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Scientific Reports Nov 2018Primary dysmenorrhea, which is menstrual pain without pelvic pathology, is the most common gynecologic condition in women. Heat therapy has been used as a treatment. We... (Meta-Analysis)
Meta-Analysis
Primary dysmenorrhea, which is menstrual pain without pelvic pathology, is the most common gynecologic condition in women. Heat therapy has been used as a treatment. We assessed the evidence on heat therapy as a treatment for primary dysmenorrhea. We searched 11 databases for studies published through July 2018. All randomized controlled trials (RCTs) that addressed heat therapy for patients with primary dysmenorrhea were included. Data extraction and risk-of-bias assessments were performed by two independent reviewers. Risk of bias was assessed using the Cochrane risk-of-bias tool. Six RCTs met our inclusion criteria. Two RCTs found favorable effects of heat therapy on menstrual pain compared with unheated placebo therapy. Three RCTs found favorable effects of heating pads on menstrual pain compared with analgesic medication (n = 274; SMD -0.72; 95% confidence interval -0.97 to -0.48; P < 0.001; two studies). One RCT showed beneficial effects of heat therapy on menstrual pain compared with no treatment (n = 132; MD -4.04 VAS; 95% CI -4.88 to -3.20; P < 0.001). However, these results are based on relatively few trials with small sample sizes. Our review provided suggestive evidence of the effectiveness of heat therapy for primary dysmenorrhea, but rigorous high-quality trials are still needed to provide robust evidence.
Topics: Dysmenorrhea; Female; Humans; Hyperthermia, Induced; Pain Management; Quality of Life; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 30389956
DOI: 10.1038/s41598-018-34303-z -
Archives of Gynecology and Obstetrics Jul 2020Primary dysmenorrhea is the most common gynecological problem in young women and adolescents. Exercise therapy provides positive effects on women with primary... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Primary dysmenorrhea is the most common gynecological problem in young women and adolescents. Exercise therapy provides positive effects on women with primary dysmenorrhea. The aim of the study was to investigate the effects of a combined exercise program on pain, sleep and menstrual symptoms in patients with primary dysmenorrhea.
METHODS
The study is a randomized controlled study. The study included 28 sedentary individuals. The participants were assigned to two groups as the exercise (mean age 22.9 ± 2.0 years) and the control (mean age 23.1 ± 1.8 years) groups. The exercise protocol was carried out with the exercise group three times a week for eight weeks. The Visual Analog Scale (VAS) was used for assessing the intensity of pain. The Menstrual Symptom Questionnaire (MSQ) and Pittsburgh Sleep Quality Index (PSQI) were used for evaluating menstrual symptoms and sleep quality, respectively. The study was registered on the Clinical Trials website by the number NCT03625375.
RESULTS
The comparisons between the groups revealed statistically significant differences in abdominal pain severity, MSQ total score and the subscale scores of negative outcomes and management methods (p < 0.05). The intragroup comparisons of the exercise group demonstrated that the scores of the low back pain and abdominal pain and the MSQ and PSQI scores were found to be significantly different after the 8-week program (p < 0.05).
CONCLUSION
The combined exercise therapy is an effective way to manage symptoms associated with primary dysmenorrhea.
Topics: Adult; Dysmenorrhea; Exercise Therapy; Female; Humans; Young Adult
PubMed: 32415471
DOI: 10.1007/s00404-020-05579-2 -
Sports Medicine (Auckland, N.Z.) Oct 2023Menstrual cycle (MC) disorders and MC-related symptoms can have debilitating effects on the health and performance of female athletes. As the participation of women in...
BACKGROUND
Menstrual cycle (MC) disorders and MC-related symptoms can have debilitating effects on the health and performance of female athletes. As the participation of women in sports continues to increase, understanding the prevalence of a range of MC disorders and MC-related symptoms may guide preventive strategies to protect the health and optimise the performance of female athletes.
OBJECTIVE
To examine the prevalence of MC disorders and MC-related symptoms among female athletes who are not using hormonal contraceptives and evaluate the assessment methods used to identify MC disorders and MC-related symptoms.
METHODS
This systematic review was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Six databases were searched until September 2022 for all original research that reported the prevalence of MC disorders and/or MC-related symptoms in athletes not using hormonal contraceptives, which included the definitions of the MC disorders examined, and the assessment methods used. MC disorders included amenorrhoea, anovulation, dysmenorrhoea, heavy menstrual bleeding (HMB), luteal phase deficiency (LPD), oligomenorrhoea, premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). MC-related symptoms included any affective and physical symptoms related to the MC that do not cause significant personal, interpersonal or functional impairment. The prevalence data across eligible studies were combined, and all studies were qualitatively synthesised to evaluate the assessment methods and tools used to identify MC disorders and MC-related symptoms. The methodological quality of studies was assessed using a modified Downs and Black checklist.
RESULTS
Sixty studies involving 6380 athletes were included. A wide range of prevalence was observed for all types of MC disorders, with a dearth of data on anovulation and LPD. Based on pooled data, dysmenorrhoea (32.3%; range 7.8-85.6%) was the most prevalent MC disorder. Studies reporting MC-related symptoms mostly examined the premenstrual and menstruation phases, where affective symptoms appeared more prevalent than physical symptoms. A larger proportion of athletes reported symptoms during the initial days of menstruation compared with the premenstrual phase. MC disorders and MC-related symptoms were retrospectively assessed using self-report methods in 90.0% of studies. Most studies (76.7%) in this review were graded as moderate quality.
DISCUSSION
MC disorders and MC-related symptoms are commonplace among female athletes, warranting further research examining their impact on performance and preventive/management strategies to optimise athlete health. To increase the quality of future studies, researchers should adopt standardised definitions of MC disorders and assessment methods such as a combination of calendar counting, urinary ovulation tests and a mid-luteal phase serum progesterone measurement when assessing menstrual function. Similarly, standardised diagnostic criteria should be used when examining MC disorders such as HMB, PMS and PMDD. Practically, implementing prospective cycle monitoring that includes ovulation testing, mid-luteal blood sampling (where feasible) and symptom logging throughout the MC could support athletes and practitioners to promptly identify and manage MC disorders and/or MC-related symptoms.
TRIAL REGISTRATION
This review has been registered in the PROSPERO database (CRD42021268757).
Topics: Female; Humans; Dysmenorrhea; Prevalence; Prospective Studies; Anovulation; Retrospective Studies; Menstrual Cycle; Premenstrual Syndrome; Menstruation Disturbances; Premenstrual Dysphoric Disorder; Athletes; Contraceptive Agents
PubMed: 37389782
DOI: 10.1007/s40279-023-01871-8 -
BMJ Clinical Evidence Oct 2014Dysmenorrhoea may begin soon after the menarche, after which it often improves with age; or it may originate later in life, after the onset of an underlying causative... (Review)
Review
INTRODUCTION
Dysmenorrhoea may begin soon after the menarche, after which it often improves with age; or it may originate later in life, after the onset of an underlying causative condition. Dysmenorrhoea is common, and in up to 20% of women it may be severe enough to interfere with daily activities.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of pharmacological treatments for primary dysmenorrhoea? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found eight studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: contraceptives (combined oral), non-steroidal anti-inflammatory drugs (NSAIDs), progestogens (intrauterine), and simple analgesics (aspirin, paracetamol) .
Topics: Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Contraceptive Agents; Dysmenorrhea; Female; Humans; Progestins; Treatment Outcome
PubMed: 25338194
DOI: No ID Found -
Gastroenterology Clinics of North... Mar 2022Endometriosis, affecting 5-10% of reproductive-age women, is a common contributor to dysmenorrhea and chronic pelvic pain. Diagnosis requires laparoscopic tissue biopsy,... (Review)
Review
Endometriosis, affecting 5-10% of reproductive-age women, is a common contributor to dysmenorrhea and chronic pelvic pain. Diagnosis requires laparoscopic tissue biopsy, but careful pelvic examination, and/or imaging with either ultrasound or MRI, may identify patients who should receive empiric first-line therapy. The presence of dyschezia, particularly with cyclical exacerbation, should raise suspicion for bowel or rectovaginal septum involvement, and a greater need for surgical management. Treatment of dysmenorrhea includes hormonal suppression of the menstrual cycle, and/or analgesics; more severe cases with strong pain and disability may require earlier surgical intervention to excise disease while preserving fertility desires.
Topics: Dysmenorrhea; Dyspareunia; Endometriosis; Female; Gastroenterologists; Humans; Laparoscopy; Pelvic Pain
PubMed: 35135662
DOI: 10.1016/j.gtc.2021.10.012 -
Women's Health (London, England) Aug 2015
Topics: Dysmenorrhea; Dyspareunia; Endometriosis; Female; Humans; Pelvic Pain; Women's Health
PubMed: 26343282
DOI: 10.2217/whe.15.61 -
European Journal of Obstetrics,... Nov 2015To evaluate the efficacy of a physiotherapy program for relieving symptoms of primary dysmenorrhea among Mexican women. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To evaluate the efficacy of a physiotherapy program for relieving symptoms of primary dysmenorrhea among Mexican women.
STUDY DESIGN
This was a single-center, prospective, experimental, parallel group, randomized controlled trial. This cross-sectional study was performed at the Universidad Politécnica de Pachuca, Hidalgo, Mexico. Female patients with primary dysmenorrhea, age of 18-22 years; pain intensity from 4 to 10cm on a Visual Analogue Scale (VAS); and sedentary lifestyle were included. The patients were then randomized to receive a physiotherapy program for three months or to no intervention program. The physiotherapy program consisted of overall stretching, specific stretches, Kegel exercises, jogging, and relaxation exercises. Patient evaluations of symptomatology and pain intensity were recorded basally and throughout for three menstrual periods. The data were entered into a computerized database for descriptive and inferential statistical analyses.
RESULTS
A per-protocol population of eighty three women with a mean age of 20.2±1.8 years underwent the physiotherapy program, and seventy seven participants with a mean age of 20.4±1.2 years received no treatment. The participant assessments of pain on the VAS during the second and the third menstrual cycles demonstrated a significant reduction in the treatment group (p<0.05) compared with the control group.
CONCLUSIONS
The results showed that strengthening, stretching and muscle relaxation techniques, in addition to jogging, are effective for reducing dysmenorrheic symptoms when they are regularly performed.
Topics: Adult; Cross-Sectional Studies; Dysmenorrhea; Female; Humans; Physical Therapy Modalities; Prospective Studies
PubMed: 26319652
DOI: 10.1016/j.ejogrb.2015.08.008 -
Lancet (London, England) Jun 2022Endometriosis is a common cause of pelvic pain in women, for which current treatment options are suboptimal. Relugolix, an oral gonadotropin-releasing hormone receptor... (Randomized Controlled Trial)
Randomized Controlled Trial
Once daily oral relugolix combination therapy versus placebo in patients with endometriosis-associated pain: two replicate phase 3, randomised, double-blind, studies (SPIRIT 1 and 2).
BACKGROUND
Endometriosis is a common cause of pelvic pain in women, for which current treatment options are suboptimal. Relugolix, an oral gonadotropin-releasing hormone receptor antagonist, combined with estradiol and a progestin, was evaluated for treatment of endometriosis-associated pain.
METHODS
In these two replicate, phase 3, multicentre, randomised, double-blind, placebo-controlled trials at 219 community and hospital research centres in Africa, Australasia, Europe, North America, and South America, we randomly assigned women aged 18-50 years with surgically or directly visualised endometriosis with or without histological confirmation, or with histological diagnosis alone. Participants were eligible if they had moderate to severe endometriosis-associated pain and, during the 35-day run-in period, a dysmenorrhoea Numerical Rating Scale (NRS) score of 4·0 or higher on two or more days and a mean non-menstrual pelvic pain NRS score of 2·5 or higher, or a mean score of 1·25 or higher that included a score of 5 or more on 4 or more days. Women received (1:1:1) once-daily oral placebo, relugolix combination therapy (relugolix 40 mg, estradiol 1 mg, norethisterone acetate 0·5 mg), or delayed relugolix combination therapy (relugolix 40 mg monotherapy followed by relugolix combination therapy, each for 12 weeks) for 24 weeks. During the double-blind randomised treatment and follow-up period, all patients, investigators, and sponsor staff or representatives involved in the conduct of the study were masked to treatment assignment. The co-primary endpoints were responder rates at week 24 for dysmenorrhoea and non-menstrual pelvic pain, both based on NRS scores and analgesic use. Efficacy and safety were analysed in the modified intent-to-treat population (randomised patients who received ≥1 study drug dose). The studies are registered at ClinicalTrials.gov (SPIRIT 1 [NCT03204318] and SPIRIT 2 [NCT03204331]) and EudraCT (SPIRIT 1 [2017-001588-19] and SPIRIT 2 [2017-001632-19]). Eligible patients who completed the SPIRIT studies could enrol in a currently ongoing 80-week open-label extension study (SPIRIT EXTENSION [NCT03654274, EudraCT 2017-004066-10]). Database lock for the on-treatment duration has occurred, and post-treatment follow-up for safety, specificially for bone mineral density and menses recovery, is ongoing at the time of publication.
FINDINGS
638 patients were enrolled into SPIRIT 1 and randomly assigned between Dec 7, 2017, and Dec 4, 2019, to receive relugolix combination therapy (212 [33%]), placebo (213 [33%]), or relugolix delayed combination therapy (213 [33%]). 623 patients were enrolled into SPIRIT 2 and were randomly assigned between Nov 1, 2017 and Oct 4, 2019, to receive relugolix combination therapy (208 [33%]), placebo (208 [33%]), or relugolix delayed combination therapy (207 [33%]). 98 (15%) patients terminated study participation early in SPIRIT 1 and 115 (18%) in SPIRIT 2. In SPIRIT 1, 158 (75%) of 212 patients in the relugolix combination therapy group met the dysmenorrhoea responder criteria compared with 57 (27%) of 212 patients in the placebo group (treatment difference 47·6% [95% CI 39·3-56·0]; p<0·0001). In SPIRIT 2, 155 (75%) of 206 patients in the relugolix combination therapy group were dysmenorrhoea responders compared with 62 (30%) of 204 patients in the placebo group (treatment difference 44·9% [95% CI 36·2-53·5]; p<0·0001). In SPIRIT 1, 124 (58%) of 212 patients in the relugolix combination therapy group met the non-menstrual pelvic pain responder criteria versus 84 (40%) patients in the placebo group (treatment difference 18·9% [9·5-28·2]; p<0·0001). In SPIRIT 2, 136 (66%) of 206 patients were non-menstrual pelvic pain responders in the relugolix combination therapy group compared with 87 (43%) of 204 patients in the placebo group (treatment difference 23·4% [95% CI 13·9-32·8]; p<0·0001). The most common adverse events were headache, nasopharyngitis, and hot flushes. There were nine reports of suicidal ideation across both studies (two in the placebo run-in, two in the placebo group, two in the relugolix combination therapy group, and three in the delayed relugolix combination therapy group). No deaths were reported. Least squares mean percentage change in lumbar spine bone mineral density in the relugolix combination therapy versus placebo groups was -0·70% versus 0·21% in SPIRIT 1 and -0·78% versus 0·02% in SPIRIT 2, and in the delayed relugolix combination group was -2·0% in SPIRIT 1 and -1·9% in SPIRIT 2. Decreases in opioid use were seen in treated patients as compared with placebo.
INTERPRETATION
Once-daily relugolix combination therapy significantly improved endometriosis-associated pain and was well tolerated. This oral therapy has the potential to address the unmet clinical need for long-term medical treatment for endometriosis, reducing the need for opioid use or repeated surgical treatment.
FUNDING
Myovant Sciences.
Topics: Analgesics, Opioid; Double-Blind Method; Dysmenorrhea; Endometriosis; Estradiol; Female; Humans; Pelvic Pain; Phenylurea Compounds; Pyrimidinones; Treatment Outcome
PubMed: 35717987
DOI: 10.1016/S0140-6736(22)00622-5 -
Revista Brasileira de Ginecologia E... Dec 2021The aim of the present systematic review meta-analysis is METHODS: Systematic search was conducted in several databases, such as PubMed, Web of Science, Cochrane,... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of the present systematic review meta-analysis is METHODS: Systematic search was conducted in several databases, such as PubMed, Web of Science, Cochrane, and Scopus, to identify relevant research up to October 26, 2019. The identified studies were evaluated based on a modified Jadad scale. The intervention involves aromatherapy alone or in combination with essential oils. There was no restriction for the control group such as a placebo group or other common treatments. The Comprehensive Meta-Analysis Version 2 (Bio stat, Englewood, NJ, USA) was used for meta-analysis. Cochran's Q and I2 tests were utilized.
RESULTS
The findings of our meta-analysis, which contained 13 trials (15 data), showed that dysmenorrhea decreased significantly in the group receiving aromatherapy with herbal compared with the control group (standardized mean difference [SMD] = -0.795; 95% confidence interval [CI]: -0.922 to- 0.667; 17 trials O < 0.001); heterogeneity; I2 = 19.47%; = 0.236). In addition, four studies with insufficient data were not included in our meta-analysis. The results of all studies suggested that aromatherapy with herbal medicine group compared with control group is effective.
CONCLUSION
Aromatherapy with herbal medicine decreased dysmenorrhea. This treatment was particularly effective when aroma oil was combined with massage or when a mixture of aroma oil was used for the treatment of dysmenorrhea.
Topics: Aromatherapy; Dysmenorrhea; Female; Humans; Massage
PubMed: 34933391
DOI: 10.1055/s-0041-1740210 -
Pediatric Annals Apr 2020Up to two-thirds of adolescent girls report painful periods but few seek medical care for their dysmenorrhea. Dysmenorrhea is associated with multiple physical and... (Review)
Review
Up to two-thirds of adolescent girls report painful periods but few seek medical care for their dysmenorrhea. Dysmenorrhea is associated with multiple physical and psychological symptoms, and the delayed evaluation and treatment of dysmenorrhea contributes to a poor quality of life and can result in lifelong health problems, including chronic pelvic pain and infertility. It is recommended that an assessment of patients' menstrual cycles be performed regularly, as identification of abnormally painful menstrual cycles may reveal potential health problems, including pelvic diseases such as endometriosis and adenomyosis. Visits to primary care providers offer an opportunity to assess and educate adolescents and their families on normal menstrual physiology. The purpose of this article is to review the evaluation and management of dysmenorrhea. [Pediatr Ann. 2020;49(4):e176-e182.].
Topics: Adolescent; Dysmenorrhea; Female; Humans; Primary Health Care
PubMed: 32275762
DOI: 10.3928/19382359-20200318-01