Self‐report pain and symptom measures for primary dysmenorrhoea: A critical review

Primary dysmenorrhoea (PD) is highly prevalent among women of reproductive age and it can have significant short‐ and long‐term consequences for both women and society as a whole. Validated symptom measures are fundamental for researchers to understand women's symptom experience of PD and to test symptom interventions. The objective of this paper was to critically review the content and psychometric properties of self‐report tools to measure symptoms of PD. Databases including PubMed, PsychoINFO, Cumulative Index of Nursing and Allied Health Literature, and Health and Psychosocial Instruments were searched for self‐report symptom measures that had been used among women with either PD or perimenstrual symptoms. A total of 15 measures met inclusion criteria and were included in the final analysis. The measures were categorized into generic pain measures, dysmenorrhoea‐specific measures, and tools designed to measure perimenstrual symptoms. These measures had varying degrees of comprehensiveness of symptoms being measured, relevance to PD, multidimensionality and psychometric soundness. No single measure was found to be optimal for use, but some dysmenorrhoea‐specific measures could be recommended if revised and further tested. Key issues in symptom measurement for PD are discussed. Future research needs to strengthen dysmenorrhoea‐specific symptom measures by including a comprehensive list of symptoms based on the pathogenesis of PD, exploring relevant symptom dimensions beyond symptom severity (e.g., frequency, duration, symptom distress), and testing psychometric properties of the adapted tools using sound methodology and diverse samples

Involvement of Prostaglandins in the Pathophysiology of Endometriosis

Prostaglandins are bioactive lipids that possess multiple and diverse functions. In reproductive biology, they are involved in the regulation of ovulation, in endometrial physiology and in the process of menstruation. Furthermore, cyclooxygenases (COX) levels, which are key enzymes for the synthesis of prostaglandins, have been found to be elevated in pathologic, tumoral and inflammatory processes. In endometriosis, prostaglandins are not only implicated in pain, but they are also critical for the establishment as well as for the development of the disease. The high levels of prostaglandin E2 (PGE2) found in the peritoneal fluid from patients with endometriosis, not only favor cellular proliferation by stimulating the activity of aromatase with the consequent estrogen production, but also these estrogens are responsible for enhancing PGE2 synthesis by stimulating COX-2 activity. PGE2 also stimulates angiogenesis and is implicated in the peritoneal immunologic alterations observed in endometriosis. COX-2 inhibitors were and are used in a vast number of preclinical and clinical studies in different types of cancer. In studies conducted both in vitro and in vivo, we have demonstrated that the selective COX-2 inhibitor, celecoxib, was efficient in inhibiting experimental endometriosis. It is important to search for new horizons in endometriosis treatment. Prostaglandins and the enzymes in charge of their synthesis, COXs, represent an attractive target for developing new therapies that attack directly the molecules involved in the causes of this pathology.Fil: Meresman, Gabriela Fabiana. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; ArgentinaFil: Olivares, Carla Noemi. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental. Fundación de Instituto de Biología y Medicina Experimental. Instituto de Biología y Medicina Experimental; Argentin

Serum levels of prostaglandins Е2 and F2α in patients with primary dysmenorrheal

Catedra de Obstetrică şi Ginecologie a USMF “N. Testemiţanu”Dysmenorrhoea is a common gynecological problem representing painful cramps accompanying menstruation which in the absence of underlying pathology is called primary dysmenorrhea. Progresses in studying the biochemistry of prostaglandins and their role in the pathophysiology of primary dysmenorrhea have established a rational basis for this disorder. The present study was designed to investigate serum levels of prostaglandin F2α and Е2 in patients with primary dysmenorrhea, to assess their role in the pathogenesis of these pathology. Our results show higher serum concentrations of PGE2 and PGF2α in patients with primary dysmenorrhea, compared with patients without dysmenorrhea. For patients with primary dysmenorrhea is characteristic increased plasma levels of PGE2 and PGF2α in the first phase of the menstrual cycle, when there is the maximum expression of clinical symptoms, compared with phase II of the menstrual cycle. These data suggest the importance of PGE2 and PGF2α in the pathogenesis of primary dysmenorrhea. Dismenoreea primară este caracterizată prin crampe menstruale dureroase, fără o patologie organică pelvină depistabilă macroscopic. Progresele obţinute în studierea biochimiei prostaglandinelor şi a rolului lor în fiziopatologia dismenoreei primare au stabilit o bază raţională pentru această dereglare. Studiul a fost destinat investigării nivelului seric al prostaglandinelor Е2 şi F2α la pacientele cu dismenoree primară, pentru aprecierea rolului lor în patogeneza patologiei respective. Rezultatele noastre demonstrează o concentraţie serică mai mare a PGE2 şi PGF2α la pacientele cu dismenoree primară, comparativ cu pacientele fără dismenoree faptul, pentru pacientele cu dismenoree primară este caracteristică creşterea concentraţiei PGE2 şi PGF2α în prima fază a ciclului menstrual când expresia simptomelor clinice este maximă, comparativ cu faza a II-a a ciclului menstrual. Aceste date sugerează importanţa PGE2 şi PGF2α în patogeneza dismenoreei primare

THE INFLUENCE OF OXYTOCIN ON THE PRODUCTION OF PROSTAGLANDINS IN VITRO AND IN VIVO

Peer Reviewe

Huge Benign Granulosa Cell Tumour In A 61 Year Old Nigerian Grandmultipara With Late Presentation

Objective: To re-appraise clinicians that huge ovarian lesions with features of malignancies may still be benign and that late presentation is a problem in genital cancer management that should be addressed. Subject, material and method: A case report of a huge benign granulosa cell tumour in a postmenopausal woman is presented. Results: She presented as a case of a huge right ovarian tumour with weight loss, respiratory and abdominal discomfort one year after initial diagnosis was made because of fear of surgery. She had laparotomy, total abdominal hysterectomy and bilateral salpingoophorectomy. Histology revealed granulosa cell tumour of the benign type. Conclusion: Huge ovarian tumours in the elderly could be benign. In the absence of proper screening technique for ovarian cancers, laparotomy for histological purposes is required. Health education and proper counselling is imperative to reduce delays of patients to hospitals. Key Words: Huge, benign, granulosa cell tumour, 61 year old, Late presentation

Cortical and Psychological Mechanisms of Visceral Pain

Objective: Dysmenorrhea is an incapacitating type of visceral pain that affects numerous menstruating women and is defined by painful menstrual cramps and often occurs in the absence of pelvic pathology. Women with dysmenorrhea have reported higher sensitivity to experimental pain, and vulnerability to pain sensitivity may be a primary risk factor for developing chronic pelvic pain for women with dysmenorrhea. Cross-organ sensitization (COS), or the theory that uterine inflammation during menstruation can contribute to chronic pelvic pain by generating neurogenic inflammation in other organs, may be a primary mechanism associated with pelvic pain in women with dysmenorrhea. Dysmenorrhea sufferers with cross-organ sensitization (D+COS), compared to those without COS, are theorized to experience higher rates of chronic visceral pain and are more susceptible to experimentally-induced pain. The implications of long-term pain sensitivity have been theorized to increase susceptibility to other chronic, visceral pain conditions, and these conditions are associated with higher rates of depression and other mood disorders. Frontal activity during pain has been linked to attentional processing, with both the right and left dorsolateral prefrontal cortices (dlPFC) negatively correlated with intensity perception and unpleasantness. However, most visceral pain research has focused on gastrointestinal disorders, making it important to identify pain mechanisms in women with dysmenorrhea. Since dysmenorrhea, depression, and somatization are associated with abnormalities in frontal cingulate networks, and given the emerging evidence supporting an association between affect and pain, it is necessary to account for the potential effects on regional brain function that may be associated with co-occurring psychological symptoms in individuals experiencing dysmenorrhea. The results of the present study provide evidence that psychological symptoms and brain activity predict increased levels of visceral pain, specifically for women with dysmenorrhea and cross-organ sensitization (COS). Results showed that somatization, depression, and frontal beta activity account for a significant amount of variance, yet somatization is the only significant link between women suffering from D+COS and bladder pain. Thus, based on these results, somatization emerged as the candidate risk factor for developing chronic pelvic pain, and somatic symptoms should be considered a primary target for prevention and intervention strategies

Comparing the Effects of Aerobic and Stretching Exercises on the Intensity of Primary Dysmenorrhea in the Students of Universities of Bushehr

Objective: To compare the effects of aerobic and stretching exercises on severity of primary dysmenorrhea. Materials and methods: This randomized clinical trial was conducted on 105 female students who were suffering from primary dysmenorrhea. The participants were divided into aerobic exercise, stretching exercise, and control groups. The two intervention groups did the exercises three times a week for eight weeks (two menstrual cycles). The intensity of dysmenorrhea was determined using a modified questionnaire that assessed several symptoms of dysmenorrhea. After all, the data were compared between and within groups through analysis of variance. Results: Before the intervention, the mean intensity of dysmenorrhea was 40.38 ± 5.5, 37.40 ± 3.8, and 38.45±3.3 in aerobic, stretching, and control groups, respectively, but the difference was not statistically significant. After the intervention, however, a significant difference was found among the three groups regarding the mean intensity of dysmenorrhea in the first and second menstrual cycles. Also, a significant difference was observed between the aerobic group and the control group as well as between the stretching group and the control group. Within group comparisons showed a significant difference in the aerobic and the stretching group before and after the interventions. However, no such difference was observed in control group. Conclusion: Both aerobic and stretching exercises were effective in reducing the severity of dysmenorrhea. Therefore, women could choose one of these two methods with regard to their interest and lifestyl

Febrile syndrome in pregnancy, childbirth and post-partum period

Catedra Obstetrică – Ginecologie FECMF USMF „Nicolae Testemiţanu”Today, in the most of countries in the world, according to the exigencies of qualitative medical care, in different domains of medicine, standardized clinical protocols have been introduced. As a result of this tendency, according to the Order of Health Care Ministry of Republic of Moldova, we offer to all obstetricians and gynaecologists a protocol of medical care which reffers to febrile syndrome in pregnancy, childbirth and post- partum period. Actualmente, în toate ţările lumii, în conformitate cu exigenţele asistenţei medicale de calitate se introduc protocoale clinice standardizate în diverse domenii ale medicinii. Drept urmare a acestei tendinţe, în conformitate cu Ordinul Ministerului Sănătăţii al Republicii Moldova pentru obstetricienii-ginecologi propunem protocolul de asistenţă medicală care vizează Sindromul febril în sarcină, naştere şi perioada post-partum

Comparing the Effects of Aerobic and Stretching Exercises on the Intensity of Primary Dysmenorrhea in the Students of Universities of Bushehr

Objective: To compare the effects of aerobic and stretching exercises on severity of primary dysmenorrhea. Materials and methods: This randomized clinical trial was conducted on 105 female students who were suffering from primary dysmenorrhea. The participants were divided into aerobic exercise, stretching exercise, and control groups. The two intervention groups did the exercises three times a week for eight weeks (two menstrual cycles). The intensity of dysmenorrhea was determined using a modified questionnaire that assessed several symptoms of dysmenorrhea. After all, the data were compared between and within groups through analysis of variance. Results: Before the intervention, the mean intensity of dysmenorrhea was 40.38 ± 5.5, 37.40 ± 3.8, and 38.45±3.3 in aerobic, stretching, and control groups, respectively, but the difference was not statistically significant. After the intervention, however, a significant difference was found among the three groups regarding the mean intensity of dysmenorrhea in the first and second menstrual cycles. Also, a significant difference was observed between the aerobic group and the control group as well as between the stretching group and the control group. Within group comparisons showed a significant difference in the aerobic and the stretching group before and after the interventions. However, no such difference was observed in control group. Conclusion: Both aerobic and stretching exercises were effective in reducing the severity of dysmenorrhea. Therefore, women could choose one of these two methods with regard to their interest and lifestyle

Primary dismernoria among teenager girls on the background of non-differentiated dysplasia of connecting tissue

Objective of the study: to identify the features of the primary dysmenorrhea clinic among adolescent girls with connective tissue dysplasia. The mean value of the rank index of pain in the main group is higher than in the comparison group. The emotional component prevailed in the inner picture of the perception of pain. Psycho-emotional status was distinguished by a high level of average score of reactive and personal anxiety. Summary. Systemic pathology associated with connective tissue dysplasia increases the clinical course of primary dysmenorrhea among adolescents, which gives grounds to differentiate the treatment and diagnostic algorith