Endometrial Cast Expulsion: A Rare Cause of Pelvic Pain Case Report and Review of the Literature

Menorrhagia is common in adolescents and may necessitate treatment with hormonal contraceptive agents. We describe a case of an adolescent female recently initiated on combined hormonal contraceptive pills with passage of an endometrial cast, a rare complication of hormonal contraceptive therapy. Similarities between this case and limited existing literature shed light on the potential pathophysiology and management of this rare, adverse event. As demonstrated by our case, membranous dysmenorrhea, the term for pain associated with shedding an endometrial cast, should be part of the differential diagnosis of an adolescent female with lower abdominal pain who has recently initiated hormonal contraceptive therapy.     

贵州省高校女大学生电子健康素养与痛经管理行为的关系

目的 了解贵州省高校痛经女大学生电子健康素养、痛经管理行为及其相互关系,为完善高校女大学生健康教育工作提供参考依据。方法 2021年3至6月通过麦客电子调查问卷,随机采集贵州省非医学专业女大学生电子健康素养和痛经管理行为数据,共纳入3587名研究对象。采用独立样本t检验、单因素方差分析对痛经女大学生的电子健康素养、痛经管理行为进行分析。采用偏相关分析探讨二者相互关系,使用多元线性回归分析痛经管理行为的影响因素。结果 调查对象的痛经自我报告率为65.74%。不同生源地（t<-4.374）、籍贯（t<2.921）、痛经频率（F<3.800）、网络途径（t<-7.337）、朋友途径（t<-2.434）、学校途径（t<-2.331）女学生的电子健康素养得分存有差异（P＜0. 05）。不同年级（F<3.390）、生源地（t<-3.505）、籍贯（t<2.730）、痛经频率（F<6.400）、网络途径（t<-10.284）、家庭途径（t<-12.137）、朋友途径（t<-11.987）、学校途径（t<-10.912）女学生的痛经管理行为得分存有差异（P＜0. 05）。偏相关分析结果显示,电子健康素养各维度得分与痛经管理行为总分呈正相关（R=0.171、0.162、0.142,P＜0. 05）。电子健康素养的应用能力维度得分会影响女大学生痛经管理行为得分（t=2.220,P=0.027）。结论 电子健康素养是影响贵州省高校女大学生痛经管理行为的重要因素,应重视高校女大学生的电子健康素养培养,提升其对痛经的管理能力。     

中药路路通散外用熏洗治疗原发性痛经的临床观察

目的：通过中药路路通散熏洗治疗痛经的临床观察,探讨外用中药对痛经的治疗效果和应用方法。方法选取本院门诊2015年收治的40例原发性痛经患者,给予中药路路通散外用熏洗治疗,观察治疗前后痛经的改善情况。结果治疗后痛经改善的总有效率为95.00%。结论中药路路通散外用熏洗治疗痛经效果明显,且安全无毒,具有临床推广价值。     

隔药灸治疗子宫内膜异位症性痛经

目的:探讨隔药灸治疗子宫内膜异位症所致痛经的临床效果。方法:选取2017年3月至2018年6月青岛市中医院收治的子宫内膜异位症性痛经患者96例作为研究对象,按照随机数字表法分为对照组和观察组,每组48例,对照组给予常规药物治疗,观察组在对照组基础上加施隔药灸治疗,观察患者痛经缓解、相关临床指标改善、不良反应发生等情况。结果:治疗第1、2、3个月经期时,观察组患者痛经程度、持续时间CMSS评分均显著低于治疗前(F=13.415、11.941,P0.05),且均显著低于对照组(P 0.05);观察组治疗后CA125、IL-8及PGF2α、OT水平均显著低于对照组(t=4.256、3.755、6.344、4.248,P0.05);观察组患者治疗后盆腔包块显著小于对照组(t=22.912,P0.05),不良反应总发生率为4.17%显著低于对照组的16.67%(χ~2=4.018,P0.05)。结论:给予内异症痛经患者隔药灸,有助于患者盆腔包块缩小,提高痛经缓解效果,减少不良反应总体疗效更为确切。     

The Effects of a Dysmenorrhea Support Program on University Students Who Had Primary Dysmenorrhea: A Randomized Controlled Study

Study ObjectiveThis study aims to determine the results of a cognitive-behavioral approach in a dysmenorrhea support program that covers the symptoms, acquaintance, and attitudes toward menstruation of university students who had primary dysmenorrhea.Design and SettingThis randomized controlled, prospective, experimental study was carried out in a nursing school using a pretest-posttest design.ParticipantsA total of 682 female nursing students and 584 volunteers from the 2017-2018 academic year participated in a study of the prevalence of primary dysmenorrhea (94.0%). Study subjects were first-year female nursing students who scored severe on a visual analog scale for primary dysmenorrhea. As a result of the analysis, 80 female nursing students were assigned to study and control groups. A total of 60 students, 29 in the study group and 31 in the control group, completed the study.InterventionThe study group participated in a 6-session cognitive-behavioral approach in a dysmenorrhea support program. No intervention was administered to the control group. The control group and the study group were followed by using data collection forms during three menstrual cycles.Outcome MeasuresThe Participant Introductory Form (PIF), Dysmenorrhea Follow-up Form (DFF), Dysmenorrhea Information Form (DIF), Functional and Emotional Dysmenorrhea Scale (FEDS), Visual Analog Scale (VAS), and Menstrual Attitude Questionnaire (MAQ) were used to measure outcomes.ResultsIn the case of primary dysmenorrhea, the use of nonpharmacological methods was higher in the study group than in the control group. In the third cycle, although the rate of analgesics use was 20.7% in the study group, it was 50% in the control group. Primary dysmenorrhea symptoms, pain levels, and analgesic use decreased. No change was observed in the attitude toward menstruation.ConclusionA cost-effective, reliable, cognitive-behavioral approach−based dysmenorrhea support program can be used to relieve symptoms, decrease the use of analgesics, and increase knowledge about primary dysmenorrhea.     

The relationship between smoking and dysmenorrhea: A meta-analysis

Many studies have investigated the potential association between smoking and dysmenorrhea. However, results from such studies have been inconsistent. In this study, we assessed the association between smoking and dysmenorrhea by meta-analysis. We performed a systematic search of the international databases, including PubMed, Scopus, Web of Science, EBSCO and Google Scholar by the MeSH heading and/or additional terms to obtain relevant studies published from 1990 until 2017. I² statistics were used to assess heterogeneity. Pooled effects size was obtained using a random effects model. Subgroup analyses were also conducted. Data were analyzed through Stata software version 12 (Stata Corp, College Station, TX, USA). A total of fourteen studies were included in meta-analysis. A significant positive association was observed between current smoking and dysmenorrhea in both the unadjusted (odds ratio [OR] = 1.60; 95 percent confidence interval [CI]: 1.35, 1.85) and adjusted models (AOR = 1.44; 95 percent CI: 1.18, 1.69). Also, the association between current smoking and primary dysmenorrhea was significant only in the unadjusted model (OR = 1.53; 95 percent CI: 1.21, 1.85). The pooled effects size showed a significant association between smoking and dysmenorrhea in the fourteen eligible studies. This provides a new approach for prevention from dysmenorrhea in females for policymakers.     

Effect of short-term,low-dose treatment with tamoxifen in patients with primary dysmenorrhea

Current treatment of painful periods and other symptoms related to primary dysmenorrhea (PD) is usually commenced with non-steroidal anti-inflammatory drugs or oral contraceptives, which fails in about 10% of affected patients. Tamoxifen, a selective estrogen-receptor modulator (SERM), has been demonstrated to directly inhibit uterine contractions, causing improvement in uterine blood flow. It could be considered for application in selected groups of dysmenorrheic patients, for instance carriers of breast cancer-associated antigen (BRCA) genes, breast cancer survivors or women with advanced endometriosis. Thus the aim of the present study was to investigate the effect of short-term treatment with tamoxifen on PD and PD-related symptoms, as well as its direct effect on parameters of intrauterine pressure during the painful menstruation, in a group of dysmenorrheic patients. After two cycles of administration of tamoxifen we noted a significant decrease in bleeding together with reductions in the severity of menstrual cramps, diarrhea, headache, fatigue and anxiety. In intrauterine pressure assessments, tamoxifen significantly decreased propagation of uterine contractions. In conclusion, SERMs such as tamoxifen may constitute a therapeutic option in selected groups of patients, improving dysmenorrheic symptoms. Additionally to its receptor-mediated effects, tamoxifen was shown to exert a direct influence on uterine contractile activity that may explain the decrease of menstrual pain and cramps noted in the studied group.     

Effect of eryngo (Eryngium caucasicum Trautv) on primary dysmenorrhea: A randomized,double-blind,placebo-controlled study

ObjectiveThis study strove to investigate the safety and effectiveness of Eryngo in the treatment of primary dysmenorrhea.Materials and methodsThe researchers conducted a blinded, randomized, trial design on 169 women, 15–30 years of age, who had been diagnosed with primary dysmenorrhea at Babol University of Medical Sciences. Subjects were randomly assigned to receive 5 ml syrup of Eryngo, placebo, or Ibuprofen (200 mg) three times a day (15 ml/day), from one day prior to the onset of bleeding for five days. The degree of dysmenorrhea was reported by two measures; Visual analogue scale (VAS), as a primary outcome, and the assessment of dysmenorrhea severity (VMS), as a secondary outcome at 4 menstrual cycles: at pretreatment phase, at the first menstrual cycle, at the second menstrual cycle, and the third menstrual cycle without drug.ResultsThe reduced peak-pain differed by the treatment length in women treated for two menstrual cycles: 4.2 (1.0) cm in the Eryngo group, 4.3 (0.0) cm in the Ibuprofen group, and 0.9 (0.1) cm in the placebo group (P < 0.0001). No serious side effects were reported in all groups under study. According to the results, minor side effects did not increase in the Eryngo group when compared with the placebo group.ConclusionEryngo relieved dysmenorrhea as effectively as Ibuprofen did. Thus, Eryngo could be regarded as a new herbal remedy for the treatment of dysmenorrhea. However, in order to prescribe Eryngo as herbal remedy, rigorous research studies are required to establish its efficacy by investigating its chemical, pharmacologic, and therapeutic properties.     

自拟痛经汤治疗寒凝血瘀型痛经的临床观察

目的：观察自拟痛经汤治疗寒凝血瘀型痛经的临床疗效。方法随机选择2013年5月～2014年5月收治的痛经患者70例，根据中医辨证均属寒凝血瘀型痛经，将患者以双盲法分为两组，对照组采用吲哚美辛栓治疗，试验组采用本院自拟痛经汤治疗，比较两组患者的临床治疗效果。结果试验组患者临床治疗总有效率明显优于对照组，且试验组痛经症状积分、VAS改善情况较对照组明显，组间比较差异均具有统计学意义（P＜0.05）。结论我院自拟痛经汤应用于寒凝血瘀型痛经治疗中的疗效确切，远期治愈率良好。