Analysis of the relationship between MRI imaging characteristics and clinical symptoms and therapeutic efficacy in adenomyosis patients / 中华妇产科杂志

Objective: To investigate the relationship between magnetic resonance imaging (MRI) imaging characteristics and clinical symptoms and therapeutic efficacy in adenomyosis patients. Methods: The clinical characteristics of the adenomyosis questionnaire was self-designed. This was a retrospective study. From September 2015 to September 2020, totally 459 patients were diagnosed with adenomyosis and underwent pelvic MRI examination at Peking University Third Hospital. Clinical characteristics and treatment were collected, MRI was used to determine the lesion location, and to measure the maximum lesion thickness, the maximum myometrium thickness, uterine cavity length, uterine volume, the minimum distance between the lesion and serosa or endometrium, and whether combined with ovarian endometrioma. The difference of MRI imaging characteristics in patients with adenomyosis and its relationship with clinical symptoms and therapeutic efficacy were analyzed. Results: (1) Among the 459 patients, the age was (39.1±6.4) years. There were 376 patients (81.9%, 376/459) with dysmenorrhea. Whether patients had dysmenorrhea were related to uterine cavity length, uterine volume, ratio of the maximum lesion thickness to the maximum myometrium thickness, and whether patients had ovarian endometrioma (all P<0.001). Multivariate analysis suggested that ovarian endometrioma was the risk factor for dysmenorrhea (OR=0.438, 95%CI: 0.226-0.850, P=0.015). There were 195 patients (42.5%, 195/459) with menorrhagia. Whether patients had menorrhagia were related to age, whether patients had ovarian endometrioma, uterine cavity length, the minimum distance between lesion and endometrium or serosa, uterine volume, ratio of the maximum lesion thickness to the maximum myometrium thickness (all P<0.001). Multivariate analysis suggested that ratio of the maximum lesion thickness to the maximum myometrium thickness was the risk factor for menorrhagia (OR=774.791, 95%CI: 3.500-1.715×105, P=0.016). There were 145 patients (31.6%, 145/459) with infertility. Whether the patients had infertility were related to age, the minimum distance between lesion and endometrium or serosa, and whether patients had ovarian endometrioma (all P<0.01). Multivariate analysis suggested that young and large uterine volume were risk factors for infertility (OR=0.845, 95%CI: 0.809-0.882, P<0.001; OR=1.001, 95%CI: 1.000-1.002, P=0.009). (2) The success rate of in vitro fertilization-embryo transfer (IVF-ET) was 39.2% (20/51). Dysmenorrhea, high maximum visual analogue scale score and large uterine volume affected the success rate of IVF-ET (all P<0.05). The smaller the maximum lesion thickness, the smaller the distance between the lesion and serosa, the larger the distance between the lesion and endometrium, the smaller the uterine volume, and the smaller the ratio of the maximum lesion thickness to the maximum myometrium thickness, the better the therapeutic efficacy of progesterones (all P<0.05). Conclusions: Concomitant ovarian endometrioma increases the risk of dysmenorrhea in patients with adenomyosis. The ratio of the maximum lesion thickness to the maximum myometrium thickness is an independent risk factor for menorrhagia. Young and large uterine volume may increase the risk of infertility. Severe dysmenorrhea and large uterine volume affect the success rate of IVF-ET. The therapeutic efficacy of progesterones is relatively better when the lesion is small and far away from the endometrium.

The Effect of Aromatherapy Alone or in Combination with Massage on Dysmenorrhea: A Systematic Review and Meta-analysis / O efeito da aromaterapia sozinha ou em combinação com massagem na dismenorreia: Uma revisão sistemática e meta-análise

Abstract Objective The aim of the present systematic review meta-analysis is to assess the effect of olfactory stimulation on reducing dysmenorrhea. Methods Systematic search was conducted in several databases, such as PubMed, Web of Science, Cochrane, and Scopus, to identify relevant research up to October 26, 2019. The identified studies were evaluated based on a modified Jadad scale. The intervention involves aromatherapy alone or in combination with essential oils. There was no restriction for the control group such as a placebo group or other common treatments. The Comprehensive Meta-Analysis Version 2 (Bio stat, Englewood, NJ, USA) was used for meta-analysis. Cochran's Q and I2 tests were utilized. Results The findings of our meta-analysis, which contained 13 trials (15 data), showed that dysmenorrhea decreased significantly in the group receiving aromatherapy with herbal compared with the control group (standardized mean difference [SMD] =-0.795; 95% confidence interval [CI]: -0.922 to- 0.667; 17 trials O < 0.001); heterogeneity; I2 = 19.47%; p = 0.236). In addition, four studies with insufficient data were not included in our meta-analysis. The results of all studies suggested that aromatherapy with herbal medicine group compared with control group is effective. Conclusion Aromatherapy with herbal medicine decreased dysmenorrhea. This treatment was particularly effective when aroma oil was combined with massage or when a mixture of aroma oil was used for the treatment of dysmenorrhea.

Resumo Objetivo O objetivo desta revisão sistemática-metanálise é avaliar o efeito da estimulação olfatória na redução da dismenorreia. Métodos Pesquisa sistemática foi realizada em várias bases de dados, como PubMed, Web of Science, Cochrane e Scopus para identificar pesquisas relevantes até 26 de outubro de 2019. Os estudos identificados foram avaliados com base em uma escala de Jadadmodificada. A intervenção envolvearomaterapiasozinhaouem combinação com óleos essenciais. Não houve restrição para o grupo de controle, como um grupo de placebo ou outros tratamentos comuns. O Comprehensive Meta-Analysis Version 2 (Bio stat, Englewood, NJ, EUA) foi usado para meta-análise. Os testes Q e I2 de Cochran foram utilizados. Resultados Os resultados da nossa meta-análise, que continha 13 ensaios (15 dados), mostraram que a dismenorreia diminuiu significativamente no grupo que recebeu aromaterapia com ervas em comparação com o grupo de controle (diferença média padronizada [DMP] = -0,795; intervalo de confiança [IC] de 95%: -0,922 a- 0,667; 17 ensaios O <0,001); heterogeneidade; I2 = 19,47%; p = 0,236). Além disso, quatro estudos com dados insuficientes não foram incluídos em nossa meta-análise. Os resultados de todos os estudos sugeriram que a aromaterapia com o grupo de fitoterápicos em comparação com o grupo de controle é eficaz. Conclusão A aromaterapia com fitoterapia diminuiu a dismenorreia. Este tratamento foi particularmente eficaz quando o óleo aromático foi combinado com massagem ou quando uma mistura de óleo aromático foi usada para o tratamento da dismenorreia.

Different stimulation methods on auricular points for primary dysmenorrhea: a randomized controlled trial / 中国针灸

OBJECTIVE@#To prove the therapeutic effect of auricular intradermal needling and auricular point sticking on primary dysmenorrhea (PD), and to explore its mechanism.@*METHODS@#A total of 90 patients with PD were randomized into an auricular intradermal needling group, an auricular point sticking group and a placebo group, 30 cases in each one. Neishengzhiqi (TF@*RESULTS@#Compared before treatment, the scores of CMSS, VAS and SAS were decreased at each time point of treatment in the auricular intradermal needling group, 2, 3 courses into treatment and at follow-up in the auricular point sticking group and 3 courses into treatment in the placebo group (@*CONCLUSION@#Auricular intradermal needling and auricular point sticking can both improve the clinical symptom of primary dysmenorrhea, relieve the pain and anxiety, their mechanism may be related to regulating the serum levels of PGF

Dismenorreia membranosa (membranácea): um relato de caso / Membranous dysmenorrhea: a case report

A dismenorreia é a queixa ginecológica mais comum em mulheres jovens adultas, com um índice que varia entre 43% e 93% das mulheres que menstruam. A dismenorreia membranosa (DM), uma subclassificação da dismenorreia, é definida como a descida espontânea de tecido endometrial pela vagina, cursando com dor em có- lica intensa e súbita. O relato de caso descrito evidencia três episódios típicos de DM, com recorrência em três vezes distintas, após uso do mesmo anticoncepcional oral combinado de baixa dosagem. Esta publicação é importante para a comunidade científica devido à escassez de informações e artigos científicos publicados sobre o assunto, propondo a elucidação de alguns aspectos sobre o tema.(AU)

Dysmenorrhea is the most common gynecological complaint in young adult women, with an index that varies between 43% and 93% of women who menstruate. Membranous dysmenorrhea (MD) is a subclassification of dysmenorrhea and is defined as the spontaneous descent of endometrial tissue through the vagina, leading to severe and sudden colic pain. The case report described shows three typical episodes of MD, with recurrence three times after the use of the same low-dose combined oral contraceptive. This publication is important for the scientific community due to the scarcity of information and scientific articles published about this subject, proposing to elucidate some aspects about this theme.(AU

Primary dysmenorrhea: assessment and treatment / Dismenorreia primária: avaliação e tratamento

Abstract Primary dysmenorrhea is defined asmenstrual pain in the absence of pelvic disease. It is characterized by overproduction of prostaglandins by the endometrium, causing uterine hypercontractility that results in uterine muscle ischemia, hypoxia, and, subsequently, pain. It is the most common gynecological illness in women in their reproductive years and one of the most frequent causes of pelvic pain; however, it is underdiagnosed, undertreated, and even undervalued by women themselves, who accept it as part of themenstrual cycle. It hasmajor implications for quality of life, such as limitation of daily activities and psychological stress, being one of themain causes of school and work absenteeism. Its diagnosis is essentially clinical, based on the clinical history and normal physical examination. It is important to exclude secondary causes of dysmenorrhea. The treatment may have different approaches (pharmacological, nonpharmacological and surgical), but the first line of treatment is the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and, in cases of women who want contraception, the use of hormonal contraceptives. Alternative treatments, such as topical heat, lifestyle modification, transcutaneous electrical nerve stimulation, dietary supplements, acupuncture, and acupressure, may be an option in cases of conventional treatments' contraindication. Surgical treatment is only indicated in rare cases of women with severe dysmenorrhea refractory to treatment.

Resumo Dismenorreia primária é definida como dormenstrual na ausência de patologia pélvica. Caracteriza-se pelo excesso de produção de prostaglandinas pelo endométrio que provocam hipercontractilidade uterina, resultando em isquemia e hipoxia do músculo uterino e, subsequentemente, dor. É a patologia ginecológica mais comum em mulheres em idade fértil e uma das causas mais frequentes de dor pélvica; contudo, é subdiagnosticada, subtratada, e até desvalorizada pelas próprias mulheres, que a aceitam como parte do ciclo menstrual. A dismenorreia tem grandes implicações na qualidade de vida, como limitação das atividades diárias e estresse psicológico, sendo uma das principais causas de absentismo escolar e laboral. O seu diagnóstico é essencialmente clínico, baseando-se na história clínica e num exame físico sem alterações. É importante excluir causas secundárias de dismenorreia. O tratamento pode ter diferentes abordagens (farmacológica, não farmacológica e cirúrgica), sendo que a primeira linha de tratamento consiste na utilização de anti-inflamatórios não esteroides (AINEs) e, em casos de mulheres que desejem contracepção, no uso de anticoncepcionais hormonais. Tratamentos alternativos, como a utilização de calor tópico, modificação do estilo de vida, estimulação elétrica nervosa transcutânea, suplementos alimentares, acupuntura e acupressão, podem ser uma opção nos casos de contraindicação da utilização dos tratamentos convencionais. O tratamento cirúrgico apenas se encontra indicado em casos raros de mulheres com dismenorreia grave e refratária aos tratamentos.

Estimulação elétrica nervosa transcutânea no tratamento da dor pélvica causada pela dismenorréia primária / Transcutaneous electrical nerve stimulation in the treatment of pelvic pain caused by the primary dysmenorrhea

Introdução: A dismenorreia causa o afastamento das mulheres ao trabalho, estudos e atividades de vida diária. Objetivos: Verificar a influência da Estimulação Elétrica Nervosa Transcutânea (TENS) na dor pélvica causada pela dismenorréia primária. Métodos: Vinte universitárias foram aleatoriamente distribuídas em dois grupos iguais de dez voluntárias: Grupo Tratamento (GT) e Grupo Controle (GC). Foram submetidas a um tratamento com TENS (GT) e TENS placebo (GC) e avaliadas pela Escala Visual Analógica da Dor (EVA) antes, depois e duas horas após o final do tratamento. Resultados: Houve redução da dor no GT (p = 0,0001) após o tratamento com a manutenção duas horas após o seu término (p = 0,0008). No GC, embora tenha havido uma redução do quadro álgico depois do tratamento (p = 0,0295), esta não se manteve duas horas após o final do mesmo (p = 0,4810). Conclusão: A TENS foi eficaz na redução da dor das participantes.

Introduction: Dysmenorrhea causes the removal of women to work, study and daily life activities. Objectives: To verify the influence of Transcutaneous Electrical Nerve Stimulation (TENS) in the pelvic pain caused by primary dysmenorrhea. Methods: Twenty university were randomly assigned into two equal groups of ten volunteers: Group Treatment (GT) and control group (GC). They were subjected to a treatment with TENS (GT) and placebo TENS (GC) and evaluated by the Visual Analog Pain Scale (EVA) before, after and two hours after the end of treatment. Results: There was reduction of pain in GT (p = 0,0001) after treatment with maintaining two hours after its end (p = 0,0008). In the GC, although there was a reduction in pain symptoms after treatment (p = 0,0295), this was not maintained two hours after the end of the same (p = 0,4810). Conclusion: TENS was effective in reducing pain of the participants.

Efeitos da bandagem funcional elástica sobre a dismenorreia primaria em universitárias / Effects of elastic bandage on primary dysmenorrhea in college students

Introdução: Apesar de a dismenorreia primária ser bastante incidente e ter impacto negativo na vida de mulheres, terapêuticas para o seu tratamento, tais como a bandagem funcional elástica, são pouco elucidadas pela literatura. Objetivo: Avaliar os efeitos da bandagem funcional sobre a dor e as atividades de vida diária (AVD) de estudantes universitárias com dismenorreia primária. Material e métodos: Ensaio clínico randomizado, realizado com 22 mulheres com dismenorreia primária, divididas aleatoriamente em dois grupos (A e B), acompanhadas durante dois ciclos menstruais. O grupo A recebeu intervenção no primeiro mês e, no segundo, fez-se o monitoramento dos sintomas. No grupo B fez-se o contrário. Resultados: Houve diminuição estatisticamente significativa na média geral de dor percebida pelos sujeitos, no grupo B, no terceiro (p = 0,01) e quarto dias (p = 0,02), a favor da intervenção. Também foi observada redução na intensidade da dor - de moderada e intensa para leve - de 72,7% dos sujeitos. Não houve diferença significativa entre a distribuição dos locais de dor e as AVD, exceto em uma delas. Conclusão: A bandagem é benéfica na dismenorreia primária em universitárias, com efeitos positivos sobre a redução da intensidade e a duração da dor. Palavras-chave: bandagens, dismenorreia, Fisioterapia. (AU)

Introduction: Despite of primary dysmenorrhea be very incident and have a negative impact in women's life, therapeutic techniques for the treatment, like kinesio taping, are little elucidated by the literature. Objective: To evaluate the effects of kinesio taping on pain and activities of daily living (ADLs) of university students with primary dysmenorrhea. Methods: Clinical randomized trial with 22 women with primary dysmenorrhea, allocated into two groups (A and B), followed for two menstrual cycles. The group A received the intervention on the first month and was monitored on the second month. In the group B were made the opposite. Results: There was a statistically significant reduction in the general average pain perceived by the women, in group B, in third (p = 0.01) and fourth days (p = 0.02), in favor to the intervention. It was also observed reduction in pain intensity of 72.7% of the subjects from moderate and intense to light. The pain distribution in body and the influence in ADLs did not have statistically difference, except in one ADL. Conclusion: The kinesio taping method is beneficial in primary dysmenorrhea in college students, with positive effects in reduction of pain intensity and duration. (AU)

Enfoque terapéutico de la dismenorrea desde la medicina tradicional china / Therapeutic approach to dysmenorrhea from traditional Chinese medicine

La dismenorrea hace referencia un síntoma consistente en dolor pélvico asociado al ciclo menstrual [1, 2, 3]. Desde la medicina alópata, su enfoque terapéutico parte de dos grandes grupos según sea su etiología, Primaria: se presenta principalmente desde la menarquía y corresponde a una causa puramente fisiológica, Secundaria: cuando se han evidenciado anormalidades pélvicas, siendo la endometriosis la principal patología asociada. [1,2] Desde la Medicina Tradicional China, la dismenorrea es un síntoma que corresponde a una manifestación orgánica de una alteración en el flujo energético adecuado en los canales de Ren Mai, Hígado, y/o Chong Mai como los principales responsables de la fisiología de la menstruación, en donde la insuficiencia y el estancamiento de Qi y la Sangre en estos dos últimos canales son los mayormente afectados [12]. La acupuntura permite la restauración del flujo energético adecuado en los canales afectados, generando una disminución en la intensidad del dolor principalmente en la dismenorrea primaria, mejorando la calidad de vida de las pacientes y disminución en el requerimiento de medicamentos analgésicos para el control de los síntomas asociados[10

Importancia de la relación cobre-zinc como indicador bioquímico de dismenorrea primaria / Importance of the copper-zinc ratio as a biochemical indicator of primary dysmenorrheal

La dismenorrea primaria requiere de una evaluación de los niveles séricos de cobre y zinc antes del ciclo menstrual y durante éste, permitiendo administrar estos elementos y minimizar el impacto que esta entidad ocasiona, tales como depresiones, dolores, irritabilidad de conducta, lo que conlleva ausentismos escolares y laborales.

[ effects of acupressure points in SP6 and SP8 on primary dysmenorrhea]

Dysmenorrhea is one of the most common disorders of women in reproductive age. In addition to physical and psychological disturbances, it may cause socioeconomic problems. The acupressure is a suggested treatments for dysmenorrhea. This study was conducted to identify and compare the effects of acupressure in Saninjo and DiJi points on pain severity of primary dysmenorrhea and systematic symptoms associated with it. This study was a cross-over clinical trial. 50 girls aged between 18 and 30 years old referred to an urban health center in Sar-e-Pol-e-Zahab city were selected. Subjects randomly allocated into two equal groups [A and B] and were assessed over three consecutive menstrual cycles. A questionnaire was used for data collection. Validity and reliability determined by content validity and test retest methods respectively. Pain severity was assessed using McGill pain ruler. At the end, data from 42 women were used for analysis with SPSS package. The severity of primary dysmenorrhea was 6.65 +/- 1.05 in SP6 and 6.84 +/- 1.9 in SP8 before acupressure and significantly decreased to 2.89 +/- 1.36 and 2.03 +/- 0.94 respectively after acupressure [P<0.001]. We can conclude that dysmenorrhea pain decreased after acupressure and SP6 and SP8 points can be used as an urgent remedy to alleviate primary dysmenorrhea

Influência do nível de atividade física na dismenorréia / Influence of physical activity in dysmenorrheal

A dismenorréia em mulheres jovens, em muitos casos, provoca interrupção das atividades habituais. Especula-se que as atividades físicas sejam benéficas aliviando as dores decorrentes da dismenorréia. Verificar a influência do nível de atividade física sobre a dismenorréia em mulheres jovens. Participaram do presente estudo 100 estudantes universitárias com idades entre 18 e 26 anos. A amostra foi obtida por conveniência, a partir da população feminina do Centro Universitário Adventista de São Paulo. Só foram incluídas mulheres com histórico de dismenorréia primária. Foram excluídas tabagistas, que possuíam filhos, acometidas por doença uterina e que faziam uso de contraceptivos hormonais. Todas responderam ao questionário internacional de atividade física (IPAQ), à anamnese de queixas relacionadas à dismenorréia e à Escala Visual Analógica (EVA) para a medida da intensidade da dor. Os dados foram considerados estatisticamente significantes quando p < 0,05. Os grupos de mulheres, segundo o nível de atividade física determinado pelo IPAQ, não diferiram quanto ao IMC, regularidade da menstruação e incômodos causados pela dismenorréia. A intensidade da dor avaliada pela EVA foi significantemente menor nos grupos de mulheres fisicamente ativas e muito ativas quando comparadas às sedentárias (p = 0,0129). Os dados do presente estudo permitem concluir que a prática regular de atividade física é eficaz na redução da dor decorrente de dismenorréia, podendo assim, constituir-se em opção de tratamento não medicamentoso.

Dysmenorrhea in young women, in many cases causing interruption of daily activities. It is speculated that physical activities are beneficial relieving pain due to dysmenorrhea. Verify the influence of physical activity on dysmenorrhea in adolescent and young women. This study included 100 college students aged between 18 and 26 years. This sample was obtained through sampling by convenience, from the female population of Adventist University of Sao Paulo. Only women with a history of primary dysmenorrhea were included. We excluded smokers, those who had children, suffer from uterine disease and those who make use of hormonal contraceptives. The participants answered to International Physical Activity Questionnaire (IPAQ) and VAS (Visual Analogue Scale) to measure the intensity of pain. In all cases, the differences between the groups of women were considered as statistically significant if p < 0,05. The level of physical activity determined by the IPAQ did not diff er in relationship to BMI, regularity of menstruation and uncomfortable caused by dysmenorrheal. The intensity of pain assessed by VAS due to dysmenorrhea was significantly lower in groups of women?s physically active and very active compared to sedentary (p = 0,0129). The practice of regular physical activity is effective in reducing dysmenorrhea and may be an option of non medicated treatment.

The effectiveness of connective tissue massage in the treatment of primary dysmenorrhea among young women / Efetividade da massagem do tecido conjuntivo no tratamento da dismenorréia primária em mulheres jovens

OBJECTIVE: to evaluate the possible effectiveness of connective tissue massage for the non-medical treatment of primary dysmenorrhea. METHODS: this was a pilot observational cohort study. SETTING: University clinics. PARTICIPANTS: Seventy two young women presenting primary dysmenorrhea. INTERVENTION: Physiotherapy students in their last year at university and physiotherapists were trained for 20 hours to apply the massage. All volunteers were submitted to lumbar connective tissue massage twice weekly, while they were not menstruating, during the three menstrual cycles that followed admission. The following regions were manipulated: sacral, lumbar, last thoracic vertebrae and subcostal. INDICATORS: Pain score, use of pain medication and other menstrual systemic symptoms over time (before treatment, after each of the three menstrual periods during treatment, and in the second and in the third month following treatment). RESULTS: after the first treatment month, the pain score decreased significantly (p<0.001). The percentage of women requiring pain medication and reporting systemic symptoms decreased over time, although there was no correlation between the number of massages and the pain score in the multiple regression analysis. CONCLUSIONS: connective tissue massage may cause a reduction in menstrual pain but the study design does leaves open the possibility of a placebo effect. The results justify performing a randomized clinical trial to confirm whether such an effect exists or not.

OBJETIVO: avaliar a possível efetividade da massagem do tecido conjuntivo para o tratamento não medicamentoso da dismenorréia primária. MÉTODOS: estudo piloto, do tipo observacional de coorte com setenta e duas mulheres jovens com dismenorréia primária em Clínica Universitária. Estudantes de fisioterapia e fisioterapeutas receberam treinamento de 20 horas para aplicar a massagem. Todas as voluntárias receberam massagem do tecido conjuntivo lombar duas vezes por semana, no período intermenstrual durante os três ciclos menstruais após a admissão. As regiões manipuladas foram: sacral, lombar, última vértebra torácica e sub-costal. Desfechos avaliados: Escore de dor, uso de medicamentos e ocorrência de outros sintomas sistêmicos ao longo do tempo (antes do tratamento, após cada ciclo menstrual durante o tratamento e nos dois meses após o tratamento). RESULTADOS: o escore de dor diminuiu significativamente após o primeiro mês de tratamento (p<0,001). A porcentagem de voluntárias que precisou de medicamentos para dor e que relatou sintomas sistêmicos diminuiu com o tempo de tratamento, mas não houve correlação entre o número de massagens e o escore de dor na análise multivariada. CONCLUSÃO: a massagem do tecido conjuntivo pode causar uma redução da dor menstrual, mas o tipo de estudo não permite excluir um efeito placebo. Os resultados justificam a realização de estudo clínico randomizado para confirmar ou não esse efeito.

Función hormonal y flujo sanguíneo útero-ovárico en pacientes sometidos a salpingectomía / Hormonal function and uterine and ovary blood flow in patients under salpingectomy

El objetivo de la investigación fue comparar los efectos de la salpingectomía sobre la función hormonal y el flujo sanguíneo útero-ovárico. Se incluyeron 33 mujeres sanas con ciclos menstruales regulares. La salpingectomía fue realizada inmediatamente en los 5 días siguientes a la menstruación. Se tomaron muestras de sangre venosa para determinar las concentraciones de las hormonas folículo estimulante y luteinizante, estradiol y progesterona antes y luego de 3 meses de la cirugía. El flujo sanguíneo fue evaluado usando Doppler color y de pulso para medir el índice de resistencia, índice de pulsatilidad y velocidad sistólica pico en la vasculatura ovárica y las arterias uterinas. Se observó un aumento estadísticamente significativo en las concentraciones de hormonas folículo estimulante y luteinizante después de 3 meses de la salpingectomía (P<0,05). No se encontraron diferencias estadísticas significativas en las concentraciones de estradiol y progesterona (P=ns). Se observaron variaciones estadísticas significativas en los valores de velocidad sistólica pico, índice de resistencia e índice de pulsatilidad de la arteria ovárica al comparar los valores antes y 3 meses después de la salpingectomia (P<0,05). También se observó un aumento estadísticamente significativo en el volumen de los ovarios después de 3 meses de la cirugía (P<0,05). Se concluye que luego de 3 meses, la salpingectomía produce cambios en las concentraciones de gonadotropinas, tamaño de los ovarios y en los parámetros ecográficos Doppler de las arterias ováricas

The objetive of research was to compare the effects of salpingectomy over hormonal function and uterine and ovary blood flow. Thirty-three healthy women with normal menstrual cycles were included. Salpingectomy was performed immediately in five days following menstruation. A venous blood sample was taken to determine folicular stimulant and luteinizant hormones, estradiol and progesterone before and after three months of surgery. Bood flow was evaluated using color and pulse Doppler to measure resistance index, pulsatility index and peak systolic flow in ovary vasculare and uterine artery. There were statically significant increased in folicular stimulant and luteinizant hormones concentrations after three months of salpingectomy (P<0.05). There were not significant differences in estradiol and progesterone concentrations (P=ns). There were statistically significant variations in values of peak systolic flow, resistance index and pulsatility index of ovarian arteries when values before and three moths after salpingectomy were compared (P<0.05). There was also a statistically significant increase in ovary volume after three months of surgery (P=0.05). It is concluded that after three months, salpingectomy produces changes in gonadotropins concentrations, ovary size and ultrasound Doppler parameters of ovarian artery

[ effects of Zingiber officinal R. on primary dysmenorrhea]

Prevalence of dysmenorrhea and its importance for women life as well as side effects of non steroid anti inflammatory drug used for its treatment increases the tendency for alternative complementary, and herbal therapy. This study was carried out to determine the effect of Zingiber offlcinale R. on primary dysmenorrheal on students residing in Dormitories' Shahed University. This clinical trial was performed on 78 unmarried students, average 21 years old with primary dysmenorrhea residing in Dormitories' Shahed University. Subjects were selected through a questionnaire which included demographic and menstrual cycle characteristics and graded of dysmenorrhea. Graded of dysmenorrhea were determined by verbal multidimensional scoring system and subjects who were graded moderate and severe dysmenorrhea were randomly allocated into two groups that received the Zingiber capsule and the placebo capsule. The subjects in Zingiber group received the 500 mg zingiber powders in capsules three times a day for three days and placebo group received 500 mg placebo capsule similarly from a day of starting of menstruation. Severity and duration of dysmenorrheal pain were determined in both groups and compared to each other. Results indicate that demographic characteristics [age, BMI and menstrual status] were similar between two groups before treatments. Severity and duration of dysmenorrhea in Zingiber group deceased significantly [p<0.01 and p<0.021 respectively] at the end of the study compared to placebo group. Administration of Zingiber 500 mg t.i.d decreases pain and duration of primary dysmenorrhea without any obvious adverse effects. The investigation for accurate effective doses of Zingiber and its adverse effect on long term administration is recommended

[Efficacy of acupuncture in control of primary dysmenorrhea related pain in 15-30 years old women at the gynecology clinic of Bouali Hospital between 2007 and 2008]

Dysmenorrhoea is the most common gynaecological disorder among adolescents. Acupuncture is a treatment that has been shown to be effective for pain relief in a variety of conditions. We evaluated the effect of acupuncture in control of primary dysmenorrhea related pain. In a randomized, double-blind, clinical trial study, 100 patients with primary dysmenorrhea were randomized to acupuncture [9 sessions over 3 months] or control group [placebo acupuncture]. All subjects were allowed to receive usual medical care. Pain was rated on a Numerical Pain Score [0-10] at three months. Patients' data were analyzed by t- test using SPSS software. This study showed significant effectiveness of acupuncture in control of primary dysmenorrhea pain after 3 months [p<0.0001]. No complications or side effects were reported due to acupuncture. Acupuncture was associated with relief of pain in patients with primary dysmenorrheal, and it is a safe and effective method in reduction of primary dysmenorrhea related pain

Dismenorrea primaria en adolescentes: revisión de la literatura / Primary dysmenorrhea in adolescent: literature review

En la población adolescente, la dismenorrea es la principal causa de consulta ginecológica y también de ausentismo escolar, laboral o de otras actividades. Aproximadamente el 10 por ciento de las adolescentes que refieren dismenorrea presentan una causa orgánica secundaria. Dismenorrea primaria comienza a manifestarse característicamente con la menarca o poco tiempo después de ésta, que coincide con la aparición del ciclos ovulatorios regulares. El clínico debe ser capaz de diferenciar las múltiples etiologías del dolor pélvico crónico: una historia clínica detallada y un buen examen físico pueden ser suficientes para diagnosticar esta entidad. Pese a la alta prevalencia de dismenorrea en las adolescentes, es alto el porcentaje que no solicita atención médica o es subtratada, por lo que el objetivo de esta revisión fue presentar una actualización de lo publicado en la literatura sobre la fisiopatología, enfrentamiento y manejo de la dismenorrea primaria, desde tratamientos clásicos a la medicina más alternativa. De esta manera podremos entregar a la adolescente un manejo más integral, y así, disminuir el impacto que provoca la dismenorrea primaria (DP) en la vida de nuestras pacientes.

Dysmenorrhea in adolescent is an important cause of gynecological consult, school and employment absenteeism. Approximately 10 percent of adolescents who report dysmenorrhoea have an organic cause. Primary dysmenorrhea begins to manifest characteristically with menarche or shortly thereafter, coinciding with the onset of regular ovulatory cycles. The clinician should beable to differentiate multiple etiologies of chronic pelvic pain: a detailed history and physical exam may be sufficient to diagnose this entity. Despite the high prevalence of dysmenorrhea in adolescent girls, a high percentage doesn’t seek medical treatment or are undertreated. The objective of this review was to provide an update of the pathophysiology, and management of primary dysmenorrhea, from traditional treatments to alternative medicine. In this way adolescent can obtain a more integrated management, and improve her life quality.

Estimulação elétrica transcutânea (TENS)em ginecologia e obstetrícia: alternativa nas síndromes dolorosas / Transcutaneous electrical nerve stimulation (TENS) in gynecology and obstetrics: pain syndromes alternative

A estimulação elétrica transcutânea (TENS) vem sendo muito utilizada como recurso não farmacológico no alívio da dor, nas mais diversas doenças. Suas aplicações variam conforme a intensidade, a freqüência, a largura do pulso na estimulação e a colocação dos eletrodos sob a pele. O conhecimento dos mecanismos de ação da TENS, no organismo humano, baseia-se principalmente no seu efeito analgésico. Muitos estudos estão sendo feitos para determinar se a TENS seria efetiva em todas as formas de sintomas dolorosos e se sua ação perdura por longo tempo não só imediatamente após a aplicação da corrente. A teoria mais aceita da ação da TENS é a Teoria das Comportas, baseada na velocidade de propagação do estímulo e na produção de neurotransmissores inibidores como a B-endorfina e a B-lipotropina. A TENS parece clinicamente eficaz nas dores agudas e crônicas, principalmente nas de carater crônico. Observa-se que seu uso vem sendo cada vez mais freqüente nas doenças ginecológicas que cursam com dor, principalmente em pós-operatório de laparotomias, dismenorréias primárias, vulvodinias, cefaléias pré-menstruais, distúrbios dolorosos da tensão pré-menstrual. A eletroestimulação transcutânea pode ser uma das opções terapêuticas no tratamento de pacientes que necessitam de analgesia, por ser um recurso de baixo custo e não apresentar efeitos colaterais.