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Background & aim:. This study systematically reviewed the clinical trials to assesse Achillea millefolium's impact on primary dysmenorrhea and menstrual bleedingMethods: In this systematic review, the databases of Science Direct, PubMed, ProQuest, Cochrane library, Scopus, Web of Science were searched using the keywords of "Dysmenorrhea", "Pain"," Menorrhagia" and "Achilles" until Aug 2022. The study population included women with moderate to severe dysmenorrhea or menorrhagia with a score of 100 on Pictorial menstrual bleeding Assessment Chart (PBLAC). Intervention included oral administration of Achillea millefoliums with other modern dosage forms. The Cochran's Risk of Bias tool was applied to evaluate the quality of articles.Results: Among 80 initial articles, six studies were systematically reviewed. Among six reviewed studies, three studies examined the impact of Achillea millefolium on primary dysmenorrhea, two studies evaluated the effect of Achillea millefolium on menorrhagia and one study assessed the impact of Achillea millefolium on both primary dysmenorrhea and menorrhagia. The results showed the effect of Achillea millefolium in pain relief of dysmenorrhea and reduction of menstrual bleeding.Conclusion: Achillea millefolium is an effective and safe herbal remedy for primary dysmenorrhea and reduction of menstrual bleeding.

The contraceptive needs of women for whom the benefits of menstrual bleeding may outweigh its disadvantages have largely been overlooked, especially outside high-income countries. Some providers and researchers have assumed that users of nonhormonal birth control (non-HBC) are misinformed about the positive and negative effects of HBC and/or the need for menstrual bleeding. This study takes the position that many of those rejecting HBC in favor of methods that do not alter bleeding are, in fact, making informed decisions. Using questionnaire data from 4,255 contraceptive users in three countries, we compared current HBC users explicitly open to hormone use ("H-receptive") and non-HBC users explicitly rejecting hormones ("H-averse"). To the extent that menstrual bleeding attitudes affect contraceptive choice, these two groups should have the greatest contrasts in those attitudes. This novel study design mitigates ambiguities arising from posing hypothetical scenarios to those ambivalent about using hormones or who are not currently using contraception. In all three countries, of those agreeing with the prompt, "I don't want to change my natural menstrual cycle," the fractions of H-averse and H-receptive users are disproportionally high and low, respectively (p ≤.0026). Responses to other prompts varied across populations, revealing complex juxtapositions of multiple criteria, including bleeding preferences, that likely influence contraceptive choices. These patterns, reflecting personal and culturally salient values, highlight the necessity of not assuming that menstrual bleeding is undesirable or relying on a single criterion to ascertain clients' contraceptive needs and preferences. Rather, acknowledging a client's personal hierarchy of preferences regarding contraceptive attributes best serves their goals. [ABSTRACT FROM AUTHOR]

Purpose: the long-acting reversible contraception progestin subdermal implant (ENG implant) may be effective to improve endometriosis-related symptoms. Since adenomyosis is a histopathological form of endometriosis, we aimed to evaluate the effectiveness of ENG implant in adenomyosis management Materials and methods: Electronic search in Medline, Scopus, Embase databases and Google Scholar using combinations of the following keywords: Progestin; subdermal implant; Implanon; Nexplanon; Adenomyosis; Endometriosis. Results: Out of 889 articles in the initial database, 5 prospective observational studies were eligible for inclusion in our literature review. Our review involving 152 participants found a significant reduction in pelvic pain and dysmenorrhoea (baseline median vAS score ranged from 10 to 7.62 before implantation vs VAS score ranged from 1.81 to 0.1 after implantation) as well as an increase in the levels of haemoglobin after implantation of the device (from 86 g/L to 129 g/L after implantation). Moreover, the improvement may be sustained throughout the long-term follow-up visits (until 36 months). The most common adverse events were changes in bleeding patterns which were tolerable in most cases. Conclusion: ENG implant may be a relevant and promising medical option in the management of adenomyosis. Nevertheless, randomised controlled trials and prospective studies with larger cohorts are needed to confirm the potential role of ENG implant in the management of adenomyosis [ABSTRACT FROM AUTHOR]

Background: This study determined the prevalence of bothersome menstrual symptoms and their association with workability in naturally menstruating women not using hormonal contraception. Materials and Methods: A representative sample of community-dwelling Australian women aged 18–39 years selected from two large national electronic databases responded to a survey on general health. This study focuses on self-reported dysmenorrhea and menstrual bleeding and their association with workability and absenteeism in working women, assessed by the Workability Index. Results: Of 3,555 women, 1,573 (44.2% [95% CI: 42.6%–45.9%]) reported moderate to severe dysmenorrhea and 774 (21.8% [95% CI: 20.4%–23.2%]) reported heavy to very heavy bleeding. Women with dysmenorrhea were 50% more likely to report poorer work performance and twice as likely to report more days of sick leave in the past year (absenteeism) than other women. Conclusions: Despite the availability of safe and effective management options, Australian working women aged 18–39 years continue to experience bothersome dysmenorrhea and menstrual bleeding. Dysmenorrhea is associated with increased absenteeism and poorer workability. Therefore, awareness needs to be raised among women and health care providers of ways to manage dysmenorrhea and heavy bleeding and the unmet need for intervention in the community, respectively. [ABSTRACT FROM AUTHOR]

Selecting an appropriate oral contraceptive can be challenging for healthcare professionals due to the abundance of marketed contraceptive options with different clinical and real-world effectiveness and safety profiles. Nomegestrol acetate + 17β-estradiol (NOMAC/E2) is a combined oral contraceptive (COC) that inhibits ovulation by suppressing ovarian function by a 17-hydroxy-progesterone derivative and an estrogen identical to that endogenously produced by the ovaries. This narrative review examines clinical and real-world studies of NOMAC/E2 based on a background literature search using PubMed and Google Scholar. The review outlines the pharmacology of NOMAC/E2, including its progestational activity, pharmacokinetics, and effects on carbohydrate metabolism, lipid metabolism, and coagulation parameters, and summarizes key clinical efficacy and safety data that led to the approval of NOMAC/E2 in Europe, Brazil, and Australia. To help elucidate how NOMAC/E2 clinical trial data translate into a real-world setting, this review describes the effectiveness and safety of NOMAC/E2 in prospective studies that include over 90,000 users (half of whom received NOMAC/E2), outlining its effects on risk of thrombosis, menstrual bleeding patterns, weight, mood, acne, bone health, and patient quality of life. Non-contraceptive benefits of NOMAC/E2 for women with endometriosis, dysmenorrhea, or pre-menstrual dysphoric disorder are also discussed. These data demonstrate that NOMAC/E2 has a long half-life and rapid absorption, is effective at preventing unwanted pregnancies, and exhibits a favorable safety profile in both clinical trials and real-world settings. Importantly, NOMAC/E2 is not associated with increased risk of venous thromboembolism, a major safety concern of healthcare professionals for women receiving hormonal contraceptives. This review highlights NOMAC/E2 as a differentiated option among COCs and could help inform oral contraceptive choice to ultimately improve patient management and outcomes in real-world settings.

Most published research focuses on the amount of menstrual blood loss and, to a lesser extent, on cyclicity. Little attention has been paid to the duration of bleeding, the factors that enable its cessation within a ‘normal’ timeframe, or to patterns that entail interruption and resumption of blood loss. The definition of what constitutes normal remains arbitrary and there is no therapy specifically designed to shorten the duration of bleeding. Here, we critically review the literature that addresses the duration of bleeding and the factors that trigger endometrial breakdown and repair. Available reports used population averages which mask inter- and intra-individual variations. The duration of bleeding is not necessarily linked to the amount of loss but may be influenced by age, ethnicity, habitus, region and altitude of residence, dieting and stress. The onset of bleeding has been linked to declining steroid production by the corpus luteum. There remains considerable controversy around the extent of endometrial shedding at menstruation. This is likely to vary within and between women. The significance of a change from previous patterns, very short or prolonged bleeding, days of light loss or spotting before or after days of bleeding, or of bleed-free days that punctuate flow, remain poorly understood.

Background: Food intake and metabolism might play central roles in causing and treating menstrual disorders. Vitamin D may lead to the improvement of folliculogenesis through anti-Mullerian hormone (AMH). This study aimed to compare the effect of vitamin D intake with that of the combined oral contraceptive (COC) capsules on ovulatory dysfunction. Methods: This study was conducted on 60 eligible women referred to Kowsar Qazvin Hospital with a complaint of abnormal uterine bleeding (AUB). They had a history of excessive, long, and irregular bleeding. The participants in the control and intervention groups received 1 oral LD capsule and a combination of vitamin D and LD capsules on a daily basis for 3 months, respectively. The menstrual bleeding volume, the number of menstrual days, and the menstrual cycle length were evaluated before, during, and after the intervention. The Mann-Whitney U test, Friedman test, independent t test, and Cochran Q test were used in SPSS version 24 for data analysis. P values less than 0.05 were considered statistically significant. Results: The menstrual bleeding intensity decreased significantly in the intervention group (vitamin D–LD capsule; P = 0.001). Over time, both intervention and control groups showed a significant improvement in the number of menstrual days and menstrual cycle length, resulting in a more normal menstrual cycle. However, these 2 parameters remained more natural in the intervention group, a finding which did not indicate any significant differences. Conclusion: Vitamin D can be used along with LD capsules as a supplementary treatment to lessen menstrual bleeding intensity.

Most published research focuses on the amount of menstrual blood loss and, to a lesser extent, on cyclicity. Little attention has been paid to the duration of bleeding, the factors that enable its cessation within a 'normal' timeframe, or to patterns that entail interruption and resumption of blood loss. The definition of what constitutes normal remains arbitrary and there is no therapy specifically designed to shorten the duration of bleeding. Here, we critically review the literature that addresses the duration of bleeding and the factors that trigger endometrial breakdown and repair. Available reports used population averages which mask inter- and intra-individual variations. The duration of bleeding is not necessarily linked to the amount of loss but may be influenced by age, ethnicity, habitus, region and altitude of residence, dieting and stress. The onset of bleeding has been linked to declining steroid production by the corpus luteum. There remains considerable controversy around the extent of endometrial shedding at menstruation. This is likely to vary within and between women. The significance of a change from previous patterns, very short or prolonged bleeding, days of light loss or spotting before or after days of bleeding, or of bleed-free days that punctuate flow, remain poorly understood. [ABSTRACT FROM AUTHOR]

Despite the amount of research into hysteroscopic myomectomy, questions about the optimal treatment of heavy menstrual bleeding remain. This study reviewed publication trends on this topic from 2002 to 2019 and assessed the usefulness of studies. A total of 580 articles were published on PubMed in this time frame, in 15 different languages. There were meta‐analyses (1.6%), systematic reviews (12%), and randomized controlled trials (4.2%). Twelve percent were published in high impact factor journals. After applying our selection criteria, the usefulness of 37 articles was assessed: one article scored high, 31 scored moderate, and five scored low. The costs of these studies were estimated at US$ 971 700. Synopsis: Usefulness assessment showed that only one article scored high, 31 scored moderate, and five scored low. Study costs were estimated to be US$ 971 700. [ABSTRACT FROM AUTHOR]

Background: No evidence exists for the lowest effective dose of magnesium on menstrual pain. Objective: To determine and compare the effects of two different doses of magnesium on pain intensity and menstrual blood loss in students with primary dysmenorrhea. Methods: Sixty dysmenorrhea patients were randomly assigned to one of two therapeutic groups and one placebo group (receiving one tablet a day of 300 or 150 mg magnesium sulphate or placebo from the 15th cycle day until no pain existed on the following cycle). Visual analogue scale (VAS) and Hjgham collected data for two cycles before and two cycles after the intervention. The data were analyzed using one-way ANOVA and ANCOVA tests. Findings: No significant difference was observed between the groups in terms of baseline characteristics. Both intervention groups outperformed the placebo group in terms of pain intensity (adjusted differences of -2.9, 95% confidence intervals of -3.3 to -2.4 and -1.9, -2.4 to -1.5, respectively) and menstrual bleeding (-20.0, -26.0 to -14.0, and -13.0, -19.0 to -7.0, respectively), as well as the secondary outcome, i.e. rest duration and ibuprofen consumption. In terms of pain alleviation and menstrual bleeding, participants in the 300 mg magnesium group outperformed those in the 150 mg magnesium group. No significant difference was observed between intervention groups regarding secondary outcomes. Conclusion: Both magnesium levels are useful in alleviating pain and reducing menstrual bleeding, although 300 mg of magnesium was more effective.

Purpose In the pediatric population, warfarin remains the recommended oral anticoagulant for valvular heart disease. Warfarin carries a risk of bleeding complications that can manifest as heavy menstrual bleeding (HMB) in postmenarchal adolescent females. As a result, these patients may be started on hormonal therapies, such as norethindrone, to suppress menstruation. Summary This case series describes a potential drug interaction between warfarin and norethindrone in 3 adolescent females with a history of mechanical mitral valve replacement who developed HMB. These patients were on stable warfarin regimens before the initiation of norethindrone and subsequently experienced increases in their international normalized ratio (INR). In response, they required an up to 50% reduction in their weekly warfarin dose over 5 to 12 weeks. Conclusion These observations suggest that use of norethindrone for the management of HMB may significantly potentiate the anticoagulant effect of warfarin. Close INR monitoring and aggressive dose adjustments during initiation and discontinuation of norethindrone are recommended in patients on warfarin. [ABSTRACT FROM AUTHOR]

Objective: To synthesize the published literature to better understand the association between cesarean scar defects (CSDs) and abnormal uterine bleeding (AUB). In particular, we aimed to evaluate the risk and pattern(s) of CSD-associated AUB in addition to exploring the relationship between defect morphology with bleeding symptoms.Design: Systematic review and meta-analysis.Setting: Not applicable.Patients: Patients with CSD and reports of uterine bleeding as an outcome were identified in 60 studies from database searches.Interventions: Studies that investigated CSD (as defined by investigators) and reported uterine bleeding, menstrual bleeding, or AUB as an outcome were included.Main Outcome Measures: The prevalence and risk of AUB (intermenstrual, postmenstrual, and unscheduled bleeding) in patients with confirmed CSD.Results: Nine studies reported on the prevalence of AUB in patients with a confirmed CSD. Patients with CSD were more likely to experience AUB, compared with those without CSD (relative risk, 3.47; 95% confidence interval [CI], 2.02-5.97; 6 studies, 1,385 patients; I2 = 67%). In a population of patients with at least 1 cesarean delivery, the prevalence of AUB in those with CSD was 25.5% (95% CI, 14.7-40.5; 6 studies, 667 patients, I2 = 93%). However, symptom prevalence was much higher in patients presenting for imaging for a gynecologic indication where the prevalence of AUB in the presence of a CSD was 76.4% (95% CI, 67.8-83.3; 5 studies, 505 patients; I2 = 71%). The mean menstrual duration in symptomatic patients with CSD was 13.4 days (95% CI, 12.6-14.2; 19 studies, 2,095 patients; I2 = 96%), and the mean duration of early-cycle intermenstrual bleeding was 6.8 days (95% CI, 5.7-7.8 days; 9 studies, 759 patients; I2 = 93%). The most common descriptor of CSD-associated AUB was "brown discharge". Patients with larger CSD experienced more bleeding symptoms.Conclusion: There is a strong and consistent association between patients with CSD and AUB. These patients experience a unique bleeding pattern, namely prolonged menstruation and early-cycle intermenstrual bleeding. These data should provide impetus for including CSD as a distinct entity in AUB classification systems. High heterogeneity in our results calls for standardization of nomenclature and outcome reporting for this condition. [ABSTRACT FROM AUTHOR]

Background: No evidence exists for the lowest effective dose of magnesium on menstrual pain. Objective: To determine and compare the effects of two different doses of magnesium on pain intensity and menstrual blood loss in students with primary dysmenorrhea. Methods: Sixty dysmenorrhea patients were randomly assigned to one of two therapeutic groups and one placebo group (receiving one tablet a day of 300 or 150 mg magnesium sulphate or placebo from the 15th cycle day until no pain existed on the following cycle). Visual analogue scale (VAS) and Hjgham collected data for two cycles before and two cycles after the intervention. The data were analyzed using one-way ANOVA and ANCOVA tests. Findings: No significant difference was observed between the groups in terms of baseline characteristics. Both intervention groups outperformed the placebo group in terms of pain intensity (adjusted differences of -2.9, 95% confidence intervals of -3.3 to -2.4 and -1.9, -2.4 to -1.5, respectively) and menstrual bleeding (-20.0, -26.0 to -14.0, and -13.0, -19.0 to -7.0, respectively), as well as the secondary outcome, i.e. rest duration and ibuprofen consumption. In terms of pain alleviation and menstrual bleeding, participants in the 300 mg magnesium group outperformed those in the 150 mg magnesium group. No significant difference was observed between intervention groups regarding secondary outcomes. Conclusion: Both magnesium levels are useful in alleviating pain and reducing menstrual bleeding, although 300 mg of magnesium was more effective. [ABSTRACT FROM AUTHOR]

Abstract Objective Levonorgestrel-releasing intrauterine devices (LNG-IUDs) and copper intrauterine devices (Cu-IUDs) offer long-acting contraception; however, some women may discontinue use within the first year due to bleeding pattern changes, limiting their potential. This systematic literature review investigated whether differences in bleeding profiles influence continuation rates in women in America, Europe and Australia. Methods Searches performed in PubMed and Embase were screened to identify publications describing bleeding patterns and rates of early IUC removal/discontinuation or continuation, descriptions of bleeding patterns, reasons for discontinuation, and patient satisfaction, acceptability and tolerability for LNG-IUDs and Cu-IUDs published between January 2010 and December 2019. The results were further restricted to capture citations related to ‘Humans’ and ‘Females’. The review was limited to studies published from 2010 onwards, as changing attitudes over time mean that results of studies performed before this date may not be generalizable to current practice. Results Forty-eight publications describing 41 studies performed principally in the USA (n = 17) and Europe (n = 13) were identified. Publications describing bleeding patterns in LNG-IUD users (n = 11) consistently observed a reduction in bleeding in most women, whereas two of three studies in Cu-IUD users reported heavy bleeding in approximately 40% of patients. Rates of discontinuation for both devices ranged widely and may be as high as 50% but were lower for LNG-IUDs versus Cu-IUDs. Discontinuation rates due to bleeding were consistently higher for Cu-IUDs versus LNG-IUDs. Conclusions Bleeding is a common reason for discontinuation of Cu-IUDs and LNG-IUDs. The more favourable bleeding pattern observed in LNG-IUD users may be associated with a lower rate of early discontinuation of LNG-IUDs versus Cu-IUDs.

Plain English summary Research has shown that experiencing side-effects is related to stopping use of contraception, even when women wish to avoid pregnancy. Most research, however, does not differentiate between distinct side-effects, such as increased bleeding or changes to sexual experience, and instead combined all into “side-effects or health concerns”. We used data from 560 women in Uganda, who were interviewed twice, 1 year apart, to see if women who reported different side-effects at the first interview were more likely to stop using contraception or switch to a different contraceptive method than women who did not report experiencing side-effects. We found that increased or decreased menstrual bleeding was associated with a higher odds of contraceptive discontinuation and switching, Contraceptive discontinuation or switching was not different by women’s reporting of vaginal dryness/reduced libido or physical discomfort, such as cramping. It is important to understand what side-effects are likely to motivate stopping or switching contraception so that education and counseling can inform women of side-effects they may experience, help them choose the best method based on what side-effects they deem important, and if necessary, aid in switching contraceptive methods.

Background: Menstrual disorders were not reported as a possible secondary effect in any of the clinical trials for the SARS-CoV-2 vaccines. Aim: To describe the prevalence of perceived premenstrual and menstrual changes after COVID-19 vaccine administration. Design: Cross-sectional study. Methods: A total of 14,153 women (mean age 31.5 ± 9.3 years old) who had received the full course of vaccination at least three months earlier were included in this cross-sectional study. Data including the type of vaccine administered, perceived changes in the amount and duration of menstrual bleeding, presence of clots, cycle length, and premenstrual symptoms were collected through a retrospective online survey from June to September 2021. Results: Of the women who participated in this study, 3136 reported no menstrual changes and 11,017 (78% of the study sample) reported experiencing menstrual cycle changes after vaccination. In summary, women who reported menstrual changes after vaccination were older (overall p < 0.001) and slightly more smokers (p = 0.05) than women who did not report any changes. The most prevalent changes in relation to premenstrual symptoms were increased fatigue (43%), abdominal bloating (37%), irritability (29%), sadness (28%), and headaches (28%). The most predominant menstrual changes were more menstrual bleeding (43%), more menstrual pain (41%), delayed menstruation (38%), fewer days of menstrual bleeding (34.5%), and shorter cycle length (32%). Conclusion: Women vaccinated against COVID-19 usually perceive mild menstrual and premenstrual changes. Future studies are warranted to clarify the physiological mechanisms behind these widely reported changes. [ABSTRACT FROM AUTHOR]

Background: The levonorgestrel-releasing intrauterine device (IUD)-also known as the hormonal IUD-is a highly effective contraceptive method that has not been widely available in the public sector in Zambia. Early introduction efforts can provide critical insights into the characteristics of users, reasons for method choice, and experiences getting their method.Methods: We conducted a survey with 710 public sector clients who received a hormonal IUD, copper IUD, implant or injectable in two provinces of Zambia, and additional in-depth interviews with 29 women. We performed descriptive analyses of survey data and fitted multivariable logistic regression models to assess factors associated with hormonal IUD use. Qualitative interviews were analyzed thematically.Results: Factors associated with hormonal IUD use included full-time or self-employment (relative to both implant and copper IUD use), as well as being older, wealthier, and partner not being aware of method use (relative to implant use only). Common reasons for choosing long-acting methods were duration, perception that the method was "right for my body," and convenience. In addition, a portion of hormonal IUD acceptors mentioned effectiveness, potential for discreet use, few or manageable side effects, and treatment for heavy or painful periods. Between 83 and 95% of women said that they were counseled about menstrual changes and/or non-bleeding side effects; however, more hormonal IUD acceptors recalled being counseled on the possibility of experiencing reduced bleeding (88%) than amenorrhea (43%). Qualitative interviews indicate that women seek methods with minimal or tolerable side effects. While most women reported their partner was aware of method use, men may be more consistently involved in the decision to use contraception rather than in the choice of a particular method. Qualitative results show an appreciation of the lifestyle benefits of reduced bleeding (especially lighter bleeding), although amenorrhea can be cause for concern.Conclusions: Initial efforts to introduce the hormonal IUD can provide valuable learnings that can inform broader method introduction to expand choice and better suit women's needs in Zambia and elsewhere. Scale-up plans should include emphasis on high quality counseling and demand generation. The government of Zambia is committed to increasing access to high-quality contraception and making more choices available to users. To date, the hormonal IUD, a highly effective, long-lasting contraceptive has not been widely available in the country. A study in pilot introduction settings provided insights into why women chose the methods, their characteristics, and their experiences getting their methods. The 710 women in the study received family planning services in public sector settings in two provinces in Zambia. Women in the study who received a hormonal IUD, copper IUD, implant, or injectable completed a quantitative survey; in-depth interviews were also conducted with 29 women. Results showed common reasons for choosing the long-acting methods (hormonal IUD, copper IUD or implants) were their duration, perception that the method was "right for my body," and convenience. In addition, some hormonal IUD acceptors indicated that they were attracted to the method's effectiveness, potential for discreet use, few or manageable side effects, and treatment for heavy or painful periods. Qualitative interviews with women also showed that women want contraceptive methods that lead to minimal or tolerable side effects. Male partners were typically aware of contraceptive use; however, men were less involved with decisions about the particular method women selected. Use of the hormonal IUD can lead to reduced menstrual bleeding, and in the interviews, women indicated that they liked reduced bleeding (especially lighter bleeding), although amenorrhea (paused bleeding) can be cause for concern. The results can help inform broader method introduction. [ABSTRACT FROM AUTHOR]

To provide an evidence-based safety and tolerability overview of dydrogesterone under various progesterone-deficient conditions as a commemoration of its role in managing women's reproductive health over the past 60 years. To identify relevant publications, we used a semi-systematic approach, which included performing a structured search through the PubMed and Cochrane central databases as well as an unstructured search for publications published in English from 2010 onward with human clinical data. A total of 32 relevant clinical studies were identified. Results were reported in the context of overall adverse events (AEs) and segregated according to various progesterone-deficient conditions. AEs concerning breasts (breast cancer risk), the endometrium (endometrial cancer risk), venous thromboembolism risk, and cardiovascular risk were found to be minimal when dydrogesterone was used as part of a menopausal hormone therapy regimen lasting ≤260 weeks. Vagina-related AEs, such as bleeding, discharge, irritation, and difficult coitus, occurred less frequently with dydrogesterone when used as luteal phase support in the context of assisted reproductive techniques (ARTs). However, other common AEs, such as headache, dizziness, abdominal pain, flatulence, and nausea, occurred more frequently with dydrogesterone. No maternal complications or congenital anomalies could be linked to dydrogesterone usage during ARTs or during early pregnancy to prevent recurrent miscarriages. Studies on dydrogesterone in endometriosis and premenstrual syndrome remain scarce. Post-approval, dydrogesterone has displayed a favorable safety and tolerability profile during its 60-year use, which is reassuring, considering its important role in managing women's reproductive health. [ABSTRACT FROM AUTHOR]

After more than half a century of development, the intrauterine contraception (IUD) has become a relatively mature method of contraception and treatment of gynecological diseases. This paper reviewed the development of IUDs, different types of IUDs, and some problems due to them, such as bleeding, infection, malposition, dislocation, expulsion, etc. And the causes of clinical side effects, complications, and corresponding treatments of IUDs were overviewed as well.

Women with a bleeding disorder (WBD), including those diagnosed as a carrier, often have heavy periods associated with prolonged bleeding and pain. This survey sought to describe the impact of this substantial burden on daily living and the personal cost of managing heavy periods.

Objective: Levonorgestrel-releasing intrauterine devices (LNG-IUDs) and copper intrauterine devices (Cu-IUDs) offer long-acting contraception; however, some women may discontinue use within the first year due to bleeding pattern changes, limiting their potential. This systematic literature review investigated whether differences in bleeding profiles influence continuation rates in women in America, Europe and Australia.Methods: Searches performed in PubMed and Embase were screened to identify publications describing bleeding patterns and rates of early IUC removal/discontinuation or continuation, descriptions of bleeding patterns, reasons for discontinuation, and patient satisfaction, acceptability and tolerability for LNG-IUDs and Cu-IUDs published between January 2010 and December 2019. The results were further restricted to capture citations related to 'Humans' and 'Females'. The review was limited to studies published from 2010 onwards, as changing attitudes over time mean that results of studies performed before this date may not be generalizable to current practice.Results: Forty-eight publications describing 41 studies performed principally in the USA (n = 17) and Europe (n = 13) were identified. Publications describing bleeding patterns in LNG-IUD users (n = 11) consistently observed a reduction in bleeding in most women, whereas two of three studies in Cu-IUD users reported heavy bleeding in approximately 40% of patients. Rates of discontinuation for both devices ranged widely and may be as high as 50% but were lower for LNG-IUDs versus Cu-IUDs. Discontinuation rates due to bleeding were consistently higher for Cu-IUDs versus LNG-IUDs.Conclusions: Bleeding is a common reason for discontinuation of Cu-IUDs and LNG-IUDs. The more favourable bleeding pattern observed in LNG-IUD users may be associated with a lower rate of early discontinuation of LNG-IUDs versus Cu-IUDs. [ABSTRACT FROM AUTHOR]

Background: Although Obesity is a risk factor of endometrial hyperplasia/carcinoma, there is no consensus on using the BMI as a predictor for endometrial biopsy screening in patients with heavy menstrual bleeding in pre-menopausal women. Therefore, it's clinically important to identify BMI cutoff values as a predictor for endometrial hyperplasia/carcinoma in premenopausal women with heavy menstrual bleeding. Aim of the Study: To determine the feasibility of using Body Mass Index (BMI) as an indicator to perform endometrial biopsy in premenopausal women presented with heavy menstrual bleeding. Patients & Methods: This is a cross-sectional study that was conducted in Obstetrics and Gynecology Clinic/Al-Emamain Al-Kadhemein teaching medical city in Baghdad where women 150 women who are 40-50 years old with heavy menstrual bleeding where sent for endometrial biopsy. 100 women had abnormal endometrial biopsy results, histopathological results of the abnormal endometrial samples were classified into following groups: hyperplasia without atypia, hyperplasia with atypia, and hyperplasia with atypia and cancer. Statistical analysis conducted to correlate The Body Mass Index (BMI) with the status of endometrial biopsy. Results: 42% of the women with BMI=30 kg/m2 have hyperplasia with atypia or carcinoma compared to 10% of women who BMI<30 kg/m2 (p<0.001). from 54 women who had hyperplasia with atypia in endometrial sample results; 77.7% of such patients were BMI=30 kg/m2. Receiver operating characteristic analysis shows that using BMI =30 kg/m2 as a predictor of hyperplasia with atypia or carcinoma carries a sensitivity of 80.77 % and specify of 86.00% with area under the curve (AUC) value of 0.83 (CI. 0.75-0.92) and (p<0.001). women with BMI=30 kg/m2 has a relative risk (RR) of 3.98 of developing endometrial hyperplasia (without atypia or with atypia+carcinoma) and a relative risk (RR) of 4.11 of developing hyperplasia with atypia or carcinoma (p<0.001). Conclusion: Our results indicate that BMI regardless of the age is the highest risk factor for abnormal endometrial hyperplasia premenopausal women. Also, BMI=30 kg/m2 has highest risk for developing endometrial hyperplasia with atypia or carcinoma. BMI=30 kg/m2 can be used as predictor of endometrial hyperplasia in premenopausal women with heavy uterine bleeding. [ABSTRACT FROM AUTHOR]

Reproductive health is a broad concept that encompasses mortality, morbidity, and quality of life associated with the reproductive system, mechanism, and incidents encountered at all ages by men and women. Orthodox Indian society finds the conversation on reproductive health to be a taboo and discourages open conversations about it. Polycystic ovary syndrome (PCOS) is a reproductive-age metabolic endocrine disorder found in females. Females suffering from PCOS are prone to reproductive, metabolic, and cardiovascular disorders. In this paper, we will systematically review about effect of PCOS on Reproductive Health of Women. The numerous electronic databases such as: BMJ, LANCET, PUBMED, Unicef Website, WHO Website and Google Scholar have been comprehensively searched for studies linked to PCOS, its various effects and effect on women's reproductive health. For additional analyses, we have reviewed reference lists of reviews and collected papers. The effects of PCOS on women's reproductive health have been verified by several scientific reports worldwide. PCOS is a hormonal condition, as per multiple reports, with the ability to lead to different outcomes. It still appears to be a common cause among females of infertility. An integral aspect of the treatment of this disease is the early diagnosis of long-term morbidities by effective screening tests. In the future, studies must concentrate on the missing holes in our growing perception of this disease. Several studies have confirmed that reproductive morbidity, including irregular uterine bleeding, abortion, miscarriage, and other risk of pregnancy during reproductive years, is associated with PCOS. PCOS is an amalgam of physiological and psychosocial dysfunction, not just an endocrine disorder. [ABSTRACT FROM AUTHOR]

Background: There is substantial evidence that contraceptive side-effects are a major deterrent to consistent use of contraception but few studies in low- or middle-income countries explore the role of specific side-effects on contraceptive use dynamics. This study used population-based, longitudinal data to explore the effect of specific side-effects on contraceptive continuation, discontinuation, and switching in Uganda. Methods: Data for this study come from two rounds of survey data collection in Uganda: PMA2020's sixth cross-sectional survey and a follow-up survey conducted 1 year later. The main outcomes of interest were discontinuation and switching among users of hormonal contraceptive methods (implants, injectables and oral pill) and the IUD at baseline (n = 560). Multivariable logistic regressions assessed the association of experiencing specific side-effects (more bleeding, less bleeding, irregular bleeding, increased dryness/reduced libido, and physical discomfort) with discontinuation and switching 1 year later, adjusting for socio-demographic characteristics, type of method, and length of use. We also examined the differential effects of side-effects between discontinuation and switching risks. Results: About 23% of hormonal and IUD contraceptive users reported experiencing side-effects at baseline survey. Overall, discontinuation and switching were higher among injectables and pill users, compared to IUD and implants users. Reporting more bleeding or less bleeding increased the odds of discontinuation and switching by 2.74 (95% CI 1.00–7.51) and 1.86 (1.04–3.34), respectively. There was no significant difference in discontinuation and switching by side-effects. Conclusions: Greater attention should be paid to understanding the unique contributions of side-effects to contraceptive behavior using population-based data. While about a quarter of women reported experiencing side effects, those who experienced bleeding specific side effects were at higher risk of contraceptive discontinuation and switching. Providing greater individualized care that includes information and counseling about common side-effects, how they may impact daily life, and how tolerable these effects may be is necessary. Plain English summary: Research has shown that experiencing side-effects is related to stopping use of contraception, even when women wish to avoid pregnancy. Most research, however, does not differentiate between distinct side-effects, such as increased bleeding or changes to sexual experience, and instead combined all into "side-effects or health concerns". We used data from 560 women in Uganda, who were interviewed twice, 1 year apart, to see if women who reported different side-effects at the first interview were more likely to stop using contraception or switch to a different contraceptive method than women who did not report experiencing side-effects. We found that increased or decreased menstrual bleeding was associated with a higher odds of contraceptive discontinuation and switching, Contraceptive discontinuation or switching was not different by women's reporting of vaginal dryness/reduced libido or physical discomfort, such as cramping. It is important to understand what side-effects are likely to motivate stopping or switching contraception so that education and counseling can inform women of side-effects they may experience, help them choose the best method based on what side-effects they deem important, and if necessary, aid in switching contraceptive methods. [ABSTRACT FROM AUTHOR]

Background: Mirena prevents pregnancy for up to five years after insertion. It is one of several hormonal intrauterine device (IUD) with Food and Drug Administration approval. Like the progestogen-related mental side effects, is still a rather unexplored scientific field? Objective: the present study aimed to assess the perception effects of mirena intrauterine contraceptives (IUC) and the actual sexual functioning, weight gain and mood changes level. Patients and Methods: this study included 46 women, using an intrauterine contraceptive method. The study was conducted in Obstetrics and Gynecology Department, Zagazig University Hospitals. All patients who enrolled in the study were subjected to full history taking, clinical examinations, and estimation of female sexual function index and BMI. Main outcomes was estimated including desire, orgasmic function, lubrication and vulvovaginal symptoms, sexual satisfaction and mood changes. Results: About 19.6% of the studied group had no pain during insertion, 36.9% had mild pain, 36.9% had moderate pain and 6.6% had high pain. Mean pain score was 4 ± 1.8 with range from 0 to 8. Most frequent complication among the studied group were vulvovaginitis (52.2%) followed by abdominal and pelvic pain (37%). Only 6.5% had heavy menstrual bleeding and no cases had uterine perforation during insertion. Conclusion: Using of mirena IUD type is not associated with changes related to sexuality of women, quality of life and body weight gain. [ABSTRACT FROM AUTHOR]

Abstract Background Many studies have described the features of menstrually-related migraines (MRM) in the natural cycle and the efficacy of prevention. MRM in combined hormonal contraceptive (CHC) users has scarcely been researched. Estrogen and progestin withdrawal in CHC users are both more abrupt and from higher hormone levels compared with the natural cycle. An advantage for prevention of MRM in CHC users is that the hormone withdrawal is predictable. It is unknown, whether the attacks during the hormone-free interval are associated with the hormone withdrawal or onset of bleeding. Improved understanding of this relation might contribute to better define and shorten the time interval for prevention. Methods For this prospective diary-based trial we collected migraine and bleeding data from CHC users with MRM in at least two of three cycles. We analyzed frequency of migraines over the whole CHC cycle. During the hormone-free phase the relation between onset of migraine and onset of bleeding was studied. We compared pain intensity and identified prolonged-migraine attacks during hormone use and the hormone-free phase. Results During the hormone-free interval the number of migraine days and the pain score/migraine day were significantly higher in comparison with the mean during hormone use. The prevalence of migraine attacks was fourfold on hormone-free days 3–6. Migraine typically started on days 1–4. Migraine in relation to bleeding mostly occurred on days − 1 to + 4. In 78% of the cycles the first migraine day occurred during bleeding days 1 ± 2 and 48% started on days − 1 and day 1. The predictability of the first bleeding day was very high. Conclusion The day of hormone-withdrawal migraine and the first bleeding day are highly predictable in CHC users. Migraine onset is mostly day − 1 and 1 of the bleeding and on days 1–4 of the hormone-free interval. Migraine attacks of CHC users in the hormone-free interval are severe and long lasting. Further trials are necessary to investigate if this knowledge can be used to optimise prevention.

Background: There is several possible mechanisms that explain the cause of menorrhagia in patient using intrauterine contraceptive device (IUCD). Abnormal uterine bleeding may be excessive to the extent of causing iron deficiency anemia. The aim of the present study was to compare of the Doppler parameter of subendometrium and uterine artery of the patients that complain of excessive menstrual bleeding after IUCD insertion to other patients have no excessive menstrual bleeding. Patients and methods: This study includes 54 women divided into three groups. Group I; included 18 women using copper intrauterine device (Tcu 380A) and complaining of menorrhagia, Group II; included 18 women using copper IUCD and not complaining of abnormal uterine bleeding and group III; included 18 women not using any contraceptive method and not complaining of abnormal uterine bleeding. Results: There is statistically significant difference between the studied groups regarding left uterine artery RI and PI. The cutoff of sub-endometrial RI in prediction of excessive menstrual bleeding if IUD inserted is ≥0.755 with area under curve 0.701 at which sensitivity 77.8%, specificity 69.4%, positive predictive value 56%, negative predictive value 86.2% and accuracy 72.2% (p<0.05). The best cutoff of uterine RI in prediction of excessive menstrual bleeding if IUD inserted is ≥0.775 with area under curve 0.807, at which sensitivity 77.8%, specificity 72.7%, positive predictive value 58.3%, negative predictive value 86.7% and accuracy 74.1% (p<0.05). Conclusion: Uterine arteries RI and PI were significantly lower in women with copper IUD induced menorrhagia. Subendometrial blood flow RI, PI were significantly lower in women with Copper IUD induced menorrhagia than women of group II and III. [ABSTRACT FROM AUTHOR]

Introduction: The rate of bleeding is associated with impaired synthesis of endometrial prostaglandins, especially PGE2. One of the most common causes of anemia in women is menstrual bleeding. Bromelain, an enzyme found in pineapple, has anti-inflammatory effects and reduces prostaglandin E2 in inflammatory regions. This study was performed with aim to compare the effects of Bromelain and Mefenamic acid on the amount of menstrual bleeding. Methods: A double-blind randomized clinical trial was conducted on 90 students with primary dysmenorrhea in dormitories of Velayat University of Iranshahr in 2017. The students were monitored for two cycles with Higham chart in terms of the rate of bleeding. Then, they were randomly assigned to two groups: Bromelain (n=32) and Mefenamic acid (n=34). The Higham chart was completed to measure menstrual bleeding in two cycles of control and two cycles of intervention. The subjects received 250mg capsules of Bromelain or 250mg capsules of Mefenamic acid, if needed, they received two interventional cycles every 6 hours during the first three days. Data was analyzed by SPSS software (version 22) and Mann-Whitney, Paired t-test and independent t-test. P

Introduction: The most common causes of Abnormal Uterine Bleeding (AUB) in women of reproductive age are uterine polyps. Operative hysteroscopy is the management of choice to remove polyp. However, the certainty of the treatment remains to be examined. Aim: To investigate the outcome of hysteroscopy polypectomy in women with AUB. Materials and Methods: This was a cross-sectional study on the samples of women with AUB who underwent a hysteroscopy polypectomy. Patients were assessed pre and postoperatively and were asked to respond to a number of outcome measures including duration of monthly cycle, menstruation cycle, heavy menstrual bleeding, the number of pads used in day and night and improvement of inter-menstrual bleeding, postcoital bleeding, and limited activity. Pre-and postsurgery data were compared using Wilcoxon and McNemar tests. Results: In all, 83 patients were entered into the study. The mean age of participants was 41.8 (±8.37) years. The most common preoperative complaint was heavy menstrual bleeding (n=63, 76%) followed by intermenstrual bleeding (n=40, 48%). There were significant differences between preoperative and postoperative symptoms (p-values

Introduction: The most common causes of Abnormal Uterine Bleeding (AUB) in women of reproductive age are uterine polyps. Operative hysteroscopy is the management of choice to remove polyp. However, the certainty of the treatment remains to be examined. Aim: To investigate the outcome of hysteroscopy polypectomy in women with AUB. Materials and Methods: This was a cross-sectional study on the samples of women with AUB who underwent a hysteroscopy polypectomy. Patients were assessed pre and postoperatively and were asked to respond to a number of outcome measures including duration of monthly cycle, menstruation cycle, heavy menstrual bleeding, the number of pads used in day and night and improvement of inter-menstrual bleeding, postcoital bleeding, and limited activity. Pre-and postsurgery data were compared using Wilcoxon and McNemar tests. Results: In all, 83 patients were entered into the study. The mean age of participants was 41.8 (±8.37) years. The most common preoperative complaint was heavy menstrual bleeding (n=63, 76%) followed by intermenstrual bleeding (n=40, 48%). There were significant differences between preoperative and postoperative symptoms (p-values <0.05). Perceived complete recovery (n=54, 65%), partial recovery (n=13, 15.7%) and satisfaction (n=66, 79.5%) were high after hysteroscopy. Conclusion: AUB due to polyp might be improved with hysteroscopy. Further investigations are needed to confirm the results and to study on co-existence of other causes of AUB after hysteroscopy polypectomy. [ABSTRACT FROM AUTHOR]

Objective: Vaginal bromocriptine significantly reduces heavy menstrual bleeding and pain in women with diffuse adenomyosis. The aim of this pilot study was to evaluate whether imaging findings of adenomyosis, as assessed by transvaginal ultrasound (TVU) and magnetic resonance imaging (MRI) reflect changes induced by the bromocriptine treatment.Study Design: Eighteen women, aged 35-50, with heavy menstrual bleeding reporting Pictorial Blood Loss Assessment Chart (PBLAC) scores >100 and diffuse adenomyosis according to both MRI and TVU were included. The subjects underwent treatment with vaginal bromocriptine for 6 months. MRI and TVU were performed at baseline and after 6 months of medication.Results: Mean age of the participants was 44.8 years, 77.8 % reported PBLAC scores > 250 and 66.7 % reported moderate to severe pain during menstruation at baseline. As compared to baseline, TVU revealed a thinner maximal Junctional Zone (JZmax) (8.5 mm [5.2-14] vs 7.9 mm [5-11.2], p = 0.02) at 6 months. Asymmetric wall thickening was seen in 13 (72 %) at baseline, and in 6 (33 %) women at 6 months, p = 0.02. No significant changes were seen in irregular endometrial-myometrial border, presence of fan-shaped shadowing, cystic changes, striations, hyperechogenic islands or lesion extension. MRI showed no significant difference in JZmax (16.0 mm[12.1-27.7] vs 15.5 mm [9.5-25.8], p = 0.81), JZdifference (9.5 mm[4.8-21.6] vs 8.4[3.8-19.5], p = 1) or Ratio JZ/myometrium (0.6 [0.5-0.8] vs. 0.6[0.4-0.8], p = 0.9) at baseline vs 6 month. Cystic lesions in the JZ were found in 9 women (50 %) before, and in 5 women (28 %) at 6 months, p = 0.13.Conclusion: TVU showed a significant decrease in JZ max and a reduced number of women with asymmetric myometrial wall thickness. The changes seen in this small pilot study may indicate that vaginal bromocriptine have an impact on adenomyosis that is reflected in radiological appearance. [ABSTRACT FROM AUTHOR]

Background: Many studies have described the features of menstrually-related migraines (MRM) in the natural cycle and the efficacy of prevention. MRM in combined hormonal contraceptive (CHC) users has scarcely been researched. Estrogen and progestin withdrawal in CHC users are both more abrupt and from higher hormone levels compared with the natural cycle. An advantage for prevention of MRM in CHC users is that the hormone withdrawal is predictable. It is unknown, whether the attacks during the hormone-free interval are associated with the hormone withdrawal or onset of bleeding. Improved understanding of this relation might contribute to better define and shorten the time interval for prevention. Methods: For this prospective diary-based trial we collected migraine and bleeding data from CHC users with MRM in at least two of three cycles. We analyzed frequency of migraines over the whole CHC cycle. During the hormone-free phase the relation between onset of migraine and onset of bleeding was studied. We compared pain intensity and identified prolonged-migraine attacks during hormone use and the hormone-free phase. Results: During the hormone-free interval the number of migraine days and the pain score/migraine day were significantly higher in comparison with the mean during hormone use. The prevalence of migraine attacks was fourfold on hormone-free days 3–6. Migraine typically started on days 1–4. Migraine in relation to bleeding mostly occurred on days − 1 to + 4. In 78% of the cycles the first migraine day occurred during bleeding days 1 ± 2 and 48% started on days − 1 and day 1. The predictability of the first bleeding day was very high. Conclusion: The day of hormone-withdrawal migraine and the first bleeding day are highly predictable in CHC users. Migraine onset is mostly day − 1 and 1 of the bleeding and on days 1–4 of the hormone-free interval. Migraine attacks of CHC users in the hormone-free interval are severe and long lasting. Further trials are necessary to investigate if this knowledge can be used to optimise prevention. [ABSTRACT FROM AUTHOR]

Objective: Adolescents with anorexia nervosa (AN) are at increased risk of unplanned pregnancies and bone loss, due to low oestrogen levels and low use of efficient contraception. The negative impact of combined hormonal contraceptives (CHC) on peak bone mass during adolescence might limit wider use in anorexic women. Another issue limiting CHC use is the concern, that CHC-induced cyclic bleeding reduces the motivation for further weight gain and thus exerts a negative impact on recovery. We wanted to find evidence based answers about the impact of CHC use on bone health and course of the disease in adolescents with AN.Methods: We performed a narrative review of the current literature investigating the effect of CHC or progestin-only contraceptives on bone density, body shape and course of disease in young women with anorexia.Results: There is no evidence that CHC use aggravates the bone loss associated with AN. In long-term users CHC exert a protective effect. Anorexic women using CHC showed at least the same or a greater weight gain in comparison with controls. Eating disorder attitudes did not worsen.Conclusion: We conclude, that at present there is no evidence, that use of CHC by AN patients has a negative impact on bone density or the course of disease. [ABSTRACT FROM AUTHOR]

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The objective of this study was highlight the adverse side effects associating the use of IUD in terms of severity and duration of menstrual bleeding and their correlation to a number of demographic characteristics such as age, residency, occupation and past obstetric history in addition the correlation to duration of use of IUD.52 women with IUD were enrolled in this cross sectional study that was carried out in some governmental and nongovernmental obstetric institutes in Al-Diwaniyah province, Mid-Euphrates region, Iraq. The study stared one January 2018 and ended on March 2019. The main outcomes were the severity and duration of menstrual bleeding. The mean duration of intrauterine contraceptive device (IUCD) was 2.39 ± 1.91 years and the duration ranged from one month up to 7 years. The duration and the severity of menstrual bleeding are shown in table 2. Four women (7.7 %) had 2-4 days/cycle duration of menstruation, 13 women (25.0%) had 4-6 days/cycle duration of menstruation and 35 women (67.3 %) had > 6 days/cycle duration of menstruation. [ABSTRACT FROM AUTHOR]

Introduction: Vitex agnus-castus, also called Vitex, is a plant with many medicinal properties. This systematic study examined the evidence of the effectiveness and safety of Vitex on menstrual bleeding (primary outcome) and its side effects (secondary outcomes). Materials and methods: This systematic review study examined all papers that were a randomized controlled trial, quasi-experimental, and cross-over conducted on the effect of Vitex on menstrual bleeding, following the PICO (population, intervention, control, and outcomes) criteria without any time limits in December 2017. The participants were women of reproductive age with no gynecologic disorders. The intervention included the use of Vitex in form of tablets, capsule, or oral drops with different doses. The control group included the placebo or mefenamic acid group. The search strategy in this study was in accordance with MeSH terms. The keywords used separately or in combination with other words were Menstrual bleeding OR Menstruation OR Menorrhagia AND Vitexcastus OR Vitex OR Chasteberry AND randomized controlled trial OR randomized trial OR randomized clinical trial OR randomized controlled. All papers, including Persian or English, were searched for in the databases; Medline (through PubMed), Scopus, Embase (through Ovid), Cochrane Library, Web of Sciences, Google Scholar, SID, Magiran, Irandoc, and Iranmedex, without any time limits. Two authors independently reviewed the quality of the papers and assessed the risk of bias based on Cochrane handbook, and the disputes were resolved through discussion and consensus with a third person. The meta-analysis was done on continuous data (mean of menstrual bleeding). In meta-analysis, subgroup analysis was performed based on the type of comparison group. Results: Out of the 8,905 searched papers in the databases, 8,905 titles, 720 abstracts, 85 full texts, and 20 references of the papers were reviewed, of which 5 papers entered this study. Based on the subgroup analysis, the consumption of Vitex did not have a significant effect on the amount of menstrual bleeding compared to the placebo group in the first (mean difference [MD]: 3.08; 95% CI: −3.11–9.26; p=0.33; I2=0%) and second menstrual cycles (MD: 0.00; 95% CI: −5.75–5.75; p=1.00; I2=0%). Also, the Higham mean score was statistically more in the Vitex group compared to the mefenamic acid group in the first menstrual cycle (MD: 7.17; 95% CI: 0.33–14.01; p=0.04; I2=0%) but there was no statistical significant difference between Vitex and mefenamic acid groups in the second menstrual cycle (MD: 12.18; 95% CI: −5.57–29.94; p=0.18; I2=75%). Only nausea and abdominal pain were reported as side effects of Vitex in the included studies. Conclusions: The results of this study showed that the consumption of Vitex in the intervention group did not have a significant effect on menstrual bleeding in comparison with the placebo group. However, due to the relatively low quality of the papers, it is essential to perform clinical trials with an appropriate design to determine the effect of Vitex on menstrual bleeding. [ABSTRACT FROM AUTHOR]

Introduction: Adenomyosis is a benign uterine disease where endometrial glands and stroma are found within the myometrium surrounded by an area of hypertrophic myometrium. Symptomatology includes heavy menstrual bleeding and pelvic pain. The pathogenesis of adenomyosis is not known; however, animal models have shown increased uterine concentration of prolactin as a risk factor. Prolactin acts as a smooth muscle cell mitogen. If prolactin is central to adenomyosis pathogenesis, reducing uterine prolactin could be a possible medical treatment option. In this pilot study, we aim to evaluate the effect of bromocriptine, a prolactin inhibitor, on menstrual bleeding and pain in women with adenomyosis.Material and Methods: 23 women with diffuse adenomyosis were enrolled from a university hospital in Sweden and a tertiary care center in the USA. Nineteen patients completed 6 months of treatment with vaginal bromocriptine at a dose of 5 mg daily. Participants completed validated measures at baseline, 3 and 6 months of treatment, and at 9 months (3 months after cessation of bromocriptine). Validated measures utilized included Pictorial Blood Loss Assessment Chart (PBLAC), Aberdeen Menorrhagia Clinical Outcomes Questionnaire (AMCOQ), Visual Analog Scale for pain (VAS), McGill Pain Questionnaire (MPQ), Endometriosis Health Profile (EHP-30), Female Sexual Function Index (FSFI) and the Fibroid Symptom Quality of Life (UFS-QOL) symptom severity and health-related quality of life (HRQL) subscores. Scores were compared between baseline and 9 months using the Wilcoxon signed rank test.Results: Mean age of participants was 44.8 years. About 77.8% reported PBLAC scores >250 and 68.4% reported moderate to severe pain at baseline. Compared with baseline, women had lower 9-month scores (median [interquartile range] for all) on PBLAC (baseline 349 [292-645] vs 9-month 233 [149-515], P = 0.003), VAS (5.0 [4-8.3] vs 2.5 [0-4.5], P < 0.001), EHP Core Pain (15.9 [9.1-50.0] vs 3.4 [2.3-34.1], P = 0.029), EHP Core Self-image (41.7 [16.7-58.3] vs 25 [0-5], P = 0.048) and Symptom Severity Score (60 [44-72] vs 44 [25-56], P < 0.001) and higher HRQL scores (57 [37-63] vs 72 [51-85], P < 0.001) following bromocriptine treatment. Other EHP core parameters and FSFI were not significantly different.Conclusions: Significant improvement in menstrual bleeding, pain and quality of life after vaginal bromocriptine treatment suggests a novel therapeutic agent for adenomyosis. [ABSTRACT FROM AUTHOR]

In this multicenter, randomized, noninferiority trial among patients aged 34 years and older with heavy menstrual bleeding, the levonorgestrel-releasing intrauterine system did not meet the noninferiority threshold when compared to endometrial ablation for mean blood loss at 24 months following intervention. Both interventions did lead to large decreases in blood loss and comparable satisfaction and quality-of-life scores. [ABSTRACT FROM AUTHOR]

Endometriosis is a common gynaecological condition affecting 10–12% of general female population. It has variable clinical presentation commonly causing infertility, chronic pelvic pain, and dysmenorrhea. Rare presentation could be a tender cervical/rectal mass therefore should be considered in women of reproductive age group. A 30 years old woman with 1.5 years history of heavy menstrual bleeding with painful menstruation, painful coitus, urinary hesitancy and constipation reported after visiting multiple hospitals and failed medical treatment with pelvic scans showing fibroid uterus. MRI excluded fibroid uterus and laparoscopic exploration of pelvis and subsequent histopathology confirm the mass to be bladder endometrioma. [ABSTRACT FROM AUTHOR]

Optimal management of hormonal contraception in patients with venous thromboembolism (VTE) requires an individualized approach considering its potential benefits and complications during and after anticoagulant treatment. Potential benefits include prevention of pregnancy and mitigation of menstrual bleeding that is often worsened after start of anticoagulation therapy. Current evidence suggests that patients may opt for a continuation of (all forms of) hormonal contraception during anticoagulant treatment, provided that they are adequately informed by the treating physicians. Combined oral contraceptives should be stopped before anticoagulant therapy may be discontinued, preferably after the second last menstrual cycle of the intended anticoagulant treatment period. If hormonal contraceptive treatment needs to be initiated in patients with a history of VTE, oral prostagen-only therapy or intra-uterine devices are to be preferred: this may be independent of the anticoagulation status and in light of a negligible risk of (recurrent) VTE associated with their use. [ABSTRACT FROM AUTHOR]

Objective: The National Family Health Survey-4 in India provided the first nationally representative estimates of hysterectomy among women aged 15-49. This paper aims to examine the national and state-level age-specific prevalence of hysterectomy, individual and household level factors associated with the procedure, and state-level indicators that may explain variation across states.Design: Cross-sectional, nationally representative household survey.Setting: National Family Health Survey was conducted across all Indian states and union territories between 2015 and 2016.Population: The survey covered 699 686 women between the ages of 15 and 49 years.Methods: Descriptive analyses and multivariate logistic regression.Main Outcome Measures: Women who reported ever having a hysterectomy and age at hysterectomy.Results: Age-specific prevalence of hysterectomy was 0.36% (0.33,0.39) among women aged 15-29; 3.59% (3.45,3.74) among women aged 30-39; and 9.20% (8.94,9.46) among women 40-49 years. There was considerable variation in prevalence by state. Four states reported age-specific prevalence similar to high-income settings. Approximately two-thirds of hysterectomies were conducted in private facilities, with similar patterns across age groups. At the national level, higher age and parity (at least two children); not having had formal schooling; rural residence (adjusted odds ratio [AOR] 1.36; 95% CI 1.27,1.45; P < 0.01) and higher wealth status were associated with higher odds of hysterectomy. Previously sterilised women had lower odds (AOR 0.64; 95% CI 0.61,0,68; P < 0.01) of reporting hysterectomy. Exploratory analyses suggest state-level factors associated with prevalence of hysterectomy include caesarean section, female illiteracy, and women's employment.Conclusions: Hysterectomy patterns among women aged 15-49 in India indicate the critical need to ensure treatment options for gynaecological morbidity and to address hysterectomy among young women in particular.Funding: This study was part of the RASTA initiative of the Population Council's India country office under the Evidence Project supported by USAID.Tweetable Abstract: Hysterectomy patterns in India highlight the need for alternatives to treat gynaecological morbidity among younger women. [ABSTRACT FROM AUTHOR]

Vaginal bleeding and subchorionic hematomas are associated with increased risk of both early and late pregnancy loss. Thrombin generation may play a pivotal role in the development of these complications. To determine the effects of thrombin on human endometrial stromal cells (hESCs), cells were treated with thrombin at baseline or during decidualization with cyclic adenosine monophosphate (cAMP)+medroxyprogesterone acetate (MPA). Next-generation RNA sequencing revealed that markers of decidualization (IGF-1, IGFBP-1, and prolactin [PRL]) were induced after the initiation of decidualization, whereas thrombin suppressed insulin-like growth factor (IGF)-1, Insulin-like growth factor binding protein (IGFBP)-1, and PRL gene expression at baseline and during decidualization. These effects were mediated through protease activated receptor (PAR)-1- and PAR-1- independent pathways. Thrombin decreased the secretion of a key marker of decidualization (PRL), altered the morphological transformation of decidualizing hESCs, and activated genes involved in matrix degradation and proinflammatory chemokines (Interleukin-8 and Interleukin-6). Genes encoding factors important for matrix stability (Col1α1, LOX) were suppressed. We suggest that intrauterine bleeding and generation of thrombin accentuates leukocyte extravasation and endometrial inflammation, impairs decidualization, and endometrial support of early pregnancy. [ABSTRACT FROM AUTHOR]

In the United States, approximately one in five persons experience period poverty, defined as the inability to obtain resources needed for healthy, safe, and dignified menstrual management. Limited access to an inadequate number of menstrual supplies may lead to longer-than-recommended use, which can increase skin chafing, disruption of vaginal flora, and intravaginal toxin overgrowth. However, period poverty goes beyond simply having enough menstrual products and can encompass the embarrassment, stigma, shame, and barriers in conversation surrounding menstruation. Discussion and critical examination of the multilayered attributes surrounding period poverty have been intermittent in academic literature, particularly from a domestic lens. Thus, this narrative review and theoretical analysis aimed to describe the epidemiology of period poverty and analyze its biological, socio-emotional, and societal implications. We applied a descriptive epidemiology approach of person, place, and time, and employed a social-ecological lens to examine risk factors. Our findings describe the incidence, distribution, and possible ways to alleviate period poverty. Practitioners, medical providers, and public health professionals may have limited knowledge of period poverty, what it entails, and who it impacts, but they have great potential to address it and associated menstrual inequities in their work. With its widespread implications for psychosocial and community-level health, this phenomenon needs urgent attention to promote menstrual equity as an issue of human rights and social justice. We conclude with research and policy recommendations for alleviating period poverty. [ABSTRACT FROM AUTHOR]

Background: Unusual menstrual bleeding is one of the most common side effects of IUD. Objective: Considering public enthusiasm to the use of herbal medicine, this study conducted to compare the effects of cumin and mefenamic acid capsules on menstrual bleeding in IUD users. Methods: This crossover triple-blind randomized clnical trial study was performed on 100 IUD users who came to 6 health centers in Karaj. Research took place in three stages. In the first stage menstrual bleeding was measured by using Hygam table. In the second stage all participants were randomly allocated to mefenamic acid and cumin groups. They took capsules for two consecutive cycle. In the third stage each research unit received the same treatment of the opposite group with replacing the medicine for two more consecutive cycle. Menstrual bleeding was assessed by using Hygam table for 5 cycle. Considering that the maximum efficacy time for cumin was 24 hours and for Mefenamic acid was6 to 8 hours, the use of drugs in 7 days during menstruation, had no effect on subsequent cycles. Data, was analyse by Chi-square and Fisherchr('39')s exact test, paired t-test, Wilcoxon. Results: The mean of menstrual bleeding was 154.26±60.08 and after treatment was 106.68±45.38 and 105.8±40.56 in the mefenamic acid and cumin groups. There was a significant difference in decrease of pain intensity in both groups (p

Introduction: Fennel has many medicinal properties and is used in the treatment of dysmenorrhea. Given the widespread use of herbal medicine among women for menstrual problems and considering the fact that there has been no study to date about the effect of fennel on menstrual bleeding and duration of menstrual bleeding through systematic review, the present study was conducted to determine the effect of fennel on the amount (primary outcome) and duration of menstrual bleeding and its side-effects (secondary outcomes). Materials: All articles, including Persian and English, with no time limit were searched for in the following databases: Medline (through PubMed), Scopus, EMBASE (through Ovid), Cochrane Library, Web of Sciences, Google Scholar, ProQuest, Clininaltrial.gov, SID, Magiran, Irandoc, and Iranmedex, using MeSH terms, including menstrual bleeding, menstruation, severity of bleeding, hypermenorrhea, menorrhagia, fennel, fennelin, Foeniculum vulgare, dysmenorrhea, and painful menstruation, which were searched separately or in combination. Two authors separately reviewed articles to determine the inclusion criteria, and any disagreement was resolved by reaching consensus with a third person. Results: A total of 7993 articles were identified through searching the databases, of which 7327 were excluded as duplicates and 666 were screened for inclusion. Six hundread and forty six were excluded by title and abstract based on not being relevant to the review and being conducted on animals. Eventually, six articles were included in the study and four articles entered into the meta-analysis. The results from meta-analysis showed that using fennel caused a significant increase in mean menstrual bleeding in the first cycle after treatment in the intervention group compared to the control (Std. mean difference: 0.46; 95 % CI: 0.18–0.73; p = 0.001; I2 = 9 %). However, it had no significant effect on menstrual bleeding in the second cycle after treatment (Mean difference: 1.44; 95 % CI:-5.09 to 7.96; p = 0.67; I2 = 0 %). Conclusions: The results of meta-analysis of four articles showed that in the first cycle after treatment, use of fennel increased menstrual bleeding in the intervention group compared to the control, but meta-analysis of two articles showed no significant difference between intervention and control groups in the amount of menstrual bleeding in the second cycle after treatment. Given the poor quality of articles, conducting clinical trials to determine the effect of fennel on menstrual bleeding appears necessary. [ABSTRACT FROM AUTHOR]

Uterine fibroids are benign uterine smooth muscle tumors that are present in up to 8 out of 10 women by the age of 50. Many of these women experience symptoms such as heavy and irregular menstrual bleeding, early pregnancy loss, and infertility. Traditionally believed to be inert masses, fibroids are now known to influence endometrial function at the molecular level. We present a comprehensive review of published studies on the effect of uterine fibroids on endometrial function. Our goal was to explore the current knowledge about how uterine fibroids interact with the endometrium and how these interactions influence clinical symptoms. Our review shows that submucosal fibroids produce a blunted decidualization response with decreased release of cytokines critical for implantation such as leukocyte inhibitory factor and cell adhesion molecules. Furthermore, fibroids alter the expression of genes relevant for implantation, such as bone morphogenetic protein receptor type II, glycodelin, among others. With regard to heavy menstrual bleeding, fibroids significantly alter the production of vasoconstrictors in the endometrium, leading to increased menstrual blood loss. Fibroids also increase the production of angiogenic factors such as basic fibroblast growth factor and reduce the production of coagulation factors resulting in heavy menses. Understanding the crosstalk between uterine fibroids and the endometrium will provide key insights into implantation and menstrual biology and drive the development of new and innovative therapeutic options for the management of symptoms in women with uterine fibroids. [ABSTRACT FROM AUTHOR]