Tuesday, March 27, 2018

What causes a menstrual cramp?

see our new publication: 10.1016/j.ajog.2018.01.035

 2018 Feb 2. pii: S0002-9378(18)30084-X. doi: 10.1016/j.ajog.2018.01.035. [Epub ahead of print]

Cine MRI during spontaneous cramps in women with menstrual pain.



The lack of noninvasive methods to study dysmenorrhea has resulted in poor understanding of the mechanisms underlying pain, insufficient diagnostic tests, and limited treatment options. To address this knowledge gap, we have developed a magnetic resonance imaging-based strategy for continuously monitoring the uterus in relationship to participants' spontaneous pain perception.


The study objective was to evaluate whether magnetic resonance imaging can detect real-time changes in myometrial activity during cramping episodes in women with dysmenorrhea, with a handheld squeeze bulb for pain reporting.


Sixteen women with dysmenorrhea and 10 healthy control women both on and off their menses were evaluated with magnetic resonance imaging while not taking analgesic medication. Continuous magnetic resonance imaging was acquired using half-Fourier acquisition single-shot turbo spin echo sequence along with simultaneous reporting of pain severity with a squeeze bulb. Pearson's coefficient was used to compare results between reviewers. Proportional differences between women with dysmenorrhea and controls on/off menses were evaluated with a Fisher exact test. The temporal relationships between signal changes were evaluated with Monte Carlo simulations.


Spontaneous progressive decreases in myometrial signal intensity were more frequently observed in women on their menses than in the absence of pain in the same women off their menses or participants without dysmenorrhea (P < .01). Women without reductions in myometrial signal intensity on their menses either had a history of endometriosis or were not in pain. Observations of myometrial events were consistently reported between 2 raters blinded to menstrual pain or day status (r = 0.97, P < .001). Episodes of cramping occurred either immediately before or 32-70 seconds after myometrial signal change onset (P < .05).


Transient decreases in myometrial uterine T2-weighted signal intensity can be reliably measured in women with menstrual pain. The directionality of signal change and temporal relationship to pain onset suggest that cramping pain may be caused by a combination of uterine pressure and hemodynamic dysfunction.


dysmenorrhea; endometriosis; magnetic resonance imaging; pain; uterus

Why does't menstrual pain always respond to NSAIDS

see our new review in AJOG: https://authors.elsevier.com/a/1WnYegm3ZgRh

 2017 Sep 6. pii: S0002-9378(17)31095-5. doi: 10.1016/j.ajog.2017.08.108. [Epub ahead of print]

Nonsteroidal antiinflammatory drug resistance in dysmenorrhea: epidemiology, causes, and treatment.

Author information

Department of Obstetrics and Gynecology, NorthShore University HealthSystem and Pritzker School of Medicine University of Chicago, Evanston, IL.
Department of Obstetrics and Gynecology, NorthShore University HealthSystem and Pritzker School of Medicine University of Chicago, Evanston, IL. Electronic address: khellman@northshore.org.


Although nonsteroidal antiinflammatory drugs can alleviate menstrual pain, about 18% of women with dysmenorrhea are unresponsive, leaving them and their physicians to pursue less well-studied strategies. The goal of this review is to provide a background for treating menstrual pain when first-line options fail. Research on menstrual pain and failure of similar drugs in the antiplatelet category suggested potential mechanisms underlying nonsteroidal antiinflammatory drug resistance. Based on these mechanisms, alternative options may be helpful for refractory cases. This review also identifies key pathways in need of further study to optimize menstrual pain treatment.


adenomyosis; endometriosis; menstrual pain; nonsteroidal antiinflammatory drugs; oral contraception; primary dysmenorrhea; secondary dysmenorrhea
 [Available on 2019-03-06]