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 .
Addition of laparoscopic uterine nerve ablation to laparoscopic bipolar coagulation of uterine vessels for women with uterine myomas and dysmenorrhea.
STUDY OBJECTIVE To assess the effectiveness of laparoscopic uterine nerve ablation ( LUNA ) in women with dysmenorrhea caused by uterine myomas treated by laparoscopic bipolar coagulation of uterine vessels ( LBCUV ) .  DESIGN Prospect i ve , r and omized , longitudinal study ( Canadian Task Force classification II-1 ) . SETTING Private practice , university-affiliated hospital . PATIENTS Eighty-five women with uterine leiomyomas and associated dysmenorrhea . INTERVENTION Laparoscopic bipolar coagulation of uterine vessels with or without LUNA . MEASUREMENTS AND MAIN RESULTS Of 85 patients who entered the study , 41 were assigned to undergo LBCUV-LUNA ( group A ) , which was successful in 40 ( 97.6 % ) . In 44 women assigned to have LBCUV only ( group B ) , 43 ( 97.7 % ) underwent successful surgery . Eighty women completed 1- , 3- , and 6-month follow-up ( 38 group A , 42 group B ) . The groups did not differ significantly in age , history of abdominopelvic surgery , intraperitoneal adhesions , endometriosis , concomitant surgery , and operating time . Seven ( 18.4 % ) of 38 women in group A and 12 ( 28.6 % ) of 42 in group B experienced lower abdominal pain postoperatively . Acceptable pain was defined as a score of zero or 1 : 31 and 30 women in groups A and B reported scores of zero ; 3 and 2 reported scores of 1 ; 4 and 8 reported scores of 2 ; zero and 2 reported scores of 3 ; and no patients reported scores of 4 . The frequency and severity of postoperative pain were less in group A than in group B ( both p < 0.05 ) . The efficacy of both methods was almost equal in shrinking the uterus and dominant myoma , and in improving menorrhagia and bulk-related symptoms . Dysmenorrhea improvement was 84.2 % and 61.9 % in groups A and B at 3 months and 92.1 % and 73.8 % at 6 months , respectively . This was more significant in group A than in group B ( p < 0.05 ) . CONCLUSION Our results suggest that LUNA may decrease postoperative ischemic pain and improve dysmenorrhea associated with uterine myomas treated by LBCUV
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 .