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Study Objective The aim of the study was to examine the effect of heavy menstrual bleeding (HMB) and dysmenorrhea on daily activity and quality of life (QoL) in young women engaged in demanding activities. Design Cross-sectional study. Participants A total of 422 Israeli women soldiers in combat and non-combat roles. Interventions Participants were asked to provide consent and to complete study questionnaires. Main Outcome Measures A pictorial bleeding assessment chart (PBAC), visual analog scale (VAS), verbal multidimensional scoring system for assessment of dysmenorrhea, and approved Hebrew-translated age-appropriate Pediatric Quality of Life Inventory (PedsQL). Results HMB (PBAC >100) and severe HMB (PBAC >185) were demonstrated in 181 (50%) and 96 (26%) participants, respectively. A high PBAC score was recorded in 20% who answered “no” or “unknown” in the questionnaire on having HMB. Mild, moderate, and severe dysmenorrhea were demonstrated in 80 (21.5%), 115 (31%), and 142 (38%) participants, respectively. The prevalence of HMB and dysmenorrhea was similar in soldiers in combat and non-combat roles. Diagnosis of HMB was related to the lower fitness-for-service score, history of bleeding, and dysmenorrhea. Daily activity and QoL were both affected by the severity of HMB and dysmenorrhea. Conclusion Underdiagnosis of HMB and dysmenorrhea results from a combination of unawareness from the women's side and inattention from the system. In an era of female empowerment, each woman should be at the optimal physiological and psychological level to start her career; thus, addressing the menstrual burden and providing effective treatment is needed in the military scenario and other settings with demanding activities.

OBJECTIVE To assess the degree to which heavy menstrual bleeding is associated with depression, independent of hormonal contraception. STUDY DESIGN We performed a retrospective cohort study of 1168 female adolescents 9-18 years old presenting to general pediatricians for heavy menstrual bleeding or well visits. Depression was the primary outcome and defined as a diagnosis in the health record. Univariable and multivariable regression models were fit to the data to identify factors associated with depression diagnosis. RESULTS In total, 581 adolescents with heavy menstrual bleeding and 587 without heavy menstrual bleeding were included. Depression diagnoses occurred with greater frequency in youth with heavy menstrual bleeding compared with those without heavy menstrual bleeding (50.9% vs 24.2% P

Von Willebrand disease (VWD) is a common bleeding disorder, affecting male and female individuals equally, that often manifests in mucosal bleeding. VWD can be secondary to a quantitative (Type 1 and Type 3) or qualitative (Type 2) defects in Von Willebrand factor (VWF). Initial testing includes VWF antigen, as well as a platelet binding assay to differentiate between qualitative and quantitative defects. Further subtyping requires additional testing and is needed to ensure appropriate treatment. Desmopressin, antifibrinolytics, hormonal treatments for heavy menstrual bleeding, and VWF concentrates are commonly used in the treatment of VWD.

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.

OBJECTIVES The aims of the study were to evaluate the effects of two types of intrauterine contraceptive device (IUCD) on uterine artery Doppler indices. METHODS A multicentre randomised clinical trial was conducted between November 2019 and August 2020. Sixty-six multiparous women aged 18-45 years seeking intrauterine contraception were randomly assigned to receive either the levonorgestrel-releasing intrauterine system (LNG-IUS) or the copper intrauterine device (Cu-IUD). Each group comprised 33 participants. Primary outcome measures were menstrual changes and changes in uterine artery Doppler indices 3 and 6 months after IUCD insertion. Secondary outcomes measures were the relation between Doppler indices and menstrual changes, adverse effects of the assigned contraceptive method and user acceptability of the method. RESULTS Uterine artery pulsatility index (PI) and resistance index (RI) were significantly higher among women in the LNG-IUS group (p

Introduction: Uterine fibroids (UFs) are the most prevalent benign neoplastic threat originating from myometria of reproductive age women, with a profound financial load valued in hundreds of billions of dollars. Unfortunately, there is no curative treatment so far except surgery and available pharmacological treatments are restricted for short-term treatment options. Thus, there is a large unmet need in the UF space for noninvasive therapeutics.Areas covered: The authors reviewed the literature available for the utility of gonadotropin-releasing hormone (GnRH) analogs in women with UFs. We also focused on clinical studies exploring the therapeutic benefits of novel oral non-peptide GnRH antagonists that were recently approved by the U.S. Food and Drug Administration (FDA) in combination with estradiol/norethindrone acetate for the management of heavy menstrual bleeding associated with UFs in premenopausal women.Expert opinion: The results regarding the efficacy of new-generation oral GnRH-antagonists, such as elagolix, relugolix and linzagolix, are promising and offer potential prospect for the future therapy of UFs. However, these antagonists must be combined with hormonal add-back therapy to minimize the resultant hypoestrogenic side effects such as bone loss.

Background: Menstrual pain is a common problem in women of reproductive age.menstrual pain begings a few hours before or at the time of menstrual bleeding and lasts for 2-3 days. The pain is most intense during the first 24-36 hours of menstruation.pharmacological and non-pharmacological therepy is a way that can be done to eliminate and reduce menstrual pain. One of the non-pharmacological metods is to do abdominal stretching exercise. Objective: To determine the effect of abdominal stretching exercise on reducing menstrual pain scale in adolescents. Methods: This research design uses quantitative research, namely pre-experimental that is usingthe type of one group prettest design. The population in this study were 222 ikrst mp students and 31 students who met the inclusion criteria. The measurement of the menstrual pain scale in this study used the Nuumeric Rating Scale (NRS). Results: There was an effect of Abdominal Streching Exercise on the reduction of menstrual pain in adolescents seen from the P value with a value of 0.000 which means that the value is

Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss that interferes with quality of life. It is an under-diagnosed and under-treated disorder due to the poor correlation between patient perception and objective menstrual blood loss, as well as the scarcity of validated diagnostic tools. Anaemia caused by HMB is a common problem, underestimated on many occasions and with consequences that go beyond the scope of gynaecology. Despite the condition's negative effect on quality of life, most of the tools validated to detect HBM do not take this into account. The aim of this paper is to review the main instruments available to detect HMB, their advantages and disadvantages, their applicability in routine clinical practice, and to recommend those with the best characteristics.

Despite high prevalence of heavy menstrual bleeding (HMB) in adolescents and young women, most recommendations are not specific for this population, which makes the diagnosis and management challenging. Gynecologists should be able to establish underlying causes of HMB, which most common are nonstructural in adolescents, and the severity of bleeding, to provide early diagnosis, using appropriate therapy for improving quality of life and iron deficiency prevention. First line management consists of hormonal therapy approved for HMB treatment, capable to normalize menstrual blood loss and iron metabolism parameters.

Objective: Is the level of shared decision-making (SDM) higher after introduction of a SDM package (including encounter decision aids on treatment options for heavy menstrual bleeding and training for clinicians) than before?. Methods: This before-after study, performed in OB-GYN practice, compared consultations before and after introduction of a SDM package. The target sample size was 25 patients per group. Women seeking treatment for heavy menstrual bleeding were eligible. After their appointments, patients filled out a three-item patient-reported SDM measure. Treatment discussions were audio-recorded and rated for SDM using Observer OPTION 5. Consultation transcripts in the ‘after’ group were checked for adherence to the steps required for intended use of decision aids. Results: 16 gynaecologists participated. 25 patients participated before introduction of the decision aids and 28 after. The proportion of women reporting optimal SDM was higher after introduction (75 %) than before (50 %;p < 0.001). The mean observer-rated level of SDM was also significantly higher after than before (MD = 12.50,95 % CI 5.53–19.47). Conclusion: The level of SDM was higher after the introduction of the package than before. Practice implications: This study was conducted in a real-life setting in three clinics, both large academic and small rural, offering opportunities for implementation in different type of organizations.

Women's lack of awareness of the problem (OMC) and lack of understanding of the importance of discussing this problem with an obstetrician – gynecologist may limit women's access to specialized medical care. Currently, there is no accurate data on the reliable number of women with heavy menstrual bleeding. OMK significantly reduces the quality of life of a woman, both in the physical and emotional sphere, so the goals of OMK therapy are to reduce blood loss during menstruation, normalize and stabilize iron (in some situations - ferritin) and clinically significant improvement in the quality of life. The described clinical case of the management of a patient with copious menstrual bleeding without organic causes allowed us to demonstrate a positive effect on OMC of a combined oral contraceptive (COC) containing estradiol valerate in combination with dienogest with a dynamic dosage regimen (Clair's drug). This was confirmed both by the improvement of hematological parameters, such as hemoglobin, hematocrit and ferritin, and the quality of life of the patient. This drug can be recommended for use in women with this pathological process – heavy menstrual bleeding without organic causes. Multicenter randomized clinical trials, as well as real clinical practice studies, have proven the effectiveness of Clyra in women with OMC. The long-term use of Clyra has also been proven to be safe in relation to the risks of venous thromboembolism. An analysis of the published data showed that the use of the Claira combination for up to 5.5 years (on average for 2.1 years) was accompanied by the same or even lower risk of VTE compared to other COC and EE/LNG.

Levonorgestrel-containing intrauterine system Mirena refers to the first-line therapy of heavy menstrual bleeding (OMC) according to the recommendations of different countries. The efficacy, acceptability, and quality of life of women using Mirena are similar to those in the surgical treatment of abnormal uterine bleeding, including endometrial ablation and hysterectomy. The clinical case presented in this study of the management of a patient with heavy menstrual bleeding allowed us to demonstrate the effectiveness of the levonorgestrel-containing Mirena intrauterine system in OMC. The patient was observed in the consultative polyclinic of the V. D. Seredavin State Medical University. At the initial treatment, she complained of heavy menstruation, decreased performance, weight gain, and periodic increases in blood pressure. After a comprehensive clinical examination, taking into account heavy menstruation, a decrease in the quality of life, as well as the need for contraception, the introduction of the Mirena IUD was recommended. A year after the introduction of the IUD, the patient had amenorrhea. 5 years after the introduction of the Mirena IUD, the patient developed hot flashes, increased sweating, vaginal dryness, mood swings, sleep disorders, accompanied by an increase in FSH levels. The intrauterine system was removed and a new IUD - Mirena-was installed as a component of menopausal hormone therapy. After 2 months from the beginning of therapy, the complaints were completely stopped, the state of health is satisfactory, dryness in the vagina does not bother. Thus, the use of the LNG – IUD Mirena was effective for the relief of heavy menstrual bleeding, in addition, in women of this age group, it is possible to continue using the levonorgestrel-containing intrauterine system Mirena as a component of menopausal hormone therapy.

Long-acting reversible contraception (LARC) is the collective name for intrauterine contraception (copper intrauterine devices and levonorgestrel intrauterine systems) and the subdermal contraceptive implant . LARC methods are highly effective, require minimal user effort and do not require regular healthcare appointments; however the insertion and removal procedures can only be undertaken by clinicians trained to do so. The progestogen-only subdermal implant is the most effective method of reversible contraception in the United Kingdom and is licensed for 3 years. The copper intrauterine device is the most effective non-hormonal method of contraception. These devices are licensed for five or 10 years and can also be used as emergency contraception . The levonorgestrel intrauterine systems (LNG-IUS) are licensed for 3, 5, or 6 years. The Mirena LNG-IUS is also licensed for use in treating heavy menstrual bleeding and for endometrial protection as part of hormone replacement therapy.

Background: The intrauterine contraceptive device (IUCD) is a frequently used method of contraception all-over the world. The most common side effect of IUCD is menorrhagia which is accountable for increased removal rate in the first year of its use. Objective: To test the hypothesis that initial uterine artery pulsatility index (PI) and resistance index (RI) before insertion of Tcu 380A IUCD could predict IUCD-related heavy menstrual bleeding or not. Methodology: A cohort study was performed on 300 women who demanded copper IUCD insertion as a method of contraception. Full history, detailed examination and investigations were done. Hemoglobin (Hb) concentration and PI and RI of uterine artery were measured using voluson B6 equipment before IUCD insertion and 3 and 6 months after insertion. Results: 162 participants who suffered from heavy menstrual bleeding (group II) had significantly lower uterine artery PI and RI than 138 participants who did not suffer from heavy menstrual bleeding (group I) before IUCD insertion and 3 and 6 months after insertion (p-value 0.05). 64 participants in group II with severe heavy menstrual bleeding required removal of the IUCD at the 3 months follow up visit. A cut-off levels for Doppler indices of uterine artery were PI ≤1.52 and RI ≤0.66. Conclusion: PI and RI of uterine artery are lower in patients with IUCD-induced heavy menstrual bleeding before IUCD insertion. Initial measurement of Doppler indices of uterine artery could predict IUCD-related heavy bleeding.

Understanding characteristics associated with adherence to pre-exposure prophylaxis (PrEP) methods for HIV-1 prevention may assist with optimizing implementation efforts. The dapivirine vaginal ring is a novel topical PrEP delivery method. Using data from a randomized, double-blind, placebo-controlled, phase III trial of the dapivirine vaginal ring conducted in four African countries, generalized estimating equation models were used to evaluate correlates of ring adherence. Two levels of quarterly dapivirine blood plasma, and dapivirine released from returned rings defined measures of adherence for recent and cumulative use, respectively. Time on study, calendar time, primary partner knowledge that the participant was taking part in the study, and use of long-acting contraceptive methods were associated with ring adherence whereas younger age, ring worries, condom use, episodes of menstrual bleeding and vaginal washing were associated with non-adherence. These findings may be useful for recruitment into future clinical studies and dapivirine ring implementation efforts.

Dysfunctional Uterine Bleeding is defined as a state of abnormal uterine bleeding without any clinically detectable organic, systemic and iatrogenic cause. The prevalence varies widely but an incidence of 10% amongst new patients attending the outpatient seems logical. Along with increased susceptibility to iron deficiency, heavy menstrual bleeding can negatively impact physical, emotional and social quality of life and reduce work capacity of females. Objective: A clinical study was conducted to evaluate the effect of Sphatikayuktha Rasa Sindoora with Lodhra Kashaya in Dysfunctional Uterine Bleeding. Design: This pre-post interventional study was conducted among 20 females in the age group 20-45 years who had the symptoms of Dysfunctional Uterine Bleeding for the past 3 cycles. Drug administration started on the 3rd day of menstruation and was continued till bleeding stopped or upto a maximum of 7 days for 3 consecutive cycles. Follow up was done in the next cycle. The condition of the patient after drug administration in the first, second and third months were separately compared with the condition of the patient before treatment. Outcome measures: Outcome variables were change in the amount, duration and frequency of bleeding. Results and Discussion: Results were analysed statistically using Wilcoxon signed rank test and Paired t-test. The treatment was effective in reducing the amount of bleeding during treatment period and the follow up period. It was effective in reducing the duration of bleeding during the treatment period as compared to the follow up period and in controlling the cycle interval during the treatment period.

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.

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., Antonio Chamorro-Alejandro Otero Research Chair, University of Granada

Background: Dysmenorrhea is a pain that occurs during menstruation, caused by the contraction of the uterine muscles during menstrual bleeding which can last between 32-48 hours. This study aims to determine the decrease in pain intensity before and after giving warm compresses. Method; Type of study design is pre-experimental study design with one group pre-test and post-test design with a sample of 38 respondents. The independent variable in this study is warm compress on adolescent girls who have menstrual pain (dysmenorrhea), The dependent variable in this study is the reduction of menstrual pain (dysmenorrhea). The results found a decrease in the average pain scale before and after warm compress therapy and after Wilcoxon signed-rank test u, the results were obtained of p-value

Objectives To assess the predictive value of the initial uterine artery Doppler indices, the pulsatility index (PI), and resistance index (RI) in the prediction of heavy menstrual bleeding before and after copper intrauterine contraceptive device (IUCD) insertion. Methods The current prospective clinical study included 100 women who intended to use a copper IUCD (Cu T-380A) and met the inclusion criteria. Uterine artery Doppler PI and RI indices were calculated before IUCD insertion and at three and six months after insertion. Based on the presence or absence of menorrhagia, all women were classified into two groups: non-bleeding (n=52) and extreme menstrual bleeding (n=48). Receiver operating curve analysis was used to determine the predictive value of uterine artery PI and RI in patients with menorrhagia relevant to IUCD. Results The PI and RI indices displayed a highly significant difference between the IUCD groups at three and six months after insertion (P

Objectives More than 60,000 hysteroscopies are performed every year in the UK for common reasons such as heavy menstrual bleeding (HMB) or postmenopausal bleeding. A significant number of women requiring hysteroscopy receive oral anticoagulants and there is often a reluctance to perform these procedures due to bleeding concerns. Study Design We are presenting the first proof of concept cohort of patients undergoing minor hysteroscopic procedures while on anticoagulant or antiplatelet medication. A variety of minor procedures such as cervical dilatation, targeted endometrial biopsies, Pipelle endometrial biopsies and insertion or removal of intrauterine contraceptive devices were performed alongside hysteroscopy. Results Completion of planned procedures was feasible in all women due to minimal bleeding despite the ongoing anticoagulation or anti-platelet treatment. Conclusion More research is needed to establish the safety of performing diagnostic and operative hysteroscopies without bridging or interrupting anticoagulation or antiplatelet treatment.

INTRODUCTION: Uterine fibroids (UFs) are the most common benign tumor arising from myometrium of reproductive age women, with significant financial burden estimated in hundreds of billions of dollars. Unfortunately, there are limitations in available long-term treatment options. Thus, there is a large unmet need in the UF space for noninvasive therapeutics. AREAS COVERED: Authors reviewed the literature available for elagolix; an orally bioavailable, second-generation, non-peptide gonadotropin-releasing hormone (GnRH) antagonist recently approved by the US Food and Drug Administration (FDA) in combination with estradiol/norethindrone acetate for the management of heavy menstrual bleeding associated with UFs in premenopausal women. EXPERT OPINION: The utility of new-generation oral GnRH-antagonists, such as elagolix, relugolix and linzagolix, is offering a new potential opportunity for the future therapy of UFs: elagolix has been the most studied drug of this class for treating benign gynecological diseases including endometriosis and UFs, for which it has been US FDA-approved in 2018 and 2020 respectively.

According to Charaka Aacharya Rakta pradara is described under Pradar Roga. Excessive white discharge per vaginally is called as Shweta Pradara, when there is excessive or heavy menstrual bleeding is called as Raktapradara. Due to pradirana ( excessive excretion) of raja ( menstrual blood ), it is named as pradara and since, there is dirana ( excessive excretion ) of asrk ( menstrual blood ) hence, it is known as Asrigdara. Asrigdara appears to analogous to menorrhagia. In this review there is compilation of drugs used to treat Asrigdara. Here, in this review management and formulations along with preparations are being described. Drugs for external use, Vasti, Nasya, Churnas, Kawatha, Kalka, Leha, Guggulu, Modak, Ksheera, Taila, Rasa are being described with separate headings. Keywords: Asrigdara, Formulations, Preparations

Heavy Menstrual Bleeding (HMB) is a common gynaecological presentation, which can affect girls and women throughout their reproductive years and cause significant health issues. This review discusses the most recent evidence-based management of HMB and strategies for providing safe and effective care during the Covid 19 pandemic. Thus protocols and recommendations for HMB, developed to tackle the Covid 19, could become the 'new normal' for both primary and secondary care. There is a need for administrative changes, improved technology and effective communication to adapt these new recommendations.

Endometrial ovarian cysts are one of the most common gynecological disorders found in women of reproductive age. They are frequently the cause of surgical interventions, undertaken not only by gynecologists but also by pelvic surgeons. Therefore, at least in this context, endometrial ovarian cysts should be considered an interdisciplinary problem. Here we present a case of 22 years old female having irregular menses, painful menstrual periods with heavy menstrual bleeding for the last 9 months, she had consulted with Gynaecologist and diagnosed with left ovarian Endometriotic Cyst. She was treated with conventional medical therapies for the last 1year but no successful result. At this point, she took homoeopathic treatment (Pulsatilla followed by Medorrhinum) and showed normal USG findings within one year. This case shows the positive role of constitutional anti miasmatic homoeopathic treatment in Endometriotic cyst.

Sexism has been an issue in bleeding disorders for centuries. Women with bleeding disorders have been underrecognized and underdiagnosed. Those who are diagnosed often experience delays in diagnosis and feel that their symptoms are dismissed or minimized. Several factors contribute to this sexism. Historically, the clinical and research focus within the bleeding disorder community has been on men and hemophilia. Von Willebrand disease, a disease that has long been recognized as affecting women, is much more common than hemophilia, yet has significantly fewer resources devoted to it. The lack of knowledge and comfort that patients and health care providers have regarding menstruation compounds the issue, as heavy menstrual bleeding is one of the most common symptoms seen in women with bleeding disorders. Stemming from the universal stigmatization of periods, this lack of comfort and knowledge results in fewer women seeking care, fewer health care providers addressing the issue, and fewer women getting the care they deserve. Progress has been made, with many organizations dedicating resources to improving the care of these women. The road is long, and much more work is needed to ensure that women with bleeding disorders receive the care they deserve.

Background and aims: Von Willebrand disease (VWD) is an inherited disorder of blood clotting in humans. The prevalence of VWD is different among various populations. The prevalence of this disorder in women with menorrhagia is less reported in Asia and Iran. The present study aimed to determine the prevalence of VWD in women of reproductive age with heavy menstrual bleeding (HMB). Materials and Methods: A total of 160 women in the reproductive age group (15-45 years) with HMB who referred to the hematology clinic of Kashan Shahid Beheshti hospital during 2019 participated in this cross-sectional study. Demographic characteristics, clinical testing, and physician-reported problems of each participate including age, menstrual cycle length, uterine myoma, and polyp were collected using a questionnaire, sonography, and physical examination of women by a physician. The laboratory tests included hemoglobin (Hb), ferritin, iron, and total iron-binding capacity (TIBC). Results: Fifteen patients (9.3%) with severe menstrual bleeding had VWD with a mean age of 34.60±6.85 years. The frequency of the uterine fibroid (myoma) in women with VWD was significantly higher than that in patients without VWD (p =0.03). The mean ferritin level among 15 women with VWD and 145 women without VWD was 23±4.28 ug/dL and 30.68±4.46 ug/dL, respectively (p =0.001). The mean serum iron in total participants was 35.3±11.48 ug/dL and VWD patients had a lower iron level compared to those without VWD (p =0.001). There was not a significant difference in TIBC level between women with and without VWD (p =0.6). Conclusion: Based on the results, 9.3% of women of reproductive age with HMB in Kashan, Iran, had VWD, which is lower compared to other regions of Asia.

Uterine fibroids are the commonest tumors in women of child bearing age. 1 These often lead to significant morbidity especially in young women. The most common symptoms associated with leiomyomas are heavy menstrual bleeding, chronic pelvic pain, infertility pressure symptoms, and repeated abortions. 2 Fibroids can cause infertility by distorting the uterine cavity thereby preventing fertilization or implantation of the fertilized ovum. We here present a case series of three patients presenting with multiple uterine fibroids with varied symptomatology who underwent open myomectomy. Keywords: Large myomas, Heavy menstrual bleeding, Primary infertility, Degenerative changes.

To develop a bleeding-pattern prediction model to inform counselling on amount and regularity of bleeding after levonorgestrel-releasing intrauterine system (LNG-IUS) placement. Fixed-cluster and regression-tree models were developed using bleeding data pooled from two clinical trials of LNG-IUSs. Models were trained and cross-validated on LNG-IUS 12 data, then applied to LNG-IUS 20 and LNG-IUS 8 data. Three clusters were generated for the fixed-cluster model: predominantly amenorrhoea; predominantly spotting; and predominantly bleeding. A random-forest model predicted the future-bleeding cluster, then the probability of cycle regularity was calculated. In the regression-tree model, women were assigned by the model to less- or more-bleeding groups. With LNG-IUS 12 (n = 1351) in the fixed-cluster model, 70.4% of women were correctly classified. The correct classification rates for LNG-IUS 20 (n = 216) and LNG-IUS 8 (n = 1300) were 72.2% and 69.0%. The probability distribution for cycle regularity showed regular and irregular bleeding were best separated with LNG-IUS 12 data, and less well with LNG-IUS 20 and LNG-IUS 8 data. In the regression-tree model there was high variability in the more- and less-bleeding group distributions with LNG-IUS 12 data. A fixed-cluster model predicted bleeding patterns better than a regression-tree model in women using LNG-IUS, yielding understandable, informative output.