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Kevin M. Hellman - One of the best experts on this subject based on the ideXlab platform.
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clinical profile of comorbid Dysmenorrhea and bladder sensitivity a cross sectional analysis
American Journal of Obstetrics and Gynecology, 2020Co-Authors: Avisek Datta, Diana Atashroo, S Senapati, Genevieve E Roth, Daniel J Clauw, Kevin M. HellmanAbstract:Background Antecedents of chronic pelvic pain are not well characterized, but pelvic organ visceral sensitivity is a hallmark of these disorders. Recent studies have identified that some Dysmenorrhea sufferers are much more likely to exhibit comorbid bladder hypersensitivity. Presumably, these otherwise healthy women may be at higher risk of developing full-blown chronic bladder pain later in life. To encourage early identification of patients harboring potential future risk of chronic pain, we describe the clinical profile of women matching this putative pain-risk phenotype. Objective(S) The objectives of the study were to characterize demographic, menstrual, pelvic examination, and psychosocial profiles of young women with comorbid Dysmenorrhea and bladder hypersensitivity, defined using a standardized experimental visceral provocation test, contrasted with healthy controls, pure Dysmenorrhea sufferers, and women with existing bladder pain syndrome. Study Design This prospective cohort study acquired data on participants with moderate to severe Dysmenorrhea (n = 212), healthy controls (n = 44), and bladder pain syndrome (n = 27). A subgroup of Dysmenorrhea patients was found on screening with noninvasive oral water challenge to report significantly higher bladder pain during experimentally monitored spontaneous bladder filling (>15 out of 100 on visual analogue scale, based on prior validation studies) and separately defined as a group with Dysmenorrhea plus bladder pain. Medical/menstrual history and pain history were evaluated with questionnaires. Psychosocial profile and impact were measured with validated self-reported health status Patient Reported Outcomes Measurement Information System short forms and a Brief Symptom Inventory for somatic sensitivity. Pelvic anatomy and sensory sensitivity were examined via a standardized physical examination and a tampon provocation test. Results In our largely young, single, nulliparous cohort (24 ± 1 years old), approximately a quarter (46 out of 212) of Dysmenorrhea sufferers tested positive for the Dysmenorrhea plus bladder pain phenotype. Dysmenorrhea-only sufferers were more likely to be African American (24%) than healthy controls (5%, post hoc χ2, P = .007). Pelvic examination findings did not differ in the nonchronic pain groups, except for tampon test sensitivity, which was worse in Dysmenorrhea plus bladder pain and Dysmenorrhea sufferers vs healthy controls (2.6 ± 0.3 and 1.7 ± 0.2 vs 0.7 ± 0.2, P Conclusion Women with Dysmenorrhea who are unaware they also have bladder sensitivity exhibit broad somatic sensitivity and elevated psychological distress, suggesting combined preclinical visceral sensitivity may be a precursor to chronic pelvic pain. Defining such precursor states is essential to conceptualize and test preventative interventions for chronic pelvic pain emergence. Dysmenorrhea plus bladder pain is also associated with higher self-reported pelvic pain unrelated to menses, suggesting central nervous system changes are present in this potential precursor state.
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Somatic symptoms in women with Dysmenorrhea and noncyclic pelvic pain
Archives of Womens Mental Health, 2018Co-Authors: Rebecca M. Zuckerman, Rebecca L. Silton, Frank F. Tu, Kevin M. HellmanAbstract:Somatic symptoms are a robust, transdiagnostic risk factor for pain conditions. However, the extent to which somatic symptoms contribute to the manifestation of the women’s pain syndromes, such as Dysmenorrhea and noncyclic pelvic pain (NCPP), is unclear due to high rates of co-occurrence. Therefore, the present study investigated the primary hypothesis that somatic symptoms would be elevated in NCPP and distinctly influence the relationship between Dysmenorrhea and co-occurring NCPP. A secondary analysis was performed on cross-sectional questionnaire data from 1012 nonpregnant reproductive-aged women. Eligible analyzed participants (n = 834) were categorized into four groups: healthy, Dysmenorrhea, NCPP, and NCPP with co-occurring Dysmenorrhea (NCPP+Dysmenorrhea). A parallel mediation analysis was run to evaluate the primary hypothesis that somatic symptoms are the primary factor associated with increased NCPP accounting for Dysmenorrhea. The NCPP+Dysmenorrhea group had higher somatic, anxiety, and depression symptom T-scores (respectively 61, 61, 60) compared to the healthy controls (46, 51, 51; p’s < .001) and the Dysmenorrhea group (50, 53, 54; p’s < .001). The pain and psychological symptoms were significantly correlated across the entire sample (r’s = .29, − .64, p’s < .01). Results from parallel mediation analysis showed that somatic symptoms were distinctly associated with NCPP+Dysmenorrhea. Women with NCPP+Dysmenorrhea have increased psychological and somatic symptoms compared to women with Dysmenorrhea alone. Given that NCPP often co-occurs with Dysmenorrhea, failure to account for comorbidity in previous studies has likely led to an overestimation of psychological symptoms in Dysmenorrhea. Future studies should evaluate whether somatic sensitivity is a modifiable risk factor for NCPP.
John M F Keogh - One of the best experts on this subject based on the ideXlab platform.
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primary Dysmenorrhea in young western australian women prevalence impact and knowledge of treatment
Journal of Adolescent Health, 1999Co-Authors: Thirza I J Hillen, Shannon L Grbavac, Philippa J Johnston, Judith A Y Straton, John M F KeoghAbstract:Abstract Purpose: To explore the prevalence of Dysmenorrhea among senior high school girls in Perth, Western Australia, its impact on school, sporting, and social activities, students' management strategies, and their knowledge of available treatment. Methods: A total of 388 female students in Grades 11 and 12 at three metropolitan secondary schools completed an anonymous questionnaire administered during class time. The following definition of dysmenorrhoea was used: any type of pain or discomfort associated with menstrual periods including cramps, nausea, and headaches. Results: The reported prevalence of Dysmenorrhea among these girls was 80%; 53% of those girls with Dysmenorrhea reported that it limited their activities. In particular, 37% said that Dysmenorrhea affected their school activities. The most common medication used by those reporting Dysmenorrhea was simple analgesics (53%), followed by nonsteroidal anti-inflammatory drugs (NSAIDs), used by 42%. More than a quarter of respondents (27%) were unaware that NSAIDs were a possible treatment option for Dysmenorrhea. Conclusion: The prevalence and impact of Dysmenorrhea on Grade 11 and 12 girls is high, and they lack knowledge of and experience with effective treatment. Health education measures are needed in this area to prevent unnecessary suffering and interruption to school routine.
Zeev Harel - One of the best experts on this subject based on the ideXlab platform.
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Dysmenorrhea in adolescents and young adults an update on pharmacological treatments and management strategies
Expert Opinion on Pharmacotherapy, 2012Co-Authors: Zeev HarelAbstract:Introduction: Dysmenorrhea is the most common gynecologic complaint among adolescents/young adults. Dysmenorrhea is usually primary and is associated with normal ovulatory cycles and with no pelvic pathology. Potent prostaglandins and potent leukotrienes play an important role in generating primary Dysmenorrhea symptoms. Adolescents/young adults with severe Dysmenorrhea symptoms may have pelvic abnormalities, such as endometriosis or uterine anomalies (secondary Dysmenorrhea). Areas covered: This review provides an update on treatments and management strategies of Dysmenorrhea in adolescents/young adults. Medical literature articles were retrieved using a Medline search on primary and secondary Dysmenorrhea. Original articles from peer-reviewed journals were selected based on relevance. Expert opinion: Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) is the preferred initial treatment for Dysmenorrhea in nonsexually active adolescents/young adults. Adolescents/young adults with symptoms that d...
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Dysmenorrhea in Adolescents
Annals of the New York Academy of Sciences, 2008Co-Authors: Zeev HarelAbstract:Dysmenorrhea is the most common gynecologic complaint among adolescent females. Dysmenorrhea in adolescents is usually primary, and is associated with normal ovulatory cycles and with no pelvic pathology. In approximately 10% of adolescents with severe dysmenorrheic symptoms, pelvic abnormalities such as endometriosis or uterine anomalies may be found. Potent prostaglandins and leukotrienes play an important role in generating the symptoms of Dysmenorrhea. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common pharmacologic treatment for Dysmenorrhea. A loading dose of NSAIDs (typically twice the regular dose) should be used as initial treatment for Dysmenorrhea in adolescents, followed by a regular dose until symptoms abate. Adolescents with symptoms that do not respond to treatment with NSAIDs for three menstrual periods should be offered hormonal treatment such as combined estrogen/progestin oral contraceptive pills for three menstrual cycles. Adolescents with Dysmenorrhea who do not respond to this treatment should be evaluated for secondary causes of Dysmenorrhea. The adolescent care provider's role is to explain the pathophysiology of Dysmenorrhea to every adolescent female, address any concern that the patient has about her menstrual period, and review effective treatment options for Dysmenorrhea with the patient.
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Dysmenorrhea in Adolescents and Young Adults: Etiology and Management
Journal of pediatric and adolescent gynecology, 2006Co-Authors: Zeev HarelAbstract:Dysmenorrhea is the most common gynecologic complaint among adolescent and young adult females. Dysmenorrhea in adolescents and young adults is usually primary (functional), and is associated with normal ovulatory cycles and with no pelvic pathology. In approximately 10% of adolescents and young adults with severe Dysmenorrhea symptoms, pelvic abnormalities such as endometriosis or uterine anomalies may be found. Potent prostaglandins and potent leukotrienes play an important role in generating Dysmenorrhea symptoms. Nonsteroidal anti-inflammatory drugs (NSAID) are the most common pharmacologic treatment for Dysmenorrhea. Adolescents and young adults with symptoms that do not respond to treatment with NSAIDs for 3 menstrual periods should be offered combined estrogen/progestin oral contraceptive pills for 3 menstrual cycles. Adolescents and young adults with Dysmenorrhea who do not respond to this treatment should be evaluated for secondary causes of Dysmenorrhea. The care provider's role is to explain about pathophysiology of Dysmenorrhea to every adolescent and young adult female, address any concern that the patient has about her menstrual period, and review effective treatment options for Dysmenorrhea with the patient.
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A Contemporary Approach to Dysmenorrhea in Adolescents
Pediatric Drugs, 2002Co-Authors: Zeev HarelAbstract:Dysmenorrhea is the most common gynecologic complaint among adolescent girls. Despite progress in understanding the physiology of Dysmenorrhea and the availability of effective treatments, many adolescent girls do not seek medical advice or are undertreated. Dysmenorrhea in adolescents is usually primary (functional), and is associated with normal ovulatory cycles and no pelvic pathology. In approximately 10% of adolescents with severe Dysmenorrhea, pelvic abnormalities such as endometriosis or uterine anomalies may be found. Potent prostaglandins from the second series and potent leukotrienes from the fourth series play an important role in generating Dysmenorrhea symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common pharmacologic treatment for Dysmenorrhea. A loading dose of NSAIDs (typically twice the regular dose) should be used as initial treatment for Dysmenorrhea in adolescents followed by a regular dose until symptoms abate. Adolescents with symptoms that do not respond to treatment with NSAIDs for three menstrual periods should be offered combined estrogen/progestin oral contraceptive pills for three menstrual cycles. Adolescents with Dysmenorrhea who do not respond to this treatment should be evaluated for secondary causes of Dysmenorrhea. Adolescent care providers have the important roles of educating adolescent girls about menstruation-associated symptoms, as well as evaluating and effectively treating patients with Dysmenorrhea.
E Deligeoroglou - One of the best experts on this subject based on the ideXlab platform.
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Dysmenorrhea.
Annals of the New York Academy of Sciences, 2006Co-Authors: E DeligeoroglouAbstract:Dysmenorrhea presents as painful periods that start two to three years after menarche. The pain usually begins when the bleeding starts and lasts for 48-32 hours. The cause of menstrual cramps and associated symptoms in primary Dysmenorrhea is related to prostaglandin production. In secondary Dysmenorrhea, there is documented pelvic pathology that causes the painful menstrual cramps, and treatment is cause related. Available treatments for primary Dysmenorrhea--NSAIDS, oral combined contraceptives, beta-blockers, psychotherapeutic methods, and cervical dilatation--are discussed.
Thirza I J Hillen - One of the best experts on this subject based on the ideXlab platform.
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primary Dysmenorrhea in young western australian women prevalence impact and knowledge of treatment
Journal of Adolescent Health, 1999Co-Authors: Thirza I J Hillen, Shannon L Grbavac, Philippa J Johnston, Judith A Y Straton, John M F KeoghAbstract:Abstract Purpose: To explore the prevalence of Dysmenorrhea among senior high school girls in Perth, Western Australia, its impact on school, sporting, and social activities, students' management strategies, and their knowledge of available treatment. Methods: A total of 388 female students in Grades 11 and 12 at three metropolitan secondary schools completed an anonymous questionnaire administered during class time. The following definition of dysmenorrhoea was used: any type of pain or discomfort associated with menstrual periods including cramps, nausea, and headaches. Results: The reported prevalence of Dysmenorrhea among these girls was 80%; 53% of those girls with Dysmenorrhea reported that it limited their activities. In particular, 37% said that Dysmenorrhea affected their school activities. The most common medication used by those reporting Dysmenorrhea was simple analgesics (53%), followed by nonsteroidal anti-inflammatory drugs (NSAIDs), used by 42%. More than a quarter of respondents (27%) were unaware that NSAIDs were a possible treatment option for Dysmenorrhea. Conclusion: The prevalence and impact of Dysmenorrhea on Grade 11 and 12 girls is high, and they lack knowledge of and experience with effective treatment. Health education measures are needed in this area to prevent unnecessary suffering and interruption to school routine.