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Purpose: To describe the self-reported menstrual health, symptomatology, and perceived effects of the menstrual cycle on athletic performance for national and international Australian football (soccer) players. Methods: Players from national and domestic teams were invited to complete an online questionnaire regarding menstrual health, use of hormonal contraceptives (HCs), negative symptomatology, and perceived disruption of the menstrual cycle to performance. Descriptive statistics and binomial regressions with odds ratios (OR) were used to report the relationship of menstrual-related variables with perceived performance disruption. Results: A total of 199 players (20.9 [5.1] y) completed the questionnaire, with 18% of players reporting using HCs. One primary amenorrhea case was detected, and 26% of players reported menarche at age ≥15 years. For non-HC users, the prevalence of secondary amenorrhea was 2%, oligomenorrhea was 19%, and heavy menstrual bleeding was 11%. Ninety-seven percent of players reported experiencing physical or affective menstrual symptoms (5 [1.3] per player), and 40% of all players reported that menstrual symptoms impacted their ability to work, study, train, or compete. Furthermore, 40% of players perceived their training or performance to be disrupted by the menstrual cycle. Increasing number of menstrual symptoms (OR = 1.43; 95% CI, 1.28–1.62; P <.001), heavy menstrual bleeding (OR = 12.73; 95% CI, 3.4–82.8; P <.001), and pelvic pain (OR = 3.40; 95% CI, 1.7–7.2; P <.001) increased the likelihood of perceiving the menstrual cycle to disrupt performance. Conclusion: Heavy menstrual bleeding and HC use were low among this cohort of national and international footballers, whereas amenorrhea and oligomenorrhoea were comparable with other football populations. Nearly all players reported menstrual symptoms, and increased symptomatology was associated with greater perceived effects on performance. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To evaluate the worldwide use of FIGO's two systems for the classification of causes and contributors to nongestational abnormal uterine bleeding in the reproductive years by obstetrics and gynecology professionals worldwide, to identify knowledge gaps, and explore barriers to implementation.An electronic survey was developed by members of FIGO's Menstrual Disorders and Related Health Impacts (MDRHI) Committee to assess knowledge of abnormal uterine bleeding (AUB) and the two FIGO AUB systems among obstetricians and gynecologists. The survey was conducted online from February 28 to June 30, 2023, and comprised demographic questions, educational content inquiries, and a knowledge assessment. Available in English, Spanish, French, and Mandarin, the survey was disseminated through representatives of the World Association of Trainees in Obstetrics and Gynecology (WATOG), as well as through digital platforms and trainee‐focused Facebook groups.Out of 1317 initial participants from 65 countries, 1114 completed the survey. The highest representation was from China (42.6%), where both trainees and clinicians participated. Participation varied across FIGO regions, with Asia‐Oceania contributing the most (n = 602) and North America the least (n = 62). Most participants were in hospital‐based residency programs (73.9%), graduating around 2012 with 3 years of postgraduate medical education. Nearly 70% reported being familiar with FIGO systems, while over 93% were familiar with PALM‐COEIN. About one‐third reported frequent use of FIGO systems by faculty, except among French‐speaking respondents. Higher composite FIGO systems knowledge scores correlated with familiarity with FIGO AUB systems and PALM COEIN. Language did not significantly affect scores.FIGO's systems for nongestational AUB are widely used but gaps persist. Targeted strategies focusing on faculty development and research are needed to improve awareness and proficiency. This study highlights the necessity for interventions in medical education to enhance trainees' understanding and utilization of standardized nomenclature. [ABSTRACT FROM AUTHOR]

Introduction: Adenomyosis is a special subtype of endometriosis, affecting the myometrium, affecting about 20% of women in the reproductive age period. Clinical symptoms and intensity are diverse and can vary from heavy menstrual bleeding and dysmenorrhea to infertility and repeated pregnancy losses. Thus, patients often present with a long history of illness pending presumptive clinical or surgical diagnosis. A definitive diagnosis of adenomyosis is made upon histopathological examination verifying ectopic endometrial tissue (endometrial glands and/or stroma) within the myometrium, surrounded by hyperplastic and hypertrophic smooth muscles. However, nowadays ultrasonographic and/or MRI signs can precisely detect it as well. The precise etiology and pathogenesis remain unclear. One theory assumes that adenomyosis occurs through metaplastic transformation or migration of stem cell‐like cells. Material and Methods: Our study examined the immunohistochemical expression of the transmembrane proteoglycan Syndecan‐1 (CD 138), a multifunctional matrix receptor and signaling co‐receptor, in the endometrium of 35 patients (n = 21 with adenomyosis and n = 14 as a control group) in the period 2016–2017. Results: As a pilot study, we concluded that Syndecan‐1 is downregulated in adenomyosis patients compared to the control group, supporting its potential role in the development of adenomyosis. Our study did not find a correlation between the immune‐expression of Syndecan‐1 and the menstrual cycle phase. Conclusions: For clinical significance in relation to our results, the investigated data showed that the downregulation of Syndecan‐1 in adenomyotic patients in our study may suggest a role in promoting the invasiveness of endometriotic islands within the myometrium. However, further studies are still needed to understand the mechanistic contribution of Syndecan‐1 to the pathogenesis of adenomyosis. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Heavy menstrual bleeding (HMB) is a significant health concern that may lead to critical medical care and impaired quality of life. The aim of the present study was to identify the clinical indicators of common causes of HMB in adolescents and evaluate the factors influencing the treatment preferences of clinicians.Between 2010 and 2022, the electronic medical records of adolescents between the ages of 10–18 with HMB were reviewed, and a final of 205 adolescents was included. Clinical, laboratory, and treatment data were retrospectively analyzed.Hypothalamic–pituitary‐ovarian (HPO) axis immaturity was diagnosed in 63.9%, bleeding disorders (BD) in 13.7%, and polycystic ovary syndrome (PCOS) in 12.2% of the patients. The presence of “heavy bleeding” and the bleeding length at presentation were not different between the groups. Patients with a BD presented with lower hemoglobin (Hb) levels (P = 0.019), and more frequently required inpatient admissions (P = 0.005). Of all patients, 34.6% were given only iron, 44.9% were given a low dose, and 15.6% were given a high‐dose hormone treatment. Factors influencing high‐dose hormone regimens were lower Hb levels (P < 0.001), the place of visit (ER rather than the clinic) (P < 0.001), and the presence of multiple ER visits (P < 0.001).Physicians base their decisions to start high‐dose hormonal therapy on objective parameters such as Hb levels and the need for hospitalization, while more precise guidelines are deemed necessary for initiating low‐dose hormonal therapy. Standardized protocols and their practical implementation at the clinical level are needed for the management of HMB in adolescence. [ABSTRACT FROM AUTHOR]

Objective: Adenomyosis occurs when endometrial glands and stroma develop in the myometrium, leading to symptoms such as pelvic pain and heavy menstrual bleeding. Method: This randomized, double-blinded, controlled trial study was conducted on patients with adenomyosis referred to the Rasul-e-Akram Hospital. Group A received vaginal bromocriptine, and group B received dienogest. Transvaginal ultrasonography (TVS), visual analog scale (VAS), and pictorial blood loss assessment chart (PBLAC) evaluation were performed at the beginning and after 3, 6, and 9 months of the study. Result: The mean blood visual chart 3 and 6 months after intervention in the bromocriptine group was significantly lower than the dienogest group (P < 0.001). The mean intensity of menstrual pain 3 months after intervention was significantly lower in the dienogest group compared to the bromocriptine group (P < 0.001). There was a significant improvement in TVS appearance in both groups at the 6-month follow-up. Conclusion: Dienogest and bromocriptine both effectively reduced pain intensity, menstrual bleeding, and sonographic characteristics in patients with adenomyosis. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Methods Results Conclusion Heavy menstrual bleeding (HMB) affects up to 37% of adolescents. Given the paucity of available tools to assess health‐related quality of life (HRQoL) in adolescents with HMB, we developed the adolescent menstrual bleeding questionnaire (aMBQ), a valid and reliable measure of bleeding‐related quality of life. The aim of this study was cross‐cultural translation and adaptation of the English aMBQ into French to ensure accessibility for more Canadian adolescents who menstruate.A five‐step process was followed: (1) forward translation from English to Canadian French; (2) backward translation from French to English; (3) review of source and translated aMBQ to create a reconciled version; (4) cognitive debriefing to ensure linguistic and clinical equivalence and (5) review of cognitive debriefings to produce the final version of the French aMBQ. Results of cognitive debriefings were reviewed after every three participants; items were revised if presented as an issue by ≥2 participants. These changes were implemented and tested in cognitive debriefings until saturation was reached.Linguistic changes were made to nine (33%) of the questions and one (3.7%) answer options. Major changes were made to four of the 27 questions (15%), and minor changes were made to five of the 27 questions (19%).Professional translators, clinical experts and patient input through cognitive debriefing are pivotal to successful cross‐cultural translation. Results of cognitive debriefing interviews suggest the French aMBQ is easily understood and confirms its face validity. [ABSTRACT FROM AUTHOR]

Introduction: Menstrual disorders are commonly reported after COVID-19 vaccination and heavy menstrual bleeding was added to the product information of the COVID-19 vaccines of Moderna and Pfizer. The aim of this review, using a systematic search, is to provide an overview of available literature on the risk of menstrual disorders after COVID-19 vaccination. Methods: The review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. A PubMed search was performed on 15 August 2023, including solely quantitative studies in English and Dutch. Results: A total of 61 studies were included, of which 40 were cross-sectional studies, 18 cohort studies, and three self-controlled case series. Outcomes included a wide variety of menstrual disorders, including changes in cycle length (n = 54), changes in the amount of bleeding (n = 44), changes in menses length (n = 30), changes in the experience of (pre)menstrual pain (n = 21), and breakthrough bleeding (n = 18). All included studies found a higher percentage of at least one menstrual disorder in the first cycle after different types of COVID-19 vaccination and after different doses. Discussion: In conclusion, evidence suggests that COVID-19 vaccines may cause menstrual changes in women of reproductive age. However, there is a need for more longitudinal studies because of important limitations in the study designs of many of the included studies. Although menstrual changes are short-lived and predominantly mild, it is important for women and healthcare professionals to be informed about these potential adverse reactions and to assess these events in clinical trials on vaccines. [ABSTRACT FROM AUTHOR]

Objective: We carried out this study to explore the possibility of initiating goserelin therapy during the non-menstrual period in patients diagnosed with adenomyosis. Methods: 115 premenopausal adenomyosis patients were enrolled and divided into three groups based on their menstrual cycle phase during the initial outpatient visit: menstrual, follicular, and luteal. Each received a 3.6 mg subcutaneous dose of goserelin monthly for three months. The endpoints encompassed alterations in uterine volume, dysmenorrhea Numerical Rating Scale (NRS) score, CA125 level, hemoglobin (HGB) after a 12-week treatment course, and the occurrence and duration of uterine hemorrhage during the first treatment cycle. Results: Analysis revealed that the timing of goserelin therapy initiation in the menstrual cycle did not significantly impact its effectiveness in reducing uterine size, alleviating pain, lowering CA125 levels, or improving hemoglobin concentrations. However, patients starting treatment during the luteal phase experienced increased uterine bleeding (reference: menstrual period, OR = 4.33, 95% CI 1.23–15.25, p =.023). Conclusions: The results suggested non-inferiority of goserelin therapy initiated during the non-menstrual period, but the uterine bleeding rate was higher in the luteal phase group. Therefore, goserelin treatment for outpatient adenomyosis patients should not be limited to starting during the menstrual period; it can also be initiated outside the menstrual period, providing more convenience for patients as most consultations occur outside the menstrual period. However, the use of goserelin during the luteal phase should be avoided to reduce the risk of exacerbated bleeding, especially in anemic patients with heavy menstrual bleeding. This study highlights the importance of individualizing treatment initiation based on the patient's health profile to optimize therapeutic outcomes and minimize adverse effects. Trial registration: ChiCTR2200059548 [ABSTRACT FROM AUTHOR]

Purpose: Evaluating menstrual blood loss (MBL) in primary healthcare is challenging. Our study aimed to assess MBL using two methods: self-perception and pictograms (Pictorial Blood Assessment Chart—PBAC and Menstrual Pictogram superabsorbent polymer-c version—MP) in women undergoing transvaginal ultrasound (TVS). Methods: We enrolled 221 premenopausal women with spontaneous menstruation, no hormonal therapy, and no ongoing pregnancy. They were divided into four age groups (12–20, 21–30, 31–40, and 41–55 years). Women self-reported normal (NMB) or heavy menstrual bleeding (HMB) and filled out PBAC and MP. A PBAC score ≥ 150 and MP score ≥ 80 ml indicated HMB. TVS was conducted on all patients, recording any pelvic pathologies. We compared self-perception with pictograms across the cohort, age groups, and ultrasound findings. Results: Of the cohort, 50.2% reported normal periods and 49.8% heavy periods. No significant differences were found between self-perception and pictograms in identifying NMB and HMB across all groups. However, significant differences were observed between PBAC and MP scores for NMB (56.1% vs 41.2%, p = 0.001) and HMB (43.9% vs 58.8%, p = 0.001), particularly in the 31–40 age group. Significant differences in PBAC and MP scores were noted between age groups 12–20 and 41–55, and 31–40 and 41–55. No significant differences were found between self-perception and pictograms regarding ultrasound findings like adenomyosis, fibroids, endometrial pathology, and uterine congenital malformations. Conclusion: Self-perception could be a reliable method for describing MBL across all age groups and ultrasound findings. Given the complexity and potential errors in using pictograms, clinicians should consider relying on self-perception for assessing menstrual cycle quantity. [ABSTRACT FROM AUTHOR]

Background: Lupus anticoagulant hypoprothrombinemia syndrome (LAHPS) is a rare autoimmune condition characterized by acquired prothrombin (FII) deficiency associated with antiphospholipid syndrome (APS) and life-threatening bleeding. We present the case of a 34-year-old woman with heavy menstrual bleeding (HMB), positive Lupus anticoagulant (LA) test, and high titer anticardiolipin antibodies Immunoglobulin G (ACA IgG) and anti-β2 glycoprotein I antibodies IgG (antiB2GPI IgG). Severe iron deficiency anemia necessitated recurrent blood transfusions and intravenous iron infusions from 2018 to 2021. Results: In January 2022, she was admitted to our clinic. Von Willebrand disease screening and platelet function analysis (PFA100) were normal. FII and FIX deficiencies were detected, without factor IX inhibitors. Anti-phosphatidylserine/prothrombin antibodies were confirmed by Padua University lab. To reduce antibody titers and menstrual bleeding, immunosuppressive therapy (Rituximab 375 mg/m2 weekly ×4 weeks) and hormonal therapy (desogestrel 75 mcg/day) were initiated. Conclusion: After 1-year, complete remission of clinical symptoms was achieved, with normalization of FII and FIX values and moderate reduction of aPS/PT titers, especially IgM isotype. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate improvements in laboratory markers of anaemia (haemoglobin, haematocrit, serum iron, and ferritin) in women with subjective heavy menstrual bleeding (HMB) treated with the levonorgestrel 19.5-mg intrauterine device. Materials and methods: We conducted a pilot study at the Department of Obstetrics and Gynaecology, University of Campinas, Faculty of Medical Sciences, Campinas, SP, Brazil. We compared anaemia markers in 73 women aged 18–48 years suffering from HMB, one year after placement of the IUD. Results: The mean age of participants was 30.0 years (range 24–38); more than half were white, and the mean body mass index (kg/m2) was 27.0. Twenty (27.4%) participants exited the study due to loss to follow-up (n = 12; 16.4%), expulsion (n = 7; 9.6%) and uterine perforation (n = 1; 1.4%). One-year post-IUD placement, amenorrhoea was reported by 10 (13.7%) women. According to intention-to-treat and per protocol analyses, the proportion of women with normal haemoglobin levels significantly improved (p = 0.014 in both analyses), as did haematocrit (p < 0.001 in both analyses) and serum iron (p = 0.003 in both analyses) compared to baseline evaluations. The proportion of women with normal ferritin levels also improved (p < 0.001) in both analyses using a cut-off of 15 ng/ml, though no significant difference was observed using a 30 ng/ml cut-off (p = 0.083 in both analyses). Conclusion: The levonorgestrel 19.5-mg IUD effectively improved laboratory markers of anaemia one year after placement in women with HMB. SHORT CONDENSATION: Our results show that the levonorgestrel 19.5-mg IUD significantly improved anaemia markers in subjects with subjective HMB one year after insertion. The occurrence of expulsions emerged as a notable concern in this treatment group. [ABSTRACT FROM AUTHOR]

• AEH is linked to a high incidence of concurrent EC. • ET >9 mm and non-oncology centre endometrial sampling increase risk of concurrent EC. • Heavy menstrual bleeding and high parity decrease the chance of concurrent EC. • Staging surgery in AEH patients will avoid re-surgeries. • It will also help in planning adjuvant treatment. The study aimed to evaluate the incidence of concurrent endometrial cancer (EC) and lymph node positivity in patients with Atypical Endometrial Hyperplasia (AEH) who underwent surgical staging with sentinel lymph node evaluation. It also sought to identify the risk factors associated with detecting concurrent endometrial cancer in patients with a preoperative diagnosis of AEH. A retrospective study was conducted at Amrita Institute of Medical Sciences, involving 54 cases of AEH diagnosed on pre-operative biopsy specimens and undergoing staging surgery between January 1, 2015, and December 31, 2020. The study analysed demographic parameters, clinical presentations, pathological features, and clinical outcomes. Categorical variables were expressed in numbers and percentages, normal distribution data were presented as mean, and non-normal distribution data were presented as median and range. Fifty-four patients diagnosed with AEH underwent surgical staging. The median age was 54 years. Final HistoPathology Report (HPR) showed 48.14 % with AEH and 51.85 % with concurrent EC. Among those with concurrent EC, 96.4 % had type I EC, and one patient was upgraded to type 2 EC. Among them, 17.8 % patients belonged to high-intermediate and high-risk categories. Patients with AEH and concurrent EC were more likely to be diabetic (OR: 3.56, p = 0.04), have a BMI ≥25 kg/m2 (OR: 1.47, p = 0.04), exhibit a thickened endometrial lining of ≥9 mm (OR: 3.13, p = 0.05) on ultrasound, and undergo preoperative biopsy at a non-oncology centre (OR: 8.33, p = 0.001) whereas experiencing heavy menstrual bleeding had a substantially lower likelihood (OR: 0.29, p = 0.01) of developing concurrent EC. The study revealed that more than half of patients undergoing staging surgery for AEH were found to be at risk of having concurrent EC in their final HPR. The research also pointed out that surgical staging can help identify both low-risk and high-risk ECs, which may require additional treatment. Higher BMI, diabetes mellitus, and an endometrial thickness of ≥9 mm were identified as significant risk factors for concurrent EC. Additionally, heavy menstrual bleeding was associated with a decreased risk of concurrent EC. [ABSTRACT FROM AUTHOR]

Premenstrual syndrome (PMS), dysmenorrhea, and abnormal uterine bleeding are frequent gynecological problems in adolescent girls. Studies show that sleep disorders and menstrual cycle irregularities are common conditions and indicate that they may occur together. Studies on the relationship between sleep quality and menstruation are mostly available for late adolescents (17 years and older) and young adult age groups. Our study aims to evaluate this relationship in adolescents aged 12-18. A survey study was structured and consisted of 4 sections. The first section includes anthropometric measurements and medical history of the participants; the second section includes "menstruation and menstruation symptoms history"; the third section includes "The Sleep Quality Scale and Sleep Variable Questionnaire"; and the fourth section includes the "Premenstrual Syndrome Assessment Scale" (PMSAS). Our survey was applied to those who visited the adolescent medicine outpatient clinic. The Sleep Quality Scale score was significantly lower in those with high PMSAS scores (P <.001). The participants who had dysmenorrhea and experienced other symptoms during menstruation had significantly lower SQS scores and sleep efficiency (SE) (P <.001). There was no significant difference between heavy menstrual bleeding, defined as lasting more than 7 days, requiring more than 5-6 pads/tampons per day, and SE/quality (P >.05). According to our study, dysmenorrhea and the presence of PMS may negatively affect the sleep quality of adolescents. Health professionals dealing with young people should take into account the effects of menstrual problems on sleep quality and offer appropriate support/treatment options. [ABSTRACT FROM AUTHOR]

The article discusses the use of menstrual suppression to reduce intrauterine device expulsion in adolescents with inherited bleeding disorders. The study found that hormonal menstrual suppression was effective in preventing early device expulsion due to excessive bleeding. The research suggests that concurrent menstrual suppression for at least 30 days after insertion may enhance safety and minimize complications in this vulnerable population. The authors emphasize the importance of managing heavy menstrual bleeding in adolescents with inherited bleeding disorders to improve outcomes and reduce expulsion rates. [Extracted from the article]

AbstractObjectiveMaterials and methodsResultsConclusions\nSHORT CONDENSATIONTo determine practice patterns in the diagnosis and management of nongestational abnormal uterine bleeding (AUB) in women in reproductive years during the SARS-CoV-2 (COVID-19) pandemic in Brazil.A web-based survey was conducted to determine the impact of the COVID-19 pandemic on the diagnosis and management of women with AUB. Survey elements included treatment location, the use of ultrasonography, laboratory evaluation for iron deficiency and some hormone determinations, and endometrial evaluation by histopathology, as well as the practice of hysteroscopy, hysterectomy and medical therapy including the placement of the 52 mg levonorgestrel-intrauterine system (LNG-IUS52). The survey was completed electronically at scientific meetings or sent by e-mail to Brazil-based OBGYNs between April and September 2021 during the COVID-19 quarantine.Fully completed questionnaires were received from 541 physicians aged (mean ± SD) 46.6 ± 12.5 years. Whereas the overall number of AUB-related visits decreased (p < 0.001) compared to the pre-pandemic period, the reduction was in office-based encounters; AUB-related visits at emergency facilities did not change. Telehealth-based AUB consultations increased from 1.3% at pre-pandemic to 34.3% (p < 0.001) during the pandemic. There were significant reductions in the use of diagnostic hysteroscopy (p < 0.001), endometrial biopsy (p < 0.001), therapies with the LNG-IUS52, combined oral contraceptives and hysterectomies (p = 0.002, p = 0.006 and p < 0.001, respectively).In Brazil, during the COVID-19 pandemic, there was a decrease in AUB-related consultations, a slight increase in telehealth visits and a reduction in the use of procedures and treatments.We observed changes in the management of women with abnormal uterine bleeding, probably because of an unprepared healthcare system and the need to direct resources to the care of COVID-19 patients. [ABSTRACT FROM AUTHOR]

The article discusses the sustained myocardial iron intake following intravenous iron therapy with ferric carboxymaltose for up to 1 year, despite the recurrence of iron deficiency. The study found that myocardial iron levels remained elevated while spleen iron levels declined over time. The findings suggest that repeated doses of intravenous iron therapy may lead to cumulative myocardial iron build-up, highlighting the need for further research on the long-term effects of this therapy on heart function and iron levels. [Extracted from the article]

Objective Methods Results Conclusion The primary objective was to evaluate the prevalence of undiagnosed iron deficiency in patients with endometriosis.We performed a multi‐center, cross‐sectional study at two tertiary care hospitals. We included 251 non‐pregnant women (18–50 years old) presenting with a clinical or surgical diagnosis of symptomatic endometriosis. Patients who consented to the study underwent screening bloodwork (including complete blood count, ferritin, and transferrin saturation) and completed the study survey assessing demographics, medical and surgical history, and validated questionnaires to assess iron deficiency and endometriosis symptoms.The prevalence of iron deficiency in our endometriosis cohort was 53.4% (134/251), and the prevalence of iron deficiency anemia was 13.5% (34/251). Patients with iron deficiency were more likely to have heavy menstrual bleeding (HMB) compared with patients without iron deficiency (66/133, 49.6% vs. 40/115, 34.8%, p = 0.022). Nonetheless, 58% (142/251) of our study population did not endorse HMB. Despite absence of HMB, 47% (67/142) of these patients were iron‐deficient. Transferrin saturation was diagnostic for iron deficiency in 63 of 176 patients (35.7%) who had a normal ferritin (≥30 ng/mL). Patients with iron deficiency had a significantly lower adjusted median Functional Assessment of Chronic Illness Therapy Fatigue Subscale score compared with those without iron deficiency (26.3. vs. 29.8, p = 0.025).This study highlights the high prevalence of iron deficiency, which remains undiagnosed in over half of patients with endometriosis presenting to a gynecologist. Future research should focus on assessing the effectiveness of iron therapy in improving symptoms and overall well‐being in this population. [ABSTRACT FROM AUTHOR]

A 33-year-old gravida 0 Black woman presents to her primary care clinician with heavy menstrual bleeding and abdominal bloating. She is noted to have irondeficiency anemia. Evaluation for thalassemia and sickle cell anemia is negative. She has no hematochezia and no family history of colon cancer or inflammatory bowel disease. She describes her menses as regular and monthly, lasting for 8 days, and unchanged over time. She uses eight or nine tampons per day for the three heaviest days of her cycle and occasionally has menstrual accidents. She is in a Ph.D. program and anticipates pursuing pregnancy in 2 years. Ultrasonography reveals an enlarged uterus with multiple fibroids and normal ovaries. How would you treat this patient? [ABSTRACT FROM AUTHOR]

Objective To explore the feasibility and clinical effects of a novel hysteroscopic levonorgestrel-releasing intrauterine system (LNG-IUS) fixation at the fundus of uterus. Methods From Aug 2023 to Jan 2024, a prospective and novel hysteroscopic LNG-IUS fixation at the fundus of uterus surgery was performed at Obstetrics and Gynecology Hospital, Fudan University. The patient’s clinical symptoms, surgical time, surgical complications, postoperative LNG-IUS expulsion, and other follow-up information were recorded. Results A total of 21 patients were included in this study, with an average age of (37.8±6.8) years old. The average uterine depth was (9.06±0.74) cm. Among them，8 cases had a history of LNG-IUS expulsion (uterine depth>8.5 cm in 5 cases, uterine depth≤8.5 cm in 3 cases, but the cervical canal was relatively loose), and other 13 cases had no history of LNG-IUS expulsion, but the uterine depth was all deeper than 8.5 cm. The average surgical time was (14.0±4.3) minutes, and the average intraoperative blood loss was (4.5±3.3) mL. All patients did not experience complications such as uterine perforation，massive bleeding, fluid overload, or postoperative infection. The average follow-up time after surgery was (3.2±0.8) months, and there was no LNG-IUS expulsion occured. The pain assessment and mean menstrual flow after operation were less than those before operation, and the endometrial thickness and mean uterine volume after operation were lower than those before operation, with statistically significant differences. For patients with dysmenorrhea, the postoperative relief rate was 95.0% (19/20), and for those with excessive menstruation, the postoperative effective rate reached 94.4% (17/18) . The main adverse reaction was irregular vaginal bleeding, with an incidence rate of 57.1% (12/21) . Conclusion Hysteroscopic LNG-IUS fixation at the fundus of uterus is safe and effective. The procedure is simple, minimally invasive, has a short surgical time, minimal bleeding, and fast recovery. It is suitable for patients with dysmenorrhea, excessive menstruation, or large uterine cavity who have previously experienced LNG-IUS expulsion. [ABSTRACT FROM AUTHOR]

Introduction: The needs of haemophilia carriers (HC) have been historically overlooked. It is now recognised that HC manifests bleeding symptoms, including haemarthrosis. The natural history of joint health in HC is not yet defined. Aim: A multi‐institutional cross‐sectional study aimed to evaluate the characteristics of joint disease in HC, aged 18–40 years, compared to age‐matched controls. Methods: The carrier cohort included females with confirmed HC status. Controls had no personal or family history of bleeding disorders. All females with a history of joint trauma or surgery within 12 months or any history of joint replacement were excluded. Joint health was assessed by clinical history, Haemophilia Joint Health Score (HJHS) and point‐of‐care musculoskeletal ultrasonography (POC‐MSKUS). Results: Thirty HC and 30 controls were enrolled. For HC, the median factor activity level was 52% (range 17%–100%). Carriers, regardless of baseline factor activity levels, reported higher prevalence of chronic joint pain (p <.001) and swelling (p =.002) than controls. Heavy menstrual bleeding, epistaxis, gingival bleeding and easy bruising were also more prevalent in HC (p <.001). Despite HC having a higher median HJHS score (5 vs. 0, p <.001), no differences were observed when using POC‐MSKUS. HC with a body mass index ≥25 mg/m2 reported more haemarthrosis (p =.037). Conclusions: HC are at increased risk of joint‐related symptoms and poorer joint health than age‐matched controls. Dedicated follow‐up to prevent and treat joint disease in HC is imperative. This study is also a call for additional investigation to clarify the association, or lack thereof, between factor activity and joint disease. [ABSTRACT FROM AUTHOR]

Introduction: Glanzmann thrombasthenia (GT) is a platelet function disorder. Symptoms include bruising and bleeding, which may be severe and life‐threatening. The day‐to‐day experiences of those affected remain poorly documented. Aims: The Glanzmann's 360 study aimed to better understand the daily realities of living with GT, exploring psychological, social and medical challenges to identify unmet need. Methods: People with GT over 18 and caregivers of children with GT participated. Mixed methods research was used, including a survey and in‐depth interviews. The interviews, reported here, were audio‐recorded, transcribed and thematically analysed. Results: Nineteen interviews were conducted; 14 with people with GT and five caregivers. Mean age of those with GT was 32.9 years (range 2–78 years). Eight themes emerged: Diagnosis, Bleeding and Treatment, Menstruation, Fatigue, Identity, Abuse, Pregnancy, and The Future. Three participants described misdiagnosis. Caregivers reported early recognition and prompt diagnosis of their children. Bruising, the most commonly reported symptom, led to assumption of abuse. Six (32%) participants reported joint bleeds. External bleeding was normalised. Access to home treatment and local care were limited. Fatigue caused by anaemia was described. All women reported heavy menstrual bleeding. Choices around pregnancy were limited by 'medical pessimism'. Nevertheless, participants remained hopeful for the development of improved treatment options. Conclusion: People with GT face significant and often overlooked challenges. There is need for improved medical and psychological treatment and support, increased awareness of these needs amongst healthcare professionals, and research into developing comprehensive care models that address medical and psychosocial needs of people with GT. [ABSTRACT FROM AUTHOR]

Cavernous hemangioma within the female genital tract is an extremely rare pathology, characterized by irregular vascular spaces containing blood or thrombus. We present a unique case of a 42-year-old primiparous woman who presented with typical endometriosis symptoms such as dysmenorrhea, dyspareunia, and heavy menstrual bleeding. The patient also experienced complex postpartum symptoms, which were misdiagnosed as cholecystitis and retained placental products. Imaging studies suggested deep infiltrative endometriosis with extraovarian endometriotic lesions. Surgical exploration revealed a hemangioma within the right anterior broad ligament alongside peritoneal endometriosis lesions. The hemangioma itself expresses estrogen and progesterone receptors in stromal cells. The presence of steroid hormone receptors strongly suggests symptom alleviation during the menstrual cycle and the postpartum period. The coexistence of cavernous hemangioma and endometriosis in the broad ligament, previously unreported, and symptomatic overlap between the two conditions complicates diagnosis and management, emphasizing the need for comprehensive evaluation integrating clinical symptoms and imaging findings. [ABSTRACT FROM AUTHOR]

Purpose: To assess the current practices surrounding Uterine Fibroid Embolization (UFE) in Canada. Methods: An online survey was sent to Canadian Association for Interventional Radiology (CAIR) members. It included questions on symptoms prompting UFE, patient awareness, investigation, UFE settings, the number of UFE procedures, and post-UFE care. The findings were discussed at CAIR's 2023 annual meeting by an expert panel. Results: Out of 792 surveys sent, 87 were filled (11%). Menorrhagia is the most common indication for UFE (87%). Women's awareness of UFE as a treatment option for fibroids is viewed as poor or average by 94% of our survey respondents. Most respondents see patients in clinics (92%) before the procedure and evaluate fibroids with MRI pre-UFE (76%). There is variability in care post-UFE, with 33% of procedures being performed as day surgery while 67% lead to overnight stay. For pain management, intravenous analgesia (including patient-controlled analgesia) is used in 76% (63/83) of cases while 19% (16/83) of respondents mentioned using epidural analgesia. Finally, there is an even split between embolic agent used; non-spherical polyvinyl alcohol (50%) and spherical particles (50%). Conclusion: Respondents believe patients in Canada still have limited awareness of UFE. Interventional radiologists are increasingly involved in the entire patient care trajectory, overseeing pre-and post-procedure care and hospitalizing patients. For pain management after UFE, it is observed that while epidural analgesia has been demonstrated more effective than alternatives, it is not widely used as the primary method. [ABSTRACT FROM AUTHOR]

Hysterectomy is among the most frequently performed major gynaecological procedures globally. The primary indications include various benign conditions that have not responded to conservative management, including heavy menstrual bleeding, symptomatic uterine fibroids, chronic pelvic pain and uterine prolapse. Surgeons must be well-versed in surgical anatomy and the various approaches for performing a hysterectomy. The appropriate approach should be tailored for each patient whilst taking into consideration surgical risk factors as well as modern management of complications of hysterectomy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Menorrhagia, or excessive menstrual bleeding, is a common symptom in women with inherited bleeding disorders; they are conditions where the blood ability to clot is impaired. Some of the common bleeding disorders include von Willebrand disease (VWD), clotting factor deficiencies, and platelet function disorders. OBJECTIVE: To assess different types of inherited bleeding disorders in women with menorrhagia referred to the National Center of Hematology/Mustansiriyah University in Baghdad/Iraq. PATIENTS AND METHODS: A prospective study was carried out on 193 women who had experienced menorrhagia for a duration of 3 years, from 2020 to 2023. These women sought consultation at the National Centre of Hematology/Mustansiriyah University. All participants were diagnosed through various laboratory tests, including complete blood count, blood film, blood group and Rh, bleeding time, prothrombin time, activated partial thromboplastin time, fibrinogen level, factor assay, von Willebrand factor antigen using ELISA technique, ristocetin cofactor, and platelet function test. RESULTS: Out of the 193 women with menorrhagia who participated in this study, the majority of whom had an unidentified cause (36.3%), followed by VWD (30.1%) and platelet function disorders (21.2%). Other bleeding disorders ( thrombocytopenia and factors deficiencies) were 5.7% and 6.7%, respectively. Furthermore, the results showed that there was a significant difference in family history and consanguinity between patients with a hereditary bleeding disorder and nonhereditary bleeding disorder (P < 0.001). CONCLUSIONS: Fifty eight percent of females with Menorrhagia in this study have inherited bleeding disorders(IBDs), VWD, and thrombasthenia account for 51.3% are the most common causes of inherit bleeding disorder (IBD). Consanguineous marriage should be discouraged in Iraqi society to reduce such inherited diseases.