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Prevalence and severity of dysmenorrhoea, and management options reported by young Australian women

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Background Little is known about the severity of dysmenorrhoea and attitudes towards its management in young females. Objective/s The aim of this study was to evaluate the prevalence and severity of dysmenorrhoea in women aged 16−25 years. Methods Participants were recruited via targeted Facebook advertising and asked to complete an online questionnaire covering medications, menstruation and lifestyle-related themes. A follow-up questionnaire on dysmenorrhoea was also administered. Results The prevalence of dysmenorrhoea was 88% (n = 247, mean age 21.5 years, SD 2.6). Only 34% of participants reported consulting a healthcare provider about their pain, whereas 86% consulted other sources. Pain medication was used by 58% of the participants. Dysmenorrhoea was associated with interference with daily activities (P <0.001). Discussion Dysmenorrhoea is highly prevalent among these women, with most indicating moderate to severe pain and a significant adverse impact on daily activities. Most women did not obtain information about dysmenorrhoea from healthcare providers, indicating the need for general practitioners to provide accurate information about dysmenorrhoea to young females.
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RESEARCH
AFP VOL.45, NO.11, NOVEMBER 2016© The Royal Australian College of General Practitioners 2016
Prevalence and severity of
dysmenorrhoea, and management
options reported by young
Australian women
Asvini K Subasinghe, Lina Happo, Yasmin L Jayasinghe, Suzanne M Garland, Alexandra Gorelik, John D Wark
ysmenorrhoea, or painful menstruation, is a common
symptom of menses.
1,2
Dysmenorrhoea is defined as a painful,
cramping sensation in the lower abdomen or back associated
with menstrual periods
3
and is classified into primary and secondary
types. Primary dysmenorrhoea is painful menstrual periods, not due
to other diseases, and often occurs soon after menarche. Secondary
dysmenorrhoea is due to an underlying pelvic abnormality, such
as endometriosis, and can be either new-onset or a change in the
nature of the dysmenorrhoea (intensity, duration) over time.
4
Dysmenorrhoea has been examined in Australian women in
only a small number of studies, mostly involving adolescent girls
recruited from secondary schools.
2,5
The national prevalence of
dysmenorrhoea is 70–90%,
2
which is comparable to that reported
worldwide. Although dysmenorrhoea is a common problem faced by
women, many are reluctant to consult their doctor about it.
6
We evaluated the prevalence and severity of dysmenorrhoea using
online questionnaires at two time points in a cohort of women aged
16–29 years. We assessed the impact of menstrual pain and its
severity on relationships, productivity, health and wellbeing. We also
sought to determine the level of concern in young women regarding
dysmenorrhoea, and their use of available treatments.
Methods
Study design
The Young Female Health Initiative (YFHI)
7
and Safe-D studies
8
are
the first comprehensive prospective studies in which clinical and
self-reported data are collected relating to sexual and mental health,
lifestyle and wellbeing in young Australian women.
Ethics
The YFHI study was approved by the Human Research and Ethics
Committee (HREC) at the Royal Women’s Hospital (approval number
Background
Little is known about the severity of dysmenorrhoea and
attitudes towards its management in young females.
Objective
The aim of this study was to evaluate the prevalence and
severity of dysmenorrhoea in women aged 16−25 years.
Method
Participants were recruited via targeted Facebook advertising
and asked to complete an online questionnaire covering
medications, menstruation and lifestyle-related themes.
A follow-up questionnaire on dysmenorrhoea was also
administered.
Results
The prevalence of dysmenorrhoea was 88% (n = 247, mean age
21.5 years, SD 2.6). Only 34% of participants reported consulting
a healthcare provider about their pain, whereas 86% consulted
other sources. Pain medication was used by 58% of the
participants. Dysmenorrhoea was associated with interference
with daily activities (
P
<0.001).
Discussion
Dysmenorrhoea is highly prevalent among these women, with
most indicating moderate to severe pain and a significant
adverse impact on daily activities. Most women did not obtain
information about dysmenorrhoea from healthcare providers,
indicating the need for general practitioners to provide accurate
information about dysmenorrhoea to young females.
D
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AFP VOL.45, NO.11, NOVEMBER 2016 © The Royal Australian College of General Practitioners 2016
11/14), and the Safe-D study by Melbourne
Health HREC (approval number 2013.007).
Procedures followed were in accordance
with the Helsinki Declaration of 2000 as
revised in 2002.
Recruitment and inclusion criteria
Eligible participants were females
aged 16−25 years and living in Victoria,
Australia.
7, 8
Advertisements were posted
on Facebook to recruit women into two
general health studies called YFHI and
Safe-D.
Clicking on the advertisement directed
respondents to secure websites containing
more information and where expressions
of interest were registered. Prospective
participants were then contacted by
investigators and consented into the study.
Participation included the completion
of a web-based questionnaire, using
SurveyMonkey (www.surveymonkey.com)
or Limesurvey (www.limesurvey.org),
covering demographics, mental health,
lifestyle and reproductive health. Existing
participants from YFHI and the Safe-D study
who had consented to be contacted for
future studies were invited to fill in a follow-
up dysmenorrhoea questionnaire.
Collection of dysmenorrhoea data
Dysmenorrhoea was defined as ‘period
pain’ of any severity in the six months
preceding questionnaire completion.
The nature of the dysmenorrhoea was
ascertained according to time of onset
in relation to menarche (‘primary onset’
at menarche, versus ‘secondary onset’
some years after menarche). This is not a
reflection of whether the dysmenorrhoea
itself was primary or secondary, as
information on underlying disease was not
ascertained for all participants.
The severity of pain and level of
interference with daily activities were
measured on a Likert scale (1 [little] to 10
[severe]). This rating was used to categorise
participants according to the Numerical
Rating Scale (NRS) for pain, which is useful
in the assessment of dysmenorrhoea.
9
A
rating of 1–3 was considered mild pain, 4–6
as moderate pain and 7–10 as severe pain.
Statistical analyses
Statistical analyses were performed
using Stata version 11.1 (StatCorp LP,
College Station, TX, USA). Analyses for
associations between dysmenorrhoea
and categorical variables were performed
using Fisher’s exact test. Ordered logistic
regression was performed to determine
the risk of interference on aspects of daily
living. A two-sided P <0.05 was defined as
statistically significant.
It is important to note that there were
missing data from participants for various
questions (4−10%). Therefore, we present
prevalence estimates using different
denominators for a number of questions.
Results
Baseline questionnaire data were available
from 250 YFHI respondents and 228 Safe-D
participants. Follow-up questionnaires
were completed by 247 participants
(YFHI n = 141, Safe-D n = 106; Figure 1).
This represented a 69% response rate
(247/359).
A difference in age was found between
YFHI and Safe-D participants who
completed the follow-up questionnaire
(Figure 1). However, after adjustment for
a delay in the inclusion of participants
aged 16–17 years in the YFHI study, no
differences in age were obser ved. Thus,
the two data sets were collated and the
results of pooled data are presented in this
paper.
Descriptive statistics
Dysmenorrhoea was reported by 88%
(n = 207/236) of respondents who
completed the follow-up dysmenorrhoea
questionnaire and had had a period
in the past 12 months. This was
comparable to the prevalence found in the
respondents who completed the baseline
questionnaires (86%, n = 369/431).
Those who reported dysmenorrhoea at
baseline did not differ, with respect to
age, marital status or education level,
from those not reporting dysmenorrhoea.
However, a greater proportion of those
who experienced dysmenorrhoea reported
depression (32% versus 19%, P = 0.04)
and had experienced a pregnancy (24%
versus 4%, P = 0.02; Table 1).
At follow-up, 19% reported mild
dysmenorrhoea, 49% moderate and 32%
severe. Dysmenorrhoea commenced
at menarche for 70% (n = 144/207)
of respondents (‘primary onset’
dysmenorrhoea), while for 30% (n =
63/207) dysmenorrhoea commenced
some years after menarche (‘secondary
onset’ dysmenorrhoea).
Primary versus secondary onset
dysmenorrhoea
No significant differences were obser ved
between those who reported primary
onset of dysmenorrhoea and secondary
onset of dysmenorrhoea with regards
to age (21.8 ± 2.5 versus 21.4 ± 2.6;
P = 0.02), current use of hormonal
contraceptives (60% versus 51%; P = 0.2)
and severity of dysmenorrhoea (P = 0.7).
Reported management options
for dysmenorrhoea
At follow-up, use of pain medication
was reported by 58% (n = 120/206) of
respondents with dysmenorrhoea. Pain
medication included paracetamol, aspirin,
mefenamic acid and ibuprofen. Those with
severe dysmenorrhoea were more likely to
use pain medication when compared with
those who experienced moderate or mild
period pain (73% versus 56% and 30%,
respectively; P = 0.001).
Hormonal contraception was used by
57% (n = 140/247) of women, with 74%
using the combined oral contraceptive pill
(COCP), 13% etonogestrel implant, 9%
levonorgestrel intrauterine device, 2%
progestogen-only oral contraceptive pill,
and 2% medroxyprogesterone acetate
injection. Period pain was the reason for
using hormonal contraception in 36%
(n = 45/117). There was no significant
difference in hormonal contraceptive use
between respondents who experienced
dysmenorrhoea and respondents who did
not (P = 0.6).
Most respondents with dysmenorrhoea
(92%; n = 190/207) indicated using non-
pharmacological measures, either alone
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or in conjunction with analgesics, to relieve
period pain. The use of heat packs was
most popular, with 54% (n = 112) reporting
their use, followed by hot baths (37%; n =
77), meditation (7%; n = 15) and exercise
(2%; n = 3).
Association between
dysmenorrhoea and consultations
Only 34% (n = 71/207) of those with
dysmenorrhoea had ever consulted a
healthcare provider about period pain.
Participants with severe dysmenorrhoea
(53%; n = 34/64) were more likely to
consult their healthcare provider than
those with mild (13%; n = 5/39) or
moderate (31%; n = 30/98) dysmenorrhoea
(P <0.001). Approximately 86% (n =
176/206) who experienced dysmenorrhoea
had sought information about period pain
from other sources (eg internet, social
media, friends, magazines), including 34%
(n = 69/206) who obtained information from
family members.
Impact of dysmenorrhoea on
quality of life
More severe dysmenorrhoea was
associated with greater risk of interference
in numerous aspects of daily living (work/
study attendance and productivity;
relationships with family, friends and
partners; exercise; sexual activity [P <0.001;
Table 2]). Among respondents experiencing
dysmenorrhoea, 24% (n = 50/207) required
time off work or study in the preceding six
months because of the pain. Taking time off
because of period pain was associated with
the severity of dysmenorrhoea (52% [n =
33/64] in severe dysmenorrhoea, 15% [n
= 15/98] in moderate and 3% [n = 1/39] in
mild; P <0.001).
Discussion
The very high prevalence of dysmenorrhoea
among the study participants falls within
the range reported in a systematic
review conducted by the World Health
Organization.
10
A greater proportion of
those who experienced dysmenorrhoea
also reported depression, compared with
those who did not. This finding is supported
by that reported in a case-control study
comprising 424 adolescents,
11
and is
intuitive as dysmenorrhoea may have a
negative impact on quality of life.
While a large proportion of
women reported moderate to severe
dysmenorrhoea, approximately 60% of
these used pain medication for relief. By
contrast, 82% of women with moderate
or severe dysmenorrhoea reported using
non-pharmacological measures, such
as heat therapy, despite the limited and
inconsistent evidence for their efficacy
in dysmenorrhoea.
12
The discrepancy
between the use of pharmacological
and non-pharmacological measures may
suggest inherent resistance in young
women towards the use of pharmacological
analgesics. Alternatively, there may be
a lack of knowledge of pharmacological
treatments for dysmenorrhoea. Further
research may shed more light on these
issues.
It is surprising that there was no
relationship between COCPs and
Figure 1. Sample derivation for follow-up dysmenorrhoea questionnaire from Young Female Health
Initiative (YFHI) and Safe-D participants
YFHI eligibility
criteria:
• Female
• Lives in Vic,
Australia
• 16–25 years old
Completed initial YFHI
questionnaire
n = 250
Completed initial Safe-D
questionnaire
n = 228
Data analysis
YFHI participants who
consented to further studies
n = 212
SAFE-D participants who
consented to further studies
n = 147
Completed follow-up
dysmenorrhoea questionnaire
n = 141 (66.5%)
Completed follow-up
dysmenorrhoea questionnaire
n = 106 (72.2%)
• Uncontactable (n = 2)
• Withdrew interest (n = 2)
• No response (n = 36)
• Incomplete
questionnaire (n = 1)
• Uncontactable (n = 3)
• Withdrew interest (n = 1)
• No response (n = 35)
• Incomplete
questionnaire (n = 5)
Subsequent analysis performed separately on data
obtained from YFHI and SAFE-D participants revealed
results of no signicant difference
Characteristic YFHI participants
n = 141*
SAFE-D participants
n = 106*
P value
Age (years), n (%)
16–20
21–25
21 (15.2)
117 (74.8)
45 (42.9)
60 (57.1) <0.001
Educational level, n (%)
<Year 12
<Year 12
9 (6.6)
128 (93.4)
28 (26.7)
77 (73.3) <0.001
Socio-economic index
, n (%)
Not lowest quartile
Lowest quartile
111 (86.1)
18 (14.0)
90 (85.7)
15 (14.3) 0.942
Menarche
Median (min–max) 13.0 (10–20) 12.8 (8–16) 0.688
Days of menstrual bleeding, n (%)
<4 days
4–6 days
>6 days
12 (8.5)
102 (72.3)
27 (19.2)
9 (8.5)
67 (63.2)
30 (28.3) 0.236
Hormonal contraception, n (%)
Currently using
81 (57.1) 59 (55.7) 0.0796
*Numbers may not add up to total due to missing data.
As determined by Socio-Economic Indexes for Areas (SEIFA) 2011 developed by the Australian Bureau of
Statistics. Ranks areas in Australia according to relative socioeconomic advantage and disadvantage based
on ve-yearly census data.
Invited to complete follow-up dysmenorrhoea questionnaire
Ongoing recruitment
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dysmenorrhoea, given the high prevalence
of dysmenorrhoea in our cohort and that
COCPs are widely used for the treatment
of dysmenorrhoea in both sexually active
and non–sexually active women.
13
This
unexpected finding may reflect the
wide variety of indications for the use of
hormonal contraception in young women,
regardless of whether they experienced
dysmenorrhoea. Indeed, approximately
one-third of women using hormonal
contraception stated that dysmenorrhoea
was the reason for use of these agents.
We did not assess the level of alleviation
women with dysmenorrhoea achieved with
the use of hormonal contraception. Data
pertaining to their use and effectiveness
was not obtained in this study and
represents an avenue for further research in
this group of women.
Although severe pain was more likely to
prompt a consultation than milder pain, the
majority of women with moderate to severe
dysmenorrhoea had never sought medical
attention for dysmenorrhoea. The low
frequency with which women seek medical
attention for dysmenorrhoea has been
previously described.
6
This is particularly
relevant in young women who perceive
dysmenorrhoea to be a common menstrual
complaint that needs to be tolerated, and
thus find difficulty determining if and when
to seek medical attention.
6
By contrast, 86%
of women with dysmenorrhoea had sought
information about period pain from other
sources such as the internet and family
members. These sources may be perceived
as ‘more accessible’ to young women than
a healthcare practitioner, but represent a
greater potential for misinformation. These
findings highlight the need for accessible,
reliable and helpful information with which
young women are comfortable.
A three-pronged approach could be
taken to better inform young women of
dysmenorrhoea and associated support
services. First, informative leaflets could
be handed out to girls in schools by the
school nurse so that adolescent females
are familiar with the symptoms for
dysmenorrhoea, which they can obser ve,
and for which they can contact their GP if
they require prescription pain medication.
Second, health professionals could be
more proactive in asking about this
sensitive topic so that if young women
have dysmenorrhoea they may be more
likely to discuss their pain. Third, given the
information-seeking behaviours reported
in this sample, health professionals and
schools could promote the use of reliable
websites on which accurate information on
dysmenorrhoea is published.
Dysmenorrhoea significantly affects the
quality of life of females in our sample.
Approximately 50% of women with
Table 1. Characteristics of respondents who experienced dysmenorrhoea versus
those who did not at baseline
Topics
Dysmenorrhoea*
n = 369
No
dysmenorrhoea*
n = 62
P
value
Age (years) mean ± SD 21.5 ± 2.7 21.4 ± 2.4 0.8
Marital status
Never married 315 (87.3) 53 (85.5) 0.7
Married/de facto 44 (12.7) 9 (14.5)
Level of education
No tertiary qualication 105 (28.8) 18 (29.0) 0.7
Undergraduate (or equivalent) 231 (63.3) 41 (66.1)
Postgraduate (or equivalent) 29 (8.0) 3 (4.8)
Employment
No paid employment 103 (28.2)
37 (10.1)
22 (35.5)
5 (8.1)
0.2
Labourer or related work 81 (22.2)
144 (39.5)
7 (11.3)
28 (45.2)
Managerial or professional occupation
Clerical or related work
SEIFA quartiles
Not lowest quartile 309 (84.7) 47 (77.1) 0.1
Lowest quartile 56 (15.3) 14 (23.0)
Current smoker 40 (11.3) 8 (13.3) 0.6
Alcohol consumption in the last 12 months
≤Once a month 91 (32.2) 19 (39.6) 0.5
2–3 days a month 70 (24.7) 11 (22.3)
1–2 days a week 92 (32.5) 16 (33.3)
≥3 days a week 30 (10.6) 2 (4.2)
Depression 117 (32.1) 12 (19.4) 0.04
Experienced a pregnancy 24 (8.8) 4 (8.5) 0.02
Current hormonal contraception use 134 (36.4) 24 (38.7) 0.7
SEIFA, Socio-Economic Indices for Areas.*n (%) unless specied otherwise; As determined by Socio-Eco-
nomic Indexes for Areas (SEIFA) 2011 developed by the Australian Bureau of Statistics. Ranks areas in
Australia according to relative socioeconomic advantage and disadvantage based on ve-yearly census data.
There were missing data for information regarding the prevalence of dysmenorrhoea for 47 participants.
Numbers may not add up to 100% due to missing values.
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Table 2. Relationship between severity of dysmenorrhoea and impact on normal daily activities
Interference Mild n (%) Moderate n (%) Severe n (%) P value OR (95% CI)
Daily activities
None 8 (20.5) 7 (7.2) 0 (0)
Mild 31 (79.5) 70 (72.2) 26 (41.9) <0.001 7.1
(4.2–12.0)
Moderate 0 (0) 19 (19.6) 12 (19.4)
Major (0) 1 (1.0) 24 (38.7)
Work/study attendance
None 3 (37.5) 9 (19.2) 3 (6.0)
Mild 5 (62.5) 26 (55.3) 15 (30.0) <0.001 3.1
(1.3–7.6)
Moderate 0 (0) 10 (21.3) 15 (40.0)
Major 0 (0) 2 (4.3) 12 (24.0)
Work/study productivity
None 6 (46.2) 9 (14.8) 4 (7.7)
Mild 6 (46.2) 34 (55.7) 20 (38.5) <0.001 3.7
(2.1–6.5)
Moderate 1 (7.7) 16 (26.2) 11 (21.2)
Major 0 (0) 2 (3.3) 17 (32.7)
Friendships
None 3 (60.0) 14 (26.4) 6 (14.3)
Mild 2 (40.0) 28 (52.8) 14 (33.3) 0.002 3.9
(1.9–7.7)
Moderate 0 (0) 11 (20.8) 15 (35.7)
Major 0 (0) 0 (0) 7 (16.7)
Family relationships
None 6 (66.7) 13 (24.1) 5 (12.2)
Mild 3 (33.3) 30 (55.6) 14 (34.2) <0.001 4.7
(2.4–9.0)
Moderate 0 (0) 11 (20.4) 15 (36.6)
Major 0 (0) 0 (0) 7 (17.1)
Relationship with partner
None 3 (30.0) 9 (16.1) 3 (8.1)
Mild 7 (70.0) 26 (46.4) 12 (32.4) 0.004 3.2
(1.7–5.9)
Moderate 0 (0) 18 (32.1) 12 (32.4)
Major 0 (0) 3 (5.4) 10 (27.0)
Sexual activity
None 1 (5.6) 3 (4.3) 1 (2.2)
Mild 9 (50.0) 23 (32.9) 7 (15.6) 0.005 2.7
(1.6–4.6)
Moderate 4 (22.2) 18 (25.7) 6 (13.3)
Major 4 (22.2) 26 (37.1) 31 (68.9)
Exercise
None 7 (26.9) 5 (5.8) 2 (3.6)
Mild 16 (61.5) 37 (43.0) 12 (21.4) <0.001 4.9
(3.0–7.9)
Moderate 3 (11.5) 30 (34.9) 12 (21.4)
Major 0 (0) 14 (16.3) 30 (53.6)
CI, condence interval; OR, odds ratio
Odds ratio, as determined by ordinal logistic regression analyses
95% condence interval
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severe dysmenorrhoea reported time
off, compared with only 2.6% with mild
dysmenorrhoea. Given that 80% of
women in our study reported moderate to
severe dysmenorrhoea, this represents a
significant recurrent burden not only for
the women themselves, but also for the
workforce and economy.
A major strength of this study is that
we were able to gain an insight into
the experience of young women with
dysmenorrhoea in a representative general
population of young females. When
compared with national data for this age
group, a greater proportion of participants
in our study had attained tertiary
education. However, no other significant
differences were obser ved. Therefore,
our findings should be generalisable to a
general population of young females.
There were a number of potential
limitations. The sample size only allowed
an estimation of dysmenorrhoea
prevalence. Additionally, the definitions
of primary onset and secondary onset
dysmenorrhoea were from self-report
rather than proven pathology.
Conclusion
The prevalence of dysmenorrhoea is
critically high in this sample of young
females, with many indicating that pain
had a significant adverse impact on
numerous daily activities. However, a large
proportion did not use pain medication and
obtained information about dysmenorrhoea
from sources other than health
professionals, which poses a large risk of
misinformation and a potential barrier to
seeking early medical advice. Therefore,
educational materials, information on
reliable websites and guidance about
dysmenorrhoea and treatment options
should be made readily available to young
women in schools as well as by health
professionals.
Implications for general practice
Dissemination of accurate information
about treatment options for
dysmenorrhoea in Victoria may improve
the quality of life of young females.
Authors
Asvini K Subasinghe PhD, Research Fellow,
Department of Microbiology and Infectious
Diseases, Royal Women’s Hospital, Parkville,
Vic; Infection and Immunity, Murdoch Childrens
Research Institute, Parkville, Vic. asvini.
subasinghe@gmail.com
Lina Happo PhD, medical student, Department of
Medicine, University of Melbourne, Parkville, Vic
Yasmin L Jayasinghe MBBS, FRANZCOG,
PhD, Paediatric and Adolescent Gynaecologist,
Department of Obstetrics and Gynaecology,
University of Melbourne, Royal Women’s Hospital,
Parkville, Vic; Department of Gynaecology, Royal
Children’s Hospital, Parkville, Vic
Suzanne M Garland MBBS, MD, FRCPA,
FAChSHM, FRANZCOG, Professor, Director of
Microbiology and Infectious Diseases, Department
of Microbiology and Infectious Diseases, Royal
Women’s Hospital, Parkville, Vic; Infection and
Immunity, Murdoch Childrens Research Institute,
Parkville, Vic; Department of Obstetrics and
Gynaecology, University of Melbourne, Royal
Women’s Hospital, Parkville, Vic
Alexandra Gorelik MSc, Biostatistician, Department
of Medicine, University of Melbourne, Parkville, Vic;
Melbourne EpiCentre, Royal Melbourne Hospital,
Parkville, Vic
John D Wark MBBS, FRACP, PhD, Professor,
Endocrinologist, University of Melbourne
Department of Medicine and Bone & Mineral
Medicine, Royal Melbourne Hospital, Parkville, Vic
Competing interests: Dr Garland reports
grants from Merck, GSK, CSL, Commonwealth
Department of Health, and non-financial support
from Merck, outside the submitted work; and has
delivered lectures and received speaking fees from
MSD and SPMSD for work performed in personal
time.
Provenance and peer review: Not commissioned,
externally peer reviewed.
Acknowledgements
We thank the YFHI and Safe-D research teams and
participants for their time. YFHI was supported by
an Australian NHMRC program grant (568971) and
Safe-D study by a NHMRC project grant (1049065).
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... 29,30 To measure pain severity, most studies used the visual analog scale (VAS; n = 18). Four studies used the numeric rating scale (NRS), [31][32][33][34] and one study each used the McGill Pain Questionnaire (MPQ), 35 Facial Pain Rating Scale (FPRS), 36 or verbal multidimensional scoring system (VMS). 37 ...
... 34,41 Another study reported an impact on sexual activity (32%, n = 1). 32 Quality of life ...
... Participants with severe pain were more likely than those with mild pain to seek professional help. 12,30,32,41,52,53 More than 50% of participants accepted DM as normal physiology, 12,18,54,55 and therefore did not seek professional advice. 15 Additionally, there is no evidence to suggest that women with mild symptoms are more accepting of DM as a normal physiological process compared with those with severe symptoms. ...
Article
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Background Heavy menstrual bleeding (HMB) and dysmenorrhea (DM) are common gynecological problems. Objective To systematically review the needs, quality of life (QOL), and effectiveness of self‐management strategies among young women (12–25 years) with DM or HMB. Search Strategy Relevant terms were searched through PubMed, EBSCO, Google Scholar, ProQuest, and Ovid between 2010 and 2022. Selection Criteria Qualitative and quantitative studies published in peer‐reviewed journals, females aged 12–25, exploring DM or HMB, reporting supportive care needs, quality of life, self‐treatment strategies, and/or treatment‐seeking behavior. Data Collection and Analysis Abstracts were reviewed for eligibility by two researchers. Included studies were extracted and assessed for quality independently by two authors, with discrepancies resolved through consensus or the involvement of a third researcher. Data extracted included study details, menstrual history, symptoms, self‐care strategies, and quality of life. The Joanna Briggs Institute checklists were used for quality assessment. Main Results The search returned 285 190 studies, of which 55 were eligible for inclusion. Prevalence rates of HMB and DM were in the ranges 4%–63% and 42%–94%, respectively. Over 80% of young women with DM and HMB experienced physical and psychological problems, including pelvic pain, sleep issues, mood disturbance, diarrhea, and nausea. Academic performance and daily activities were severely affected. Most (>62%) named their mothers as their primary source of information, and friends as the secondary source (10%–65%). Few studies explored needs, but they could be inferred and fell under school‐related and social needs. QOL was poorer in those who had DM than those who did not. Pain was the most common issue that drove young women to find treatment. More than 70% used medication to reduce pain. More than half chose home remedies (e.g., heat therapy, massages, herbal tea, hot drinks). No studies provided information about the efficacy and dosage of medication and herbal remedies. Conclusions HMB and DM have a large impact on daily living, with large areas of unmet need. Limited access to information impairs the management of symptoms and consequent QOL.
... Furthermore, the study found that there was no difference in relation to whether the university was public or private, and no difference was found when the different university careers were compared. Reports on PD prevalence in university students around the world have differed significantly from one geographic area to another, perhaps influenced by local factors inherent to the region, varying from 41.7% in China 22 ; 71.6% in USA 2 ; 72.7-88% in Turkey 23,24 ; 73.2% in Iran 25 ; 74.8% in Spain 26 ; 85% in Ethiopia 27 ; 85.1% in Palestine 28 ; 88% in young Australian women 29 ; 85.7% in Saudi Arabia 30 ; to 91.5% in third level Irish students 31 . 62.4% of the present sample mentioned that the pain began on the 1 st day of menstruation, differing from other studies, whose reports vary between 28% and 73.1% 2,21,22,24,28 , and 28% (2018) 21 and 55% (1991) 26 , in Venezuelan medical students. ...
... Our students reported that PD was disabling in 54.4% of them, which affects common daily activities such as sitting, walking, sleeping, studying, physical activity, academic and work absenteeism; lack of concentration at the moment of studying; insomnia, and alteration of interpersonal relationships. Different authors report lower percentages than those evidenced in our survey 2,25,29 . ...
Article
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Introduction: Primary dysmenorrhea (PD), defined as menstrual pain in the absence of an underlying pelvic pathology, is one of the most common gynecologic problems in reproductive-age women, affecting 10-15% of the these. Psychosocial stress in students constitutes a predisposing risk factor for presenting and exacerbating PD symptoms, due to somatization of the trigger event. Objective: Determine the prevalence of primary dysmenorrhea (PD) in Venezuelan university students, along with factors that influence its rise, particularly stress. Materials and Methods: Between February 2022 and June 2023, a cross-sectional and population study was carried out, in a sample of 608 female Venezuelan university students (n = 20 public/private universities). Results: 90.6% of the sample (n = 551) reported suffering from PD, being as disabling by 54.4% (n = 300) of the latter. 86.3% (n = 525) mentioned experiencing stress; 68.8% (n = 361; p < 0.0001) reported changes in their menstrual cycles, as well as alterations in their amount of menstrual flow, increased dysmenorrhea, and/or worsening of symptoms associated with menstrual period. Likewise, it was found that the younger the age of onset of PD, the more likely the patient is to present PD, with more intensity and more disabling pain, as well as a greater chance of having changes in their menstrual cycles. Conclusion: There has been a significant increase in the prevalence of PD in Venezuelan female university students, with stress constituting an important risk factor for this condition.
... Menstrual pain is one of the major cause for increase in the rate of absenteeism at school/college or work. 10 The disabling nature of dysmenorrhea places a notable burden on the public health care system. 9 Despite such high prevalence and diminished quality of life, most of the women do not seek medical care for this condition. ...
... It can be new onset of dysmenorrhea or a change in its nature (intensity, duration) over time. 10 It could be because of various diseases/disorders related to pelvic floor and/or uterus such as endometriosis, polycystic ovarian syndrome, pelvic inflammatory disease. ...
Article
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Dysmenorrhea is defined as difficulty in menstrual flow and refers to painful cramps during menstruation. There are 2 types of dysmenorrhea, primary and secondary dysmenorrhea respectively. Early diagnosis of these conditions which may be responsible for dysmenorrhea is necessary to curb the rising prevalence of infertility. There are no adequate screening questionnaires available for Indian population which can screen dysmenorrhea and differentiate primary and secondary dysmenorrhea. : The objective of phase-1 of this study comprised of constructing menstrual disorder screening questionnaire and content validating the questionnaire and the objective of phase-2 was to administer the developed questionnaire on the targeted population. This was a cross-sectional study in which a questionnaire was developed and content validated by experts. The expert panel was asked to validate each question on a four-point Likert scale for relevance, clarity, ease of comprehension and the question was represented in participants correct section. A pilot study was carried out on 31 participants. A total of 142 participants were participated in the study.Dysmenorrhea was reported by a total of 129 participants i.e. 90.85% whereas only 9.15% reported of having no pain during menstruation. Dysmenorrhea symptoms experienced only sometimes by 56 participants, but 73 participants reported to experience them with each cycle. The questionnaire developed, and content validated in this study can be used as a self-reporting screening tool to detect menstrual abnormalities in the Indian population
... It is known that PD affects adolescent girls and women, with prevalence that ranges from 70 to 90% [6,7], with 2-29% of women reporting severe PD-related pain [8,9]. Previous studies have reported some associated factors, including heavy and more prolonged menstrual bleeding, younger age, nulliparity, irregular menstrual cycle, and a family history of dysmenorrhea [1,9]. ...
... Although most studies found that PD-related pain intensity varies from moderate to severe [10], women often consider the pain a common characteristic of the menstrual cycle and do not report it [11] and/or do not seek medical care [7,12]. However, pain intensity may directly impact the women's daily activities, as it could be considered debilitating and result in absence from school or work [13,14]. ...
Article
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Background Primary dysmenorrhea (PD) is an etiological cyclic pelvic pain related to the menstrual period; it can negatively impact women’s quality of life and productivity. The aim of the present study was to estimate the prevalence of PD and analyze associated symptoms in Brazilian women. Methods An online cross-sectional study was carried out in Brazil, with a structured questionnaire regarding dysmenorrhea and associated symptoms. PD intensity was measured with the Numerical Rating Scale for Pain and classified as mild (1–3), moderate (4–7) and severe (> 8). The association between qualitative variables was performed using Pearson’s Chi-Square Test. The quantification of this association was measured using multinomial logistic regression models, with calculation of Odds Ratio and confidence interval. A significance level of 5% was considered. Results A total of 10,070 women were included. Most participants classified PD intensity as moderate (40.4%, 41.9% and 49.7%) and severe (21.2%, 24.8% and 28.4%) in the previous month, 3 months and 5 years, respectively. The most common symptoms associated with PD were irritability, abdominal distension sensation, anxiety and feeling more emotional. The increased of the risk (OR > 1.0) for moderate and severe PD-related pain intensity is related to age, nulliparity and presence PD since adolescence. Conclusion There is a high prevalence of PD among Brazilian women, and the most common symptoms reported were irritability, abdominal distension sensation, anxiety and feeling more emotional.
... Furthermore, this finding aligns with the research reported by Findlay et al. (2020), which reveals that 51 % of athletes perceive menstruation as an impediment to their training and performance, and 93 % of female athletes experience adverse physical and psychological symptoms associated with their menstrual cycle. Specific instances indicate that approximately 75 % of women in their reproductive years' experience menstrual discomfort; this condition is particularly prevalent among young women; it is also experienced by approximately 90 % of Australian adolescents who experience menstrual pain (Parker, Sneddon, & Arbon, 2010;Subasinghe et al., 2016). Additionally, 58 % of teenage volleyball athletes also experience pain prior to the onset of menstruation, while 66 % following menstruation (Wodarska et al., 2013). ...
Article
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Background. Gaining a comprehensive understanding of the menstrual cycle, its associated health concerns, and the subsequent effects on athlete performance could facilitate the formulation of educated and tailored strategies for training and participating in competitive sports. In turn, this can decrease the probability of injuries, maintain psychological well-being, and ultimately enhance athlete performance. Objectives. The study aimed to investigate the perspective of collegiate student-athletes related to health issues and sports performance during their menstrual period, both in terms of training and competition, as well as the athletes’ willingness to discuss pertaining their menstrual cycle. Materials and methods. Our study included 115 female student-athletes participating in land-based individual/team sports (n = 95) and a combination of land/water-based sports (n = 20). A questionnaire was used to collect data for this cross-sectional study, which was undertaken and completed by the participants. A descriptive analysis was performed, with results reported in frequency and percentage, followed by the Wilcoxon rank-sum test (Mann-Whitney) to analyze the mean differences between the training participation groups during menstruation. Results. In general, all athletes experienced several health issues, with abdominal pain and lower back pain being the most prevalent. Furthermore, nearly all of them (95.33%) experienced pain on the first day of their periods. Menstruation also influences the performance of female athletes during exercise (70.43%) and competition (73.91%), causing increased fatigue and reduced endurance in the majority of them. Additionally, there is a significant difference between the context of training engagement and the number of weekly exercise sessions (0.011) during the menstrual cycle. Conclusions. Menstruation significantly affects the health and performance of female athletes, both during training and competition. Coaches and athletes must comprehend the menstrual cycle to address this issue effectively. It is crucial that coaches and athletes possess a comprehensive understanding of the menstrual cycle in order to effectively address this issue. Moreover, involving medical professionals and sports nutritionists in managing menstrual cycles is also another strategy for enhancing athlete performance.
... Although estimates of the prevalence of dysmenorrhea vary extensively, they range from 45 to 93% of women of reproductive age with adolescents reporting the greatest rates [11,12]. Women do not report it13 or seek medical attention since it is accepted 116 as a typical part of the menstrual cycle and is therefore tolerated [13,14]. Some women (3 to 33%) have very severe pain, severe enough to render them incapacitated for 1 to 3 days each menstrual cycle, requiring absence from school or work [15,16]. ...
Article
Background: Dysmenorrhea is a common symptom secondary to various gynecological disorders, but it is also represented in most women as a primary form of disease. Pain associated with dysmenorrhea is caused by hypersecretion of prostaglandins and an increased uterine contractility. The primary dysmenorrhea is quite frequent in young women and remains with a good prognosis, even though it is associated with low quality of life. Objectives: The aim of this study is to evaluate of the efficacy and safety of dienogest in the treatment of primary dysmenorrhea: a study in a district-level hospital in Bangladesh. Methods: The cross-sectional observational study was conducted in the Department of Gynae and Obs, Naogaon Sadar Hospital from July 2022 to June 2023. A total of 100 subjects who received DNG (1 mg/day, orally) were included in the study. Data were collected by face-to-face interview and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 24. Results: In this study, most of the patients 43% lies between 21 years to 25 years and body weight of 24% patients were between 51 to 55 kg. In this study, most of the patients 41% body mass index were 18.5 – 24.9 kg/m2. Most of the patients’ clinical symptoms were cramping pain in the lower abdomen (89%), low back pain (86%), pain spreading down to the leg (73%), fatigue (64%). About (56%) adverse effects were body weight gain and irregular uterine bleeding occurred in 35 of 100 cases (35%). Conclusion: Primary dysmenorrhea is one of the most common illnesses in women of childbearing age. When severe, it may interfere with the activities of daily living and may lead to school and work absenteeism. Primary dysmenorrhea is also one of the most underdiagnosed diseases, so clinicians should suspect the diagnosis in a timely manner and provide appropriate treatment.
Article
Introduction: Primary dysmenorrhea (PD) is a public disease of young female worldwide, it affects their daily performances. Severe recurrent uterine cramps are the main complaints in 90% of adolescents and 50% of reproductive-age females. This study aimed to evaluate the use of magnetic field therapy in the treatment of severe dysmenorrhea grade 3 and provide an encouraging goal to continue daily work without pain. Methods: Two hundred and fifty female patients were recruited in this study from gynecological clinics in Basrah, southern Iraq. All had severe dysmenorrhea, patients were subjected to a questionnaire form, Visual Analog Scale, and verbal multidimensional scoring system to determine the pain intensity and grade of dysmenorrhea. Only 38 young females had severe dysmenorrhea grade 3 with ages ranging from 16 to 28 years with a mean age of 22.04 ± 1.43 years and body mass index 23.81 ± 1.94, patients subjected to electromagnetic field therapy (EMFT), two sessions per week for 20 min each for 6 weeks. Three categories were assessed, working ability, associated symptoms, and drugs used. Data were collected and statistically analyzed using SPSS version 22. Results: The present study showed statistically significant progress (P < 0.05) in reducing pain, rare physical and mental complaints, and improved working ability with no need for drugs in majority of patients. Conclusion: EMFT has better results than other methods in relieving pain and symptoms of dysmenorrhea with a settled lifestyle.
Article
Primary dysmenorrhea, or painful menstruation in the absence of any particular pelvic disorders, is one of the most prevalent complaints among women and the most common gynaecological condition globally. The majority of them feel some level of pain and discomfort during their menstrual cycle, which might interfere with their everyday activities and productivity at work. This appears to be the major cause of absence. This study looks on the prevalence of primary dysmenorrhea in young people in order to better understand the disorder and its impact on teenage females. Aim And Objectives: The study's objective is to determine the prevalence of primary dysmenorrhea in young individuals in order to gain a better understanding of the illness and its impact on teenage girls. Methods: A cross-sectional research was undertaken among 200 students (females) from several institutions in Rohtak, Haryana, with the goal of determining the frequency and severity of dysmenorrhea and its implications on quality of life, namely absence from school. Students were given a self-administered questionnaire to complete, which included questions on the menstrual cycle, the severity of dysmenorrhoea, PMS, and how dysmenorrhoea affected their employment, studies, and daily lives. Data was gathered and evaluated. Results: Prevalence of dysmenorrhoea was 93% out of which 61.5% participants suffered pain every time they menstruate whereas 31.5% sometimes got menstrual pain. 26.5% participants take painkillers for menstrual pain, 20% reported social withdrawal during mensuration, 33% of students stop going to school when they mensurate whereas 23.5% have trouble concentrating at school when they mensurate. Conclusions: Dysmenorrhea is a prevalent condition among females, affecting both their quality of life and their productivity at work. It is critical to raise knowledge about the causes and treatment of dysmenorrhoea in order to minimise unnecessary pain and absence from job and study
Article
Objectives To determine the proportion of Australian adolescent girls who experience menstrual pain (dysmenorrhea); to assess associations of dysmenorrhea and period pain severity with adolescents missing regular activities because of their periods. Study design Prospective, population‐based cohort study; analysis of Longitudinal Study of Australian Children (LSAC) survey data. Setting, participants Female adolescents in the nationally representative cross‐sequential sample of Australian children recruited in 2004 for the Kinder cohort (aged 4–5 years at enrolment). Survey data from waves 6 (mean age 14 years), wave 7 (16 years) and wave 8 (18 years) were analysed. Main outcome measures Severity of period pain during the preceding three months (very, quite, a little, or not at all painful); number of activity types missed because of periods; relationship between missing activities and period pain severity. Results Of the 1835 participating female members of the LSAC Kinder cohort at waves 6 to 8, 1600 (87%) responded to questions about menstruation during at least one of waves 6 to 8 of data collection. At wave 6 (14 years), 227 of 644 respondents (35%) reported dysmenorrhea, 675 of 1341 (50%) at wave 6 (16 years), and 518 of 1115 (46%) at wave 8 (18 years). Of the 366 participants who reported period pain severity at all three waves, 137 reported no dysmenorrhea at all three waves (37%), 66 reported dysmenorrhea at all three waves (18%), 89 reported increasing period pain over time (24%), and 38 reported declining pain (10%). At wave 6, 223 of 647 participants reported missing at least one activity because of their periods (34%), 454 of 1341 at wave 7 (34%), and 344 of 1111 at wave 8 (31%). Of the participants who experienced very painful periods, 72% (wave 6), 63% (wave 7), and 65% (wave 8) missed at least one activity type because of their periods, as did 45% (wave 6), 36% (wave 7), and 40% (wave 8) of those who experienced quite painful periods. Conclusions A large proportion of adolescent girls in Australia experience period pain that affects their engagement in regular activities, including school attendance. Recognising adolescent period pain is important not only for enhancing their immediate quality of life with appropriate support and interventions, but also as part of early screening for chronic health conditions such as endometriosis.
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em>Background . Vitamin D deficiency has been associated with both poor bone health and mental ill-health. More recently, a number of studies have found individuals with depressive symptoms tend to have reduced bone mineral density. To explore the interrelationships between vitamin D status, bone mineral density and mental-ill health we are assessing a range of clinical, behavioural and lifestyle factors in young women (Part A of the Safe-D study). Design and methods. Part A of the Safe-D study is a cross-sectional study aiming to recruit 468 young females aged 16-25 years living in Victoria, Australia, through Facebook advertising. Participants are required to complete an extensive, online questionnaire, wear an ultra-violet dosimeter for 14 consecutive days and attend a study site visit. Outcome measures include areal bone mineral measures at the lumbar spine, total hip and whole body, as well as soft tissue composition using dual energy x-ray absorptiometry. Trabecular and cortical volumetric bone density at the tibia is measured using peripheral quantitative computed tomography. Other tests include serum 25-hydroxyvitamin D, serum biochemistry and a range of health markers. Details of mood disorder/s and depressive and anxiety symptoms are obtained by self-report. Cutaneous melanin density is measured by spectrophotometry. Expected impact. The findings of this cross-sectional study will have implications for health promotion in young women and for clinical care of those with vitamin D deficiency and/or mental ill-health. Optimising both vitamin D status and mental health may protect against poor bone health and fractures in later life.
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Recruitment of young people for health research by traditional methods has become more expensive and challenging over recent decades. The Internet presents an opportunity for innovative recruitment modalities. To assess the feasibility of recruiting young females using targeted advertising on the social networking site Facebook. We placed an advertisement on Facebook from May to September 2010, inviting 16- to 25-year-old females from Victoria, Australia, to participate in a health study. Those who clicked on the advertisement were redirected to the study website and were able to express interest by submitting their contact details online. They were contacted by a researcher who assessed eligibility and invited them to complete a health-related survey, which they could do confidentially and securely either at the study site or remotely online. A total of 551 females responded to the advertisement, of whom 426 agreed to participate, with 278 completing the survey (139 at the study site and 139 remotely). Respondents' age distribution was representative of the target population, while 18- to 25-year-olds were more likely to be enrolled in the study and complete the survey than 16- to 17-year-olds (prevalence ratio=1.37, 95% confidence interval 1.05-1.78, P=.02). The broad geographic distribution (major city, inner regional, and outer regional/remote) and socioeconomic profile of participants matched the target population. Predictors of participation were older age, higher education level, and higher body mass index. Average cost in advertising fees per compliant participant was US $20, making this highly cost effective. Results demonstrate the potential of using modern information and communication technologies to engage young women in health research and penetrate into nonurban communities. The success of this method has implications for future medical and population research in this and other demographics.
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The aim of this study was to: (1) establish the typical experience of menstruation for senior high school girls and (2) determine how many experience considerable menstrual disturbance that could require further investigation and management of underlying pathology. Cross-sectional study. Senior High Schools in the Australian Capital Territory (ACT), Australia. A total of 1051 girls aged between 15 and 19 years. Data based on a quantitative survey. Self-reports of menstrual bleeding patterns, typical and atypical symptoms and morbidities. Typical menstruation in adolescence includes pain (93%), cramping (71%), premenstrual symptoms (96%) and mood disturbance (73%). Highly significant associations were found between increasing severity of menstrual pain, number of menstrual-related symptoms, interference with life activities and school absence. These associations indicate that approximately 25% of the sample had marked menstrual disturbance: 21% experienced severe pain; 26% school absence; 26% suffering five or more symptoms; > or =24% reporting moderate to high interference with four out of nine life activities. Approximately 10% reported atypical symptoms associated with menstruation. Diagnosis of menstrual pathology in the sample was low, even though 33% had seen a GP and 9% had been referred to a specialist. Menstrual pain and symptoms are common in teenagers. Girls indicating moderate to severe pain in association with a high number of menstrual symptoms, school absence and interference with life activities should be effectively managed to minimise menstrual morbidity. Those girls who do not respond to medical management should be considered for further investigation for possible underlying pathology, such as endometriosis.
Article
BACKGROUND Numerous studies concerning endometriosis and pain have been reported. However, there is no consensus on the best method to evaluate pain in endometriosis and many scales have been used. Moreover, there are only a few descriptions of minimal clinically important differences after treatment (MCID) to evaluate variations in pain. In our study, we aim to identify pain scales used in endometriosis pain treatment, to address their strong and weak points and to define which would be the ideal scale to help clinicians and researchers to evaluate endometriosis-related pain.
Article
To examine the relationship between primary dysmenorrhea and symptoms of depression and anxiety among adolescent female students in Tbilisi, Georgia. A case-control study. Tbilisi, Georgia. Four hundred twenty-four postmenarcheal girls aged 14-20 years (a subset of a larger study involving 2561 girls). The data was gathered in 2011 by the use of a questionnaire prepared for the purpose of this study, completed anonymously. Menstrual pattern, depression and anxiety level were evaluated in both groups; continuous and categorical variables were compared by Pearson chi-square test. Depressive symptoms were determined by a self-reporting scale (Beck Depression Inventory); anxiety was determined using Taylor Manifest Anxiety Scale (TMAS) and Spielberger State-Trait Anxiety Inventory (STAI). Differences in mental health between two groups. Patients with primary dysmenorrhea (PD) had significantly higher scores of depression than the control subjects: moderate depression, 15.9% in PD patients vs 6.2% in control subjects and severe depression, 1.8% vs 0% (P < .003, LR 0.001). High anxiety (TMAS) was also more prevalent in adolescents with primary dysmenorrhea (44% vs 9.9%; P < .001, LR < 0.001). STAI scores were also significantly higher in these patients than in healthy women (68.9% vs 25.0%; P < .001, LR < 0.001). Primary dysmenorrhea is strongly linked with positive scores for depression and anxiety. Because of this association, attention should be given to effective mental health screening in these patients; psychological support may be necessary during their treatment and follow-up.
Article
This review will empower the primary care provider (PCP) to evaluate, manage, and refer as needed adolescents with dysmenorrhea and/or chronic pelvic pain (CPP) who are suspected to have endometriosis. Endometriosis is a common cause of CPP in adolescents who do not respond to primary medical treatment. The presentation in adolescents is unique, causing high rates of misdiagnosis or delayed treatment. Endometriosis-related pain has a marked negative impact on social and mental health. Simple treatments that are available in the primary care setting can alleviate pain and improve quality of life for these young women if initiated in a timely fashion. Adolescents usually turn to their PCP for evaluation of dysmenorrhea and CPP. By maintaining a high index of suspicion, initiating treatment, and referring when needed, the PCP can have a tremendous effect on the patient's present and future quality of life.
Article
To evaluate the efficacy and safety of low-dose oral contraceptives (IKH-01; 0.035 mg ethinyl estradiol and 1 mg norethisterone) for patients with primary dysmenorrhea. Placebo-controlled, double-blind, randomized trial. Clinical trial sites in Japan. One hundred fifteen patients with primary dysmenorrhea. Patients randomly assigned to receive IKH-01 or placebo for four cycles. Total dysmenorrhea score, verbal rating scale defining pain according to limited ability to work and need for analgesics, and visual analog scale (VAS). Reduction in total dysmenorrhea score and VAS before and after treatment was significantly higher in the IKH-01 group than in the placebo group. Total dysmenorrhea score and VAS in the IKH-01 group significantly decreased from cycles 2 to 5. Overall incidence of adverse events was significantly higher in the IKH-01 group. Incidence decreased over time in the IKH-01 group; it was invariable in the placebo group. No serious adverse events occurred. IKH-01 could be used as a single agent or in combination with analgesics for treatment of primary dysmenorrhea.
Article
The data on the menstrual cycle as a health endpoint and as a risk factor for chronic disease are inadequate. Specifically the data on menstrual cycle length and blood loss do not have the detail on within-woman variability needed to allow women and clinicians to anticipate certain bleeding changes that tend to develop at different life stages to distinguish between potentially pathologic alterations from short-term aberrations and to recognize bleeding patterns that may be risk factors for the development of chronic disease. Lack of data on bleeding changes in premenopausal and menopausal women concerns many health professionals considering the many physician visits for abnormal bleeding and the prevalence of hysterectomy among women aged more than 35. Thus development of objective criteria on how much bleeding is too much is needed so women can determine whether their daily blood loss is or is not a concern. Women also need more information on what constitutes menstrual dysfunction. Some basic research needs include definition of population patterns of gynecologic disease identification of potentially modifiable risk factors the influence of recreational activity in gynecologically mature women influence of hard physical activity in the context of womens daily work life interaction of low weight and physical activity in developing countries effects of work stress effects of family interactions effects of violence environmental risk factors (e.g. pesticides) and physiologic variation across the menstrual cycle. Research on menstrual cycle-related risk factors for chronic disease could explain womens long term health status and identify preventive strategies for premenopausal women. Current womens health research tends to ignore hormonal influences. The limited available research on immune parameters suggests that follicular/luteal classification may not be able to detect meaningful variation. In conclusion a comprehensive research program would fill the many gaps in scientific knowledge about the menstrual cycle.
Article
To explore the prevalence of dysmenorrhea among senior high school girls in Perth, Western Australia, its impact on school, sporting, and social activities, students' management strategies, and their knowledge of available treatment. A total of 388 female students in Grades 11 and 12 at three metropolitan secondary schools completed an anonymous questionnaire administered during class time. The following definition of dysmenorrhoea was used: any type of pain or discomfort associated with menstrual periods including cramps, nausea, and headaches. The reported prevalence of dysmenorrhea among these girls was 80%; 53% of those girls with dysmenorrhea reported that it limited their activities. In particular, 37% said that dysmenorrhea affected their school activities. The most common medication used by those reporting dysmenorrhea was simple analgesics (53%), followed by nonsteroidal anti-inflammatory drugs (NSAIDs), used by 42%. More than a quarter of respondents (27%) were unaware that NSAIDs were a possible treatment option for dysmenorrhea. The prevalence and impact of dysmenorrhea on Grade 11 and 12 girls is high, and they lack knowledge of and experience with effective treatment. Health education measures are needed in this area to prevent unnecessary suffering and interruption to school routine.
Article
Dysmenorrhea is the leading cause of short-term school absenteeism. It is associated with a negative impact on social, academic, and sports activities of many female adolescents. Dysmenorrhea has not previously been described among Hispanic adolescents, the fastest growing minority group in the United States. To determine the prevalence of dysmenorrhea among Hispanic female adolescents; its impact on academic performance, school attendance, and sports and social activities; and its management. A total of 706 Hispanic female adolescents, in grades 9 through 12, completed a 31-item questionnaire about the presence, duration, severity, treatment, and limitations of dysmenorrhea at a local urban high school. Among participants who had had a period in the previous 3 months, 85% reported dysmenorrhea. Of these, 38% reported missing school due to dysmenorrhea during the 3 months prior to the survey and 33% reported missing individual classes. Activities affected by dysmenorrhea included class concentration (59%), sports (51%), class participation (50%), socialization (46%), homework (35%), test-taking skills (36%), and grades (29%). Treatments taken for dysmenorrhea included rest (58%), medications (52%), heating pad (26%), tea (20%), exercise (15%), and herbs (7%). Fourteen percent consulted a physician and 49% saw a school nurse for help with their symptoms. Menstrual pain was significantly associated with school absenteeism and decreased academic performance, sports participation, and socialization with peers (P<.01). Dysmenorrhea is highly prevalent among Hispanic adolescents and is related to school absenteeism and limitations on social, academic, and sports activities. Given that most adolescents do not seek medical advice for dysmenorrhea, health care providers should screen routinely for dysmenorrhea and offer treatment. As dysmenorrhea reportedly affects school performance and attendance, school administrators may have a vested interest in providing health education on this topic to their students. Arch Pediatr Adolesc Med. 2000;154:1226-1229.