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Pain catastrophizing is a prominent psychological factor that is strongly correlated with pain. Although the complex properties of pain catastrophizing vary across different pain phases, the contribution of chronic pain to its progression from a general trait to a higher state remains unclear. This study aimed to examine the neural mechanisms and degree to which pain catastrophizing is reinforced in the context of primary dysmenorrhea (PDM), one of the most prevalent gynaecological complaints experienced by women of reproductive age. Altogether, 29 women with moderate-to-severe PDM were included in this study. Arterial spin labelling was used to quantify the cerebral blood flow (CBF) in each participant in both the pain-free and painful phases. The pain catastrophizing scale (PCS) was completed in two phases, and the Short-Form McGill Pain Questionnaire was completed in the painful phase. Compared with pain catastrophizing in the pain-free phase (PCS pf ), pain catastrophizing in the painful phase (PCS p ) is higher and positively correlated with the composite factor of menstrual pain. CBF analysis indicated that the PCS p is positively associated with CBF in the frontal cortex, hippocampus and amygdala. The reinforcement of pain catastrophizing correlates with CBF in the prefrontal cortex. Specifically, the medial prefrontal cortex, which correlates with pain state, plays a crucial role in mediating the reinforcing effect of pain in the PCS p . These results promote the mechanical comprehension of pain catastrophizing management in individuals with chronic pain., (© 2024 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)

Pain empathy enables us to understand and share how others feel pain. Few studies have investigated pain empathy-related functional interactions at the whole-brain level across all networks. Additionally, women with primary dysmenorrhea (PDM) have abnormal pain empathy, and the association among the whole-brain functional network, pain, and pain empathy remain unclear. Using resting-state functional magnetic resonance imaging (fMRI) and machine learning analysis, we identified the brain functional network connectivity (FNC)-based features that are associated with pain empathy in two studies. Specifically, Study 1 examined 41 healthy controls (HCs), while Study 2 investigated 45 women with PDM. Additionally, in Study 3, a classification analysis was performed to examine the differences in FNC between HCs and women with PDM. Pain empathy was evaluated using a visual stimuli experiment, and trait and state of menstrual pain were recorded. In Study 1, the results showed that pain empathy in HCs relied on dynamic interactions across whole-brain networks and was not concentrated in a single or two brain networks, suggesting the dynamic cooperation of networks for pain empathy in HCs. In Study 2, PDM exhibited a distinctive network for pain empathy. The features associated with pain empathy were concentrated in the sensorimotor network (SMN). In Study 3, the SMN-related dynamic FNC could accurately distinguish women with PDM from HCs and exhibited a significant association with trait menstrual pain. This study may deepen our understanding of the neural mechanisms underpinning pain empathy and suggest that menstrual pain may affect pain empathy through maladaptive dynamic interaction between brain networks., Competing Interests: Declarations. Ethical approval: The study protocol was approved by the Institutional Review Board of the First Affiliated Hospital of the Medical College of Xi’an Jiaotong University. Consent to participate: Written informed consent was obtained from all participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The enhanced efficacy of vinegar-processed Cyperus rotundus (VCR) in treating primary dysmenorrhea (PD) has been observed. However, the active components and potential mechanisms of synergy are still unclear. The objective of this study was to develop a method that combines bionic technology, plant metabolomics and network pharmacology to discover the active components and potential mechanisms underlying the enhanced therapeutic effects of VCR for PD. Vinegar processing alters the flavor of C. rotundus, leading to changes in its properties. The acidic nature of vinegar enhances the selectivity of the medicine toward the liver, thereby improving its ability to soothe the liver, regulate qi and provide pain relief. Through gas chromatography-mass spectrometry and multivariate statistical analysis, 30 key differential components between raw C. rotundus and VCR have been screened and identified. These differential components primarily exert their therapeutic effects in treating PD by modulating targets such as interleukin-6, TNF, TP53 and PTGS2, as well as pathways including the estrogen signaling pathway, ovarian steroidogenesis, the TNF signaling pathway and the HIF-1 signaling pathway. The findings of this study serve as a reference for the application of VCR in compound formulas and clinic practiceal. Furthermore, the methodology employed in this study provides research insights for the processing of other Chinese medicines., (© 2024 John Wiley & Sons Ltd.)

Background: Dysmenorrhea, or menstrual pain, is a subjective experience, and can only be assessed by patient-reported outcomes. These instruments should be reliable, valid and responsive., Aim: To identify and critically appraise the available evidence for the measurement properties of specific patient-reported outcome measures used for dysmenorrhea., Methods: The PRISMA statement was used to report this systematic review. Databases searched were PubMed, SCOPUS, CINAHL, Web of Science, ScienceDirect and Google Scholar (April 2021; updated on February 2023). Original studies with primary data collection, with no restriction on language and publication date that reported psychometric properties of one or more dysmenorrhea-related patient-reported outcome measure. The literature searches, selection of studies, data extraction and assessment of the risk of bias were performed independently by two reviewers and followed the COSMIN guidelines., Results: Thirty studies were analysed in this review, and 19 patient-reported outcome measures were evaluated. The instruments varied in relation to the measured construct and measurement properties (validity, reliability and responsiveness). The methodological quality of the studies and the quality of evidence of the patient-reported outcome measures were variable. Among the 13 studies that reported the development of patient-reported outcome measures, most had inadequate methodological quality, and the overall rating was insufficient or inconsistent., Conclusions: The Dysmenorrhea Symptom Interference (DSI) scale was the only identified patient-reported outcome measure that has the potential to be recommended because of its sufficient rating combined with moderate quality of evidence for content validity. Future studies should further evaluate the measurement properties of the existing patient-reported outcome measures, or develop new patient-reported outcome measures following the COSMIN methodology., Patient or Public Contribution: Not applicable as this is a systematic review., Trial Registration: PROSPERO protocol: CRD42021244410. Registration on April 22, 2021., (© 2024 John Wiley & Sons Ltd.)

Objective: Clinical characteristics of patients with endometrioma without dysmenorrhea have not been well delineated; our goal was to remedy this issue by performing a retrospective cohort study., Methods: A total of 379 patients who underwent laparoscopic surgery for endometrioma ≥4 cm at a tertiary hospital were included in this retrospective study. Patients were divided into two groups based on the presence of dysmenorrhea at the time of hospital visit; with dysmenorrhea group and without dysmenorrhea group., Results: Patients without dysmenorrhea comprised 9.5% of all surgically confirmed endometriomas. Significant differences were found in the revised American Society for Reproductive Medicine (rASRM) stage, age at surgery, and bilaterality. Patients with rASRM stage IV were more likely to have dysmenorrhea than were subjects with rASRM stage III (odds ratio (OR), 10.58; 95% confidence interval (CI), 4.63-24.21; P < 0.001). Older patients were less likely to have dysmenorrhea (OR, 0.94; 95% CI, 0.88-1.00; P = 0.045), as were patients with bilateral rather than unilateral endometrioma (OR, 0.36; 95% CI, 0.15-0.82; P = 0.015). No significant differences in cyst size, age at menarche, body mass index (BMI), parity, or history of previous ovarian surgery were found between the two groups., Conclusion: Patients without dysmenorrhea comprised 9.5% of endometrioma cases and had less advanced rASRM stage, were older at surgery, and had a higher probability of bilateral than unilateral endometrioma than patients with dysmenorrhea., (© 2024 International Federation of Gynecology and Obstetrics.)

Aim: To examine the effect of listening to music and drawing on coping with dysmenorrhea complaints of nursing students., Methods: The study was a double-blind, three parallel-group randomized controlled trial conducted between August 2023 and May 2024 at Bartın University, Faculty of Health Sciences, Department of Nursing. Ninety-six dysmenorrheic nursing students with regular menstrual cycles were included in the study and randomly assigned to three groups as drawing, music and control groups. Visual Analog Scale (100mmVAS of pain), Perceived Stress Scale (PSS) and Menstrual Symptoms Scale (MSS) were applied to the students at baseline, 1st and 2nd months. The interventions were as follows: the music group listened to a 29-minute and 32-second song three days before menstruation and on the first day of menstruation in the third month composed by Juan Sebastian Martin-Saavedra, while the drawing group created art for the same duration. The pain scores, perceived stress, and menstrual symptoms were measured in all groups after the interventions., Results: Pretest, 1st and 2nd months 100mmVAS of pain score averages were 7.16 ± 1.99, 7.16 ± 1.99 and 7.50 ± 1.98 for the control group, 7.22 ± 1.64, 4.84 ± 1.80 and 2.13 ± 1.45 for the music group and 6.69 ± 1.80, 5.09 ± 1.55 and 2.91 ± 1.33 for the drawing group, respectively. Pretest, 1st and 2nd months PSS score averages were 28.75 ± 3.71, 29.09 ± 3.87 and 30.03 ± 4.16 for the control group, 29.91 ± 3.98, 14.06 ± 4.06 and 3.59 ± 3.82 for the music group and 27.38 ± 3.63, 18.13 ± 5.60 and 8.34 ± 5.46 for the drawing group, respectively. Pretest, 1st and 2nd months MSS score averages were 79.25 ± 15.41, 88.00 ± 20.08 and 90.66 ± 19.13 for the control group, 85.41 ± 10.77, 62.41 ± 15.23 and 34.00 ± 12.62 for the music group and 80.69 ± 11.07, 65.53 ± 15.37 and 47.31 ± 15.11 for the drawing group, respectively. Mean menstrual pain intensity, mean perceived stress level, and mean menstrual symptoms level in the art and music group decreased significantly at 1st and 2nd months post-intervention (p < .001). A significant increase in score levels was observed in the control group., Conclusions: Both art and music practices are effective in significantly reducing menstrual pain, perceived stress, and menstrual symptoms in nursing students with dysmenorrhea. It is important to include listening to music and drawing on women's health and disease nursing practices to control menstrual pain, perceived stress, and menstrual symptoms in dysmenorrhea., Clinical Trials Registration Number: https://clinicaltrials.gov identifier NCT06027489; registered August 30, 2023., (© 2024. The Author(s).)

Background: Heavy menstrual bleeding (HMB) and dysmenorrhea (DM) are common gynecological problems., Objective: To systematically review the needs, quality of life (QOL), and effectiveness of self-management strategies among young women (12-25 years) with DM or HMB., Search Strategy: Relevant terms were searched through PubMed, EBSCO, Google Scholar, ProQuest, and Ovid between 2010 and 2022., Selection Criteria: Qualitative and quantitative studies published in peer-reviewed journals, females aged 12-25, exploring DM or HMB, reporting supportive care needs, quality of life, self-treatment strategies, and/or treatment-seeking behavior., Data Collection and Analysis: Abstracts were reviewed for eligibility by two researchers. Included studies were extracted and assessed for quality independently by two authors, with discrepancies resolved through consensus or the involvement of a third researcher. Data extracted included study details, menstrual history, symptoms, self-care strategies, and quality of life. The Joanna Briggs Institute checklists were used for quality assessment., Main Results: The search returned 285 190 studies, of which 55 were eligible for inclusion. Prevalence rates of HMB and DM were in the ranges 4%-63% and 42%-94%, respectively. Over 80% of young women with DM and HMB experienced physical and psychological problems, including pelvic pain, sleep issues, mood disturbance, diarrhea, and nausea. Academic performance and daily activities were severely affected. Most (>62%) named their mothers as their primary source of information, and friends as the secondary source (10%-65%). Few studies explored needs, but they could be inferred and fell under school-related and social needs. QOL was poorer in those who had DM than those who did not. Pain was the most common issue that drove young women to find treatment. More than 70% used medication to reduce pain. More than half chose home remedies (e.g., heat therapy, massages, herbal tea, hot drinks). No studies provided information about the efficacy and dosage of medication and herbal remedies., Conclusions: HMB and DM have a large impact on daily living, with large areas of unmet need. Limited access to information impairs the management of symptoms and consequent QOL., (© 2024 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Primary dysmenorrhea (PD) is a common global health concern. However, limited studies explored the association between soft drinks intake and PD among female undergraduates in China. To determine the association between soft drinks (carbonated soft drinks, etc.) as well coffee intake and the incidence/severity of PD among female undergraduates in China. We performed a cross-sectional study among 1809 female undergraduates in China from September 29, 2020 to October 22, 2020. The demographic information and menstrual information of the participants were collected by a self-administrated questionnaire. Chi-square test, ANOVA test, and logistic regression test were used to investigate the association between soft drinks intake and the incidence/severity of PD. We also conducted stratification analysis among different locations (rural or urban). The prevalence of PD was 47.1% (n = 852). There were 221 (25.9%) participants suffered from severe pain. In the participants with PD, the OR of carbonated soft drinks intake was 1.244 (95% CI 1.010-1.533). Among the participants with PD from rural areas, the OR of carbonated soft drinks intake was 1.402 (95% CI 1.045-1.881), compared with the non-carbonated soft drink group. In the participants with moderate and severe PD, the OR of coffee intake was 0.451 (95% CI 0.228-0.892), compared with the non-coffee-drinking group. There was a significant association between carbonated soft drinks intake frequency and the severity of PD (P < 0.05). Our study showed that carbonated soft drinks intake is a risk factor for PD, especially in participants from rural areas. Coffee intake is a protective factor for the severity of PD. Periodical awareness programs about adverse effects of excessive soft drink consumption should be introduced to reduce the prevalence and exacerbation of PD. Coffee intake might be helpful to relieve the severity of PD., (© 2024. The Author(s).)

Primary dysmenorrhea (PD), a prevalent menstrual condition characterized by pelvic pain during the menstrual cycle, significantly impacts the quality of life of women and produces increased pain sensitivity that can persist throughout the menstrual cycle. However, scientific literature has not studied whether there are implications for alterations in muscle function and endurance in the abdominopelvic region during the non-painful phases of the menstrual cycle. The aim of this study was to compare muscle function and endurance capacity in the abdominopelvic region in women with PD versus women without this condition. An observational, cross-sectional study was designed to analyze muscle activation and endurance capacity using electromyography (EMG) during McGill exercises. Forty-four women were included, 22 with PD and 22 without dysmenorrhea. The results did not indicate significant differences in muscle activation and endurance of the abdominopelvic musculature between the two groups (p > 0.05). However, the analysis suggests that women with primary dysmenorrhea might develop compensatory strategies that allow them to maintain physical function despite their condition. These results suggest that the approach to PD could focus more on pain management rather than physical functionality, and more studies are needed from a comprehensive approach to more accurately evaluate the relationship between PD and muscle function., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Institutional Review Board Statement: The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Commission of Universidad Europea de Madrid (protocol code CIPI/23.146; date of approval: April 20, 2023). Informed consent: Informed consent was obtained from all participants involved in the study., (© 2024. The Author(s).)

Background: Exercise is increasingly being promoted as an effective treatment for primary dysmenorrhea (PD). This study aims to conduct a comprehensive network meta-analysis (NMA) of randomized controlled trials to identify the optimal types and dosages of exercise for managing PD in women., Methods: Adhering to PRISMA-NMA guidelines, we systematically reviewed RCTs from the Cochrane Library, Web of Science, PubMed, and Embase databases up to May 23, 2024. Data analysis was performed using 'GEMTC' and 'BUGSnet' packages within a Bayesian framework in R and a hierarchy of exercise treatments was also calculated using surface under the cumulative ranking curve (SUCRA) values. Subgroup analyses were conducted to identify the most effective exercise regimens, including duration, frequency, and volume of the exercise interventions., Results: Forty-nine studies representing 3,129 participants (1,640 exercises and 1,489 controls) were included. The results showed that all exercise interventions significantly reduced menstrual pain of the PD patients. Of six exercise intervention modalities based on the study ranked effectiveness, statistically significant reductions in pain intensity were found for resistance exercise and multi-component exercise. Multi-component exercise and stretching exercise were ranked best for menstrual symptoms, while core-strengthening exercise and multi-component exercise had the greatest impact on reducing pain duration. Significant and clinically important reductions or reliefs in pain occurred with 4 to 8 weeks of exercise training from all exercises, with resistance exercise showing the best efficacy when the duration exceeded 8 weeks, followed by multi-component exercise and mind-body exercise. Multi-component exercise and aerobic exercise with 1 to 3 sessions per week induced greater benefit in performance improvements, while resistance exercise with increased frequency showed the enhanced performance. Resistance exercise could elicit better efficacy within` 30-minute training duration, and multi-component exercise was ranked the best if such a training over 30 min., Conclusion: This study provided quantitative insight into efficacy and effectiveness of exercise interventions on PD treatments. All six different exercises are associated with positive influence on PD management. Our study indicates that this exercise training induced adaptation may have therapeutic benefits for PD patients; however, such alterations and improvements are affected by exercise regiments., Competing Interests: Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Primary dysmenorrhea is a common gynecological disorder that affects many women of reproductive age. Ginger, a widely used spice with anti-inflammatory properties, has been suggested as a potential treatment for the painful cramps associated with this condition. Objective: The aim of this systematic review and meta-analysis was to evaluate the efficacy of ginger for pain management in primary dysmenorrhea. Methods: Our systematic review was registered in Prospero (CRD42023418001). Six English (PubMed, Scopus, Web of Science, PsycINFO, CINAHL complete, and Cochrane) and one Persian electric database (SID) was searched up to May 2023 for English or Persian studies that measure the effect of ginger on pain in dysmenorrhea. The Cochrane tool was used to assess the risk of bias of the included studies. Random effects meta-analyses were performed to obtain standardized mean differences (SMD) and 95% confidence intervals (CI). Results: Out of the 804 articles initially identified from the search, 24 were included for qualitative analysis and 12 for quantitative analysis after a full-text evaluation. The combined results of the studies indicate that ginger is notably more effective than placebo in reducing both the intensity (SMD = -1.13; 95% CI = -1.59 to -0.68, I 2 The results of this meta-analysis suggest that ginger can effectively reduce pain associated with dysmenorrhea. The findings are limited due to risk of bias in the included studies and the unclear risk-benefit ratio. Conclusions: The results of this meta-analysis suggest that ginger can effectively reduce pain associated with dysmenorrhea. The findings are limited due to risk of bias in the included studies and the unclear risk-benefit ratio.

This research wasdesigned to provide a visual analysis of the current status, hotspots, and trends of global acupuncture for dysmenorrhea over the past 2 decades. The literature about acupuncture for dysmenorrhea from the Web of Science Core Collection database. Cite Space (5.6.R3) was used to analyze the volume of publications, journals, authors, cited journals, cited authors, countries, cited references, institutions, and keywords by using standard bibliometric measures. The most productive countries and institutions in this area were China (79) and BeijingUniversity of Chinese Medicine (24). The Evidence-Based Complementary and Alternative Medicine was the most published journal (29) and also had the highest number of citations (80). The article by Woo HL (2018) (number of citations: 13) and the article by (centrality: 0.38) were the most representative references. JiangZhu (17) was the most productive author and Dawood MY (47) was the top cited author. The number one keyword in terms of frequency and centrality was 'primary dysmenorrhea", and the leading hotspot from 2002 to 2022 was "Functional connectivity". The three forefront topics were "prevalence", "impact"and "point'. This research is thefirst bibliometric analysis of the current situation and new trends about acupuncture for dysmenorrhea in the past 20 years using CiteSpace. It offered some information on acupuncture for dysmenorrhea and valuable information for researchers to identify prospective collaborators, partner institutions, popular topics, and research frontiers.

Ethnopharmacological Relevance: Pain and inflammation are the most frequent reasons for which people seek medical care. Currently available analgesics against these conditions produce fatal adverse effects. NPK 500 capsules is an alternative herbal analgesic employed to treat dysmenorrhea, peptic ulcer and pain. NPK 500 is produced from Cassia sieberiana. A plant used in traditional medicine to treat pain and inflammation., Aim of the Study: This study reports the analysis, phytochemical characterization and mechanism of analgesic and anti-inflammatory activities of two NPK 500 capsules, called old and new NPK500 capsules (ONPK500 and NNPK500) respectively., Materials and Methods: Physicochemical, organoleptic, GC-MS and LC-MS methods were employed to analyze the NPK 500 capsules. Analgesic activity was evaluated using tail immersion, Randall-Selitto and acetic acid induced writing tests. Anti-inflammatory activity was evaluated using carrageenan-induced rat paw inflammation. Additionally, pro-inflammatory mediators such as prostaglandin E2 (PGE2), inducible nitric oxide synthase (iNOS), cyclooxygenase 1 and 2 (COX-2 and COX-1) were quantified in the sera of the rats using Enzyme Linked Immunosorbent Assay (ELISA) kits., Results: Thirteen major compounds were characterized in the NNPK 500 capsules via the GC-MS and LC-MS spectroscopies. Kaempferol was the major compound characterized in addition to physcion, β-sitosterol 3-O-β-D-glucopyranoside, betulinic acid and nine others. Physicochemical and organoleptic indices of the capsules were also derived for its authentication and quality control. Furthermore, NNPK 500 0.5-1.5 mg/kg p.o. produce significant (P < 0.5) analgesic activity (160-197%) higher than that of ONPK500 (109.8%) and Morphine (101%) in the tail immersion test. The analgesic activity of NNPK 500 0.5-1.5 mg/kg p.o. (171.0-258.3%) and ONPK 500 (179.5%) were also significant (P < 0.01) and higher than that of Aspirin (103.00%) in the Randall-Selitto test. Both capsules also demonstrated significant (P < 0.5) analgesic and anti-inflammatory activities in the acetic acid-induced writhing and carrageenan-indued paw edema tests respectively. The two NPK500 capsules also, significantly (P < 0.5) inhibited PGE2 and iNOS but not COX-2 and COX-1 in the carrageenan-indued paw edema test., Conclusion: These results show that NNPK 500 and ONPK 500 capsules possessed potent analgesic and anti-inflammatory activities via inhibition of PGE2 and iNOS as a result of their chemical constituents. NPK500 capsules thus, relief acute pain and inflammation without causing gastrointestinal, renal or hepatic injuries, since they did not inhibit COX-1., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The human brain is a dynamic system that shows frequency-specific features. Neuroimaging studies have shown that both healthy individuals and those with chronic pain disorders experience pain influenced by various processes that fluctuate over time. Primary dysmenorrhea (PDM) is a chronic visceral pain that disrupts the coordinated activity of brain's functional network. However, it remains unclear whether the dynamic interactions across the whole-brain network over time and their associations with neurobehavioral symptoms are dependent on the frequency bands in patients with PDM during the pain-free periovulation phase. In this study, we used an energy landscape analysis to examine the interactions over time across the large-scale network in a sample of 59 patients with PDM and 57 healthy controls (HCs) at different frequency bands. Compared with HCs, patients with PDM exhibit aberrant brain dynamics, with more significant differences in the slow-4 frequency band. Patients with PDM show more indirect neural transition counts due to an unstable intermediate state, whereas neurotypical brain activity frequently transitions between 2 major states. This data-driven approach further revealed that the brains of individuals with PDM have more abnormal brain dynamics than HCs. Our results suggested that unstable brain dynamics were associated with the strength of brain functional segregation and the Pain Catastrophizing Scale score. Our findings provide preliminary evidence that atypical dynamics in the functional network may serve as a potential key feature and biological marker of patients with PDM during the pain-free phase. PERSPECTIVE: We applied energy landscape analysis on brain-imaging data to identify relatively stable and dominant brain activity patterns for patients with PDM. More atypical brain dynamics were found in the slow-4 band and were related to the strength of functional segregation, providing new insights into the dysfunction brain dynamics., (Copyright © 2024 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)

The Liangfu formula, as described in 'Liangfang Jiye', is well-known for its efficacy in treating stomach pain, abdominal pain, and dysmenorrhea. This research aimed to investigate the pharmacokinetics and tissue distribution of 5-hydroxy-7-(4-hydroxy-3-methoxyphenyl)-1-phenyl-3-heptanone (DPHA), Galangin, Kaempferide, 5-Hydroxy-1,7-diphenyl-3-heptanone (DPHC), α-Cyperone, and Nootkatone in vivo using an LC-MS/MS method. The method successfully separated the six active components and internal standards (Chrysin and Yakuchinone-A) on an XB-C18 column with a mobile phase of 0.2 ‰ formic acid water-acetonitrile. It demonstrated good linearity with a correlation coefficient (r 2 ) ≥ 0.9911 and a lower limit of quantification (LLOQ) of 5-80 ng/mL for the different components. Precision, accuracy, matrix effects, and recovery rates were within acceptable ranges. Pharmacokinetic analysis revealed significant differences in parameters between primary dysmenorrhea (PD) and normal rats (especially AUC, T max, and CL z /F). Tissue distribution showed that the six active components of the herbal pair Alpinia officinarum Hance-Cyperus rotundus L. (HPAC) extract was primarily distributed in the liver, lung, and kidney. This study offers valuable insights into the potential mechanisms of action and drug development for treating PD., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Social determinants of health play a key role in health disparities. Dysmenorrhea is a highly prevalent and impactful public health problem affecting reproductive-age females. Systematically examining social determinants of health (SDoH) in dysmenorrhea is important for identifying gaps in the literature and informing research, policy, and clinical practice to reduce the public health burden associated with dysmenorrhea. The purpose of this systematic review was to synthesize the literature on SDoH and dysmenorrhea. The review protocol was prospectively registered. We searched Medline, EMBASE, CINAHL, PsycINFO, Scopus, and Google Scholar through February 2024 using search strategies informed by the literature. Screening of the articles, data extraction, and risk-of-bias (RoB) assessment were conducted independently by at least 2 reviewers on the Covidence platform. Among 2,594 unique records screened, 166 met eligibility criteria and were included for data extraction and RoB assessment. Evidence suggests traumatic experiences, toxic environmental exposures, female genital mutilation, job-related stress, lack of menstrual education, and low social support were associated with worse dysmenorrhea outcomes. However, evidence was equivocal regarding the relationships between dysmenorrhea outcomes and SDoH factors, including socioeconomic status, geographical location, race/ethnicity, employment, and religion. Nearly all articles (99.4%) had a high or very high overall RoB. The relationships between SDoH and dysmenorrhea outcomes were often inconsistent and complicated by heterogeneous study populations and methodologies. More rigorous research examining SDoH in dysmenorrhea is needed to inform policy and clinical practice. PERSPECTIVE: This systematic review synthesizes evidence linking SDoH and dysmenorrhea. The relationships between SDoH and dysmenorrhea were often equivocal and complicated by heterogeneous study populations and methodologies. We identify directions for future research and SDoH factors that could be addressed clinically (eg, trauma, menstrual education, and occupational stress)., (Copyright © 2024 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)

Primary dysmenorrhea (PDM) refers to the occurrence of spasmodic colicky pain in the lower abdomen without any obvious pelvic pathology, often accompanied by other systemic symptoms, which significantly reduces the quality of life of women with PDM, 45%-95% of menstrual women are affected by it. Despite the high incidence of PDM, it is often not well treated and is ignored by relevant researchers and women themselves. Herbs-partitioned moxibustion (HPM) is a characteristic external therapy in traditional Chinese medicine (TCM), which is widely used to treat diseases in China; it treats diseases by applying a Chinese herbal formula on the patient's acupoints and then igniting moxa sticks on the herbal formula for moxibustion therapy. The primary effectiveness of the herbs utilized in this study is meridian activation and warmth, which encourages qi circulation to relieve pain. Moxibustion's heat stimulation could hasten the infusion of the herbs into the human body. Consequently, HPM, which combines acupoint, herbal, and heat stimulations, is appropriate for treating gynecological disorders, particularly functional diseases such as PDM. This paper provides a detailed description of the procedures and precautions for HPM at the Shenque (CV8) acupoint in female experimental rats, which 0provides an experimental basis for better promoting the application and development of HPM on the navel in PDM.

Objectives: To observe the differences in the effects of different dosages of grain-sized moxibustion on uterine artery blood flow in patients with cold and dampness primary dysmenorrhea (PD)., Methods: A total of 60 patients with PD were randomly divided into 3 groups with 20 cases in each group. Acupoints Sanyinjiao (SP6), Diji (SP8) and Xuehai (SP10) were selected in all the 3 groups, and different dosages of grain-sized moxibustion were used (3 moxa cones, 6 moxa cones, 9 moxa cones) respectively. Treatment started 7 days before menstruation for 3 times, lasting for a total of 3 menstrual cycles. The values of uterine artery blood flow parameters including pulsatility index (PI), resistance index (RI), and systolic/diastolic ratio (S/D) were recorded before and after treatment. The visual analog scale (VAS) score and cox menstrual symptom scale (CMSS) score (including severity ［CMSS-S］ and time of duration ［CMSS-T］) were evaluated before treatment, at the end of each menstrual cycle, and one menstrual cycle after treatment., Results: The values of uterine artery blood flow parameters (PI, RI, S/D) after treatment in the 9 moxa cones group were lower than those before treatment, as well as lower than those in the 3 and 6 moxa cones groups after treatment ( P <0.05). The VAS scores of the 3 moxa cones group were lower than those before treatment in the first and second cycle ( P <0.05). The VAS scores of the 6 and 9 moxa cones groups were lower than those before treatment at each observation point ( P <0.05), and were lower than those of the 3 moxa cones group in the third cycle of treatment and follow-up period ( P <0.05). And the VAS score of the 9 moxa cones group was lower than that of the 6 moxa cones group during the follow-up period ( P <0.05). Compared with the scores before treatment, the CMSS-T scores at each observation point after treatment were lower in the 9 moxa cones group ( P <0.05)；the CMSS-T scores in the second and third cycle after treatment, and follow-up period were lower in the 6 moxa cones group ( P <0.05), with the CMSS-S scores in the second and third cycle after treatment, and follow-up period lower in the 6 and 9 moxa cones groups ( P <0.05). The CMSS-T and CMSS-S scores of the 6 and 9 moxa cones groups were lower than those of the 3 moxa cones group in the third cycle and follow-up period ( P <0.05). The CMSS-T and CMSS-S scores of the 9 moxa cones group were lower than those of the 6 moxa cones group during the follow-up period ( P <0.05)., Conclusions: Grain-Sized moxibustion has dose-effect relationship in the treatment of PD. Compared with 3 and 6 moxa cones groups, 9 moxa cones group has advantages in improving uterine artery blood flow parameters and alleviating dysmenorrhea symptoms in PD patients.

Aim: In April 2020, the Japanese government introduced a Specific Medical Fee for managing secondary dysmenorrhea (SD). This initiative provided financial incentives to medical facilities that provide appropriate management of SD with hormonal therapies. We aimed to assess how this policy affects the management processes and outcomes of patients with SD., Methods: Using a large Japanese administrative claims database, we identified outpatient visits of patients diagnosed with SD from April 2018 to March 2022. We used an interrupted time-series analysis and defined before April 2020 as the pre-introduction period and after April 2020 as the post-introduction period. Outcomes were the monthly proportions of outpatient visits due to SD and hormonal therapy among women in the database and the proportions of outpatient visits for hormonal therapy and continuous outpatient visits among patients with SD., Results: We identified 815 477 outpatient visits of patients diagnosed with SD during the pre-introduction period and 920 183 outpatient visits during the post-introduction period. There were significant upward slope changes after the introduction of financial incentives in the outpatient visits due to SD (+0.29% yearly; 95% confidence interval, +0.20% to +0.38%) and hormonal therapies (+0.038% yearly; 95% confidence interval, +0.030% to +0.045%) among the women in the database. Similarly, a significant level change was observed after the introduction of continuous outpatient visits among patients with SD (+2.68% monthly; 95% confidence interval, +0.87% to +4.49%)., Conclusions: Government-issued financial incentives were associated with an increase in the number of patients diagnosed with SD, hormonal therapies, and continuous outpatient visits., (© 2024 The Authors. Journal of Obstetrics and Gynaecology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Obstetrics and Gynecology.)

Endometriosis is a chronic disorder often beginning in adolescence. Despite the high prevalence of the disease and the symptom burden, adolescents may experience suboptimal management and a delay in diagnosis. The symptoms and laparoscopic findings in adolescents with endometriosis may differ from that of adults. This article aims to equip readers with the tools necessary to diagnose and manage endometriosis in adolescents., Competing Interests: Disclosure Dr J. Shim receives author royalties from UpToDate., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Primary dysmenorrhea leads to significant gynecological consultations, school absenteeism, disrupted daily activities, and adversely affects overall quality of life (QOL)., Purpose: This study compared the effects of aquatic exercise versus aerobic exercise on primary dysmenorrhea and QOL in adolescent females., Subjects and Methods: Sixty adolescent females suffering from primary dysmenorrhea with moderate to severe intensity were distributed randomly and equally into two groups was registered at ClinicalTrials.gov (NCT06129708) the Registration Date, November 13, 2023; group A was treated by aquatic exercise for 12 weeks, while group B was treated by aerobic exercise for 12 weeks. Assessment of both groups before and after treatment involved evaluating dysmenorrhea severity using the WaLIDD Score, measuring pain intensity with the numeric pain rating scale (NPRS), determining pressure pain threshold (PPT) with an algometry, and evaluating the QOL using EuroQol-5 Dimension-3 Level (EQ-5D-3L) and EuroQol-visual analog scale (EQ-VAS)., Results: Both groups, A and B, experienced significant reductions in the WaLIDD score, NPRS, and all domains of EQ-5D-3L (p < 0.05), coupled with significant increases in PPT and EQ-VAS (p < 0.05). Posttreatment comparisons between the groups showed insignificant differences in WaLIDD score, NPRS, and PPT (p > 0.05). However, there was a significant decrease in EQ-5D-3L and a significant increase in EQ-VAS, favoring group A (p < 0.05)., Conclusion: Both aquatic and aerobic exercises are effective methods in primary dysmenorrhea management and QOL improvement in adolescent females, with a better effect of aquatic exercise in enhancing QOL., (© 2024 John Wiley & Sons Ltd.)

Ethnopharmacological Relevance: Traditional Chinese Medicine (TCM) formula Wenjing Decoction (WJD) longstanding efficacy in enhancing blood circulation, resolving blood stasis, and mitigating dysmenorrhea symptoms. Despite its prevalent application, the specific mechanism underlying effect of WJD remains elusive., Objective: The purpose of this study is to examine the material basis of Wenjing Decoction and explore the effect of WJD on rat models of dysmenorrhea with blood stasis syndrome and elucidate its mechanism., Methods: In this study, we initially identified the chemical constituents of WJD using liquid chromatography-mass spectrometry (LC-MS). Subsequently, we employed network pharmacology to predict the mechanism of WJD in treating acute blood stasis dysmenorrhea. To further investigate the role of WJD, we established a rat model of acute blood stasis. We monitored changes in blood coagulation indexes, IL-6, TNF-α, NO, and COX-2 in rats before and after administration to confirm the successful establishment of the rat model and evaluate the therapeutic effect of WJD on dysmenorrhea and acute blood stasis. Finally, real-time fluorescence quantitative PCR (qPCR) and Western blot (WB) were utilized to investigate its mechanism., Results: Through LC-MS analysis, 69 chemical substances were identified in WJD. Network pharmacology study revealed that the mechanism of WJD in treating BSS may be associated with the PI3K/AKT/NF-κB pathway. Following administration, the WJD group showed gradual recovery of physical signs and coagulation index to a healthy level. Additionally, the levels of IL-6, TNF-α, and COX-2 decreased in a dose-dependent manner, whereas NO levels increased. Results from QPCR and WB detection indicated increased expression levels of p-PI3K, p-AKT, Bcl-2, and eNOS, and decreased expression levels of Bax, NFκBp65, ICAM1, and VCAM1., Conclusion: The results show that WJD significantly improves the characterization, dysmenorrhea index, and coagulation-related factors in BSS rats. Through network pharmacological prediction, real-time fluorescence quantitative PCR, and Western blot analysis, it is postulated that the beneficial effects of WJD on dysmenorrhea may be linked to the PI3K/AKT/NF-κB signaling pathway. These findings offer a theoretical foundation for the advancement and utilization of WJD., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: To observe the clinical efficacy of Fu 's subcutaneous needling combined with monkshood cake-separated moxibustion for primary dysmenorrhea with cold congealing and blood stasis., Methods: Sixty patients with primary dysmenorrhea of cold congealing and blood stasis were randomly divided into an observation group (30 cases, 1 case dropped out) and a control group (30 cases, 2 cases dropped out). The control group received monkshood cake-separated moxibustion at Shenque (CV 8) and bilateral Zigong (EX-CA 1), while the observation group received Fu 's subcutaneous needling based on the control group. The muscles were palpated and the affected muscles were determined. Needles were inserted 5-10 cm away from the affected muscles and reperfusion activity was performed simultaneously. All the treatment started on the first day of menstrual cycle pain, once a day, for 3 days, totaling for 3 menstrual cycles. The visual analogue scale (VAS) score, Cox menstrual symptom scale (CMSS) score, and traditional Chinese medicine (TCM) syndrome score in the two groups were observed before treatment, after 2 treatment courses and after 3 treatment courses. The serum prostaglandin F2α(PGF2α) levels before and after 3 treatment courses were measured, and the clinical efficacy of the two groups was evaluated., Results: After 2 and 3 treatment courses, the VAS scores, CMSS scores, and TCM syndrome scores in the two groups were lower than those before treatment ( P <0.05), and the scores in the observation group were lower than those in the control group ( P <0.05). After 3 treatment courses, the PGF2α level in the observation group was decreased ( P <0.05), and were lower than that in the control group ( P <0.05). The total effective rate was 96.6% (28/29) in the observation group, which was higher than 64.3% (18/28) in the control group ( P <0.05)., Conclusion: Fu 's subcutaneous needling combined with monkshood cake-separated moxibustion could effectively reduce the pain intensity, improve clinical symptoms of dysmenorrhea, and lower PGF2α level in patients with primary dysmenorrhea of cold congealing and blood stasis.

This study aimed to explore the regulating effect of Gegen Decoction(GGD) on the hypothalamic-pituitary-ovarian axis(HPOA) dysfunction in the mouse model of primary dysmenorrhea(PD). The mouse model of PD with periodic characteristics was established by administration of estradiol benzoate and oxytocin. Mice were randomized into control, model, GGD, and ibuprofen groups. The writhing response, hypothalamus index, pituitary index, ovary index, and uterus index were observed and determined. The serum levels of prostaglandin F&#95;(2α)(PGF&#95;(2α)), gonadotropin-releasing hormone(GnRH), follicle-stimulating hormone(FSH), luteinizing hormone(LH), and estrogen(E&#95;2) levels were measured by ELISA kits. Western blot and qPCR were employed to determine the protein and mRNA levels, respectively, of gonadotropin-releasing hormone receptor(GnRH-R) in the pituitary tissue, follicle-stimulating hormone receptor(FSHR) and luteinizing hormone receptor(LHR) in the ovarian tissue, and estrogen receptor(ER) in the uterine tissue. The results showed that the writhing response, serum levels of PGF&#95;(2α), GnRH, FSH, LH, and E&#95;2, ovarian and uterine indexes, the protein and mRNA levels of GnRH-R in the pituitary tissue, FSHR and LHR in the ovarian tissue, and ER in the uterine tissue were significantly increased in the model group compared with those in the control group. GGD inhibited the writhing response, reduced the serum levels of PGF&#95;(2α), GnRH, FSH, LH, and E&#95;2, decreased the ovarian and uterine indexes, and down-regulated the protein and mRNA levels of GnRH-R in the pituitary tissue, FSHR and LHR in the ovarian tissue, and ER in the uterine tissue. The data suggested that GGD can regulate the HPOA and inhibit E&#95;2 generation in the mice experiencing recurrent PD by down-regulating the expression of proteins and genes related to HPOA axis, thus exerting the therapeutic effect on PD.