Pregnancy and dysmenorrhea
Issue 06: 13 Mar 2006
Source: International Journal of Gynecology & Obstetrics 2006; 92: 221-7
Researchers have shed new light on the impact of pregnancy on the severity
of primary dysmenorrhea.
Specialists from centers in Taipei and Kin-Man, in Taiwan, conducted an
8-year prospective, observational study to evaluate the effect of gestation
time and mode of delivery on the severity of dysmenorrhea.
The subjects were primigravida women who presented to an obstetric clinic
for their first prenatal check-up reporting a history of cramping pelvic
pain during menstruation that had required pain-relief drugs or had resulted
in absenteeism from school or work.
Women completed a questionnaire, including a visual analogue scale to
determine the severity of menstrual pain, at baseline and 6 months
postpartum (and again 12 months postpartum if menstruation had not resumed
by 6 months postpartum).
Evaluations were repeated if a woman went on to have a second or third
delivery in the study period.
Four subgroups studied
Writing in the latest issue of the International Journal of Gynecology &
Obstetrics, the researchers present their findings based on data from 3,694
women.
They compared outcomes in four study subgroups based on length of gestation
and method of delivery:
Spontaneous delivery (full-term).
Cesarean delivery (full-term).
Preterm spontaneous delivery.
Preterm cesarean delivery.
In the first three of these groups, but not in the preterm cesarean group,
visual analogue scale results indicated statistically significant
improvements in dysmenorrhea after first delivery.
The greatest improvement after first delivery was seen in the spontaneous
delivery group, with an average reduction of 51 points in the 100-point
visual analogue scale, from just under 70 at baseline to just under 20 at 6
months postpartum. (On the scale, a score of 1 to 50 is considered to be
mild pain, 51 to 80 is moderate pain, and 81 to 100 is severe pain.)
For second deliveries, only women in the spontaneous delivery subgroup
showed significant improvement in dysmenorrhea.
In none of the four groups did dysmenorrhea improve after a third delivery.
Comparing mode of delivery for first deliveries, women having a spontaneous
delivery (full-term or pre-term) showed significantly more improvement in
dysmenorrhea than women having a cesarean delivery (full-term or pre-term).
Comparing length of gestation for first deliveries, women delivering at term
(spontaneous or cesarean) showed significantly more improvement in
dysmenorrhea than women delivering pre-term (spontaneous or cesarean).
The researchers say the results of the study provide objective evidence to
validate the old concept that severity of dysmenorrhea can be relieved by
childbirth.
After a detailed discussion of other findings, and of possible explanations,
they conclude with a practical message: This study conveys an important
message that if a dysmenorrheic woman does not get relief after childbirth,
she should see a gynecologist to check the possibility of pelvic pathology.
Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service Mob 0418 371862
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