dysmenorrhea
American Heritage Dictionary:
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dys·men·or·rhe·a
Britannica Concise Encyclopedia:
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dysmenorrhea
Pain or cramps before or during menstruation. In primary dysmenorrhea, caused by endocrine imbalances, severity varies widely. Irritability, fatigue, backache, or nausea may also occur. Long assumed to be psychosomatic, it is now known to be due to excess prostaglandins, which contract the uterus, causing cramps. Pain relievers that block prostaglandin formation can decrease its severity, which may also be eased after childbearing. Secondary dysmenorrhea is caused by other disorders, including genital obstructions, pelvic inflammation, infection, polyps, or tumours. Treatment is directed toward the underlying disorder.
For more information on dysmenorrhea, visit Britannica.com.
Oxford Food & Fitness Dictionary:
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dysmenorrhoea
Pain during menstruation. There are many possible causes including reduced blood supply to the uterus and psychological factors. Dysmenorrhoea is less common in physically active women. See also amenorrhoea and menstruation.
Gale Encyclopedia of Children's Health:
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Dysmenorrhea
Definition
Dysmenorrhea refers to the pain or discomfort associated with menstruation. Although not a serious medical problem, the term describes a woman adolescent girl with menstrual symptoms severe enough to keep her from functioning for a day or two each month.
Description
Menstrual cramps are a common problem for adolescent girls and women. They may be mild, moderate, or severe and are the single most common cause of days missed from school and work. About 10 percent of girls are incapacitated for up to three days each month. Although many teens do not suffer from dysmenorrhea because their uterus is still growing, they may get it several years after their first period begins. The symptoms may begin one to two days before menses, peak on the first day of flow, and subside during that day or over several days.
Causes and Symptoms
Primary dysmenorrhea is the more common type of dysmenorrhea and is due to the production of prostaglandins. Prostaglandins are natural substances made by cells in the inner lining of the uterus and other parts of the body. Those made in the uterus make the uterine muscles contract and help the uterus to shed the lining that has built up during the menstrual cycle. It appears, however, that the level of prostaglandins has nothing to do with how strong a woman's cramps are. Some women have high levels of prostaglandins and no cramps, whereas other women with low levels have severe cramps. Thus cramps must also be related to something other than prostaglandins, such as genetics, stress, and different body types. The first year or two of a girl's periods are not usually very painful; however, once ovulation begins, the blood levels of the prostaglandins rise, leading to stronger contractions during menstruation. Prostaglandins can also cause headaches, nausea, vomiting, and diarrhea. The likelihood that a woman will have cramps increases if the following apply to her:
- She has a family history of painful periods.
- She leads a stressful life.
- She does not get enough exercise.
- She uses caffeine.
- She has pelvic inflammatory disease.
Primary dysmenorrhea usually presents during adolescence, within three years of menarche. It is unusual for symptoms to start within the first six months after menarche. Affected young women experience sharp, intermittent spasms of pain, usually centered in the suprapubic area. Pain may radiate to the back of the legs or the lower back. Systemic symptoms of nausea, vomiting, diarrhea, fatigue, fever, headache, or lightheadedness are fairly common. Pain usually develops within hours of the start of menstruation and peaks as the flow becomes heaviest during the first day or two of the cycle. Some women notice that painful periods disappear after having their first child. This could be due to the stretching of the opening of the uterus or the fact that birth improves the uterine blood supply and muscle activity.
Secondary dysmenorrhea is defined as menstrual pain due to pelvic pathology. This condition usually occurs after a woman has had normal menstrual periods for some time. It differs from primary dysmenorrheal in that the pain is caused by an abnormality or disease of the uterus, tubes, or ovaries. The most common causes are:
- pelvic inflammatory disease
- fibroids (intracavitary or intramural)
- intrauterine contraceptive devices
- endometriosis
- inflammation and scarring(adhesions)
- functional ovarian cysts
- benign or malignant tumors of ovary, bowel or bladder, or other site
- inflammatory bowel disease
Diagnosis
A focused history and physical examination are usually sufficient to make the diagnosis of primary dysmenorrhea. The history reveals the typical cramping pain with menstruation, and the physical examination is completely normal. A doctor should perform a thorough pelvic exam and take a patient history to rule out an underlying condition that could cause cramps. It is usually possible to differentiate dysmenorrhea from premenstrual syndrome (PMS) based on the patient's history. The pain associated with PMS is generally related to breast tenderness and abdominal bloating, rather than a lower abdominal cramping pain. PMS symptoms begin before the menstrual cycle and resolve shortly after menstrual flow begins.
Circumstances that may indicate secondary dysmenorrheal include the following:
- dysmenorrhea occurring during the first one or two cycles after menarche (congenital outflow obstruction)
- dysmenorrhea beginning after 25 years of age
- late onset of dysmenorrhea after a history without previous pain with menstruation (possibly caused by complications of pregnancy: ectopic or threatened spontaneous abortion)
- pelvic abnormality on physical examination; infertility (possible endometriosis, pelvic inflammatory disease or other causes of scarring); heavy menstrual flow or irregular cycles (consider adenomyosis, fibroids, polyps); dyspareunia
- little or no response to therapy with nonsteroidal anti-inflammatory drugs, oral contraceptives, or both
Treatment
Secondary dysmenorrhea is controlled by treating the underlying disorder.
The appropriate choice of therapy for most women with primary dysmenorrheal is a nonsteroidal anti-inflammatory drug (NSAIDs), which prevents the formation and release of prostaglandins. Aspirin is not used for the treatment of dysmenorrheal because it is not potent enough in the usual dosage. Response to NSAIDs usually occurs within 30 to 60 minutes, but since individual response may vary, it is sometimes necessary to try different NSAIDs if the pain is not relieved with the first drug after one or two menstrual cycles. The NSAIDs include ibuprofen, naproxen (Aleve), and Motrin.
If an NSAID is not available, acetaminophen (Tylenol) may help ease the pain. Heat applied to the painful area may bring relief, and a warm bath twice a day also may help. Birth control pills are 90 percent effective in easing the pain of dysmenorrheal. They work by a twofold action: they reduce the menstrual fluid volume and suppress ovulation. They are generally not prescribed initially because it is a daily medication unless the woman also wants a birth control method. They may be chosen as a first line of therapy.
Alternative Treatment
Simply changing the position of the body can help ease cramps. The simplest technique is assuming the fetal position, with knees pulled up to the chest while hugging a heating pad or pillow to the abdomen. Likewise, several yoga positions are popular ways to ease menstrual pain. In the "cat stretch," position, the woman rests on her hands and knees, slowly arching the back. The pelvic tilt is another popular yoga position, in which the woman lies on her back with knees bent and then lifts the pelvis and buttocks.
Dietary recommendations to ease cramps include increasing fiber, calcium, and complex carbohydrates, cutting fat, red meat, dairy products, caffeine, salt, and sugar. Smoking also has been found to worsen cramps. Some research suggests that vitamin B supplements, primarily vitamin B6 in a complex, magnesium, and fish oil supplements (omega-3 fatty acids) also may help relieve cramps.
Other women find relief through visualization, concentrating on the pain as a particular color, and gaining control of the sensations. Aromatherapy and massage may ease pain for some women. Others find that imagining a white light hovering over the painful area can actually lessen the pain for brief periods.
Exercise may be a way to reduce the pain of menstrual cramps through the brain's production of endorphins, the body's own painkillers. And orgasm can make a woman feel more comfortable by releasing tension in the pelvic muscles.
Acupuncture and Chinese herbs are additional alternative treatments for cramps.
Prognosis
Medication should lessen or eliminate pain by the end of three menstrual cycles. If it does not work, then a re-evaluation is necessary.
Prevention
NSAIDs taken one to two days before a period begins should eliminate cramps for some women.
Resources
Books
Carlson, K. J., et al. The New Harvard Guide to Women's Health. Cambridge, MA: Harvard University Press, 2004.
Organizations
National Women's Health Network. 514 10th St. NW, Suite 400, Washington, DC 20004. Web site: www.womenshealthnetwork.org.
Web Sites
Clark, Alan D. "Dysmenorrhea." eMedicine, October 12, 2004. Available online at
[Article by: Linda K. Bennington]
Oxford Dictionary of Sports Science & Medicine:
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dysmenorrhoea
Severe pain during menstruation. This often interferes with training and competition, but it is sometimes possible to change the timing of the menstrual cycle by using contraceptive pills or other substances. It is important thatathletes taking medication to treat dysmenorrhoea check that the medication doesnot include any substances on the World Anti-Doping Agency's 2005 Prohibited List. There is some evidence that regular aerobic exercise reduces the incidence of dysmenorrhoea.
Random House Word Menu:
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categories related to 'dysmenorrhea'
- Afflictions and Conditions - dysmenorrhea: painful, difficult menstruation
Wikipedia on Answers.com:
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Dysmenorrhea
| Dysmenorrhea | |
|---|---|
| Classification and external resources | |
| ICD-10 | N94.4-N94.6 |
| ICD-9 | 625.3 |
| DiseasesDB | 10634 |
| MedlinePlus | 003150 |
| MeSH | D004412 |
Dysmenorrhea (or dysmenorrhoea) is a gynecological medical condition of pain during menstruation that interferes with daily activities, as defined by ACOG[1] and others.[2] Still, dysmenorrhea is often defined simply as menstrual pain,[3][4] or at least menstrual pain that is excessive.[5] This article uses the dysmenorrhea definition of menstrual pain that interferes with daily activities, and uses the term menstrual pain as any pain during menstruation whether it is normal or abnormal.
Menstrual pain is often used synonymously with menstrual cramps, but the latter may also refer to menstrual uterine contractions, which are generally of higher strength, duration and frequency than in the rest of the menstrual cycle.[6]
Dysmenorrhea can feature different kinds of pain, including sharp, throbbing, dull, nauseating, burning, or shooting pain. Dysmenorrhea may precede menstruation by several days or may accompany it, and it usually subsides as menstruation tapers off. Dysmenorrhea may coexist with excessively heavy blood loss, known as menorrhagia.
Secondary dysmenorrhea is diagnosed when symptoms are attributable to an underlying disease, disorder, or structural abnormality either within or outside the uterus. Primary dysmenorrhea is diagnosed when none of these are detected.
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Contents
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Classification
Dysmenorrhea can be classified as either primary or secondary based on the absence or presence of an underlying cause. Secondary dysmenorrhea is dysmenorrhea which is associated with an existing condition. The most common cause of secondary dysmenorrhea is endometriosis.[7] Other causes include leiomyoma,[8] adenomyosis,[9] ovarian cysts, and pelvic congestions.[10] The presence of a copper IUD can also cause dysmenorrhea.[11][12] In patients with adenomyosis, the levonorgestrel intrauterine system (Mirena) was observed to provide relief.[13]
Signs and symptoms
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This unreferenced section requires citations to ensure verifiability. |
The main symptom of dysmenorrhea is pain concentrated in the lower abdomen, in the umbilical region or the suprapubic region of the abdomen. It is also commonly felt in the right or left abdomen. It may radiate to the thighs and lower back.
Symptoms often co-occurring with menstrual pain include nausea and vomiting, diarrhea or constipation, headache, dizziness, disorientation, hypersensitivity to sound, light, smell and touch, fainting, and fatigue. Symptoms of dysmenorrhea often begin immediately following ovulation and can last until the end of menstruation. This is because dysmenorrhea is often associated with changes in hormonal levels in the body that occur with ovulation. The use of certain types of birth control pills can prevent the symptoms of dysmenorrhea, because the birth control pills stop ovulation from occurring.
Pathophysiology
During a woman's menstrual cycle, the endometrium thickens in preparation for potential pregnancy. After ovulation, if the ovum is not fertilized and there is no pregnancy, the built-up uterine tissue is not needed and thus shed.
Molecular compounds called prostaglandins are released during menstruation, due to the destruction of the endometrial cells, and the resultant release of their contents.[14] Release of prostaglandins and other inflammatory mediators in the uterus cause the uterus to contract. These substances are thought to be a major factor in primary dysmenorrhea.[15] When the uterine muscles contract, they constrict the blood supply to the tissue of the endometrium, which, in turn, breaks down and dies. These uterine contractions continue as they squeeze the old, dead endometrial tissue through the cervix and out of the body through the vagina. These contractions, and the resulting temporary oxygen deprivation to nearby tissues, are responsible for the pain or "cramps" experienced during menstruation.
Compared with other women, females with primary dysmenorrhea have increased activity of the uterine muscle with increased contractility and increased frequency of contractions.[16]
In one research study using MRI, visible features of the uterus were compared in dysmenorrheic and eumenorrheic (normal) participants. The study concluded that in dysmenorrheic patients, visible features on cycle days 1-3 correlated with the degree of pain, and differed significantly from the control group.[17]
Diagnosis
The diagnosis of dysmenorrhea is usually made simply on a medical history of menstrual pain that interferes with daily activities. However, there is no universally accepted gold standard technique for quantifying the severity of menstrual pains.[18] Yet, there are quantification models, called menstrual symptometrics, that can be used to estimate the severity of menstrual pains as well as correlate them with pain in other parts of the body, menstrual bleeding and degree of interference with daily activities.[18]
Further work-up
Once a diagnosis of dysmenorrhea is made, further work-up is required to search for any underlying cause of it, in order to be able to treat it specifically and to avoid aggravation of a perhaps serious underlying cause.
Further work-up includes a specific medical history of symptoms and menstrual cycles and a pelvic exam.[1] Based on results from these, additional exams and tests may be motivated, such as:
- A pap test[1]
- Certain lab tests[1]
- Gynecologic ultrasonography[1]
In some cases, laparoscopy may be required.[1]
Management
NSAIDs
Non-steroidal anti-inflammatory drugs (NSAIDs) are effective in relieving the pain of primary dysmenorrhea.[19] They can have side effects of nausea, dyspepsia, peptic ulcer, and diarrhea.[20] People who are unable to take the more common NSAIDs, may be prescribed a COX-2 inhibitor.[21]Chantler I, Mitchell D, Fuller A (2008). "The effect of three cyclo-oxygenase inhibitors on intensity of primary dysmenorrheic pain". Clin J Pain 24 (1): 39–44. doi:10.1097/AJP.0b013e318156dafc. PMID 18180635.</ref> besides these drugs anti-spasmodic's like drotravine is used that relax the muscles and helps to reduce the pain.
Hormonal contraceptives
Although use of hormonal contraception can improve or relieve symptoms of primary dysmenorrhea,[22][23] a 2001 systematic review found that no conclusions can be made about the efficacy of commonly used modern lower dose combined oral contraceptive pills for primary dysmenorrhea.[24] Norplant[25] and Depo-provera[26][27] are also effective, since these methods often induce amenorrhea. The IntraUterine System (Mirena IUD) has been cited as useful in reducing symptoms of dysmenorrhea.[28]
Other
A review indicated the effectiveness of use of transdermal nitroglycerin.[29] In case of severe blood loss, iron supplements like folic acid and iron polymaltose are used.
Alternative medicine
A number of alternative therapies have been studied in the treatment of dysmenorrhea. The effectiveness of acupressure, behavioral interventions, thiamine, vitamin E, topical heat, and transcutaneous electrical nerve stimulation is likely while the effects of acupuncture, fish oil, magnets and vitamin B12 is unknown.[30] Spinal manipulation is unlikely to be helpful.[30]
A 2008 systematic review found promising evidence for Chinese herbal medicine for primary dysmenorrhea, but that the evidence was limited by its poor methodological quality.[31]
Behavioral therapies assume that the physiological process underlying dysmenorrhea is influenced by environmental and psychological factors, and that dysmenorrhea can be effectively treated by physical and cognitive procedures that focus on coping strategies for the symptoms rather than on changes to the underlying processes. A 2007systematic review found some scientific evidence that behavioral interventions may be effective, but that the results should be viewed with caution due to poor quality of the data.[32]
Acupuncture and acupressure are used to treat dysmenorrhea. A review cited four studies, two of which were patient-blind, indicating that acupuncture and acupressure were effective.[33] This review stated that the treatments appear "promising" for dysmenorrhea, and that the researchers considered further studies to be justified. Another study indicated that acupuncture "reduced the subjective perception of dysmenorrhea",[34] still another indicated that adding acupuncture in patients with dysmenorrhea was associated with improvements in pain and quality of life.[35]
Although claims have been made for chiropractic care, under the theory that treating subluxations in the spine may decrease symptoms,[36] a 2006 systematic review found that overall no evidence suggests that spinal manipulation is effective for treatment of primary and secondary dysmenorrhea.[37]
Epidemiology
The prevalence of dysmenorrhea is estimated to be approximately 25% of women.[38] Reports of dysmenorrhea are greatest among individuals in their late teens and 20s, with reports usually declining with age. The prevalence in adolescent females has been reported to be 67.2% by one study[39] and 90% by another.[38] It has been stated that there is no significant difference in prevalence or incidence between races.[38] Yet, a study of Hispanic adolescent females indicated a high prevalence and impact in this group.[40] Another study indicated that dysmenorrhea was present in 36.4% of participants, and was significantly associated with lower age and lower parity.[41] Childbearing is said to relieve dysmenorrhea, but this does not always occur. One study indicated that in nulliparous women with primary dysmenorrhea, the severity of menstrual pain decreased significantly after age 40.[42] A questionnaire concluded that menstrual problems, including dysmenorrhea, were more common in females who had been sexually abused.[43]
A survey in Norway showed that 14 percent of females between the ages of 20 to 35 experience symptoms so severe that they stay home from school or work.[44] Among adolescent girls, dysmenorrhea is the leading cause of recurrent short-term school absence in this group.[7]
References
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- ^ TheFreeDictionary > dysmenorrhea Citing:
- Jonas: Mosby's Dictionary of Complementary and Alternative Medicine. Copyright 2005
- ^ TheFreeDictionary > dysmenorrhea Citing:
- Gale Encyclopedia of Medicine. Copyright 2008
- Dorland's Medical Dictionary for Health Consumers. Copyright 2007
- The American Heritage Medical Dictionary Copyright 2007
- Mosby's Medical Dictionary, 8th edition.
- McGraw-Hill Concise Dictionary of Modern Medicine. Copyright 2002
- ^ eMedicine Specialties > Dysmenorrhea Authors: Andre Holder, Laurel D Edmundson, Mert Erogul. Updated: Dec 31, 2009
- ^ MedlinePlus > Painful menstrual periods Update Date: 9/2/2009 by: Susan Storck. Also reviewed by David Zieve
- ^ medicinenet.com > Menstrual Cramps Retrieved January 2011
- ^ a b French L (2008). "Dysmenorrhea in adolescents: diagnosis and treatment". Paediatr Drugs 10 (1): 1–7. PMID 18162003.
- ^ Hilário SG, Bozzini N, Borsari R, Baracat EC (2008). "Action of aromatase inhibitor for treatment of uterine leiomyoma in perimenopausal patients". Fertil. Steril. 91 (1): 240–3. doi:10.1016/j.fertnstert.2007.11.006. PMID 18249392.
- ^ Nabeshima H, Murakami T, Nishimoto M, Sugawara N, Sato N (2008). "Successful total laparoscopic cystic adenomyomectomy after unsuccessful open surgery using transtrocar ultrasonographic guiding". J Minim Invasive Gynecol 15 (2): 227–30. doi:10.1016/j.jmig.2007.10.007. PMID 18312998.
- ^ Hacker, Neville F., J. George Moore, and Joseph C. Gambone. Essentials of Obstetrics and Gynecology, 4th ed. Elsevier Saunders, 2004. ISBN 0-7216-0179-0
- ^ Hubacher D, Reyes V, Lillo S et al (2006). "Preventing copper intrauterine device removals due to side effects among first-time users: randomized trial to study the effect of prophylactic ibuprofen". Hum. Reprod. 21 (6): 1467–72. doi:10.1093/humrep/del029. PMID 16484309.
- ^ Johnson BA (2005). "Insertion and removal of intrauterine devices". Am Fam Physician 71 (1): 95–102. PMID 15663031.
- ^ Cho S, Nam A, Kim H et al (2008). "Clinical effects of the levonorgestrel-releasing intrauterine device in patients with adenomyosis". Am. J. Obstet. Gynecol. 198 (4): 373.e1–7. doi:10.1016/j.ajog.2007.10.798. PMID 18177833.
- ^ Lethaby A, Augood C, Duckitt K, Farquhar C (2007). Lethaby, Anne. ed. "Nonsteroidal anti-inflammatory drugs for heavy menstrual bleeding". Cochrane Database Syst Rev (4): CD000400. doi:10.1002/14651858.CD000400.pub2. PMID 17943741.
- ^ Wright, Jason and Solange Wyatt. The Washington Manual Obstetrics and Gynecology Survival Guide. Lippincott Williams and Wilkins, 2003. ISBN 0-7817-4363-X
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- ^ Kataoka M, Togashi K, Kido A et al (2005). "Dysmenorrhea: evaluation with cine-mode-display MR imaging--initial experience". Radiology 235 (1): 124–31. doi:10.1148/radiol.2351031283. PMID 15731368.
- ^ a b [1] Wyatt, KM; Dimmock, PW; Hayes-Gill, B; Crowe, J; O'Brien, PM (2002). "Menstrual symptometrics: a simple computer-aided method to quantify menstrual cycle disorders". Fertility and Sterility 78 (1): 96–101. PMID 12095497.
- ^ Marjoribanks, J; Proctor, M, Farquhar, C, Derks, RS (2010 Jan 20). Marjoribanks, Jane. ed. "Nonsteroidal anti-inflammatory drugs for dysmenorrhoea". Cochrane database of systematic reviews (Online) (1): CD001751. doi:10.1002/14651858.CD001751.pub2. PMID 20091521.
- ^ Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006. ISBN 0-9757919-2-3
- ^ <own observation by Dr Waheed Iqbal
- ^ Archer DF (November 2006). "Menstrual-cycle-related symptoms: a review of the rationale for continuous use of oral contraceptives". Contraception 74 (5): 359–66. doi:10.1016/j.contraception.2006.06.003. PMID 17046376.
- ^ Harel Z (December 2006). "Dysmenorrhea in adolescents and young adults: etiology and management". J Pediatr Adolesc Gynecol 19 (6): 363–71. doi:10.1016/j.jpag.2006.09.001. PMID 17174824.
- ^ Proctor ML, Roberts H, Farquhar CM (2001). Wong, Chooi L. ed. "Combined oral contraceptive pill (OCP) as treatment for primary dysmenorrhoea". Cochrane Database Syst Rev (4): CD002120. doi:10.1002/14651858.CD002120. PMID 11687142.
- ^ Power J, French R, Cowan F (2007). Power, Jo. ed. "Subdermal implantable contraceptives versus other forms of reversible contraceptives or other implants as effective methods of preventing pregnancy". Cochrane Database Syst Rev (3): CD001326. doi:10.1002/14651858.CD001326.pub2. PMID 17636668.
- ^ Glasier, Anna (2006). "Contraception". In DeGroot, Leslie J.; Jameson, J. Larry (eds.). Endocrinology (5th ed.). Philadelphia: Elsevier Saunders. pp. 2993–3003. ISBN 0-7216-0376-9.
- ^ Loose, Davis S.; Stancel, George M. (2006). "Estrogens and Progestins". In Brunton, Laurence L.; Lazo, John S.; Parker, Keith L. (eds.). Goodman & Gilman's The Pharmacological Basis of Therapeutics (11th ed.). New York: McGraw-Hill. pp. 1541–1571. ISBN 0-07-142280-3.
- ^ Gupta HP, Singh U, Sinha S (2007). "Laevonorgestrel intra-uterine system--a revolutionary intra-uterine device". J Indian Med Assoc 105 (7): 380, 382–5. PMID 18178990.
- ^ Morgan PJ, Kung R, Tarshis J (2002). "Nitroglycerin as a uterine relaxant: a systematic review". J Obstet Gynaecol Can 24 (5): 403–9. PMID 12196860.
- ^ a b Latthe, PM; Champaneria, R, Khan, KS (2011 Feb 21). "Dysmenorrhoea". Clinical evidence 2011. PMID 21718556.
- ^ Zhu X, Proctor M, Bensoussan A, Wu E, Smith CA (2008). Zhu, Xiaoshu. ed. "Chinese herbal medicine for primary dysmenorrhoea". Cochrane Database Syst Rev (2): CD005288. doi:10.1002/14651858.CD005288.pub3. PMID 18425916.
- ^ Proctor ML, Murphy PA, Pattison HM, Suckling J, Farquhar CM (2007). Proctor, Michelle. ed. "Behavioural interventions for primary and secondary dysmenorrhoea". Cochrane Database Syst Rev (3): CD002248. doi:10.1002/14651858.CD002248.pub3. PMID 17636702.
- ^ White A (2003). "A review of controlled trials of acupuncture for women's reproductive health care". J Fam Plann Reprod Health Care 29 (4): 233–6. doi:10.1783/147118903101197863. PMID 14662058.
- ^ Jun E (2004). "[Effects of SP-6 acupressure on dysmenorrhea, skin temperature of CV2 acupoint and temperature, in the college students]". Taehan Kanho Hakhoe Chi 34 (7): 1343–50. PMID 15687775.
- ^ Witt CM, Reinhold T, Brinkhaus B, Roll S, Jena S, Willich SN (2008). "Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care". Am. J. Obstet. Gynecol. 198 (2): 166.e1–8. doi:10.1016/j.ajog.2007.07.041. PMID 18226614.
- ^ Chapman-Smith D (2000). "Scope of practice". The Chiropractic Profession: Its Education, Practice, Research and Future Directions. West Des Moines, IA: NCMIC. ISBN 1-892734-02-8.
- ^ Proctor ML, Hing W, Johnson TC, Murphy PA (2006). Proctor, Michelle. ed. "Spinal manipulation for primary and secondary dysmenorrhoea". Cochrane Database Syst Rev 3 (3): CD002119. doi:10.1002/14651858.CD002119.pub3. PMID 16855988.
- ^ a b c eMedicine > Dysmenorrhea By Andre Holder, Laurel D Edmundson and Mert Erogul. Updated: Dec 31, 2009
- ^ Sharma P, Malhotra C, Taneja DK, Saha R (2008). "Problems related to menstruation amongst adolescent girls". Indian J Pediatr 75 (2): 125–9. doi:10.1007/s12098-008-0018-5. PMID 18334791.
- ^ Banikarim C, Chacko MR, Kelder SH (2000). "Prevalence and impact of dysmenorrhea on Hispanic female adolescents". Arch Pediatr Adolesc Med 154 (12): 1226–9. PMID 11115307. http://archpedi.ama-assn.org/cgi/pmidlookup?view=long&pmid=11115307.
- ^ Sule ST, Umar HS, Madugu NH (2007). "Premenstrual symptoms and dysmenorrhoea among Muslim women in Zaria, Nigeria". Ann Afr Med 6 (2): 68–72. doi:10.4103/1596-3519.55713. PMID 18240706.
- ^ Juang CM, Yen MS, Horng HC, Cheng CY, Yuan CC, Chang CM (2006). "Natural progression of menstrual pain in nulliparous women at reproductive age: an observational study". J Chin Med Assoc 69 (10): 484–8. doi:10.1016/S1726-4901(09)70313-2. PMID 17098673. http://ajws.elsevier.com/ajws_pubmed/pubmed_switch.asp?journal_issn=1726-4901&art_pub_year=2006&%20art_pub_month=10&art_pub_vol=69&art_sp=484.
- ^ Vink CW, Labots-Vogelesang SM, Lagro-Janssen AL (2006). "[Menstruation disorders more frequent in women with a history of sexual abuse]" (in Dutch; Flemish). Ned Tijdschr Geneeskd 150 (34): 1886–90. PMID 16970013.
- ^ "Mozon: Sykemelder seg på grunn av menssmerter". Mozon. 2004-10-25. http://www.mozon.no/php/art.php?id=349090. Retrieved 2007-02-02.
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