Surgical treatment of primary dysmenorrhea with laparoscopic uterine nerve ablation. Herbal and dietary therapies for primary and secondary dysmenorrhoea. Primary Dysmenorrhea: Alleviation by an Inhibitor of Prostaglandin Synthesis and Action Prostaglandins in primary dysmenorrhea. Comparison of prophylactic and nonprophylactic treatment with ibuprofen and use of oral contraceptives. A comparative study of the effect of high-intensity transcutaneous nerve stimulation and oral naproxen on intrauterine pressure and menstrual pain in patients with primary dysmenorrhea. A randomized clinical trial of the effectiveness of an acupressure device (relief brief) for managing symptoms of dysmenorrhea. Effectiveness of transcutaneous electrical nerve stimulation and interferential current in primary dysmenorrhea. Addition of laparoscopic uterine nerve ablation to laparoscopic bipolar coagulation of uterine vessels for women with uterine myomas and dysmenorrhea. Low-dose oral contraceptive pill for dysmenorrhea associated with endometriosis: a placebo-controlled, double-blind, randomized trial. Long-term effectiveness of presacral neurectomy for the treatment of severe dysmenorrhea due to endometriosis. Effectiveness of presacral neurectomy in women with severe dysmenorrhea caused by endometriosis who were treated with laparoscopic conservative surgery: a 1-year prospective randomized double-blind controlled trial. Clinical Evaluation to Assess the Safety and Efficacy of Coded Herbal Medicine “Dysmo-off” versus Allopathic Medicine “Diclofenac Sodium” for the Treatment of Primary Dysmenorrhea Persistence of dysmenorrhea and nonmenstrual pain after optimal endometriosis surgery may indicate adenomyosis. Presacral neurectomy for the treatment of pelvic pain associated with endometriosis: a controlled study. Long-term oral contraceptive pills and postoperative pain management after laparoscopic excision of ovarian endometrioma: a randomized controlled trial. The impact of a novel herbal Shirazi Thymus Vulgaris on primary dysmenorrhea in comparison to the classical chemical Ibuprofen The Efficacy of Presacral Neurectomy for the Relief of Midline Dysmenorrhea
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 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 Sixteen young women ( 18–35 years old ) suffering from severe primary dysmenorrhea were treated with the anti-inflammatory drug Flunalgan [ flufenamic acid ; N-(α , α , α-trifluorom-tolyl ) anthranilic acid ] , 125 mg tid or qid , during one to three menstrual periods . In all patients ( a total of 31 treated cycles ) the drug afforded symptomatic relief . Treatment with other analgesic spasmolytic or tranquilizing drugs  , or with placebos , was ineffective in these patients ( 72 control cycles ) . Flufenamic acid inhhibits prostagl and in synthetase and the biologic action of prostagl and in F2α on smooth muscle in laboratory animal preparations . The hypothesis is discussed that excessive amounts of prostagl and in originating from breakdown of the “ pseudodecidual ” tissue of the premenstrual endometrium during cyclic progesterone withdrawal may be the cause of painful myometrial contractures and of the accompanying gastrointestinal symptoms that characterize this syndrome . Further study of the efficacy and safety of drugs that antagonize prostagl and in synthesis and /or action in the treatment of primary dysmenorrhea seems indicated Prostagl and in synthetase inhibitors have been used in clinical trials for the treatment of primary dysmenorrhea on the theory that the disorder may be caused by a high level of prostagl and ins . However , a causal role of prostagl and in in dysmenorrhea has not been established , and there is only indirect evidence that the amelioration of dysmenorrhea by prostagl and in synthetase inhibitors is related to their inhibition of prostagl and in synthesis in the uterus . We , therefore , monitored menstrual prostagl and in release in 14 dysmenorrheic patients in a controlled , double-blind , cross-over trial of ibuprofen ( Motrin ) and in two dysmenorrheic subjects while they were receiving oral contraceptive therapy and while they were not . A total of 89 menstrual cycles were studied . We found that ibuprofen therapy reduced menstrual prostagl and in release and relieved dysmenorrhea but that placebo therapy did not . Oral contraceptives decreased menstrual flow , reduced prostagl and in release and also alleviated dysmenorrhea . We conclude that primary dysmenorrhea is related to a high level of menstrual prostagl and in release .  Ibuprofen inhibits prostagl and in synthesis whereas oral contraceptives inhibit ovulation and cyclic endometrial development . Thus , the two drugs suppress endometrial prostagl and in through different mechanisms . Reduction of menstrual prostagl and in release leads to alleviation of dysmenorrhea OBJECTIVE Our purpose was to compare the effects of high-intensity transcutaneous electrical nerve stimulation and oral naproxen ( 500 mg ) on intrauterine pressure and menstrual pain . STUDY DESIGN An open , r and omized crossover study was performed on 12 women with primary dysmenorrhea .  Intrauterine pressure was recorded with a microtransducer catheter , and the pain score was assessed by a visual analog scale . RESULTS Before treatment all patients displayed signs of uterine hyperactivity  as judged by a high resting pressure ( 7.5 + /- 0.4 kPa ) , high active pressure ( 24.0 + /- 0.8 kPa ) , and a high frequency of pressure cycles ( 13.3 + /- 0.5 contractions per 0.5 hour ) . Oral administration of naproxen suppressed ( p < 0.01 ) all uterine activity parameters . Treatment with transcutaneous electrical nerve stimulation induced a prompt onset of pain relief in a strictly segmental manner , but there were no significant changes in uterine activity . The pain score was significantly reduced ( p < 0.001 ) from 30 to 60 minutes after treatment with transcutaneous electrical nerve stimulation and from 19 to 120 minutes after naproxen administration . CONCLUSIONS Treatment with transcutaneous electrical nerve stimulation induced a prompt onset of pain relief without any significant changes in uterine activity . Possible mechanisms for the pain relief , decreased uterine ischemia or decreased activity in the pain transmission system at spinal or supraspinal levels , are discussed OBJECTIVES To develop and test the safety and effectiveness of an acupressure garment ( the Relief Brief ) in decreasing the pain and symptom distress associated with dysmenorrhea . DESIGN A r and omized clinical trial applied a 2 ( Relief Brief use or control group ) x 3 ( baseline and two treatment measurement occasions ) mixed factorial design . PARTICIPANTS Sixty-one ( 61 ) women with moderately severe primary dysmenorrhea were r and omly assigned to the st and ard treatment control group  or the  Relief Brief acupressure device group after one pretreatment menses , with 58 women reporting the effect on their pain during two post-treatment menstrual cycles . The acupressure garment : The Relief Brief is a cotton Lycra panty brief with a fixed number of lower abdominal and lower back latex foam acupads that provide pressure to dysmenorrhea-relieving Chinese acupressure points . OUTCOME MEASURES Menstrual pain severity ( worst pain and symptom intensity ) , pain medication use , and adverse effects were analyzed using between-groups and repeated measures analyses of treatment effects . Statistical and clinical significance criteria were applied a priori . RESULTS For pain measures and pain medication use , the group main effect , time main effect and group x time interaction were statistically significant . Median pain medication use , the same for both groups at baseline ( 6 pills per day ) , dropped to 2 pills per day for the Relief Brief group but remained at 6 pills for the control group at the second treatment cycle . Predicted clinical significance criteria were surpassed : almost all ( 90 % ) women wearing the Relief Brief obtained at least a 25 % reduction in menstrual pain severity ( a 2 - 3 point drop ) compared to only 8 % of the control group ( z = 6.07 ; p < 0.05 ) . Relief Brief use was associated with at least a 50 % decline in menstrual pain symptom intensity in more than two thirds of the women . CONCLUSIONS An acupressure device is an effective and safe nonpharmacologic strategy for the treatment of primary dysmenorrhea . With design modifications , it could serve as a main treatment modality for women who suffer from primary dysmenorrhea and do not wish to or can not use the conventional pharmacologic agents . In addition , this acupressure device may serve as an adjuvant therapy to medication in more severe cases of dysmenorrhea OBJECTIVE To compare the effectiveness of transcutaneous electrical nerve stimulation and interferential current in primary dysmenorrhea . DESIGN A prospect i ve , r and omized , and controlled study . SETTING Hacettepe University School of Physical Therapy and Rehabilitation . PATIENTS Thirty-four volunteer subjects with primary dysmenorrhea ( mean age : 21.35 + /- 1.70 years ) were included . Statistical analyses were performed in 32 subjects who completed all measures . INTERVENTIONS Fifteen subjects received interferential current application for 20 minutes and 17 subjects received transcutaneous electrical nerve stimulation for 20 minutes when they were experiencing dysmenorrhea . OUTCOME MEASURES Physical characteristics , years since menarche , length of menstrual cycle ( days ) , and duration of menstruation ( days ) were recorded . Visual analog scale ( VAS ) intensities of menstrual pain , referred lower limb pain , and low back pain were recorded before treatment , and immediately , 8 hours , and 24 hours after treatment . RESULTS Intensities of the evaluated parameters decreased beginning from just after the applications in both groups ( P<0.05 ) . Intensity of referring low back pain in first three measurement times was different between the groups ( P<0.05 ) , but this difference is thought to be due to the baseline values of the groups . So , it can be said that no superiority existed between the methods ( P>0.05 ) . CONCLUSION Both transcutaneous electrical nerve stimulation and interferential current appear to be effective in primary dysmenorrhea . As they are free from the potentially adverse effects of analgesics , and no adverse effects are reported in the literature nor observed in this study , a clinical trial of their effectiveness in comparison with untreated and placebo-treated control groups is warranted STUDY OBJECTIVE To assess the effectiveness of laparoscopic uterine nerve ablation ( LUNA ) in women with dysmenorrhea caused by uterine myomas treated by laparoscopic bipolar coagulation of uterine vessels ( LBCUV ) .  DESIGN Prospect i ve , r and omized , longitudinal study ( Canadian Task Force classification II-1 ) . SETTING Private practice , university-affiliated hospital . PATIENTS Eighty-five women with uterine leiomyomas and associated dysmenorrhea . INTERVENTION Laparoscopic bipolar coagulation of uterine vessels with or without LUNA . MEASUREMENTS AND MAIN RESULTS Of 85 patients who entered the study , 41 were assigned to undergo LBCUV-LUNA ( group A ) , which was successful in 40 ( 97.6 % ) . In 44 women assigned to have LBCUV only ( group B ) , 43 ( 97.7 % ) underwent successful surgery . Eighty women completed 1- , 3- , and 6-month follow-up ( 38 group A , 42 group B ) . The groups did not differ significantly in age , history of abdominopelvic surgery , intraperitoneal adhesions , endometriosis , concomitant surgery , and operating time . Seven ( 18.4 % ) of 38 women in group A and 12 ( 28.6 % ) of 42 in group B experienced lower abdominal pain postoperatively . Acceptable pain was defined as a score of zero or 1 : 31 and 30 women in groups A and B reported scores of zero ; 3 and 2 reported scores of 1 ; 4 and 8 reported scores of 2 ; zero and 2 reported scores of 3 ; and no patients reported scores of 4 . The frequency and severity of postoperative pain were less in group A than in group B ( both p < 0.05 ) . The efficacy of both methods was almost equal in shrinking the uterus and dominant myoma , and in improving menorrhagia and bulk-related symptoms . Dysmenorrhea improvement was 84.2 % and 61.9 % in groups A and B at 3 months and 92.1 % and 73.8 % at 6 months , respectively . This was more significant in group A than in group B ( p < 0.05 ) . CONCLUSION Our results suggest that LUNA may decrease postoperative ischemic pain and improve dysmenorrhea associated with uterine myomas treated by LBCUV OBJECTIVE To evaluate the efficacy of a low-dose oral contraceptive pill ( OCP ) for patients with dysmenorrhea associated with endometriosis . DESIGN A double-blind , r and omized , placebo-controlled trial . SETTING S Clinical trial sites in Japan . PATIENT(S ) One hundred patients with dysmenorrhea associated with endometriosis . Most enrolled patients had radiologic evidence of endometriosis rather than surgical diagnosis . INTERVENTION(S ) Patients were r and omly assigned to receive either monophasic OCP ( ethinylestradiol plus norethisterone ) or placebo . Participants used their usual pain medications as needed during the trial . MAIN OUTCOME MEASURE(S ) After four cyclic treatments , we used a zero- to three-point verbal rating scale and a visual analogue scale to measure the severity of disability because of dysmenorrhea in daily life , and the patients ' use of analgesics . RESULT ( S ) Total dysmenorrhea scores assessed by the verbal rating scale were significantly decreased at the end of treatment in both groups . From the first cycle through the end of treatment , dysmenorrhea in the OCP group was significantly milder than in the placebo group . Nonmenstrual pelvic pain was present at baseline in 24.5 % ( 12 of 49 ) of the OCP group and 34.0 % ( 16 of 47 ) of the placebo group . The volume of endometrioma ( larger than 3 cm in diameter ) was significantly decreased in the OCP group , but not in the placebo group . No serious adverse events related to using OCPs occurred . CONCLUSION ( S ) The present study clearly demonstrated for the first time that OCPs could be used to effectively and safely treat pain associated with endometriosis STUDY OBJECTIVE To assess the long-term effectiveness of presacral neurectomy ( PSN ) in women with severe dysmenorrhea due to endometriosis treated with conservative laparoscopic surgical intervention .  DESIGN R and omized , controlled trial ( Canadian Task Force classification I ) . SETTING University-affiliated department of obstetrics and gynecology . PATIENTS One hundred forty-one sexually active women of reproductive age . INTERVENTION Conservative laparoscopic surgery without ( group A ) or with ( group B ) PSN . MEASUREMENTS AND MAIN RESULTS At entry and 24-months after surgical procedures , cure rates ; frequency and severity of dysmenorrhea , dyspareunia , and chronic pelvic pain ; and quality of life were evaluated . At follow-up visit , the cure rate was significantly ( P<0.05 ) higher in group B ( 83.3 % ) than in group A ( 53.3 % ) . The frequency and severity of dysmenorrhea , dyspareunia , and chronic pelvic pain were significantly ( P<0.05 ) lower in both groups compared with baseline values , and only severity was significantly ( P<0.05 ) lower in group B. A significant ( P<0.05 ) improvement in quality of life was observed after surgery in both groups and was significantly ( P<0.05 ) increased in group B compared with group A. CONCLUSION PSN improves long-term cure rates and quality of life in women treated with conservative laparoscopic surgery for severe dysmenorrhea due to endometriosis OBJECTIVE The purpose of this study was to assess the effectiveness of presacral neurectomy in women with severe dysmenorrhea caused by endometriosis that was treated with conservative surgical intervention . STUDY DESIGN One hundred forty-one sexually active women of fertile age with chronic severe dysmenorrhea caused by endometriosis were treated with conservative laparoscopic surgery . Patients were assigned r and omly to not receive ( group A ) or receive ( group B ) presacral neurectomy . At 6 and 12 months after the surgical procedures , the cure rate was evaluated in each patient . The frequency and severity of dysmenorrhea , dyspareunia , and chronic pelvic pain were also evaluated at the same time intervals . RESULTS The cure rate was significantly higher in group B compared with group A at a follow-up examination at 6 months ( 87.3 % vs 60.3 % ) and 12 months ( 85.7 % vs 57.1 % ) . At follow-up visits , the frequency and severity of dysmenorrhea , dyspareunia , and chronic pelvic pain were significantly lower in both groups compared with baseline values ; in particular , significantly lower values were observed in group B versus group A for the severity . CONCLUSION Presacral neurectomy improves the cure rate in women who are treated with conservative laparoscopic surgery for severe dysmenorrhea caused by endometriosis The purpose of the present research work was to carry out clinical study on primary dysmenorrhea to comparatively examine the coded herbal drug formulation “ Dysmo-off ” with authentic allopathic medicine “ Diclofenac sodium ” ( NSAIDs ) . A r and om controlled clinical trial was conducted to compare the efficacy and safety of coded herbal medicinal treatments Dysmo-off with Diclofenac sodium/Phenylacetic acid . These evaluations were based on verbal rating scale so as to ascertain the rate of analgesic effects on dysmenorrhoeic pain . The patients were r and omly allocated with the ratio of 1:2 for controlled treatment with nonsteroidal anti-inflammatory drugs ( NSAIDs ) ( n = 40 ) received Diclofenac sodium tablets twice daily for 4 days ( 50 mg one day prior to and three days after the menstruation ) , and test treatment with Dysmo-off ( n = 80 ) received powdered Dysmo-off twice daily for four days ( 5 g one day prior to and three days after the menstruation ) . Treatment lasted for 4 consecutive menstrual cycles . Hemoglobin , ESR and ultrasound were measured at baseline during study . All subjects were clinical ly studied and completed the assigned therapy during the period May 2001 to June 2004 OBJECTIVE To evaluate whether persistence of pelvic pain after excision of endometriosis was associated with adenomyosis as defined by a thickened uterine junctional zone ( JZ ) on magnetic resonance ( MR ) imaging . DESIGN Prospect i ve clinical trial . SETTING Government research hospital . PATIENT(S ) Fifty-three women with chronic pelvic pain . INTERVENTION(S ) Preoperative MR imaging to measure uterine JZ thickness , surgical excision , and pathologic diagnosis of endometriosis . Those with biopsy-proven endometriosis were r and omized to raloxifene or placebo .  Visual analog scale ( VAS ) was used to rate dysmenorrhea and nonmenstrual pain severity before surgery and 3 months later . MAIN OUTCOME MEASURE(S ) Comparison of JZ thickness and pain severity before and 3 months after surgery in women with endometriosis controlling for medical treatment . RESULT ( S ) Forty of the 53 patients had biopsy-proven endometriosis , and 6 of these 40 women with endometriosis had a thickened JZ . Overall , dysmenorrhea at 3 months was positively correlated with preoperative JZ thickness ( r = 0.47 , P=.01 ) . Dysmenorrhea pain severity showed no significant decrease in those patients whose JZ measured > or=11 mm compared with those with JZ < 8 mm ( P<.0001 ; VAS decreased 4.3 + /- 0.6 ) , or > or=8 and < 11 mm ( P<.02 ; VAS decreased 4.8 + /- 1.3 ) . Nonmenstrual pain severity was correlated with JZ thickness ( r = 0.51 , P=.004 ) at 3 months with a significant decrease in nonmenstrual pain only in women with a JZ < 8 mm ( VAS decreased 4.0 + /- 0.7 , P<.0001 ) . The association between dysmenorrhea and nonmenstrual pain reduction and thinner JZ remained after controlling for medical treatment . CONCLUSION ( S ) Following surgical excision of endometriosis , chronic pelvic pain was significantly more likely to persist with JZ thickness > 11 mm on preoperative MR imaging . This suggests that myometrial JZ abnormalities or adenomyosis may contribute to chronic pelvic pain in women with endometriosis OBJECTIVE Our objective was to evaluate the efficacy of presacral neurectomy combined with conservative surgery for the treatment of  pelvic pain associated with endometriosis . STUDY DESIGN In a r and omized , controlled study performed in a tertiary institution 71 patients with moderate or severe endometriosis and midline dysmenorrhea were r and omly assigned to conservative surgery alone ( n = 36 ) or conservative surgery and presacral neurectomy ( n = 35 ) . Main outcome measures were relief of dysmenorrhea , pelvic pain , and deep dyspareunia after surgery according to a multidimensional and an analog pain scale . RESULTS Presacral neurectomy markedly reduced the midline component of menstrual pain , but no statistically significant differences were observed between the two groups in the frequency and severity of dysmenorrhea , pelvic pain , and dyspareunia in the long-term follow-up . After presacral neurectomy , constipation developed or worsened in 13 patients and urinary urgency occurred in three and a painless first stage of labor in two . CONCLUSION Presacral neurectomy should be combined with conservative surgery for endometriosis only in selected cases OBJECTIVE To evaluate postoperative long-term cyclic and continuous administration of combined oral contraceptive ( OC ) pills in preventing endometriosis-related pain recurrence . DESIGN Prospect i ve , r and omized , controlled trial . SETTING Tertiary care university hospital . PATIENT(S ) Three hundred eleven women who underwent laparoscopic excision for symptomatic ovarian endometrioma . INTERVENTION(S ) Patients were r and omly divided into three groups : nonuser group receiving no therapy , and cyclic user group and continuous user group receiving low-dose , monophasic OC pills for 24 months in either cyclic or continuous administration . MAIN OUTCOME MEASURE(S ) Presence and intensity of dysmenorrhea , dyspareunia , and chronic pelvic pain were assessed by a 10-point visual analogue scale ( VAS ) at 6 , 12 , 18 , and 24 months postoperatively . RESULT ( S ) A significant reduction in recurrence rate and VAS scores for dysmenorrhea was evident in the continuous users versus the other groups at 6 months , and in cyclic users versus nonusers at 18 months postoperatively . No significant differences in recurrence rate and VAS scores for dyspareunia and chronic pelvic pain were demonstrated among the groups . The increase of VAS scores from 6 - 24 months during the study period for dysmenorrhea , dyspareunia , and chronic pelvic pain was significantly higher in nonusers than in the other groups . CONCLUSION ( S ) Long-term postoperative use of OC pills can reduce the frequency and the severity of recurrent endometriosis-related dysmenorrhea Objective : Primary dysmenorrhea is defined as painful cramps during menstruation with no pelvic pathology . Due to the adverse effects of Non-Steroidal Anti-Inflammatory Drugs ( NSAIDs ) are considered as the most common pharmacological treatment for this disorder . The present study was conducted to assess the impact of Shirazi Thymus Vulgaris compared to that of Ibuprofen on primary dysmenorrhea . Material s and Methods : A r and omized , single-blind clinical trial was conducted amongst 120 female students ofIlam University of Medical Sciences , aged 18 - 25 years who suffered from primary dysmenorrhea . The participants were r and omly divided into two groups ; one received the herbal and the other classical treatments . The herbal group received 5 ml of the Shirazi Thymus Vulgaris medication that commercially called BronchoT.D , orally four times a day . The classic group received Ibuprofen orally three times a day . A visual analogue scale ( VAS ) was used to record pain severity . Results : Pain severity was reduced in both herbal and classic groups with no significant differences . Pain duration at the first and second month of treatment was also similar between two groups . Conclusions : Shirazi Thymus Vulgaris decreased dysmenorrhea symptoms , which might be attributed to its antispasmodic effects . The herbal Shirazi Thymus Vulgaris can be recommended as an effective medication fortreatment of the primary dysmenorrhea disorder The present study was undertaken to evaluate prospect ively the efficacy of presacral neurectomy for the treatment of midline dysmenorrhea .  All patients had moderate to severe dysmenorrhea and stage III-IV endometriosis . Of the patients undergoing presacral neurectomy ( N=17 ) , only two had a recurrence of pain . The remainder of the patients undergoing presacral neurectomy  remain pain-free at 42 months of follow-up . Of the patients undergoing resection of endometriosis but not presacral neurectomy ( N=9 ) , none received relief of midline pain . Relief of lateral pain , back pain , and dyspareunia was variable in both groups . Our findings corroborate previous retrospective studies showing that presacral neurectomy is highly effective in the treatment of dysmenorrhea . We speculate that the most common reasons for failure of presacral neurectomy are inappropriate selection of patients and incomplete resection of the presacral nerve
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 .