Search Results (79)

Background/Objectives: Primary dysmenorrhea (DysP) is a prevalent gynecological condition characterized by painful uterine contractions. However, the underlying mechanism of action of dysmenorrhea has not been fully elucidated. This study aimed to standardize an animal model of dysmenorrhea using diethylstilbestrol and oxytocin to mimic pathophysiological mechanisms in female Wistar rats. Methods: For the induction of dysmenorrhea, diethylstilbestrol (s.c.) and oxytocin (i.p.) were used. Results: The model effectively reproduced hypercontractility and impaired uterine relaxation. The in vivo evaluations demonstrated increased pain responses (DysP group = 119 ± 6.9; control group CG = 3.0 ± 1.0), which were partially attenuated by standard medications (scopolamine/dipyrone and ibuprofen). In vitro assays revealed greater contractile reactivity when compared to that in the control group, in the DysP group, using oxytocin (pEC₅₀ = 3.6 ± 0.2 and E_max = 145.1 ± 8.7; CG (pEC₅₀ = 3.1 ± 0.1 and E_max = 100%); KCl (DysP pEC₅₀ = 2.2 ± 0.1 and E_max = 164 ± 8.0); CG (pEC₅₀ = 1.8 ± 0.1) and PGF_2α (DysP pEC₅₀ = 7.4 ± 0.2 and E_max = 127.3 ± 15.6); CG (pEC₅₀ = 6.2 ± 0.1)), while the relaxation responses to isoprenaline and nifedipine were decreased compared to those in the CG. The model promoted an imbalance in oxidative stress by increasing malondialdehyde (MDA) levels and reducing the total antioxidant capacity (TAC) in the uterine tissue. Conclusions: These findings suggest that the new virgin rat model is capable of replicating key aspects of the clinical features of DysP in humans and offers a valuable tool for studying its pathogenetic mechanisms and testing potential therapeutic agents. Full article

Background/Objectives: Although pain education is a very important component of chronic pain management, its effects on primary dysmenorrhea (PD) have not been investigated. The aim of this study was to compare the effects of pain neuroscience education (PNE) or biomedical pain education (BPE) combined with exercise training (ET) in PD. Methods: Individuals with PD were randomly assigned to PNE or BPE combined with ET (stretching and relaxation exercises) for two menstrual cycles. The PNE focused on pain neurobiology, central sensitization, and brain pain-modulation mechanisms, while the BPE included anatomical and biomechanical explanations of pain. Assessments were conducted at the start of the study, after the intervention period, and at the one-month follow-up after the intervention. The primary outcome measure was menstrual pain (mean and maximum pain) intensity, while the secondary outcome measures included menstrual stress, central sensitization symptoms, and pain catastrophizing. Results: All the individuals assigned to the PNE+ET (n = 19) and BPE+ET (n = 19; control) groups were included in the analysis. PNE or BPE with ET led to improvements in all outcome measures (p < 0.05). Furthermore, PNE was found to reduce menstrual pain, central sensitization symptoms, and pain catastrophizing more after the intervention and at follow-up compared to BPE (p < 0.05, Cohen’s d = 0.683–1.174). However, menstrual stress decreased at similar levels in both groups (p > 0.05). Conclusions: The combination of PNE or BPE with ET was demonstrated to be an effective approach for the management of menstrual pain and stress in PD. Furthermore, PNE appears to be more efficacious in addressing menstrual pain, symptoms of central sensitization, and pain cognition compared with BPE. Further studies could investigate the combination of PNE with different education parameters and physiotherapy methods to manage PD. Full article

Primary dysmenorrhea (PD) is characterized by lower abdominal spasms and painful cramps during menstruation in females with a normal pelvic anatomy. Cymbopogon citratus (DC.) Stapf, commonly known as lemongrass, is consumed in the form of herbal tea around the world. It has been traditionally used for menstrual disorders in several communities. This study aims to evaluate the traditional use of C. citratus for its efficacy in alleviating the symptoms of PD. C. citratus extract (CcE) was chemically characterized using HPLC and GCMS, which indicated the presence of several phenolic compounds and long-chain fatty acids. The anti-inflammatory activity of CcE was assessed by COX-I, COX-II, and 5-LOX enzyme inhibition with IC₅₀ values of 143.7, 91.7, and 61.5 µg/mL, respectively, and showed good total antioxidant capacity and free radical scavenging activity. PD was induced in female Wistar rats by administering estradiol valerate followed by oxytocin to induce PD symptoms. CcE efficacy was assessed at 30, 100, and 300 mg/kg concentrations and compared with ibuprofen. CcE 300 mg/kg reduced abdominal contortions and inflammation in the rat uterus. The inflammatory (COX-II, TNFα and IL-10) and oxidative stress (TAC, TOS, MDA and SOD) markers in uterine tissue homogenate were also improved. An in vivo analgesic assessment through hot-plate, tail-flick, and acetic acid-induced writhing assays showed good analgesic activity by CcE, while ex vivo experiments described tocolytic effects in rat uterine muscles. CcE alleviates PD by its antioxidant, anti-inflammatory, analgesic, and tocolytic effects. Full article

Endometriosis is a chronic inflammatory disease characterized by the presence of ectopic endometrial tissue, mainly in the pelvic cavity. It primarily affects women of reproductive age and is associated with significant morbidity, particularly chronic pelvic pain and infertility. Despite its high prevalence, diagnosis is often delayed, contributing to prolonged suffering and increased healthcare burden. This review examines the management of endometriosis in Primary Care, focusing on clinical presentation, risk factors, diagnostic approaches, and therapeutic options. A comprehensive bibliographic search was conducted using PubMed, Scopus, and Uptodate, including evidence-based clinical guidelines and literature up to January 2025. Women diagnosed with endometriosis in Primary Care are typically of reproductive age, with symptoms including dysmenorrhea, dyspareunia, and abnormal uterine bleeding. Risk factors include early menarche, low birth weight, short menstrual cycles, and family history. Transvaginal ultrasound is the recommended first-line imaging tool. Treatment includes analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), and hormonal therapies such as combined oral contraceptives or progestins. Non-pharmacological interventions, including dietary modifications and psychological support, are also relevant. Early identification in Primary Care is key to improving out-comes. Enhancing awareness among healthcare providers and promoting multidisciplinary management are essential to optimize care and reduce diagnostic delays. Full article

Background: Hormonal fluctuations during the menstrual cycle (MC) influence pain perception, potentially affecting exercise performance and rehabilitation in women. This effect may be more pronounced in individuals with primary dysmenorrhea (PD), requiring tailored physiotherapeutic and exercise interventions. Objective: To analyze the influence of MC phases on sensory electrical threshold (SET) and pain electrical threshold (PET) in eumenorrheic women with and without PD, considering the potential implications for physical activity and rehabilitation. Methods: An observational longitudinal study was conducted with 34 physically active women, divided into a control group (CG) and a PD group. SET and PET were measured using transcutaneous electrical nerve stimulation (TENS) at the forearm (peripheral site) and lower abdomen (pain-referred site) across five MC phases. Pain intensity was assessed using a Visual Analog Scale (VAS). Results: SET and PET were significantly lower in the premenstrual phase (p < 0.001), suggesting increased pain sensitivity. VAS scores were higher in the PD group during all phases, except for the follicular phase (p < 0.033), with the highest pain levels recorded in the menstrual and premenstrual phases. While no significant differences in SET and PET were found between groups across most phases, the PD group exhibited a significantly higher SET in the forearm during the premenstrual phase (p = 0.005), potentially indicating altered central pain modulation. Conclusions: MC-related hormonal fluctuations affect pain sensitivity, particularly in women with PD. These findings underscore the need for phase-specific exercise adaptations and rehabilitation strategies to improve performance, pain management, and recovery in physically active women. Full article

Background/Objectives: Sedentary behavior is an independent risk factor for various health conditions, but its association with dysmenorrhea has been little investigated. This study aimed to examine whether sedentary behavior is independently associated with primary dysmenorrhea in young women, controlling for moderate-to-vigorous physical activity and other known risk factors. Methods: An online survey was conducted in 603 young women in South Korea in 2023. Menstrual pain intensity was measured using a numeric rating scale, and symptoms were assessed with the Cox Menstrual Symptom Scale. Sedentary behavior and physical activity were assessed using the Global Physical Activity Questionnaire. Known risk factors for dysmenorrhea included menstrual and lifestyle characteristics, sleep quality, and stress. Results: Longer sedentary time (hours/day) was correlated with more frequent (r = 0.144; p < 0.001) and severe (r = 0.123; p < 0.01) menstrual symptoms but not with pain intensity. Multiple linear regression analysis showed that sedentary time was independently associated with the frequency (β = 0.10; p < 0.01) and severity (β = 0.09; p < 0.05) of menstrual symptoms after adjusting for physical activity and other risk factors for dysmenorrhea. Multiple logistic regression analysis showed that women with higher levels of sedentary time had 1.05 times greater odds (95% CI, 1.00–1.10; p < 0.05) of experiencing severe pain compared to those with less sedentary time, even after adjusting for physical activity and other risk factors. Conclusions: Prolonged sedentary behavior in young women is associated with more frequent and severe menstrual symptoms, including more intense menstrual pain. These findings highlight the need for public health strategies that reduce sedentary behavior to alleviate dysmenorrhea. Full article

Background: Endometriosis is one of the most common gynecological diseases, affecting up to 10–15% of women of reproductive age. It is a chronic, estrogen-dependent condition that often presents with heterogeneous symptoms, complicating diagnosis and delaying treatment. Methods: This is a narrative review based on a comprehensive analysis of recent literature regarding hormonal treatment options for endometriosis, including primary and adjuvant therapies. Results: Combined oral contraceptives (COCs) are effective in reducing dysmenorrhea, but show limited benefit for other symptoms and may not prevent disease progression. Progestins, particularly dienogest, demonstrate superior long-term efficacy with favorable side-effect profiles. GnRH agonists and antagonists are reserved for second-line treatment due to side effects and hypoestrogenism, but can significantly reduce endometriotic lesions. The levonorgestrel intrauterine system (LNG-IUS) is especially effective in patients with adenomyosis. Conclusions: Hormonal therapies are central to the management of endometriosis. Progestins are considered the most suitable long-term option. Despite promising results, evidence quality varies, and further studies are needed to establish long-term efficacy, patient-specific outcomes, and direct comparisons between agents. Full article

Background: Intrauterine adhesions (IUAs) or Asherman syndrome (AS) represent pathological conditions that affect the endometrium and significantly influence female fertility through a variety of mechanisms. This study aims to identify risk factors, explore pathophysiological mechanisms, diagnostic approaches, and assess how medical background influence the development of these conditions. It also seeks to associate the severity of conditions with clinical outcomes, such as fertility, miscarriages, and menstrual cycle disorders, using American Fertility Society (AFS) scoring system. Materials and methods: This retrospective cohort study included 134 patients aged 18 to 45, who followed hysteroscopy between 2016 and 2024 at two hospitals in Iasi, focusing on those diagnosed with IUAs (102 patients) and AS (32 patients), based on hysteroscopic approach. The exclusions were based of factors like acute uterine bleeding, intrauterine device, obesity and other severe conditions. Results and discussions: Women over 35 years are more likely to develop these conditions due to prior gynaecological procedures which are often associated with fertility issues. Hysteroscopy is established as the gold standard for both diagnosis and treatment, intraoperative diagnosis representing 45.6 % of cases. Amenorrhea is a primary indicator in AS patients (OR = 26.19) and dysmenorrhea as a potential marker for IUAs (OR = 2.67). Patients with IUAs and primary infertility (82.9%) typically have an AFS score 1, corresponding to improved conception rates. Those with AS and primary infertility often present an AFS score 2 (54.5%); patients with AS and secondary infertility were linked to AFS score 3 (58.8%; p = 0.137). Although the incidence of miscarriages is comparable between the two groups, the timing differs: IUAs are predominantly associated with first trimester losses (64.9%), whereas AS is more commonly linked to second trimester miscarriages (45.5%; p = 0.001). Conclusions: The study highlights the necessity of a personalized approach in diagnosing and treating IUAs and AS, considering factors such as age, fertility index, and disease severity. The integration of hysteroscopic techniques with individualized treatment plans based on the patient’s unique medical profile is crucial for adequate management of IUAs and AS. Full article

Background/Objectives: Primary dysmenorrhea (PD) is a condition characterized by painful pelvic cramps onsetting shortly before menses and lasting for 3 days, negatively impacting the quality of life of young females. Further, menstrual cycle disorders are common in athletes. This study investigated differences in dietary habits, hormonal and immuno-metabolic parameters, and susceptibility to disordered eating attitudes (DEAs) between dysmenorrheic (D group) and non-dysmenorrheic (no-D group) young female basketball players. It also aimed to identify risk factors for PD, focusing on nutrition, anthropometric parameters, and biochemical markers. Materials and Methods: The study included 25 female basketball players (mean age: 16 years), categorized into D and no-D groups. Blood samples were analyzed for hormonal, metabolic, and inflammatory markers, including follicle-stimulating hormone, luteinizing hormone, total testosterone, androstenedione, dehydroepiandrosterone sulfate, estradiol, sex hormone-binding globulin, cortisol, prolactin, fasting glucose, fasting insulin, C-reactive protein, lipid profile, and 25-hydroxyvitamin D3. Dietary intake was assessed via a three-day food record, and DEA susceptibility was evaluated using the Eating Attitudes Test (EAT-26). Logistic regression identified independent PD risk factors. Results: The D group had significantly higher EAT-26 scores and prolactin and cortisol levels than the no-D group (p = 0.0284, p = 0.0108, p = 0.0035, respectively). Elevated prolactin, cortisol, and EAT-26 scores were associated with increased PD risk (OR = 1.75; OR = 1.02; OR = 1.14). Conclusions: Female basketball players with PD show higher prolactin and cortisol levels and greater DEA susceptibility. These factors may contribute to PD risk, warranting further research. Full article

Background: Dysmenorrhea, categorized as primary (PD) or secondary (SD), significantly affects females during their reproductive years, impairing quality of life, performance, and social relationships. Alongside medical treatment, exercise and probiotics are complementary measures for managing PD and promoting health. This study examined the impact of probiotic supplementation and high-intensity interval training (HIIT) on PD severity, physiological modulation, and physical fitness. Methods: Participants, recruited according to the primary dysmenorrhea criteria, were divided into non-PD (control) and PD groups, with the PD group further classified into dysmenorrhea (Dysmen), dysmenorrhea with probiotics (DysmenPro), dysmenorrhea with exercise (DysmenEx), and dysmenorrhea with both (DysmenExPro). Interventions included 10 weeks of HIIT and probiotics. Pre- and post-intervention assessments included questionnaires on premenstrual and menstrual symptoms, physical fitness evaluations, and blood sample analyses for biochemical, hormonal, and prostaglandin levels. Results: HIIT significantly reduced premenstrual symptoms, menstrual distress, and pain severity, likely due to hormone (estradiol, prolactin, progesterone, cortisol) modulation and decreased inflammation (high-sensitivity C-reactive protein, PGE2, PGF2α). Cardiovascular endurance and explosive strength showed improvement through high-intensity interval training (HIIT), whereas probiotics had no significant effect on these aspects of physical fitness. While probiotics reduced premenstrual and menstrual distress symptoms, they had no notable impact on pain, inflammation, or hormone levels. Dysmenorrhea-related discomforts were correlated significantly with inflammation and hormones. Conclusions: The intervention strategy involving probiotics and HIIT exercise may be utilized as an alternative and complementary treatment to alleviate PD symptoms. Furthermore, this strategy could also be incorporated into educational health plans to promote women’s health and potentially prevent gynecological disorders in the adolescent population. Full article

Primary dysmenorrhea (PD) is a common gynecological condition characterized by menstrual pain without underlying pelvic pathology. It has been linked to functional and structural changes in the core musculature, but limited evidence exists regarding its association with diaphragmatic and respiratory mechanics. This study aimed to elaborate on these potential associations by assessing the diaphragmatic structure and respiratory function in women with PD compared to healthy controls, utilizing ultrasound imaging, spirometry and respiratory pressure measurements. Methods: An observational, cross-sectional study was conducted with 44 female participants (22 with PD and 22 healthy controls). Diaphragmatic structure was evaluated through ultrasound, measuring the intercostal distance, diaphragmatic thickness, and diaphragmatic excursion at rest and during maximum voluntary contraction. Spirometric assessments included forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and the FVC/FEV1 ratio, along with measurements of maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP). Group differences were analyzed using Student’s t-test and effect sizes were reported with Cohen’s d. Results: No significant differences were observed between the groups in diaphragmatic thickness, diaphragmatic excursion, or global respiratory capacity (p > 0.05). However, women with PD presented a significant reduction in the left intercostal distance both at rest (p = 0.035, d = 0.56) and during contraction (p = 0.039, d = 0.54). No other significant group differences were detected. Conclusions: While primary dysmenorrhea does not appear to affect overall diaphragmatic function or respiratory capacity, it is associated with subtle localized changes in the left intercostal dynamics. These findings suggest a potential compensatory mechanical adaptation rather than global respiratory dysfunction. Further longitudinal studies with larger sample sizes are needed to explore the clinical significance of these findings. Full article

Background and Objectives: Autonomic nervous system (ANS) disorders are responsible for primary dysmenorrhea and are closely linked to the spine. This study aims to evaluate the effects of sacroiliac joint manipulation on the ANS and lower abdominal pain in women with primary dysmenorrhea and proposes an alternative treatment method. Materials and Methods: A total of 40 participants were randomly assigned; however, 35 participants remained in the final analysis after 5 dropped out; they were assigned to either the sacroiliac joint manipulation group (n = 18) or the superficial heat therapy group (n = 17). Assessments included heart rate variability (HRV), visual analogue scale (VAS) scores for lower abdominal pain, the pressure pain threshold (PPT) of the sacroiliac joint, and the Moos Menstrual Distress Questionnaire (MMDQ) at baseline and after 4 weeks. Only the VAS and MMDQ scores were reassessed after 8 weeks to evaluate the sustained effects of the treatment. Results: Changes in HRV showed improvements in ANS balance only in the sacroiliac joint manipulation group (p < 0.05). It was found to be more effective than superficial heat therapy (p < 0.05). A significant decrease in lower abdominal pain following the intervention was observed in both groups (p < 0.05), along with the sustained effects of the treatment (p < 0.05). The MMDQ scores decreased after sacroiliac joint manipulation (p < 0.05), with greater improvements compared to the superficial heat therapy (p < 0.05). Conclusions: Sacroiliac joint manipulation positively affects ANS balance and is effective in alleviating lower abdominal pain and menstruation-related symptoms, with sustained effects observed over time. Therefore, sacroiliac joint manipulation can be an effective alternative treatment for women with primary dysmenorrhea. Full article

Background and Clinical Significance: Symptoms of spontaneous intracranial hypotension include orthostatic headaches due to decreased cerebrospinal fluid (CSF) levels. Here, we present a 24-year-old female admitted to an obstetrics and gynecology department with primary complaints of lower abdominal pain and dysmenorrhea with subsequent diagnosis of spontaneous intracranial hypotension (SIH). Case Presentation: The patient had experienced nausea and lower abdominal pain independent of her menstrual cycle 5 days before admission, for which she visited the emergency department 3 days later. On admission, her symptoms were temporarily relieved by administering analgesics; thus, she was discharged. However, later, the symptoms worsened. Consequently, she returned to the emergency department for further evaluation, including blood tests, imaging, and endoscopy, which revealed no nausea- or abdominal pain-related organic abnormalities. On day 10, she developed a headache, aggravated by lying in the supine position and improved by sitting. Additional history revealed a diagnosis of SIH owing to the worsening abdominal pain in the supine position. An ¹¹¹In CSF cavity scintigram showed no spinal fluid leakage; early intrabladder radioisotope (RI) accumulation was observed, and the residual 24 h CSF cavity RI was >30%. At a referral specialist hospital, an epidural saline infusion test was performed, which improved her headache and lower abdominal pain. Blood patch therapy improved her lower abdominal pain, headache, and dysmenorrhea. Conclusions: The final diagnosis was SIH, with symptoms attributed to CSF depletion. The patient also experienced rare paradoxical postural-related headaches and lower abdominal pain, aggravated by lying in the supine position, contributing to the final diagnosis. Full article

Background/Objectives: Postsurgical lower urinary tract dysfunction (LUTD) is a common problem following deep infiltrating endometriosis (DIE) resection. The condition may be caused either by surgically induced damage to the bladder innervation or by pre-existing endometriosis-associated nerve damage. The aim of this study is to evaluate the efficacy of preoperative and postoperative multichannel urodynamic testing (UD) in identifying pre-existing or surgically induced LUTD among patients with DIE. Methods: Women with suspected DIE and planned surgical resection of DIE at the Department of Obstetrics and Gynecology at the University Hospital of Bern from September 2015 to October 2022 were invited to participate in this prospective cohort study. UD was performed before and 6 weeks after surgery. The primary outcome was the maximum flow rate (uroflow), an indicator of LUTD. Secondary outcomes were further urodynamic observations of cystometry and pressure flow studies, lower urinary tract symptoms (LUTS) as assessed by the International Prostate Symptom Score (IPSS), and pain as assessed by the visual analog scale (VAS). Results: A total of 51 patients requiring surgery for DIE were enrolled in this study. All patients underwent surgical excision of the DIE. The cohort demonstrated a uroflow of 22.1 mL/s prior to surgery, which decreased postoperatively to 21.5 mL/s (p = 0.56, 95%CI −1.5–2.71). The mean bladder contractility index (BCI) exhibited a notable decline from 130.4 preoperatively to 116.6 postoperatively (p = 0.046, 95%CI 0.23–27.27). Significant improvements were observed in the prevalence of dysmenorrhea, abdominal pain, dyspareunia, and dyschezia following surgical intervention (p = <0.001). The IPSS score was within the lower moderate range both pre- and postoperatively (mean 8.37 vs. 8.51, p = 0.893, 95%CI −2.35–2.05). Subgroup analysis identified previous endometriosis surgery as a significant preoperative risk factor for elevated post-void residual (43.6 mL, p = 0.026, 95%CI 13.89–73.37). The postoperative post-void residual increased among participants with DIE on the rectum to 54.39 mL (p = 0.078, 95%CI 24.06–84.71). Participants who underwent hysterectomy exhibited a significantly decreased uroflow (16.4 mL/s, p = 0.014, 95%CI 12–20) and BCI (75.1, p = 0.036, 95%CI 34.9–115.38). Conclusions: Nerve-respecting laparoscopy for DIE may alter bladder function. UD is not advisable before surgery, but the measurement may detect patients with LUTD. Full article

Background/Objectives: Primary dysmenorrhea (PD) is a common condition affecting up to 90% of menstruating women, which often results in significant pain without an underlying pathology. Zinc, recognized for its anti-inflammatory and antioxidant effects through inhibiting prostaglandin production and superoxide dismutase 1 (SOD1) upregulation, alleviates menstrual pain by preventing uterine spasms and enhancing microcirculation in the endometrium, suggesting its potential as an alternative treatment for primary dysmenorrhea. The goal of this systematic review and meta-analysis was to assess the efficacy and safety of zinc supplementation in reducing pain severity among women with PD and to explore the influence of dosage and treatment duration. Methods: Following the PRISMA 2020 guidelines, we conducted an extensive search across databases such as PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar, up to May 2024. Randomized controlled trials assessing the effects of zinc supplementation on pain severity in women with PD were included. Pain severity was evaluated with established tools, such as the Visual Analog Scale (VAS). Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB2) tool. Two reviewers independently performed the data extraction, and a random-effects model was used for meta-analysis. Meta-regressions were conducted to examine the influence of zinc dosage and treatment duration on pain reduction. Adverse events were also analyzed. Results: Six RCTs involving 739 participants met the inclusion criteria. Zinc supplementation significantly reduced pain severity compared to placebo (Hedges’s g = −1.541; 95% CI: −2.268 to −0.814; p < 0.001), representing a clinically meaningful reduction in pain. Meta-regression indicated that longer treatment durations (≥8 weeks) were associated with greater pain reduction (p = 0.003). While higher zinc doses provided additional pain relief, the incremental benefit per additional milligram was modest (regression coefficient = −0.02 per mg; p = 0.005). Adverse event rates did not differ significantly between the zinc and placebo groups (odds ratio = 2.54; 95% CI: 0.78 to 8.26; p = 0.122), suggesting good tolerability. Conclusions: Zinc supplementation is an effective and well-tolerated option for reducing pain severity in women with primary dysmenorrhea. Doses as low as 7 mg/day of elemental zinc are sufficient to achieve significant pain relief, with longer durations (≥8 weeks) enhancing efficacy. The favorable safety profile and ease of use support the consideration of zinc supplementation as a practical approach to managing primary dysmenorrhea. Full article