To obtain descriptive information concerning female bodybuilders and women who weight train, a questionnaire concerning training regimes, menstrual history and dieting strategies was developed and administered with the EDI included as part of the questionnaire. Factors assessed included: incidence of menstrual irregularity, scores on the Eating Disorder Inventory (EDI), prevalence of behaviors associated with eating disorders, and mean body fat. Subjects were between the ages of 18 and 35 and included individuals from Personal Health Classes at Virginia Tech, the Virginia Tech Weight Lifting Club, and Goad's Gym in Blacksburg, Virginia. Subjects were classified by activity (weight lifters versus controls), involvement (high, moderate and low) and competition (noncompetitive and competitive). Chi-square analysis indicated that there was no difference in incidence rates of menstrual irregularity between weight lifters (WLs) and controls (Cs); however, the rates of both groups were higher than the general population. Although there was no difference in menstrual function of involvement groups, 50% of the competitors, significantly more than non-competitors, were classified as oligomenorrheic or amenorrheic. All subject groups had mean scores approaching anorexic patient norms on the EDI Bulimia and Maturity Fears subscales. WLs were significantly higher on Drive for Thinness than Cs and more WLs had subscale scores higher than the mean scores presented for anorexics. Additionally, significantly more WLs reported uncontrollable urges to eat, fear of fat, and history of anorexia. Mean %BF of the WLs was 20.18% with competitors being significantly leaner than non-competitors. The high degree of menstrual dysfunction in both WLs and Cs is confusing; yet, the 27% incidence of oligomenorrhea and amenorrhea in WLs is much higher than the rates documented for the general population. The high Drive for Thinness and incidence of negative eating behaviors indicate that the prevalence of eating disorders in this population may progress as this relatively new sport evolves and competitive participation increases. / M.S.

Primary dysmenorrhoea, or painful menstruation in the absence of pelvic pathology, is a common, and often debilitating, gynaecological condition that affects between 45 to 95% of menstruating women. Despite the high prevalence, dysmenorrhoea is often poorly treated, and even disregarded, by health professionals, pain researchers, and the women themselves, who may accept it as a normal part of the menstrual cycle. The overall purpose of this thesis is two-fold: first, to contribute knowledge about the impact and consequences of recurrent severe menstrual pain on pain sensitivity, mood, quality of life and sleep in women with primary dysmenorrhoea, and secondly, to investigate day-time and night-time treatment of recurrent primary dysmenorrhoeic pain. For this thesis, I completed five separate studies on three different groups of young, otherwise healthy women with a history of severe primary dysmenorrhoea, and age-matched controls without dysmenorrhoea. The first two studies, presented in Chapter 2, addressed the question of whether women with primary dysmenorrhoea are hypersensitive to experimental pain. I used clinically-relevant experimentally-induced muscle pain stimuli (intramuscular injection of hypertonic saline and ischaemia) in referred and non-referred sites of menstrual pain, at different phases of the menstrual cycle. Women with dysmenorrhoea, compared to women without dysmenorrhoea, had increased sensitivity to deep-muscle pain both within the area of referred menstrual pain and at a remote pain-free site. Further, the increased muscle pain sensitivity was evident even in phases of the menstrual cycle when women did not have menstrual pain, illustrating that the changes in pain perception extend outside of the painful menstruation phase. These findings suggest that women with dysmenorrhoea show long-lasting changes in pain processing possibly because of the recurrent dysmenorrhoeic pain. A secondary aim of the study presented in Chapter 2a, was to determine the impact of menstrual cycle phase on experimentally-induced muscle pain sensitivity in women with and without primary dysmenorrhoea. My results suggest that menstrual cycle phase has no effect on pain sensitivity in either group of women. As part of my studies, I investigated the impact of dysmenorrhoeic pain on quality of life and mood. I found that women with dysmenorrhoea had a significantly reduced quality of life (Chapter 3) and poorer mood (Chapter 2a and Chapter 5), during menstruation compared to their pain-free follicular phase, and compared to the menstruation phase of the pain-free control women. These data highlight the negative impact that primary dysmenorrhoea has on young women, for up to a few days every month. Non-steroidal anti-inflammatory drugs (NSAIDs) are often prescribed as the first-line therapy for menstrual pain. Yet, severe dysmenorrhoeic pain is often poorly managed, especially at night, when the pain likely disrupts sleep. I conducted two studies investigating the effectiveness of diclofenac potassium, a readily-available NSAID with a low side-effect profile, compared to placebo, in alleviating severe primary dysmenorrhoeic pain across the day (Chapter 4), and during the night (Chapter 5). I also investigated the effectiveness of diclofenac potassium in improving subjective and objective sleep quality (Chapter 5). I found that the daily recommended dose (150 mg) of diclofenac potassium, administered at three timepoints across the first 24 hours of menstruation, significantly reduced perceived menstrual pain, compared to placebo. I confirmed that dysmenorrhoeic pain reduces polysomnographic and subjective measures of sleep quality compared with the pain-free follicular phase. I also showed, for the first time, that diclofenac potassium is effective, compared to placebo, in alleviating nocturnal pain, along with restoring subjective sleep quality and polysomnographic measures of objective sleep quality in women with severe primary dysmenorrhoea. My studies have addressed several gaps in the knowledge about primary dysmenorrhoea. I have shown that women with primary dysmenorrhoea are hypersensitive to deep muscle pain, supporting the hypothesis of other researchers that the recurrent menstrual pain experienced by these women is associated with central sensitisation, and may predispose women with primary dysmenorrhoea to other chronic painful conditions. Therefore, limiting the monthly noxious input into the central nervous systems of these women, by means of effective treatment of dysmenorrhoea, may improve their long-term health. The research presented in this thesis further highlights the efficacy of diclofenac potassium in relieving not only day-time and night-time dysmenorrhoeic pain, but also in restoring objective and subjective pain-induced sleep disturbances in women with dysmenorrhoea. Further, my research has shown that dysmenorrhoeic pain has an immediate negative impact on quality of life and mood during menstruation. The results of this thesis show the multi-factorial impact of dysmenorrhoea and should stimulate further research about the long-term benefits of effective treatment of menstrual pain.

Thesis (Ph. D.)--Texas Woman's University, 2004. / Includes bibliographical references (leaves 111-132). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Thesis (Ph. D.)--Texas Woman's University, 2004. / Includes bibliographical references (leaves 111-132).

Submitted in partial compliance with the requirements of the Master’s Degree in Technology in Homoeopathy, Durban University of Technology, Durban, South Africa, 2018. / Dysmenorrhoea is the term used to describe painful menstrual cramps, and is the most commonly encountered gynaecological disorder. It affects more than 50% of women of reproductive age, of which 10% to 12% experience severe dysmenorrhoea that interferes with their daily lives by incapacitating them for 1 to 3 days each month. Dysmenorrhoea is estimated to be the single greatest cause of working hours lost by women and school absence in teenage girls (Dawood 2008; Lindeque 2015: 6-9). Primary dysmenorrhoea is defined as painful, spasmodic cramping in the lower abdomen just before and/or during menstrual bleeding, in the absence of any identifiable macroscopic pathology. It is related to increased levels of inflammatory markers such as vasopressin, prostaglandins (PGF2α) and leukotrienes from the secretory endometrium. These induce ischaemia due to excessive prolonged uterine contractions, increased the sensitivity of pain fibres, and cause vasoconstriction (Iacovides, Avidon and Baker 2015: 1-17; Stewart and Deb 2014: 296-302). This double-blinded randomised study aimed to establish the efficacy of a homoeopathic complex (consisting of Angelica sinensis 6cH, Dioscorea villosa 6cH, Matricaria chamomilla 6cH, Viburnum opulus 6cH and Zingiber officinalis 6cH) compared to a homoeopathic similimum in 30cH plussed potency in the treatment of the symptoms of primary dysmenorrhoea, in terms of the participants’ perception of the treatment. Thirty female students, who signed the inform consent forms (Appendices B and D), from the Durban University of Technology were selected based on specified inclusion and exclusion criteria after they underwent an abdominal ultrasound examination (Appendix D) by a gynaecologist. They were randomly divided by means of convenience sampling according to a randomisation sheet into two groups. There were 20 in the experimental group which received the homoeopathic complex, and 10 in the control group which received the homoeopathic similimum. The study took place at the Homoeopathic Day Clinic, located at the Durban University of Technology. It was conducted over a period of three menstrual cycles per participant. The initial consultation took place prior to a menstrual period and the subsequent three follow-ups took place once a month, a week after each menstrual period. During each consultation, a detailed homoeopathic case history was conducted and a physical examination including an abdominal examination was performed. In addition, the participants were required to complete the Moos Menstrual Distress Questionnaire (Moos 1968) (Appendix G) and the Pain Rating Scale (British Pain Society 2006) (Appendix H). SPSS version 23.0 software was used to analyse the data collected from these questionnaires. The quantitative variables across the groups were compared using the Kruskal-Wallis test since the captured data was non-parametric. The one-way analysis of variance (ANOVA) was used to compare intra-group data. Quantitative variables were expressed as a mean ± standard deviation. A p-value less than 0.05 was considered significant. The intra-group analysis using the PRS and the MDQ scales (Appendices G and H) showed statistically significant changes in the subcategories of pain in the simillimum group, while these changes were noticed in the complex group only with the PRS scale, when different follow up mean pain score was compared to that at baseline. The different comparisons and p-values can be found in the Appendix G1. The homoeopathic complex group showed more statistically significant changes in the subcategories of behaviour change, negative affect, and control (Appendix G1); while the homoeopathic similimum also revealed other statistically significant changes in the autonomic response and appetite change subgroups (Appendix G1). The inter-group analysis did not reveal any statistically significant change between the groups, although a decrease in the majority of the various mean scores was observed throughout the study. The study’s results led to the conclusion that both the homoeopathic complex and homoeopathic similimum were effective (Appendix G1) in the treatment of symptoms of primary dysmenorrhoea during various follow-ups, as well as reducing the need for allopathic pain medications in the participants during the study. However that efficacy shown by the presence of statistically significant results could not been maintained throughout the study from the baseline to the third follow-ups, this could be due to the smaller sample size of the participants, the need for a better suited similimum remedy with a higher potency for the control group; or the need for another complex remedy, It was also noted that there was no evidence that one treatment was more beneficial than the other even though a decrease in the mean scores was observed in both groups. / M