primary outcome is the hysterectomy rate at 24 months following endometrial ablation. Secondary outcomes include women’s satisfaction, reinterventions, complications, side effects, menstrual bleeding patterns, quality of life, societal costs. Discussion The results of this study will help clinicians inform women with HMB who opt for treatment with endometrial ablation about whether concomitant use of the LNG-IUS is beneficial for reducing the need for hysterectomy due to ongoing bleeding and/or pain symptoms. Trial registration Dutch Trial registration: NL7817. Registered 20 June 2019, https://www.trialregister.nl/trial/7817 .

Many women experience negative feelings during menstrual bleeding. Aim of the study was to evaluate the attitudes of Italian women towards menstrual bleeding, their desire to reduce its frequency and knowledge of the existence of methods capable of achieving such an objective. An internet-based anonymous questionnaire has been sent to women willing to fill it in through different social media (Instagram, WhatsApp, Facebook, Twitter). The survey evaluated, objective parameters such as number of pads, use of painkillers, duration of period and pain intensity. Judgement towards period and knowledge about methods to reduce frequency and amount of menstrual flow were analysed. 1072 Women aged 18 − 40 years, answered the survey. The level of education of responders was high, with 61.7% having a university degree. 27.5% of respondents viewed positively the occurrence of a menstrual period. Ideal frequency of menstrual cycles was considered 3 months and the perfect duration was considered to be 3 days. Half of the respondents ignored the existence of methods to suppress menstruation or reduce its frequency. 52% of participants stated that they would not use a contraceptive method because they considered it not 'natural'. In our sample, in spite of the discomfort reported by half of the women interviewed, menstruation was considered positively by one fourth as because confirm their fertility. The majority of women did consider bleeding every month a healthy, but they preferred a three-monthly frequency. Knowledge of contraceptive methods capable of reducing the frequency of menstrual bleeding was scarce. [ABSTRACT FROM AUTHOR]

Menstruation research is an important aspect of women's health. The pursuit of inclusive health has increased the importance of women's health in recent years. The purpose of this paper is to delve into the knowledge, attitudes, and the relationship between menstrual diseases and health-seeking behaviour. The current research was carried out on married Kuki women from two blocks in Manipur's Kangpokpi District. 491 Kuki married women with at least one child are included in this study. In this work, a pre-planned schedule is used. Fieldwork took place between December 2018 and November 2019. The primary goal of this study is to look into the age of menarche, menstrual knowledge prior to menarche, and menstrual abnormalities in relation to health seeking behaviour. According to the findings, the average age of menarche is 14.74 years. Prior to attending menarche, 382 (77.8 %) of the women had no knowledge, while 109 (22.2 %) were well educated in menstrual information. Women with premenstrual syndrome (PMS) are more likely to experience dysmenorrhoea (p<0.001). To summarise, the importance of socio-demographic variables in menstruation research is emphasised in this study. [ABSTRACT FROM AUTHOR]

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Dysmenorrhoea effects up to 90% of women of reproductive age, with medical management options including over-the-counter analgesia or hormonal contraception. There has been a recent surge in medicinal cannabis research and its analgesic properties. This paper aims to critically investigate the current research of medicinal cannabis for pain relief and to discuss its potential application to treat dysmenorrhoea. Relevant keywords, including medicinal cannabis, pain, cannabinoids, tetrahydrocannabinol, dysmenorrhoea, and clinical trial, have been searched in the PubMed, EMBASE, MEDLINE, Google Scholar, Cochrane Library (Wiley) databases and a clinical trial website (clinicaltrials.gov). To identify the relevant studies for this paper, 84 papers were reviewed and 20 were discarded as irrelevant. This review critically evaluated cannabis-based medicines and their mechanism and properties in relation to pain relief. It also tabulated all clinical trials carried out investigating medicinal cannabis for pain relief and highlighted the side effects. In addition, the safety and toxicology of medicinal cannabis and barriers to use are highlighted. Two-thirds of the clinical trials summarised confirmed positive analgesic outcomes, with major side effects reported as nausea, drowsiness, and dry mouth. In conclusion, medicinal cannabis has promising applications in the management of dysmenorrhoea. The global medical cannabis market size was valued at USD 11.0 billion in 2021 and is expected to expand at a compound annual growth rate (CAGR) of 21.06% from 2022 to 2030. This will encourage academic as well as the pharmaceutical and medical device industries to study the application of medical cannabis in unmet clinical disorders. [ABSTRACT FROM AUTHOR]

Abstract Background Brain-derived neurotrophic factor (BDNF) is a known regulator of the development and maintenance of chronic pain in various chronic disorders. Together with its high-affinity tyrosine kinase type B (TrKB) receptor, BDNF is extensively expressed in the mammalian female reproductive system. However, BDNF and TrKB expression in different stages of endometriosis and the relationship between the expression of each in ectopic lesions and endometriosis pain remain unclear. Methods Sixty-two women who underwent laparoscopic surgery were enrolled in this study: forty-six diagnosed with ovarian endometrioma (study group) and sixteen diagnosed with ovarian benign tumours (control group). Samples from eutopic endometrium and ovarian endometriotic lesions were obtained at laparoscopic surgery. BDNF and TrKB messenger RNA (mRNA) and proteins levels in the eutopic and ectopic endometrium of both groups were measured by real-time PCR and immunohistochemical staining, respectively. Before the surgery the visual analogue scale (VAS) was used to measure dysmenorrhoea. Results BDNF and TrKB expression levels were higher in ovarian endometriotic lesions than in eutopic endometrium and normal endometrium (P 0.05). Additionally, correlation coefficients for the association analysis between the mRNA expression of BDNF or TrKB in eutopic endometrium and the dysmenorrhoea VAS score were r = 0.52 and r = 0.56 for BDNF and TrKB, respectively (P

• A meta-analysis compared gonadotrophin-releasing hormone (GnRH) antagonists, add-back therapy and pain reduction efficacy. • To aid comparability, pain score mean differences were converted to the visual analogue scale scores. • GnRH antagonists reduced pain and analgesic use, and improved quality of life. • GnRH antagonists with add-back therapy maintained a significant pain reduction. • Response rates and adverse events rates were weakly positively correlated. Gonadotrophin-releasing hormone (GnRH) antagonists have been demonstrated to reduce endometriosis-associated pain. Because of the hypo-oestrogenic state they induce, however, higher dosages of GnRH antagonists are not recommended for used long term. This unwanted effect may be eliminated by so-called add-back therapy (ABT). This review was conducted to assess the safety and efficacy of GnRH antagonists, with or without add-back hormonal replacement therapy. Out of the 345 studies selected through the initial search, seven randomized controlled trials were included, comparing different oral GnRH antagonists at varying dosages, from a minimum of 50 mg to a maximum of 200 mg once or twice daily. Women treated with the lowest dose of GnRH antagonists had significantly greater mean pain score reductions from baseline throughout treatment compared with those treated with placebo (odds ratio [OR] –13.12, 95% CI –17.35 to –8.89 and OR –3.08, 95% CI –4.39 to –1.76 for dysmenorrhoea and non-menstrual pelvic pain, respectively). Compatible with the dose–response effect, a positive correlation was found between response rates and adverse event rates. While GnRH antagonists offer an advantage in terms of pain reduction for endometriosis, the more recent literature suggests using GnRH antagonists with ABT, which, while mitigating the hypo-oestrogenic effects of GnRH antagonists, maintain their efficacy, while allowing their long-term use. [ABSTRACT FROM AUTHOR]

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This was a randomised trial aimed to determine squatting exercises' effects on menstruation, pelvic mechanics, and uterine circulation in primary dysmenorrhoea. A total of 120 females with primary dysmenorrhoea were assigned into group (A), receiving yoga protocol, or groups (B, C & D), receiving yoga protocol added to modified wall squat, sumo squat, or deep squat, respectively. Menstrual pain and distress, pelvic inclination, and uterine circulation were measured before and after interventions using a pain scale, a questionnaire, palpation metre, and Doppler ultrasonography, respectively. There was a significant reduction in pain intensity in groups B & C (effect size = 3.97 & 5.89, respectively), compared to group A (effect size = 3.68), and in group C (effect size = 5.89) compared to group D (effect size = 3.94), pain subscale in the groups B, C & D (effect size = 1.69, 3.3 & 3.41, respectively), compared to group A (effect size= 2.47), water retention subscale in group D effect size 0.90 compared to group A (effect size =0.41) and in the questionnaire total scores in the groups C &D (effect size = 2.3 & 2.46, respectively) when compared to group A (effect size =1.94). Adding squatting exercises to yoga is more effective than yoga alone in reducing menstrual pain and distress. What is already known on this subject? Physical exercises positively affect primary dysmenorrhoea in terms of decreased pain and distress, possibly through altering faulty posture. Squatting exercises affect lumbopelvic mechanics. What do the results of this study add? This study explores the effect of squatting exercises on pelvic inclination, menstrual aspects, and circulation. What are the implications of these findings for clinical practice and/or further research? Squatting exercises can be utilised to affect pelvic mechanics leading to decreased menstrual pain and distress, because of decreased pelvic congestion. [ABSTRACT FROM AUTHOR]

Background: Dysmenorrhoea refers to the menstrual cramps that usually a female undergoes before or even during menstruation. This common problem interferes in between their daily activities in numerous ways like being absent for work, lack of concentration or may be even activity intolerance. Dysmenorrhoea is also associated with symptoms other than pain like, fatigue, weakness, nausea and diarrhoea which mostly effects adolescents during their lifetime specially in academic period. Objectives: 1. To assess the symptoms of dysmenorrhoea among adolescent girls residing nursing hostel. 2. To find the association of symptoms of dysmenorrhoea with selected socio demographic variables. Materials and method: A descriptive study approach was used for this study. The study was conducted in selected nursing students residing at the nursing hostel of KIMDSU, Karad. Non probability purposive sampling technique was used to select 60 students from nursing hostel. Informed consent was taken from each participant after explaining the objectives of the study. Data was collected using symptoms questionnaires for dysmenorrhoea. The data was later tubulated and calculations were done using descriptive and inferential statistics. Result: The result shows that majority students had severe pain i.e., 85% (51), 73% of them felt fatigue regularly, 70% (42) of them felt nausea, 52% (31) of them had diarrhoea sometimes, 35% (21) sweated sometimes and often felt weakness. Study also revealed the factors that were relatable to dysmenorrhoea were age of menarche, length of menstrual cycle, days of menstrual flow, family history having dysmenorrhoea, treatment for dysmenorrhoea, reasons for not taking any treatment and finally how it impacted on daily life for the selected adolescent. Conclusion: The study shown that adolescent girls staying in hostel faced symptoms of dysmenorrhoea like pain, fatigue, weakness, nausea, and diarrhoea. These symptoms of dysmenorrhoea affected them in their daily life and academic presence as per their severity they faced. The importance awareness for female reproductive health can be suggested by the study findings. [ABSTRACT FROM AUTHOR]

Aims: The extent to which maternal transmission of primary dysmenorrhoea is genetically determined in adolescents and young women has yet to be determined. We aimed to assess heritability and associations relevant to primary pain syndromes using a twin family study. Methods: Participants were young menstruating female twins, and their oldest sisters and mothers, whose families were registered with Twins Research Australia and previously participated in a twin family study of primary paediatric pain disorders. Questionnaire packs were mailed, assessing current maximum and average menstrual pain intensity, current pain interference with activities and retrospective dysmenorrhea secondary symptoms. Results: The sample comprised 206 twin individuals (57 monozygous (MZ) and 46 dizygous (DZ) pairs) aged 10–22 years, eldest siblings (n = 38) aged 13–28 years and mothers (n = 101) aged 32–61 years. The estimated regression coefficient of the relationship between mother–daughter and twin–sibling dyads indicated significant associations for the measures of dysmenorrhea and supported heritability. Adjusted for age, the within twin‐pair correlation for MZ twins was generally more than twice that of DZ twins. Heritability estimates were maximal pain intensity 0.67 (P = 3.8 × 10−11), average pain intensity 0.63 (P = 3.7 × 10−10), pain interference 0.57 (P = 1.8 × 10−8) and retrospective symptoms 0.57 (P = 1.8 × 10−8). Twin individuals with a lifetime (three‐month) history of iron deficiency and those with painless restless legs syndrome (RLS) were significantly more likely to have more intense pain associated with menstruation. Conclusion: Primary dysmenorrhea in adolescents and young women was shown to be relatively strongly genetically influenced and associated especially with a history of iron deficiency and painless RLS which have potential therapeutic implications. [ABSTRACT FROM AUTHOR]