M.Tech. / Dysmenorrhoea is the most common of all gynaecological complaints, leading to absence from work or school and the inability to participate in sports or other activities (Edmundson et al, 2006). Headache, nausea, constipation or diarrhoea, and urinary frequency are common concomitant symptoms; vomiting occasionally occurs (Beers et al, 2006). In research by Klein and Litt, although black adolescents reported no increased incidence of dysmenorrhoea, they were absent from school more frequently than whites (Callis, 2006). Primary dysmenorrhoea is defined as severe or incapacitating uterine cramping during ovulatory menses, in the absence of demonstrable disorders of the pelvis (Carr and Bradshaw, 2005). Primary dysmenorrhoea is related to excessive production of prostaglandins which cause ischaemia in the myometrium of the uterus, with increased contraction and vasoconstriction (Callis, 2006). The aim of this study was to evaluate, using case studies, the effect of the homeopathic similimum in the treatment of the symptoms of primary dysmenorrhoea in black females. Evaluation was based on the evaluation of symptoms form (Appendix E), which rated the common symptoms namely lower abdominal pain, nausea, vomiting, diarrhoea, constipation, fatigue, irritability, mood swings, menstrual flow and breast tenderness, and on the history taken and follow up consultation, looking at overall symptom change of each participant. The research study used a convenience sample of ten black females, aged between eighteen and twenty-five, who had been suffering from primary dysmenorrhoea for the previous three or more months. The volunteers were recruited by advertising posters (Appendix A) on the University of Johannesburg campuses. They were given an information and consent form (Appendix B) to read, understand and complete if they agreed with the given information and explained procedures. They were then screened for suitability using a screening questionnaire (Appendix C). From this questionnaire ten suitable participants were selected. A full case history of each participant was taken and a full physical examination (Appendix F) was conducted on each of the ten suitable participants. The full case and physical examination findings were evaluated and a homeopathic similimum remedy was selected under supervision of the research supervisor. Data was collected from the evaluation of symptoms form (Appendix E), and this was statistically analysed and is presented graphically. From the case history (Appendix C) and follow-up (Appendix D) forms, data was analysed by the researcher and it was discussed in terms of clinical efficacy. The outcome of this study showed the statistical and clinical effectiveness of homeopathic similimum treatment in reducing or improving primary dysmenorrhoea and the symptoms associated with it, in black females.

M.Tech. / Dysmenorrhoea is the most common of all gynaecological complaints, leading to absence from work or school and the inability to participate in sports or other activities (Edmundson et al, 2006). Headache, nausea, constipation or diarrhoea, and urinary frequency are common concomitant symptoms; vomiting occasionally occurs (Beers et al, 2006). In research by Klein and Litt, although black adolescents reported no increased incidence of dysmenorrhoea, they were absent from school more frequently than whites (Callis, 2006). Primary dysmenorrhoea is defined as severe or incapacitating uterine cramping during ovulatory menses, in the absence of demonstrable disorders of the pelvis (Carr and Bradshaw, 2005). Primary dysmenorrhoea is related to excessive production of prostaglandins which cause ischaemia in the myometrium of the uterus, with increased contraction and vasoconstriction (Callis, 2006). The aim of this study was to evaluate, using case studies, the effect of the homeopathic similimum in the treatment of the symptoms of primary dysmenorrhoea in black females. Evaluation was based on the evaluation of symptoms form (Appendix E), which rated the common symptoms namely lower abdominal pain, nausea, vomiting, diarrhoea, constipation, fatigue, irritability, mood swings, menstrual flow and breast tenderness, and on the history taken and follow up consultation, looking at overall symptom change of each participant. The research study used a convenience sample of ten black females, aged between eighteen and twenty-five, who had been suffering from primary dysmenorrhoea for the previous three or more months. The volunteers were recruited by advertising posters (Appendix A) on the University of Johannesburg campuses. They were given an information and consent form (Appendix B) to read, understand and complete if they agreed with the given information and explained procedures. They were then screened for suitability using a screening questionnaire (Appendix C). From this questionnaire ten suitable participants were selected. A full case history of each participant was taken and a full physical examination (Appendix F) was conducted on each of the ten suitable participants. The full case and physical examination findings were evaluated and a homeopathic similimum remedy was selected under supervision of the research supervisor.

There are few data available about the menstrual patterns of Australian teenagers and the prevalence of menstrual disorder in this age group. Aims To establish the typical experience of menstruation in a sample of 16-18 year old women attending ACT Secondary Colleges of Education. To determine the number of teenagers experiencing menstrual disorder that could require further investigation and management. Method The MDOT questionnaire was used to survey participants about their usual pattern of menstruation, signs and symptoms experienced with menses and how menstruation affected various aspects of their lives including school attendance, completion of school work, relationships, social, sexual and physical activity. Data analysis included exploration of aggregated data, as well as individual scrutiny of each questionnaire to determine menstrual disturbance requiring follow up. Those participants whose questionnaire indicated a requirement for further investigation, and who consented to being contacted, were followed up through an MDOT Clinic. Results One thousand and fifty one (1,05 1) completed questionnaires - 98% response rate. The typical experience of menstruation in the MDOT sample includes: bleeding patterns within normal parameters for this age group; menstrual pain, 94%; cramping pain, 71 %; symptoms associated with menstruation, 98.4%; PMS symptoms, 96%; mood disturbance before or during periods, 73%; school absence related to menstruation, 26%; high menstrual interference on one or more life activity, 55.8%; asymptomatic menstruation, 1 %; True response to 'My periods seem pretty normal' 7 1.4%. Statistically significant associations were found between each and all of: menstrual pain, symptoms, interference on life activities and school absence. The prevalence of significant menstrual disturbance in the sample is approximately 25% where: 2 1 % experienced severe pain; 26% reported school absence; 33% had seen a GP about periods; 26.9% think there is something wrong with periods; 23.5% require follow up based on individual scrutiny of each questionnaire; 10- 14% require further investigation to rule out endometriosis. Referral and investigation of menstrual pain, symptoms, and diagnosis of menstrual pathology in the sample was low. Conclusion The MDOT questionnaire has helped to establish a clearer picture of typical menstruation in the population sample. Where 1% of girls reported having asymptomatic menstruation, the majority of teenagers in the study reported menstrual pain and symptoms that could be experienced as part of the dysmenorrhoeic syndrome of symptoms, PMS, or underlying pathology such as endometriosis. Due to the overlap in symptoms and a propensity to be dismissive of menstrual pain and symptoms, many girls are suffering menstrual morbidities that could be well managed with NSAIDs and the oral contraceptive pill (OCP) if non-pathological, or investigated further if a menstrual pathology is suspected. Considering these results the reported school absence rate of 26% is not surprising. Whilst this study does not cost the true impact of menstrual disturbance on schooling, the results of the MDOT questionnaire reflect significant physical and emotional impact on a considerable number of teenager's lives which could also have repercussions on education, schooling performance and other areas of their lives. Future research is planned to determine the MDOT questionnaire's validity for identifying pathological menstrual disorder so it can act as a screening tool to facilitate earlier detection. Replication of the MDOT study should be done in younger teenagers (from menarche) to determine menstrual disturbance in the younger age group.

Title of thesis: The Benefits of Physiotherapy in the Treatment of Patients Suffering from Primary Dysmenorrhoea. The concept of the problem: Primary dysmenorrhoea is one of the most common gynecological affections, which affects the female population of working age. It is characterized as a set of symptoms associated with menstruation, of which the main is pain and general fatigue, anorexia, nausea, to the pathological changes in mood, in the sence depression or syncopes. This menstrual period becomes considerable discomfort for women and it distorts her life also from psychosocial page. Given the critical role of women in family and society, it is necessary to deal with this situation and seek effective methods of conservative treatment of primary dysmenorrhoea. Objectives: Determination the effectiveness of acupressure therapy as a possible means of medical rehabilitation in the conservative treatment of primary dysmenorrhoea. Extending expertise of physiotherapy intervention of primary dysmenorrhoea and their implementation into the attention of patients and a general public as well as into the attention of other physiotherapists, gynecologists and other health workers. Methods: The theoretical part deals with the issue at the level of the search and theoretical owerview of current knowledge of...

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.

Plants used by southern African traditional healers for the treatment of menstrual pains were screened for prostaglandin-synthesis inhibitors and the ability to reduce isolated uterine muscle contraction using the cyclooxygenase (Cox-1) and in vitro uterine bioassays respectively. Prostaglandins are synthesized from arachidonic acid and the enzyme that drives this reaction is cyclooxygenase. The excessive production of prostaglandins by the myometrium and endometrium induces uterine contractions. Inhibition of cyclooxygenase and hence of the prostaglandin biosynthetic pathway may lead to relief of menstrual pain. Nine plants used by traditional healers for menstrual pains were assayed for cyclooxygenase inhibitory activity. Several plant extracts exhibited high inhibitory activity in the assay. The highest activities were obtained with ethanolic extracts of Siphonochilus aethiopicus, Cenchrus cilliaris and Solanum mauritianum. None of the ethanolic plant extracts were able to relax or reduce the contractions of a precontracted guinea pig uterus. Bioassay guided fractionation was used in an attempt to isolate the active compound(s) from the leaves of Siphonochilus aethiopicus. Isolation techniques employed were serial solvent extraction, bulk extraction, silica gel, Sephadex LH20 column, and high pressure liquid chromatography. Biological activity was followed through each purification step using the cyclooxygenase bioassay as a guide with respect to anti-inflammatory activity. / Thesis (M.Sc.)-University of Natal, Pietermaritzburg, 1999.

Bakgrund: Endometrios är en kronisk östrogenberoende inflammatorisk sjukdomsom drabbar omkring 10 % av alla kvinnor i fertil ålder runt om i världen. Vägen tilldiagnos är svår och behandlingen bör individanpassas. Kvinnor känner sig oftamisstrodda och erbjuds inte alltid en god vård för sina besvär. Sjuksköterskan behöverse kvinnan ur ett helhetsperspektiv och är ofta den första kontakten kvinnan möter.Livsvärldsperspektivet användes som teoretisk referensram. Syfte: Syftet var attbeskriva hur kvinnors vardagsliv påverkades av sjukdomen endometrios. Metod: Enlitteraturöversikt med kvalitativ design baserad på 12 artiklar söktes i databaserna CINAHL och PsycInfo. Artiklarna genomgick en kvalitetsgranskning utifrån ettgranskningsprotokoll. Dataanalysen är gjord utifrån Fribergs fem steg. Resultat:Resultatet presenterades i fyra kategorier och nio subkategorier: Påverkan på detpsykiska måendet (besvär av psykiska symtom och förändrad kroppsuppfattning),Påverkan på det sociala livet (ökad ensamhet, konsekvenser av fysiska symtom ochminskade sociala relationer), Påverkan på sexuella relationer (svårigheter medintimitet och oro för infertilitet) samt Påverkan på arbetslivet (utmaningar i arbetslivetoch påfrestad ekonomi). Slutsats: Endometrios begränsade kvinnors vardagsliv ochmedförde ett stort lidande. Sjukdomen påverkade kvinnor både psykiskt, fysiskt,socialt och sexuellt och resulterade i en känsla av ensamhet. Stöd och förståelse överkvinnans situation och individanpassad vård är centralt för sjuksköterskansomvårdnad och för att kunna erbjuda en god vård. / Background: Endometriosis is a chronic oestrogen-dependent inflammatory diseasethat affects about 10% of all women of reproductive age worldwide. The path todiagnosis is difficult and the treatment should be individualized. Women often feelmistrusted and are not always offered good care for their problems. The nurse needsto see the woman from a holistic perspective and is often the first contact the womanmeets. The lifeworld perspective was used as a theoretical framework. Aim: The aimwas to describe how women's everyday lives were affected by the diseaseendometriosis. Method: A literature review with a qualitative design based on 12articles searched in the databases CINAHL and PsycInfo. The articles were analyzedwith a quality protocol. Friberg´s analysis in five steps was used in the analysis process.Result: The results were presented in four categories and nine subcategories: Impacton psychological well-being (distress of psychological symptoms and changed bodyimage),Impact on social life (increased loneliness, consequences of physical symptomsand decreased social relationships), Impact on sexual relationships (difficulties withintimacy and concerns about infertility) and Impact on working life (challenges at workand strained economy). Conclusion: Endometriosis limited women's everyday livesand caused suffering. The disease affected the women mentally, physically, socially andsexually and resulted in a feeling of loneliness. Support and understanding of thewoman's situation and individualized care are central to the nurse's care and to beingable to offer good care.