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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]

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]

Background and Objectives Study Design and Methods Results Conclusion Reproductive‐aged women are at an increased risk of developing iron deficiency (ID). We aimed to develop a non‐invasive screening tool to identify ID in women and assess the acceptability of screening.We screened women (age 18–49 years) in the community of Western Australia. Primary outcome: acceptability of screening, assessed by the feasibility of recruiting the required sample size (n = 323). Secondary outcomes: Hand grip strength, finger prick haemoglobin concentration (Hb), prevalence of heavy menstrual bleeding (HMB), diet, pregnancy history, blood donation, symptoms of ID and history of ID or anaemia (Hb < 120 g/L). Those with Hb <130 g/L and no history of iron therapy in the past 2 years were given referrals for venous full blood count and ferritin sampling.Across 5 days, we recruited 640 eligible women. Of which, 178 (28%) had HMB and 79 (12%) were anaemic. Mean age was 33.5 ± 9.2 years, and mean Hb was 132.4 ± 11.9 g/L. In the past 2 years: 335 (52%) were diagnosed with ID or anaemia; 322 (50%) had taken oral iron; and 210 (33%) had an intravenous iron infusion. Vegetarian diets were followed by 89 (14%); 40 (6%) were regular blood donors; 290 (45%) had a previous pregnancy.HMB increased the risk of symptoms of ID and having prior ID/anaemia diagnosis (67% vs. 47%) or treatment (p < 0.022). Hand grip strength showed a positive relationship with both Hb (adjusted R2 = 0.012, p = 0.004) and ferritin (adjusted R2 = 0.135, p = 0.005).ID screening was well accepted by women in the community, with high recruitment rates over a short period. Future screening tool development may consider incorporating hand grip strength and HMB assessment. [ABSTRACT FROM AUTHOR]

The phrase "abnormal uterine bleeding" (AUB) refers to a broad spectrum of irregularities in the menstrual cycle, such as differences in the volume, regularity, frequency, and length of flow outside of pregnancy. Excessive monthly blood loss, known as heavy menstrual bleeding, has a detrimental effect on a woman's social, physical, emotional, and/or economical well-being. It might show up alone or in combination with other symptoms. First line option includes LNG-IUS, hormonal medications like combined oral contraceptive pills, cyclical progesterons, non-hormonal medications like tranexamic acid, NSAIDS. The T-shaped, MIRENA is a cylindrical device that controls the pace at which hormones are released. It comprises 52 milligrams of levonorgestrel enclosed in a rate-regulating membrane. Initially, levonorgestrel is released at a rate of 20 µg per 24 hours; this drops to 11 µg per 24 hours after five years, yielding an average daily release rate of 14 µg over the device's lifetime. A prospective research was conducted on patients who were enrolled from February 2017 to February 2018 at the gynecology and obstetrics department of Rohilkhand Medical College and Hospital in Bareilly. We made use of the patient's data regarding her menstrual cycle and related adverse effects. It was utilized for follow up of patient. Pictorial Blood Loss Assessment Chart, weight, and hemoglobin were used to measure blood loss during each menstrual cycle in addition to other information. [ABSTRACT FROM AUTHOR]

Background: Contraceptive methods are well-established in their ability to prevent pregnancy and increase individual agency in childbearing. Evidence suggests that contraceptives can also be used to treat adverse conditions associated with menstruation, including abnormal and prolonged uterine bleeding, heavy menstrual bleeding, painful menstruation, endometriosis, uterine fibroids, and premenstrual dysphoric disorders. This review investigates the effects of contraceptive techniques such as contraceptive pills, and long-acting reversible contraceptives (e.g. intrauterine devices, implants) on menstrual morbidity. Methods: Over ten databases with no geographical boundaries were searched from inception until October 2023. Study designs were one of the following types to be included: parallel or cluster randomised controlled trials, controlled clinical trials, controlled before and after studies, interrupted time series studies, cohort or longitudinal analyses, regression discontinuity designs, and case-control studies. Ten team members screened the papers in pairs with a Kappa score of more than 7, and Covidence was used. Conflicts were resolved by discussion, and the full papers were divided among the reviewers to extract the data from eligible studies. Results: Hormonal contraceptives are considered a well-tolerated, non-invasive, and clinically effective treatment for abnormal and prolonged uterine bleeding, heavy menstrual bleeding, painful menstruation, endometriosis, uterine fibroids, and premenstrual dysphoric disorders. Our studies investigating quality of life or well-being in women with heavy menstrual bleeding, endometriosis, or uterine fibroids have found improvements in all dimensions assessed. Conclusions: Hormonal contraceptives significantly reduce pain, symptom severity, and abnormal bleeding patterns associated with women who suffer from heavy menstrual bleeding, endometriosis, and uterine fibroids. SHORT CONDENSATION: Hormonal contraceptives significantly reduce pain, symptom severity, and abnormal bleeding patterns associated with women who suffer from heavy menstrual bleeding, endometriosis, and uterine fibroids. Findings can inform clinical practice and policy decisions to ensure that women have access to safe and effective contraceptive options that promote both reproductive and non-reproductive health. [ABSTRACT FROM AUTHOR]

Aim: The 2018 International Federation of Gynecology and Obstetrics abnormal uterine bleeding System‐1 defines menstrual flow volume on a 3‐point scale based on subjective assessment. However, the normal flow range has not been established, and it is unclear whether subjective assessment is accurate. We investigated the normal menstrual flow volume range in Japanese women and whether the actual measured menstrual flow volume agreed with the subjective evaluation. Methods: We included female menstruating volunteers aged 18–49 years in this prospective observational study. Menstrual napkins were weighed before and after use for up to three cycles, and the values were recorded in an online diary. Results: Overall, 211 participants were recruited. All items were completed by 167 participants, and 497 menstrual cycles were included in the analysis. The median total menstrual flow volume per cycle for 497 cycles was 56.7 g. The 5th–95th percentile values ranged from 15.7 to 166.4 g. The mean value was 77.6 ± 99.6 g, with no significant differences according to age group. In the 25 cycles corresponding to heavy flow, that is, above the 95th percentile of measured flow volume, 92% were underrated as "normal" by subjective evaluation, and only 8% were correctly rated as "heavy." Conclusions: Our results clarify the actual menstrual flow volume in the Japanese population; this will contribute toward making women aware of the normal range of menstrual flow volume, which may facilitate appropriate preconception care. [ABSTRACT FROM AUTHOR]

Background: Heavy menstrual bleeding (HMB) and dysmenorrhea (DM) are common gynecological problems. Objective: To systematically review the needs, quality of life (QOL), and effectiveness of self‐management strategies among young women (12–25 years) with DM or HMB. Search Strategy: Relevant terms were searched through PubMed, EBSCO, Google Scholar, ProQuest, and Ovid between 2010 and 2022. Selection Criteria: Qualitative and quantitative studies published in peer‐reviewed journals, females aged 12–25, exploring DM or HMB, reporting supportive care needs, quality of life, self‐treatment strategies, and/or treatment‐seeking behavior. Data Collection and Analysis: Abstracts were reviewed for eligibility by two researchers. Included studies were extracted and assessed for quality independently by two authors, with discrepancies resolved through consensus or the involvement of a third researcher. Data extracted included study details, menstrual history, symptoms, self‐care strategies, and quality of life. The Joanna Briggs Institute checklists were used for quality assessment. Main Results: The search returned 285 190 studies, of which 55 were eligible for inclusion. Prevalence rates of HMB and DM were in the ranges 4%–63% and 42%–94%, respectively. Over 80% of young women with DM and HMB experienced physical and psychological problems, including pelvic pain, sleep issues, mood disturbance, diarrhea, and nausea. Academic performance and daily activities were severely affected. Most (>62%) named their mothers as their primary source of information, and friends as the secondary source (10%–65%). Few studies explored needs, but they could be inferred and fell under school‐related and social needs. QOL was poorer in those who had DM than those who did not. Pain was the most common issue that drove young women to find treatment. More than 70% used medication to reduce pain. More than half chose home remedies (e.g., heat therapy, massages, herbal tea, hot drinks). No studies provided information about the efficacy and dosage of medication and herbal remedies. Conclusions: HMB and DM have a large impact on daily living, with large areas of unmet need. Limited access to information impairs the management of symptoms and consequent QOL. Synopsis: Heavy menstrual bleeding and dysmenorrhea significantly affect daily life, leaving numerous unmet needs. Insufficient information hinders symptom management, leading to compromised quality of life. [ABSTRACT FROM AUTHOR]

Objective: To determine whether adenomyosis is present in the cornual portion of hysterectomies of symptomatic sterilization device users and in patients hysterectomized for different benign causes and who presented with pelvic pain and/or menstrual alterations. Methods: An observational, analytical, cross‐sectional, single‐center, retrospective cohort study was conducted in a secondary level hospital. Cohort 1 consisted of women who had Essure® hysteroscopic sterilization devices inserted between 2009 and 2017, who developed gynecologic symptoms (pelvic pain, heavy menstrual bleeding, and/or abnormal uterine bleeding) and who underwent a hysterectomy for explantation of the devices. Cohort 2 consisted of women with the same gynecologic symptoms, who underwent a hysterectomy for other benign causes. All surgeries were performed by the gynecology team between 2018 and 2022. A descriptive and comparative analysis of sociodemographic, clinical characteristics, and pathologic findings between cohorts was made. Results: In total, 96 patients were studied (cohort 1 included 34 women, cohort 2 included 62 women). Pelvic pain was found to be more frequent in the cohort of Essure users (76.47% vs. 50%, P = 0.012), with a ratio of three times higher in this group (odds ratio 3.25, 95% confidence interval 1.27–8.28). Adenomyosis was more frequently found in the Essure group, both at corporal and cornual portions, the latter being five times higher in this cohort (relative risk = 5.47; 95% confidence interval 1.17–25.64). Conclusions: The present study may be the first to describe cornual adenomyosis related to Essure devices. These devices may play a role in the development of adenomyosis and, consequently, pelvic pain. However, causality is difficult to establish. Synopsis: The study provides new histopathologic findings in women with Essure® devices, suggesting new lines of research to deepen the symptomatology of its users. [ABSTRACT FROM AUTHOR]

AbstractObjectivesMaterials and methodsResultsConclusion\nSHORT CONDENSATIONTo 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.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.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).The levonorgestrel 19.5-mg IUD effectively improved laboratory markers of anaemia one year after placement in women with HMB.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]

Considering menstruation as a crucial factor in females' health and fertility, any factor that could change its cycle is important. This study was conducted from April 2021 to October 2022 on females who got 3 doses of vaccines against SARS‐CoV‐2 through different platforms. The participants were requested to provide the trained experts with any changes regarding menstrual cycles after each dose of the vaccine up to 6 months after the booster shots. The disturbances related to the vaccines were identified by the adverse events committee to find possible associations with the applied vaccines. Of 308 women who participated until the end of the study, 22 (7.1%) complained about at least one abnormality in their menstrual patterns. The most common disturbance was metrorrhagia as 10 (48%) incidences followed by menorrhagia as 6 events (24.2%). Notably, the identified complaints were persistent in 59% of the patients. In addition, 14 studied cases developed COVID‐19 infection after menstrual disorders. In these cases, COVID‐19 could also play a role in the persistence of postvaccine menstrual disturbances. COVID‐19 vaccination could affect menstrual cycle in women with no remarkable previous medical history. More longitudinal studies are required regarding this issue. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To investigate the benefits of menstrual management in women undergoing hematopoietic stem cell transplantation (HSCT), in whom heavy menstrual bleeding (HMB) can be an underestimated bleeding complication.This was a retrospective cohort study. Patients who had undergone HSCT in the Gynecological Endocrinology Clinic of Peking University People's Hospital were included over 10 years. The data of hematology and menstruation for all participants were collected. The management methods of the intervention group include gonadotropin‐releasing hormone agonists (GnRHa), combined oral contraceptives (COC), or low‐dose mifepristone. Patients who did not receive management were included in the control group.There were 112 patients included in the intervention group and 218 patients included in the control group. In all, 90.0%(297/330) of patients presented with HMB before HSCT. In the control group, 83.5%(182/218) of patients experienced menstruation in the laminar air‐flow room (LAFR), whereas only 22.3%(25/112) did in the intervention group. After leaving the LAFR, the incidence of recurrent uterine bleeding was significantly reduced in the intervention group (17.9%(20/112/) versus 50.9%(111/218), p < 0.001). Patients who did not undergo menstrual management had a higher risk of bleeding than those who did (odds ratio 18.12, p < 0.001).Menstrual management significantly reduces the incidence of HMB in HSCT patients and acts as a protective factor to prevent menstrual bleeding in the LAFR. [ABSTRACT FROM AUTHOR]

Aim: To investigate the clinical characteristics, diagnosis, and clinical treatment of submucosal cystic adenomyosis. Methods: The clinical data of five cases of patients with submucosal cystic adenomyosis in our hospital from January 2020 to June 2023 were retrospectively analyzed. Results: The average age of the patients was 37.8 ± 4.5 years old, three of them experienced prolonged menstruation and heavy menstrual bleeding. All patients had a history of abnormal uterine bleeding and mild to moderate dysmenorrhea, with a VAS score of 2.8 ± 1.6. The average Carbohydrate antigen 125 (CA125) value was 29.9 ± 23.6U/ml. Two out of the five patients (40%) had CA125 values above the upper limit of normal. The nodules had a diameter of 3.2 ± 1.3 cm and a cavity size of 1.3 ± 0.7 cm. Color ultrasound revealed hypo or iso or anechoic echoic cysts, and blood flow signals were detected. The magnetic resonance imaging (MRI) findings varied among each patient. All the patients underwent hysteroscopy and resection of uterine cavity-occupying lesions, and no recurrence was observed. Conclusions: The clinical features of submucosal cystic adenomyosis include abnormal uterine bleeding and menstrual changes, and the degree of dysmenorrhea is generally not severe. The diagnostic utility of CA125 in submucosal cystic adenomyosis may be limited. The three-dimensional ultrasound and MRI are valuable preoperative examination methods currently. Hysteroscopy can not only diagnose submucosal cystic adenomyosis, but also treat it, and preserve the fertility function of the patient. [ABSTRACT FROM AUTHOR]

This article discusses the accuracy of ultrasound in detecting adenomyosis, a uterine disease characterized by the presence of ectopic endometrium and stroma in the myometrium. The study found that ultrasound performed poorly in detecting adenomyosis, especially when fibroids were present. The sensitivity of ultrasound was compared to magnetic resonance imaging (MRI), which was found to be more accurate in diagnosing adenomyosis. The authors suggest that access to MRI should be improved to ensure appropriate management of adenomyosis. [Extracted from the article]

Objectives: The aim of the study was to identify an optimal magnetic resonance imaging (MRI)-based classification for the severity of adenomyosis and explore the factors associated with disease severity (dysmenorrhea or menorrhagia). Design: and Participants: Several classifications based on MRI have been proposed, and their phenotypes are reported to be associated with the severity of adenomyosis. However, a consensus classification based on MRI findings has not yet been reached. Our study was designed to retrospectively analyze data from a cohort of patients in the Affiliated Nanchong Central Hospital of North Sichuan Medical College from June 2017 to December 2021 before focused ultrasound ablation surgery (FUAS), identify the optimal classification of adenomyosis severity from different classification criteria, and explore factors associated with the presence of symptoms. Methods: The proportions of disease severity among different classification groups were compared to obtain the one generating the most considerable χ2 value, which was identified as the optimal classification for informing disease severity. A logistic regression model was constructed to explore factors associated with disease severity. Results: Classification of Kobayashi H (classification 4) concerning the affected areas and size (volumes of lesions) was recognized as the optimal one, which identified dysmenorrhea (χ2 = 18.550, p value = 0.002) and menorrhagia (χ2 = 15.060, p value = 0.010) secondary to adenomyosis. For volumes of the uterine wall <2/3, the dysmenorrhea rate in subtype 4 was higher than that in subtype 1 (χ2 = 4.114, p value = 0.043), and the dysmenorrhea rate in subtype 5 was higher than that in subtype 2 (χ2 = 4.357, p value = 0.037). Age (odds ratio [OR] = 0.899, 95% confidence interval [CI] = 0.810∼0.997, p value = 0.044) and external phenotype (OR = 3.588, 95% CI = 1.018∼12.643, p value = 0.047) were associated with dysmenorrhea. Concerning volumes of the uterine wall ≥2/3, the menorrhagia rate in subtype 3 remarkably increased compared with that in subtype 6 (χ2 = 9.776, p value = 0.002), and internal phenotype was identified as an independent factor associated with menorrhagia (OR = 1.706, 95% CI = 1.131∼2.573, p value = 0.011). Limitations: Patients in our study were all included before FUAS, which limited our result interpretation for the general patient population. Conclusions: MRI-based classification 4 is identified as an optimal classification for informing the severity of adenomyosis. The phenotype of classification is the main characteristic associated with disease severity. [ABSTRACT FROM AUTHOR]

Introduction: A number of barriers in care exist for women/girls with bleeding disorders. Little progress has been made to overcome them, particularly regarding levels of awareness of healthcare professionals (HCPs) and women/girls. Aim: To evaluate awareness and perception of heavy menstrual bleeding (HMB) and bleeding disorders among HCPs and women/girls. Methods: A three‐part qualitative study was conducted, including HCPs and women/girls from over seven countries. Part 1 included eleven 60‐min interviews with experts discussing HMB diagnostic barriers, which were further assessed in surveys among 6099 women/girls, 353 general practitioners (GPs), and 426 obstetricians and gynaecologists (OB/GYNs) during Part 2. Part 3 included three 1.5–2‐h workshops with 20 clinicians and patient representatives covering HMB knowledge, criteria defining HMB and HCP resourcing for diagnosis. Results: Many HCPs do not conduct certain investigations for women/girls presenting with HMB, and 22% of GPs lack confidence in the management of HMB. Only 8% of GPs use screening tools to evaluate menstrual blood loss, and 13% of GPs and 15% of OB/GYNs assess underlying bleeding disorders. Seventy‐six percent of menstruating women/girls believed they could recognise HMB symptoms 'well'. However, 23% of these women/girls would not seek medical advice for abnormal/prolonged menstruation disrupting their lives. Disruptions were reported in 34% of women/girls from the general population and 61% of women with at‐risk symptoms of HMB. Conclusion: Many women/girls and HCPs have limited awareness of important HMB indicators. There is a need for standardized clinical criteria to promote efficient diagnoses and management. [ABSTRACT FROM AUTHOR]

Tranexamic acid (TXA) is widely used among young women because of its ability to whiten skin and treat menorrhagia. Nevertheless, its potential effects on oocyte maturation and quality have not yet been clearly clarified. Melatonin (MT) is an endogenous hormone released by the pineal gland and believed to protect cells from oxidative stress injury. In the present study, we used an in vitro maturation model to investigate the toxicity of TXA and the protective role of MT in mouse oocytes. Compared with the control group, the TXA-exposed group had significantly lower nuclear maturation (57.72% vs. 94.08%, P < 0.001) and early embryo cleavage rates (38.18% vs. 87.66%, P < 0.001). Further study showed that spindle organization (52.56% vs. 18.77%, P < 0.01) and chromosome alignment (33.23% vs. 16.66%, P < 0.01) were also disrupted after TXA treatment. Mechanistically, we have demonstrated that TXA induced early apoptosis of oocytes (P < 0.001) by raising the level of reactive oxygen species (P < 0.001), which was consistent with an increase in mitochondrial damage (P < 0.01). Fortunately, all these effects except the spindle defect were successfully rescued by an appropriate level of MT. Collectively, our findings indicate that MT could partially reverse TXA-induced oocyte quality deterioration in mice by effectively improving mitochondrial function and reducing oxidative stress-mediated apoptosis. NEW & NOTEWORTHY: Tranexamic acid is increasingly used to whiten skin, reverse dermal damages, and treat heavy menstrual bleeding in young women. However, its potential toxicity in mammalian oocytes is still unclear. Our study revealed that tranexamic acid exposure impaired the mouse oocyte quality and subsequent embryo development. Meanwhile, melatonin has been found to exert beneficial effects in reducing tranexamic acid-induced mitochondrial dysfunction and oxidative stress. [ABSTRACT FROM AUTHOR]

Introduction: Abnormal uterine bleeding is defined as ‘‘bleeding from the uterine corpus that is abnormal in volume, regularity, and/or timing’’Menorrhagia is socially embarrassing, physically incapacitating condition and has great financial drain. About 10-15 % of women experience episodes of abnormal uterine bleeding at sometime during the reproductive years of their life. Its common during extremes of reproductive life, following pregnancy and during lactation. Material and Methods: The present study was undertaken to evaluate and compare the effect of ormeloxifene as compared to norethisterone on PBAC score, hemoglobin and endometrial thickness and any side effect arising out of their use. The present study was carried out in 70 women of age 25 to 40 years with complain of heavy and prolonged menstrual bleeding attending out patient and in patient department of Obstetrics and Gynaecology at VALASMC, Etah . The cases were randomly allocated to two groups. Group 1- included 31 cases who received ormeloxifene 60 mg twice a week for 12 weeks followed by 60 mg once a week for next 12 weeks & Group 2- included 32 cases who received 5 mg norethisterone twice daily for 21 days for 6 consecutive cycle. Results: After six months of Ormeloxifene treatment, mean hemoglobin increased from 8.1 gm/dl to 10.2 gm/dl. This increase was statistically significant (P< 0.0001. With Norethisterone, mean hemoglobin increased from 8.2 gm/dl to 9.6 gm/dl after six months of treatment. This increase was statistically significant (P< 0.0001). After three months of treatment with Ormeloxifene, mean endometrial thickness was decreased from 8.9 mm to 7.1 mm. This decrease was statistically significant (P< 0.0001). With Norethisterone, mean endometrial thickness was decreased from 9.1 mm to 8.1 mm after three months of treatment. This decrease was statistically significant (P< 0.0001). After six months of Ormeloxifene treatment, mean endometrial thickness was decreased from 8.9 mm to 6.1 mm. This decrease was statistically significant (P< 0.0001). After six months of Norethisterone treatment, mean endometrial thickness was decreased from 9.1 mm to 7.2 mm. This decrease was statistically significant (P< 0.0001) Conclusion: Thus it was concluded from the present study that both drugs were effective in treating abnormal uterine bleeding. . In the study Ormeloxifene was found to be effective than Norethisterone in reducing blood loss, improving Haemoglobin level and reducing endometrial thickness for treating AUB patients. Also compliance of the patients was good because drug was well tolerated, convenient dosage schedule for treatment of AUB.It can be used in any age group and is oncologically protective to the breast and endometrium. [ABSTRACT FROM AUTHOR]

Introduction: The study aimed to examine anemia prevalence and risk factors in employed women at a medical center compared to unemployed women from a charity center, with anemia defined as hemoglobin <120 g/L and iron deficiency as serum ferritin <30 ng/mL or serum iron <10 mcg/dL. Material and Methods: This cross-sectional study included 651 employed, non-pregnant randomly selected women aged 20-67 years. Participants completed questionnaires on sociodemographic, nutritional, and obstetrical characteristics. Blood indicators such as hemoglobin, serum ferritin, iron, and TIBC were measured. Results: Out of 651 participants, 395 (60.7%) had anemia/IDA (Hb <120 g/L, ferritin <30 ng/mL, or iron <10mcg/dL), comprising 308 (47.3%) having IDA and 215 (33%) having anemia. Younger age (<40 years) and menorrhagia were individually associated with 1.84- and 2.79- times increased risk of developing anemia in the studied population, respectively. A higher number of shifts and lack of vegetable consumption were found to be significantly prevalent in the anemic group. The prevalence of anemia/IDA among hospital staff and referred women was 60.7% and 43.1%, respectively. Conclusions: The study emphasized the influence of employment on the prevalence of anemia/IDA among hospital staff compared to unemployed women. [ABSTRACT FROM AUTHOR]

This article discusses the need for equitable access to menopause care for women, as they often experience inequitable healthcare. The British Menopause Society aims for every primary healthcare team to have a clinician with a special interest in menopause. The menopause can have a significant impact on women's physical and psychological well-being, and it is important to prioritize access to quality menopause care. The article describes a pilot project in central Liverpool that aims to improve patient access to specialist menopause care and reduce waiting times for appointments. The project involves collaboration between primary care networks and the local menopause service. The article also highlights the importance of women's health hubs, which can bridge the gap between primary and secondary care and provide quicker access to specialists. The funding model for the pilot project involves paying the primary care network per appointment attended. The article concludes by discussing the benefits of this model, including financial sustainability, improved access for patients, and potential capacity for other services. Overall, the pilot project aims to provide cost-effective and accessible menopause care for women in the region. [Extracted from the article]

Introduction: The study aimed to examine anemia prevalence and risk factors in employed women at a medical center compared to unemployed women from a charity center, with anemia defined as hemoglobin

Objective: Identification of heavy menstrual bleeding (HMB) cases in primary care settings is often done by using pictorial blood assessment charts (PBAC). The study aims to highlight the challenge of assessing blood loss, to develop a standardized method to efficiently customize a patient-reported pictorial chart, to validate the tool produced with our proposed method, and to demonstrate the feasibility of using PBACs in settings where resources are scarce. Materials and methods: Using blood samples and feedback from 21 women aged 30–51 years, we followed guidelines suggested in the literature, developed a method to produce PBACs for regular, long and night sizes, and had 9 participants testuse them. Linear regression analysis was performed to determine the correlation between participants’ scores and menstrual blood weight. Results: The study demonstrated the feasibility of customizing product-sensitive and size-specific pictorial charts by adopting essential steps including collecting menstrual blood with menstrual cups, employing fluid application techniques, and using sanitary pads as icons for easy identification. Linear regression analyses of score versus blood weight showed that the recorded blood weight was around 95% of the scored values (R2 = 0.9428, 0.947, and 0.9508, respectively; p

Background: Leiomyoma, also known as uterine fibroid, is a non-malignant tumor originating from the uterus's smooth muscles. It is the most common benign tumor in the female genital tract, exhibiting varying size and form that can distort the uterus's shape. Uterine fibroids affect 2.7-10.7% of pregnant women and can lead to increased risks during pregnancy, such as miscarriage, placental abruption, preterm labor, and fetal malpresentation. Myomectomy is a surgical intervention for uterine fibroids, but it has drawbacks, including hemorrhage, fever, infection, ureter ligation, adhesive disorders, and unplanned hysterectomy. Case Presentation: In this case report, we present a 32-yr-old woman with a large leiomyoma who underwent laparotomy myomectomy due to abdominal pain and heavy menstrual bleeding. 4 wk after the myomectomy, she was referred to the Obstetric Clinic of Ayatollah Taleghani hospital, Tehran, Iran complaining of delayed menstruation. Her beta-human chorionic gonadotropin test was positive. Ultrasound revealed a fetus with an estimated gestational age of 6 wk and 4 days. The pregnancy continued with no complications. At 38 wk of gestation, she underwent a cesarean section and delivered a healthy newborn. Conclusion: This case report supports previous publications that have demonstrated the safety of myomectomy during pregnancy. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the feasibility of further reducing the incidence of occult endometrial cancer in women undergoing hysterectomy for benign gynecological indications. Methods: Patients who underwent hysterectomies for presumed benign gynecologic conditions at Peking Union Medical College Hospital were retrospectively identified. Patients with occult endometrial cancer, which was defined as endometrial cancer diagnosed on postoperative histopathology with no preoperative confirmed malignancy, were selected. Results: 24/7558 (0.32%; 95% CI 0.20–0.47%) patients undergoing hysterectomy for benign indications had occult endometrial cancer. Asymptomatic patients with normal endometrial imaging all tended to have favorable pathology. Heavy menstrual bleeding was the most overlooked AUB pattern in the premenopausal group. In the postmenopausal group, all the patients with serous adenocarcinoma or G3 endometrioid adenocarcinoma histology/stage T1b disease/LVSI space invasion had a history of persistent or recurrent PMB ≥ 6 months and/or an intracavitary lesion > 20 mm in diameter. 3/4 of the samples of the postmenopausal patients did not have adequate endometrium for evaluation. Conclusion: To further reduce the incidence of occult endometrial cancer, physicians should focus on the patient's bleeding pattern and actively implement endometrial sampling whenever indicated. Transvaginal ultrasonography is a valuable preoperative evaluation. Hysteroscopy with directed biopsy is the preferred procedure in postmenopausal patients. [ABSTRACT FROM AUTHOR]

Background The mechanism of livedoid vasculopathy (LV) remains unknown. Objectives To investigate the association between coagulation factors and LV and to assess the efficacy and safety of rivaroxaban in the treatment of patients with LV. Methods From May 2019 to July 2022, 89 patients with LV and 35 healthy controls were included in a cross-sectional cohort to measure the levels of coagulation factors. In addition, 55 patients with LV treated with rivaroxaban were included in a treatment cohort to assess the complete remission rate of ulcers (n = 44) and retiform purpura (n = 11) within 12 weeks. Results In the cross-sectional cohort, the activities of coagulation factor X in patients with LV were significantly higher than those in healthy controls: median 110.5% [interquartile range (IQR) 97.5–127.0%] vs. 101.3% (IQR 91.6–115.6); P = 0.05. In addition, coagulation factor X activities in the progressive stage were higher than at the stable stage: median 111.6% (IQR 102.3–132.5) vs. 105.4% (IQR 92.9–118.8); P = 0.04. Moreover, coagulation factor X activities were higher at the progressive stage than at the stable stage in a subgroup of 20 patients with LV (P = 0.04). In the treatment cohort taking rivaroxaban, 91% (40/44) of patients with ulcers achieved complete remission within 12 weeks, and 73% (8/11) of patients with retiform purpura achieved complete remission within 12 weeks. Mild side-effects occurred in 25% of patients (14/55), including menorrhagia (n = 10), gingival bleeding (n = 3) and haemorrhage (n = 1). Conclusions Coagulation factor X was associated with the incidence and severity of LV in this study. In addition, rivaroxaban was an effective and safe treatment for ulcers and retiform purpura in people with LV. [ABSTRACT FROM AUTHOR]

Introduction: To prevent blood donors from developing iron deficiency (ferritin <15 μg/L) and subsequent anemia (hemoglobin <120 g/L), blood services rely on information about known risk factors, including the donor's sex and age. For example, while Finnish women are able to donate whole blood with a minimum donation interval of 91 days, women in the 18 to 25‐year‐old age group are recommended to donate no more than once per year. Menstrual blood loss is not accounted for in blood donation interval recommendations, despite being a known risk factor of iron deficiency. We aim to investigate to what extent menstrual bleeding is associated with ferritin and hemoglobin levels in female blood donors, and quantify the association of other menstruation‐related variables not currently accounted for by blood services (i.e., use of hormonal contraception, heavy menstrual bleeding) with iron deficiency or anemia. Material and Methods: The study population consisted of 473 premenopausal and 491 postmenopausal Dutch whole blood donors. Exclusion criteria were current pregnancy, BMI ≥50, ferritin ≥200, pictorial blood assessment chart (PBAC) ≥400, and age <18 or ≥70 years. Menstrual blood loss was quantified using a PBAC, a semiquantitative method to evaluate the number of used menstrual products and the degree of staining. We identified predictors of log(ferritin)/hemoglobin and iron deficiency/anemia using Bayesian linear and logistic regression models and quantified the average percentage of variance in log(ferritin) and hemoglobin explained by the covariates. Results: Menstrual blood loss accounted for most of the explained variance in hemoglobin (8%) and second only to the number of days since last donation for ferritin (8%). Heavy menstrual bleeding (PBAC ≥150, OR = 3.56 [1.45–8.85], prevalence 13%) was associated with anemia, and use of levonorgestrel‐releasing intrauterine device was negatively associated with iron deficiency (OR = 0.06 [0.01–0.44]). After statistical control for menstrual blood loss, age was not associated with iron status. Conclusions: Menstrual blood loss and blood donation were the most important determinants of iron status in premenopausal women. Thus, results suggest that accounting for menstrual blood loss in donation interval guidelines may benefit blood donors. [ABSTRACT FROM AUTHOR]

Background and Objective: During the COVID-19 vaccination campaign, over 34,000 reports of heavy menstrual bleeding following the administration of COVID-19 vaccines originating in the Economic European Area were submitted to EudraVigilance, the European Union database of suspected adverse drug reactions. More than 90% of these reports were sent by consumers while the remaining by healthcare professionals. Public concerns regarding menstruation disorders in COVID-19 vaccinees were also covered by the media. We investigated the impact of media attention on the reporting trends of heavy menstrual bleeding to EudraVigilance. Methods: We used media outlets published in the Economic European Area on menstrual disorders and COVID-19 vaccines from the beginning of the vaccination campaign in the Economic European Area (1 January, 2021) until December 2022 (i.e., after the regulatory request to add the adverse event to the product information) and spontaneous reports from EudraVigilance. Results: We found that the publication of safety updates from regulatory authorities and subsequent coverage in media outlets preceded increased reporting to EudraVigilance. Furthermore, the heavy menstrual bleeding reported in the cases occurred several weeks or months earlier and were not submitted to the respective date. The analysis suggests that the spikes in reporting of heavy menstrual bleeding were to some extent influenced by media coverage in some countries. Conclusions: Consumer reporting to the European Union spontaneous data collection system, EudraVigilance, was of high value for regulatory safety reviews, albeit the reporting behaviours were not free of the influence of the media. These sources of information can be investigated to understand the context of safety concerns of public health interest. [ABSTRACT FROM AUTHOR]