Herbal and dietary therapies for primary and secondary dysmenorrhoea. Surgical treatment of primary dysmenorrhea with laparoscopic uterine nerve ablation. Comparison of laparoscopic presacral neurectomy and laparoscopic uterine nerve ablation for primary dysmenorrhea. Prospective, randomized, double-blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild, and moderate endometriosis. Menstrual blood loss in dysmenorrhoea: effects of proquazone and indomethacin Effects of acupressure at the Sanyinjiao point on primary dysmenorrhoea. The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2-5 year follow-up. Prevalence and correlates of three types of pelvic pain in a nationally representative sample of Australian women.
Background Dysmenorrhoea refers to the occurrence of painful menstrual cramps of uterine origin and is a common gynaecological complaint . Common treatment for dysmenorrhoea is medical therapy such as nonsteroidal anti-inflammatories ( NSAIDs ) or oral contraceptive pills ( OCPs ) which both work by reducing myometrial activity ( contractions of the uterus ) . The efficacy of conventional treatments such as nonsteroidals is considerable , however the failure rate is still often 20 - 25 % . Many consumers are now seeking alternatives to conventional medicine and research into the menstrual cycle suggests that nutritional intake and metabolism may play an important role in the cause and treatment of menstrual disorders . Herbal and dietary therapies number among the more popular complementary medicines yet there is a lack of taxonomy to assist in classifying them . In the US , herbs and other phytomedicinal products ( medicine from plants ) have been legally classified as dietary supplements since 1994 . Included in this category are vitamins , minerals , herbs or other botanicals , amino acids and other dietary substances . For the purpose of this review we use the wider term herbal and dietary therapies to include the assorted herbal or dietary treatments that are classified in the US as supplements and also the phytomedicines that may be classified as drugs in the European Union . Objectives To determine the efficacy and safety of  herbal and dietary therapies  for the treatment of  primary and secondary dysmenorrhoea  when compared to each other , placebo , no treatment or other conventional treatments ( e.g. NSAIDS ) . Search methods Electronic search es of the Cochrane Menstrual Disorders and Subfertility Group Register of controlled trials , CCTR , MEDLINE , EMBASE , CINAHL , Bio extracts , and PsycLIT were performed to identify relevant r and omised controlled trials ( RCTs ) . The Cochrane Complementary Medicine Field 's Register of controlled trials ( CISCOM ) was also search ed . Attempts were also made to identify trials from the National Research Register , the Clinical Trial Register and the citation lists of review articles and included trials . In most cases , the first or corresponding author of each included trial was contacted for additional information . Selection criteria The inclusion criteria were RCTs of herbal or dietary therapies as treatment for primary or secondary dysmenorrhoea vs each other , placebo , no treatment or conventional treatment . Interventions could include , but were not limited to , the following ; vitamins , essential minerals , proteins , herbs , and fatty acids . Exclusion criteria were : mild or infrequent dysmenorrhoea or dysmenorrhoea from an IUD . Data collection and analysis Seven trials were included in the review . Quality assessment and data extraction were performed independently by two review ers . The main outcomes were pain intensity or pain relief and the number of adverse effects . Data on absence from work and the use of additional medication was also collected if available . Data was combined for meta- analysis using Peto odds ratios for dichotomous data or weighted mean difference for continuous data . A fixed effects statistical model was used . If data suitable for meta- analysis could not be extracted , any available data from the trial was extracted and presented as descriptive data . Main results MAGNESIUM :  Three small trials were included that compared magnesium and placebo . Overall magnesium was more effective than placebo for pain relief and the need for additional medication was less . There was no significant difference in the number of adverse effects experienced . VITAMIN B6 : One small trial of vitamin B6 showed it was more effective at reducing pain than both placebo and a combination of magnesium and vitamin B6 . MAGNESIUM AND VITAMIN B6 : Magnesium was shown to be no different in pain outcomes from both vitamin B6 and a combination of vitamin B6 and magnesium by one small trial . The same trial also showed that a combination of magnesium and vitamin B6 was no different from placebo in reducing pain .  VITAMIN B1 : One large trial showed vitamin B1 to be more effective than placebo in reducing pain .  VITAMIN E : One small trial comparing a combination of vitamin E ( taken daily ) and ibuprofen ( taken during menses ) versus ibuprofen ( taken during menses ) alone showed no difference in pain relief between the two treatments . OMEGA-3 FATTY ACIDS : One small trial showed fish oil ( omega-3 fatty acids ) to be more effective than placebo for pain relief . JAPANESE HERBAL COMBINATION : One small trial showed the herbal combination to be more effective for pain relief than placebo , and less additional pain medication was taken by the treatment group . Authors ' conclusions Vitamin B1 is shown to be an effective treatment for dysmenorrhoea taken at 100 mg daily , although this conclusion is tempered slightly by its basis on only one large RCT . Results suggest that magnesium is a promising treatment for dysmenorrhoea . It is unclear what dose or regime of treatment should be used for magnesium therapy , due to variations in the included trials , therefore no strong recommendation can be made until further evaluation is carried out . Overall there is insufficient evidence to recommend the use of any of the other herbal and dietary therapies considered in this review for the treatment of primary or secondary dysmenorrhoea With approximately 25 % of dysmenorrheic patients reporting no improvement with nonsteroidal anti-inflammatory drugs , a study was devised to evaluate the effectiveness of a laparoscopic technique for the interruption of the uterosacral nerves . In a double-blind study of 21 patients with primary dysmenorrhea , 81 % ( 9 of 11 ) reported significant relief from menstrual pain after the surgery . Performed as an outpatient procedure , laparoscopic uterine nerve ablation may alleviate dysmenorrheic complaints when other modalities have failed . Half the treated women reported continued relief of menstrual pain at 12 months . These results suggest that uterosacral nerve interruption may prove an effective alternative treatment for this menstrual disorder OBJECTIVE To compare laparoscopic presacral neurectomy and laparoscopic uterine nerve ablation for  primary dysmenorrhea .  STUDY DESIGN Sixty-eight patients with primary dysmenorrhea and a poor response to medical treatment were r and omized into two groups . One group ( 33 patients ) had laparoscopic presacral neurectomy ( LPSN ) and the other group ( 35 patients ) , laparoscopic uterine nerve ablation ( LUNA ) . RESULTS There were no complications , and all the patients left the hospital within 24 hours after surgery . The efficacy of both surgical methods was almost equal ( 87.9 % vs. 82.9 % ) at the 3-month postoperative follow-up visit , but the efficacy of LPSN was significantly better than that of LUNA ( 81.8 % vs 51.4 % ) at the 12-month visit . CONCLUSION LPSN is a valid option for treating primary dysmenorrhea OBJECTIVE To assess the efficacy of laser laparoscopic surgery in the treatment of  pain associated with minimal , mild , and moderate endometriosis . DESIGN A prospect i ve , r and omized , double-blind , and controlled clinical study . SETTING Royal Surrey County Hospital , Guildford , United Kingdom , a referral center for the laser laparoscopic treatment of endometriosis . PATIENTS Sixty-three patients with pain ( dysmenorrhoea , pelvic pain , or dyspareunia ) and minimal to moderate endometriosis . INTERVENTIONS The patients were r and omized at the time of laparoscopy to laser ablation of endometriotic deposits and laparoscopic uterine nerve ablation or expectant management .  Pain symptoms were recorded subjectively and by visual analogue scale . The women were unaware of the treatment allocated as was the nurse who assessed them at 3 and 6 months after surgery . MAIN OUTCOME MEASURE Improvement or resolution of pain symptoms assessed subjectively and by visual analogue score . RESULTS Laser laparoscopy results in statistically significant pain relief compared with expectant management at 6 months after surgery . Sixty-two and a half percent of the lasered patients reported improvement or resolution of symptoms compared with 22.6 % in the expectant group . Results were poorest for minimal disease and , if patients with mild and moderate disease only are included , 73.7 % of patients achieved pain relief . There were no operative or laser complications . CONCLUSIONS Laser laparoscopy is a safe , simple , and effective treatment in alleviating pain symptoms in women with stages I , II , and III endometriosis Summary . Abnormal production of uterine prostagl and ins ( PG ) causes primary dysmenorrhoea and excessive menstrual blood loss ( MBL ) . We measured here MBL in primary dysmenorrhoea and found it to be normal during treatment with opiate analgesics ( 33.5±1.6 ml ; mean±D , n=13 ) , placebo ( 33.4±18.6 ml ; n=8 ) , proquazone ( 31.8±18.0ml ; n=8 ) and indomethacin ( 26.4±18.7 ml ; n=8 ) . Proquazone and indomethacin  relieved pain and other dysmenorrhoeic symptoms similarly in 33 women AIM This paper presents the findings of a study that assessed the effects of acupressure at the Sanyinjiao point on symptoms of primary dysmenorrhoea among adolescent girls . BACKGROUND Dysmenorrhoea is the most common gynaecological disorder among adolescents . Traditional Chinese acupressure derived from acupuncture is a non-invasive technique . Despite renewed interest in the use of acupressure , relatively few studies have been undertaken to examine its effects on primary dysmenorrhoea . METHODS An experimental study was conducted between December 2000 and August 2001 . Participants were female students attending a technical college in Taiwan . None of the 69 participants had a prior history of gynaecological disease or secondary dysmenorrhoea , and all were rated higher than five for pain on a visual analogue scale from 0 to 10 . The experimental group ( n = 35 ) received acupressure at Sanyinjiao ( above the ankle ) while the control group ( n = 34 ) rested for 20 min , while the control group underwent rest in the school health centre for 20 min without receiving acupressure .  Fifty participants ( 30 experimental , 20 control ) completed the 4 - 6-week follow-up session . Five instruments were used to collect pretest and post-test data at each session : ( 1 ) Visual Analogue Scale for pain ; ( 2 ) the Short-Form McGill Pain Question naire ; ( 3 ) the Menstrual Distress Question naire ; ( 4 ) the Visual Analogue Scale for anxiety ; and , for the experimental group only , ( 5 ) the Acupressure Self- Assessment Form . Data were analysed using the chi-square test , two- sample t-test and repeated measures two-way anova . RESULTS Acupressure at Sanyinjiao during the initial session reduced the pain and anxiety typical of dysmenorrhoea . In the self-treatment follow-up session , acupressure at Sanyinjiao significantly reduced menstrual pain but not anxiety . Thirty-one ( 87 % ) of the 35 experimental participants reported that acupressure was helpful , and 33 ( 94 % ) were satisfied with acupressure in terms of its providing pain relief and psychological support during dysmenorrhoea . CONCLUSION The findings suggest that acupressure at Sanyinjiao can be an effective , cost-free intervention for reducing pain and anxiety during dysmenorrhoea , and we recommend its use for self-care of primary dysmenorrhoea BACKGROUND This study investigates the outcomes for women up to 5 years after laparoscopic excision of endometriosis . METHODS In this prospect i ve observational cohort study , 254 women with chronic pelvic pain were referred to two units specializing in minimal access surgical management of endometriosis . Of these , 216 women underwent surgical assessment and 176 were confirmed to have endometriosis .  Question naires and visual analogue scale ( VAS ) scores for dysmenorrhoea , non-menstrual pelvic pain , dyspareunia and dyschesia as well as quality of life instruments ; the EQ-5Dindex and  EQ-5Dvas  ,  Short-Form 12 ( SF-12 ) and  sexual activity question naires were completed pre-operatively . Intra-operative details of revised American Fertility Society ( rAFS ) stage , site of disease , associated tests , duration of surgery and complications were noted . Follow-up was performed by postal question naire and chart review . For women who had further surgery , rAFS stage , site of disease , other procedures and histology were all recorded . RESULTS Pain scores were all significantly reduced at 2 - 5 years for dysmenorrhoea ( median VAS baseline versus follow-up 2 - 5 years ) ; 9 versus 3.3 ( P < 0.0001 ) , non-menstrual pelvic pain 8 versus 3 ( P < 0.0001 ) , dyspareunia 7 versus 0 ( P < 0.0001 ) and dyschesia 7 versus 2 ( P < 0.0001 ) . Quality of life was improved for the EQ-5Dindex ( P = 0.008 and the EQ-5Qvas ( P = 0.03 ) and for sexual function with pleasure ( P = 0.001 ) and habit ( P = 0.012 ) being improved and discomfort being decreased ( P = 0.001 ) . The chance of requiring further surgery as determined by the Kaplan-Meier survival curve was 36 % . A rAFS score of > 70 was predictive of requiring further surgery ( P = 0.03 ) . Of women who had further surgery , endometriosis was found histologically in 68 % . CONCLUSIONS Laparoscopic excision of endometriosis significantly reduces pain and improves quality of life for up to 5 years . The probability of requiring further surgery is 36 % . Return of pain following laparoscopic excision is not always associated with clinical evidence of recurrence OBJECTIVE To identify the prevalence and correlates of three types of pelvic pain ( dysmenorrhoea , dyspareunia , and other chronic pelvic pain [ CPP ] ) in a nationally representative sample of Australian women . DESIGN AND SETTING The CPP survey was part of a broader national study of health and relationships . Computer-assisted telephone interviews were administered to a r and om sample of 8656 Australian households ; 4366 women aged between 16 and 64 years were interviewed in 2004 and 2005 . Eighteen of the more than 200 potential survey questions related to pelvic pain . MAIN OUTCOME MEASURES Self-reports of dysmenorrhoea , dyspareunia , and any other CPP not associated with sexual intercourse or menstruation . RESULTS Data on 1983 women aged 16 - 49 years who were still menstruating and sexually active were analysed . Prevalences were 71.7 % for dysmenorrhoea , 14.1 % for dyspareunia and 21.5 % for other CPP ; 23.3 % of women reported no pelvic pain of any kind . Severe pain was reported by 15.0 % ( 95 % CI , 13.0%-17.1 % ) of women with dysmenorrhoea , 7.8 % ( 95 % CI , 5.0%-11.9 % ) of women with dyspareunia and 20.0 % ( 95 % CI , 16.1%-24.6 % ) of women with other CPP . Just over a third ( 34.2 % ) of women who reported any pain had sought advice from a health professional . Women reporting CPP were also likely to report other health conditions , most notably depression and anxiety . There were clear associations between CPP and sexual difficulties , pregnancy and pregnancy outcomes . CONCLUSIONS Rates of pelvic pain in Australian women are high . General practitioners need to be ready to discuss these issues with patients , particularly in relation to underlying anxiety and depression
MAIN RESULTS For the treatment of primary dysmenorrhoea there is some evidence of the effectiveness of uterine nerve ablation ( UNA ) when compared to a control of no treatment .
The comparison between UNA with presacral neurectomy ( PSN ) for primary dysmenorrhoea showed no significant difference in pain relief in the short term , however long term PSN was shown to be significantly more effective .
The treatment of UNA combined with surgical treatment of endometrial implants versus surgical treatment of endometriosis alone showed that the addition of UNA did not aid pain relief .
For PSN combined with endometriosis treatment versus endometriosis treatment alone there was also no overall difference in pain relief , although the data suggests a significant difference in relief of midline abdominal pain .
Adverse events were significantly more common for presacral neurectomy , however the majority were complications such as constipation , which may spontaneously improve .
REVIEW ER 'S CONCLUSIONS There is insufficient evidence to recommend the use of nerve interruption in the management of dysmenorrhoea , regardless of cause .
BACKGROUND Dysmenorrhoea is the occurrence of painful menstrual cramps of uterine origin and is a very common gynaecological complaint .
Medical therapy for dysmenorrhoea includes oral contraceptive pills ( OCP ) and nonsteroidal anti-inflammatory drugs ( NSAIDS ) which both act by suppressing prostagl and in levels .
While these treatments are very successful there is still a 20 - 25 % failure rate and surgery has been an option for cases of dysmenorrhoea that fail to respond to medical therapy .
Uterine nerve ablation ( UNA ) and presacral neurectomy ( PSN ) are two surgical treatments that have become increasingly utilised in recent years .
These procedures both interrupt the majority of the cervical sensory nerve fibres , thus diminishing uterine pain .
Uncontrolled studies have supported the use of these procedures for primary dysmenorrhoea however both operations only partially interrupt some of the cervical sensory nerve fibres in the pelvic area ; therefore dysmenorrhoea associated with additional pelvic pathology may not always benefit from this type of surgery .
OBJECTIVES To assess the effectiveness of surgical interruption of pelvic nerve pathways as treatment for primary and secondary dysmenorrhoea , and to determine the most effective surgical treatment .