BackgroundDysmenorrhea is highly prevalent among young women and impairs their academic performance and quality of life. Zinc and vitamin E may influence menstrual pain via anti-inflammatory and antioxidant pathways; however, data on habitual intake in Southeast Asia are limited.AimThis study aimed to describe the adequacy of zinc and vitamin E intake among Indonesian female medical students and explore their associations with dysmenorrhea severity.MethodsA cross-sectional study was conducted with 107 female medical students in Indonesia. Dietary zinc and vitamin E intakes were assessed using a validated semi-quantitative food frequency questionnaire. Intake adequacy was defined as ≥77% of the Indonesian Recommended Dietary Allowance. Dysmenorrhea severity was measured using the Working Ability, Location, Intensity, Days of Pain, Dysmenorrhea (WaLIDD) score and was categorized as mild, moderate, or severe. Associations were examined using Fisher's exact test, with exploratory quartile analyses to assess potential intake-severity patterns.ResultsZinc intake was adequate in almost all participants (98.1%), whereas vitamin E intake inadequacy was widespread (83.2%). Dysmenorrhea was highly prevalent, with 29.9% reporting mild symptoms, 55.1% moderate symptoms, and 15.0% severe symptoms. No significant associations were observed between zinc (P = 0.745) or vitamin E (P = 0.337) intake adequacy and dysmenorrhea severity, and quartile analyses showed no clear dose-response patterns.ConclusionVitamin E inadequacy was highly prevalent, whereas zinc intake was generally adequate among Indonesian female medical students. Although no significant associations with dysmenorrhea severity were observed, these findings should be interpreted with caution. Further biomarker-based and longitudinal studies are warranted.

This study aimed to determine the national pooled prevalence of abnormal uterine bleeding (AUB), its subtypes, and dysmenorrhea among adolescent girls in India. We conducted a systematic review and meta-analysis following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, searching PubMed, Embase, and Web of Science from inception to December 4, 2024. Twenty nine observational studies involving adolescent girls aged 10-19 years, with sample sizes ranging from 127 to 2,000, conducted across India, were included. Due to high heterogeneity, pooled prevalence estimates were calculated using random-effects models. The pooled prevalence of AUB was 18.0% (95% confidence interval (CI), 14.0%-22.0%). Among AUB subtypes, oligomenorrhea (24%, 95% CI: 15%-34%) and metrorrhagia (24%, 95% CI: 4%-44%) were the most common, followed by menorrhagia (18%, 95% CI: 14%-23%). Additionally, the pooled prevalence of dysmenorrhea was notably high at 53% (95% CI: 46%-61%, I[2] = 99.4%). Significant heterogeneity (I[2] > 99.1%) and regional disparities in prevalence were observed across all analyses. This study found that about one in five adolescent girls in India experience AUB. These findings support the need for future studies to evaluate the effectiveness, accuracy, and feasibility of screening strategies for their widespread implementation.

Non-steroidal anti-inflammatory drugs (NSAIDs) are considered a first-line treatment for dysmenorrhea (menstrual pain). However, as much as 20% of women fail to achieve sufficient pain relief from NSAIDs, although factors associated with NSAID non-response are not well-known. The purpose of this study was to investigate factors associated with analgesic response to NSAIDs for dysmenorrhea.

Uterine leiomyomas are the most common benign tumors in women of reproductive age. Although hysterectomy is the definitive treatment for symptomatic fibroids, uterine-preserving procedures are preferred in young women, particularly when fertility is desired. Hysterectomy in women in their 20s due to extensive leiomyomatosis is uncommon. We report the case of a 25-year-old multiparous woman who presented with progressive abdominal distension, constipation, heavy menstrual bleeding, and dysmenorrhea for one year. Examination revealed a large abdominopelvic mass extending to the xiphisternum. Imaging demonstrated a massive, multinodular uterine mass that replaced the uterus. Following counseling regarding myomectomy and possible hysterectomy, an exploratory laparotomy was performed. Intraoperatively, the uterus was completely replaced by multiple leiomyomata, making myomectomy impossible. Total abdominal hysterectomy with ovarian conservation was undertaken. The specimen measured 22 × 17 × 8 cm and weighed 4.1 kg. Histopathology confirmed multiple benign leiomyomas without atypia or malignant features. Recovery was uneventful. This case highlights that uterine preservation should be pursued whenever safely feasible; however, hysterectomy may represent the safest option when complete replacement of the uterus precludes reconstruction.

This study screened for major depression and generalized anxiety disorder (GAD) across the menstrual cycle among women with sickle cell disease (SCD) and examined associations with heavy menstrual bleeding (HMB), dysmenorrhea, and sex hormones. A total of 125 Jamaican women aged 18 and over with SCD, regular menses, and no recent hormonal contraceptive use completed follicular- and luteal-phase visits including serum estradiol and progesterone measurements and validated mental and menstrual health and quality-of-life questionnaires. Higher Menstrual Symptom Questionnaire and Menstrual Bleeding Questionnaire scores reflect more severe menstrual pain and menstrual heaviness, respectively, including quality-of-life impact. Menstrual scores were standardized as z-scores and odds ratios represent the change in odds per one-standard deviation change from the sample mean. Major depression and GAD were screened using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Screen-positive rates for major depression and GAD were 44.8% and 39.2% with no differences between phases; and 32% reported passive self-harm ideations. Marginal mean scores were HMB 11.6 ± 4.9 (scale: 0-24) and dysmenorrhea 62.9 ± 13.5 (scale: 24-120). Worse dysmenorrhea was associated with higher odds of major depression risk (odds ratio, OR = 2.6), whereas better quality-of-life in pain (OR = 0.9) and sleep (OR = 0.8) were associated with lower odds. Severe genotypes (OR = 0.1) and better quality-of-life in stiffness (OR = 0.9) and sleep (OR = 0.9) were associated with lower odds of GAD risk. Estradiol, progesterone, and HMB showed no significant adjusted effects. The high prevalence of GAD and major depression risk, and the association between depression and dysmenorrhea suggest that routine screening is needed in this vulnerable group.