Herbal and dietary therapies for primary and secondary dysmenorrhoea. Surgical treatment of primary dysmenorrhea with laparoscopic uterine nerve ablation. Comparison of laparoscopic presacral neurectomy and laparoscopic uterine nerve ablation for primary dysmenorrhea. Prospective, randomized, double-blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild, and moderate endometriosis. Menstrual blood loss in dysmenorrhoea: effects of proquazone and indomethacin Effects of acupressure at the Sanyinjiao point on primary dysmenorrhoea. The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2-5 year follow-up. Prevalence and correlates of three types of pelvic pain in a nationally representative sample of Australian women. The community prevalence of chronic pelvic pain in women and associated illness behaviour. Tiaprofenic acid in the treatment of primary dysmenorrhoea. Six-Month Evaluation of the Benefits of the Low-Dose Combined Oral Contraceptive Chlormadinone Acetate 2 mg/Ethinylestradiol 0.03 mg in Young Women The efficacy of etoricoxib vs mefenamic acid in the treatment of primary dysmenorrhoea: A randomised comparative trial The efficacy and safety of aceclofenac versus placebo and naproxen in women with primary dysmenorrhoea. Deep infiltrating endometriosis: relation between severity of dysmenorrhoea and extent of disease. Randomised trial of hysterectomy, endometrial laser ablation, and transcervical endometrial resection for dysfunctional uterine bleeding A systematic nerve‐sparing radical hysterectomy technique in invasive cervical cancer for preserving postsurgical bladder function Indomethacin in the treatment of primary dysmenorrhoea Effectiveness of the association micronized N-Palmitoylethanolamine (PEA)-transpolydatin in the treatment of chronic pelvic pain related to endometriosis after laparoscopic assessment: a pilot study. Effects of acupressure on menstrual distress in adolescent girls: a comparison between Hegu-Sanyinjiao matched points and Hegu, Zusanli single point. Flurbiprofen in the treatment of primary dysmenorrhoea. Comparison between fluproquazone and indomethacin in treatment of primary dysmenorrhoea. CORONIS - International study of caesarean section surgical techniques: the follow-up study Effect of rhubarb (Rheum emodi) in primary dysmenorrhoea: a single-blind randomized controlled trial
Background Dysmenorrhoea refers to the occurrence of painful menstrual cramps of uterine origin and is a common gynaecological complaint . Common treatment for dysmenorrhoea is medical therapy such as nonsteroidal anti-inflammatories ( NSAIDs ) or oral contraceptive pills ( OCPs ) which both work by reducing myometrial activity ( contractions of the uterus ) . The efficacy of conventional treatments such as nonsteroidals is considerable , however the failure rate is still often 20 - 25 % . Many consumers are now seeking alternatives to conventional medicine and research into the menstrual cycle suggests that nutritional intake and metabolism may play an important role in the cause and treatment of menstrual disorders . Herbal and dietary therapies number among the more popular complementary medicines yet there is a lack of taxonomy to assist in classifying them . In the US , herbs and other phytomedicinal products ( medicine from plants ) have been legally classified as dietary supplements since 1994 . Included in this category are vitamins , minerals , herbs or other botanicals , amino acids and other dietary substances . For the purpose of this review we use the wider term herbal and dietary therapies to include the assorted herbal or dietary treatments that are classified in the US as supplements and also the phytomedicines that may be classified as drugs in the European Union . Objectives To determine the efficacy and safety of  herbal and dietary therapies  for the treatment of  primary and secondary dysmenorrhoea  when compared to each other , placebo , no treatment or other conventional treatments ( e.g. NSAIDS ) . Search methods Electronic search es of the Cochrane Menstrual Disorders and Subfertility Group Register of controlled trials , CCTR , MEDLINE , EMBASE , CINAHL , Bio extracts , and PsycLIT were performed to identify relevant r and omised controlled trials ( RCTs ) . The Cochrane Complementary Medicine Field 's Register of controlled trials ( CISCOM ) was also search ed . Attempts were also made to identify trials from the National Research Register , the Clinical Trial Register and the citation lists of review articles and included trials . In most cases , the first or corresponding author of each included trial was contacted for additional information . Selection criteria The inclusion criteria were RCTs of herbal or dietary therapies as treatment for primary or secondary dysmenorrhoea vs each other , placebo , no treatment or conventional treatment . Interventions could include , but were not limited to , the following ; vitamins , essential minerals , proteins , herbs , and fatty acids . Exclusion criteria were : mild or infrequent dysmenorrhoea or dysmenorrhoea from an IUD . Data collection and analysis Seven trials were included in the review . Quality assessment and data extraction were performed independently by two review ers . The main outcomes were pain intensity or pain relief and the number of adverse effects . Data on absence from work and the use of additional medication was also collected if available . Data was combined for meta- analysis using Peto odds ratios for dichotomous data or weighted mean difference for continuous data . A fixed effects statistical model was used . If data suitable for meta- analysis could not be extracted , any available data from the trial was extracted and presented as descriptive data . Main results MAGNESIUM :  Three small trials were included that compared magnesium and placebo . Overall magnesium was more effective than placebo for pain relief and the need for additional medication was less . There was no significant difference in the number of adverse effects experienced . VITAMIN B6 : One small trial of vitamin B6 showed it was more effective at reducing pain than both placebo and a combination of magnesium and vitamin B6 . MAGNESIUM AND VITAMIN B6 : Magnesium was shown to be no different in pain outcomes from both vitamin B6 and a combination of vitamin B6 and magnesium by one small trial . The same trial also showed that a combination of magnesium and vitamin B6 was no different from placebo in reducing pain .  VITAMIN B1 : One large trial showed vitamin B1 to be more effective than placebo in reducing pain .  VITAMIN E : One small trial comparing a combination of vitamin E ( taken daily ) and ibuprofen ( taken during menses ) versus ibuprofen ( taken during menses ) alone showed no difference in pain relief between the two treatments . OMEGA-3 FATTY ACIDS : One small trial showed fish oil ( omega-3 fatty acids ) to be more effective than placebo for pain relief . JAPANESE HERBAL COMBINATION : One small trial showed the herbal combination to be more effective for pain relief than placebo , and less additional pain medication was taken by the treatment group . Authors ' conclusions Vitamin B1 is shown to be an effective treatment for dysmenorrhoea taken at 100 mg daily , although this conclusion is tempered slightly by its basis on only one large RCT . Results suggest that magnesium is a promising treatment for dysmenorrhoea . It is unclear what dose or regime of treatment should be used for magnesium therapy , due to variations in the included trials , therefore no strong recommendation can be made until further evaluation is carried out . Overall there is insufficient evidence to recommend the use of any of the other herbal and dietary therapies considered in this review for the treatment of primary or secondary dysmenorrhoea With approximately 25 % of dysmenorrheic patients reporting no improvement with nonsteroidal anti-inflammatory drugs , a study was devised to evaluate the effectiveness of a laparoscopic technique for the interruption of the uterosacral nerves . In a double-blind study of 21 patients with primary dysmenorrhea , 81 % ( 9 of 11 ) reported significant relief from menstrual pain after the surgery . Performed as an outpatient procedure , laparoscopic uterine nerve ablation may alleviate dysmenorrheic complaints when other modalities have failed . Half the treated women reported continued relief of menstrual pain at 12 months . These results suggest that uterosacral nerve interruption may prove an effective alternative treatment for this menstrual disorder OBJECTIVE To compare laparoscopic presacral neurectomy and laparoscopic uterine nerve ablation for  primary dysmenorrhea .  STUDY DESIGN Sixty-eight patients with primary dysmenorrhea and a poor response to medical treatment were r and omized into two groups . One group ( 33 patients ) had laparoscopic presacral neurectomy ( LPSN ) and the other group ( 35 patients ) , laparoscopic uterine nerve ablation ( LUNA ) . RESULTS There were no complications , and all the patients left the hospital within 24 hours after surgery . The efficacy of both surgical methods was almost equal ( 87.9 % vs. 82.9 % ) at the 3-month postoperative follow-up visit , but the efficacy of LPSN was significantly better than that of LUNA ( 81.8 % vs 51.4 % ) at the 12-month visit . CONCLUSION LPSN is a valid option for treating primary dysmenorrhea OBJECTIVE To assess the efficacy of laser laparoscopic surgery in the treatment of  pain associated with minimal , mild , and moderate endometriosis . DESIGN A prospect i ve , r and omized , double-blind , and controlled clinical study . SETTING Royal Surrey County Hospital , Guildford , United Kingdom , a referral center for the laser laparoscopic treatment of endometriosis . PATIENTS Sixty-three patients with pain ( dysmenorrhoea , pelvic pain , or dyspareunia ) and minimal to moderate endometriosis . INTERVENTIONS The patients were r and omized at the time of laparoscopy to laser ablation of endometriotic deposits and laparoscopic uterine nerve ablation or expectant management .  Pain symptoms were recorded subjectively and by visual analogue scale . The women were unaware of the treatment allocated as was the nurse who assessed them at 3 and 6 months after surgery . MAIN OUTCOME MEASURE Improvement or resolution of pain symptoms assessed subjectively and by visual analogue score . RESULTS Laser laparoscopy results in statistically significant pain relief compared with expectant management at 6 months after surgery . Sixty-two and a half percent of the lasered patients reported improvement or resolution of symptoms compared with 22.6 % in the expectant group . Results were poorest for minimal disease and , if patients with mild and moderate disease only are included , 73.7 % of patients achieved pain relief . There were no operative or laser complications . CONCLUSIONS Laser laparoscopy is a safe , simple , and effective treatment in alleviating pain symptoms in women with stages I , II , and III endometriosis Summary . Abnormal production of uterine prostagl and ins ( PG ) causes primary dysmenorrhoea and excessive menstrual blood loss ( MBL ) . We measured here MBL in primary dysmenorrhoea and found it to be normal during treatment with opiate analgesics ( 33.5±1.6 ml ; mean±D , n=13 ) , placebo ( 33.4±18.6 ml ; n=8 ) , proquazone ( 31.8±18.0ml ; n=8 ) and indomethacin ( 26.4±18.7 ml ; n=8 ) . Proquazone and indomethacin  relieved pain and other dysmenorrhoeic symptoms similarly in 33 women AIM This paper presents the findings of a study that assessed the effects of acupressure at the Sanyinjiao point on symptoms of primary dysmenorrhoea among adolescent girls . BACKGROUND Dysmenorrhoea is the most common gynaecological disorder among adolescents . Traditional Chinese acupressure derived from acupuncture is a non-invasive technique . Despite renewed interest in the use of acupressure , relatively few studies have been undertaken to examine its effects on primary dysmenorrhoea . METHODS An experimental study was conducted between December 2000 and August 2001 . Participants were female students attending a technical college in Taiwan . None of the 69 participants had a prior history of gynaecological disease or secondary dysmenorrhoea , and all were rated higher than five for pain on a visual analogue scale from 0 to 10 . The experimental group ( n = 35 ) received acupressure at Sanyinjiao ( above the ankle ) while the control group ( n = 34 ) rested for 20 min , while the control group underwent rest in the school health centre for 20 min without receiving acupressure .  Fifty participants ( 30 experimental , 20 control ) completed the 4 - 6-week follow-up session . Five instruments were used to collect pretest and post-test data at each session : ( 1 ) Visual Analogue Scale for pain ; ( 2 ) the Short-Form McGill Pain Question naire ; ( 3 ) the Menstrual Distress Question naire ; ( 4 ) the Visual Analogue Scale for anxiety ; and , for the experimental group only , ( 5 ) the Acupressure Self- Assessment Form . Data were analysed using the chi-square test , two- sample t-test and repeated measures two-way anova . RESULTS Acupressure at Sanyinjiao during the initial session reduced the pain and anxiety typical of dysmenorrhoea . In the self-treatment follow-up session , acupressure at Sanyinjiao significantly reduced menstrual pain but not anxiety . Thirty-one ( 87 % ) of the 35 experimental participants reported that acupressure was helpful , and 33 ( 94 % ) were satisfied with acupressure in terms of its providing pain relief and psychological support during dysmenorrhoea . CONCLUSION The findings suggest that acupressure at Sanyinjiao can be an effective , cost-free intervention for reducing pain and anxiety during dysmenorrhoea , and we recommend its use for self-care of primary dysmenorrhoea BACKGROUND This study investigates the outcomes for women up to 5 years after laparoscopic excision of endometriosis . METHODS In this prospect i ve observational cohort study , 254 women with chronic pelvic pain were referred to two units specializing in minimal access surgical management of endometriosis . Of these , 216 women underwent surgical assessment and 176 were confirmed to have endometriosis .  Question naires and visual analogue scale ( VAS ) scores for dysmenorrhoea , non-menstrual pelvic pain , dyspareunia and dyschesia as well as quality of life instruments ; the EQ-5Dindex and  EQ-5Dvas  ,  Short-Form 12 ( SF-12 ) and  sexual activity question naires were completed pre-operatively . Intra-operative details of revised American Fertility Society ( rAFS ) stage , site of disease , associated tests , duration of surgery and complications were noted . Follow-up was performed by postal question naire and chart review . For women who had further surgery , rAFS stage , site of disease , other procedures and histology were all recorded . RESULTS Pain scores were all significantly reduced at 2 - 5 years for dysmenorrhoea ( median VAS baseline versus follow-up 2 - 5 years ) ; 9 versus 3.3 ( P < 0.0001 ) , non-menstrual pelvic pain 8 versus 3 ( P < 0.0001 ) , dyspareunia 7 versus 0 ( P < 0.0001 ) and dyschesia 7 versus 2 ( P < 0.0001 ) . Quality of life was improved for the EQ-5Dindex ( P = 0.008 and the EQ-5Qvas ( P = 0.03 ) and for sexual function with pleasure ( P = 0.001 ) and habit ( P = 0.012 ) being improved and discomfort being decreased ( P = 0.001 ) . The chance of requiring further surgery as determined by the Kaplan-Meier survival curve was 36 % . A rAFS score of > 70 was predictive of requiring further surgery ( P = 0.03 ) . Of women who had further surgery , endometriosis was found histologically in 68 % . CONCLUSIONS Laparoscopic excision of endometriosis significantly reduces pain and improves quality of life for up to 5 years . The probability of requiring further surgery is 36 % . Return of pain following laparoscopic excision is not always associated with clinical evidence of recurrence OBJECTIVE To identify the prevalence and correlates of three types of pelvic pain ( dysmenorrhoea , dyspareunia , and other chronic pelvic pain [ CPP ] ) in a nationally representative sample of Australian women . DESIGN AND SETTING The CPP survey was part of a broader national study of health and relationships . Computer-assisted telephone interviews were administered to a r and om sample of 8656 Australian households ; 4366 women aged between 16 and 64 years were interviewed in 2004 and 2005 . Eighteen of the more than 200 potential survey questions related to pelvic pain . MAIN OUTCOME MEASURES Self-reports of dysmenorrhoea , dyspareunia , and any other CPP not associated with sexual intercourse or menstruation . RESULTS Data on 1983 women aged 16 - 49 years who were still menstruating and sexually active were analysed . Prevalences were 71.7 % for dysmenorrhoea , 14.1 % for dyspareunia and 21.5 % for other CPP ; 23.3 % of women reported no pelvic pain of any kind . Severe pain was reported by 15.0 % ( 95 % CI , 13.0%-17.1 % ) of women with dysmenorrhoea , 7.8 % ( 95 % CI , 5.0%-11.9 % ) of women with dyspareunia and 20.0 % ( 95 % CI , 16.1%-24.6 % ) of women with other CPP . Just over a third ( 34.2 % ) of women who reported any pain had sought advice from a health professional . Women reporting CPP were also likely to report other health conditions , most notably depression and anxiety . There were clear associations between CPP and sexual difficulties , pregnancy and pregnancy outcomes . CONCLUSIONS Rates of pelvic pain in Australian women are high . General practitioners need to be ready to discuss these issues with patients , particularly in relation to underlying anxiety and depression BACKGROUND Chronic pelvic pain has often been described as a major women 's health issue , but no information exists on the extent of the problem in the United Kingdom . AIM To investigate the community prevalence of chronic pelvic pain and its effect on the lives of consulting and non-consulting women . DESIGN OF STUDY Postal question naire survey . SETTING Women aged 18 to 49 ( n = 3916 ) r and omly selected from the Oxfordshire Health Authority Register . METHOD The question naire response rate ( adjusted for non-deliveries ) was 74 % ( 2304/3106 ) . Chronic pelvic pain was defined as recurrent or constant pelvic pain of at least six months ' duration , unrelated to periods , intercourse , or pregnancy . Case subgroups comprised recent consulters , past consulters , and non-consulters . Women who reported dysmenorrhoea alone formed a comparison group . RESULTS The three-month prevalence of chronic pelvic pain was 24.0 % ( 95 % CI = 22.1 % to 25.8 % ) . One-third of women reported pain that started more than five years ago . Recent consulters ( 32 % of cases ) were most affected by their symptoms in terms of pain severity , use of health care , physical and mental health scores , sleep quality , and pain-related absence from work . Non-consulters ( 41 % of cases ) did not differ from women with dysmenorrhoea in terms of symptom-related impairment . Irrespective of consulting behaviour , a high rate of symptom-related anxiety was found in women with chronic pelvic pain ( 31 % ) compared with women with dysmenorrhoea ( 7 % ) . CONCLUSIONS This study showed a high community prevalence of chronic pelvic pain in women of reproductive age . Cases varied substantially in the degree to which they were affected by their symptoms . The high symptom-related anxiety in these women emphasises the need for more information about chronic pelvic pain and its possible causes Thirty-one patients with primary dysmenorrhoea were treated in a double-blind , six-period , cross-over clinical trial with tiaprofenic acid , naproxen sodium and a placebo in r and omized order , each for 2 consecutive cycles . Complete disappearance of the symptoms or pronounced therapeutic effects were obtained with tiaprofenic acid , naproxen sodium and the placebo in 74 % , 65 % and 35 % of cases , respectively , while these treatments were ineffective in 3 % , 6 % and 38 % of cases , respectively . Tiaprofenic acid was superior to the placebo for relieving pelvic pain and overall discomfort and for reducing the need for bed-rest .  Naproxen sodium compared favourably with the placebo with respect to pelvic pain and overall discomfort . The effects of tiaprofenic acid and naproxen sodium  were not significantly different . Tiaprofenic acid had no side-effects , whereas tiredness was experienced in 3 cases of naproxen sodium treatment . The results indicate that tiaprofenic acid is a useful alternative for the treatment of primary dysmenorrhoea Abstract Background : In clinical trials and non-interventional studies encompassing > 50 000 women , the monophasic , low-dose combined oral contraceptive ( OC ) chlormadinone acetate 2 mg/ethinylestradiol 0.03 mg ( CMA/EE ) has been shown to have various non-contraceptive benefits , as well as contraceptive efficacy and good tolerability . However , there is a paucity of data on use of this OC in young women . Objective : To investigate the relevance of , and changes in , cycle disorders , dysmenorrhoea and skin problems in addition to the efficacy and tolerability of CMA/EE in young women . Methods : In this prospect i ve , observational , non-interventional , multicentre study ( TeeNIS [ Teenager in Non-Interventional Study 2 mg CMA/0.03mgEE ] ) , young women ( ≤20 years of age ) were administered CMA/EE ( Belara ® ) once daily for 21 days ( one blister strip ) , followed by either a 7-day pill-free interval ( conventional cycle regimen ; 89.3 % ) or a pill-free interval after two blister strips or more ( extended cycle regimen ; 3.7 % ) , over a 6-month treatment period . Data on the mode of administration were missing for 7.1 % of patients . The study included a safety population of 7462 patients ( the efficacy population consisted of 6885 patients ) from 886 gynaecological centres throughout Germany . Results : Compared with baseline , CMA/EE intake result ed in significant reductions in the numbers of patients with cycle disorders , i.e. spotting ( −46 % ) , breakthrough bleeding ( −64 % ) , heavy bleeding ( −95 % ) and absence of any bleeding ( secondary amenorrhoea ; −76 % ) [ all p≤ 0.001 ] , and with dysmenorrhoea ( −56 % ) [ p≤ 0.001 ] . Similarly , there was a significant decrease in the number of patients who used analgesics ( −75 % ) , had dysmenorrhoea-associated symptoms ( back pain [ −69 % ] , headache [ −70 % ] , nausea/vomiting [ −85 % ] , diarrhoea [ −80 % ] , mood swings [ −75 % ] or absence from school/job due to dysmenorrhoea [ −92 % ] ) , or were restricted in their leisure/sporting activities because of dysmenorrhoea ( −83 % ) [ all p ≤ 0.001 ] . Another major benefit of CMA/EE was a significant reduction in the number of patients with skin problems ( acne and acne-prone skin ) [ −55 % ; p≤ 0.001 ] . In parallel , the number of patients who needed dermatological treatment  ( −67 % ; p≤ 0.001 ) and  concealer cosmetics  ( −55 % ; p≤ 0.001 ) was significantly reduced , and significantly fewer patients felt that their self-esteem was restricted due to skin problems ( −67 % ; p≤ 0.001 ) . There were no relevant weight changes during the observation period ; mean bodyweight remained virtually constant ( mean weight change < 1 kg ) . At final assessment , physicians ’ expectations were either ‘ completely fulfilled ’ or ‘ exceeded ’ with regard to cycle stability , regular bleeding , dysmenorrhoea , effects on weight , and skin problems in 78–95 % of patients . CMA/EE  provided high contraceptive efficacy with an unadjusted Pearl index of 0.25 , calculated from 41 601 cycles of exposure ; seven out of eight pregnancies were attributable to user failure , thus result ing in an adjusted Pearl index of 0.03 . The tolerability  of CMA/EE was excellent , with no unexpected adverse effects . Conclusions : This observational , non-interventional study in young women showed that CMA/EE had a significantly beneficial effect on cycle disorders , dysmenorrhoea and skin disorders , and confirmed the good efficacy and tolerability of this combined OC Summary Dysmenorrhoea is painful menstruation that occurs in 45–72 % of all women . This was a prospect i ve r and omised study of the efficacy of etoricoxib ( Arcoxia ® ) compared with mefenamic acid ( Ponstan ® ) in treating primary dysmenorrhoea . All single , sexually inactive women with primary dysmenorrhoea were r and omised into two groups ( mefenamic acid and etoricoxib ) of pain relief and underwent a cross-over study . The success of treatment as evidence d by pain relief , the side-effects and complications were observed and analysed . Some 80 % ( 20 women ) had significantly better pain relief with etoricoxib , compared with only 20 per cent in the mefenamic acid group ( p = 0.007 ) . Etoricoxib  has significantly fewer side-effects compared with mefenamic acid ( p = 0.005 ) with significantly reduced menstrual blood loss ( p = 0.025 ) . In conclusion , etoricoxib is a better treatment for primary dysmenorrhoea with better pain relief , less menstrual blood loss and fewer side-effects compared with mefenamic acid OBJECTIVE To determine the analgesic efficacy and safety of a single oral dose of aceclofenac 100 mg and compare that with placebo and naproxen 500 mg in women with primary dysmenorrhoea . STUDY DESIGN In this double-blind , prospect i ve , multicentre , r and omised , three-way , crossover study , women were r and omly assigned to receive one of six treatment sequences , comprising single oral doses of aceclofenac 100 mg , naproxen 500 mg or placebo , when menstrual pain reached a predetermined level of severity . A single dose of the assigned study medication was taken on three menstrual periods ; a different medication was taken on each treatment day . Analgesic efficacy was determined by self-reported analgesia scoring and participants ' and investigators ' global evaluation of treatment effectiveness . Measurements also included physical examination and adverse events . RESULTS Total pain relief scores were not statistically significantly different for aceclofenac and naproxen , and both were statistically significantly more effective than placebo ( p = 0.019 and 0.002 , respectively ) . This finding was supported by secondary endpoints including sum of pain intensity differences ( SPID/8 ) , peak analgesia ( peak pain intensity and peak pain relief ) , and participants ' and investigators ' overall evaluation of effectiveness . Both aceclofenac and naproxen were well tolerated . CONCLUSIONS Aceclofenac ( 100 mg ) and naproxen ( 500 mg ) effectively treated the pain associated with primary dysmenorrhoea , and both were more effective than placebo at easing menstrual pain assessed by various pain relief criteria BACKGROUND Little is known about the precise nature of the relationship between dysmenorrhoea ( DM ) and endometriosis . Our aim was to evaluate the relationship between the severity of DM in women with posterior deep infiltrating endometriosis ( DIE ) and indicators of the extent of their disease . METHODS Various indicators of the extent of DIE were recorded during surgery in 209 women . The severity of their DM was assessed with a  pain scale .  The scale was retrospective for 155 women and prospect i ve for 54 . Correlations were sought with an ordinal logistic regression model with cumulative odds . RESULTS On univariate analysis the following variables were related to the severity of DM : number of previous surgical procedures for endometriosis ; revised American Fertility society classification ; extensiveness of adnexal adhesion ; Douglas obliteration ; size of the posterior DIE implant ; extent of the sub-peritoneal infiltration by the posterior DIE ( rectal , vaginal or both versus sub-peritoneal only ) . Current infertility was associated with less severe DM . After multiple regression analysis , presence of a rectal or vaginal infiltration by the posterior DIE and extensiveness of adnexal adhesion were the only factors that remained related to DM severity . CONCLUSIONS The concept of ' very deep infiltrating endometriosis ' , defined as implants invading the wall of the pelvic organ , should be tested in future classification systems specifically addressed to the prediction of endometriosis-related pain Abstract Objective : To evaluate the effectiveness and safety of endometrial laser ablation and transcervical resection of the endometrium compared with hysterectomy in the surgical treatment of women with dysfunctional uterine bleeding .  Design : Prospect i ve r and omised controlled trial . Setting : Gynaecology department of a large teaching hospital . Subjects : 204 women who would otherwise have been undergoing hysterectomy for menorrhagia were recruited between August 1990 and March 1992 and r and omly allocated to hysterectomy ( n=99 ) or conservative ( hysteroscopic ) surgery ( transcervical resection ( n=52 ) and laser ablation ( n=53 ) ) . Main outcome measures : Operative complications , postoperative recovery , relief of menstrual and other symptoms , patient satisfaction with treatment after six and 12 months . Results - Women treated by hysteroscopic surgery had less early morbidity and a significantly shorter recovery period than those treated by hysterectomy ( median time to full recovery 2 - 4 weeks v 2 - 3 months , P<0.001 ) . Twelve months later 17 women in the hysteroscopy group had had a hysterectomy , 11 for continuing symptoms ; 11 women had had a repeat hysteroscopic procedure ; 45 were amenorrhoeic or had only a brown discharge ; and 35 had light periods . Dysmenorrhoea and premenstrual symptoms improved in most women in both groups . After 12 months 89 % ( 79/89 ) in the hysterectomy group and 78 % ( 75/96 ) in the hysteroscopy group were very satisfied with the effect of surgery ( P<0.05 ) ; 95 % ( 85/89 ) and 90 % ( 86/96 ) thought that there had been an acceptable improvement in symptoms , and 72 % ( 64/89 ) and 71 % ( 68/96 ) would recommend the same operation to others . Conclusions : Hysteroscopic endometrial ablation was superior to hysterectomy in terms of operative complications and postoperative recovery . Satisfaction after hysterectomy was significantly higher , but between 70 % and 90 % of the women were satisfied with the outcome of hysteroscopic surgery . Hysteroscopic surgery can be recommended as an alternative to hysterectomy for dysfunctional uterine bleeding The objective of this study is to describe a technique for preserving the autonomic nerve systematic ally , including the hypogastric nerves , pelvic splanchnic nerves , and pelvic plexus and its vesical branches , based on anatomic considerations for the autonomic nerves innervating the urinary bladder , in radical hysterectomies and to assess postsurgical bladder function . A nerve-sparing radical hysterectomy was carried out on 27 consecutive patients with uterine cervical cancer treated between 2000 and 2002 . The FIGO stages of the disease consisted of 10 stage Ib1 , 6 stage Ib2 , 3 stage IIa , and 8 stage IIb . The nerve-sparing procedure was successfully completed in 22 of the 27 patients ( 81.5 % ) in the study . At 1 year after the operation , bladder symptoms were significantly improved in the nerve-sparing group compared to the non – nerve-sparing group . Urinary incontinence and abnormal ( diminished ) bladder sensation were observed in three of the five patients ( two patients had both symptoms ) , for whom the nerve-sparing procedure could not be performed , but none of the 22 patients for whom the nerve-sparing procedure was performed had incontinence , and only two patients had abnormal ( increased ) bladder sensation ( P = 0.0034 for incontinence and P = 0.030 for abnormal bladder sensation ) . The patients ' survival was not adversely affected by the nerve-sparing procedure . Although it is still preliminary , the surgical technique described in this report is thought to be effective for preserving bladder function , and thus , the quality of life could be improved for patients with cervical cancer who are treated with a radical hysterectomy . For further evaluation of the efficacy of nerve-sparing radical hysterectomy , a prospect i ve r and omized trial needs to be performed Summary The efficacy of indomethacin , a prostagl and in synthetase inhibitor , in  severe dysmenorrhoea  was established in a double-blind crossover study using aspirin and placebo as the control drugs . Forty-seven female undergraduates were treated twice with each of the three substances during six consecutive menstrual cycles . Good or moderate relief was achieved in 71 % of the cycles treated with indomethacin , in 40 % of those treated with aspirin and in 21 % of those treated with the placebo .  Dizziness and drowsiness were cited by 14 patients ( 30 % ) as side-effects of indomethacin , none of these patients discontinued the therapy because all obtained good or moderate relief from dysmenorrhoea .  Indomethacin proved to be a valuable agent , and significantly better than aspirin in the treatment of dysmenorrhoea . It allowed many dysmenorrhoeic women to carry out their normal activities and work during the menstrual period OBJECTIVE Aim of our study was to evaluate the effectiveness of the association between N-Palmitoylethanolamine and transpolydatin in the management of  chronic pelvic pain related to EMS . STUDY DESIGN This was a r and omized , double-blind , parallel-group , placebo-controlled clinical trial involving 61 subjects , su bmi tted to a first line laparoscopic conservative surgery , who were r and omized into 3 groups receiving : group A ( n=21 ) the association N-Palmitoylethanolamine-transpolydatin 400 mg + 40 mg twice a day for 3 months ; group B ( n=20 ) the placebo for 3 months ; group C ( n=20 ) a single course of Celecoxib 200 mg twice a day for 7 consecutive days . Assessment s of the severity of pelvic endometriosis ( pelvic pain , dysmenorrhoea and dyspareunia ) were recorded before and after treatment on a question naire and a 10-point VAS . Differences between groups were verified with Kruskal-Wallis ANOVA for non-parametric multiple comparisons . RESULTS A marked decrease in dysmenorrhoea , dyspareunia and pelvic pain was observed in all groups , and the association between N-Palmitoylethanolamine and transpolydatin result ed to be more effective than placebo ( P<.001 ) . Additionally , the treatment with Celecoxib result ed in a decrease in pelvic pain more effective either than the association N-Palmitoylethanolamine and transpolydatin or placebo . CONCLUSION These preliminary results show that the association between micronized N-Palmitoylethanolamine and transpolydatin is effective in the management of pelvic pain related to endometriosis after laparoscopy . Additionally , this association seems to be safe , shows an optimal control of pain and can be used in patients who are unable to receive other therapies AIM AND OBJECTIVES To examine a comparison between Hegu and Sanyinjiao matched points and Hegu , Zusanli single point on adolescent girls ' menstrual distress , pain and anxiety perception . BACKGROUND Primary dysmenorrhoea is a major cause of temporary disability , with a prevalence ranging from 60 - 93 % , depending upon the population and study . No one has yet compared the effects of single point and multiple point acupressures . Design . A single blind r and omised experimental study was used . METHODS Adolescents ( n = 134 ) r and omly assigned to experimental groups Zusanli ( n = 30 ) , Hegu ( n = 33 ) and Hegu-Sanyinjiao Matched Points ( n = 36 ) received acupressure intervention protocol for 20 minutes , while the control group ( n = 35 ) did not receive any acupressure intervention . Four instruments were used to collect data : ( 1 ) the Visual Analog Scale for Pain ; ( 2 ) the Menstrual Distress Question naire Short Form ; ( 3 ) the Short-Form McGill Pain Question naire and ( 4 ) the Visual Analog Scale for Anxiety . RESULTS During the six-month follow-up , acupressure at matched points Hegu and Sanyinjiao reduced the pain , distress and anxiety typical of dysmenorrhoea . Acupressure at single point Hegu was found , effectively , to reduce menstrual pain during the follow-up period , but no significant difference for reducing menstrual distress and anxiety perception was found . Zusanli acupressure had no significant effects of reducing menstrual pain , distress and anxiety perception . CONCLUSION This controlled trial provides preliminary evidence that six-month acupressure therapy provides female adolescents with dysmenorrhoea benefits . RELEVANCE TO CLINICAL PRACTICE Acupressure is an effective and safe non-pharmacologic strategy for the treatment of primary dysmenorrhoea . We recommend the use of acupressure for self-care of primary dysmenorrhoea at Hegu and Sanyinjiao matched points and single point Hegu , as pressure placement at these points is easy for adolescent girls to learn and practice 1 In a double-blind crossover study , flurbiprofen produced marked relief of pain which was significantly more than with aspirin and placebo in patients suffering from primary dysmenorrhoea . In contrast , there was no significant difference between the relief of pain obtained with aspirin and placebo . 2 The clinician 's overall assessment of efficacy also indicated that flurbiprofen produced better response as compared to aspirin and placebo in these patients with dysmenorrhoea . 3 Both flurbiprofen and aspirin did not produce any apparent adverse effects on blood loss during the menstrual period . 4 In conclusion , the analgesic effect of flurbiprofen seen in this trial establishes the therapeutic usefulness of the drug in the treatment of primary dysmenorrhoea Two prostagl and in synthesis inhibitors , fluproquazone ( 100 mg ) and indomethacin ( 25 mg ) , were compared in a double-blind , crossover study for treatment of primary dysmenorrhoea in 31 patients . Each drug was used during two consecutive menstruations in r and omized order . Both treatments significantly relieved spasmodic pains and other dysmenorrhoeic symptoms . No significant differences were found between the treatments in regard to the overall efficacy assessed at the end of each treated cycle . However , 20 patients preferred indomethacin and 7 patients fluproquazone . Three patients reported mild side-effects with fluproquazone as compared to five patients wih indomethacin . It is concluded that both treatments can be used for treatment of primary dysmenorrhoea The CORONIS Trial was a 2 × 2 × 2 × 2 × 2 non-regular , fractional , factorial trial of five pairs of alternative caesarean section surgical techniques on a range of short-term outcomes , the primary outcome being a composite of maternal death or infectious morbidity . The consequences of different surgical techniques on longer term outcomes have not been well assessed in previous studies . Such outcomes include those related to subsequent pregnancy : mode of delivery ; abnormal placentation ( e.g. accreta ) ; postpartum hysterectomy , as well as longer term pelvic problems : pain , urinary problems , infertility . The Coronis Follow-up Study aims to measure and compare the incidence of these outcomes between the r and omised groups at around three years after women participated in the CORONIS Trial . This study will assess the following null hypotheses : In women who underwent delivery by caesarean section , no differences will be detected with respect to a range of long-term outcomes when comparing the following five pairs of alternative surgical techniques evaluated in the CORONIS Trial : Blunt versus sharp abdominal entry Exteriorisation of the uterus for repair versus intra-abdominal repair Single versus double layer closure of the uterus Closure versus non-closure of the peritoneum ( pelvic and parietal ) Chromic catgut versus Polyglactin-910 for uterine repair Blunt versus sharp abdominal entry Exteriorisation of the uterus for repair versus intra-abdominal repair Single versus double layer closure of the uterus Closure versus non-closure of the peritoneum ( pelvic and parietal ) Chromic catgut versus Polyglactin-910 for uterine repair The outcomes will include ( 1 ) women ’s health : pelvic pain ; dysmenorrhoea ; deep dyspareunia ; urinary symptoms ; laparoscopy ; hysterectomy ; tubal/ovarian surgery ; abdominal hernias ; bowel obstruction ; infertility ; death . ( 2 ) Outcomes of subsequent pregnancies : inter-pregnancy interval ; pregnancy outcome ; gestation at delivery ; mode of delivery ; pregnancy complications ; surgery during or following delivery . The results of this follow-up study will have importance for all pregnant women and for health professionals who provide care for pregnant women . Although the results will have been collected in seven countries with limited health care re sources ( Argentina , Chile , Ghana , India , Kenya , Pakistan , Sudan ) any differences in outcomes associated with different surgical techniques are likely to be generalisable throughout the world . IS RCT Abstract Background : The aim of this study was to investigate and evaluate the efficacy of Rheum emodi in the management of primary dysmenorrhoea .  Methods : A r and omized , single-blind , st and ard controlled trial compared efficacy of R. emodi against mefenamic acid on diagnosed subjects of primary dysmenorrhoea for three consecutive cycles . Experimental group ( n=30 ) received capsules of R. emodi powder two times a day , two days before the expected date of menstruation , and continued first three days of menstruation , while control group ( n=15 ) participants received mefenamic acid capsules three times a day on the same protocol . The primary outcome measures were reduced in severity and duration of pain , assessed by visual analogue scale ( VAS ) and verbal multidimensional scoring system ( VMSS ) , and secondary outcome measures were overall improvement of dysmenorrhoea and improved in quality of life ( QOL ) . Statistical analysis was done by repeated measures analysis of variance and Chi-square/Fisher Exact test . Results : The menstrual pain was significantly decreased in both groups after three-cycle intervention . Significant changes were observed in VAS ( p<0.001 ) and VMSS ( p<0.001 ) in the experimental group . There is a significant ( p<0.001 ) reduction in duration of pain in both the groups . Associated symptoms and QOL were markedly improved after treatment ( p<0.001 ) . Conclusions : It has been clear from the above result that R. emodi is an effective herb in alleviating symptoms of primary dysmenorrhoea . It can serve as an alternative treatment without any apparent side effects . These results deserve further investigations
MAIN RESULTS For the treatment of primary dysmenorrhoea there is some evidence of the effectiveness of uterine nerve ablation ( UNA ) when compared to a control of no treatment .
The comparison between UNA with presacral neurectomy ( PSN ) for primary dysmenorrhoea showed no significant difference in pain relief in the short term , however long term PSN was shown to be significantly more effective .
The treatment of UNA combined with surgical treatment of endometrial implants versus surgical treatment of endometriosis alone showed that the addition of UNA did not aid pain relief .
For PSN combined with endometriosis treatment versus endometriosis treatment alone there was also no overall difference in pain relief , although the data suggests a significant difference in relief of midline abdominal pain .
Adverse events were significantly more common for presacral neurectomy , however the majority were complications such as constipation , which may spontaneously improve .
REVIEW ER 'S CONCLUSIONS There is insufficient evidence to recommend the use of nerve interruption in the management of dysmenorrhoea , regardless of cause .
BACKGROUND Dysmenorrhoea is the occurrence of painful menstrual cramps of uterine origin and is a very common gynaecological complaint .
Medical therapy for dysmenorrhoea includes oral contraceptive pills ( OCP ) and nonsteroidal anti-inflammatory drugs ( NSAIDS ) which both act by suppressing prostagl and in levels .
While these treatments are very successful there is still a 20 - 25 % failure rate and surgery has been an option for cases of dysmenorrhoea that fail to respond to medical therapy .
Uterine nerve ablation ( UNA ) and presacral neurectomy ( PSN ) are two surgical treatments that have become increasingly utilised in recent years .
These procedures both interrupt the majority of the cervical sensory nerve fibres , thus diminishing uterine pain .
Uncontrolled studies have supported the use of these procedures for primary dysmenorrhoea however both operations only partially interrupt some of the cervical sensory nerve fibres in the pelvic area ; therefore dysmenorrhoea associated with additional pelvic pathology may not always benefit from this type of surgery .
OBJECTIVES To assess the effectiveness of surgical interruption of pelvic nerve pathways as treatment for primary and secondary dysmenorrhoea , and to determine the most effective surgical treatment .