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Primary dysmenorrhea and uterine blood flow
Abstract
OBJECTIVE: To examine pulsatility index (PI) and resistance index (RI) values in the uterine and arcuate arteries of patients with primary dysmenorrhea (PD) by color Doppler ultrasonography. STUDY DESIGN: A total of 49 female university students were recruited for this prospective, observational study. The study group consisted of 25 nulliparous women with PD and a control group of 24 healthy, nulliparous women without dysmenorrhea. The women were examined using transabdominal color Doppler ultrasonography during the midluteal phase (days 18-22) and on the first day of the menstrual cycle. The mean PI and RI values for the right and left uterine arteries and arcuate artery were determined. Student's t test was used to compare the results between and within groups. RESULTS: The mean PI and RI values for the uterine and arcuate arteries in patients with PD were significantly higher on the first day of the menstrual cycle than in the midluteal phase (p < 0.001). Women with PD had significantly higher mean PI and RI values in all 3 arteries on the first day of the menstrual cycle than did the controls (p < 0.05). The Doppler index values of all 3 arteries during the midluteal phase were not significantly different between the groups. CONCLUSION: There is increased impedance to blood flow within the uterus of women with PD on the first day of the menstrual cycle. This may be a sign of constriction of the uterine vessels and the cause of pain.
... La dismenorrea primaria es un desorden que afecta a la población femenina en edad reproductiva. La incidencia y la prevalencia son evidentemente altas y son el resultado de diferentes criterios diagnósticos aplicados por diferentes estudios 5 . Algunos autores definen la dismenorrea primaria como una ligera molestia en el primer día del ciclo, mientras que otros solo consideran los síntomas más severos 6 . ...
... Debido a que no existe una prueba diagnóstica para la dismenorrea primaria, el diagnóstico solo se puede hacer por la ausencia de una causa identificable. Antecedentes de dolor abdominal bajo persistente y necesidad de utilizar cualquier fármaco durante la menstruación son hallazgos importantes para el diagnóstico 5 . ...
... Al igual que los resultados de la presente investigación, estudios previos 5,15 han demostrado que las mujeres con dismenorrea primaria tienen valores significativamente más altos de los índices de pulsatilidad y resistencia en el primer día del periodo menstrual. Altunyurt et al. 5 demostraron que las diferencias solo se observaban en las arterias uterinas y arcuatas, mientras Dmitrovic et al. 15 demostraron que las diferencias estaban presentes en todas las ramas, aunque el flujo sanguíneo de la arteria uterina en las mujeres con dismenorrea primaria leve era similar al de las mujeres con síntomas severos en las mediciones de la arteria uterina, esta diferencia se volvía aún más significativa en las ramas más pequeñas de esta arteria. Parece posible que los parámetros de flujo cíclico estén afectados solo en las mujeres con dismenorrea primaria severa, lo cual puede estar relacionado con la alteración del balance hormonal en este grupo de mujeres 5 . ...
Objective
To identify the parameters of blood flow in the uterine arteries in women with primary dysmenorrhea.Methods
We selected women attending the Nuestra Señora de Chiquinquirá and Central Dr. Urquinaona hospitals in Maracaibo, Venezuela. There were 40 women with primary dysmenorrhea (group A) and 40 women without dysmenorrhea (group B). Blood flow in the uterine arteries, women's general characteristics, Doppler blood flow parameters in the uterine arteries and symptom severity were evaluated.ResultsThe mean age was 28.3 ± 5.8 years in group A and 26.4 ± 5.0 years in group B (P=ns). Doppler ultrasound evaluation was performed on the second day of menstruation in all women in both groups. The pulsatility index, resistance index and systolic / diastolic ratio of the uterine arteries in women with a diagnosis of primary dysmenorrhea were significantly higher than in controls (P<.05). The uterine artery resistance index showed a moderate, positive and significant correlation with pain intensity (r = 0.570; P<.05).Conclusion
Women with dysmenorrhea showed alterations in uterine artery blood flow compared with women without dysmenorrhea.
... To evaluate the circulatory indices, a curvilinear abdominal transducer (2-5 MHz) of a high-resolution, Type-B Colour Doppler ultrasound system GE Vivid S5 (GE Vingmed Ultrasound AS, Horten, Norway) was used to examine pulsatility index and resistivity index values in the uterine arteries (Altunyurt et al. 2005). Indices for the right and left uterine arteries were taken by an experienced radiologist at the level of the cervico-corporeal junction (Ma et al. 2010). ...
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.
• IMPACT STATEMENT
• 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.
... Research using intrauterine pressure found severe spontaneous uterine contractions with high f r e q u e n c y a n d a m p l i t u d e a t t h e t i m e o f dysmenorrhea (Mrugacz et al. 2013), and oral contraceptives have been known to decrease this intrauterine pressure to relieve pain by changing the imbalance in ovarian hormones (Ekström et al. 1989). This imbalance with increased estrogen was reported to stimulate synthesis and/or release of prostaglandin (Ekström et al. 1989), and enhanced prostaglandin release was believed to cause myometrial hypercontractility (Iacovides et al. 2015), contraction of the blood vessels and the myometrium (Yang et al. 2015), uterine ischemia (Altunyurt et al. 2005), as well as being directly proportional to menstrual pain severity (Dawood 2006). Additionally, although the distorted menstrual-associated hormones were also found in dysmenorrhea patients during their pain-free phase, the relationship between uterine movement profiles in the pain absence stage and following pain severity is especially largely unclear (Baker et al. 1999;Ma et al. 2013). ...
Primary dysmenorrhea (PDM), defined as painful menstrual cramps of uterine origin, could cause brain structural and functional changes after long-term menstrual pain. Here, we aimed to investigate the predictive value of uterine morphological features and microstructural/functional properties of the brain extracted from periovulatory phases for the intensity of menstrual pain as rated by women with PDM during their subsequent menstrual period. Forty-five women with PDM were recruited and classified into the high and mild pain intensity groups. Pelvic MRI was employed to extract the uterine texture features. White matter diffusion properties, grey matter and functional connectivity features were extracted as brain features. Multivariate logistic regression models with iteration optimization were built for classifying different pain intensity groups. Texture features from myometrium and uterine junction zone had outstanding prediction performance with an area under the receiver operating characteristic (AUC) of 0.96 (P < 0.05, permutation test), and diffusion properties along the thalamic fiber bundles were the most discriminative features with AUC of 0.95. Applying features from uterus and brain together, we could gain better prediction performance. Our results indicated that accumulated differences in menstrual pain were associated not only with uterine structure but also diffusion properties of thalamic-related fiber tracts, suggesting that treatment options of PDM patients may be expanded from only being able to manage pain in the uterus focusing on the functional/structural modifications of the pain processing system.
... ст.), а также частота маточных сокращений, в том числе и несогласованных [18]. Данные допплерографии показали, что сильные и ненормальные сокращения миометрия во время менструации связаны с пониженным маточным кровотоком, ишемией, гипоксией и, как следствие, с болью [22]. ...
The article is devoted to the subject of topical interest to women of reproductive age. Affecting not only the health of women, but also various aspects of their life, dysmenorrhea is a medical and social problem. The use of nonsteroidal anti-inflammatory agents in this condition is an effective means of pathogenetic therapy that significantly improves the quality of life of women.
... Those studies showed that uterine artery blood flow reduced in dysmenorrhea patients with higher PI and RI values and S/D ratio, leading to resultant myometrial ischemia, and hence pain. [32,52] Moreover, the severity of symptoms in PD could be reflected by doppler index values. [37] In terms of TCM theory, pain is always due to "qi and blood stagnation". ...
Background:
Acupuncture has been widely used to treat primary dysmenorrhea (PD) with satisfactory outcomes. Sanyinjiao (SP6) is the most commonly used acupoint for PD. Different needling techniques may influence the effect of SP6, and its underlying mechanism needs to be explored. This randomized controlled parallel trial is designed to evaluate the immediate analgesic effect and hemodynamic responses in uterine arterial blood flow of perpendicular needling and transverse needling at SP6 in patients with PD of cold-dampness stagnation pattern using color doppler ultrasonography.
Methods:
Forty-eight patients who meet inclusion criteria will be randomized in a ratio of 1:1 to either perpendicular needling or transverse needling groups. Every participant will receive 1 session of acupuncture treatment for 10 minutes at bilateral SP6. In the perpendicular needling group, needles will be inserted vertically 1 to 1.2 cun and will be manipulated to achieve needling sensation. In transverse needling group, the needles will be inserted transversely 1 to 1.2 cun toward the abdomen without any manipulation to avoid needling sensation. Color doppler ultrasonography will be performed before, during, and after needling. The primary outcome measure is visual analog scale for pain. The secondary outcome measures include the uterine artery blood flow changes by measuring pulsatility index, resistance index values, and ratio of systolic peak and diastolic peak, the Hamilton anxiety scale, blood pressure, and heart rate. Adverse events in both groups also will be recorded.
Discussion:
This trial will be the first study protocol designed to explore the influence of needling techniques on the analgesia effect of solo acupoint and its hemodynamic responses for PD. It will promote more widespread awareness of the benefits of using suitable needling techniques in acupuncture clinical setting and provide a further explanation of the underlying hemodynamic mechanism.
Trial registration:
This study protocol was registered at the Chinese clinical trial registry (ChiCTR1900026051).
... This phenomenon favors the idea that ischemia due to hypercontractility causes primary dysmenorrhea. 3,4 There are various techniques available to treat PD. In Western Medicine (WM), therapies commonly focus on pain control by relaxing uterine muscle contractions with nonsteroidal anti-inflammatory drugs (NSAIDs) or oral contraceptive pills (OCPs). ...
Objective: Needling technique is an important factor contributing to the efficacy of an acupuncture point. In previous studies, Sanyinjiao (SP 6) had an immediate analgesic effect on primary dysmenorrhea (PD) with strengthened acupuncture stimulation. Transverse needling without De Qi is accepted more easily by patients who dislike De Qi. This kind of needling also has certain effects on some conditions. This study compared the immediate analgesic effect of perpendicular De Qi needling with transverse non-De Qi needling at SP 6 in patients with PD. Materials and Methods: Twenty-six participants with PD were randomly allocated to a perpendicular needling group (Group A; n = 13) or a transverse needling group (Group B; n = 13). Visual analogue scale (VAS; 0-100 mm) pain levels and skin-temperature measurements were determined at 4 acupuncture points before and after the interventions. Results: Severity of dysmenorrhea was significantly decreased at 30 minutes after the interventions and at 10 minutes after needle removal in both groups (Group A: 35.77 mm and 39.62 mm less pain, respectively, on VAS; P < 0.001; Group B: 22.69 mm and 30.38 mm less pain, respectively, on VAS; P < 0.001). There was no significant difference in VAS-P [VAS for pain] scores after the interventions between the 2 groups (P > 0.05). Skin temperature at CV 4 was significantly increased after the intervention in group A only (P = 0.001). Conclusions: Both perpendicular and transverse needling at SP 6 had an immediate analgesic effect on primary dysmenorrhea. Proper needling techniques may be applied according to the tolerance of patients.
... Современный взгляд на патогенез первичной дисменореи позволяет выделить несколько его ключевых звеньев. Так, у пациенток с первичной дисменореей выявляется повышение базального тонуса матки, увеличение силы и частоты активных сокращений миометрия, которые происходят дискоординированно и приводят к гемодинамическим нарушениям и ишемии миометрия, вызывая боль [10]. ...
The article considers the causes for the development and modern methods of managing dysmenorrhea. The conservative therapy includes the use of combined hormonal contraceptives, physiotherapy procedures, vitamins and symptomatic drugs. The authors stress the significance of Nimesil® in the first-line therapy of primary dysmenorrhea of the syndrome along with the combined hormonal contraceptives and symptomatic agents. The use of this drug is characterized by rapid onset of effect, strong analgesic effect and good tolerability.
... Pressure during contractions can reach 150 to 180 mmHg [4]. When the uterine pressure exceeds the systemic arterial pressure, anaerobic metabolites are released due to ischemia and these metabolites stimulate nerve fibers leading to dysmenorrhea [5]. e uterocervical angle (UCA), which is between the cervical canal and the uterus frontal wall, is a newly investigated ultrasonographic parameter. ...
Background:
Primary dysmenorrhea, defined as painful menstrual cramps originating in the uterus without underlying pathology, is a gynecological disease that affects quality of life and school success. Our goal was to determine the effect of anterior uterocervical angle on primary dysmenorrhea and disease severity.
Methods:
A total of 200 virgin adolescents, 16 to 20 years of age, were included in the study. The Andersch and Milsom scale was used to determine dysmenorrhea severity. Those with pathologies causing secondary dysmenorrhea were excluded from the study. Study subjects were grouped based on severity of pain. Demographic characteristics and uterocervical ultrasonographic measurements were compared among groups.
Results:
Of the 200 participants enrolled in the study, 50 were healthy controls and 150 had primary dysmenorrhea. Those with primary dysmenorrhea had a significant family history of primary dysmenorrhea compared with controls (P < 0.001). Age (P=0.668), body mass index (P=0.898), menarche age (P=0.915), and length of menstrual cycles (P=0.740) were similar in all groups. The uterine corpus longitudinal axis, uterine corpus transverse axis, and uterine cervix longitudinal axis were also similar (P=0.359, P=0.279, and P=0.369, resp.). The mean uterocervical angle was 146.8 ± 6.0 in controls and 143.3 ± 7.3 in those with mild pain with no significant difference between the groups. In those with moderate pain, the mean uterocervical angle was 121.2 ± 7.3 compared with 101 ± 9.2 in those with severe pain, which was a significant difference. Additionally, there was also a significant difference in the uterocervical angle among those with mild, moderate, and severe pain (P < 0.001).
Conclusion:
Our results indicate that a narrower anterior uterocervical angle is associated with primary dysmenorrhea and disease severity.
... Prostoglandinlerin sistemik dolaşıma geçmesi ve gastrointestinal sistemi uyarmasıyla bulantı, kusma ve ishal gibi semptomlar görülebilmektedir. Ayrıca, prostoglandin sentez inhibitörlerinin kullanımıyla dismenorenin azalması, prostoglandinlerin etiyolojideki rolünü desteklemektedir (11,12). ...
Kadınlarda dismenore sık karşılaşılan, hastanın yaşam kalitesini azaltan, önemli bir sağlık sorunudur. Dismenorenin sağlık sistemi üzerine ekonomik yükü de oldukça fazladır. Dismenore, şiddetine bağlı olarak iş, okul ve diğer günlük aktivitelerden alıkoyabilmektedir. Primer dismenore, herhangi bir pelvik patoloji olmadan, menstrüasyon sırasında alt abdominal bölgede görülen, tekrarlayan, kramp tarzında ağrıdır. Sekonder dismenore ise pelvik patoloji varlığında görülen menstrüasyon ağrısıdır. Primer dismenore reprodüktif yaş grubunda, özellikle de adölesanlarda çok sık rastlanan bir problem iken, sekonder dismenore kırklı ve ellili yaşlarda daha sık görülür. Doğru tanı için, semptomların detaylı olarak değerlendirilmesi ve kapsamlı bir fizik muayene çok önemlidir. Hastalığın tedavi seçenekleri için konservatif yaklaşımlardan medikal tedaviye kadar, geniş bir yelpaze söz konusudur. Bu derlemede primer dismenoreyi güncel bilgiler eşliğinde ele almak ve tedavi yaklaşımları konusunda bilgi vermek amaçlanmıştır.
... The supernatant obtained from 2.7 was used to measure the levels of PGF 2a , PGE 2 and Ca 2+ in uterine smooth muscle tissue of mice by enzyme linked immunosorbent assay (ELISA) in accordance with manufactures instructions [14,25,26] . ...
Objective:
To study the effect of Alpinia officinarum Hance (A. officinarum) 80% alcohol extract on the primary dysmenorrhea.
Methods:
A. officinarum 80% alcohol extract were enriched by macroporous adsorption resins. Female mice of primary dysmenorrhea model were established by oxytocin induction; the effects of A. officinarum 80% alcohol extract on primary dysmenorrhea were observed by body twist method; and the homogenate level of prostaglandin F2α (PGF2α), prostaglandin E2 (PGE2) and Ca(2+) in the uterus were observed in oxytocin-induced female mice.
Results:
The writhing frequency of primary dysmenorrhea mice was significantly decreased after treatment of A. officinarum 80% alcohol extract and the level of PGF2α, PGE2 and Ca(2+) in mice uterus was significantly decreased (P < 0.05, P < 0.01) in groups of mice treated with middle and high dosage of A. officinarum 80% alcohol extract compared with that of model group.
Conclusions:
These findings suggest that A. Officinarum 80% alcohol extract can significantly relieve primary dysmenorrhea.
... There were six association studies that we considered eligible for inclusion in this review. 6,16,23,40,77,78 A further four studies considered the prevalence of PVI in non-pain populations 68,76,79,80 and three studies investigated the relationship between PVI and venous insufficiency of the lower limbs. 37,77,81 The quality assessment of the case-control studies is summarised in Table 3. ...
Purpose:
Chronic pelvic pain (CPP) in the presence of dilated and refluxing pelvic veins is often described as pelvic congestion syndrome (PCS), although the causal relationship between pelvic vein incompetence and CPP has not been established. Percutaneous embolization is the principal treatment for PCS, with high success rates cited. This study was undertaken to systematically and critically review the effectiveness of embolization of incompetent pelvic veins.
Materials and methods:
A comprehensive search strategy encompassing various terms for pelvic congestion, pelvic pain, and embolization was deployed in 17 bibliographic databases, with no restriction on study design. Methodologic quality was assessed. The quality and heterogeneity generally precluded meta-analysis. Results were tabulated and described narratively.
Results:
Twenty-one prospective case series and one poor-quality randomized trial of embolization (involving a total of 1,308 women) were identified. Early substantial relief from pain was observed in approximately 75% of women undergoing embolization, and generally increased over time and was sustained. Significant pain reductions following treatment were observed in all studies that measured pain on a visual analog scale. Repeat intervention rates were generally low. There were few data on the impact on menstruation, ovarian reserve, or fertility, but no concerns were noted. Transient pain was common following foam embolization, and there was a < 2% risk of coil migration.
Conclusions:
Embolization appears to provide symptomatic relief of CPP in the majority of women and is safe, although the quality of the evidence is low.
... Coupled with their elevated PG levels, dysmenorrheic women have higher levels of uterine activity during menstruation compared with asymptomatic women; basal or resting uterine tone (.10 mmHg), active intrauterine pressure (.120 mmHg), frequency of uterine contractions, and uncoordinated uterine contractions all are greater in dysmenorrheic women (Akerlund, 1979;Dawood, 1995Dawood, , 2006Hofmeyr, 1996). Furthermore, studies investigating uterine blood flow using Doppler ultrasonography have shown that the strong and abnormal uterine contractions in women with dysmenorrhea during menstruation are associated with reduced uterine blood flow and resultant myometrial ischemia, and hence pain (Altunyurt et al., 2005). Thus, during menstruation, excessive release of PGs by the endometrium results in hypercontractility of the uterus, and subsequent uterine muscle ischemia and hypoxia (Dawood, 1995;Hofmeyr, 1996). ...
BACKGROUND Primary dysmenorrhea, or painful menstruation in the absence of pelvic pathology, is a common, and often debilitating, gynecological
condition that affects between 45 and 95% of menstruating women. Despite the high prevalence, dysmenorrhea is often poorly
treated, and even disregarded, by health professionals, pain researchers, and the women themselves, who may accept it as a
normal part of the menstrual cycle. This review reports on current knowledge, particularly with regards to the impact and
consequences of recurrent menstrual pain on pain sensitivity, mood, quality of life and sleep in women with primary dysmenorrhea.
... Butylscopolamine (alone or in combination with analgesics) has been shown to be effective in treating dysmenorrhoea [16,17] though the quality of these trials is only moderate. At first glance this may not be astonishing since butylscopolamine as a spasmolytic agent relaxes the uterine musculature [18] which is believed to cause the cramping pain in dysmenorrhoea in response to endometrial prostaglandin release [19] though an ischemic nature of the pain via reduced uterine blood flow has also been proposed [20]. However, orally administered butylscopolamine is only minimally absorbed [21] and hence can hardly act on the uterine muscle. ...
Background: A majority of people suffering from functional abdominal complaints treat themselves with OTC medication. Aim: To gain information on symptoms and their interpretation in patients self-treating abdominal cramping and pain with a spasmolytic (butylscopolamine). Method: 4,680 questionnaires were distributed by 306 pharmacists in Germany to patients suffering from abdominal complaints and buying butylscopolamine. Key findings: Questionnaires from 1,539 respondents were returned, and 1,417 could be evaluated. Abdominal cramping was the major reason for buying butylscopolamine. Only a minority of respondents had consulted a general practitioner (27.3%) and even less a specialist (12.5%). Only a minority of subjects met expert criteria for irritable bowel syndrome (13%). There was a large overlap between self-reported dysmenorrhoea and bowel symptoms (35%). Conclusions: Real life conditions do not seem to be well covered by expert criteria. Differentiating bowel origin from uterine origin in pelvic pain syndromes seems especially problematic. This may particularly apply to the OTC market.
... Previous etiological studies have demonstrated the close relationship between PD and abnormal increased prostanoid secretion [7,9]. The abnormal prostanoid levels induce frequent or dysrhythmic uterine contractions, which can reduce the uterine blood flow and be regarded as the main factors leading to menstrual pain [4,10]. ...
Primary dysmenorrhea (PD) is a common gynecological disorder. Hitherto, animal models which recapitulate clinical features of PD have not been fully established. We aimed to examine whether a pain model in mice could mimic the clinic features of PD.
After pretreated with estradiol benzoate (1 mg/kg/d) intraperitoneally (i.p.) for 3 consecutive days, non-pregnant female Imprinting Control Region mice (6-8 weeks old) was injected with 0.4 U of oxytocin to induce the stretching or writhing response which was recorded for a time period of 30 min. During the writhing period, the uterine artery blood flow alterations were examined by Doppler ultrasound detection. After writhing test, the uterine morphological changes were observed by hematoxylin and eosin (H&E) staining histopathology. In addition, enzyme-linked immunosorbent assay kit was used to measure the levels of prostaglandins F2α/prostaglandins E2 (PGF2α/PGE2) and TXB2 (a metabolite of TXA2)/6-keto-PGF1α (a metabolite of PGI2) in the uterine tissue homogenates and plasma, respectively. Western blot analyses were performed to determine the expressions of oxytocin receptor (OTR), beta2-adrenergic receptor (beta2-AR), and cyclooxygenase-2 (COX-2) in uterine, which are responsible for the uterine contraction.
The writhing response only occurred in the estrogen pretreated female mice. The area of uterine myometrium significantly decreased along with the increased thickness in the oxytocin-induced estrogen pretreated mice model. The uterine artery blood flow velocity dropped, while the pulsatility index and resistance index slightly increased after the injection of oxytocin. The PGF2α/PGE2 level significantly increased and the plasma TXB2/6-keto-PGF1α level significantly enhanced. Compared with the control group, the uterine histopathology demonstrated moderate to severe edema of endometrium lamina propria. In consistent with the uterine morphological changes, a significant reduction of beta2-AR and a significant increase of OTR and COX-2 in the uterine tissue were observed.
The writhing response was caused by the abnormal contraction of uterus. The uterine spasm and ischemia changes of oxytocin-induced estrogen pretreated female mice model were similar to the pathology of human PD. We reported an in vivo mice model, which can be used to study PD and for clinical therapeutic evaluations.
... Queste anomalie fanno sì che l'utero sia scarsamente perfuso e, quindi, mal ossigenato. Flusso ematico uterino -Oggi è possibile effettuare una valutazione dell'indice di resistenza e di pulsatilità delle arterie uterine e arcuate mediante ecografia Doppler a colori 37 . Utilizzando questa tecnica si è dimostrato in vari studi che gli indici di resistenza e pulsatilità delle arterie uterine e alcune sono significativamente più elevati nel primo giorno del ciclo mestruale delle donne con dismenorrea primaria, quindi l'aumentata vasocostrizione causata dall'attività contrattile uterina è causa di dolore. ...
INTRODUZIONE Il termine "Dismenorrea" deriva dal greco e significa letteralmente flusso mensile difficoltoso; la dismenorrea è suddivisa in due tipologie, primaria e secondaria. La dismenorrea primaria si definisce come la presenza di ricorrenti e crampiformi dolori al ventre durante le mestruazioni, in giovani donne con anatomia pelvica normale. La dismenorrea secondaria si caratterizza, invece, per la presenza di dolori mestruali che sottostanno a patologie pelviche, come ad esempio l'endometriosi o i fibromi. La dismenorrea primaria è, per la maggior parte dei casi riportati in letteratura, una condizione benigna nelle adolescenti. Il disturbo inizia all'instaurarsi dei primi cicli ovulatori, quindi circa 6–12 mesi dal menarca. L'instaurarsi della dismenorrea, subito dopo il menarca o in donne con cicli certamente anovulatori, dovrebbe allertare il medico sulla possibilità di malformazioni ostruttive dell'apparato genitale. La comparsa di dolore mestruale dopo svariati anni di mestruazioni non accompagnate da disturbi dovrebbe, invece, orientare verso una dismenorrea secondaria 2 . Tipicamente, la dismenorrea primaria è caratterizzata da un dolore sovrapubico crampiforme, che comincia alcune ore dopo l'inizio del sanguinamento mestruale. Il picco d'intensità dei sintomi è avvertito durante i momenti in cui il sanguinamento è più abbondante e, solitamente, non dura più di un giorno, ma il dolore può persistere fin'anche a due o tre giorni. I sintomi non variano molto da un ciclo mestruale ad un altro. I dolori crampiformi al basso ventre, possono irradiarsi anche alla schiena e lungo le cosce; inoltre possono essere anche presenti alcuni sintomi sistemici come nausea, vomito, diarrea o stipsi, emicrania, astenia fino ad episodi di svenimento. EPIDEMIOLOGIA La dismenorrea primaria è una condizione comune che affligge, secondo i dati riportati in letteratura, dal 60% 1 fino anche al 90% 3 delle donne. Precedenti studi riportano alte quote di assenteismo da scuola o lavoro dovute alla dismenorrea, con il 13–51% 4 di donne che occasionalmente sono assenti e il 5–14% 5 delle donne che sono frequentemente assenti da tali ambienti. Età -La prevalenza della dismenorrea primaria si concentra nelle donne di età compresa fra i 14 e i 24 anni, mentre decresce progressivamente dopo i 25 anni 6 . Vari studi dimostrano come molteplici fattori contribuiscano a concentrare proprio nelle donne di queste età i disturbi legati al ciclo mestruale. In primo luogo, la presenza di cicli privi di ovulazione è maggiore nei periodi che limitano l'età fertile della donna, cioè menarca e menopausa; da qui risulta chiaro come la dismenorrea primaria non caratterizzi le giovanissime al di sotto dei 14 anni d'età e le donne in fase premenopausale. Inoltre la parità, secondo molti studi, pare essere un fattore protettivo rispetto la dismenorrea 7 . Etnia – Gli studi sulla popolazione suggeriscono che le donne che soffrono di dismenorrea sono diffuse in tutte le diverse popolazioni 8 .
... Coupled with their elevated PG levels, dysmenorrheic women have higher levels of uterine activity during menstruation compared with asymptomatic women; basal or resting uterine tone (.10 mmHg), active intrauterine pressure (.120 mmHg), frequency of uterine contractions, and uncoordinated uterine contractions all are greater in dysmenorrheic women (Akerlund, 1979;Dawood, 1995Dawood, , 2006Hofmeyr, 1996). Furthermore, studies investigating uterine blood flow using Doppler ultrasonography have shown that the strong and abnormal uterine contractions in women with dysmenorrhea during menstruation are associated with reduced uterine blood flow and resultant myometrial ischemia, and hence pain (Altunyurt et al., 2005). Thus, during menstruation, excessive release of PGs by the endometrium results in hypercontractility of the uterus, and subsequent uterine muscle ischemia and hypoxia (Dawood, 1995;Hofmeyr, 1996). ...
Primary dysmenorrhea is the most common gynecological condition among women of reproductive age. Although dysmenorrhea has been reported to affect the ability of women to carry out daily activities, the impact of primary dysmenorrheic pain specifically on quality of life (QoL), has yet to be elucidated. We investigated whether QoL varies between women with and without severe primary dysmenorrhea, and whether QoL is impaired only during menstruation or also during pain-free phases of the menstrual cycle. Twelve women with severe primary dysmenorrhea and nine control women completed the quality of life enjoyment and satisfaction questionnaire (Q-LES-Q-SF) during menstruation and during the late follicular phase. Women with dysmenorrhea had a significant reduction in Q-LES-Q-SF scores (mean ± SD: 54 ± 18%, percentage of the total maximum possible score) when they were experiencing severe menstrual pain compared with their own pain-free follicular phase (80 ± 14%, p < 0.0001) and compared with controls during menstruation (81 ± 10%, p < 0.0001). They also rated their overall life satisfaction and contentment as poorer during menstruation. Severe menstrual pain associated with primary dysmenorrhea, therefore, impacts health-related of QoL.
... In the pathology of pain in primary dysmenorrhea it was detected that increasing prostaglandin production and high uterine resistance in uterine arteries. 20 Altunyurt et al. 21 reported that dysmenorrheic patients had significantly higher mean PI and RI values in , before therapy; , after therapy. *P < 0.0001, compared to group 1 and group 2. **P < 0.0001, compared with before therapy values. ...
The aim of this case-control study was to compare the efficacy of ethinyl estradiol/drospirenone and Fructus agni casti in women with severe primary dysmenorrhea measuring uterine artery blood flow via Doppler ultrasonography.
A total of 60 women with severe primary dysmenorrhea and 30 healthy women (control) were included in this study. Thirty patients were treated with ethinyl estradiol 0.03 mg/drospirenone (group 1) and another 30 were treated with Fructus agni casti (group 2) during three menstrual cycles. Before and at the end of third month of therapy visual analog scale (VAS) scores, pulsatility index (PI), resistance index (RI) of uterine artery were recorded before and after receiving therapy on the first day of the menstrual cycle.
Mean PI and RI values in patients with severe primary dysmenorrhea were significantly higher than in the control groups on the first day of the menstrual cycle (P < 0.0001). Mean PI and RI values were significantly lower after the treatment in both groups compared to before values (P < 0.001 for both). After using the drugs for three menstrual cycles, VAS scores were significantly dropped in both groups compared to before treatment values (P < 0.0001 for both); however, there were no significant differences in terms of Doppler findings between group 1 and 2.
The effectiveness of Fructus agni casti was similar to that of ethinyl estradiol/drospirenone in patients with primary dysmenorrhea.
... pelvic adhesions, minimal endometriosis, etc.). Changes in uterine artery indices in patients with PD, however, have been documented previously (Dmitrovic, 2000;Altunyurt et al., 2005). Color Doppler ultrasound comparisons have been used in clinical trials that studied the relaxing effects of NO in PD patients (Paulus et al., 2002). ...
Is a vaginal preparation of sildenafil citrate capable of alleviating acute menstrual pain in patients with primary dysmenorrhea (PD)?
A vaginal preparation of sildenafil citrate is capable of alleviating acute menstrual pain in patients with PD with no observed adverse effects.
Oral preparations of nitric oxide (NO) donor drugs augment relaxant effects of NO on myometrial cells, reverse the vasoconstriction caused by prostaglandins and successfully alleviate pain, but the incidence of side effects is too high for routine clinical use. Sildenafil citrate inhibits type 5-specific phosphodiesterase (PDE5), thus preventing the degradation of cyclic guanosine monophosphate (cGMP) in the muscle and augmenting the vasodilatory effects of NO. Therefore, by inhibiting PDE5, the tissue remains relaxed and more blood can circulate through. It has been used previously in a vaginal form with no observed side effects, and it enhances endometrial blood flow.
A double-blind, randomized, controlled trial comparing vaginal preparation of sildenafil citrate (100 mg single dose) to a placebo in 62 PD patients at the time of painful menstruation was conducted. The primary outcome was total pain relief over 4 consecutive hours (TOPAR4) comparing sildenafil citrate to placebo, where higher TOPAR4 scores represent better pain relief. Secondary outcomes were pain relief as measured by the visual analog scale (VAS) and uterine artery pulsatility index (PI). Subjects were recruited from December 2007 to January 2011. The trial was stopped due to closeout of the funding for the study.
Participants were women in good health, were aged 18-35 years and suffered from moderate to severe PD. They were randomized to either vaginal placebo or 100 mg vaginal sildenafil citrate in a 1:1 ratio using random permuted blocks having a block size of 4. At baseline and 1, 2, 3, and 4 h post-treatment, patients were asked to provide assessment of their degree of pain using two scales: (i) pain on the 5-level ordinal scale used for TOPAR4 calculation and (ii) pain level on the VAS. The study ended 4 h after treatment initiation.
Twenty-five subjects completed the study. Using the TOPAR4 score, the sildenafil citrate group had significantly better pain relief compared with the placebo group [mean (SD): 11.9 (3.2) versus 6.4 (2.1), respectively; difference in means = 5.3; 95% CI: (2.9,7.6); P < 0.001)]. On the VAS, sildenafil citrate provided better pain relief than placebo at each time point. At the 2-h time point, the PI was significantly lower in the sildenafil citrate group compared with the placebo group [mean (SD): 1.6 (0.6) versus 2.3 (0.5), respectively; difference in means = -0.7; 95% CI: (-1.2, -0.1); P = 0.01)].
Since we did not meet our sample size due to the loss of funding and could not confirm our primary hypothesis, larger studies of longer duration, likely multi-center, are needed to confirm the findings from this study.
A number of medications have been investigated to improve the treatment options for PD, but most have proven unsuccessful or to have an unfavorable risk/benefit ratio. Since PD is a condition that most women suffer from and seek treatment for at some point in their lives, our study offers hope that vaginal sildenafil citrate is a safe and effective option for patients who do not desire or are unresponsive to treatments now available on the market.
Funding for this study was provided by National Institutes of Health (NIH) grants RO3 TW007438 and K24 HD01476. The authors report no relevant conflicts of interest.
NCT00123162 (Clinical trials.gov).
... NO is a free radical, and the excessive production of NO by iNOS is responsible for cytotoxicity by promoting iron-mediated lipid peroxidation (NO releases iron from cell stores) and by stimulating other proinflammatory enzymes such as COX-2 (Gu et al. 2002;Nogawa et al. 1998). Many reports suggest that frequent and prolonged uterine contractions cause dysmenorrhea because they decrease blood flow to the myometrium resulting in ischemia (Altunyurt et al. 2005;Buhimschi et al. 1995;Izumi et al. 1993). Therefore, reactive oxygen species have been implicated in the pathogenesis of a variety of injury models, including dysmenorrhea. ...
To examine the efficacy of YuanHu painkillers (YHP) as a treatment for primary dysmenorrhea and to reveal YHP's principle formula.
A Wistar rat uterine contraction model was utilized in this study. Rats were given 0.698g/kg YHP, 0.07g/kg tetrahydropalmatine (THP; YHP's main component), 0.02g/kg imperatorin (IMP), or THP+IMP (0.07+0.02g/kg) as polypharmacy (PG) by gavage. H&E staining and histopathological examination of the uteri tissue samples were performed. We then detected superoxide dismutase (SOD) and malondialdehyde (MDA), nitric oxide (NO), as well as inducible nitric oxide synthase (iNOS), i-κB, nuclear factor-κB (NF-κB), and cyclooxygenase-2 (COX-2) indices.
PG significantly inhibited the uterine contraction of the primary dysmenorrhea rat model (p<0.05), and was significantly different than single-agent therapy (p<0.05). Histopathological examination showed inflammation in the uteri of the control group which YHP and its main constitutes alleviated. THP significantly inhibited the contraction of isolated uteri caused by Ach, PGF2α and oxytocin in a concentration-dependent fashion. THP and IMP both significantly affected the levels of NO, activation of NF-κB, up-regulated the expression of i-κB and down-regulated the expression of both iNOS and COX-2. IMP obviously decreased the level of MDA and increased the activation of SOD (p<0.05). PG obviously improved all the parameters mentioned above (p<0.05).
YHP exerted protective effects on primary dysmenorrhea in rats and remarkably alleviated the severity of experimental primary dysmenorrhea. The combined strategy proved to be more effective than either THP or IMP alone and may have synergistic effects in combination in primary dysmenorrhea. Mechanisms that might account for the beneficial effects include abating oxidative stress, inhibiting over-inflammatory reaction, and alleviating the contraction of isolated rat uteri by inhibiting the influx of extracellular Ca(2+). Broad potential for future clinical practice is foreseeable.
... This is supported by Doppler ultrasound studies showing high uterine artery resistance on the first day of menses in patients with primary dysmenorrhea compared with a control group. 21 Dawood demonstrated that the intensity of menstrual cramps and associated symptoms of dysmenorrhea are directly proportional to the amount of prostaglandins released in endometrial secretions, 22,23 making excessive production of prostaglandins the problem rather than an increased sensitivity to the effect of prostaglandins. It has been suggested that vasopressin may also be involved in the etiology of primary dysmenorrhea, but its role remains controversial. ...
This article reviews the literature on management of chronic cyclical pelvic pain (CCPP). Electronic resources including Medline, PubMed, CINAHL, The Cochrane Library, Current Contents, and EMBASE were searched using MeSH terms including all subheadings and keywords: "cyclical pelvic pain", "chronic pain", "dysmenorrheal", "nonmenstrual pelvic pain", and "endometriosis". There is a dearth of high-quality evidence for this common problem. Chronic pelvic pain affects 4%-25% of women of reproductive age. Dysmenorrhea of varying degree affects 60% of women. Endometriosis is the commonest pathologic cause of CCPP. Other gynecological causes are adenomyosis, uterine fibroids, and pelvic floor myalgia, although other systems disease such as irritable bowel syndrome or interstitial cystitis may be responsible. Management options range from simple to invasive, where simple medical treatment such as the combined oral contraceptive pill may be used as a first-line treatment prior to invasive management. This review outlines an approach to patients with CCPP through history, physical examination, and investigation to identify the cause(s) of the pain and its optimal management.
... In primary dysmenorrhea, pain resulted from vasoconstriction, which manifested as an increase PI and RI values of the pelvic arteries. [19][20][21] It is reasonable to assume that the pathology of pain in patients with CPP is possible due to extremely increased blood flow observed in the uterine arteries. ...
To determine the value of transvaginal color Doppler study of uterine artery and investigate the differences in blood flow of uterine artery among women with chronic pelvic pain (CPP).
A total of 50 female patients were recruited. The study group consisted of 25 women with CPP of possible gynecological origin. Twenty-five women without CPP made a control group. All women were examined using transvaginal color Doppler ultrasonogram after negative finding of pelvic examination. The mean pulsality index (PI) and resistant index (RI) of the uterine arteries were recorded and compared.
The mean ages were 36.6 ± 10.6 and 32.0 ± 6.7 years in the study group and control group, respectively. The duration of pain ranges from 6-48 months (mean, 14.8). The mean PI and RI values of the uterine arteries in patients with CPP were significantly lower than in the control group; PI = 2.12 ± 0.78, 2.76 ± 0.84 and RI = 0.79 ± 0.19, 0.89 ± 0.05, respectively (P < 0.05).
Doppler flow indices demonstrated significant increase of uterine arteries vascularization in CPP women related to pelvic causes. Transvaginal ultrasound with noninvasive Doppler study could be a useful primary investigation for CPP women, especially when financial resource is an issue.
... 27 In Western medicine, Doppler flow studies have found that the pulsatility index and resistance index of both uterine arteries and the arcuate arteries were significantly higher on the first day of menstruation in women with primary dysmenorrhoea, suggesting increased blood flow impedance and indicating uterine vasoconstriction as a cause of the menstrual pain. 2,[32][33][34] This may indicate that the underlying pathological condition of impaired blood flow that is thought to cause primary dysmenorrhoea from a TCM perspective is the same for both Australian and Chinese women. This may also draw a parallel between Western medicine and TCM in terms of fundamental pathological condition in primary dysmenorrhoea. ...
To explore the extent to which traditional Chinese medicine (TCM) diagnostic categories for primary dysmenorrhoea are useful in describing the clinical presentation of this condition in Australian women in comparison with Chinese women, and therefore the potential usefulness of these categories in guiding TCM treatment of Australian women.
A comparative study of 120 Australian and 122 Chinese women aged from 18 to 45 years with primary dysmenorrhoea.
Modified valid TCM diagnostic protocol.
Difference in menstruation and menstrual pain profiles between the two groups of women found in the same study did not translate into differences in the underlying syndrome according to TCM diagnostic categories. The study found that Australian and Chinese women were represented in broadly similar proportions across the defined five diagnostic categories.
Some evidence suggests that although the clinical presentation of symptoms in Australian and Chinese women is different, the distribution of women across the diagnostic categories in TCM is similar. Therefore, the TCM protocol used to diagnose primary dysmenorrhoea and guide treatment is unlikely to require adaptation for use with Australian women.
Background: Primary dysmenorrhea (PD) is one of the most common diseases in women of reproductive age. Our aim was to examine whether a twice-weekly thirty-minute exercise intervention could result in a difference in the pulsatility index (PI) of the uterine arteries (UAs) and level of menstrual pain in patients with PD. Methods: In our prospective observational trial, the observation period included one spontaneous menstrual cycle and the consecutive time of the next menstruation of all participants, aged 18–44, with no extensive sports experience. In total, 73 volunteers were enrolled: 38 persons in the intervention group (IG) and 35 in the control group (CG). The intervention program was accompanied by music, performed in groups under the supervision of a qualified instructor in Hungary. The primary outcome was the difference between the IG and CG regarding the PI values of UAs at the 1st and the 2nd ultrasound (US) Doppler flowmetry. The secondary outcome was the difference between the IG and CG regarding the PI of UAs and menstrual pain measured by using the Numeric Rating Scale and adherence to the intervention. Statistical tests such as an independent-samples t-test, chi-square test, Mann–Whitney test and analysis of covariance (ANCOVA) were used during the analyses. Results: Examining the mean of the PI of UAs in the IG and the CG at the 1st and the 2nd US measurement, a significant difference was found in the change in the measured value (Z = −2.545; p = 0.011). The IG showed a significantly higher increase in the mean of the PI of UAs (Median = 0.825) than the CG (Median = 0.130). The difference in the PI of the UAs of the IG and the CG is not related to the level of pain in any group (p = 0.336) and not related to the whole sample (p = 0.354); furthermore, the level of pain did not significantly differ between the two groups. Conclusions: Our study is the first to document the significant effects of mild-to-moderate exercise training on the change in the PI of the UAs in individuals with PD. The IG had a reduced blood flow due to circulatory redistribution after exercise. The level of menstrual pain of primary dysmenorrhea patients is independent of the level of blood circulation regarding the PI of the UAs. Randomized controlled studies with more participants and a longer research period are needed to confirm our findings regarding the association between regular exercise and the PI of UAs. The study was registered at clinicaltrials.gov: NCT04618172.
Background and aim:
Primary dysmenorrhea (PD) is a common presentation for emergency departments. This study investigates the diagnostic value of oxidative stress and ischemia markers in patients with PD.
Materials and methods:
The participants were classified into the PD group (patients with PD) and the control group (healthy volunteers). Thiol/Disulfide Homeostasis (TDH) parameters (Ds, Disulfide; NT, Native Thiol; TT, Total Thiol) and serum ischemia modified albumin (IMA) levels of the groups were measured. The Numeric Rating Scale (NRS) was used for pain assessment. Bivariate correlation analysis was performed to test the relationship between NRS and oxidative stress parameters. A P < 0.05 was considered significant.
Results:
A total of 135 patients (PD group, n = 83; Control group, n = 52) were included in the study. PD group had statistically higher oxidant biomarkers (Ds level, Ds/NT ratio and Ds/TT ratio) and lower antioxidant biomarkers (NT/TT ratio) compared to the control group (p = 0.001; 0.003; 0.002, and 0.002, respectively). Serum IMA level in the PD group was higher than in the control group (P = 0.000). There was a positive correlation between IMA and NRS score (r = 0.342, P < 0.01), but no correlation was found between the other oxidative stress parameters and NRS.
Conclusions:
PD is characterized by increased oxidative stress and ischemia in the endometrium, which can be detected by TDH parameters and serum IMA. NRS score in PD patients is positively correlated with serum IMA level, which suggests IMA level can be valuable to determine the severity of endometrial ischemia and pain in patients with PD.
Objective
To observe the effects of ginger-partitioned moxibustion at Shenque (CV8) and Guanyuan (CV4) on the expression levels of endocrine-related molecules and their receptors in rats with primary dysmenorrhea (PD) due to cold-dampness stagnation, thus to explore their analgesic mechanisms.Methods
Thirty-two female Wistar rats were divided into a normal group, a model group, a ginger-partitioned moxibustion group, and a Western medicine group according to the random number table method, with 8 rats in each group. Except for rats in the normal group, all other rats were treated with oxytocin combined with ice-water bath to establish the rat models of PD due to cold-dampness stagnation. After successful modeling, rats in the normal group and the model group did not receive treatment; rats in the ginger-partitioned moxibustion group received treatments with ginger-partitioned moxibustion at Shenque (CV8) and Guanyuan (CV4); rats in the Western medicine group received ibuprofen by intragastric administration. The writhing response of rats was compared among groups, and the serum levels of prostaglandin F2α (PGF2α), estrogen (estradiol, E2), progesterone (P), and the mRNA expression of PGF2α and E2 receptors in the uterine tissues were detected.ResultsNo writhing behavior was observed in the normal group; compared with the normal group, the serum PGF2α and E2 levels in the model group were increased (P<0.01), while the P level was decreased (P<0.01), and the mRNA expression levels of the uterine PGF2α and E2 receptors were increased (P<0.01, P<0.05). Compared with the model group, the writhing behavior latency was prolonged, and the writhing response score was decreased in the ginger-partitioned moxibustion group and the Western medicine group (P<0.01); the serum PGF2α and E2 levels in the ginger-partitioned moxibustion group and the Western medicine group were decreased, while the P level was increased (P<0.05 or P<0.01); the mRNA expression levels of the uterine PGF2α and E2 receptors in the ginger-partitioned moxibustion group and the Western medicine group were decreased (P<0.05). Compared with the Western medicine group, the ginger-partitioned moxibustion group showed a prolonged writhing behavior latency, reduced writhing response score (P<0.05), and decreased serum E2 level (P<0.05), while no statistical differences in the serum PGF2α and P levels, or the mRNA expression levels of uterine PGF2α and E2 receptors (P>0.05).Conclusion
The analgesic effect of ginger-partitioned moxibustion on PD due to cold-dampness stagnation may be related to regulating the mRNA expression levels of PGF2α and E2 receptors in the uterine tissues.
We aimed to compare low-level light therapy with oral contraceptive pills for pain relief and serum levels of nitric oxide and prostaglandin E2 in patients with primary dysmenorrhoea. This was a randomised, active comparator-controlled, multicentre study. In total, 156 patients were randomised to receive either low-level light therapy with light-emitting diodes (LED) applying on two acupoints, namely, conception vessel 4 (CV4) and CV6 or conventional treatment with oral Marvelon, 30 µg of ethinyl estradiol and 150 µg of desogestrel (DSG/EE), for three consecutive menstrual cycles. The main outcome was the proportion of patients who achieved 33% or more decrease in pain scores measured using the visual analogue scale, which was deemed as efficient rate. Absolute changes in visual analogue scale scores, serum levels of nitric oxide (assessed by nitrites and nitrates reflecting nitric oxide metabolism) and prostaglandin E2 (measured by enzyme-linked immunosorbent assay) were the secondary outcomes. A total of 135 patients completed the study (73 in the light therapy group and 62 in the DSG/EE group). The efficient rate at the end of treatment was comparable between the groups (73.6% vs. 85.7%, χ² = 2.994, p = 0.084). A more significant reduction in pain scores was observed in the DSG/EE group (39.25% vs. 59.52%, p < 0.001). Serum levels of prostaglandin E2 significantly decreased from baseline but did not differ between groups (− 109.57 ± 3.99 pg/mL vs. − 118.11 ± 12.93 pg/mL, p = 0.51). Nitric oxide concentration remained stable in both groups. Low-level light therapy with LED-based device applied on acupuncture points CV4 and CV6 demonstrated a similar level of dysmenorrhoea pain reduction to DSG/EE combined contraceptive. Both treatment modalities achieved clinically meaningful levels of pain reduction. Registration on ClinicalTrials.gov: TRN: NCT03953716, Date: April 04, 2019.
Objective
To explore the analgesic effects and uterine hemodynamics of perpendicular needling (PN) and transverse needling (TN) at SP 6 in patients with primary dysmenorrhea (PD).
Methods
In this randomized controlled trial, patients with PD diagnosed with cold-dampness congealing pattern were randomly assigned in a ratio of 1:1 to receive PN or TN at bilateral SP 6 for 10 min. Acupuncture was performed when the menstrual pain score was over 40 mm on the first day of menstruation, as measured using the visual analog scale for pain (VAS-P). The primary outcome was average menstrual pain (VAS-P). Secondary outcomes included the pulsatility index (PI), resistance index (RI), and systolic-diastolic peaks ratio (S/D) in uterine arteries as measured using color Doppler ultrasonography; anxiety as assessed using the Hamilton Anxiety Rating Scale (HAMA), blood pressure (BP), and heart rate (HR).
Results
Forty-eight patients completed the study. The TN group exhibited a significant reduction in VAS-P scores (–5.71 mm, 95% confidence interval (CI): –8.78, –2.63, P = .001), RI values (–0.05, 95% CI: –0.09, –0.01, P = .015), and HAMA values (–2.50, 95% CI: –4.78, –0.22, P = .032) when compared with the PN group. No significant differences in PI, S/D, BP, or HR values were observed between the two groups (P > .05).
Conclusion
TN at SP 6 was superior to PN in alleviating menstrual pain and anxiety in patients with PD. This analgesic effect of TN may be due to its better ability to improve uterine arterial blood flow via decreases in RI values.
Guizhi-Fuling capsule (GZFLC), originated from a classical traditional Chinese herbal formula Guizhi-Fuling Wan, has been clinically used for primary dysmenorrhea in China. Nonetheless, the underlying pharmacological mechanisms of GZFLC remain unclear. The integration of computational and experimental methods of network pharmacology might be a promising way to decipher the mechanisms. In this study, the target profiles of 51 representative compounds of GZFLC were first predicted by a high-accuracy algorithm, drugCIPHER-CS, and the network target of GZFLC was identified. Then, potential functional modules of GZFLC on primary dysmenorrhea were investigated using functional enrichment analysis. Potential bioactive compounds were recognized by hierarchical clustering analysis of GZFLC compounds and first-line anti-dysmenorrhea drugs. Furthermore, the potential anti-dysmenorrhea mechanisms of GZFLC were verified through enzyme activity assays and immunofluorescence tests. Moreover, effects of GZFLC on primary dysmenorrhea were evaluated in oxytocin-induced dysmenorrhea murine model. In the network target analysis, GZFLC may act on five functional modules of pain, inflammation, endocrine, blood circulation and energy metabolism. Integrating computational and experimental approaches, we found that GZFLC significantly inhibited the writhing response and reduced the degree of uterine lesions in oxytocin-induced dysmenorrhea murine model. Furthermore, GZFLC may partially alleviate primary dysmenorrhea by inhibiting cyclooxygenase 2 (COX2) and downregulating MAPK signaling pathway. Consequently, GZFLC presented pain relief and sustained benefits for primary dysmenorrhea. This study could provide a scientific approach for deciphering pharmacological mechanisms of herbal formulae through network pharmacology.
Primary dysmenorrhea (PD) is one of the most common gynecological disorders among young women. Bergamot is rich in natural bioactive ingredients, which could potentially ameliorate PD. We aimed to investigate whether the bergamot products (essential oil, juice, and ethanol extract) could improve PD induced by estradiol benzoate and oxytocin. The rats were supplemented with the three doses of bergamot products and positive drugs by gastric perfusion, respectively. The results demonstrated that bergamot products could alleviate PD with dose‐dependence via inhibiting the growth of PGF2α/PGE2 ratio, accumulation of MDA, and release of iNOS, and promoting the activities of T‐AOC, SOD, CAT, and GSH in uterine tissues. Furthermore, bergamot products could mitigate the writhing response and histopathological alterations in uterine tissues. In addition, bergamot essential oil had greater benefits than the corresponding dose of juice and ethanol extract.
Practical applications
An increasing number of young women suffered PD, severely impacting their life. Seeking a healthy diet therapy can effectively avoid the adverse effects of PD drugs. Bergamot as natural fruit is rich in several bioactive ingredients. This study reported the function of bergamot products for alleviating PD via regulating the levels of prostaglandins and inflammatory mediator, and the capacities of antioxidants. This research provides insights for the development of functional foods with improving effect against PD. It also offers us a theoretical basis for the reasonable application of different forms of bergamot products.
Objective Primary dysmenorrhea occurs due to abnormal levels of prostanoids, uterine contractions, and uterine blood flow. However, the reasons for pain in primary dysmenorrhea have not yet been clarified. We examined the blood flow alterations in patients with primary dysmenorrhea and determined the relationship between ischemia-modified albumin (IMA) levels, as an ischemia indicator, and primary dysmenorrhea.
Methods In the present study, 37 patients who had primary dysmenorrhea and were in their luteal and menstrual phase of their menstrual cycles were included. Thirty individuals who had similar demographic characteristics, who were between 18 and 30 years old and did not have gynecologic disease were included as control individuals. Their uterine artery Doppler indices and serum IMA levels were measured.
Results Menstrual phase plasma IMA levels were significantly higher than luteal phase IMA levels, both in the patient and in the control groups (p < 0.001). Although the menstrual phase IMA levels of patients were significantly higher than those of controls, luteal phase IMA levels were not significantly different between the two groups. Menstrual uterine artery pulsatility index (PI) and resistance index (RI) of primary dysmenorrhea patients were significantly different when compared with luteal uterine artery PI and RI levels. There was a positive correlation between menstrual phase IMA and uterine artery PI and RI in the primary dysmenorrhea.
Conclusion Ischemia plays an important role in the etiology of the pain, which is frequently observed in patients with primary dysmenorrhea. Ischemia-modified albumin levels are considered as an efficient marker to determine the severity of pain and to indicate ischemia in primary dysmenorrhea.
Primary dysmenorrhea is defined as pain during the menstrual cycle in the absence of an identifiable cause. It is one of the most common causes of pelvic pain in women. Dysmenorrhea can negatively affect a woman's quality of life and interfere with daily activities. The pathophysiology of primary dysmenorrhea is likely a result of the cyclooxygenase pathway producing increased prostanoids, particularly prostaglandins (PGs). The increased PGs cause uterine contractions that restrict blood flow and lead to the production of anaerobic metabolites that stimulate pain receptors. Women with a history typical for primary dysmenorrhea can initiate empiric treatment without additional testing. Shared decision making is key to effective management of dysmenorrhea to maximize patient compliance and satisfaction. After a discussion of their risks and benefits, extremely effective empiric therapies are nonsteroidal antiinflammatory drugs and contraceptive hormonal therapy. Other treatments for primary dysmenorrhea can be employed solely or in combination with other modalities, but the literature supporting their use is not as convincing. The physician should initiate an evaluation for secondary dysmenorrhea if the patient does not report improved symptomatology after being compliant with their medical regimen.
Objectives
To investigate the association between tea drinking and dysmenorrhoea among women of reproductive age.
Design
A cross-sectional study based on Shanghai Birth Cohort Study.
Setting
Two preconceptional care clinics in Shanghai, China.
Participants
1183 women of reproductive age who sought preconceptional care were recruited from August 2013 to April 2015.
Primary and secondary outcome measures
Participants were asked if they had pelvic pain associated with menstrual bleeding during the past 12 months and to further grade the intensity of menstrual cramp as mild, moderate and severe. Multinomial logistic regression was performed to assess the association of tea drinking and dysmenorrhoea. Other information, such as demographic and lifestyle factors, was also collected and assessed in relation to dysmenorrhoea.
Results
The prevalence of dysmenorrhoea was 57.8%, among whom 10.4% and 3.5% had moderate and severe dysmenorrhoea, respectively. Tea drinking was associated with a lower prevalence of dysmenorrhoea (adjusted OR [aOR]=0.68, 95% CI 0.50 to 0.93 for mild dysmenorrhoea; aOR=0.59 (95% CI 0.32 to 1.04) for moderate-to-severe dysmenorrhoea). Green tea and oolong tea appeared to have most reduction in the prevalence of dysmenorrhoea (for mild dysmenorrhoea: green tea: aOR=0.63 (95% CI 0.44 to 0.90) and oolong tea: aOR=0.60 (95% CI 0.35 to 1.03); for moderate-to-severe dysmenorrhoea: green tea: aOR=0.42 (95% CI 0.20 to 0.85) and oolong tea: aOR=0.34 (95% CI 0.11 to 1.09)).
Conclusions
Consumptions of green tea and possibly oolong tea were associated with a lower prevalence of dysmenorrhoea.
The traditional concept of the uterus is that the endometrium is the dynamic tissue, providing an intricate set of functions throughout the menstrual cycle-a process that rarely culminates in implantation and pregnancy. The myometrium has been viewed as an inert tissue, chiefly important during pregnancy and, when abnormal, providing the surgical livelihood of clinical gynecologists. To understand both the physiology of menstruation and the pathophysiology of abnormal uterine bleeding (AUB), both the myometrial and the endometrial layers of the uterus are important. This chapter covers both myometrial disease (adenomyosis and leiomyomas) and endometrial diseases (polyps, AUB, intrauterine adhesions, and dysmenorrhea). The objective is to provide the reader with an understanding of the various clinical presentations as well as the molecular pathophysiology of the disease process and to enlist various therapeutic options for these benign uterine diseases.
Pain relief of two different oral contraceptive pills (OCPs) in severe primary dysmenorrhoea (PD) was compared. Sixty-six nulliparous patients with severe PD requiring contraception were evaluated. Group 1 comprised 33 healthy controls. Patients with severe PD were divided into two groups. Patients in Group 2 were administered oestradiol valerate/dienogest and patients in Group 3 were administered ethinylestradiol/drospirenone. Doppler indices of both uterine arteries (left and right) including systolic/diastolicrates (S/D), pulsatility index (PI) and resistance index (RI) were measured, and a visual analogue scale (VAS) was applied to patients before treatment. VAS scores and Doppler indices were repeated after 3 months of OCP treatment and the changes in values were compared. The demographic and clinical characteristics of the patients were similar. The mean value of RI was significantly lower after therapy in Groups 2 and 3 in the right and left uterine arteries (p = .001 and p = .039, respectively). The clinical trial number was NCT03124524.
• Impact Statement
• What is already known on this subject: OCPs are the most appropriate treatment option for PD. There is no clear data about OCP containing dienogest for treatment in PD. Dienogest has been reported to be highly effective in the treatment of endometriosis and is also recommended as first-line therapy for pelvic pain-associated endometriosis.
• What the results of this study add: In this study, although there was no superiority in pain relief between the treatment groups, lower VAS scores and lower RI values of uterine arteries were seen after treatment. Both OCPs relieve pain in severe PD. There was no serious adverse effect in the patients.
• What the implications are of these findings for clinical practice and/or further research: Estradiol valerate/dienogest, which is a routinely prescribed drug for heavy menstrual bleeding in women who desire oral contraception, is as effective as ethinylestradiol/drospirenone in pain relief.
Primary dysmenorrhoea is a common problem among women and might be one of the main causes for absence from school, studies and work. There are many studies indicating a positive effect of sports and exercise on dysmenorrhoea, although some results are inconsistent. Since 2011 several prospective randomized trials have been published indicating a benefit of exercise in reducing dysmenorrhoea, either by Yoga or water exercise. Nonsteroidal anti-inflammatory drugs and hormones like oral contraceptives are effective therapy options, but advantages of exercise as a treatment for dysmenorrhoea are the non-pharmacological approach and the absence of negative side effects. Therefore, it can recommended as a long term treatment for dysmenorrhoea.
The uterine tetanic contraction and uterine artery blood flow reduction are possible reasons for primary dysmenorrhea (PD). In the present study, we aimed to evaluate the uterine relaxant effect and the influence on uterine artery blood velocity of Ge-Gen Decoction (GGD), a well-known Chinese herbal formula. In female ICR mice, uterine contraction was induced by oxytocin exposure following estradiol benzoate pretreatment, and the uterine artery blood velocity was detected by Doppler ultrasound. Histopathological examination of the uterine tissue samples were performed by H&E staining. Ex vivo studies demonstrated that oxytocin, posterior pituitary, or acetylcholine induced contractions in isolated mouse uterus. GGD inhibited both spontaneous and stimulated contractions. In vivo study demonstrated that GGD significantly reduced oxytocin-induced writhing responses with a maximal inhibition of 87%. Further study demonstrated that GGD normalized oxytocin-induced abnormalities of prostaglandins F2 alpha (PGF2α) and Ca2+ in mice. In addition, injection of oxytocin induced a decrease in uterine artery blood flow velocity. Pretreatment with GGD reversed the oxytocin response on blood flow velocity. Histopathological examination showed pretreatment with GGD alleviated inflammation and edema in the uterus when compared with the model group. Both ex vivo and in vivo results indicated that GGD possessed a significant spasmolytic effect on uterine tetanic contraction as well as improvement on uterine artery blood velocity which may involve PGF2α and Ca2+ signaling, suggesting that GGD may have a clinic potential in PD therapy.
Background:
Pelvic congestion syndrome (PCS) is described as chronic pelvic pain (CPP) arising from dilated and refluxing pelvic veins, although the causal relationship between pelvic vein incompetence (PVI) and CPP is not established. Non-invasive screening methods such as Doppler ultrasound and magnetic resonance venography are used before confirmation by venography. Percutaneous embolisation has become the principal treatment for PCS, with high success rates often cited.
Objectives:
Our proposal aimed to systematically and critically review the definitions and diagnostic criteria of PCS, the association between PVI and CPP, the accuracy of various non-invasive imaging techniques and the effectiveness of embolisation for PVI; and to identify factors associated with successful outcome. We also wished to survey clinicians and patients to assess awareness and management of PCS and gauge the enthusiasm for further research.
Data sources:
A comprehensive search strategy encompassing various terms for pelvic congestion, pain, imaging techniques and embolisation was deployed in 17 bibliographic databases, including MEDLINE, EMBASE and Web of Science. There was no restriction on study design.
Methods:
Methodological quality was assessed using appropriate tools. Online surveys were sent to clinicians and patients. The quality and heterogeneity generally precluded meta-analysis and so results were tabulated and described narratively.
Results:
We identified six association studies, 10 studies involving ultrasound, two studies involving magnetic resonance venography, 21 case series and one poor-quality randomised trial of embolisation. There were no consistent diagnostic criteria for PCS. We found that the associations between CPP and PVI were generally fairly similar, with three of five studies with sufficient data showing statistically significant associations (odds ratios of between 31 and 117). The prevalence of PVI ranged widely, although the majority of women with PVI had CPP. Transvaginal ultrasound with Doppler and magnetic resonance venography are both useful screening methods, although the data on accuracy are limited. Early substantial relief from pain symptoms was observed in approximately 75% of women undergoing embolisation, a figure which generally increased over time and was sustained. Reintervention rates were generally low. Transient pain was a common occurrence following foam embolisation, while there was a < 2% risk of coil migration. Confidence in the embolisation technique is reasonably high, although there is a desire to strengthen the evidence base. Even among women with CPP, fewer than half had any knowledge about PCS.
Conclusions:
The data supporting the diagnosis and treatment of PCS are limited and of variable methodological quality. There is some evidence to tentatively support a causative association, but it cannot be categorically stated that PVI is the cause of CPP in women with no other pathology, as the six most pertinent drew on clinically disparate populations and defined PVI inconsistently. Embolisation appears to provide symptomatic relief in the majority of women and is safe. However, the majority of included studies of embolism were relatively small case series and only the randomised controlled trial was considered at risk of potential biases. There is scope and demand for considerable further research. The question of the association of PVI and CPP requires a well-designed and well-powered case-control study, which will also provide data to derive a diagnostic standard. An adequately powered randomised trial is essential to provide evidence on the effectiveness of embolisation, but this faces methodological challenges.
Study registration:
This study is registered as PROSPERO CRD42012002237 and CRD42012002238.
Funding:
The National Institute for Health Research Health Technology Assessment programme.
In the presented work antitumor effects of thermo- and phagelysates of Ps.aeruginosa and E.coli on Ehrlich carcinoma growth in mice have been studied. The treatment efficacy was evaluated according to the dynamic changes in volume of cancer tissue, cancer growth inhibition percent and calculations using Semi-empirical mathematical model describing cancer volume variations in relation to time passed after carcinoma inoculation. It was shown that at the early stage of cancer growth all tested bacterial preparations significantly inhibit cancer growth. Antitumor treatment effects were better expressed in animal studies using bacterial pagelysates in comparison to that of thermolysates. Comparative analysis of anticancer treatment efficacy of Ps.aeruginosa and E.coli phagelysates have shown that E.coli phagelysates reveal stronger and more prolonged anticancer treatment properties than phagelysates of Ps.aeruginosa.
Las dismenorreas corresponden a los dolores pélvicos durante las menstruaciones. Son de dos tipos: primarias y secundarias. Las dismenorreas primarias afectan a muchas jóvenes algunos meses o años después de la menarquia. En general guardan relación con una alteración incipiente del ciclo menstrual y, a menudo, carecen de un sustrato anatómico ginecológico. A pesar de su carácter funcional, tienen una repercusión social nada desdeñable. Las dismenorreas secundarias, en cambio, afectan a las mujeres de 30-40 años. Casi siempre obedecen a una enfermedad orgánica pélvica. Las pruebas complementarias sólo son necesarias si se sospecha una lesión orgánica que, en algunos casos, puede observarse en las jóvenes. El tratamiento de las dismenorreas primarias es simple y consiste en dos clases terapéuticas: antiinflamatorios y estroprogestágenos, solos o combinados, con un índice elevado de buenos resultados. El tratamiento de las dismenorreas secundarias es causal y no se detallará en este artículo.
Adolescent gynecology is a rapidly developing area. Dysmenorrhea is one of the most common complaints among women of young reproductive age. About 25-95% of young women suffers with dysmenorrhoea and is associated with significant psychological, physical, behavioral and social distress. This review summarizes epidemiology, strategies of establishing the diagnosis, discussion of pathophysiology of the disease and risk factors. We performed a comprehensive search through MEDLINE, EMBASE, Scopus, MD consult and Web of Science. Inclusion criteria specified review and research articles reporting primary dysmenorreah in adolescents. The search resulted in 214 articles. We point out a variety of noninvasive nutritional and psychological therapeutic interventions that have been suggested to relieve dysmenorrheal. This review of Primary Dysmenorreah identifies gaps in the literature, some contradictions and highlights the need for further study.
The objective of this study was to compare the effects of Sanyinjiao (SP6), Xuanzhong (GB39), and an adjacent non-meridian point on menstrual pain and uterine arterial blood flow in primary dysmenorrhea patients.
The design of the study was a prospective, randomized controlled trial.
The setting of the study was the Shandong Institute of Medical Imaging, Jinan, China.
The patients were 52 women with primary dysmenorrhea.
Women received electroacupuncture (EA) at SP6 (n=13), GB39 (n=14), and an adjacent non-meridian point (n=12), respectively, for 10 minutes when scored ≥40 on a 100-mm visual analog scale (VAS), and for 30 minutes on the next 2 days. There was no EA in the waiting list group (n=13).
Primary outcomes were menstrual pain, resistance index (RI), and the ratio between peak systolic to end-diastolic flow velocity (S/D) in uterine arteries. Secondary outcomes included verbal rating scale (VRS) and retrospective symptom scale (RSS).
The SP6 group had a highly significant reduction in VAS scores compared with the waiting list group (-23.19mm, 95% confidence interval [CI]-32.06 to -14.33, P<0.0001), GB39 group (-18.58mm, 95% CI -27.29 to -9.88, P<0.0001) and the non-meridian point group (-20.78mm, 95% CI -29.82 to -11.73, P<0.0001), respectively. A significant reduction in VRS scores was found in the SP6 group compared with the GB39 group (P=0.034) and the non-meridian point group (P=0.038). There were no significant differences of RI, S/D-values and RSS scores among the four groups (P>0.05).
EA at SP6 can immediately relieve menstrual pain and minimize the influence of pain on daily life compared with GB39 and an adjacent non-meridian point. The data preliminarily show the specificity of SP6 for the immediate pain relief of primary dysmenorrhea.
Primary dysmenorrhea is commonly a straightforward diagnosis that can be made accurately with an attentive history. In young women who have classic symptoms and no specific indication, a pelvic examination is often unnecessary in the initial evaluation. The opportunity for primary care practitioners to support women in unearthing the best approach to this chronic recurrent discomfort to minimize adverse life impact is significant and valuable. Identification of patients who are incapacitated by their symptoms or have symptoms that represent underlying pathology is a critical component of a careful history. The wide range of treatments available for primary dysmenorrhea virtually ensures that all females troubled by the symptoms can find relief with safe and inexpensive treatments while limiting negative side effects.
The aim of the study was to examine whether there was a relationship between primary dysmenorrhea and serum levels of malondialdehyde (MDA), nitric oxide (NO) and adrenomedullin (AM) in young women.
Sixty female subjects without serious medical problems, aged between 20 and 34, who had regular menses for at least six previous cycles, were involved. Blood samples were obtained from each patient on the first and the 21st days of her menstrual cycles. Pelvic examination and ultrasound were performed to determine any organic cause for dysmenorrhea in each patient. The subjects were divided into two groups. The study group consisted of 30 subjects with primary dysmenorrhea, and the control group consisted of 30 healthy subjects.
No statistically significant difference was observed in comparison of the following variables between the groups: age, parity and body mass index. The serum levels of MDA, NO, and AM were significantly higher on the first day compared to those on the 21(st) day in the study group (P < 0.05). The serum levels of MDA, NO, and AM were significantly higher in the study group compared to the control group both on the first and the 21st days of the menstrual cycles (P < 0.05).
In conclusion, the results of this study showed that the serum levels of MDA, NO, and AM increase in subjects with primary dysmenorrhea, suggesting the possibility that lipid peroxidation and oxidative stress play a significant role in the etiopathogenesis of primary dysmenorrhea.
The purpose of this study was to compare acetaminophen with ibuprofen for pain relief and menstrual fluid prostaglandin F2alpha (PGF2alpha) suppression in primary dysmenorrhea.
Twelve subjects were randomized to placebo, acetaminophen (1000 mg orally, 4 x daily for 3 days) or ibuprofen (400 mg orally, 4 x daily for 3 days), once during each cycle in a prospective, double-blinded, crossover study. Using preweighed super absorbent tampons, menstrual fluid was collected, extracted, and PGF2alpha radioimmunoassayed.
Ten patients completed the study. Ibuprofen (P = .002) and acetaminophen (P = .022) were rated significantly better than placebo. Total menstrual fluid PGF2alpha with placebo was 36.2 + 6.1 microg but were 14.8 + 3.0 microg with ibuprofen (P = .001) and 21.4 + 3.4 microg with acetaminophen (P = .008). PGF2alpha concentrations with placebo were 0.34 + 0.054 microg/mL, with ibuprofen 0.16 + 0.026 microg/mL (P = .001), and with acetaminophen 0.23 + 0.029 microg/mL (P = .016).
Both ibuprofen and acetaminophen were superior to placebo for pain relief and menstrual fluid PGF2alpha suppression, with ibuprofen being more potent.
Eleven women with primary dysmenorrhea completed a randomized, double-blind, placebo-controlled, three-way cross-over study comparing 200 and 400mg suprofen. Menstrual fluid volume did not change. Mean+/-S.E.M. menstrual fluid PGF2a was significantly suppressed from 18.9+/-1.9 microg (placebo) to 10.9+/-1.7 and 9.3+/-2.1 microg with 200 and 400 mg suprofen, respectively (p=<0.005). PGE2 dropped from 7.8+/-0.9 to 4.6+/-0.8 and 4.6+/-1.1 microg (p=<0.05) and TxB2 from 17.5+/-4.3 to 7.5+/-2.9 and 3.6+/-1.3 microg (p=<0.01), respectively. 6-Keto PGF1a was significantly suppressed (2.7+/-0.4 to 1.9+/-0.5 microg, p=<0.025) with only 400 mg suprofen. Six subjects rated placebo poor and five fair to very good. In contrast, nine rated suprofen excellent to fair while two rated poor. Thus, suprofen was clinically effective but the differential suppression of prostanoids favors 200mg which spares 6-keto PGF1a.
Most traditional Chinese herbal formulas consist of at least four herbs. Four-Agents-Decoction (Si Wu Tang) is a documented eight hundred year old formula containing four herbs and has been widely used to relieve menstrual discomfort in Taiwan. However, no specific effect had been systematically evaluated. We applied Western methodology to assess its effectiveness and safety for primary dysmenorrhoea and to evaluate the compliance and feasibility for a future trial.
A randomised, double-blind, placebo-controlled, pilot clinical trial was conducted in an ad hoc clinic setting at a teaching hospital in Taipei, Taiwan. Seventy-eight primary dysmenorrheic young women were enrolled after 326 women with self-reported menstrual discomfort in the Taipei metropolitan area of Taiwan were screened by a questionnaire and subsequently diagnosed by two gynaecologists concurrently with pelvic ultrasonography. A dosage of 15 odorless capsules daily for five days starting from the onset of bleeding or pain was administered. Participants were followed with two to four cycles for an initial washout interval, one to two baseline cycles, three to four treatment cycles, and three follow-up cycles. Study outcome was pain intensity measured by using unmarked horizontal visual analog pain scale in an online daily diary submitted directly by the participants for 5 days starting from the onset of bleeding or pain of each menstrual cycle. Overall-pain was the average pain intensity among days in pain and peak-pain was the maximal single-day pain intensity. At the end of treatment, both the overall-pain and peak-pain decreased in the Four-Agents-Decoction (Si Wu Tang) group and increased in the placebo group; however, the differences between the two groups were not statistically significant. The trends persisted to follow-up phase. Statistically significant differences in both peak-pain and overall-pain appeared in the first follow-up cycle, at which the reduced peak-pain in the Four-Agents-Decoction (Si Wu Tang) group did not differ significantly by treatment length. However, the reduced peak-pain did differ profoundly among women treated for four menstrual cycles (2.69 (2.06) cm, mean (standard deviation), for the 20 women with Four-Agents-Decoction and 4.68 (3.16) for the 22 women with placebo, p = .020.) There was no difference in adverse symptoms between the Four-Agents-Decoction (Si Wu Tang) and placebo groups.
Four-Agents-Decoction (Si Wu Tang) therapy in this pilot post-market clinical trial, while meeting the standards of conventional medicine, showed no statistically significant difference in reducing menstrual pain intensity of primary dysmenorrhoea at the end of treatment. Its use, with our dosage regimen and treatment length, was not associated with adverse reactions. The finding of statistically significant pain-reducing effect in the first follow-up cycle was unexpected and warrants further study. A larger similar trial among primary dysmenorrheic young women with longer treatment phase and multiple batched study products can determine the definitive efficacy of this historically documented formula.
Controlled-Trials.com ISRCTN23374750.
The aim of this work is to suggest a new diagnostic approach to the "female varicocele syndrome" which utilizes transvaginal ultrasonography. The presence of circular or linear anechogenic structures with a diameter greater than 5 mm, which were found in transverse and oblique sections of the lateral fornices, was indicative of pelvic varices. The vascular nature of these structures was confirmed with the Valsalva's maneuver and in the upright position. The presence of "pelvic varices" was confirmed by retrograde phlebography of the left ovarian vein in 46% of the cases. In such cases the parity was greater than in subjects without "pelvic varices" (chi square = 12.75, p less than 0.001), and the principal symptoms were characterized by pelvic pains and menstrual cycle disorders.
Eighty-eight female high school adolescents in two separate physical education classes were surveyed for the prevalence of dysmenorrhea and premenstrual symptoms. Each group answered a questionnaire requesting age; presence, severity, and nature of dysmenorrhea and premenstrual symptoms; and course of treatment. Questions were also asked to determine the perceived impact of these symptoms on academic performance, ability to concentrate, study, or take tests, and classes missed. The results showed that the majority of the female adolescents identified dysmenorrhea and premenstrual symptoms as problems that significantly affected their academic performance and were responsible for school absenteeism. Contradictory to common belief, premenstrual symptoms in these adolescents (76 of 88, 86%) were found to be as prevalent as symptoms of dysmenorrhea (80 of 88, 91%), and most of the girls were unaware of the causes and treatments of these symptoms. Subsequently, we designed a model for use by health professionals to educate girls in self-help methods and to screen for and detect these problems.
To determine the prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in a clinical population of reproductive-age women.
A ten-page questionnaire was administered to a consecutive sample of women age 18-45 years who were approached in the waiting areas of two obstetrics and gynecology practices and three family medicine practices in central North Carolina. Of 701 women approached to fill out the questionnaire, 581 (83%) returned completed forms suitable for analysis.
The reported prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome was 90, 46, 39, and 12%, respectively. Low income was found to be a risk factor for dysmenorrhea and dyspareunia, and African-American race was found to be a risk factor for pelvic pain. Pelvic pain was also more common among women 26-30 years old. Otherwise, dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome were not associated with age, parity, marital status, race, income, or education.
Dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome are common complaints among women of reproductive age and are not consistently associated with demographic risk factors. Therefore, inquiry about these pelvic pain complaints should be a routine part of health care for women.
Increased intra-uterine pressure due to exaggerated myometrial contractions is an important factor in the pathogenesis of dysmenorrhea, its treatment being associated with uterine muscle relaxation. Diminished synthesis of endogenous nitric oxide has been shown to induce myometrial contractions and, conversely, the administration of exogenous nitric oxide has successfully resulted in uterine relaxation in a variety of obstetrical/gynecological disorders. The objective of this study was to determine the role of transdermal glyceryl trinitrate, as a source of exogenous nitric oxide, in the management of primary dysmenorrhea.
This was a multi-national, double-blind, randomized and cross-over study in patients with primary dysmenorrhea. Eighty-eight patients from six countries were evaluated during three menstrual cycles while receiving glyceryl trinitrate patches, 0.1 mg/h (x) or matching placebo patches. Pain intensity scores assessed on a visual analog scale and the time-weighted sum of the pain intensity differences (SPID) were evaluated during days 1, 2 and 3 of each cycle using an analysis of variance (ANOVA) model. Overall assessment of efficacy and the incidence of adverse events were analyzed by the Stuart-Maxwell or the McNemar tests as appropriate.
Efficacy was determined for the first day of each cycle, all days/all cycles and for patients who completed at least one cycle in each treatment modality. In all three analyses, SPIDs were statistically superior (P<0.01) for the glyceryl trinitrate patches. Pain intensity differences from hours 1 to 6 also showed statistically significant differences in favor of the active treatment. In the overall assessment of efficacy, glyceryl trinitrate patches were statistically superior as well. The incidence of headache was 26% for the active drug and 6.1% for placebo (P<0.01).
The data indicate that transdermal glyceryl trinitrate, as a source of exogenous nitric oxide, is useful as a modulator of uterine contractility representing, therefore, a new and mechanistically different therapeutic alternative for the management of primary dysmenorrhea.
The pain in primary dysmenorrhea is caused by excessive prostaglandin production that leads to vasoconstriction and uterine ischemia. Changes in uterine blood flow are important factors in pathophysiology of primary dysmenorrhea. The aim of the study was to determine if vasoconstriction of the uterine vessels in patients with primary dysmenorrhea is detectable by transvaginal color Doppler ultrasound.
Forty-two women with primary dysmenorrhea and fifty healthy controls were included in this prospective study. Women were examined with transvaginal color Doppler ultrasound on first day of the cycle, once in the follicular and once in the luteal phase. Measurements of pulsatility index in uterine, arcuate, radial and spiral arteries were performed. Student's t-test was used to establish statistical significance between groups.
Women in dysmenorrhea group had significantly higher uterine blood flow indices than healthy controls in all three measurements periods. This includes all vessels studied on the first day of the cycle, the radial and spiral arteries during the follicular phase and the arcuate, radial and spiral arteries during the luteal phase.
We found that women with primary dysmenorrhea have elevated Doppler indices in uterine arteries not only on first day of the cycle but throughout the whole cycle. Therefore we postulated that primary dysmenorrhea is not only the disorder of menstruation but also a disease of a menstrual cycle as a whole.
Effect of the side of ovulation on uterine, ovarian, and follicular blood flow parameters and various hormone levels.
Prospective, observational study.
Fertility Clinic, St. George's Hospital.
Nineteen women with regular menstrual cycles. Pulsed Doppler measurements and serum hormonal concentrations during midfollicular, periovulatory, and midluteal phase for three successive cycles.
Doppler blood flow and serum hormones.
Doppler blood flow of the ovarian stroma and follicular and uterine arteries showed no differences in the three phases between the right and left sides. Left-side uterine peak systolic velocity (PSV) (right-side PSV, 31.51cm/s; left-side PSV, 37.38 cm/s) during the periovulatory phase tended to be higher in the nondominant ovary; however, this was not quite significant. The serum hormone concentration showed no significant differences.
The side of ovulation did not influence the Doppler blood flow to the ovarian stroma or follicular and uterine arteries. The side of ovulation had no effect on serum FSH, LH, 17beta-estradiol, P, inhibin A, or inhibin B levels.
Doppler findings in women with severe symptoms of primary dysmenorrhea include high impedance to blood flow in uterine arteries with a preserved cyclic pattern throughout the whole cycle. Doppler findings in women who present with mild symptoms of primary dysmenorrhea are not yet documented. The aim of this study was to investigate possible differences in Doppler findings among women with mild and severe primary dysmenorrhea.
One hundred and fifty four women were examined with color Doppler ultrasound: 50 in the control group, 60 in the mild and 44 in the severe primary dysmenorrhea subgroup. We calculated resistance index in uterine arteries in these women on the first day of the cycle, in the follicular (days 9-12) and the luteal (days 20-23) phase of the cycle and used analysis of variance for comparing results.
The rate of visualization was 100% for uterine and arcuate arteries, 44-76% for the radial and 32-62% for spiral arteries, respectively. A significant difference in Doppler index values among the mild and severe dysmenorrheic group was observed in the luteal phase for the arcuate artery and in all the three measurement periods for the radial and spiral arteries.
There is a difference in Doppler findings between women with mild and severe symptoms of primary dysmenorrhea.
Twelve healthy women with regular menstrual cycles were examined with a combination of two-dimensional real-time ultrasound and color and spectral Doppler techniques on cycle days 4 and 8 and daily from cycle day 12 until follicular rupture, then days + 1, +2, +5, +7 and +12 after follicular rupture. The uterine and subendometrial arteries, arteries in the ovarian stroma and hilum, in the wall of the largest follicle of each ovary, and in the wall of the corpus luteum were examined. The pulsatility index and the time-averaged maximum velocity were calculated. In the uterine arteries the pulsatility index was highest on day + 2, after which it decreased successively to its lowest value, whereas the time-averaged maximum velocity reached its highest value on day + 12. Similar changes were observed in the subendometrial arteries. In the non-dominant ovary, neither the pulsatility index nor the time-averaged maximum velocity manifested any consistent changes during the cycle. In the dominant ovary, the time-averaged maximum velocity increased and the pulsatility index decreased after follicular rupture, being significantly higher and lower, respectively, in the luteal than in the follicular phase. These changes were seen in the ovarian hilum, stroma and follicular wall, but were most obvious in the wall of the dominant follicle and of the corpus luteum. We conclude that the blood circulation in the uterus and in the dominant ovary changes considerably during the menstrual cycle, whereas that in the non-dominant ovary shows no unequivocal changes.