Abstract
Introduction
Dysmenorrhoea may begin soon after the menarche, after which it often improves with age, or it may originate later in life after the onset of an underlying causative condition. Dysmenorrhoea is common, and in up to 20% of women it may be severe enough to interfere with daily activities.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for primary dysmenorrhoea? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
Results
We found 35 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
Conclusions
In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupressure, acupuncture, aspirin, behavioural interventions, contraceptives (combined oral), fish oil, herbal remedies, magnets, non-steroidal anti-inflammatory drugs, paracetamol, progestogens (intrauterine), spinal manipulation, surgical interruption of pelvic nerve pathways, thiamine, toki-shakuyaku-san, topical heat, transcutaneous electrical nerve stimulation (TENS), vitamin B12, and vitamin E.
Key Points
Dysmenorrhoea may begin soon after the menarche, where it often improves with age, or may originate later in life after the onset of an underlying causative condition.
Dysmenorrhoea is very common, and in up to 20% of women it may be severe enough to interfere with daily activities.
Dysmenorrhoea is more likely in women who smoke, and those with an earlier age at menarche or longer duration of menstruation.
NSAIDs reduce moderate to severe pain in women with primary dysmenorrhoea compared with placebo, but we don't know whether any one NSAID is superior to the others.
Simple analgesics such as aspirin and paracetamol may reduce pain in the short term, although few studies have been of good quality.
The herbal remedies toki-shakuyaku-san and Iranian herbal remedy (saffron, celery, and anise) may reduce pain compared with placebo. We don't know whether Chinese herbal remedies are beneficial compared with placebo, but we found limited evidence that they may be effective compared with other treatments for dysmenorrhoea.
Thiamine and vitamin E may reduce pain compared with placebo in young women with primary dysmenorrhoea.
Combined oral contraceptives may be more effective at reducing pain in women with primary dysmenorrhoea compared with placebo; however, few trials have been of good quality.
Topical heat (about 39 °C) may be as effective as ibuprofen and more effective than paracetamol at reducing pain.
High-frequency transcutaneous electrical nerve stimulation (TENS) may reduce pain compared with sham TENS, but seems to be less effective than ibuprofen.
Acupressure may be more effective than sham acupressure or no treatment at relieving dysmenorrhoea.
Spinal manipulation may be no more effective than placebo at reducing pain after 1 month in women with primary dysmenorrhoea.
Relaxation may be better than no treatment at relieving dysmenorrhoea.
We don't know whether acupuncture, fish oil, vitamin B12 , magnets, or intrauterine progestogens reduce dysmenorrhoea.
Surgical interruption of pelvic nerve pathways is not beneficial in treating dysmenorrhoea, and may be associated with adverse effects including constipation.
About this condition
Definition
Dysmenorrhoea is painful menstrual cramps of uterine origin. It is commonly divided into primary dysmenorrhoea (pain without organic pathology) and secondary dysmenorrhoea (pelvic pain associated with an identifiable pathological condition, such as endometriosis [see review on endometriosis] or ovarian cysts). The initial onset of primary dysmenorrhoea is usually shortly after menarche (6–12 months), when ovulatory cycles are established. Pain duration is commonly 8 to 72 hours and is usually associated with the onset of menstrual flow. Secondary dysmenorrhoea can also occur at any time after menarche, but may arise as a new symptom during a woman's fourth and fifth decades, after the onset of an underlying causative condition. In this review we only consider studies in women with primary dysmenorrhoea. However, the results may also be generalisable to women with secondary dysmenorrhoea. Studies in women with endometriosis, adenomyosis, pelvic congestion, and fibroids may also examine dysmenorrhoea/pain as an outcome. For more information on these conditions and studies, see also reviews on endometriosis, menorrhagia, pelvic inflammatory disease, and fibroids.
Incidence/ Prevalence
Variations in the definition of dysmenorrhoea make it difficult to determine prevalence precisely. Studies tend to report on prevalence in adolescent girls, and the type of dysmenorrhoea is not always specified. Adolescent girls tend to have a higher prevalence of primary dysmenorrhoea than older women, as primary dysmenorrhoea can improve with age (see Prognosis). Secondary dysmenorrhoea rates may be lower in adolescents, as onset of causative conditions may not yet have occurred. Therefore, the results from prevalence studies of adolescents may not always be extrapolated to older women, or be accurate estimates of the prevalence of secondary dysmenorrhoea. However, various types of studies have found a consistently high prevalence in women of different ages and nationalities. One systematic review (search date 1996) of the prevalence of chronic pelvic pain, summarising both community and hospital surveys from developed countries, estimated prevalence to be 45% to 95%. A second systematic review of studies in developing countries (search date 2002) found that 25% to 50% of adult women and about 75% of adolescents experienced pain with menstruation, with 5% to 20% reporting severe dysmenorrhoea or pain that prevents them from participating in their usual activities. A third systematic review and meta-analysis of prevalence rates among high-quality studies with samples representative of the general worldwide population (search date 2004) found that prevalence of dysmenorrhoea was 59% (95% CI 49% to 71%). Prevalence rates reported in the UK were between 45% and 97% for any dysmenorrhoea in community-based studies and between 41% and 62% in hospital-based studies.
Aetiology/ Risk factors
A systematic review (search date 2004) of cohort and case-control studies concluded that age <30 years, low BMI, smoking, earlier menarche (<12 years), longer cycles, heavy menstrual flow, nulliparity, premenstrual syndrome, sterilisation, clinically suspected pelvic inflammatory disease, sexual abuse, and psychological symptoms were associated with increased risk of dysmenorrhoea.
Prognosis
Primary dysmenorrhoea is a chronic recurring condition that affects most young women. Studies of the natural history of this condition are sparse. One longitudinal study in Scandinavia found that primary dysmenorrhoea often improves in the third decade of a woman's reproductive life, and is also reduced after childbirth. We found no studies that reliably examined the relationship between the prognosis of secondary dysmenorrhoea and the severity of the underlying pathology, such as endometriosis.
Aims of intervention
To relieve pain from dysmenorrhoea, with minimal adverse effects.
Outcomes
Pain: pain relief, measured either by a visual analogue scale, other pain scales (such as the TOTPAR [TOPAR] score, TOTPAR-8 [TOPAR-8], or SPID-8), or as a dichotomous outcome (pain relief achieved yes/no); overall improvement in dysmenorrhoea measured by change in dysmenorrhoeic symptoms either self reported or observed, proportion of women requiring analgesics in addition to their assigned treatment. Quality of life: quality of life scales, or other similar measures such as the Menstrual Distress or Menstrual Symptom Questionnaires. Daily activities and work: proportion of women reporting activity restriction or absences from work or school and hours or days of absence as a more selective measure. Adverse effects of treatment (incidence and type of adverse effects).
Methods
Clinical Evidence search and appraisal January 2010. The following databases were used to identify studies for this systematic review: Medline 1966 to January 2010, Embase 1980 to January 2010, and The Cochrane Database of Systematic Reviews 2009, Issue 4 (1966 to date of issue). An additional search within The Cochrane Library was carried out for the Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment (HTA). We also searched for retractions of studies included in the review. Abstracts of the studies retrieved from the initial search were assessed by an information specialist. Selected studies were then sent to the contributor for additional assessment, using predetermined criteria to identify relevant studies. Study design criteria for inclusion in this review were: published systematic reviews of RCTs and RCTs in any language, at least single blinded, and containing >20 individuals of whom >80% were followed up. There was no minimum length of follow-up required to include studies. We excluded all studies described as "open", "open label", or not blinded unless blinding was impossible. We aimed to include studies in women with primary dysmenorrhoea or where a subgroup analysis was carried out in women with primary dysmenorrhoea. However, where studies included a mixture of primary and secondary dysmenorrhoea, we included studies in which at least 66% of women had primary dysmenorrhoea. We included systematic reviews of RCTs and RCTs where harms of an included intervention were studied applying the same study design criteria for inclusion as we did for benefits. In addition we use a regular surveillance protocol to capture harms alerts from organisations such as the FDA and the MHRA, which are added to the reviews as required. To aid readability of the numerical data in our reviews, we round many percentages to the nearest whole number. Readers should be aware of this when relating percentages to summary statistics such as relative risks (RRs) and odds ratios (ORs). We have performed a GRADE evaluation of the quality of evidence for interventions included in this review (see table). The categorisation of the quality of the evidence (high, moderate, low, or very low) reflects the quality of evidence available for our chosen outcomes in our defined populations of interest. These categorisations are not necessarily a reflection of the overall methodological quality of any individual study, because the Clinical Evidence population and outcome of choice may represent only a small subset of the total outcomes reported, and population included, in any individual trial. For further details of how we perform the GRADE evaluation and the scoring system we use, please see our website (www.clinicalevidence.com).
Table.
GRADE Evaluation of interventions for Dysmenorrhoea.
| Important outcomes | Daily activities and work, Pain, Quality of life | ||||||||
| Studies (Participants) | Outcome | Comparison | Type of evidence | Quality | Consistency | Directness | Effect size | GRADE | Comment |
| What are the effects of treatments for primary dysmenorrhoea? | |||||||||
| 19 (1175) | Pain | NSAIDs versus placebo | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for unclear randomisation methodology and reporting of results post-crossover |
| at least 4 (at least 229) | Daily activities and work | NSAIDs versus placebo | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for unclear randomisation methodology. Directness point deducted for inclusion of data on aspirin v placebo |
| 6 (972) | Pain | Different NSAIDs versus each other | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for unclear randomisation methodology and reporting of results post-crossover. Directness point deducted for large number of comparators |
| 2 (205) | Pain | Acupressure versus sham acupressure or no treatment | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for incomplete reporting of results. Directness point deducted for narrow inclusion criteria |
| 1 (144) | Pain | Acupressure versus NSAIDs | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Directness point deducted for narrow inclusion criteria |
| 9 (522) | Pain | Aspirin versus placebo | 4 | –2 | –1 | 0 | 0 | Very low | Quality points deducted for short follow-up and reporting of results post-crossover. Consistency point deducted for different results for different outcomes |
| at least 3 (at least 203) | Daily activities and work | Aspirin versus placebo | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for short follow-up and reporting of results post-crossover |
| 1 (30) | Pain | Paracetamol versus placebo | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, incomplete reporting, and reporting of results post-crossover |
| 1 (30) | Pain | Paracetamol versus aspirin | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, incomplete reporting, and reporting of results post-crossover |
| 1 (32) | Pain | Aspirin versus NSAIDs | 4 | –3 | 0 | 0 | 0 | Very low | Quality point deducted for sparse data, incomplete reporting, and methodological weaknesses including short follow-up, and reporting of results post-crossover |
| 2 (128) | Pain | Paracetamol versus NSAIDs | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, incomplete reporting, and methodological weaknesses including short follow-up, and reporting of results post-crossover |
| 1 (556) | Pain | Thiamine versus placebo | 4 | 0 | 0 | –1 | 0 | Moderate | Directness point deducted for restricted population (Indian adolescent women) |
| 1 (50) | Pain | Toki-shakuyaku-san versus placebo | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, unclear allocation methodology, and incomplete reporting of results |
| 1 (40) | Pain | Topical heat versus placebo | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for inclusion of volunteer women as well as those presenting for medical care |
| 1 (41) | Pain | Topical heat versus NSAIDs | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for inclusion of volunteer women as well as those presenting for medical care |
| 1 (301) | Pain | Topical heat versus paracetamol | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for incomplete reporting of results and short follow-up |
| at least 3 (at least 75) | Pain | High-frequency TENS versus placebo TENS | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, reporting of results post-crossover, and uncertainty about randomisation and blinding |
| 1 (24) | Daily activities and work | High-frequency TENS versus placebo TENS | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data and uncertainty about randomisation and blinding |
| 1 (26) | Quality of life | High-frequency TENS versus placebo TENS | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and reporting of results post-crossover |
| 4 (86) | Pain | Low-frequency TENS versus placebo TENS or placebo tablet | 4 | –3 | –1 | 0 | 0 | Very low | Quality points deducted for sparse data, reporting of results post-crossover, and uncertainty about randomisation and blinding. Consistency point deducted for different results for different outcomes |
| 1 (24) | Daily activities and work | Low-frequency TENS versus placebo TENS or placebo tablet | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data and uncertainty about randomisation and blinding |
| 3 (at least 39) | Pain | High-frequency TENS versus low-frequency TENS | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, reporting of results post-crossover, and uncertainty about randomisation and blinding |
| 1 (24) | Daily activities and work | High-frequency TENS versus low-frequency TENS | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data and uncertainty about randomisation and blinding |
| 1 (32) | Pain | High-frequency TENS versus NSAIDs | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and reporting of results after crossover |
| 3 (478) | Pain | Vitamin E versus placebo | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for uncertainty about method of randomisation and no significance assessment performed in 1 RCT |
| 3 (292) | Pain | Acupuncture versus placebo acupuncture or no treatment | 4 | 0 | 0 | –2 | 0 | Low | Directness points deducted for uncertainty about method for assessing outcomes (use of non-validated pain scales in 1 RCT), inclusion of women with secondary dysmenorrhoea in 1 RCT, and large number of comparators |
| 1 (201) | Quality of life | Acupuncture versus placebo acupuncture or no treatment | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for significant baseline differences. Directness point deducted for inclusion of women with secondary dysmenorrhoea |
| 1 (120) | Pain | Acupuncture versus NSAIDs | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 1 (69) | Pain | Relaxation treatment versus no treatment/waiting list control | 4 | –1 | –1 | –1 | 0 | Very low | Quality point deducted for sparse data. Consistency point deducted for different results for subgroups. Directness point deducted for older classification of disease no longer used |
| 6 (497) | Pain | Combined oral contraceptives versus placebo/no treatment | 4 | –1 | –1 | 0 | 0 | Low | Quality point deducted for methodological flaws in included RCTs. Consistency point deducted for statistical heterogeneity |
| 2 (<120) | Pain | Fish oil versus placebo | 4 | –2 | –1 | –1 | 0 | Very low | Quality points deducted for sparse data and reporting of results post-crossover. Consistency point deducted for conflicting results. Directness point deducted for uncertainty about diagnosis |
| 3 (204) | Pain | Chinese herbal medicine versus placebo/no treatment | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for incomplete reporting of results. Directness point deducted for inclusion of different regimens |
| 14 (1441) | Pain | Chinese herbal medicine versus NSAIDs | 4 | 0 | –1 | –2 | 0 | Very low | Consistency point deducted for statistical heterogeneity. Directness points deducted for large number of comparators and inclusion of additional treatments |
| 2 (156) | Pain | Chinese herbal medicine versus acupuncture | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data and methodological weakness in RCTs (uncertainty about follow-up, randomisation method, and blinding) |
| 1 (55) | Pain | Chinese herbal medicine versus topical heat | 4 | –3 | 0 | –1 | +2 | Low | Quality points deducted for sparse data and methodological weaknesses (uncertainty about follow-up and randomisation method). Directness point deducted for uncertainty about method of assessment of outcome. Effect-size points added for large effect size |
| 1 (108) | Pain | Iranian herbal medicine versus placebo/no treatment | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (106) | Pain | Iranian herbal medicine versus mefenamic acid | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for no direct statistical comparison between groups |
| 2 (68) | Pain | Laparoscopic uterine nerve ablation versus diagnostic laparoscopy | 4 | –1 | –1 | 0 | 0 | Low | Quality point deducted for sparse data. Consistency point deducted for different results at different time points |
| 1 (68) | Pain | Laparoscopic uterine nerve ablation versus laparoscopic presacral neurectomy | 4 | –1 | –1 | 0 | 0 | Low | Quality point deducted for sparse data. Consistency point deducted for different results at different time points |
| 3 (207) | Pain | Spinal manipulation versus sham manipulation or no treatment | 4 | –2 | –1 | 0 | 0 | Very low | Quality points deducted for sparse data and methodological weaknesses (poor allocation concealment and poor blinding). Consistency point deducted for different results at different time points and between studies |
We initially allocate 4 points to evidence from RCTs, and 2 points to evidence from observational studies. To attain the final GRADE score for a given comparison, points are deducted or added from this initial score based on preset criteria relating to the categories of quality, directness, consistency, and effect size. Quality: based on issues affecting methodological rigour (e.g., incomplete reporting of results, quasi-randomisation, sparse data [<200 people in the analysis]). Consistency: based on similarity of results across studies. Directness: based on generalisability of population or outcomes. Effect size: based on magnitude of effect as measured by statistics such as relative risk, odds ratio, or hazard ratio.
Glossary
- Behavioural interventions
Treatments attempting modification of thought and beliefs (cognition) about symptoms and pain, or treatments that attempt modification of behavioural or physiological responses to symptoms, pain, or both; for example, relaxation and exercise.
- Congestive dysmenorrhoea
A dull aching pain in the lower abdomen as well as other areas of the body that may begin several days before menstruation and can include other premenstrual symptoms such as irritability.
- Double dummy
Design pertaining to an RCT in which multiple treatments are compared (usually against a placebo) and the treatments have dissimilar presentations. Each participant will receive either active treatment or placebo for each treatment. Because multiple treatments are being compared (at least 2), it allows identification of treatment effects against placebo, as well as the additive effects of treatments.
- Efficacy RCT
A trial designed to study if an intervention works in ideal conditions (e.g., when people receive treatments exactly as prescribed). By contrast, effectiveness trials evaluate the effects of treatments in “real life” conditions. Analysis in efficacy trials usually involves only the participants who were fully compliant with the therapeutic regimen. The applicability of the results from efficacy trials may be limited because conditions are artificial and hence response may be different in real life situations.
- High-velocity, low-amplitude (HVLA) manipulation
A technique of spinal manipulation that uses high-velocity, low-amplitude thrusts to manipulate vertebral joints. The technique is designed to restore motion to a restricted joint and improve function. The physician positions the person at the barrier of restricted motion and then gives a rapid, accurate thrust in the direction of the restricted barrier to resolve the restriction and improve motion.
- Laparoscopic presacral neurectomy (LPSN)
Involves the total removal of the presacral nerves lying within the boundaries of the interiliac triangle. This procedure interrupts most of the cervical sensory nerve fibres and is used to diminish uterine pain.
- Laparoscopic uterine nerve ablation (LUNA)
Involves laparoscopic surgery to transect (usually involves cutting and then electrocauterisation) the uterosacral ligaments at their insertion into the cervix. This procedure interrupts most of the cervical sensory nerve fibres and is used to diminish uterine pain.
- Low-quality evidence
Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
- Moderate-quality evidence
Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
- Placebo acupuncture
Also known as sham acupuncture, this is a commonly used control intervention involving the use of acupuncture needles to stimulate non-acupuncture points in areas outside of Chinese meridians. These points can be identified by a point detector as areas of the skin that do not have skin electrical activity similar to acupuncture points. There is some disagreement over correct needle placement, as placement of a needle in any position may elicit some biological response that can complicate the interpretation of results.
- Placebo manipulation
Also known as sham manipulation, this is a control intervention. The main principle is to use a non-therapeutic level of torque. There are two common techniques for placebo manipulation. In one, thrust is given but the posture of the participant is such that the mechanical torque of the manipulation is substantially reduced. In the other, an activator adjusting tool is used; this can make spinal adjustments using spring recoil, whereby the spring is set so that no force is exerted on the spine.
- SPID-8
An outcome measure commonly used in pharmaceutical trials of treatments for pain. The difference in pain intensity from baseline up to 8 hours after dosing is measured. The SPID-8 is the sum of the pain intensity differences of all participants up to 8 hours after dosing. Pain intensity can be measured on any categorical scale, but typically a low score will mean less pain and a high score more pain.
- Spasmodic dysmenorrhoea
Spasms of acute pain that typically begin on the first day of menstruation.
- TOTPAR (TOPAR) score
An outcome measure commonly used in pharmaceutical trials of treatment for pain. The pain relief scores for all participants at various time points after dosing are totalled and a mean calculated. Pain relief can be measured on any categorical scale, but typically a low score will mean less pain relief and a high score more pain relief.
- TOTPAR-8 (TOPAR-8) score
The same as TOTPAR (see above), but measured up to 8 hours after dosing.
- Toftness manipulation
A low-force technique of chiropractic adjustment that uses a sensometer to detect sites of abnormal electromagnetic radiation, and to determine which sites to adjust. Adjustment is then delivered using a metered, hand held-pressure applicator.
- Transcutaneous electrical nerve stimulation (TENS)
Electrodes are placed on the skin and different electrical pulse rates and intensities are used to stimulate the area. Low-frequency TENS (also referred to as acupuncture-like TENS) usually consists of pulses delivered at 1 to 4 Hz at high intensity, so they evoke visible muscle fibre contractions. High-frequency TENS (conventional TENS) usually consists of pulses delivered at 50 to 120 Hz at a low intensity, so there are no muscle contractions.
- Very low-quality evidence
Any estimate of effect is very uncertain.
- Visual analogue scale
A commonly used scale in pain assessment. It is a 10-cm horizontal or vertical line with word anchors at each end, such as "no pain" and "pain as bad as it could be". The person is asked to make a mark on the line to represent pain intensity. This mark is converted to distance in either centimetres or millimetres from the "no pain" anchor to give a pain score that can range from 0 to 10 cm or 0 to 100 mm.
Endometriosis
Disclaimer
The information contained in this publication is intended for medical professionals. Categories presented in Clinical Evidence indicate a judgement about the strength of the evidence available to our contributors prior to publication and the relevant importance of benefit and harms. We rely on our contributors to confirm the accuracy of the information presented and to adhere to describe accepted practices. Readers should be aware that professionals in the field may have different opinions. Because of this and regular advances in medical research we strongly recommend that readers' independently verify specified treatments and drugs including manufacturers' guidance. Also, the categories do not indicate whether a particular treatment is generally appropriate or whether it is suitable for a particular individual. Ultimately it is the readers' responsibility to make their own professional judgements, so to appropriately advise and treat their patients. To the fullest extent permitted by law, BMJ Publishing Group Limited and its editors are not responsible for any losses, injury or damage caused to any person or property (including under contract, by negligence, products liability or otherwise) whether they be direct or indirect, special, incidental or consequential, resulting from the application of the information in this publication.
Contributor Information
Pallavi Manish Latthe, Birmingham Women's NHS Foundation Trust, Birmingham, UK.
Rita Champaneria, University of Birmingham, Birmingham, UK.
References
- 1.Fraser I. Prostaglandins, prostaglandin inhibitors and their roles in gynaecological disorders. Bailliere's Clinical Obstet Gynaecol 1992;6:829–857. [DOI] [PubMed] [Google Scholar]
- 2.Zondervan KT, Yudkin PL, Vessey MP, et al. The prevalence of chronic pelvic pain in the United Kingdom: a systematic review. Br J Obstet Gynaecol 1998;105:93–99. [DOI] [PubMed] [Google Scholar]
- 3.Harlow SD, Campbell OM. Epidemiology of menstrual disorders in developing countries: a systematic review. BJOG 2004;111:6–16. [DOI] [PubMed] [Google Scholar]
- 4.Latthe P, Latthe M, Gulmezoglu M, et al. WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health 2006;6:177. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Latthe P, Mignini L, Gray R, et al. Factors predisposing women to chronic pelvic pain: systematic review. BMJ 2006;332:749–755. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Sundell G, Milsom I, Andersch B. Factors influencing the prevalence and severity of dysmenorrhoea in young women. Br J Obstet Gynaecol 1990;97:588–594. [DOI] [PubMed] [Google Scholar]
- 7.Marjoribanks J, Proctor ML, Farquhar C. Nonsteroidal anti-inflammatory drugs for primary dysmenorrhoea. In: The Cochrane Library, Issue 4, 2009. Chichester, UK: John Wiley & Sons, Ltd. Search date 2003. [DOI] [PubMed] [Google Scholar]
- 8.Mehlisch DR, Ardia A, Pallotta T. Analgesia with ibuprofen arginate versus conventional ibuprofen for patients with dysmenorrhea: a crossover trial. Curr Ther Res 2003:64;327–337. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Malmstrom K, Kotey P, Cichanowitz N, et al. Analgesic efficacy of etoricoxib in primary dysmenorrhea: results of a randomized, controlled trial. Gynecol Obstet Invest 2003;56:65–69. [DOI] [PubMed] [Google Scholar]
- 10.Daniels S, Gitton X, Zhou W, et al. Efficacy and tolerability of lumiracoxib 200 mg once daily for treatment of primary dysmenorrhea: results from two randomized controlled trials. J Womens Health (Larchmt) 2008;17:423–437. [DOI] [PubMed] [Google Scholar]
- 11.Daniels S, Robbins J, West CR, et al. Celecoxib in the treatment of primary dysmenorrhea: results from two randomized, double-blind, active- and placebo-controlled, crossover studies. Clin Ther 2009;31:1192–1208. [DOI] [PubMed] [Google Scholar]
- 12.Nahid K, Fariborz M, Ataolah G, et al. The effect of an Iranian herbal drug on primary dysmenorrhea: a clinical controlled trial. J Midwifery Womens Health 2009;54:401–404. [DOI] [PubMed] [Google Scholar]
- 13.de Mello NR, Baracat EC, Tomaz G, et al. Double-blind study to evaluate efficacy and safety of meloxicam 7.5 mg and 15 mg versus mefenamic acid 1500 mg in the treatment of primary dysmenorrhea. Acta Obstet Gynecol Scand 2004;83:667–673. [DOI] [PubMed] [Google Scholar]
- 14.Ylikorkala O, Puolakka J, Kauppila A. Comparison between naproxen tablets and suppositories in primary dysmenorrhea. Prostaglandins 1980;20:463–468. [DOI] [PubMed] [Google Scholar]
- 15.Zhu X, Proctor M, Bensoussan A, et al. Chinese herbal medicine for primary dysmenorrhoea. In: The Cochrane Library, Issue 4, 2009. Chichester, UK: John Wiley & Sons, Ltd. Search date 2007. [Google Scholar]
- 16.Yang H, Liu CZ, Chen X, et al. Systematic review of clinical trials of acupuncture-related therapies for primary dysmenorrhea. Acta Obstet Gynecol Scand 2008;87:1114–1122. [DOI] [PubMed] [Google Scholar]
- 17.Taylor D, Miaskowski C, Kohn J. A randomized clinical trial of the effectiveness of an acupressure device (relief brief) for managing symptoms of dysmenorrhea. J Altern Complement Med 2002;8:357–370. [DOI] [PubMed] [Google Scholar]
- 18.Pouresmail Z, Ibrahimzadeh R. Effects of acupressure and ibuprofen on the severity of primary dysmenorrhea. J Tradit Chin Med 2002;22:205–210. [PubMed] [Google Scholar]
- 19.Wu RD, Zhang HD, Lin LF, et al. Observation on ear point taping and pressing therapy for treatment of primary dysmenorrhea. Zhongguo Zhen Jiu 2007;27:815–817. [In Chinese] [PubMed] [Google Scholar]
- 20.Zhang WY, Li Wan Po A. Efficacy of minor analgesics in primary dysmenorrhoea: a systematic review. Br J Obstet Gynaecol 1998;105:780–789. [DOI] [PubMed] [Google Scholar]
- 21.Proctor ML, Murphy PA. Herbal and dietary therapies for primary and secondary dysmenorrhoea. In: The Cochrane Library, Issue 4, 2009. Chichester, UK: John Wiley & Sons, Ltd. Search date 2000. 11687013 [Google Scholar]
- 22.Akin MD, Weingand KW, Hengehold DA, et al. Continuous low-level topical heat in the treatment of dysmenorrhea. Obstet Gynecol 2001;97:343–349. [DOI] [PubMed] [Google Scholar]
- 23.Akin M, Price W, Rodriguez G Jr, et al. Continuous, low-level, topical heat wrap therapy as compared to acetaminophen for primary dysmenorrhea. J Reprod Med 2004;49:739–745. [PubMed] [Google Scholar]
- 24.Proctor ML, Smith CA, Farquhar CM, et al. Transcutaneous electrical nerve stimulation for primary dysmenorrhoea. In: The Cochrane Library, Issue 4, 2009. Chichester, UK: John Wiley & Sons, Ltd. Search date 2009. [Google Scholar]
- 25.Wang S-F, Lee JP, Hwa H-L, et al. Effect of transcutaneous electrical nerve stimulation on primary dysmenorrhea. Neuromodulation 2009;12:302–309. [DOI] [PubMed] [Google Scholar]
- 26.Hedner N, Milsom I, Eliasson T, et al. TENS is effective in painful menstruation. Lakartidningen 1996;93:1219–1222. [In Swedish] [PubMed] [Google Scholar]
- 27.Dawood MY, Ramos J. Transcutaneous electrical nerve stimulation (TENS) for the treatment of primary dysmenorrhea: a randomized crossover comparison with placebo TENS and ibuprofen. Obstet Gynecol 1990;75:656–660. [PubMed] [Google Scholar]
- 28.Fugh-Berman A, Kronenberg F. Complementary and alternative medicine (CAM) in reproductive-age women: a review of randomized controlled trials. Reprod Toxicol 2003:17;137–152. Search date 2002. [DOI] [PubMed] [Google Scholar]
- 29.Ziaei S, Zakeri M, Kazemnejad A. A randomised controlled trial of vitamin E in the treatment of primary dysmenorrhoea. BJOG 2005;112:466–469. [DOI] [PubMed] [Google Scholar]
- 30.Ziaei S, Faghihzadeh S, Sohrabvand F, et al. A randomised placebo-controlled trial to determine the effect of vitamin E in treatment of primary dysmenorrhoea. BJOG 2001;108:1181–1183. [DOI] [PubMed] [Google Scholar]
- 31.Witt CM, Reinhold T, Brinkhaus B, et al. Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care. Am J Obstet Gynecol 2008;198:166–168. [DOI] [PubMed] [Google Scholar]
- 32.Kempf D, Berger D, Ausfeld-Hafter B. Laser needle acupuncture in women with dysmenorrhoea: a randomised controlled double blind pilot trial. Forsch Komplementarmed 2009;16:6–12. [In German] [DOI] [PubMed] [Google Scholar]
- 33.Helms JM. Acupuncture for the management of primary dysmenorrhea. Obstet Gynecol 1987;69:51–56. [PubMed] [Google Scholar]
- 34.Zhi LX. Randomized controlled study on superficial needling for treatment of primary dysmenorrhea. Zhongguo Zhen Jiu 2007;27:18–21. [In Chinese] [PubMed] [Google Scholar]
- 35.Proctor M, Murphy PA, Pattison HM, et al. Behavioural interventions for primary and secondary dysmenorrhoea. In: The Cochrane Library, Issue 4, 2009. Chichester, UK: John Wiley & Sons, Ltd. Search date 2005. [Google Scholar]
- 36.Chesney MA, Tasto DL. The effectiveness of behavior modification with spasmodic and congestive dysmenorrhea. Behav Res Ther 1975;13:245–253. [DOI] [PubMed] [Google Scholar]
- 37.Israel RG, Sutton M, O'Brien KF. Effects of aerobic training on primary dysmenorrhea symptomatology in college females. J Am Coll Health 1985;33:241–244. [DOI] [PubMed] [Google Scholar]
- 38.Amodei N, Nelson RO, Jarrett RB, et al. Psychological treatments of dysmenorrhea: differential effectiveness for spasmodics and congestives. J Behav Ther Exp Psychiatry 1987;18:95–103. [DOI] [PubMed] [Google Scholar]
- 39.Wong CL, Farquhar C, Roberts H, et al. Oral contraceptive pill for primary dysmenorrhoea. In: The Cochrane Library, Issue 4, 2009. Chichester, UK: John Wiley & Sons, Ltd. Search date 2008. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 40.Deutch B, Jorgensen EB, Hansen JC. Menstrual discomfort in Danish women reduced by dietary supplements of omega-3 PUFA and B12 (fish oil or seal oil capsules). Nutr Res 2000;20:621–631. [Google Scholar]
- 41.Yeh LL, Liu JY, Lin KS, et al. A randomised placebo-controlled trial of a traditional Chinese herbal formula in the treatment of primary dysmenorrhoea. PLoS ONE 2007;2:e719. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 42.Tseng YF, Chen CH, Yang YH. Rose tea for relief of primary dysmenorrhea in adolescents: a randomized controlled trial in Taiwan. J Midwifery Womens Health 2005;50:e51–e57. [DOI] [PubMed] [Google Scholar]
- 43.Ozgoli G, Goli M, Moattar F. Comparison of effects of ginger, mefenamic acid, and ibuprofen on pain in women with primary dysmenorrhea. J Altern Complement Med 2009;15:129–132. [DOI] [PubMed] [Google Scholar]
- 44.Kim KS, Lee YJ. The effect of magnetic application for primary dysmenorrhea. Kanhohak Tamgu 1994;3:148–173. [In Korean] [PubMed] [Google Scholar]
- 45.Proctor ML, Latthe P, Farquhar CM, et al. Surgical interruption of pelvic nerve pathways for primary and secondary dysmenorrhoea. In: The Cochrane Library, Issue 4, 2009. Chichester, UK: John Wiley & Sons, Ltd. Search date 2004. 16235288 [Google Scholar]
- 46.Latthe PM, Proctor ML, Farquhar CM, et al. Surgical interruption of pelvic nerve pathways in dysmenorrhea: a systematic review of effectiveness. Acta Obstet Gynecol Scand 2007;86:4–15. [DOI] [PubMed] [Google Scholar]
- 47.Daniels J, Gray R, Hills RK, et al. Laparoscopic uterosacral nerve ablation for alleviating chronic pelvic pain: a randomized controlled trial. JAMA 2009;302:955–961. [DOI] [PubMed] [Google Scholar]
- 48.National Institute for Health and Clinical Excellence. Laparoscopic uterine nerve ablation (LUNA) for chronic pelvic pain. October 2007. Interventional procedure guidance 234. Available at http://www.nice.org.uk/IPG234 (last accessed 1 February 2011). [Google Scholar]
- 49.Proctor ML, Hing W, Johnson TC, et al. Spinal manipulation for primary and secondary dysmenorrhoea. In: The Cochrane Library, Issue 4, 2009. Chichester, UK: John Wiley & Sons, Ltd. Search date 2006. 16855988 [Google Scholar]
- 50.Varma R, Sinha D, Gupta JK, et al. Non-contraceptive uses of levonorgestrel-releasing hormone system (LNG-IUS) - a systematic enquiry and overview. Eur J Obstet Gynecol Reprod Biol 2006;125:9–28. [DOI] [PubMed] [Google Scholar]
- 51.Baldaszti E, Wimmer-Puchinger B, Loschke K, et al. Acceptability of the long-term contraceptive levonorgestrel-releasing intrauterine system (Mirena): a 3-year follow-up study. Contraception 2003;67:87–91. [DOI] [PubMed] [Google Scholar]
- 52.Rosenwaks Z, Jones GS, Henzl MR, et al. Naproxen sodium, aspirin, and placebo in primary dysmenorrhoea. Reduction of pain and blood levels of prostaglandin-F2-alpha metabolite. Am J Obstet Gynecol 1981;140:592–598. [DOI] [PubMed] [Google Scholar]