BACKGROUND: Dysmenorrhoea-Related Pelvic Pain (DRPP) is a common condition, which may or may not include bladder-related symptoms. Primary health care practitioners (PHCP) rely heavily on language for diagnosis of DRPP-related conditions. However, there are no established pain descriptors to assist PHCP to determine whether an individual\'s DRPP may include a bladder component.
OBJECTIVE: To identify differences in the use of pain descriptors in women with DRPP with and without a co-existing bladder pain component, through an exploratory study of the language of pelvic pain in women.
METHODS: A cross-sectional online survey of Australian and New Zealand women (n = 750, ages 18-49) who have self-identified pelvic pain. Free text and predetermined pain descriptors used by women with a self-perceived bladder pain component (DRPPB+, n = 468) were compared to those without bladder pain (DRPPB-, n = 282). Statistical analysis included Pearson χ2, logistic regression and analysis of variance tests using StataCorp Stata Statistical Software combined with qualitative data from AntConc concordance software.
RESULTS: Within free-form text, bloating (P = 0.014) and pressure (P = 0.031) were used more commonly to describe dysmenorrhoea in women with DRPPB+, while the word excruciating (P < 0.001) was more commonly used by women with DRPPB-. From a pre-determined list of descriptors, pounding (P < 0.001), tingling (P < 0.001), stabbing (P = 0.010), burning (P = 0.002) and cramping (P = 0.021) were more commonly used by women with DRPPB+, than women with DRPPB-.
CONCLUSIONS: Systematic patterns of word use should encourage practitioners to further enquire about bladder symptoms that may co-exist with dysmenorrhoea. Knowledge of these words may be useful in targeting diagnostic and therapeutic interventions.

OBJECTIVE: How do different warning indicators help to identify disabling dysmenorrhoea among women in young adulthood?
METHODS: A nationwide cross-sectional study of women aged 18-25 years from the CONSTANCES cohort was constructed. Disability was assessed with the Global Activity Limitation Indicator question \'For the past 6 months, have you been limited in routine activities?Yes, severely limited/Yes, limited/ No, not limited\'. Dysmenorrhoea pain intensity and other chronic pelvic pain symptoms (dyspareunia and non-menstrual pain) were evaluated according to questions from a specific questionnaire. Probability of disability was estimated using a logistic prediction model according to dysmenorrhoea intensity, other indicators of pelvic pain symptoms and other obvious covariates. The results of the predictive model of disabling dysmenorrhoea were presented on a nomogram.
RESULTS: Among 6377 women, the rate of disability was estimated at 7.5%. Increased intensity of dysmenorrhoea (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.04-1.13), increased frequency of dyspareunia (from OR 1.69, 95% CI 1.33-2.14 up to OR 3.41, 95% CI 2.16-5.38) non-menstrual chronic pelvic pain (OR 1.75, 95% CI 1.40-2.19), body mass index over 25 kg/m2 (OR 1.45, 95% CI 1.17-1.80) and non-use of the hormonal contraceptive pill (OR 1.29, 95% CI 1.05-1.59) were significantly associated with disability. According to the nomogram, a predicted probability of 15% or more could be chosen as a threshold. This represents almost 4.6% of young women in this sample being classified at risk of disabling dysmenorrhoea.
CONCLUSIONS: Dysmenorrhoea pain intensity and associated pelvic pain symptoms are warning indicators that can be measured to help screen young women who may suffer from disabling dysmenorrhoea.

Vitamin D reduces prostaglandin levels and inflammation, making it a promising treatment option for dysmenorrhoea. However, its effects on pain intensity in different types of dysmenorrhoea remain unclear. We examined whether vitamin D supplementation decreases pain intensity in patients with dysmenorrhoea. The Cochrane Library, Embase, Google Scholar, Medline, and Scopus databases were searched from inception to 30 December 2023. Randomised controlled trials (RCTs) evaluating vitamin D supplementation effects on such patients were included. The primary and secondary outcomes were measured by the changes in pain intensity and rescue analgesic use, respectively. Pooled mean differences and rate ratios were calculated using a random-effect model; trial sequential analysis (TSA) was also performed. Overall, 11 studies involving 687 participants were included. Vitamin D supplementation significantly decreased pain intensity in patients with dysmenorrhoea compared with controls (pooled mean difference, -1.64; 95% confidence interval, -2.27 to -1.00; p < 0.001; CoE, moderate; I2 statistic, 79.43%) and indicated substantial heterogeneity among the included studies. TSA revealed that the current RCTs provide sufficient information. In subgroup analyses, vitamin D supplement reduced primary dysmenorrhoea pain but not secondary dysmenorrhoea pain. In conclusion, although substantial heterogeneity persists, vitamin D supplementation decreased pain intensity in patients with dysmenorrhea, especially in those with primary dysmenorrhoea.

OBJECTIVE: What is the contribution of sociodemographic, psychosocial, lifestyle and reproductive factors up to the age of 11-12 years to the occurrence of dysmenorrhoea at age 15-16 years within the Amsterdam Born Children and their Development (ABCD) study?
METHODS: Data of 1038 female adolescents were used. Participants\' baseline characteristics were obtained using self-reported questionnaires up to the age of 11-12 years, as well as the obstetric information of their mothers during pregnancy. Dysmenorrhoea was assessed at the age of 15-16 years, and was deemed to be present if an adolescent reported menstrual abdominal and/or back pain and therefore took medication and/or hormonal contraception. Using a backward selection approach, potential determinants of dysmenorrhoea were selected and multivariable associations were determined.
RESULTS: The overall prevalence of dysmenorrhoea was 49.5% among the participants. Intake of 3-4.5 sugar-sweetened beverages/day (P = 0.035) and higher gynaecological age (i.e. years since menarche) (P < 0.001) were significantly associated with higher occurrence of dysmenorrhoea in the final model, which explained 8.1% of the total variance in the occurrence of dysmenorrhoea. No significant associations were found between the occurrence of dysmenorrhoea and sociodemographic or psychosocial factors.
CONCLUSIONS: This investigation of various potential risk factors for dysmenorrhoea suggests that diet and reproductive factors are particularly important predictors of the occurrence of dysmenorrhoea among young adolescents. Specifically, intake of sugar-sweetened beverages and higher gynaecological age were predictive of the occurrence of dysmenorrhoea. Other lifestyle factors were also identified as possible risk factors. Using this knowledge, effective strategies can be developed to reduce the burden of dysmenorrhoea among adolescents, and to provide appropriate care for those suffering from the condition.

Background: Adenomyosis is a common disorder in women of reproductive age. The gold standard for diagnosis is histopathological examination of hysterectomy specimen. However, only a small percentage of women undergo surgery as treatment is primarily hormonal. Non-invasive methods of diagnosis include transvaginal sonography and magnetic resonance imaging. Patient management in adenomyosis is often based on ultrasonographic diagnosis alone, highlighting the importance of a uniform, reproducible, clinically relevant and validated sonological classification and scoring system. Although a few investigators have proposed classification and scoring system for diagnosis of adenomyosis, none of those have been validated yet. This study aimed to propose and validate a new sonological classification and scoring system for adenomyosis. Methods: This was a prospective observational pilot study. A new sonological classification and scoring system of adenomyosis was proposed based on topography, type, size and extent, which was validated by comparing the sonological reporting with histopathological reporting. The main outcome measures that were measured were rate of agreement (Cohen\'s kappa) between the findings of sonologist and pathologist; and diagnostic accuracy of the sonological classification of adenomyosis. Results: This pilot study included 30 women who underwent hysterectomy over a time period of one year with ultrasonographic diagnosis of adenomyosis. The rate of agreement (Cohen\'s kappa) between the findings of sonologist and pathologist showed substantial agreement (0.703) for topography and almost perfect agreement for type (0.896), extent (0.892) and size (0.898). Conclusions: Our newly proposed sonological classification and scoring system for adenomyosis is valid and can be used for clinical application in interpersonal communication between clinicians, to prognosticate patients about the disease severity, to assess the candidates for surgical management and in further studies to correlate with symptoms severity and effectiveness of medical therapies.

Introduction One-third to one-half of females with primary dysmenorrhea are missing school or work at least once per cycle, and more frequently 5% to 14% of them. Dysmenorrhea is one of the most common gynecologic disorders among young girls and is the major cause of activity restriction and college absence. A direct link between primary menstrual abnormalities and chronic conditions such as obesity has been established, though the exact pathology behind it is yet unknown. Method A total of 420 female students between 18 and 25 years of age from various professional colleges in a metro city were included in the study. Semi-structured questionnaire was used. Students were examined for height and weight. Results History of dysmenorrhea was given by 82.6% students. Out of these, 30% had severe pain and required medication. Only 20% took professional help for the same. There was a high prevalence of dysmenorrhea in participants who ate food outside frequently. Prevalence of irregular menstruation was more (41.94%) in girls having junk food three to four times a week. Conclusion The prevalence of dysmenorrhea and premenstrual symptoms were much higher as compared to the other menstrual abnormalities. The study revealed a direct association between consumption of junk food and an increase in dysmenorrhea.

OBJECTIVE: To determine the efficacy of zinc sulfate supplementation in managing dysmenorrhoea.
METHODS: In total, 103 high school students were randomised into an experimental arm (52 students) and a control arm (51 students) and received 40-mg zinc sulfate or placebo, respectively, over three cycles. Primary outcome measures were the mean Visual Analogue Scale score, which measured pain over three cycles, and the frequency of nausea and vomiting. Secondary outcomes were the use of additional analgesics and the frequency of allergic reactions.
RESULTS: Fifty participants were analysed in each group. Mean pain scores were not significantly different between the groups before administering zinc sulfate therapy. Following the intervention, the mean pain scores for the treatment (2.80 ± 2.28) and placebo (3.48 ± 2.85) groups were not significantly different in the first cycle; however, scores in the treatment group were significantly better in the second (2.56 ± 1.97 vs 3.80 ± 2.77) and third (1.95 ± 1.72 vs 3.95 ± 2.82) cycles. No significant differences were observed between the groups in the nausea and vomiting incidence and the requirement for additional analgesics.
CONCLUSIONS: Zinc sulfate reduces dysmenorrhoea severity with minimal or no adverse effects, especially with more than one cycle of usage.Trial Registration Number: PACTR202105843292338. The trial is publicly available and was registered at www.pactr.org on 25 May 2021.

UNASSIGNED: Primary aim of this study was to investigate endometriosis characteristics of patients with psychiatric conditions or depression. The secondary aim was to study tolerability of dienogest in this context.
UNASSIGNED: This observational case-control study included endometriosis data from patients visiting our clinic from 2015-2021. We collected information from patient charts and in phone interviews based on a structured survey. Patients with surgical confirmed endometriosis were included.
UNASSIGNED: 344 patients fulfilled the inclusion criteria: n = 255 no psychiatric disorder, n = 119 any psychiatric disorder and n = 70 depression. Patients with depression (EM-D, p=.018; p=.035) or psychiatric condition (EM-P, p=.020; p=.048) suffered more often from dyspareunia and dyschezia. EM-P patients had more often primary dysmenorrhoea with higher pain scores (p=.045). rASRM stage or localisation of lesions did not differ. EM-D and EM-P patients discontinued dienogest treatment more often related to worsening of mood (p= .001, p=.002).
UNASSIGNED: EM-D or EM-P had a higher prevalence of pain symptoms. This could not be attributed to differences in rASRM stage or location of endometriosis lesions. Strong primary dysmenorrhoea might predispose to develop chronic pain-based psychological symptoms. Therefore, early diagnosis and treatment are relevant. Gynaecologist should be aware of the potential impact of dienogest on mood.
Women with endometriosis and psychiatric disorders especially have more dyschezia and dyspareunia, independent from rASRM stage, depth of infiltration and localisation of endometriosis lesions. Dienogest has an impact on mood especially in already prone patients.Trial registration: trial registration number: NCT04816357. https://clinicaltrials.gov/ct2/show/NCT04816357Date of registration: 22.03.2021, date of enrolment of the first subject: 25.03.2021.

OBJECTIVE: Knowing the population\'s needs in order to plan measures to reduce emergency department (ED) use is fundamental. The objective of this study was to describe gynaecological ED visits and associated findings in women of reproductive age.
METHODS: This study was a retrospective anonymized chart review analysis of visits to the ED for gynaecological disturbances at the University Hospital of Modena. All consecutive women of reproductive age were included. Women aged <18 years and postmenopausal women were excluded from this study.
RESULTS: In total, 461 records were analysed. The median age was 41 (interquartile range 34-46) years. The most common symptom was dysmenorrhoea (42.7 %), followed by heavy menstrual bleeding (33.2 %). The most common gynaecological findings in the ED were adenomyosis (86.1 %), endometriosis (37.1 %) and leiomyomas (13.7 %). Adenomyosis was the most common finding, regardless of age. Endometriosis was more prevalent in women aged <41 years (43.8 % vs 31.2 %; p < 0.05). Meanwhile, adenomyosis and leiomyomas were more prevalent in women aged ≥41 years (81.11 % vs 90.57 % and 7.37 % vs 19.26 %, respectively; p < 0.05). Moreover, potentially life-threatening findings had low prevalence [i.e. haemorrhagic ovarian cyst (0.2 %), tubo-ovarian abscess (0.2 %) and pelvic inflammatory disease (0.4 %)].
CONCLUSIONS: In the study setting, chronic pathologies such as adenomyosis, endometriosis and leiomyomas significantly impacted use of the ED. Adenomyosis was the most common pathology, regardless of age. Adenomyosis and leiomyomas were more prevalent in women aged ≥41 years, and endometriosis was more prevalent in women aged <41 years.

This was a randomised trial aimed to determine squatting exercises\' effects on menstruation, pelvic mechanics, and uterine circulation in primary dysmenorrhoea. A total of 120 females with primary dysmenorrhoea were assigned into group (A), receiving yoga protocol, or groups (B, C & D), receiving yoga protocol added to modified wall squat, sumo squat, or deep squat, respectively. Menstrual pain and distress, pelvic inclination, and uterine circulation were measured before and after interventions using a pain scale, a questionnaire, palpation metre, and Doppler ultrasonography, respectively. There was a significant reduction in pain intensity in groups B & C (effect size = 3.97 & 5.89, respectively), compared to group A (effect size = 3.68), and in group C (effect size = 5.89) compared to group D (effect size = 3.94), pain subscale in the groups B, C & D (effect size = 1.69, 3.3 & 3.41, respectively), compared to group A (effect size= 2.47), water retention subscale in group D effect size 0.90 compared to group A (effect size =0.41) and in the questionnaire total scores in the groups C &D (effect size = 2.3 & 2.46, respectively) when compared to group A (effect size =1.94). Adding squatting exercises to yoga is more effective than yoga alone in reducing menstrual pain and distress.IMPACT STATEMENTWhat is already known on this subject? Physical exercises positively affect primary dysmenorrhoea in terms of decreased pain and distress, possibly through altering faulty posture. Squatting exercises affect lumbopelvic mechanics.What do the results of this study add? This study explores the effect of squatting exercises on pelvic inclination, menstrual aspects, and circulation.What are the implications of these findings for clinical practice and/or further research? Squatting exercises can be utilised to affect pelvic mechanics leading to decreased menstrual pain and distress, because of decreased pelvic congestion.