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This article summarizes Professor TIAN Conghuo 's key points and features of acupuncture for primary dysmenorrhea. Professor TIAN believes that the location of dysmenorrhea is in the uterus, and the fundamental pathogenesis is the disharmony of both form and spirit. During clinical treatment, he first conducts abdominal palpation, often detecting cord-like nodules around Guilai (ST 29), Huangshu (KI 16), and Zigong (EX-CA 1). Needling reaches the depth of these nodules. Additionally, the use of four acupoints around the navel (Shuifen [CV 9], bilateral Huangshu (KI 16), and Yinjiao [CV 7]), and four back- shu points (Ganshu [BL 18], Pishu [BL 20], Shenshu [BL 23], and Geshu [BL 17]) is applied to regulate the spirit and strengthen the body. Point selection is further based on syndrome differentiation. The "Three layers" needling technique is used, emphasizing the mental and emotional state of the patients, calming the spirit and regulating qi and blood, to achieve a harmonious treatment of both form and spirit for dysmenorrhea.

Background: Primary dysmenorrhea (PD) is one of the most common pains experienced by women. Stress Inoculation Training (SIT) is a cognitive-behavioral technique that immunizes them against future periods of stress. The purpose of this research is to investigate the effectiveness of a computer-based stress inoculation approach on pelvic pain, depression, and anxiety symptoms in students with PD., Methods: The present study is a clinical trial conducted on 100 students with PD. The SIT intervention consisted of eight consecutive sessions. The content of the sessions was created as multimedia on a computer platform of a site. In each session, several interactive questions were asked about the topics of that session, and participants answered them, with responses recorded in the system. Then, each individual session, lasting about 50 min, was sent as a link (offline) to a participant. Data collection tools included the demographics Checklist, McGill Pain Questionnaire (MPQ), Moos Menstrual Distress Questionnaire (MMDQ), Hospital Anxiety and Depression Scale (HADS), Pain Self-Efficacy Questionnaire (PSEQ), and Perceived Stress Scale (PSS-14), which were completed on the second menstrual day of the cycle before the study and for three consecutive cycles after the intervention by each student. The data were analyzed using chi-square, generalized linear mixed models (GLMM), and multiple linear regression tests. The significance level was set at P < 0.05., Results: The results of the GLMM test showed that the SIT intervention decreased depression (p = 0.002), anxiety (p = 0.001), menstrual distress (p = 0.001), pain intensity (p = 0.003), and perceived stress (p = 0.002), while it increased pain self-efficacy (p = 0.001). Based on multiple linear regression analysis, the main predictors of depression were the student's age and residence in a dormitory (β=-0.255, p = 0.047 and β=-0.376, p = 0.005, respectively). The factors influencing pain self-efficacy were birth rank and the type of university admission (β=-0.351, p = 0.027 and β=-0.249, p = 0.030, respectively). In the presence of confounding variables, increasing age and living in a dormitory were risk factors that increased depression, while studying with tuition fees and a higher birth rank were associated with decreased self-efficacy., Conclusion: The computer-based SIT was effective in reducing pelvic pain, and psychological factors, and in increasing pain self-efficacy in students with primary dysmenorrhea. Therefore, it can be used as a useful solution to manage complications associated with primary dysmenorrhea., Trial Registration: IRCT20230130057274N5 Date of registration: 2024-04-29 Retrospectively registered., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Ethics Committee of Babol University of Medical Sciences (IR.MUBABOL.REC.1400.184), and registered in the IRCT (IRCT20230130057274N5). Participants signed a written informed consent form before taking part in the study, in accordance with the guidelines of the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Dysmenorrhea is a common gynecological condition that is further divided into two categories, namely primary and secondary dysmenorrhea. Traditional Chinese Medicine (TCM) gives good clinical results for the treatment of dysmenorrhea based on the basic principles of holistic view and syndrome differentiation. However, presently, the clinical practice guidelines in TCM for dysmenorrhea treatment are required. The guideline is formulated in strict accordance with the principles of evidence-based medicine with reference to the General Principles for the Compilation of International Guidelines for Diagnosis and Treatment of Traditional Chinese Medicine Syndromes and General Principles for the Compilation of International Clinical Practice Guidelines for Traditional Chinese Medicine Diseases and accordance with the principles and methods of The Appraisal of Guidelines for Research and Evaluation in China (AGREE-China) and World Health Organization guidelines. This guideline includes clinical issues by literature search and questionnaire survey, and eight background questions and 23 prospect questions were finally created. Based on the evidence retrieval, synthesis, consideration of patient preferences and values, intervention costs, advantages, and disadvantages, recommendations are created using the Delphi method and expert consensus method. This guideline clarified the definition, diagnosis, and TCM syndrome classification for dysmenorrhea, and recommends different TCM treatments based on the level of evidence, including Chinese herbal medicine, Chinese patent medicine, acupuncture, and other auxiliary therapies. The present guideline is an international clinical practice guideline for the treatment of dysmenorrhea using TCM. This guideline will provide substantive evidence and standardized guidance for the treatment of dysmenorrhea using TCM, improve the quality and safety of medical services, and standardize diagnosis and treatment plans for dysmenorrhea.

Endometriosis is a chronic disorder often beginning in adolescence. Despite the high prevalence of the disease and the symptom burden, adolescents may experience suboptimal management and a delay in diagnosis. The symptoms and laparoscopic findings in adolescents with endometriosis may differ from that of adults. This article aims to equip readers with the tools necessary to diagnose and manage endometriosis in adolescents., Competing Interests: Disclosure Dr J. Shim receives author royalties from UpToDate., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This study aimed to systematically review existing randomized clinical trials on the effect of dietary interventions on endometriosis. A search was performed on the Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Clinical Trials, EMBASE, PubMed, Lilacs, and Cielo databases. The search terms were used: "endometriosis", "endometrioma", "diet", "supplements" and "nutrition". Electronic literature searches through databases yielded 866 publications. Two authors performed The study selection independently (and blinded), and disagreements were discussed. Eleven RCTs were included in the systematic review, with 716 women randomized. Most studies reported a positive effect on endometriosis pain scores; however, they were characterized by moderate or high-risk bias. Of these, six RCTs, including 457 women with endometriosis, were included in the meta-analysis. Compared with Placebo, antioxidant use was associated with a reduction in dysmenorrhea (mean difference - 1.95 [CI 95%, -3.78 to -0.13]. Supplementation was not significant for reducing chronic pelvic pain (mean difference - 2.22 [95% CI, -4.99 to 0.55] and dyspareunia (MD - 2.56 [95% CI, - 5. 22 to 0.10]. Both analyses showed a high degree of heterogeneity. Moreover, studies with low risk of bias did not show significant results compared to those on Placebo. The effects of nutrient compounds seem to have the potential to reduce pain in women with endometriosis, mainly to reduce dysmenorrhea. However, the available studies present high heterogeneity and moderate/high risk of bias. More randomized clinical trials are needed to accurately determine dietary interventions' short- and long-term efficacy and safety in managing endometriosis pain., Competing Interests: Declarations. Conflict of Interest: There is no type of conflict of interest with the participants or any other collaborator, direct or indirect, for the development of this study., (© 2024. The Author(s), under exclusive licence to Society for Reproductive Investigation.)

Background: This study examined the improvement of dysmenorrhoea and menorrhagia after uterine artery embolisation (UAE) in women with symptomatic adenomyosis and identified factors that could predict the improvement of dysmenorrhoea and menorrhagia., Methods: This retrospective study included women with adenomyosis who underwent bilateral UAE between December 2014 and December 2016. The percentage of the volume of the absence of contrast enhancement on T1-weighted images was evaluated 5-7 days after UAE. A receiver operating characteristic (ROC) analysis was used to determine a cut-off point and predict the improvement of dysmenorrhoea and menorrhagia., Results: Forty-eight patients were included. At 24 and 36 months after UAE, the improvement rates for dysmenorrhoea and menorrhagia were 60.4% (29/48) and 85.7% (30/35), and the recurrence rates were 19.4% (7/36) and 9.1% (3/33), respectively. Only the percentage of the volume of the absence of contrast enhancement on T1-weighted images was associated with the improvement of dysmenorrhoea ( p   =   0.001, OR = 1.051; 95% CI: 1.02-1.08) and menorrhagia ( p   =   0.006, OR = 1.077; 95% CI: 1.021-1.136). When the cut-off value of the ROC analysis was 73.1%, sensitivity, specificity, positive predictive value, and negative predictive value for the improvement of dysmenorrhoea were 58.6%, 94.7%, 94.4%, and 60%, while they were 58.9%, 80%, 100%, 100%, and 45.5% for the improvement of dysmenorrhoea., Conclusion: Bilateral UAE for symptomatic adenomyosis led to good improvement of dysmenorrhoea and menorrhagia. The percentage of the volume of the absence of contrast enhancement on T1-weighted images of the uterus in postoperative magnetic resonance imaging might be associated with the improvement of dysmenorrhoea and menorrhagia.

Objective: To evaluate the impact of self-crosslinked hyaluronic acid (SCH) gel on endometrium recovery after artificial abortion. Methods: A multicenter, prospective randomized controlled trial was conducted across 18 hospitals from December 2021 to February 2023, involving 382 women who underwent artificial abortion. Participants were randomly allocated to receive either treatment with SCH gel (SCH group) or no treatment (control group) in a 1∶1 ratio. The primary outcome was endometrium thickness in 14 to 18 days after the first postoperative menstruation. Secondary outcomes included changes in menstrual volume during the first postoperative menstruation, menstruation resumption within 6 postoperative weeks, time to menstruation resumption, duration of the first postoperative menstruation, and incidence of dysmenorrhea. Results: Baseline characteristics of participants were comparable between the two groups (all P >0.05), with 95.3% (182/191) in SCH group and 92.7% (177/191) in the control group completed the study. The postoperative endometrial thickness in SCH group was significantly greater than that in the control group [(9.78±3.15) vs (8.95±2.32) mm; P =0.005]. SCH group also had significantly fewer participants with reduced menstrual volume [23 cases (12.6%, 23/182) vs 31 cases (17.5%, 31/177); P =0.038]. Although SCH group experienced less dysmenorrhea during the first postoperative menstrual period, this difference was not statistically significant [28.5% (51/179) vs 37.1% (65/175); P =0.083]. Outcomes were similar between SCH group and the control group regarding the proportion of participants who resumed menstruation within 6 weeks postoperatively, time to menstruation resumption, and duration of the first postoperative menstruation ( P =0.792, 0.485, and 0.254, respectively). No serious adverse events were observed during the study period, and no adverse events were attributed to SCH gel treatment. Conclusion: The application of SCH gel after artificial abortion is safe and might aid in the recovery of the endometrium.

Background: Exercise is increasingly being promoted as an effective treatment for primary dysmenorrhea (PD). This study aims to conduct a comprehensive network meta-analysis (NMA) of randomized controlled trials to identify the optimal types and dosages of exercise for managing PD in women., Methods: Adhering to PRISMA-NMA guidelines, we systematically reviewed RCTs from the Cochrane Library, Web of Science, PubMed, and Embase databases up to May 23, 2024. Data analysis was performed using 'GEMTC' and 'BUGSnet' packages within a Bayesian framework in R and a hierarchy of exercise treatments was also calculated using surface under the cumulative ranking curve (SUCRA) values. Subgroup analyses were conducted to identify the most effective exercise regimens, including duration, frequency, and volume of the exercise interventions., Results: Forty-nine studies representing 3,129 participants (1,640 exercises and 1,489 controls) were included. The results showed that all exercise interventions significantly reduced menstrual pain of the PD patients. Of six exercise intervention modalities based on the study ranked effectiveness, statistically significant reductions in pain intensity were found for resistance exercise and multi-component exercise. Multi-component exercise and stretching exercise were ranked best for menstrual symptoms, while core-strengthening exercise and multi-component exercise had the greatest impact on reducing pain duration. Significant and clinically important reductions or reliefs in pain occurred with 4 to 8 weeks of exercise training from all exercises, with resistance exercise showing the best efficacy when the duration exceeded 8 weeks, followed by multi-component exercise and mind-body exercise. Multi-component exercise and aerobic exercise with 1 to 3 sessions per week induced greater benefit in performance improvements, while resistance exercise with increased frequency showed the enhanced performance. Resistance exercise could elicit better efficacy within` 30-minute training duration, and multi-component exercise was ranked the best if such a training over 30 min., Conclusion: This study provided quantitative insight into efficacy and effectiveness of exercise interventions on PD treatments. All six different exercises are associated with positive influence on PD management. Our study indicates that this exercise training induced adaptation may have therapeutic benefits for PD patients; however, such alterations and improvements are affected by exercise regiments., Competing Interests: Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Dysmenorrhea, or menstrual pain, is a subjective experience, and can only be assessed by patient-reported outcomes. These instruments should be reliable, valid and responsive., Aim: To identify and critically appraise the available evidence for the measurement properties of specific patient-reported outcome measures used for dysmenorrhea., Methods: The PRISMA statement was used to report this systematic review. Databases searched were PubMed, SCOPUS, CINAHL, Web of Science, ScienceDirect and Google Scholar (April 2021; updated on February 2023). Original studies with primary data collection, with no restriction on language and publication date that reported psychometric properties of one or more dysmenorrhea-related patient-reported outcome measure. The literature searches, selection of studies, data extraction and assessment of the risk of bias were performed independently by two reviewers and followed the COSMIN guidelines., Results: Thirty studies were analysed in this review, and 19 patient-reported outcome measures were evaluated. The instruments varied in relation to the measured construct and measurement properties (validity, reliability and responsiveness). The methodological quality of the studies and the quality of evidence of the patient-reported outcome measures were variable. Among the 13 studies that reported the development of patient-reported outcome measures, most had inadequate methodological quality, and the overall rating was insufficient or inconsistent., Conclusions: The Dysmenorrhea Symptom Interference (DSI) scale was the only identified patient-reported outcome measure that has the potential to be recommended because of its sufficient rating combined with moderate quality of evidence for content validity. Future studies should further evaluate the measurement properties of the existing patient-reported outcome measures, or develop new patient-reported outcome measures following the COSMIN methodology., Patient or Public Contribution: Not applicable as this is a systematic review., Trial Registration: PROSPERO protocol: CRD42021244410. Registration on April 22, 2021., (© 2024 John Wiley & Sons Ltd.)

This research wasdesigned to provide a visual analysis of the current status, hotspots, and trends of global acupuncture for dysmenorrhea over the past 2 decades. The literature about acupuncture for dysmenorrhea from the Web of Science Core Collection database. Cite Space (5.6.R3) was used to analyze the volume of publications, journals, authors, cited journals, cited authors, countries, cited references, institutions, and keywords by using standard bibliometric measures. The most productive countries and institutions in this area were China (79) and BeijingUniversity of Chinese Medicine (24). The Evidence-Based Complementary and Alternative Medicine was the most published journal (29) and also had the highest number of citations (80). The article by Woo HL (2018) (number of citations: 13) and the article by (centrality: 0.38) were the most representative references. JiangZhu (17) was the most productive author and Dawood MY (47) was the top cited author. The number one keyword in terms of frequency and centrality was 'primary dysmenorrhea", and the leading hotspot from 2002 to 2022 was "Functional connectivity". The three forefront topics were "prevalence", "impact"and "point'. This research is thefirst bibliometric analysis of the current situation and new trends about acupuncture for dysmenorrhea in the past 20 years using CiteSpace. It offered some information on acupuncture for dysmenorrhea and valuable information for researchers to identify prospective collaborators, partner institutions, popular topics, and research frontiers.

Aim: To examine the effect of listening to music and drawing on coping with dysmenorrhea complaints of nursing students., Methods: The study was a double-blind, three parallel-group randomized controlled trial conducted between August 2023 and May 2024 at Bartın University, Faculty of Health Sciences, Department of Nursing. Ninety-six dysmenorrheic nursing students with regular menstrual cycles were included in the study and randomly assigned to three groups as drawing, music and control groups. Visual Analog Scale (100mmVAS of pain), Perceived Stress Scale (PSS) and Menstrual Symptoms Scale (MSS) were applied to the students at baseline, 1st and 2nd months. The interventions were as follows: the music group listened to a 29-minute and 32-second song three days before menstruation and on the first day of menstruation in the third month composed by Juan Sebastian Martin-Saavedra, while the drawing group created art for the same duration. The pain scores, perceived stress, and menstrual symptoms were measured in all groups after the interventions., Results: Pretest, 1st and 2nd months 100mmVAS of pain score averages were 7.16 ± 1.99, 7.16 ± 1.99 and 7.50 ± 1.98 for the control group, 7.22 ± 1.64, 4.84 ± 1.80 and 2.13 ± 1.45 for the music group and 6.69 ± 1.80, 5.09 ± 1.55 and 2.91 ± 1.33 for the drawing group, respectively. Pretest, 1st and 2nd months PSS score averages were 28.75 ± 3.71, 29.09 ± 3.87 and 30.03 ± 4.16 for the control group, 29.91 ± 3.98, 14.06 ± 4.06 and 3.59 ± 3.82 for the music group and 27.38 ± 3.63, 18.13 ± 5.60 and 8.34 ± 5.46 for the drawing group, respectively. Pretest, 1st and 2nd months MSS score averages were 79.25 ± 15.41, 88.00 ± 20.08 and 90.66 ± 19.13 for the control group, 85.41 ± 10.77, 62.41 ± 15.23 and 34.00 ± 12.62 for the music group and 80.69 ± 11.07, 65.53 ± 15.37 and 47.31 ± 15.11 for the drawing group, respectively. Mean menstrual pain intensity, mean perceived stress level, and mean menstrual symptoms level in the art and music group decreased significantly at 1st and 2nd months post-intervention (p < .001). A significant increase in score levels was observed in the control group., Conclusions: Both art and music practices are effective in significantly reducing menstrual pain, perceived stress, and menstrual symptoms in nursing students with dysmenorrhea. It is important to include listening to music and drawing on women's health and disease nursing practices to control menstrual pain, perceived stress, and menstrual symptoms in dysmenorrhea., Clinical Trials Registration Number: https://clinicaltrials.gov identifier NCT06027489; registered August 30, 2023., (© 2024. The Author(s).)

Background: Menstruation is a physical symptom that occurs in women of reproductive age. It has a significant impact on the daily life and health of women when their academic and social activities are most active. Since many women experience difficulties in daily life because of premenstrual syndrome and dysmenorrhea, it is important to identify, prepare for, and manage the menstrual cycle in advance., Objective: This study aimed to investigate the relationship between menstruation-related experiences and the use of mobile-based period tracker apps by millennial and generation Z (gen Z) individuals. The objectives of this study are to investigate (1) menstrual cycle management, (2) factors affecting app usage (3) factors affecting cycle management, and (4) motivators and barriers to using period tracker apps, in millennial and gen Z women., Methods: A mixed methods design was used for this study. The participants were young women aged 20-39 years and recruited via the Ovey application. Data were collected through surveys and focus group interviews. The survey was conducted among 700 women, and 8 of them participated in the focus group interviews., Results: In total, 431 (62.3%) participants used period tracker apps primarily to predict their next menstrual cycle. Factors affecting app usage included childbirth experience (odds ratio [OR] 0.475, P<.05), number of dysmenorrhea symptoms (OR 1.136, P<.05), and cycle management level (OR 2.279, P<.001). Additionally, education level (OR 1.122, P<.05 [university level compared high school level]) and the number of dysmenorrhea symptoms (OR 1.024, P<.05) showed a positive association with the cycle management level. However, childbirth experience (OR 0.902, P<.05) and period irregularity (OR 0.929, P<.001) were negatively associated with the cycle management level., Conclusions: Period tracker apps are becoming the new normal among millennials and gen Z individuals for managing their menstrual cycles. The use of a period tracker app empowers women by helping them gain a better understanding of their bodies, ultimately enhancing their social, academic, and health-related lives. Improving the accuracy and literacy of the app is an ongoing task for period-tracking apps, and it is important to provide added value tailored to users' needs. Therefore, the findings of this study should be considered when designing or upgrading period tracker apps to facilitate the adoption of digital technology among young women, thereby promoting their overall well-being and reproductive health., (©Minji Hong, Vasuki Rajaguru, KyungYi Kim, Suk-Yong Jang, Sang Gyu Lee. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 10.10.2024.)

Primary dysmenorrhea (PDM) refers to the occurrence of spasmodic colicky pain in the lower abdomen without any obvious pelvic pathology, often accompanied by other systemic symptoms, which significantly reduces the quality of life of women with PDM, 45%-95% of menstrual women are affected by it. Despite the high incidence of PDM, it is often not well treated and is ignored by relevant researchers and women themselves. Herbs-partitioned moxibustion (HPM) is a characteristic external therapy in traditional Chinese medicine (TCM), which is widely used to treat diseases in China; it treats diseases by applying a Chinese herbal formula on the patient's acupoints and then igniting moxa sticks on the herbal formula for moxibustion therapy. The primary effectiveness of the herbs utilized in this study is meridian activation and warmth, which encourages qi circulation to relieve pain. Moxibustion's heat stimulation could hasten the infusion of the herbs into the human body. Consequently, HPM, which combines acupoint, herbal, and heat stimulations, is appropriate for treating gynecological disorders, particularly functional diseases such as PDM. This paper provides a detailed description of the procedures and precautions for HPM at the Shenque (CV8) acupoint in female experimental rats, which 0provides an experimental basis for better promoting the application and development of HPM on the navel in PDM.

Objectives: The objective of the study was to compare the effectiveness of combined exercise training during different menstrual phases on pain, quality of life and menstrual symptoms., Methods: A total of 72 participants for the study were randomly assigned into three groups: Group 1 (N = 24), Group 2 (N = 24) and Group 3 (N = 24) which had undergone combined exercise training during the follicular, luteal and bleeding phases of their menstrual cycle, respectively. The treatment programme included combined exercise training involving deep breathing exercises, Kegel exercises, core strengthening exercises and stretching exercises. Exercises were repeated 5 times with hold duration of 15 s with total of 30-40 min session with 5-10 min of warm-up and cooldown sessions. Demographic data and outcome measures (Visual Analogue Scale [VAS], Menstrual Symptom Questionnaire [MSQ], and Working ability, Location, Intensity, Days, Duration [WaLIDD]) were assessed at baseline and assessed again during the first menstrual cycle after the completion of the treatment programme. One-way ANOVA was used for between-group comparisons of the normally distributed data., Results: Within-group comparison of the outcome variables except VAS in group 3 showed a statistically significant difference in all groups. Comparison of post-intervention results of the outcome measures of all the groups revealed a statistically significant difference for the VAS, while there was no statistically significant difference for in between the comparison of the WaLIDD and MSQ scoring., Conclusion: Combined exercise training is effective in reducing pain only when performed during follicular and luteal phases and significantly improve quality of life and menstrual symptoms in all phases of the menstrual cycle., (© 2024 John Wiley & Sons Ltd.)

Background: Heavy menstrual bleeding (HMB) and dysmenorrhea (DM) are common gynecological problems., Objective: To systematically review the needs, quality of life (QOL), and effectiveness of self-management strategies among young women (12-25 years) with DM or HMB., Search Strategy: Relevant terms were searched through PubMed, EBSCO, Google Scholar, ProQuest, and Ovid between 2010 and 2022., Selection Criteria: Qualitative and quantitative studies published in peer-reviewed journals, females aged 12-25, exploring DM or HMB, reporting supportive care needs, quality of life, self-treatment strategies, and/or treatment-seeking behavior., Data Collection and Analysis: Abstracts were reviewed for eligibility by two researchers. Included studies were extracted and assessed for quality independently by two authors, with discrepancies resolved through consensus or the involvement of a third researcher. Data extracted included study details, menstrual history, symptoms, self-care strategies, and quality of life. The Joanna Briggs Institute checklists were used for quality assessment., Main Results: The search returned 285 190 studies, of which 55 were eligible for inclusion. Prevalence rates of HMB and DM were in the ranges 4%-63% and 42%-94%, respectively. Over 80% of young women with DM and HMB experienced physical and psychological problems, including pelvic pain, sleep issues, mood disturbance, diarrhea, and nausea. Academic performance and daily activities were severely affected. Most (>62%) named their mothers as their primary source of information, and friends as the secondary source (10%-65%). Few studies explored needs, but they could be inferred and fell under school-related and social needs. QOL was poorer in those who had DM than those who did not. Pain was the most common issue that drove young women to find treatment. More than 70% used medication to reduce pain. More than half chose home remedies (e.g., heat therapy, massages, herbal tea, hot drinks). No studies provided information about the efficacy and dosage of medication and herbal remedies., Conclusions: HMB and DM have a large impact on daily living, with large areas of unmet need. Limited access to information impairs the management of symptoms and consequent QOL., (© 2024 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Objective: To observe the clinical efficacy of Fu 's subcutaneous needling combined with monkshood cake-separated moxibustion for primary dysmenorrhea with cold congealing and blood stasis., Methods: Sixty patients with primary dysmenorrhea of cold congealing and blood stasis were randomly divided into an observation group (30 cases, 1 case dropped out) and a control group (30 cases, 2 cases dropped out). The control group received monkshood cake-separated moxibustion at Shenque (CV 8) and bilateral Zigong (EX-CA 1), while the observation group received Fu 's subcutaneous needling based on the control group. The muscles were palpated and the affected muscles were determined. Needles were inserted 5-10 cm away from the affected muscles and reperfusion activity was performed simultaneously. All the treatment started on the first day of menstrual cycle pain, once a day, for 3 days, totaling for 3 menstrual cycles. The visual analogue scale (VAS) score, Cox menstrual symptom scale (CMSS) score, and traditional Chinese medicine (TCM) syndrome score in the two groups were observed before treatment, after 2 treatment courses and after 3 treatment courses. The serum prostaglandin F2α(PGF2α) levels before and after 3 treatment courses were measured, and the clinical efficacy of the two groups was evaluated., Results: After 2 and 3 treatment courses, the VAS scores, CMSS scores, and TCM syndrome scores in the two groups were lower than those before treatment ( P <0.05), and the scores in the observation group were lower than those in the control group ( P <0.05). After 3 treatment courses, the PGF2α level in the observation group was decreased ( P <0.05), and were lower than that in the control group ( P <0.05). The total effective rate was 96.6% (28/29) in the observation group, which was higher than 64.3% (18/28) in the control group ( P <0.05)., Conclusion: Fu 's subcutaneous needling combined with monkshood cake-separated moxibustion could effectively reduce the pain intensity, improve clinical symptoms of dysmenorrhea, and lower PGF2α level in patients with primary dysmenorrhea of cold congealing and blood stasis.

Purpose of Review: Adenomyosis is a common cause of abnormal uterine bleeding (AUB), dysmenorrhea, and pelvic pain. Definitive diagnosis and treatment have historically been by uterine histopathology at time of hysterectomy; however, advances in imaging have supported earlier diagnosis and subsequent conservative treatment. This review aims to update the evidence supporting the uterine-sparing, procedural management options with a focus on clinical outcomes., Recent Findings: Uterine artery embolization (UAE), radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), percutaneous microwave ablation (PMWA), and adenomyomectomy are minimally invasive interventions proven to be effective in reducing AUB and dysmenorrhea due to adenomyosis. Symptom improvement is associated with a decrease in uterine volume. Studies support the use of alternative treatment options given the overall low rates of symptom recurrence and reintervention. Combination therapy may be more effective than monotherapy., Summary: This review provides the current evidence for use of alternative treatment options for adenomyosis. Access to ablative therapies in the USA is limited and primarily off label, given lack of FDA approval. High-quality prospective and randomized controlled trials are needed in order to further delineate treatment comparisons, efficacy, safety, and ideal patient selection for these treatments. More data are needed to assess safety and utility in those desiring future fertility., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Study Question: Is increasing the intensity of high-intensity focused ultrasound (HIFU) by 30% in the treatment of rectal endometriosis a safe procedure?, Summary Answer: This study demonstrates the safety of a 30% increase in the intensity of HIFU in the treatment of rectal endometriosis, with no Clavien-Dindo Grade III complications overall, and namely no rectovaginal fistulae., What Is Known Already: A feasibility study including 20 patients with rectal endometriosis demonstrated, with no severe complications, a significant improvement in digestive disorders, dysmenorrhoea, dyspareunia, and health status, although the volume of the endometriosis nodule did not appear to be reduced., Study Design, Size, Duration: A prospective multicentre cohort study was conducted between 2020 and 2022 with 60 patients with symptomatic rectal endometriosis. Following the failure of medical treatment, HIFU treatment was offered as an alternative to surgery., Participants/materials, Setting, Methods: As the main objective of this study was to examine safety, all adverse events observed during the 6 months of follow-up were analysed and graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) and Clavien-Dindo classifications. Secondary objectives included evaluating the evolution of symptoms using validated questionnaires: gynaecological and digestive pain symptoms with a visual analogue scale, health status with the Medical Outcomes Study 36-item Short Form (SF-36) questionnaire, average post-operative daily pain level, and analgesic medication required in the 10 days following treatment. MRI was also performed at Day 1 to detect early complications. Finally, we performed a blinded MRI review of the evolution of the nodule at 6 months post-treatment., Main Results and the Role of Chance: The procedure was performed under spinal anaesthesia for 30% of the patients. The median duration of treatment was 32 min. Fifty-five patients left the hospital on Day 1. MRI scans performed on Day 1 did not highlight any early-onset post-operative complication. Using the Clavien-Dindo classification, we listed 56.7% Grade I events, 3.4% Grade II events, and no events Grade III or higher. At 1, 3, and 6 months, all gynaecologic, digestive and general symptoms, as well as health status, had significantly improved. The evolution of the nodule was also significant (P < 0.001) with a 28% decrease in volume., Limitations, Reasons for Caution: The main objective was safety and not effectiveness. The study was not randomized and there was no control group., Wider Implications of the Findings: HIFU treatment for rectal endometriosis results in an improvement of symptoms with low morbidity; as such, for selected patients, it could be a valuable alternative to surgical approaches following the failure of medical treatment., Study Funding/competing Interest(s): The study was funded by the company EDAP TMS. Professors Dubernard and Rousset are consultants for EDAP TMS. Dubernard received travel support from EDAP-TMS. Dr F. Chavrier received industrial grants from EDAP-TMS. He has developed a device for generating focused ultrasonic waves with reduced treatment time. This device has been patented by EDAP-TMS. Dr Lafon received industrial grants from EDAP-TMS; he declares that EDAP-TMS provided funding directly to INSERM to support a young researcher chair in therapeutic ultrasound, which is unrelated to the current study., Trial Registration Number: ClinicalTrials.gov identifier NCT04494568., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.)

Background: The use of self-analgesics among women for dysmenorrhoea is common. Non-pharmacological methods can be employed to effectively cope with dysmenorrhoea. Psychoeducation based on Leventhal's Self-Regulation Model (SRM) is an affordable, easy, and non-pharmacological way that clinics can use to cope with dysmenorrhoea., Method: This study aimed to investigate how psychoeducation affected dysmenorrhoea for nursing students using SRM. The sample consisted of 66 female students suffering from moderate-to-severe menstrual pain. A three-session psychoeducation based on SRM was applied to the intervention group. An 'Introductory Information Form', 'Visual Analogue Scale', 'Functional and Emotional Measure of Dysmenorrhoea (FEMD)', and 'Menstrual Symptom Questionnaire (MSQ)' were used to collect the data. All the measurements were carried out over three consecutive menstrual cycles., Results: A generalised linear model was used to analyse the data. After receiving psychoeducation, the pain and functional and emotional symptoms of dysmenorrhoea mean scores significantly decreased in the intervention group compared to the control group (p < .05), whereas there was no significant difference between the groups' MSQ mean scores (p > .05)., Conclusion: The psychoeducation reduced the severity of dysmenorrhoea pain and the functional and emotional impact levels of dysmenorrhoea and it was proved to be effective at helping the subjects cope with pain in the long term., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024. Published by Elsevier Inc.)

Objectives: To observe the differences in the effects of different dosages of grain-sized moxibustion on uterine artery blood flow in patients with cold and dampness primary dysmenorrhea (PD)., Methods: A total of 60 patients with PD were randomly divided into 3 groups with 20 cases in each group. Acupoints Sanyinjiao (SP6), Diji (SP8) and Xuehai (SP10) were selected in all the 3 groups, and different dosages of grain-sized moxibustion were used (3 moxa cones, 6 moxa cones, 9 moxa cones) respectively. Treatment started 7 days before menstruation for 3 times, lasting for a total of 3 menstrual cycles. The values of uterine artery blood flow parameters including pulsatility index (PI), resistance index (RI), and systolic/diastolic ratio (S/D) were recorded before and after treatment. The visual analog scale (VAS) score and cox menstrual symptom scale (CMSS) score (including severity ［CMSS-S］ and time of duration ［CMSS-T］) were evaluated before treatment, at the end of each menstrual cycle, and one menstrual cycle after treatment., Results: The values of uterine artery blood flow parameters (PI, RI, S/D) after treatment in the 9 moxa cones group were lower than those before treatment, as well as lower than those in the 3 and 6 moxa cones groups after treatment ( P <0.05). The VAS scores of the 3 moxa cones group were lower than those before treatment in the first and second cycle ( P <0.05). The VAS scores of the 6 and 9 moxa cones groups were lower than those before treatment at each observation point ( P <0.05), and were lower than those of the 3 moxa cones group in the third cycle of treatment and follow-up period ( P <0.05). And the VAS score of the 9 moxa cones group was lower than that of the 6 moxa cones group during the follow-up period ( P <0.05). Compared with the scores before treatment, the CMSS-T scores at each observation point after treatment were lower in the 9 moxa cones group ( P <0.05)；the CMSS-T scores in the second and third cycle after treatment, and follow-up period were lower in the 6 moxa cones group ( P <0.05), with the CMSS-S scores in the second and third cycle after treatment, and follow-up period lower in the 6 and 9 moxa cones groups ( P <0.05). The CMSS-T and CMSS-S scores of the 6 and 9 moxa cones groups were lower than those of the 3 moxa cones group in the third cycle and follow-up period ( P <0.05). The CMSS-T and CMSS-S scores of the 9 moxa cones group were lower than those of the 6 moxa cones group during the follow-up period ( P <0.05)., Conclusions: Grain-Sized moxibustion has dose-effect relationship in the treatment of PD. Compared with 3 and 6 moxa cones groups, 9 moxa cones group has advantages in improving uterine artery blood flow parameters and alleviating dysmenorrhea symptoms in PD patients.

Background: Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological treatment that works by delivering electrical currents via electrodes attached to the skin at the site of pain. It can be an alternative to pharmacological treatments. The mechanism of action of TENS for pain relief is related to the inhibition of the transmission of painful stimuli, release of endogenous opioids, and reduced muscle ischaemia of the uterus. Although it has been used for primary dysmenorrhoea ((PD); period pain or menstrual cramps), evidence of the efficacy and safety of high-frequency TENS, low-frequency TENS, or other treatments for PD is limited., Objectives: To evaluate the effectiveness and safety of transcutaneous electrical nerve stimulation (TENS) in comparison with placebo, no treatment, and other treatments for primary dysmenorrhoea (PD)., Search Methods: We searched the Gynaecology and Fertility Group's Specialized Register of controlled trials, CENTRAL, MEDLINE, Embase, PsycINFO, AMED, CINAHL, and the Korean and Chinese language databases up to 9 April 2024. We also searched for ongoing trials in trials registries and the reference lists of relevant studies for additional trials. Language restrictions were not applied., Selection Criteria: We included randomized controlled trials (RCTs) that included women (aged 12 to 49 years) with PD. Included trials compared low-frequency TENS or high-frequency TENS with other TENS, placebo, or other treatment., Data Collection and Analysis: Four review authors screened the trials, extracted the data according to the protocol, assessed the risk of bias using RoB 2, and assessed the certainty of evidence for all review comparisons and primary outcomes (i.e. pain relief and adverse effects) using the GRADE approach., Main Results: This review replaces the current review, published in 2009. We included 20 RCTs involving 585 randomized women with high-frequency TENS, low-frequency TENS, placebo or no treatment, or other treatment. We included five comparisons: high-frequency TENS versus placebo or no treatment, low-frequency TENS versus placebo or no treatment, high-frequency TENS versus low-frequency TENS, high-frequency TENS versus other treatments, and low-frequency TENS versus other treatments. High-frequency TENS versus placebo or no treatment High-frequency TENS may reduce pain compared with placebo or no treatment (mean difference (MD) -1.39, 95% confidence interval (CI) -2.51 to -0.28; 10 RCTs, 345 women; low-certainty evidence; I 2 = 88%). Two out of three RCTs reported no adverse effects and hence we were unable to estimate the effect of high-frequency TENS on adverse effects. Low-frequency TENS versus placebo or no treatment Low-frequency TENS may reduce pain compared with placebo or no treatment (MD -2.04, 95% CI -2.95 to -1.14; 3 RCTs, 645 women; low-certainty evidence; I 2 = 0%). No trials reported adverse effects for this comparison. High-frequency TENS versus low-frequency TENS It is uncertain whether high-frequency TENS had an effect on pain relief compared with low-frequency TENS (MD 0.89, 95% CI -0.19 to 1.96; 3 RCTs, 54 women; low-certainty evidence; I 2 = 0%). One trial contributed data on adverse effects but no adverse events occurred. High-frequency TENS versus other treatments It is uncertain whether high-frequency TENS had an effect on pain relief compared to acupressure (MD -0.66, 95% CI -1.72 to 0.40; 1 RCT, 18 women; very low-certainty evidence), acetaminophen (paracetamol) (MD -0.98, 95% CI -3.30 to 1.34; 1 RCT, 20 women; very low-certainty evidence), and interferential current therapy (MD -0.03, 95% CI -1.04 to 0.98; 2 RCTs, 62 women; low-certainty evidence; I 2 = 0%). The occurrence of adverse effects may not differ significantly between high-frequency TENS and NSAIDs (OR 12.06, 95% CI 0.26 to 570.62; 2 RCTs, 88 women; low-certainty evidence; I 2 = 78%). Low-frequency TENS versus other treatments It is uncertain whether low-frequency TENS had an effect on pain relief compared with acetaminophen (MD -1.48, 95% CI -3.61 to 0.65; 1 RCT, 20 women; very low-certainty evidence). No trials reported adverse effects for this comparison., Authors' Conclusions: High-frequency TENS and low-frequency TENS may reduce pain compared with placebo or no treatment. We downgraded the certainty of the evidence because of the risk of bias. Future RCTs should focus more on secondary outcomes of this review (e.g. requirement for additional analgesics, limitation of daily activities, or health-related quality of life) and should be designed to ensure a low risk of bias., (Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Gonadotropin-Releasing Hormone Agonist (GnRH-a) and levonorgestrel releasing intrauterine system (LNG-IUS) are conventional conservative treatments for adenomyosis, and high-intensity focused ultrasound (HIFU) is a novel ablation technique. This study aimed to investigate the effectiveness of HIFU combined with GnRH-a or LNG-IUS for adenomyosis patients. In this systematic review and meta-analysis, Pubmed, Embase, Cochrane Library and Scopus databases were searched up to December 2021. Published studies comparing HIFU plus GnRH-a with HIFU plus LNG-IUS in adenomyosis patients were assessed for eligibility by two independent authors. Risk of bias tool was utilized for risk evaluation. We selected treatment effective rate of dysmenorrhea (pain during menstruation) as the primary outcome; effective rate of menorrhagia severity and reduction rate of adenomyotic lesion as the secondary outcomes. Adverse effects were assessed. Four studies with a total 729 patients were enrolled in the meta-analysis. HIFU plus LNG-IUS showed lower dysmenorrhea [within 6 months: risk ratio (RR) 0.88, 95% confidence interval (CI) 0.83-0.93, p < 0.00001; over 1 year: RR 0.73, 95% CI 0.65-0.82, p < 0.00001] and less menorrhagia severity (RR 0.63, 95% CI 0.60-0.66, p < 0.00001) than HIFU plus GnRH-a. Both groups demonstrated equal efficacy in adenomyotic lesion reduction rate (RR 1.03, 95% CI 0.97-1.09, p = 0.30). Adverse effects happened equally in both groups. Combination therapy of HIFU and LNG-IUS revealed better effectiveness in treating dysmenorrhea and menorrhagia than that of HIFU and GnRH-a. However, interpreting the conclusion should be approached with caution as a result of significant heterogeneity., Competing Interests: Declaration of competing interest All authors have declared no conflicts of interest., (Copyright © 2024. Published by Elsevier B.V.)

Background: Primary dysmenorrhea leads to significant gynecological consultations, school absenteeism, disrupted daily activities, and adversely affects overall quality of life (QOL)., Purpose: This study compared the effects of aquatic exercise versus aerobic exercise on primary dysmenorrhea and QOL in adolescent females., Subjects and Methods: Sixty adolescent females suffering from primary dysmenorrhea with moderate to severe intensity were distributed randomly and equally into two groups was registered at ClinicalTrials.gov (NCT06129708) the Registration Date, November 13, 2023; group A was treated by aquatic exercise for 12 weeks, while group B was treated by aerobic exercise for 12 weeks. Assessment of both groups before and after treatment involved evaluating dysmenorrhea severity using the WaLIDD Score, measuring pain intensity with the numeric pain rating scale (NPRS), determining pressure pain threshold (PPT) with an algometry, and evaluating the QOL using EuroQol-5 Dimension-3 Level (EQ-5D-3L) and EuroQol-visual analog scale (EQ-VAS)., Results: Both groups, A and B, experienced significant reductions in the WaLIDD score, NPRS, and all domains of EQ-5D-3L (p < 0.05), coupled with significant increases in PPT and EQ-VAS (p < 0.05). Posttreatment comparisons between the groups showed insignificant differences in WaLIDD score, NPRS, and PPT (p > 0.05). However, there was a significant decrease in EQ-5D-3L and a significant increase in EQ-VAS, favoring group A (p < 0.05)., Conclusion: Both aquatic and aerobic exercises are effective methods in primary dysmenorrhea management and QOL improvement in adolescent females, with a better effect of aquatic exercise in enhancing QOL., (© 2024 John Wiley & Sons Ltd.)

Aim: In April 2020, the Japanese government introduced a Specific Medical Fee for managing secondary dysmenorrhea (SD). This initiative provided financial incentives to medical facilities that provide appropriate management of SD with hormonal therapies. We aimed to assess how this policy affects the management processes and outcomes of patients with SD., Methods: Using a large Japanese administrative claims database, we identified outpatient visits of patients diagnosed with SD from April 2018 to March 2022. We used an interrupted time-series analysis and defined before April 2020 as the pre-introduction period and after April 2020 as the post-introduction period. Outcomes were the monthly proportions of outpatient visits due to SD and hormonal therapy among women in the database and the proportions of outpatient visits for hormonal therapy and continuous outpatient visits among patients with SD., Results: We identified 815 477 outpatient visits of patients diagnosed with SD during the pre-introduction period and 920 183 outpatient visits during the post-introduction period. There were significant upward slope changes after the introduction of financial incentives in the outpatient visits due to SD (+0.29% yearly; 95% confidence interval, +0.20% to +0.38%) and hormonal therapies (+0.038% yearly; 95% confidence interval, +0.030% to +0.045%) among the women in the database. Similarly, a significant level change was observed after the introduction of continuous outpatient visits among patients with SD (+2.68% monthly; 95% confidence interval, +0.87% to +4.49%)., Conclusions: Government-issued financial incentives were associated with an increase in the number of patients diagnosed with SD, hormonal therapies, and continuous outpatient visits., (© 2024 The Authors. Journal of Obstetrics and Gynaecology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Obstetrics and Gynecology.)

Introduction: Primary dysmenorrhoea (PD) is a common menstrual concern with significant physical and psychosocial impacts. The effectiveness and safety of transcutaneous electrical acupoint stimulation (TEAS) in alleviating PD symptoms remain uncertain due to insufficient evidence. This single-centre, parallel, randomised controlled study intends to evaluate the efficacy and safety of TEAS for PD management., Methods and Analysis: 60 participants aged 18-40 years diagnosed with moderate to severe PD will be recruited from Tai'an Hospital of Traditional Chinese Medicine (TCM) and randomly assigned to either a TEAS group or a TEAS-sham group (1:1). The TEAS group will undergo 12 sessions of TEAS treatment over two menstrual cycles, with 30 min per session, three sessions weekly. Participants in the TEAS-sham group will receive TEAS stimulation using identical devices and protocols but without current output. The primary outcome is the Visual Analogue Scale (VAS) for pain assessment. Secondary outcomes are Short-Form McGill Pain Questionnaire, total effective rate, uterine artery haemodynamics, prostaglandin and β-endorphin level, mental well-being and quality of life. Adverse events and their potential reasons and the use of analgesics will also be recorded., Ethics and Dissemination: This study was approved by the Medical Ethics Committee of Tai'an Hospital of TCM. Written informed consent will be obtained from each participant. The results will be submitted for publication in a peer-reviewed journal., Trial Registration Number: ChiCTR2300071686., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: Different nonpharmacological strategies are adopted to decrease primary dysmenorrhea (PD)-related pain. The present study aimed to verify women's use of nonpharmacological methods for pain and compare them with evidence from the literature. Materials & methods: A two-step study was conducted, comprising an online survey with 9144 women to assess nonpharmacological strategies for relieving PD-related pain, and a literature review on PubMed of verify the evidence of nonpharmacological methods. Results: Many women reported using heat therapy (61.5%), tea (42.4%) and massage (30.9%) to alleviate menstrual pain. However, the literature on these methods is limited. Conclusion: Several nonpharmacological methods are used by women to relieve PD-related pain and studies with low bias risk are needed to prove their effectiveness.

Objective: To assess the use of evidence-based research (EBR) approach in randomized controlled trials (RCTs) of acupuncture-related therapies for primary dysmenorrhea (PD)., Methods: PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Database, and China Science and Technology Journal Database were searched from January 2013 to December 2022 for RCTs of acupuncture on PD. The full text and references of each RCT were read to assess whether systematic reviews (SRs) or other types of studies with similar research questions and end-users' perspectives were cited to justify and design the trial. In addition, the discussion section were analyzed to evaluate whether trials placed the new result in the existing SRs to draw a conclusion. Multivariable logistic regression was used to find variables that associated with 3 aspects of EBR approach: (1) citing clinical studies for justification, (2) citing relevant studies that obtain the perspectives of end users, and (3) citing clinical studies for results discussion., Results: Of 473 RCTs included, 45.67% (216) of the trials cited relevant similar studies, 21.56% (102) referenced to the studies that collected end-users' perspectives, and 10.99% (52) placed result in the context of the previous research. Few RCTs appropriately applied EBR approach. Among all the included studies, 3.17% (15) of the trials used SRs to inform study questions but none of them used updated SRs with acceptable quality; 1.05% (5) of the trials cited SRs of end-user's perspectives in the justification and design of the study, and only 1 trial added results in existing SR to draw a conclusion. Year of publication, language, funding, registration, ethical approval and number of sites were significantly associated with 1 of the 3 aspects of EBR approach., Conclusions: Few RCTs in acupuncture-related therapies for PD used the EBR approach to minimize research redundancy. Researchers, research institutes, funding agencies, ethics committees, journals and peer reviewers in acupuncture should make efforts to use and promote the EBR approach to ensure the value of new trials., (© 2023. The Chinese Journal of Integrated Traditional and Western Medicine Press and Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Electroacupuncture (EA) has been applied in dysmenorrhea and has shown good efficacy. The mechanisms of EA are associated with autonomic nervous system adjustments and neuroendocrine regulation. Laser acupuncture (LA), however, has been widely investigated for its noninvasiveness. However, it remains uncertain whether LA is as effective as EA. This study aimed to compare EA and LA head to head in dysmenorrhea. Methods: A crossover, randomized clinical trial was conducted. EA or LA was applied to selected acupuncture points. Participants were randomized into two sequence treatment groups who received either EA or LA twice per week in luteal phase for 3 months followed by 2-month washout, then shifted to other groups (sequence 1: EA > LA; sequence 2: LA > EA). Outcome measures were heart rate variability (HRV), prostaglandins (PGs), pain, and quality-of-life (QoL) assessment (QoL-SF12). We also compared the effect of EA and LA in low and high LF/HF (low frequency/high frequency) status. Results: Totally, 43 participants completed all treatments. Both EA and LA significantly improved HRV activity and were effective in reducing pain (Visual Analog Scale [VAS]; EA: p  < 0.001 and LA: p  = 0.010) and improving QoL (SF12: EA: p  < 0.001, LA, p  = 0.017); although without intergroup difference. EA reduced PGs significantly ( p  < 0.001; δ p  = 0.068). In low LF/HF, EA had stronger effects than LA in increasing parasympathetic tone in respect of percentage of successive RR intervals that differ by more than 50 ms (pNN50; p  = 0.053) and very low-frequency band (VLF; p  = 0.035). Conclusion: There is no significant difference between EA and LA in improving autonomic nervous system dysfunction, pain, and QoL in dysmenorrhea. EA is prominent in PGs changing and preserving vagus tone in low LF/HF; yet LA is noninvasive for those who have needle phobia. Whether LA is equivalent with EA and the mechanism warrants further study. Clinical trial identification number: NCT04178226.

Graphene-based warm uterus acupoint paste (GWUAP) is an emerging non-drug alternative therapy for the treatment of primary dysmenorrhea (PD), but the underlying mechanism is still unclear. SD female rats were randomly divided into control group, model group and treatment group to explore the mechanism of GWUAP in the treatment of PD. Combined with 16S rDNA and fecal metabolomics, the diversity of microbiota and metabolites in each group was comprehensively evaluated. In this study, GWUAP reduced the torsion score of PD model rats, improved the pathological morphology of uterine tissue, reduced the pathological damage score of uterine tissue, and reversed the expression levels of inflammatory factors, pain factors and sex hormones. The 16 S rDNA sequencing of fecal samples showed that the abundance of Lactobacillus in the intestinal flora of the model group decreased and the abundance of Romboutsia increased, while the abundance of Lactobacillus in the intestinal flora of the treatment group increased and the abundance of Romboutsia decreased, which improved the imbalance of flora diversity in PD rats. In addition, 32 metabolites related to therapeutic effects were identified by metabolomics of fecal samples. Moreover, there is a close correlation between fecal microbiota and metabolites. Therefore, the mechanism of GWUAP in the treatment of PD remains to be further studied., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Wang, Li, Cao, Zhao, Xu, Chai, Zhang, Liu and Wang.)

Objectives: To assess the relative benefits of various non-pharmacological interventions on treating primary dysmenorrhoea within a network meta-analysis., Study Design: Systematic review and Bayesian network meta-analysis., Inclusion Criteria: Randomised controlled trial involving patient with primary dysmenorrhoea and received non-pharmacological interventions., Data Sources: Four databases (Medline, Embase, Cochrane Library and Web of Science) were searched from inception to October first, 2022., Risk-Of-Bias Rob Assessment: RoB 2.0 assessment tools was used to assess the risk of bias in the included studies., Synthesis of Results: Conventional meta-analysis was conducted by pairwise comparison between non-pharmacological therapy and control treatment. The Bayesian network meta-analysis was conducted by the Aggregate Data Drug Information System Software based on the consistency or inconsistency model, and rank probability was used to indicate the priority of non-pharmacological therapy., Results: 33 studies involving eight non-pharmacological interventions were included. With regard to conventional meta-analysis, we selected Visual Analogue Scale (VAS) as primary outcome to evaluate the pain intensity. The result showed that eight interventions (Exercise, Herb, Acupuncture, Aromatherapy, Transcutaneous Electrical Nerve Stimulation, Topical heat, Acupressure, Yoga) displayed positive effect on reduction of menstrual pain compared with placebo or no treatment. A Bayesian network meta-analysis revealed that exercise -3.20 (95% CI -4.01 to -2.34), acupuncture -2.90 (95% CI -3.97 to -2.85) and topical heat -2.97 (95% CI -4.66 to -1.29) probably resulted in a reduction in pain intensity (VAS) ., Conclusions: Non-pharmacological interventions may result in a reduction or slight reduction in pain intensity compared with no treatment or placebo. Specifically, exercise and acupuncture are considered as potentially effective non-pharmacological treatments in short-term treatment. Indeed, larger and better methodological quality research is needed., Trial Registration Number: CRD42022351021., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This study tested the usability of a home-based self-administration transcranial direct current stimulation (tDCS) device designed specifically for women's health needs. This is a single center triple blinded clinical usability study for a new wireless, Bluetooth-controlled wearable tDCS device for women's health. The study aims to evaluate the usability and effective blinding of a home-based tDCS system. A total of forty-nine women of reproductive age were randomly allocated (1:1) to receive one session of active tDCS (n = 24) or sham tDCS (n = 25) over the motor and dorsolateral prefrontal cortex. Each participant self-administered one 20-minute session without supervision following guidance on a software application alone. The System Usability Scale (SUS) and the Patient Global Impression of Change (PGIC) were used to evaluate the usability of the system. Regardless of sham or active conditions, all users found the system easy to use without the support of researchers. Usability scores were considered to be "excellent" in both groups and no significant difference was found between sham and active groups showing effective blinding of the device (Active group: 93.7 (83.1-97.5); Sham group 90 (86.2-95) p = 0.79) and PGIC (Active group: 2 (1-2.75); Sham group 2 (1-2) p = 0.99) using an unpaired t-test or non-parametric statistical tests accordingly. The new Bluetooth-controlled wearable tDCS device is easy, safe to use and completely controlled by a smartphone app. This device is focused on women's health and will be tested as an alternative treatment for chronic pelvic pain and mood disturbance associated with menstrual cycles in further research., Competing Interests: Emilė Radytė, Alexander Anthony Cook and Ervinas Bernatavičius are employees and own shares in Samphire Neuroscience Ltd. Samphire Neuroscience Ltd contributed to the trial design, technical feasibility, questionnaire selection and data interpretation but did not participate in data collection or analysis. Other authors declare no conflict of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Rodrigues et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To analyze the efficacy of high-intensity focused ultrasound (HIFU) for adenomyosis and postoperative recurrence and its influencing factors., Methods: Clinical and follow-up data of 308 patients with adenomyosis who were treated with HIFU in Haifu Center, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from September 2017 to January 2022 were retrospectively analyzed. The recurrence of adenomyosis and the efficacy of HIFU at 6 months after surgery were followed up. To explore factors influencing postoperative prognosis and recurrence, the following variables were analyzed: patients' age, course of disease, gravidity and parity, size of the uterus, duration of HIFU, duration of irradiation, treatment intensity, dysmenorrhea score, time of follow-up, combined treatment of traditional Chinese medicine (TCM), western medicine adjuvant treatment, lesion location and type, and menorrhagia., Results: Among the 308 patients, 238 (77%) were followed up from 6 to 36 months, with an average follow-up time of 15.24 ± 9.97 months. The other 70 (23%) were lost to follow-up. At 6-month after surgery, efficacy rates of dysmenorrhea and menorrhagia management were 86.7% and 89.3%, respectively. Postoperative recurrence rates were 4.8% (1-12 months), 9.0% (12-24 months), and 17.0% (24-36 months) for dysmenorrhea; and 6.3% (1-12 months), 2.4% (12-24 months), and 12.2% (24-36 months) for menorrhagia. Multivariate logistic regression analyses showed that parity (P = 0.043, OR = 1.773, 95% CI 1.018-3.087), uterine size (P = 0.019, OR = 1.004, 95% CI 1.001-1.007), combined treatment of TCM (P = 0.047, OR = 1.846, 95% CI 1.008-3.381), diffuse lesion type (P = 0.013, OR = 0.464, 95% CI 0.254-0.848) and ablation rate (P = 0.015, OR = 0.481, 95%CI 0.267-0.868) were prognostic factors (P < 0.05). Age, course of disease, gravidity, duration of HIFU, duration of irradiation, treatment intensity, preoperative dysmenorrhea score, time of follow-up, western medicine adjuvant therapy, lesion location, and preoperative menstrual volume had no effect on prognosis (P > 0.05)., Conclusion: HIFU can effectively relieve dysmenorrhea and reduce menstrual volume in patients with adenomyosis. Parity, uterine size, lesion type (diffuse), and ablation rate are risk factors for symptom recurrence after HIFU, while the combination of TCM therapy is a protective factor for relapse. We, therefore, recommend TCM in the adjuvant setting after HIFU according to patient condition., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Primary dysmenorrhea is a common gynecological problem characterized by menstrual pain without any pelvic pathology. It affects a significant portion of women of reproductive age, impacting their quality of life and daily activities. Physiotherapy interventions such as therapeutic exercise, manual therapy, electrotherapy, and kinesio taping reduce menstrual pain and symptoms. However, there is no study investigating the effects of combined physiotherapy interventions., Primary Study Objective: This study aimed to evaluate and compare the effects of exercises combined with either kinesio taping or electrotherapy on reducing menstrual pain and associated symptoms in women suffering from primary dysmenorrhea., Methods: The randomized controlled clinical trial., Setting: Biruni University Department of Physiotherapy and Rehabilitation Laboratory., Participants: Thirty-six women diagnosed with primary dysmenorrhea by a Gynecologist and Obstetrician were randomized into the kinesio-taping group (n=19) and the electrotherapy group (n=17)., Intervention: A similar exercise program was carried out in both groups for eight weeks, two days a week and 40 minutes a day. To increase blood flow in the pelvic region and reduce pain mediators, taping was applied to the sacral and pubic regions using the ligament technique in the kinesio taping group, and a vacuum interferential current was applied to the lumbar and gluteal regions in the electrotherapy group., Primary Outcome Measures: The menstrual pain intensity and menstrual symptoms were assessed with valid and reliable the Visual Analogue Scale (VAS) and the Menstrual Symptom Questionnaire (MSQ)., Results: The VAS (kinesio taping and electrotherapy group: P < .001), MSQ-pain symptoms (kinesio taping group: P = .014, electrotherapy group: P = .032), and MSQ-coping methods scores (kinesio taping group: P = .001, electrotherapy group: P = .005) decreased both statistically and clinically in both groups. In addition, a statistically significant improvement in MSQ-negative effects/somatic complaints (P = .047) and MSQ total scores (P = .030) was observed in the electrotherapy group. There was no statistically significant difference between the two groups regarding substantial changes (P > .05)., Conclusion: The exercises combined with either kinesio taping or electrotherapy effectively reduced menstrual pain intensity and menstrual symptoms related to pain and coping methods in women with primary dysmenorrhea. Notably, exercises combined with electrotherapy also improved menstrual symptoms related to negative effects and somatic complaints. These findings suggest that both kinesio taping and electrotherapy, when combined with exercises, are viable options for managing primary dysmenorrhea, potentially offering clinicians flexible treatment approaches.

Objective: To examine the effects of Jacobson's Progressive Muscle Relaxation Technique (JPMRT) on menstrual pain and symptoms, anxiety, quality of life (QoL), social activity, and work/school performance in primary dysmenorrhea (PD)., Materials and Methods: Women with PD were randomly divided into two groups as relaxation and control groups. JPMRT was applied three times a week from the estimated date of ovulation to the onset of the next menstruation. No treatment was performed in the control group. Pain intensity, menstrual symptoms, anxiety, impacts on QoL, social activity, and work/school performance were assessed before and after the interventions., Results: After the interventions, there was a further decrease in menstrual pain intensity, menstrual symptoms, anxiety level, the impact of QoL, and the work/school performance scores in the relaxation group than in the control group (p < 0.05)., Conclusion: JPMRT might be used as an alternative method in the treatment of PD., Competing Interests: Conflict of interest The authors declare that they have no conflict of interest., (Copyright © 2024. Published by Elsevier B.V.)

Objective: The objective of this study was to evaluate the efficacy of electrotherapy and manual therapy for the treatment of women with primary dysmenorrhea., Methods: Systematic searches were conducted in Scopus, Web of Science, PubMed, CINAHL, and MEDLINE. The articles must have been published in the last 10 years, had a sample exclusively of women with primary dysmenorrhea, had a randomized controlled trial design, and used interventions that included some form of manual therapy and/or electrotherapy techniques. Two reviewers independently screened articles for eligibility and extracted data. Difference in mean differences and their 95% CIs were calculated as the between-group difference in means divided by the pooled standard deviation. The I2 statistic was used to determine the degree of heterogeneity., Results: Twelve selected studies evaluated interventions, with 5 evaluating electrotherapy techniques and 7 evaluating manual therapy techniques. All studies analyzed identified improvements in pain intensity and meta-analysis confirmed their strong effect., Conclusions: Manual therapy and electrotherapy are effective for the treatment of women with primary dysmenorrhea. Transcutaneous electrical nerve stimulation combined with thermotherapy and effleurage massage stands out for its effects on the intensity and duration of pain with the application of a few sessions and their long-term effects., Impact: Manual therapy techniques and electrotherapy methods reduce the pain intensity of women with primary dysmenorrhea. Quality of life and degree of anxiety improved significantly with manual therapy interventions. Transcutaneous electrical nerve stimulation combined with thermotherapy and effleurage massage are the interventions with which positive effects were achieved with fewer sessions., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

In this systematic review and meta-analysis, we explored the efficacy of taping as a non-pharmacological intervention for pain reduction in primary dysmenorrhoea (PD), a prevalent condition causing significant quality of life impairment. We conducted a comprehensive search across databases including PubMed, PEDro, and Web of Science to identify randomized controlled trials assessing taping's effectiveness in PD for pain relief. Our criteria focused on studies comparing taping to no intervention or alternatives, with pain outcomes primarily measured using the Visual Analogue Scale (VAS). The quality assessment utilized the PEDro scale, with scores ranging from 4 to 8, indicating a spectrum of moderate to high-quality evidence. The results indicate that both kinesiotaping (SMD = -1.22; 95 % CI: -2.15, -0.29; p = 0.01) and other tapes (SMD = -1.61, 95 % CI: -2.15, -0.65; p = 0.001) significantly reduces pain intensity in women with PD. However, the certainty of evidence was very low according to GRADE criteria. This underscores the necessity for further research to understand taping's analgesic mechanisms, its long-term effects, and its influence on related symptoms and overall quality of life. Our findings advocate for the inclusion of taping in PD management, offering a promising direction for enhancing care in affected women., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: To investigate the effect of electroacupuncture (EA) on Rho/Rho-associated coiled-coil-forming kinases (ROCK) signaling pathway of uterus tissue in rats with dysmenorrhea, so as to explore the underlying mechanism of EA treating primary dysmenorrhea (PD) and uterine smooth muscle spasm, and to observe whether there is a difference in the effect of meridian acupoints in Conception Vessel (CV) and Governer Vessel (GV)., Methods: Sixty female SD rats were randomly divided into saline, model, CV, GV, and non-acupoint groups, with 12 rats in each group. The dysmenorrhea model was established by subcutaneous injection of estradiol diphenhydrate combined with intraperitoneal injection of oxytocin (OT). EA (2 Hz) was applied to "Qihai" (CV6) and "Zhongji" (CV3) for CV group, "Mingmen" (GV4) and "Yaoshu" (GV2) for GV group, "non-acupoint 1" and "non-acupoint 3" on the left side for non-acupoint group, and manual acupuncture was applied to "Guanyuan" (CV4) for CV group, "Yaoyangguan" (GV3) for GV group, "non-acupoint 2" on the left side for non-acupoint group. The treatment was conducted for 20 min each time, once daily for 10 days. The writhing score was evaluated. The smooth myoelectric signals of rats' uterus in vivo were recorded by multi-channel physiological recorder. The uterine histopathological changes were observed by HE staining. The contents of prostaglandin F2α (PGF 2α ), OT and calcium ion (Ca 2+ ) in uterine tissue of rats were detected by ELISA. The protein and mRNA expression levels of smooth muscle 22-α (SM22-α), RhoA and ROCKⅡ in uterine tissue were detected by Western blot and fluorescence quantitative PCR, respectively., Results: Compared with the saline group, the writhing score of rats in the model group was increased ( P <0.01), the amplitude voltage of uterine smooth muscle in vivo was elevated ( P <0.01), the contents of PGF 2α , OT and Ca 2+ , the protein and mRNA expression of SM22-α, RhoA and ROCK Ⅱ in uterine tissue were all increased ( P <0.01). Compared with the model and the non-acupoint groups, the writhing scores of the CV and the GV groups were decreased ( P <0.01, P <0.05), the amplitude voltage of uterine smooth muscle was decreased ( P <0.01), the contents of PGF 2α , OT and Ca 2+ in uterine tissue were decreased ( P <0.01, P <0.05), and the protein expression and mRNA expression of SM22-α, RhoA and ROCKⅡ in uterine tissue were decreased ( P <0.01, P <0.05). HE staining showed extensive exfoliation of uterine intima with severe edema and increased glandular secretion in the model group, which was alleviated in the CV and GV groups., Conclusions: EA at acupoints of CV and GV can significantly reduce the writhing score, uterine smooth muscle amplitude voltage, pathological injury degree of uterus, and relieve spasm of uterine smooth muscle in dysmenorrhea rats, which may be related to its effect in regulating PGF 2α and OT contents, inhibiting the Rho/ROCK signaling pathway, and reducing the SM22-α, RhoA, ROCKⅡ protein and mRNA expression, and Ca 2+ content in uterine tissue.

Introduction: Primary dysmenorrhea (PD) is a public disease of young female worldwide, it affects their daily performances. Severe recurrent uterine cramps are the main complaints in 90% of adolescents and 50% of reproductive-age females. This study aimed to evaluate the use of magnetic field therapy in the treatment of severe dysmenorrhea grade 3 and provide an encouraging goal to continue daily work without pain., Methods: Two hundred and fifty female patients were recruited in this study from gynecological clinics in Basrah, southern Iraq. All had severe dysmenorrhea, patients were subjected to a questionnaire form, Visual Analog Scale, and verbal multidimensional scoring system to determine the pain intensity and grade of dysmenorrhea. Only 38 young females had severe dysmenorrhea grade 3 with ages ranging from 16 to 28 years with a mean age of 22.04 ± 1.43 years and body mass index 23.81 ± 1.94, patients subjected to electromagnetic field therapy (EMFT), two sessions per week for 20 min each for 6 weeks. Three categories were assessed, working ability, associated symptoms, and drugs used. Data were collected and statistically analyzed using SPSS version 22., Results: The present study showed statistically significant progress (P < 0.05) in reducing pain, rare physical and mental complaints, and improved working ability with no need for drugs in majority of patients., Conclusion: EMFT has better results than other methods in relieving pain and symptoms of dysmenorrhea with a settled lifestyle., (Copyright © 2024 Copyright: © 2024 Annals of African Medicine.)

This study aimed to investigate the efficacy and safety of using optimized parameters obtained by computer simulation for ultrasound-guided high-intensity focused ultrasound (HIFU) treatment of uterine adenomyosis in comparison with conventional parameters. We retrospectively assessed a single-institution, prospective study that was registered at Clinical Research Information Service (CRiS) of Republic of Korea (KCT0003586). Sixty-six female participants (median age: 44 years) with focal uterine adenomyosis were prospectively enrolled. All participants were treated with a HIFU system by using treatment parameters either for treating uterine fibroids (Group A, first 20 participants) or obtained via computer simulation (Group B, later 46 participants). To assess the treatment efficacy of HIFU, qualitative indices, including the clinically effective dysmenorrhea improvement index (DII), were evaluated up to 3 years after treatment, whereas quantitative indices, such as the nonperfused volume ratio and adenomyosis volume shrinkage ratio (AVSR), on MRI were evaluated up to 3 months after treatment. Quantitative/qualitative indices were compared between Groups A and B by using generalized linear mixed effect model. A safety assessment was also performed. Results showed that clinically effective DII was more frequently observed in Group B than in Group A (odds ratio, 3.69; P = 0.025), and AVSR were higher in Group B than in Group A (least-squares means, 21.61; P = 0.001). However, two participants in Group B developed skin burns at the buttock and sciatic nerve pain and required treatment. In conclusion, parameters obtained by computer simulation were more effective than the conventional parameters for treating uterine adenomyosis by using HIFU in terms of clinically effective DII and AVSR. However, care should be taken because of the risk of adverse events., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Bae et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Study Objective: Early diagnosis and treatment of endometriosis in adolescents and young women is considered essential for improving their quality of life and for prevention of long-term complications. In adult women with endometriosis, significant delays in diagnosis and medical or surgical treatment have been described. Our study aimed to investigate the delay in diagnosis and treatment of adolescents and young women with suspected endometriosis., Methods: A retrospective study of adolescents and young women (12-22 years-old) who were evaluated for suspected endometriosis at the endometriosis clinic in the Shamir medical center between January 2017 and December 2022. All patients were referred by their primary care gynecologists. The evaluation in the endometriosis clinic included targeted history, physical exam and a focused ultrasound survey for endometriosis (performed trans-abdominally in all cases, and trans-vaginally in sexually active women)., Results: Out of 400 women with suspected endometriosis evaluated in our endometriosis clinic during the study period, 68 were adolescents and young women <22 years old. Their mean age at time of evaluation for endometriosis was 18 ± 2.5 years, and the mean time-period from onset of symptoms to the endometriosis evaluation was 4.0 ± 2.9 years. Their most common symptoms were dysmenorrhea (in 61 cases, 89.7 %), followed by gastrointestinal symptoms (in 32 cases, 47.1 %). In 30 (44.1 %) cases, hormonal treatment was prescribed by the primary care gynecologist prior to their appointment in the endometriosis clinic. On comparison of patients with delay of <4 years (N = 31) versus ≥4 years (N = 37) from symptom onset to the endometriosis evaluation, patients with shorter duration of symptoms were more likely to decline any hormonal treatment for endometriosis while patients with longer duration of symptoms were more likely to accept the recommendation for hormonal treatment (16.2 % versus 0 %, p = 0.02, and 83.8 % versus 100 %, p = 0.03, respectively)., Conclusion: Adolescents and young women with suspected endometriosis may experience significant delays in diagnosis and medical care, similar to adult patients., Competing Interests: Declaration of competing interest The authors indicate no conflicts of interest., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Objective: To explore the short-term and long-term efficacy of buccal acupuncture therapy in the treatment of patients with primary dysmenorrhea (PD)., Methods: A total of 90 patients with PD who were admitted to the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from January 2020 to December 2021 were included in this study and randomly divided into three groups, including the observation group, the control group, and the placebo group, with 30 patients in each group. Patients in the observation group were treated according to the syndrome types of Traditional Chinese Medicine, those in the control group were treated with Saridon, and those in the placebo group received a placebo. The visual analog scale (VAS) scores of these patients were evaluated at different time points (before treatment, 5 min after needle retention, 30 min after needle retention, 1 h after treatment, 2 h after treatment, 1 d after treatment, and 2 d after treatment). The Cox Menstrual Symptom Scale (CMSS) scores were assessed before the treatment and after three courses of treatment. Besides, these two scales were also evaluated during follow-up. Moreover, the pain score and adverse reactions of these patients were assessed during treatment., Results: After treatment, the VAS and CMSS scores in the observation group decreased significantly ( P < 0.05) 5 and 30 min after needle retention and after treatment., Conclusion: Buccal acupuncture therapy is verified to have short-term efficacy in the treatment of PD. In addition, this therapy has an immediate analgesic effect and long-term efficacy in reducing the severity and frequency of PD.

Background: Endometriosis-related pain encompassing dysmenorrhea, dyspareunia, and chronic pelvic pain, reduces the quality of life in premenopausal women. Although treatment options for endometriosis alleviate this pain, approximately one-third of women still experience pain even after receiving treatment, indicating the need for novel approaches to pain relief in those women. The Angel Touch device (AT-04) is a portable magnetic fields irradiation device that incorporates a combination of mixed alternative magnetic fields at 2 kHz and 83.3 MHz. A phase III trial confirmed the efficacy and safety of AT-02, a prototype of AT-04, for pain relief in patients with fibromyalgia., Methods: This is a phase III, multicenter, prospective, randomized, sham device-controlled, double-blind, parallel study. The participants will be premenopausal women aged > 18 years who have endometriosis-related pain with at least moderate severity. Considering dropouts, 50 participants have been deemed appropriate. Eligible women will be centrally registered, and the data center will randomly allocate them in a 1:1 ratio to the intervention and control groups. Women in the intervention group will receive electromagnetic wave irradiation generated by AT-04 and those who in the control group will wear a sham device for 16 weeks, and both groups will wear AT-04 for another 4 weeks. The primary outcome measure is the change in the Numeric Rating Scale score at 16 weeks compared with the baseline. Secondary outcome measures are efficacy for pelvic pain including dysmenorrhea and non-menstrual pain, and chronic pelvic pain not related to menstruation, dysmenorrhea, and dyspareunia, and improvement of quality of life during the study period. Safety will be evaluated by device defects and the frequency of adverse events. The study protocol has been approved by the Clinical Study Review Board of Chiba University Hospital, Chiba, Japan, and will be conducted in accordance with the principles of the Declaration of Helsinki and the Japanese Clinical Trials Act and relevant notifications., Discussion: This study aims to develop a novel method of managing endometriosis-related pain. The AT-04 is an ultralow-invasive device that can be used without inhibiting ovulation, suggesting potential benefits to women of reproductive-age. Trial registration number Japan Registry of Clinical Trials (jRCTs032230278)., (© 2024. The Author(s).)

Objectives: To investigate the effects of graphene-based warm uterus acupoint paste on uterine Toll-like receptor 4 (TLR4)/myeloid differentiation factor 88 (MyD88)/nuclear transcription factor-kappa B p65 (NF-κB p65) signaling pathway and Th1/Th2 immune balance in primary dysmenorrhea ( PD ) model rats, so as to reveal its immunological mechanisms of relieving dysmenorrhea., Methods: Thirty SD female rats were randomly divided into 3 groups：normal group, model group and acupoint paste group, with 10 rats in each group. PD rat model was established by subcutaneous injection of estradiol benzoate for 10 consecutive days. At the same time of modeling, graphene-based warm uterus acupoint paste was applied to the acupoints of "Guanyuan" (CV4), bilateral "Zigong" (EX-CA1) and "Sanyinjiao" (SP6) of rats in the acupoint paste group. The application was continuously applied once daily for 10 d, 5 h each time. On the 11 th day, oxytocin was injected intraperitoneally to observe the writhing latency, writhing times within 30 min and writhing score of rats in each group. The spleen and thymus indexes were calculated. The pathological changes of spleen and thymus tissue were observed after HE staining. The contents of serum immunoglobulin (Ig) A, IgG, tumor necrosis factor-α (TNF-α), interleukin (IL)-2, interferon-γ (IFN-γ), IL-4 and IL-10 were detected by ELISA . The protein and mRNA expression levels of TLR4, MyD88 and NF-κB p65 in rat uterine tissue were detected by Western blot and real-time quantitative PCR, respectively., Results: Compared with the normal group, the writhing times and writhing scores within 30 min of rats in the model group were significantly increased( P <0.001), and the rats showed writhing reaction ( P <0.01). The spleen index and thymus index were significantly decreased( P <0.01, P <0.05). The spleen and thymus had obvious pathological changes. The contents of IgA, IgG, TNF-α, IL-2 and IFN-γ in serum were significantly increased, while the contents of serum IL-4 and IL-10 were significantly decreased( P <0.001, P <0.01). The expression levels of TLR4, MyD88, NF-κB p65 protein and corresponding mRNA in uterine tissue were significantly increased( P <0.001). Following intervention, compared with the model group, the writhing latency time of rats in the acupoint paste group was prolonged, and the writhing times and writhing scores within 30 min were significantly decreased ( P <0.001). The spleen index and thymus index were significantly increased( P <0.01, P <0.05). The pathological changes of spleen and thymus were improved. The contents of serum IgA, IgG, TNF-α, IL-2 and IFN-γ were significantly decreased, while the contents of IL-4 and IL-10 were significantly increased( P <0.001, P <0.05, P <0.01). The expression of TLR4, MyD88, NF-κB p65 protein and the corresponding mRNA levels in uterine tissue were decreased( P <0.001, P <0.01)., Conclusions: Graphene-based warm uterus acupoint paste can regulate the immune balance of Th1/ Th2 by regulating TLR4/ MyD88/ NF-κB p65 signaling pathway, repair the pathological damage of immune tissue, improve immune function, and effectively relieve the pain symptoms of PD rats.

Background and Objective : Primary dysmenorrhea (PD) is one of the most common clinical disorders in women of reproductive age. Our aim was to examine whether a twice-weekly thirty-minute Aviva exercise intervention could result in improvements in pain level and body awareness in patients with PD. Materials and Methods : In our prospective observational trial, the observation period included two consecutive menstrual cycles and the period of the next menstrual bleeding. The first menstrual bleeding period was the first measurement time (T1), the second was the second measurement time (T2), and the third was the third measurement time (T3) in a total of 78 volunteers. The primary endpoint was the change in the level of menstrual pain according to the Numeric Rating Scale (NRS) questionnaire between the intervention group (IG) and the control group (CG) at T1, T2, and T3. In this study, the secondary outcomes were the differences between the IG and CG regarding the different subscales of the Hungarian version of the Body Awareness Questionnaire (BAQ-H) at T1, T2, and T3; the Borg scale results of the IG; and adherence to the intervention. Statistical tests such as independent-sample t -tests, chi-square tests, Pearson's linear correlation coefficient, and repeated-measure ANCOVA were used for the analyses. Results : In total, 78 volunteers were enrolled: 40 persons in the IG and 38 in the CG. There was a significant change in the level of menstruation pain according to the NRS questionnaire between the IG and CG ( p < 0.001). There was no significant difference between the IG and CG regarding the different subscales of the BAQ-H. Only in the case of the "Note responses or changes in body process" subscale of the BAQ-H was there a trend-like effect from the Aviva exercises ( p = 0.086). Conclusions : The Aviva exercise could contribute to pain relief from PD. Regarding body awareness, no significant difference was found between the two groups. Due to the short detection period and prospective observational design, our results are preliminary and need to be confirmed in larger clinical trials.

Objective: Aim: The aim of our study was detection and correction of dysmenorrhea in teenage girls with autonomic dysfunction syndrome., Patients and Methods: Materials and Methods: The research group consisted of 37 teenage girls, aged 12-16 years, who were undergoing rehabilitation treatment with signs of dysmenorrhea and vegetative dysfunction syndrome. The study lasted for 2 years (2020-2021). A study of the variability of the heart rate at rest and under the conditions of an orthostatic test was carried out using the "Cardiolab" complex by the method of spectral analysis., Results: Results: Analyzing the initial state of the autonomic nervous system in girls with menstrual cycle disorders, the primary predominance of the sympathetic nervous system in 33.3% of girls was revealed. Before treatment, autonomic reactivity was characterized by a hypersympathetic type in 44.4% of girls, by an asympathetic type in 22.3% of children. Spectral analysis at the beginning of treatment showed that high frequencies (HF) prevail in most girls (66.0%), which indicates an increased influence of the parasympathetic part of the autonomic nervous system, and 18.5% of girls have a balanced state of the autonomic nervous system. Predominance in the spectrum of LF and VLF components was found in 15.5%, which indicates the predominance of central humoral-metabolic ergotropic effects on heart rate variability. After the course of treatment an improvement in the condition of teenage girls was observed. Menstruation became less painful or painless at all, the duration and frequency of menstruation (from 1 to 3 days, on average 1.8±0.1) and blood loss decreased. The girls felt better, did not complain of dizziness and headache., Conclusion: Conclusions: According to the results of the study, it was found that the proposed course of treatment for teenage girls with a menstrual cycle disorder with signs of autonomic dysfunction contributed to the normalization of the cycle, improvement of the general condition of the girls.

Endometriosis is a chronic condition, with debilitating symptoms affecting all ages. Dysmenorrhea and pelvic pain often begin in adolescence, affecting school, daily activities, and relationships. Despite the profound burden of endometriosis, many adolescents experience suboptimal management and significant delay in diagnosis. The symptomatology and laparoscopic findings of endometriosis in adolescents are often different than in adults, and the medical and surgical treatments for adolescents may differ from those for adults as well. This Narrative Review summarizes the diagnosis, evaluation, and management of endometriosis in adolescents. Given the unique challenges and complexities associated with diagnosing endometriosis in this age group, it is crucial to maintain a heightened level of suspicion and to remain vigilant for signs and symptoms. By maintaining this lower threshold for consideration, we can ensure timely and accurate diagnosis, enabling early intervention and improved management in our adolescent patients., Competing Interests: Financial Disclosure Jon I. Einarsson is a consultant for Arthrex. Marc R. Laufer is an advisor to Organon, Roche, and NextGen Jane, has received research awards from the J Willard and Alice S Marriott Foundation, and reports ongoing financial relationships with Wolters Kluwer Publishing and NextGen Jane. Nichole A. Tyson disclosed receiving payment from HRA Pharmaceuticals for consultation regarding the OPILL use in adolescents. The other authors did not report any potential conflicts of interest., (Copyright © 2023 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To conduct a systematic review of the quality of patient-reported outcome measures (PROMs) for primary dysmenorrhea (PDys) using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology, and to derive recommendations for use of the PROMs., Methods: We searched PubMed and Web of Science for studies reporting on the development and/or validation of any PROMs for women with PDys. Applying the COSMIN Risk of Bias Checklist, we assessed the methodological quality of each included study. We further evaluated the quality of measurement properties per PROM and study according to the criteria for good measurement properties, and graded the evidence. Based on the overall evidence, we derived recommendations for the use of the included PROMs., Results: Data from seven studies reporting on four PROMs addressing different outcomes were included. Among those, the Adolescent Dysmenorrhic Self-Care Scale (ADSCS) and the on-menses version of the Dysmenorrhea Symptom Interference Scale (DSI) can be recommended for use. The Exercise of Self-Care Agency Scale (ESCAS) and the Dysmenorrhea Daily Diary (DysDD) have the potential to be recommended for use, but require further validation. The off-menses version of the DSI cannot be recommended for use., Conclusions: The ADSCS can be recommended for the assessment of self-care behavior in PDys. Regarding measures of impact, the on-menses version of the DSI is a suitable tool. Covering the broadest spectrum of outcomes, the DysDD is promising for use in medical care and research, encouraging further investigations. Further validation studies are indicated for all included PROMs., (© 2023. The Author(s).)

Background: Dysmenorrhoea, or period pain, is a prevalent gynaecological condition that can result in functional interference during menstruation. Despite the significant disruption dysmenorrhoea can have on functioning and well-being, medical help-seeking rates are low. Little is known about what factors may predict help-seeking for dysmenorrhoea., Objectives: The current study aimed to test the predictive validity of the Behavioural Model of Health Services Use (BMHSU) for help-seeking behaviour in dysmenorrhoea, whereby help-seeking behaviour was operationalised as having attended to a healthcare professional for dysmenorrhoea-related care., Design: A cross-sectional observational design was used., Methods: Participants ( N  = 439) completed an online survey, which measured the following eight predictor variables: menstrual pain characteristics, health beliefs, self-efficacy, social support utilisation and satisfaction, perceived healthcare availability, and pain intensity and interference. Participants were also asked to report whether they had ever attended to a healthcare professional for their menstrual pain., Results: The BMHSU accounted for 8% of the variance in help-seeking behaviour. Pain interference and appointment availability were significant predictors of the variance in past help-seeking behaviour, such that those who experienced greater pain interference, and those who perceived greater availability of healthcare appointments were less likely to have visited a healthcare professional for their menstrual pain. The BMHSU had an overall 69% classification accuracy in predicting help-seeking behaviour., Conclusion: Although the BMHSU demonstrated reasonably good model fit, it does not appear to be a particularly robust model for predicting help-seeking behaviour for dysmenorrhoea. Future research should explore whether a refined BMHSU or an alternative theoretical model can provide more useful insight into this behaviour. Better understanding of the determinants of help-seeking behaviour will enable the development of interventions to promote appropriate help-seeking and improve health outcomes for individuals with menstrual pain.

Background: Primary dysmenorrhea (PD) is a common gynecological condition causing depression. Acupuncture is an effective option for PD management but its effects on PD-associated depression remain unclear., Methods: A retrospective cohort study involving 35,099 propensity score-matched pairs of acupuncture users and non-users with PD was conducted using data from Taiwan's Longitudinal Generation Tracking Database 2000. Cox proportional hazard models were used to estimate depression risk, and bioinformatics analyses were performed to uncover underlying molecular mechanisms., Results: The risk of developing depression was reduced by 64 % in acupuncture users compared with non-acupuncture users during the 19-year follow-up period. The decrease was dose-dependent. Bioinformatics analyses identified 34 co-expressed targets for acupuncture, PD, and depression; and eight hub genes (coding for interleukin 6 and 1B, tumor necrosis factor, albumin, vascular endothelial growth factor A, C-reactive protein, prostaglandin-endoperoxide synthase 2, and brain-derived neurotrophic factor) potentially involved in the therapeutic effects of acupuncture. Several molecular pathways were found to be involved, including cytokine-cytokine receptor interaction, neuroactive ligand-receptor interaction, cyclic adenosine 3',5'-monophosphate signaling pathway, mitogen-activated protein kinase signaling pathway, serotonergic synapse, and estrogen signaling pathway., Limitations: Bias in the selection of participants could have been introduced as a consequence of the retrospective nature of the study. Data were derived from a single national database, and acupuncture treatment details were unavailable., Conclusion: Acupuncture may protect against the development of depression in patients with PD. This study provides insight into the potential molecular mechanisms underlying the therapeutic effects of acupuncture in PD management and depression prevention., Competing Interests: Declaration of competing interest The authors declare no conflict of interest. The funders had no role in the study design, data collection, and analysis, the decision to publish, or the preparation of the manuscript., (Copyright © 2023 Elsevier B.V. All rights reserved.)