Unmet Needs and Experiences of Adolescent Girls with Heavy Menstrual Bleeding and Dysmenorrhea: A Qualitative Study

Study ObjectiveTo identify and examine the key areas of need and explore the experiences of adolescent girls with heavy menstrual bleeding and/or dysmenorrhea.Design and SettingQualitative interview study using semi-structured interviews. Gynaecology outpatient clinic at The Royal Children's Hospital, Melbourne, Australia.ParticipantsAdolescent girls (12-18 years; mean age, 14.8 ± 1.5 years) presenting with heavy menstrual bleeding and/or dysmenorrhea at the clinic (N = 30).Interventions and Main Outcome MeasuresIn-depth semi-structured interviews were conducted between May and August 2018. Interview data were thematically analyzed using a grounded theory approach. Themes covered experiences and unmet needs of adolescent girls with heavy menstrual bleeding and/or dysmenorrhea.ResultsA total of 12 themes were identified, and covered the impact of symptoms, experiences, and/or unmet needs of these adolescents. Key themes highlighting experiences and unmet needs related to (1) coordination of healthcare, (2) day-to-day coping, (3) school, and (4) information surrounding menstrual issues. From these themes, 7 unmet needs emerged and were organized under 3 key areas of need: (1) treatment, management, and care, (2) improvements in the school environment, and (3) menstrual health as a gendered issue.ConclusionMenstrual concerns can have a profound physical and psychosocial impact on adolescents. Effective school-based menstrual education programs may be key in reducing stigma, fear, and shame surrounding menstruation, in teaching positive management strategies and in encouraging adolescents to seek help for their menstrual concerns.     

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.     

复方口服避孕药治疗原发性痛经的系统评价

目的:复方口服避孕药(COC)治疗原发性痛经是否有效尚缺乏大样本高质量的临床研究证实,本研究旨在通过循证医学方法评价COC治疗原发性痛经的安全性及有效性。方法:计算机检索Medline、EMbase、Cochrane Library、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊全文数据库,检索时间从各数据库建立至2011年7月;同时辅助其他检索方法,所检索文献由两名系统评价者独立评价纳入研究并提取资料,并用RevMan5.1软件进行统计学分析。结果:共纳入8项研究,Meta分析结果显示:与安慰剂组相比,COC组可以降低患者McGill疼痛问卷(MDQ)评分(MD=2.7,95%CI:0.92～4.48,P=0.003)和目测类比疼痛(VAS)评分(MD=0.87,95%CI:0.54～1.21,P<0.000 01),2组不良反应发生率差异无统计学意义;第1、2代COC与第3代COC相比,患者疼痛缓解率差异无统计学意义(OR=1.13,95%CI:0.76～1.68,P=0.54)。结论:COC可缓解原发性痛经患者症状且不良反应发生率低,值得临床推广应用。鉴于目前研究样本量小,评价指标欠统一,COC治疗原发性痛经的有效性有待于更多高质量研究的进一步证实。     

Using ginseng for menopausal women's health care: A systematic review of randomized placebo-controlled trials

PurposeThis systematic review aimed to update the evidence of ginseng on menopausal women's health care.MethodsWe searched six databases (PubMed, AMED, EMBASE, the Cochrane Library, RISS, and KoreaMed) from their inception to April 2022 and included all placebo-controlled RCTs comparing any type of ginseng in menopausal women. The methodological quality of all studies was assessed using the Cochrane Risk of Bias Tool 2.0.ResultsWe included 15 RCTs with our inclusion criteria. The majority of studies considered bias a concern. Ginseng reduced menopausal symptoms in three studies (n = 515; standardized mean difference (SMD): −0.40, 95% confidence interval (CI): −0.73 to −0.07, P = 0.02) and lowed hot flashes (n = 515; SMD: −0.34, 95% CI: −0.66 to −0.01, P = 0.04). The meta-analysis of three other studies failed to show that ginseng was beneficial for sexual function (n = 491; SMD: 0.31, 95% CI: −0.30 to 0.92, P = 0.32). Three RCTs showed positive effects of ginseng on the quality of life score (n = 515, SMD: −0.31, 95% CI: −0.61 to −0.01, P = 0.05). In two studies, ginseng failed to produce significant effects on the vaginal maturation index and vaginal pH. Another three RCTs failed to demonstrate a beneficial effect of Korean red ginseng (KRG) on endometrial thickness.ConclusionThis study demonstrated that ginseng can significantly reduce hot flashes, menopausal symptoms, and quality of life in menopausal women. In contrast, neither KRG nor ginseng appeared to have any direct effect on sexual dysfunction, hormones or biomarkers, or endometrial thickness. More rigorous RCTs are needed to overcome the current limitations.     

Prevalence and Risk Factors Associated with Primary Dysmenorrhea among Chinese Female University Students: A Cross-sectional Study

Study ObjectiveTo examine prevalence and risk factors associated with primary dysmenorrhea among Chinese female university students in Hunan province, China.DesignA cross-sectional study.SettingFemale university students in Changsha city, Hunan province, China.ParticipantsFour thousand six hundred six female individuals selected using a multistage cluster random sampling method.InterventionsA self-administered questionnaire, which included sociodemographic information, lifestyle habits, emotional characteristics, and menstruation pattern, was used to collect data.Main Outcome MeasuresInformation about menarche, body mass index, cycle length and regularity, primary dysmenorrhea, physical exercise, depression, and anxiety.ResultsThe prevalence of primary dysmenorrhea was 41.7% (1921/4606) among Chinese female university students. Multivariate binary logistic regression indicated that being a minority (odds ratio [OR], 1.335; 95% confidence interval [CI], 1.083-1.646), underweight (OR, 1.249; 95% CI, 1.08-1.42), annual household income less than 80,000 CNY (OR, 1.169; 95% CI, 1.018-1.342), maternal history of dysmenorrhea (OR, 2.553; 95% CI, 2.236-2.915), age at menarche younger than 12 years (OR, 1.161; 95% CI, 1.013-1.329), irregular menstrual cycle (OR, 1.216; 95% CI, 1.063-1.391), and skipping breakfast (OR, 1.294; 95% CI, 1.124-1.490) were associated risk factors of primary dysmenorrhea.ConclusionThe prevalence of primary dysmenorrhea among Chinese university students is relatively high. Various risk factors were identified that associated with primary dysmenorrhea. More effort and attention should therefore be directed toward this health problem in China.     

Cesarean Scar Pregnancies: Incidence and Factors Associated with Conversion to Surgery from Medical Management

Study ObjectiveTo describe the incidence, management, and complications of cesarean scar pregnancy (CSP) and define risk factors for conversion from medical to surgical treatment of CSP.DesignRetrospective clinical study (Canadian Task Force classification II-3).SettingTertiary medical center.PatientsAll patients who were admitted and treated for CSP between 2008 and 2016.InterventionsThe cohort was divided according to management, and demographic, clinical, and sonographic data were collected. Rates of conversion were compared between groups, and risk factors necessitating conversion were sought.Measurements and Main ResultsForty-six cases of CSP were identified. The incidence of CSP has increased from 0.05% to 0.09% of all deliveries. A regression model for absolute numbers of CSP predicted an additional 0.47 CSP each year (p = .03). The most common treatment modalities were systemic treatment with methotrexate (28.2%) and ultrasound-guided intrasac injection of KCl with systemic treatment of methotrexate (58.7%). The mean sac diameter (MSD) of cases that were converted was 11.2 mm larger than in cases that were not converted (p < .001). No patients with an MSD <10 mm or a trophoblastic mass <20 mm³ were converted to surgical management. Maximal levels of beta human chorionic gonadotropin (β-hCG) were significantly associated with the risk of conversion. Only 6.3% of patients with a β-hCG level <10,000 IU at presentation were converted from medical to surgical management. There was no significant association between fetal cardiac activity and conversion from medical to surgical management.ConclusionsCSP has emerged as an important phenomenon in modern obstetrics and gynecology, and its frequency appears to be on the rise. The preferred method of treatment remains unclear; however, it is possible that a large MSD and trophoblastic mass at presentation should prompt surgical treatment.     

Birth ball use for women in labor: A systematic review and meta-analysis

ObjectiveTo evaluate, with the best level of evidence, the possible benefits of using birth balls during labor in maternal and neonatal outcomes.MethodsThis research was made using MEDLINE/PubMed, LILCAS, CINAHL, CENTRAL, and SCOPUS databases, with no period or language restrictions. The terms "labor" and "birth ball" were used. Clinical trials (randomized and non-randomized) were included when compared a group with parturients using birth ball with control group under usual care. The following primary outcomes were: maternal outcomes: pain intensity; length of first and second stage; perineal trauma and episiotomy. Neonatal outcomes: APGAR score, admission to neonatal intensive care unit and delivery room resuscitation. The quality of evidence was evaluated by the GRADE system. Quantitative analysis through meta-analysis was also applies whenever possible.ResultsSeven studies were included. The pain outcome showed differences in the subgroups of 20/30 min on the birth ball (mean difference) −1,46; 95% Confidence Interval: 2,15 to −0,76, p < 0.0001), 60 min (mean difference −1,95; 95% Confidence Interval: 2,68 to −1,22; p < 0.00001) and 90 min (mean difference −1,72; 95% Confidence Interval: 2,44 to −1,00; p < 0.0001), based in a moderated quality of evidence. Other outcomes did not showed differences between groups after the interventions, with a low and very low level of evidence.ConclusionsUse the birth ball reduced pain after 20–90 min of use and there was no difference in the other outcomes. The low quality of the studies included in this meta-analysis suggests that new trials with better methodology quality are necessary.     

Assessment of Anxiety and Depression in Adolescents with Primary Dysmenorrhea: A Case-Control Study

Study ObjectiveTo examine the relationship between primary dysmenorrhea and symptoms of depression and anxiety among adolescent female students in Tbilisi, Georgia.DesignA case-control study.SettingTbilisi, Georgia.ParticipantsFour hundred twenty-four postmenarcheal girls aged 14-20 years (a subset of a larger study involving 2561 girls).MethodsThe 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).Main Outcome MeasuresDifferences in mental health between two groups.ResultsPatients 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).ConclusionPrimary 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.     

Factors Associated with Pain Complaints in a Clinical Sample of Postmenopausal Women

The aims of this study were to evaluate the relationships occurring between pain complaints and postmenopausal status, and to look at the correlation between such complaints and other symptoms commonly related to the climacterium. A clinical sample of 99 consecutive postmenopausal patients requiring medical help were studied: 36 complained of muscle-skeletal pains whereas 33 presented with headache limiting daily activity. Climacteric syndrome, level of distress, coping style and bone mineral density were assessed with appropriate questionnaires and instruments. Neither bone mineral density, nor body mass index nor time since menopause were associated with either headaches or muscle–skeletal pains. According to the logistic regression being younger, being without a job, suffering from insomnia and having a lower ability in self-support by the means of comforting ideas predicts suffering from headache. A high level of distress and an avoidance behavior to problem facing predict the presence of pain complaints. In such cases the ineffectiveness of the coping mechanism (i.e. avoid the problem) could be the reason for the increased level of psychological distress. These findings indicate that complaining of pains or headache is not dependent upon postmenopausal status. Individual coping strategies and their effectiveness seem the main reasons for the presence of disabling musculoskeletal pains or headache.     

Pain in women's health: a multi-faceted approach toward understanding

Pain has always been a part of women's health experiences, inherent to such physiologic processes as menstrual cramping, labor contractions, and uniquely female illnesses, such as cervical or ovarian cancer. However, the understanding of pain-its nature, its purpose, and its sometimes debatable need for removal-remains elusive. Pain's origins are in the physical realm, but it is manifested through an array of psychological, social, and cultural factors. The concept of pain is explored using an evolutionary approach to understanding the mechanisms associated with the physiologic, psychological, developmental, and sociocultural aspects of this phenomenon. The relevance of this exploratory look at pain as it relates to offering health care to women is discussed. The manner in which pain affects individuals and the methods with which it can be treated are critical elements in the provision of quality health care.     

The Effect of Zumba Exercise on Reducing Menstrual Pain in Young Women with Primary Dysmenorrhea: A Randomized Controlled Trial

Study ObjectiveTo study the effectiveness of performing Zumba exercise on the severity and duration of pain in patients with primary dysmenorrhea.DesignRandomized controlled trial.SettingCairo University gynecology Hospital and Bahgat gym and fitness center.ParticipantsNinety-eight women diagnosed with primary dysmenorrhea.InterventionsStudy participants were divided randomly into 2 equal groups: group I included women who engaged in Zumba exercise for 60 minutes twice weekly for 8 weeks, and group II was a control group with no intervention.Main Outcome MeasuresThe primary outcome was the menstrual pain intensity measured using the visual analogue scale scores at 4 and 8 weeks after starting Zumba exercise. The secondary outcome was the difference in the duration of pain in both groups.ResultsBoth groups were homogeneous regarding the baseline demographic characteristics. The severity of primary dysmenorrhea at the beginning of the study was not significantly different between the 2 groups. Menstrual pain intensity was significantly decreased in the Zumba group after 4 and 8 weeks of Zumba compared with the control group (mean difference, −2.94 [95% confidence interval, −3.39 to −2.48] and −3.79 [95% confidence interval, −4.16 to −3.43], respectively; P = .001). Also, the duration of pain was shorter in the Zumba group compared with the control group at 8 weeks (4.92 ± 1.90 vs 9.10 ± 2.92 hours, respectively; P = .001).ConclusionThe Zumba intervention can reduce the severity and duration of menstrual pain thus suggesting that regularly performing Zumba might be a possible complementary treatment for primary dysmenorrhea.     

Screening for cervical cancer among HIV-positive and HIV-negative women in Cameroon using simultaneous co-testing with careHPV DNA testing and visual inspection enhanced by digital cervicography: Findings of initial screening and one-year follow-up

Objective

The World Health Organization (WHO)'s cervical cancer screening guidelines for limited-resource settings recommend sequential screening followed by same-day treatment under a “screen-and-treat” approach. We aimed to (1) assess feasibility and clinical outcomes of screening HIV-positive and HIV-negative Cameroonian women by pairing visual inspection with acetic acid and Lugol's iodine enhanced by digital cervicography (VIA/VILI-DC) with careHPV, a high-risk human papillomavirus (HR-HPV) nucleic acid test designed for low-resource settings; and (2) determine persistence of HR-HPV infection after one-year follow-up to inform optimal screening, treatment, and follow-up algorithms.

Increased beat-to-beat variability during uterine contractions: A common association in uncomplicated labor

A computerized system was used during labor to provide a quantitative and objective analysis of fetal heart rate, beat-to-beat variability, and uterine contractions. Twenty-nine healthy pregnant women at term participated in this study. Each woman was studied for a 40-minute period during the active phase of spontaneous labor. The results indicate that beat-to-beat variability rises from a value of 4.62 ± 1.11 (mean ± SD) between contractions to 6.86 ± 1.53 during contractions. This rise is significant (p < 0.01). At the same time, changes in fetal heart rate are small, inconsistent, and not significant. We conclude that an increased beat-to-beat variability is commonly associated with uterine contractions in normal fetuses. This increase is probably due to mild hypoxia caused by decreased perfusion of the placenta and to increased vagal tone caused by fetal head compression.     

Polycystic ovary syndrome: a biopsychosocial understanding in young women to improve knowledge and treatment options

Aim.?To assess psychological features in young women with and without PCOS.

Methods.?Observational, cross-sectional pilot study in young women aged 18–25 with (n?=?24) or without (n?=?22) PCOS (age: 22.41?±?0.39 vs. 21.95?±?0.47 years, p?=?0.46; BMI: 29.17?±?1.54 vs. 22.05?±?0.83?kg/m², p?=?0.0003). The main outcome measures were quality of life, anxiety, depression, risk perception and fears on future health.

Results.?Women with PCOS demonstrated worsened quality of life (p?=?0.033) and greater anxiety (p?=?0.01) and depression (p?=?0.023) than women without PCOS related to BMI status. Women with PCOS were more likely to perceive themselves as at risk of obesity (p?=?0.012) and infertility (p?<?0.0001), and perceived greater importance in reducing future risk of prediabetes (p?=?0.027), gestational diabetes (p?=?0.039), type 2 diabetes (p?=?0.01), heart disease (p?=?0.005), obesity (p?=?0.0007) and infertility (p?=?0.023) than women without PCOS. Women with PCOS were more likely to have fears about future health related to weight gain (p?=?0.045), loss of femininity (p?=?0.035), loss of sexuality (p?=?0.003) and infertility (p?=?0.019) than women without PCOS.

Conclusions.?Worsened quality of life, anxiety and depression in young women with PCOS is related to BMI. Risk perception is appropriately high in PCOS, yet perceived risks of future metabolic complications are less common than those related to weight gain and infertility.     

Pelvic Floor Biometric Changes Assessed by 4D Translabial Ultrassound in Women With Vulvodynia Submitted to Physical Therapy: A Pilot Study of a Randomized Controlled Trial

BackgroundVulvodynia is a disabling condition in which pelvic floor muscles' (PFM) hypertonicity plays an important role.AimTo evaluate biometric changes in PFM in women with vulvodynia undergoing kinesiotherapy treatment protocol (KTP).MethodsA single-blinded randomized controlled trial of 57 women with vulvodynia randomly assigned to either KTP + amitriptyline or amitriptyline alone (controls) for treatment. Four-dimensional translabial ultrasound assessed PFM regarding symphysis-levator distance at rest, anorectal angle at rest, excursion of the levator plate angle, and levator hiatal narrowing. Volunteers underwent a vaginal examination for a cotton swab test (CST), fulfillment of Friedrich criteria score and PFM power of contraction, and completed a diary of sexual pain and frequency of vaginal intercourse. Outcomes were assessed at baseline and after 8 weeks of treatment.OutcomesPrimary outcomes were differences in biometric parameters assessed by four-dimensional translabial ultrasound after treatment, between groups. Secondary outcomes were changes in clinical variables (CST, Friedrich criteria, PFM power of contraction, frequency of intercourse, and intensity of sexual pain) between groups and correlation analysis between biometric parameters and clinical variables.ResultsOnly the KTP group had statistically significant changes in biometric parameters after treatment (symphysis-levator distance: 0.22 ± 0.2, 95% CI = 0.1–0.4, P = .008; levator hiatal narrowing: −0.33 ± 0.2, 95% CI = −1 to −0.2, P = .04). Comparisons between groups showed that symphysis-levator distance (0.3, 95% CI = 0.2–0.6, P = .005) and excursion of levator plate angle (4.9, 95% CI = −0.4 to 10.1, P = .02) improved significantly after KTP treatment. Clinical variables showed greater improvement in the group treated with KTP for CST (difference of −3.7, 95% CI = −7 to −0.4, P = .01), Friedrich criteria (difference of −1.9, 95% CI = −3.2 to −0.6, P = .003), PFM power of contraction (0.3, 95% CI = 0.1–0.6, P = .05) and intensity of sexual pain (reduction of 1.7, 95% CI = −3.1 to −0.2, P = .01). Some clinical and biometric variables correlated positively, for example, frequency of vaginal intercourse and anorectal angle (P = .04; r = 0.25), or inversely, for example, pain intensity at CST and anorectal angle (P = .004, r = −0.31).Clinical ImplicationsThis study provides evidence on efficiency of a physical therapy protocol for improvement of symptoms of vulvodynia and hypertonicity changes.ConclusionThis pilot study suggests that KTP for women with vulvodynia promoted significant changes in PFM biometric measures, consistent with alterations in hypertonicity and clinical improvement.Bardin MG, Giraldo PC, Martinho N. Pelvic Floor Biometric Changes Assessed by 4D Translabial Ultrassound in Women With Vulvodynia Submitted to Physical Therapy: A Pilot Study of a Randomized Controlled Trial. J Sex Med 2020;17:2236–2246.