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 .
Surgical treatment of primary dysmenorrhea with laparoscopic uterine nerve ablation.
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
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 .