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Simoncini T, Arab H, Pedachenko N, Tian Q, Pineda F, Puranam B, Sohail R, Wender MCO. Unmet needs in abnormal uterine bleeding due to ovulatory dysfunction. Gynecol Endocrinol 2024; 40:2362244. [PMID: 38946226 DOI: 10.1080/09513590.2024.2362244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/27/2024] [Indexed: 07/02/2024] Open
Abstract
Ovulatory disorders are a common cause of abnormal uterine bleeding in women of reproductive age. The International Federation of Gynecology and Obstetrics currently offers a causal classification system for ovulatory disorders but does not provide clear management recommendations. There remains regional disparity in treatment practices, often influenced by institutional and insurance regulations as well as cultural and religious practices. A panel of experts evaluated current gaps in ovulatory disorder management guidelines and discussed potential strategies for addressing these unmet needs. Key gaps included a lack in consensus about the effectiveness of combined estrogen and progestogen versus progestogen alone, a paucity of evidence regarding the relative effectiveness of distinct hormonal molecules, a lack of data regarding optimal treatment duration, and limited guidance on optimal sequencing of treatment. Recommendations included development of a sequential treatment-line approach and development of a clinical guide addressing treatment scenarios common to all countries, which can then be adapted to local practices. It was also agreed that current guidelines do not address the unique clinical challenges of certain patient groups. The panel discussed how the complexity and variety of patient groups made the development of one single disease management algorithm unlikely; however, a simplified, decision-point hierarchy could potentially help direct therapeutic choices. Overall, the panel highlighted that greater advocacy for a tailored approach to the treatment of ovulatory disorders, including wider consideration of non-estrogen therapies, could help to improve care for people living with abnormal uterine bleeding due to ovarian dysfunction.
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Affiliation(s)
- Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Hisham Arab
- Obstetrics and Gynecology Department, Dr. Arab Medical Center, Jeddah, Saudi Arabia
| | - Nataliia Pedachenko
- Obstetrics, Gynecology and Perinatology Department, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Qinjie Tian
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Fernando Pineda
- Gynecology, Obstetrics and Urology, Higher School of Medicine of the National Polytechnic Institute, Mexico City, Mexico
| | - Balamba Puranam
- Obstetrics and Gynecology Department, Shalini Hospital, Barkatpura, India
| | - Rubina Sohail
- Department of Obstetrics and Gynecology, Services Institute of Medical Sciences, Lahore, Pakistan
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Sharp GC, Lavu D, Cooper A, Yarlett F, Brauer R. Intersection of menstrual and menopausal health with mental health: implications for general practice. Br J Gen Pract 2024; 74:390-391. [PMID: 39209720 PMCID: PMC11349366 DOI: 10.3399/bjgp24x739149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Affiliation(s)
- Gemma C Sharp
- Department of Psychology, Faculty of Health and Life Sciences, University of Exeter, Exeter
| | - Deepthi Lavu
- APEx (Exeter Collaboration for Academic Primary Care), Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter
| | - Alison Cooper
- Division of Population Medicine, School of Medicine, Cardiff University; GP Rumney Primary Care Centre, Cardiff
| | | | - Ruth Brauer
- Research Department of Practice and Policy, School of Pharmacy, University College London, London
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Zaheer A, Komel A, Abu Bakr MB, Singh AK, Saji AS, Kharal MM, Ahsan A, Khan MH, Akbar A. Potential for and challenges of menstrual blood as a non-invasive diagnostic specimen: current status and future directions. Ann Med Surg (Lond) 2024; 86:4591-4600. [PMID: 39118774 PMCID: PMC11305704 DOI: 10.1097/ms9.0000000000002261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/29/2024] [Indexed: 08/10/2024] Open
Abstract
Menstrual blood, which is often discarded as a waste product, has emerged as a valuable source of health information. The components of menstrual blood, such as endometrial cells, immune cells, proteins, and microbial signatures, provide insights into health. Studies have shown encouraging results for using menstrual blood to diagnose a variety of conditions, including hormonal imbalances, cervical cancer, endometriosis, chlamydia, diabetes, and other endocrine disorders. This review examines the potential of menstrual blood as a non-invasive diagnostic specimen, exploring its composition, promising applications, and recent advances. This review also discusses challenges to utilizing menstrual blood testing, including ethical considerations, the lack of standardized collection protocols, extensive validation studies, and the societal stigma around menstruation. Overcoming these challenges will open new avenues for personalized medicine and revolutionize healthcare for individuals who menstruate.
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Affiliation(s)
- Amna Zaheer
- Liaquat National Hospital and Medical College
| | - Aqsa Komel
- Department of Internal Medicine, Nishtar Medical University, Multan
| | | | | | - Alen Sam Saji
- Department of Anesthesiology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | | | - Areeba Ahsan
- Foundation University Medical College, Islamabad
| | | | - Anum Akbar
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
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Saeed Alqahtani SA, Osman Ali HT, Alasmre FA, Alghamdi RF, Alasmre HA, Alasmre LA, ALMuqrin F, Almuntashiri AA, Alshahrani MA, Majrashi MM. Effects of Weather on the Severity of Menstrual Symptoms Among College- and High School-Going Women in the Southern Regions of Saudi Arabia. Cureus 2024; 16:e66786. [PMID: 39268266 PMCID: PMC11392056 DOI: 10.7759/cureus.66786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND The effects of weather on the severity of menstrual symptoms have been a topic of interest and research for many years. While some studies have shown a correlation between weather conditions and increased severity of menstrual symptoms, others have found no significant relationship. OBJECTIVE The current study aimed to assess the effects of weather on the severity of menstrual symptoms among women going to college and high school in the southern regions of Saudi Arabia. METHODS A descriptive cross-sectional study was conducted targeting all women going to college and high school in southern regions of Saudi Arabia. An online questionnaire was used for data collection. The data were entered and analyzed in IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, NY), and stored with no attempts to identify the participants. RESULTS The study included 484 participants; most of them were 20-30 years old; 64.5% had regular menstrual cycles. It was observed that mood fluctuations, bloating, difficulty concentrating, breast pain, irritability, anxiety, social isolation, feeling tired, headaches, and mood changes are all affected to some degree before and during menstruation. On the other hand, the amount of blood, duration of the course, physical activity during menstruation, nutritional habits, lower back pain, and sleep disorders showed varying percentages of impact. These findings provide valuable insights into the physiological and psychological changes that occur during the menstrual cycle. CONCLUSION In conclusion, the relationship between weather and the severity of menstrual symptoms is a complex and multifaceted topic. While some women may perceive a correlation between certain weather conditions and an increase in symptom severity, the scientific evidence in support of this connection is still limited and inconclusive. Further research is needed to better understand the underlying mechanisms and to provide evidence-based recommendations for managing menstrual symptoms in relation to weather conditions.
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Affiliation(s)
| | | | - Faris A Alasmre
- Internal Medicine, College of Medicine, King Khalid University, Abha, SAU
| | | | - Hind A Alasmre
- Medicine, College of Medicine, King Khalid University, Abha, SAU
| | - Lujain A Alasmre
- Medicine, College of Medicine, King Khalid University, Abha, SAU
| | - Farah ALMuqrin
- Medicine, Imam Muhammed Ibn Saud Islamic University, Riyadh, SAU
| | - Ali A Almuntashiri
- General Practice, Um Sarar Primary Health Care Center, Khamis Mushait, SAU
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Payne LA, Seidman LC, Napadow V, Nickerson LD, Kumar P. Functional connectivity associations with menstrual pain characteristics in adolescents: an investigation of the triple network model. Pain 2024:00006396-990000000-00659. [PMID: 39037861 DOI: 10.1097/j.pain.0000000000003334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/12/2024] [Indexed: 07/24/2024]
Abstract
ABSTRACT Menstrual pain is associated with deficits in central pain processing, yet neuroimaging studies to date have all been limited by focusing on group comparisons of adult women with vs without menstrual pain. This study aimed to investigate the role of the triple network model (TNM) of brain networks in adolescent girls with varied menstrual pain severity ratings. One hundred participants (ages 13-19 years) completed a 6-min resting state functional magnetic resonance imaging (fMRI) scan and rated menstrual pain severity, menstrual pain interference, and cumulative menstrual pain exposure. Imaging analyses included age and gynecological age (years since menarche) as covariates. Menstrual pain severity was positively associated with functional connectivity between the cingulo-opercular salience network (cSN) and the sensory processing regions, limbic regions, and insula, and was also positively associated with connectivity between the left central executive network (CEN) and posterior regions. Menstrual pain interference was positively associated with connectivity between the cSN and widespread brain areas. In addition, menstrual pain interference was positively associated with connectivity within the left CEN, whereas connectivity both within the right CEN and between the right CEN and cortical areas outside the network (including the insula) were negatively associated with menstrual pain interference. Cumulative menstrual pain exposure shared a strong negative association with connectivity between the default mode network and other widespread regions associated with large-scale brain networks. These findings support a key role for the involvement of TNM brain networks in menstrual pain characteristics and suggest that alterations in pain processing exist in adolescents with varying levels of menstrual pain.
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Affiliation(s)
- Laura A Payne
- McLean Hospital, Belmont, MA, United States
- Harvard Medical School, Boston, MA, United States
| | | | - Vitaly Napadow
- Harvard Medical School, Boston, MA, United States
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
| | - Lisa D Nickerson
- McLean Hospital, Belmont, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Poornima Kumar
- McLean Hospital, Belmont, MA, United States
- Harvard Medical School, Boston, MA, United States
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Martin FZ, Easey KE, Howe LD, Fraser A, Lawlor DA, Relton CL, Sharp GC. A novel hypothesis-generating approach for detecting phenotypic associations using epigenetic data. Epigenomics 2024; 16:851-864. [PMID: 39016098 PMCID: PMC11370959 DOI: 10.1080/17501911.2024.2366157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/06/2024] [Indexed: 07/18/2024] Open
Abstract
Aim: Hypotheses about what phenotypes to include in causal analyses, that in turn can have clinical and policy implications, can be guided by hypothesis-free approaches leveraging the epigenome, for example.Materials & methods: Minimally adjusted epigenome-wide association studies (EWAS) using ALSPAC data were performed for example conditions, dysmenorrhea and heavy menstrual bleeding (HMB). Differentially methylated CpGs were searched in the EWAS Catalog and associated traits identified. Traits were compared between those with and without the example conditions in ALSPAC.Results: Seven CpG sites were associated with dysmenorrhea and two with HMB. Smoking and adverse childhood experience score were associated with both conditions in the hypothesis-testing phase.Conclusion: Hypothesis-generating EWAS can help identify associations for future analyses.
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Affiliation(s)
- Florence Z Martin
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Kayleigh E Easey
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Laura D Howe
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Caroline L Relton
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- London School of Hygiene & Tropical Medicine, London, UK
| | - Gemma C Sharp
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- School of Psychology, University of Exeter, Exeter, UK
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Mao C, Liu X, Guo SW. Meclizine improves endometrial repair and reduces simulated menstrual bleeding in mice with induced adenomyosis. Am J Obstet Gynecol 2024; 231:113.e1-113.e13. [PMID: 38367751 DOI: 10.1016/j.ajog.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/31/2024] [Accepted: 02/11/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Adenomyosis is one of the structural causes of abnormal uterine bleeding, which often presents as heavy menstrual bleeding. Mostly because of the poor understanding of its pathophysiology, medical management of adenomyosis-induced heavy menstrual bleeding is still a challenge. We have previously reported that glycolysis is crucial to endometrial repair following menstruation and that suppressed glycolysis can cause heavy menstrual bleeding. OBJECTIVE This study aimed to test the hypothesis that meclizine, a drug with an excellent safety profile, alleviates heavy menstrual bleeding in mice with induced adenomyosis using a simulated menstruation model. STUDY DESIGN Adenomyosis was induced in 36 female C57BL/6 mice using endometrial-myometrial interface disruption. Three months after induction, the mice were randomly divided into the following 3 groups: low-dose meclizine, high-dose meclizine, and controls. Treatment with meclizine or vehicle started shortly before the simulated menstruation procedure and ended before progesterone withdrawal. The amount of blood loss was quantified and uterine tissue was harvested for histologic evaluation of the grade of endometrial repair. We performed immunohistochemistry analysis of 4 proteins critically involved in glycolysis: Glut1 (glucose transporter 1), Hk2 (hexokinase 2), Pfkfb3 (6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3), and Pkm2 (pyruvate kinase M2). The extent of tissue fibrosis in both ectopic and eutopic endometria was evaluated using Masson trichrome staining. RESULTS In mice with induced adenomyosis, meclizine accelerated endometrial repair in a dose-dependent manner and reduced the amount of menstrual bleeding. Meclizine administration raised endometrial immunoexpression of Hk2 and Pfkfb3 but not of Glut1 or Pkm2. The extent of endometrial fibrosis was reduced following the meclizine administration. Remarkably, these favorable changes were accompanied by the suppression of lesional progression, as evidenced by the dose-dependent reduction in the extent of fibrosis (a surrogate for lesional progression). CONCLUSION These encouraging results, taken together, suggest that glycolysis may be a promising therapeutic target and that meclizine may hold therapeutic potential as a nonhormonal treatment for adenomyosis-induced heavy menstrual bleeding without exacerbating the disease.
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Affiliation(s)
- Chenyu Mao
- Department of General Gynecology, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China
| | - Xishi Liu
- Department of General Gynecology, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China
| | - Sun-Wei Guo
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China; Research Institute, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China.
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Iolascon A, Andolfo I, Russo R, Sanchez M, Busti F, Swinkels D, Aguilar Martinez P, Bou-Fakhredin R, Muckenthaler MU, Unal S, Porto G, Ganz T, Kattamis A, De Franceschi L, Cappellini MD, Munro MG, Taher A. Recommendations for diagnosis, treatment, and prevention of iron deficiency and iron deficiency anemia. Hemasphere 2024; 8:e108. [PMID: 39011129 PMCID: PMC11247274 DOI: 10.1002/hem3.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/16/2024] [Accepted: 05/27/2024] [Indexed: 07/17/2024] Open
Abstract
Iron is an essential nutrient and a constituent of ferroproteins and enzymes crucial for human life. Generally, nonmenstruating individuals preserve iron very efficiently, losing less than 0.1% of their body iron content each day, an amount that is replaced through dietary iron absorption. Most of the iron is in the hemoglobin (Hb) of red blood cells (RBCs); thus, blood loss is the most common cause of acute iron depletion and anemia worldwide, and reduced hemoglobin synthesis and anemia are the most common consequences of low plasma iron concentrations. The term iron deficiency (ID) refers to the reduction of total body iron stores due to impaired nutrition, reduced absorption secondary to gastrointestinal conditions, increased blood loss, and increased needs as in pregnancy. Iron deficiency anemia (IDA) is defined as low Hb or hematocrit associated with microcytic and hypochromic erythrocytes and low RBC count due to iron deficiency. IDA most commonly affects women of reproductive age, the developing fetus, children, patients with chronic and inflammatory diseases, and the elderly. IDA is the most frequent hematological disorder in children, with an incidence in industrialized countries of 20.1% between 0 and 4 years of age and 5.9% between 5 and 14 years (39% and 48.1% in developing countries). The diagnosis, management, and treatment of patients with ID and IDA change depending on age and gender and during pregnancy. We herein summarize what is known about the diagnosis, treatment, and prevention of ID and IDA and formulate a specific set of recommendations on this topic.
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Affiliation(s)
- Achille Iolascon
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università degli Studi di Napoli Federico II Napoli Italy
- CEINGE Biotecnologie Avanzate Franco Salvatore Napoli Italy
| | - Immacolata Andolfo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università degli Studi di Napoli Federico II Napoli Italy
- CEINGE Biotecnologie Avanzate Franco Salvatore Napoli Italy
| | - Roberta Russo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche Università degli Studi di Napoli Federico II Napoli Italy
- CEINGE Biotecnologie Avanzate Franco Salvatore Napoli Italy
| | - Mayka Sanchez
- Department of Basic Sciences, Iron metabolism: Regulation and Diseases Universitat Internacional de Catalunya (UIC) Barcelona Spain
| | - Fabiana Busti
- Department of Medicine, Section of Internal Medicine and Azienda Ospedaliera Universitaria Integrata of Verona, EuroBloodNEt Referral Center for Iron Disorders, Policlinico G.B. Rossi University of Verona Verona Italy
| | - Dorine Swinkels
- Department of Laboratory Medicine, Translational Metabolic Laboratory (TML 830) Radboud University Medical Center Nijmegen The Netherlands
| | - Patricia Aguilar Martinez
- Department of Hematological Biology, Reference Center on Rare Red Cell Disorders Montpellier University Hospital Montpellier France
| | - Rayan Bou-Fakhredin
- Department of Clinical Sciences and Community Health University of Milan Milan Italy
| | - Martina U Muckenthaler
- Molecular Medicine Partnership Unit European Molecular Biology Laboratory Heidelberg Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), University of Heidelberg Heidelberg Germany
- German Centre for Cardiovascular Research, Partner Site Heidelberg Germany
| | - Sule Unal
- Department of Pediatric Hematology Hacettepe University Ankara Turkey
| | - Graça Porto
- HematologyServiço de Imuno-hemoterapia, CHUdSA-Centro Hospitalar Universitário de Santo António Porto Portugal
| | - Tomas Ganz
- Department of Medicine David Geffen School of Medicine at UCLA Los Angeles California USA
| | - Antonis Kattamis
- Division of Pediatric Hematology-Oncology, First Department of Pediatrics, National & Kapodistrian University of Athens "Aghia Sophia" Children's Hospital Athens Greece
| | - Lucia De Franceschi
- Department of Medicine University of Verona & AOUI Verona, Policlinico GB Rossi Verona Italy
| | - Maria Domenica Cappellini
- Department of Clinical Sciences and Community University of Milan, Cà Granda Foundation IRCCS Maggiore Policlinico Hospital Milan Italy
| | - Malcolm G Munro
- Department of Obstetrics and Gynecology David Geffen School of Medicine Los Angeles California USA
| | - Ali Taher
- Division of Hematology-Oncology, Department of Internal Medicine American University of Beirut Medical Center Beirut Lebanon
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Srinivasa Gopalan S, Mann C, Rhodes RE. Impact of symptoms, experiences, and perceptions of the menstrual cycle on recreational physical activity of cyclically menstruating individuals: A systematic review. Prev Med 2024; 184:107980. [PMID: 38704099 DOI: 10.1016/j.ypmed.2024.107980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/13/2024] [Accepted: 04/30/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE The menstrual cycle often presents barriers to participation in daily life activities, including physical activity (PA), which is a cornerstone of health and well-being. The purpose of this systematic review was to explore and summarize the impact of symptoms, experiences, and perceptions of the menstrual cycle on recreational PA (RPA), including sports, exercise and active recreation, in the general population. METHODS Six databases were searched for studies that investigated the impact of the menstrual cycle on PA among individuals who were cyclically menstruating, healthy, and not involved in professional sports training. RESULTS The search yielded 3025 studies that were screened for relevance and eligibility, resulting in 25 eligible studies, which were found to be of moderate-to-high quality following a quality and risk-of-bias assessment. Thematic synthesis of qualitative and quantitative data from the selected studies, constituting 16,557 adults and 3715 adolescents, identified the impact of menstrual symptoms on the physical and psychological capability to participate in RPA, social opportunity barriers to RPA (e.g., social pressure due to the sociocultural taboo against menstruation), as well reflective (knowledge) and automatic (habit) motivation on RPA behaviours. CONCLUSION The variability in menstrual symptoms and corresponding experiences suggested the need for an individualized approach to RPA promotion. Furthermore, this review highlighted the need to address the sociocultural taboo against menstruation, as well as improve the provision of knowledge and resources related to the menstrual cycle and RPA, in order to promote and facilitate RPA for cyclically menstruating individuals throughout the menstrual cycle.
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Affiliation(s)
- Sharan Srinivasa Gopalan
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada.
| | - Caitlin Mann
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Ryan E Rhodes
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
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Gimunová M, Bozděch M, Bernaciková M, Fernandes R, Kumstát M, Paludo A. The relationship between low energy availability, injuries, and bone health in recreational female athletes. PeerJ 2024; 12:e17533. [PMID: 38915384 PMCID: PMC11195543 DOI: 10.7717/peerj.17533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/17/2024] [Indexed: 06/26/2024] Open
Abstract
Background Low energy availability (LEA) causes pathophysiology of the female athlete's body affecting the bone and reproductive health and was observed to have a high prevalence in recreational female athletes previously. The aim of this study was to analyse the relationship between low energy availability in females questionnaire (LEAF-Q), bone mineral density (BMD), and postural stability in recreational athletes. Methods Recreational female athletes (n = 24, age: 23.71 ± 2.94, Tier I) completed LEAF-Q, postural stability measurement during quiet stance (Zebris platform FDM; GmbH) and their BMD was measured using DXA (Hologic QDR Horizon A). Non-parametric statistical tests were used to analyse the relationships between LEAF-Q, BMD, and postural stability and to compare differences between participants divided by the LEAF-Q score and its subscales. Results Risk of LEA was observed in 50% of recreational athletes participating in this study. Up to 46% of participants perceived menstrual bleeding changes related to training and 37.50% experienced menstrual dysfunction. Body composition and body weight fluctuations were observed to affect postural stability and BMD. With the risk score for LEA, the BMD and postural stability were not negatively affected in recreational athletes. However, the high number of recreational athletes in the risk score for LEA and menstrual dysfunctions highlights the need for public health programs aimed to increase awareness of LEA and its health consequences and for open communication about the menstrual cycle. Future longitudinal studies observing LEA, BMD, menstrual function, postural stability, and their interrelationship in female athletes are needed to increase the knowledge of this topic.
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Affiliation(s)
- Marta Gimunová
- Department of Physical Activities and Health Sciences, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Michal Bozděch
- Department of Physical Education and Social Sciences, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Martina Bernaciková
- Department of Physical Activities and Health Sciences, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Romulo Fernandes
- Laboratory of InVestigation in Exercise–LIVE, Department of Physical Education, Sao Paulo State University (UNESP), Sao Paulo, Brazil
| | - Michal Kumstát
- Department of Sport Performance and Exercise testing, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Ana Paludo
- Department of Sport Performance and Exercise testing, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
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Leal CR, Vannuccini S, Jain V, Dolmans MM, Di Spiezio Sardo A, Al-Hendy A, Reis FM. Abnormal uterine bleeding: The well-known and the hidden face. JOURNAL OF ENDOMETRIOSIS AND UTERINE DISORDERS 2024; 6:100071. [PMID: 38764520 PMCID: PMC11101194 DOI: 10.1016/j.jeud.2024.100071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
Abnormal uterine bleeding (AUB) is a bleeding from the uterine corpus that is abnormal in regularity, volume, frequency or duration. It encompasses heavy menstrual bleeding, irregular menstrual bleeding and intermenstrual bleeding, which are common symptoms among women of reproductive age, impacting their overall well-being. Menstruation involves interactions between endometrial epithelial and stromal cells, immune cell influx, and changes in endometrial vasculature. These events resemble an inflammatory response with increased vessel permeability, tissue breakdown, and the arrival of innate immune cells. However, the mechanisms of menstrual cessation are poorly understood. AUB can be related to structural causes (polyp, adenomyosis, leiomyoma, malignancy/hyperplasia) and nonstructural conditions (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic). While transvaginal ultrasound is the primary method for the screening of intracavitary lesions, saline infusion sonohysterography is more accurate to detect endometrial polyps and submucous leiomyomas, while hysteroscopy with biopsy remains the reference method for a definitive diagnosis. The main goals in managing AUB are addressing and correcting the underlying primary cause, if possible, and establishing a regular bleeding pattern or amenorrhea, which can be done with antifibrinolytic agents, progestins, gonadotropin-releasing hormone agonists and antagonists, or surgical interventions, each one with specific indications and limitations. Further research is necessary to assess the effectiveness and the long-term effects of various medical and surgical treatments. Meanwhile, the availability of diagnostic methods such as transvaginal ultrasound and hysteroscopy and the universal distribution of medical treatments for AUB should be prioritized by policymakers to minimize the diagnostic and treatment delay and thus reduce the risk of AUB-related anemia and the need of hysterectomy.
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Affiliation(s)
- Caio R.V. Leal
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Silvia Vannuccini
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Varsha Jain
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Marie-Madeleine Dolmans
- Pôle de Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- Gynecology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Fernando M. Reis
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Katz C, Evans S, Mikocka-Walus A. 'Listen to women as if they were your most cherished person': Australian women's perspectives on living with the pain of endometriosis: A mixed-methods study. J Health Psychol 2024:13591053241250101. [PMID: 38738914 DOI: 10.1177/13591053241250101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
This mixed-methods study used an online cross-sectional survey to explore perspectives of 533 adult Australian women living with endometriosis pain, and their relationship with biopsychosocial factors. Four themes were constructed: The primary theme, 'Stigma and change' reflected women's experience of dismissal, and the wish to reverse the narrative of pain as normal. Some women emphasised self-education and self-advocacy to affect change, reflecting the theme 'self-empowerment'. Participants described the 'debilitating impact' of endometriosis and the enduring difficulty of 'inadequate healthcare', reflecting themes three and four. Analysis indicated type of social support may impact perceived outcomes for endometriosis. Hierarchical regression analyses indicated too few significant relationships between biopsychosocial factors and themes to indicate meaningful patterns without risk of common method variance. Future research should explore the influence of social support and interventions which develop participant autonomy and practitioner competence and knowledge, using disease-specific measures over time.
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Huijs DPC, Derickx AJM, Beelen P, Leemans JC, van Kuijk SMJ, Bongers MY, Geomini PMAJ. A 52-mg levonorgestrel-releasing intrauterine system vs bipolar radiofrequency nonresectoscopic endometrial ablation in women with heavy menstrual bleeding: long-term follow-up of a multicenter randomized controlled trial. Am J Obstet Gynecol 2024; 230:542.e1-542.e10. [PMID: 38280433 DOI: 10.1016/j.ajog.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/16/2024] [Accepted: 01/21/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND The symptom of heavy menstrual bleeding has a substantial impact on professional, physical, and social functioning. In 2021, results from a randomized controlled trial comparing a 52-mg levonorgestrel-releasing intrauterine system and radiofrequency nonresectoscopic endometrial ablation as treatments for women with heavy menstrual bleeding were published. Both treatment strategies were equally effective in treating heavy menstrual bleeding during 2-year follow-up. However, long-term results are also relevant for both patients and healthcare providers. OBJECTIVE This study aimed to assess long-term differences in reintervention risk and menstrual blood loss in women with the symptom of heavy menstrual bleeding treated according to a strategy starting with a 52-mg levonorgestrel-releasing intrauterine system or radiofrequency nonresectoscopic endometrial ablation. STUDY DESIGN This study was a long-term follow-up study of a multicenter randomized controlled trial (MIRA trial), in which women were allocated to either a 52-mg levonorgestrel-releasing intrauterine device (n=132) or radiofrequency nonresectoscopic endometrial ablation (n=138). Women from the original trial were contacted to fill out 6 questionnaires. The primary outcome was the reintervention rate after allocated treatment. Secondary outcomes included surgical reintervention rate, menstrual bleeding measured by the Pictorial Blood Loss Assessment Chart, (disease-specific) quality of life, sexual function, and patient satisfaction. RESULTS From the 270 women who were randomized in the original trial, 196 (52-mg levonorgestrel-releasing intrauterine system group: n=94; radiofrequency nonresectoscopic endometrial ablation group: n=102) participated in this long-term follow-up study. Mean follow-up duration was 7.4 years (range, 6-9 years). The cumulative reintervention rate (including both medical and surgical reinterventions) was 40.0% (34/85) in the 52-mg levonorgestrel-releasing intrauterine system group and 28.7% (27/94) in the radiofrequency nonresectoscopic endometrial ablation group (relative risk, 1.39; 95% confidence interval, 0.92-2.10). The cumulative rate of surgical reinterventions only was significantly higher among patients with a treatment strategy starting with a 52-mg levonorgestrel-releasing intrauterine system compared with radiofrequency nonresectoscopic endometrial ablation (35.3% [30/85] vs 19.1% [18/94]; relative risk, 1.84; 95% confidence interval, 1.11-3.10). However, the hysterectomy rate was similar (11.8% [10/94] in the 52-mg levonorgestrel-releasing intrauterine system group and 18.1% [17/102] in the radiofrequency nonresectoscopic endometrial ablation group; relative risk, 0.65; 95% confidence interval, 0.32-1.34). Most reinterventions occurred during the first 24 months of follow-up. A total of 171 Pictorial Blood Loss Assessment Chart scores showed a median bleeding score of 0.0. No clinically relevant differences were found regarding quality of life, sexual function, and patient satisfaction. CONCLUSION The overall risk of reintervention after long-term follow-up was not different between women treated according to a treatment strategy starting with a 52-mg levonorgestrel-releasing intrauterine system and those treated using a strategy starting with radiofrequency nonresectoscopic endometrial ablation. However, women allocated to a treatment strategy starting with a 52-mg levonorgestrel-releasing intrauterine system had a higher risk of surgical reintervention, which was driven by an increase in subsequent endometrial ablation. Both treatment strategies were effective in lowering menstrual blood loss over the long term. The results of this long-term follow-up study can support physicians in optimizing the counseling of women with heavy menstrual bleeding, thus promoting informed decision-making regarding choice of treatment.
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Affiliation(s)
- Daniëlle P C Huijs
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands; GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.
| | - Arianne J M Derickx
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Pleun Beelen
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Jaklien C Leemans
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Marlies Y Bongers
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands; GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Peggy M A J Geomini
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
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Tu FF, Hellman KM, Darnell SE, Harber KA, Bohnert AM, Singh L, Walker LS. A multidimensional appraisal of early menstrual pain experience. Am J Obstet Gynecol 2024; 230:550.e1-550.e10. [PMID: 38290643 PMCID: PMC11165568 DOI: 10.1016/j.ajog.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 12/01/2023] [Accepted: 01/21/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Symptomatic dysmenorrhea is a global problem, affecting more than 40% of menstruating persons. Cross-sectional studies have implicated psychosocial, biological, and sensory factors in dysmenorrhea but the mechanisms are not fully understood. Only a few prospective longitudinal studies have evaluated such factors in relation to the emergence and course of dysmenorrhea at menarche. OBJECTIVE This study aimed to describe the initial menstruation experience and to evaluate the association of premenarchal psychosocial and sensory factors with the intensity of dysmenorrhea during the period in the fourth month. STUDY DESIGN This was a prospective cohort study of adolescents who completed premenarchal assessments and postmenarchal daily menstrual diaries for their first (n=149) and fourth month periods (n=114). They were recruited shortly before menarche and completed baseline assessments, including psychosocial questionnaires and experimental pain sensitivity (pressure testing, bladder provocation), and their parents completed related pain questionnaires. The relation between the hypothesized premenarchal factors and month 4 dysmenorrhea intensity was evaluated using Kruskal-Wallis and chi-square tests for low (<3 on a 0-10 scale) vs higher (≥3) menstrual pain groups based on maximal pain ratings recorded in a daily diary. RESULTS Low levels of dysmenorrhea characterized the first (median, 1; interquartile range, 0-2) and fourth month periods (1; 0-3). Maximal pain ratings increased from the first to the fourth period (3; 1-5 vs 4; 1-6; P=.007). The distribution of dysmenorrhea was multimodal at month 4 with 31.6% of the participants having low levels of maximal pain (1; 0-1) and 68.4% having higher levels (5; 4-6; Hartigan's dip test P<.001). The baseline demographic, psychosocial, and parental pain characteristics were not associated with the development of worse dysmenorrhea. The baseline experimental pain sensitivity, based on pressure pain thresholds, did not differ between the low (15.7 N; 12.5-22.3) and higher (15.0 N; 10.9-21.4]) level dysmenorrhea groups. Baseline bladder pain at first urge also did not differ (low, 6; 0-20 vs higher, 7; 0-19). CONCLUSION By their fourth month period, two-thirds of adolescents fell into the higher group for maximal dysmenorrhea, half reported some related impairments in physical activity, and one-seventh reported some related school absence. Premenarchal factors (experimental pain sensitivity, psychosocial profile, parental pain experience) linked to chronic pain emergence in the adult literature did not predict dysmenorrhea intensity, suggesting the dominant factor at menarche may be peripheral afferent activation. Further research is needed to understand the evolution of psychosocial and sensory mechanisms in the development and course of dysmenorrhea.
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Affiliation(s)
- Frank F Tu
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL; Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, IL.
| | - Kevin M Hellman
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL; Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Sarah E Darnell
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL
| | - Kaela A Harber
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL
| | - Amy M Bohnert
- Department of Psychology, Loyola University Chicago, Chicago, IL
| | - Lavisha Singh
- Department of Biostatistics, NorthShore University HealthSystem, Evanston, IL
| | - Lynn S Walker
- Department of Psychology, Vanderbilt University, Nashville, TN
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Özcan H, Burger NB, Derksen ME, Peute LW, Huirne JAF, De Leeuw RA. The differences between adults and adolescents using a mobile health application for menstrual complaints: A usability and qualitative study. Int J Med Inform 2024; 185:105382. [PMID: 38437753 DOI: 10.1016/j.ijmedinf.2024.105382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/19/2024] [Accepted: 02/16/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND A "Menstruatie Educatie Kalender" application (Menstruation Education Calendar, (MEK-APP)) was developed for adults to evaluate menstrual complaints. The future aim of this app is to use it as a self-diagnostic instrument for menstrual abnormalities for both adults and adolescents. Early identification of the potential of an application for future use by both user groups would increase implementation success and adoption of the application. OBJECTIVE To compare differences in experienced usability by adults versus adolescents and to identify factors influencing future use for both age groups in one mHealth application (in this study the MEK-APP). METHODS This study consisted of three phases: (1) usability testing of the MEK-APP for iOS and Android by think-aloud method, (2) two-month daily use and (3) in-depth individual interview. During the think-aloud sessions, twelve tasks were performed in the application while they were thinking aloud. Usability problems were rated for their severity with Nielsen' Severity Scale. Both the think-aloud sessions and in-depth interviews were verbatim transcribed and thematically analyzed to determine the factors influencing future use for both groups. In addition, the System Usability Scale (SUS) and Intrinsic Motivation Inventory (IMI) questionnaires were filled out during the interviews. RESULTS Seven adults (>18 years) and seven adolescents (14-18 years) evaluated the MEK-APP. There were 14 usability issues and 16 bugs in both groups. There were no differences between adults and adolescents. In the thematic qualitative analysis, the following future use factors were identified: user-expectation, motivation, privacy, understandability, and user-experience. The user-expectation, motivation and privacy differed between both groups but did not influence usage. No differences were observed in SUS and IMI scores between both groups. CONCLUSIONS There are five factors influencing the future use of a menstrual-related mHealth application for both adults and adolescents. It is possible to serve different age groups with a single application.
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Affiliation(s)
- Habibe Özcan
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Location AMC and VUmc, Amsterdam, the Netherlands
| | - Nicole B Burger
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Location AMC and VUmc, Amsterdam, the Netherlands
| | - Marloes E Derksen
- Department of Medical Informatics, eHealth Living & Learning Lab Amsterdam, Amsterdam UMC, Location University of Amsterdam, the Netherlands; Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
| | - Linda W Peute
- Department of Medical Informatics, eHealth Living & Learning Lab Amsterdam, Amsterdam UMC, Location University of Amsterdam, the Netherlands; Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Location AMC and VUmc, Amsterdam, the Netherlands
| | - Robert A De Leeuw
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Location AMC and VUmc, Amsterdam, the Netherlands.
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Mirghafourvand M, Ebadi A, Jahanfar S, Khorashadizadeh F, Shirzadi S. Exploring the practice of Iranian adolescent females during menstruation and related beliefs: a qualitative study. BMC Public Health 2024; 24:1145. [PMID: 38658910 PMCID: PMC11040887 DOI: 10.1186/s12889-024-18600-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Menstruation is a natural occurrence that women experience during their reproductive years and may encounter many years throughout their lifespan. Many adolescent females lack accurate knowledge about menstruation, so they may face issues from receiving incorrect information from unreliable sources. Our study aimed to investigate the practices and beliefs surrounding menstruation among Iranian adolescent females. METHODS This qualitative study was conducted using conventional content analysis. A purposeful sampling method was used to select 18 adolescent females from secondary and high schools located in the three regions of Neyshabur City-Iran. Data were collected through in-depth, semi-structured interviews. RESULTS Three main themes were extracted, consisting of lifestyle and related beliefs, lake of support, and awareness and information. CONCLUSIONS misconceptions and wrong behaviors during menstruation indicate that the lake of knowledge an traditional factors influence adolescent girls' health. The study provides the basis for intervention planning in this regard and different levels (individual, intrapersonal, health systems, and community).
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Affiliation(s)
- Mojgan Mirghafourvand
- Social Determinants of Health Research Center, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Centre, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Shayesteh Jahanfar
- Department of Public Health and Community Medicine, Tufts School of Medicine, Boston, USA
| | - Fatemeh Khorashadizadeh
- Department of Epidemiology and Biostatistics, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Shayesteh Shirzadi
- Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran.
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Özcan H, Burger NB, Dulmen-den Broeder EV, van Baal MW, den Boogaard EV, De Leeuw RA, Huirne JAF. Instruments to Identify Menstrual Complaints and Their Impact on Adolescents: A Systematic Review. J Pediatr Adolesc Gynecol 2024; 37:106-120. [PMID: 38104798 DOI: 10.1016/j.jpag.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
STUDY OBJECTIVE The aim of this review was to create an overview of available instruments used to evaluate the menstrual complaints of dysmenorrhea and heavy menstrual bleeding (HMB) in adolescents. METHODS The search was conducted in PubMed, Web of Science, Embase, and PsycINFO on December 1, 2022. Studies published in English reporting on menstrual complaints among girls aged 10-19 were included. The quality and bias risk was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. RESULTS Of 8994 identified studies, 57 were included. In these studies, 19 instruments were described, of which 8 were validated in adolescents. One was difficult to use in daily practice, 1 had low sensitivity and specificity in the detection of HMB, 2 were validated by face validity, and 2 were not specifically developed to evaluate (the impact of) menstrual complaints. Therefore, only 2 were validated and feasible to measure adolescent menstrual complaints: the Period ImPact and Pain Assessment (PIPPA) and the Adolescent Menstrual Bleeding Questionnaire (aMBQ). Remarkably, the Pictorial Blood Loss Assessment Chart (PBAC) was the most frequently used instrument in adolescents. There was one modified version of the PBAC for adolescents, which had a lower cutoff value for HMB and low sensitivity and specificity. CONCLUSION We found that the PIPPA and aMBQ are suitable for assessing menstrual complaints and their impact on daily activities and health-related quality of life in adolescents. The PBAC, which is used frequently in adults, needs to be further assessed specifically for adolescents. In particular, the clinical relevance of the PBAC cutoff value for HMB should be determined for this age group. Considering the different interpretations, experiences, and limited knowledge of menstrual complaints, instruments suitable for adults may not be suitable for adolescents.
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Affiliation(s)
- Habibe Özcan
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands
| | - Nicole B Burger
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands
| | - Eline van Dulmen-den Broeder
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands
| | - Marchien W van Baal
- Department of Obstetrics and Gynaecology, Flevo Hospital, Almere, The Netherlands
| | - Emmy van den Boogaard
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands
| | - Robert A De Leeuw
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location AMC and VUmc, Amsterdam, The Netherlands.
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Lang AL, Bruhn RL, Fehling M, Heidenreich A, Reisdorf J, Khanyaree I, Henningsen M, Remschmidt C. Feasibility Study on Menstrual Cycles With Fitbit Device (FEMFIT): Prospective Observational Cohort Study. JMIR Mhealth Uhealth 2024; 12:e50135. [PMID: 38470472 DOI: 10.2196/50135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/26/2023] [Accepted: 01/24/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Despite its importance to women's reproductive health and its impact on women's daily lives, the menstrual cycle, its regulation, and its impact on health remain poorly understood. As conventional clinical trials rely on infrequent in-person assessments, digital studies with wearable devices enable the collection of longitudinal subjective and objective measures. OBJECTIVE The study aims to explore the technical feasibility of collecting combined wearable and digital questionnaire data and its potential for gaining biological insights into the menstrual cycle. METHODS This prospective observational cohort study was conducted online over 12 weeks. A total of 42 cisgender women were recruited by their local gynecologist in Berlin, Germany, and given a Fitbit Inspire 2 device and access to a study app with digital questionnaires. Statistical analysis included descriptive statistics on user behavior and retention, as well as a comparative analysis of symptoms from the digital questionnaires with metrics from the sensor devices at different phases of the menstrual cycle. RESULTS The average time spent in the study was 63.3 (SD 33.0) days with 9 of the 42 individuals dropping out within 2 weeks of the start of the study. We collected partial data from 114 ovulatory cycles, encompassing 33 participants, and obtained complete data from a total of 50 cycles. Participants reported a total of 2468 symptoms in the daily questionnaires administered during the luteal phase and menses. Despite difficulties with data completeness, the combined questionnaire and sensor data collection was technically feasible and provided interesting biological insights. We observed an increased heart rate in the mid and end luteal phase compared with menses and participants with severe premenstrual syndrome walked substantially fewer steps (average daily steps 10,283, SD 6277) during the luteal phase and menses compared with participants with no or low premenstrual syndrome (mean 11,694, SD 6458). CONCLUSIONS We demonstrate the feasibility of using an app-based approach to collect combined wearable device and questionnaire data on menstrual cycles. Dropouts in the early weeks of the study indicated that engagement efforts would need to be improved for larger studies. Despite the challenges of collecting wearable data on consecutive days, the data collected provided valuable biological insights, suggesting that the use of questionnaires in conjunction with wearable data may provide a more complete understanding of the menstrual cycle and its impact on daily life. The biological findings should motivate further research into understanding the relationship between the menstrual cycle and objective physiological measurements from sensor devices.
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Affiliation(s)
| | - Rosa-Lotta Bruhn
- Faculty of Health, University Witten Herdecke, Witten Herdecke, Germany
| | | | | | | | | | - Maike Henningsen
- Faculty of Health, University Witten Herdecke, Witten Herdecke, Germany
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Munro CB, Walker EN, Schembri R, Moussaoui D, Grover SR. Periods Shouldn't Bring Any Adolescents' World to a Full Stop. Period. An Online Survey of Adolescents' Experience of Menstruation. J Pediatr Adolesc Gynecol 2024; 37:18-24. [PMID: 37722525 DOI: 10.1016/j.jpag.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023]
Abstract
STUDY OBJECTIVE Few studies have explored what specific outcome measures contained in assessment tools for period and pelvic pain are most relevant to adolescents. Co-design is a valuable method of ensuring input from those with lived experience. The Longitudinal Study of Teenagers with Endometriosis Periods and Pelvic Pain in Australia (LongSTEPPP) Co-Design Periods Survey comprised an anonymous online survey of adolescents' experience of menstruation to inform patient-reported outcome measures for the larger 5-year project. METHODS Adolescents aged 12-18 years whose periods had commenced at least 3 months previously and with demonstrated capacity to consent were invited to participate in an online survey. Recruitment was primarily via social media channels. RESULTS Of the 1811 adolescents who participated, 85% reported that periods had a "moderate" or greater impact on their life. Pain (90.7%), heavy flow (56.2%), and worry about leakage (49%) were common reasons for missed activities. Menstrual symptoms were wide-ranging and included cramping, nausea, poor energy, and impacts on mood. When asked where adolescents sought assistance with their periods, 39.8% had seen their general practitioner, 21.3% their school nurse, and almost 1 in 10 had consulted a mental health practitioner (9.3%). To manage menstrual symptoms, heat packs (66.0%), over-the-counter medications (55.8%), and prescription medications (28.6%) were used. CONCLUSION We found a lack of menstrual health awareness in adolescents. Periods had a significant effect on their lives, and adolescents commonly missed activities. In managing menstruation, a wide range of practitioners were consulted. Nearly a third were prescribed medication to manage their periods. These findings have directed the longitudinal study as to how best to capture outcome measures that reflect the impact of periods on adolescents.
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Affiliation(s)
- Courtney B Munro
- Department of Pediatric and Adolescent Gynecology, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Emma N Walker
- Department of Neurology, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
| | - Rachel Schembri
- Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Dehlia Moussaoui
- Department of Pediatric and Adolescent Gynecology, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Sonia R Grover
- Department of Pediatric and Adolescent Gynecology, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
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20
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Gambadauro P, Hadlaczky G, Wasserman D, Carli V. Menstrual symptoms and subjective well-being among postmenarchal adolescents. AJOG GLOBAL REPORTS 2024; 4:100304. [PMID: 38304304 PMCID: PMC10830861 DOI: 10.1016/j.xagr.2023.100304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Menstrual symptoms are predominantly studied among adults but may occur directly after menarche. Adolescent menstrual healthcare, however, faces specific obstacles and more research into menstrual symptoms as a determinant of adolescent well-being is therefore advocated. OBJECTIVE This study aimed to investigate menstrual symptoms and their impact on everyday life and well-being among postmenarchal adolescents. STUDY DESIGN A survey was delivered to a random sample of 1644 schoolgirls, drawn from a population-based project involving 116 lower secondary education schools (7th and 8th grade) in Stockholm, Sweden. Menstrual symptoms (ie, dysmenorrhea, heavy bleeding, irregular periods, mood disturbance, other general symptoms) were investigated through multiple choice questions and defined according to their impact on everyday life as mild (seldom affected), moderate (affected but possible to cope) and severe (affected and difficult to cope). Subjective well-being was measured with the World Health Organization Five Well-Being index. Postmenarchal respondents were eligible for analysis; those with incomplete outcome data or using hormonal contraception were excluded. The frequency and severity of symptoms across different postmenarchal years (1st, 2nd, 3rd, 4th, or 5th+ year after menarche) were studied with Chi-square and Kendall's tau statistics. Analysis of variance was used to study the association between menstrual symptoms and World Health Organization Five Well-Being index scores. A composite menstrual health index variable was obtained through principal component analysis and used to study the overall impact of menstrual symptoms on well-being in regression analyses. RESULTS Of 1100 postmenarchal girls (mean age, 14.1±0.7 years), 93.2% reported menstrual symptoms, 81.3% had at least 1 moderate symptom and 31.3% had at least 1 severe symptom. The most frequent symptoms were dysmenorrhea (80.4%) and mood disturbance (81.1%), followed by irregular periods (67.9%), heavy bleeding (60.4%), and other general symptoms (60.4%). Throughout postmenarchal years, there was a significant increase in frequency and severity (P<.001) of dysmenorrhea (τ=0.148), heavy bleeding (τ=0.134), mood disturbance (τ=0.117), and other general symptoms (τ=0.110), but not irregular periods (τ=-0.0201; P=.434). Girls with menstrual symptoms had significantly lower World Health Organization Five Well-Being index scores than those without symptoms (mean difference, -17.3; 95% confidence interval, -22.4 to -12.3). Analysis of variance showed significant associations (P<.001) with World Health Organization Five Well-Being index scores for each of the examined menstrual symptoms. In post hoc pairwise comparisons with peers without symptoms, the greatest reductions in World Health Organization Five Well-Being index score were found among girls with severe symptoms (mean difference for: dysmenorrhea, -20.72; heavy bleeding, -15.75; irregular periods, -13.81; mood disturbance, -24.97; other general symptoms, -20.29), but significant differences were observed even for moderate or mild symptoms. The composite menstrual health index was significantly associated with World Health Organization Five Well-Being index scores in regression analysis, independently of age, age at menarche, body mass index, smoking, physical activity, own and parental country of birth, biparental care, and socioeconomic status. CONCLUSION Despite growing awareness about the relevance of menstruation to women's health, unmet menstrual health needs are a potential threat to the well-being of adolescents. Education, screening, and clinical competence are important tools to reduce the burden of menstrual symptoms during adolescence and to prevent long-term consequences. The development of novel person-centered strategies should be a priority for clinical practice and research in adolescent menstrual health.
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Affiliation(s)
- Pietro Gambadauro
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden (Drs Gambadauro, Hadlaczky, Wasserman, and Carli)
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden (Dr Gambadauro)
- Stockholm Health Care Services, Stockholm, Sweden (Drs Gambadauro, Hadlaczky, and Carli)
- Res Medica Sweden, Uppsala, Sweden (Dr Gambadauro)
| | - Gergö Hadlaczky
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden (Drs Gambadauro, Hadlaczky, Wasserman, and Carli)
- Stockholm Health Care Services, Stockholm, Sweden (Drs Gambadauro, Hadlaczky, and Carli)
| | - Danuta Wasserman
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden (Drs Gambadauro, Hadlaczky, Wasserman, and Carli)
| | - Vladimir Carli
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden (Drs Gambadauro, Hadlaczky, Wasserman, and Carli)
- Stockholm Health Care Services, Stockholm, Sweden (Drs Gambadauro, Hadlaczky, and Carli)
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21
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Johnson CY, Grajewski B, Lawson CC, MacDonald LA, Rocheleau CM, Whelan EA. Occupational physical demands and menstrual cycle irregularities in flight attendants and teachers. Occup Environ Med 2024; 81:oemed-2023-109099. [PMID: 38184367 PMCID: PMC11226562 DOI: 10.1136/oemed-2023-109099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/01/2023] [Indexed: 01/08/2024]
Abstract
OBJECTIVES Flight attendants perform physically demanding work such as lifting baggage, pushing service carts and spending the workday on their feet. We examined if more frequent exposure to occupational physical demands could explain why previous studies have found that flight attendants have a higher reported prevalence of menstrual cycle irregularities than other workers. METHODS We conducted a cross-sectional analysis of 694 flight attendants and 120 teachers aged 18-44 years from three US cities. Eligible participants were married, had not had a hysterectomy or tubal ligation, were not using hormonal contraception and were not recently pregnant. Participants reported menstrual cycle characteristics (cramps, pain, irregular cycles, flow, bleed length, cycle length) and occupational physical demands (standing, lifting, pushing/pulling, bending/twisting, overall effort). We used modified Poisson regression to examine associations between occupation (flight attendant, teacher) and menstrual irregularities; among flight attendants, we further examined associations between occupational physical demands and menstrual irregularities. RESULTS All occupational physical demands were more commonly reported by flight attendants than teachers. Flight attendants reported more frequent menstrual cramps than teachers, and most occupational physical demands were associated with more frequent or painful menstrual cramps. Lifting heavy loads was also associated with irregular cycles. CONCLUSIONS Occupational physical demands were associated with more frequent and worse menstrual pain among flight attendants. The physical demands experienced by these workers may contribute to the high burden of menstrual irregularities reported by flight attendants compared with other occupational groups, such as teachers.
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Affiliation(s)
- Candice Y Johnson
- Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Barbara Grajewski
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Christina C Lawson
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Leslie A MacDonald
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Carissa M Rocheleau
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Elizabeth A Whelan
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
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22
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Martens KL, Samuelson Bannow B. Antiplatelet period drama: a rush of blood or classic crimson tide? Res Pract Thromb Haemost 2024; 8:102320. [PMID: 38356853 PMCID: PMC10865471 DOI: 10.1016/j.rpth.2024.102320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 02/16/2024] Open
Affiliation(s)
- Kylee L. Martens
- Division of Hematology & Medical Oncology, Oregon Health & Science University, Portland, Oregon, USA
| | - Bethany Samuelson Bannow
- The Hemostasis and Thrombosis Center at Oregon Health & Science University, Portland, Oregon, USA
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23
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Wiggleton-Little J. "Just" a painful period: A philosophical perspective review of the dismissal of menstrual pain. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241255646. [PMID: 38773901 PMCID: PMC11113068 DOI: 10.1177/17455057241255646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 05/24/2024]
Abstract
Science and society typically respond to dysmenorrhea-or painful menstrual cramps-as a normal, natural, and inevitable part of menstruation. This normalization has greatly contributed to the systemic dismissal of painful menstrual cramps. Stigma, secrecy, and the expectation to "cope" fuel the normalization of menstrual pain. In this article, I argue that the normalization of menstrual pain restricts the ability to share an excruciating menstrual pain in a way that would otherwise elicit alarm or concern. This can cause clinicians to downgrade menstrual pain, and even menstruating persons to downgrade their own pain. I refer to the dismissal of menstrual pain as an example of a pain-related motivational deficit. A pain-related motivational deficit describes instances in which an utterance fails to motivate due to societal practices and ideas that make it difficult to recognize the import of the embodied experience being shared.
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24
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Vygivska LA, Rudenko LA, Pliekhova OO, Rakytianskyi IY. Abnormal uterine bleeding and its causes. Literature review. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2024; 52:457-461. [PMID: 39360728 DOI: 10.36740/merkur202404112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
Based on the analysis of information from available sources of scientific literature, the article provides an overview of the problem of abnormal uterine bleeding and its causes. Preservation of women's reproductive health is an urgent problem of the whole world. AUB is a debilitating symptom that affects a large number of women and one of the most common gynecological abnormalities. АUB, as a rule, does not threaten a woman's life, but significantly decreases its quality. Menstrual disorders affect all aspects of a woman's life, even increasing the risk of premature death. Women with AUB are more likely to seek medical care due to social and physical factors, while 50% of female patients have mental health problems due to anxiety and depression. Structural causes of uterine bleeding increase as a woman ages, which can affect reproductive health. Extragenital disorders are considered one of the most frequent causes of AUB. This is explained by the features of the endometrium, the state of which is influenced by general changes in a woman's hormonal status and the functional state of some organs and systems. AUB can be caused by diseases of the thyroid gland, uncorrected diabetes, obesity, blood coagulation disorders (most often von Willebrand's disease), infectious diseases, certain drugs (corticosteroids, antipsychotic or antiepileptic drugs), climate change and diet, psychological stress, etc. Management of patients with abnormal uterine bleeding is a complex problem that should include assessment of gynecological status and consultation of related specialists (endocrinologists, cardiologists, etc.).
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Casola AR, Rea O, Ho T. Family physicians and menstrual care: An analysis of CERA 2023. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241247799. [PMID: 38676375 PMCID: PMC11055483 DOI: 10.1177/17455057241247799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/15/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Menstrual health is an important indicator of overall health and has large impacts on quality of life. Despite number and impact, discussion of menstruation remains largely taboo within health care. Patients and physicians are not engaging in regular, meaningful discussions on menstruation. Family physicians, as primary care providers, can facilitate these important conversations. OBJECTIVES We sought to understand the profile of menstrual care providing family physicians and assessed physician comfort, knowledge, training, and perceived importance regarding menstrual care. DESIGN/METHODS This is a cross-sectional analysis of the 2022 Council of Academic Family Medicine Educational Research Alliance survey. The survey included actively practicing US physicians who are members of the Council of Academic Family Medicine organizations. Descriptive demographic statistics were calculated; chi-square tests were generated for menstrual care-specific items; logistic regression models were fit to determine the association between receiving formal menstrual care training, importance of physician training in menstrual care, and demographic factors. RESULTS Eighty-five percent of respondents report frequently providing menstrual care. Participants of younger age, or who had earned their degree more recently, were significantly more likely to provide frequent menstrual care. Respondents who earned their medical degree at an earlier year were significantly more likely to believe that physician training in menstrual care was of limited importance (OR = 1.02, 95% CI = 1.00, 1.03). CONCLUSIONS Our findings show that family physicians are providing menstrual care, despite non-uniform training, and recognize its importance to patients. By understanding physician profile and the care they provide, we can work toward comprehensive physician education in menstrual care and providing appropriate menstrual care to patients.
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Affiliation(s)
- Allison R Casola
- Department of Family & Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Olivia Rea
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Tiffany Ho
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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26
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Ciołek A, Kostecka M, Kostecka J, Kawecka P, Popik-Samborska M. An Assessment of Women's Knowledge of the Menstrual Cycle and the Influence of Diet and Adherence to Dietary Patterns on the Alleviation or Exacerbation of Menstrual Distress. Nutrients 2023; 16:69. [PMID: 38201899 PMCID: PMC10780571 DOI: 10.3390/nu16010069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
A growing number of women of reproductive age experience menstrual disorders. The menstrual cycle is considerably influenced by dietary habits, physical activity, and the use of stimulants. The main aim of this study was to assess women's knowledge about the menstrual cycle and the influence of diet and lifestyle factors on menstrual symptoms, and to identify dietary models that may alleviate or exacerbate menstrual distress. A total of 505 young women participated in the study. Nearly 90% of the respondents reported at least one menstrual disorder, mostly dysmenorrhea (70.7%), whereas secondary amenorrhea was least frequently reported (13.8%) (p = 0.002). In the study population, dysmenorrhea/menstrual distress was linked with higher consumption frequency of certain food groups. Women with severe dysmenorrhea consumed refined cereal products, processed meat, sugar, and water significantly more frequently than women with moderate menstrual pain. In turn, sweetened dairy products, animal fats, and fruit were consumed more frequently by women with low intensity of menstrual pain (mild pain). Significant differences in knowledge about the menstrual cycle and physiological changes in the body were observed between the compared dietary models.
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Affiliation(s)
- Anna Ciołek
- Department of Chemistry, Faculty of Food Science and Biotechnology, University of Life Sciences, Akademicka 15, 20-950 Lublin, Poland; (A.C.); (P.K.)
| | - Malgorzata Kostecka
- Department of Chemistry, Faculty of Food Science and Biotechnology, University of Life Sciences, Akademicka 15, 20-950 Lublin, Poland; (A.C.); (P.K.)
| | - Julianna Kostecka
- Faculty of Medicine, Medical University of Lublin, Chodźki 19, 20-093 Lublin, Poland;
| | - Paulina Kawecka
- Department of Chemistry, Faculty of Food Science and Biotechnology, University of Life Sciences, Akademicka 15, 20-950 Lublin, Poland; (A.C.); (P.K.)
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Masuda H, Okada S. Menstruation-related symptoms are associated with physical activity and midpoint of sleep: a pilot study. Front Glob Womens Health 2023; 4:1260645. [PMID: 38179154 PMCID: PMC10765530 DOI: 10.3389/fgwh.2023.1260645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction Menstruation-related symptoms (MRSs) significantly impact women's health and contribute to economic burdens worldwide. Current interventions, primarily pharmacological ones, have limitations and side effects that underscore the need for alternative management strategies. This study explores the association between MRSs and lifestyle factors, specifically physical activity and sleep timing across menstrual cycle phases, to inform non-pharmacological intervention development. Methods Fourteen female students from Ritsumeikan University, Japan, with regular menstrual cycles (25-38 days), not on hormonal treatment or engaged in shift work, participated in this observational study. Using a Fitbit Inspire 2, total daily energy expenditure (TDEE) and sleep timing were monitored over a complete cycle. Menstrual cycle phases were defined based on ovulation day, predicted using home luteinizing hormone tests. Participants completed daily electronic questionnaires rating MRSs using a modified menstrual distress questionnaire. Data were analyzed using a generalized linear mixed model with a gamma distribution and logarithmic link function, examining the relationship of TDEE and the midpoint of sleep time (MS time) with MRS severity. Results and discussion The following observations were noted: first, MRS severity, except for behavioral change symptoms, significantly increased during the menstrual and luteal phases compared to the follicular phase. Second, delayed MS time was associated with reduced pain, concentration symptoms, water retention, and negative affect during the menstrual phase and reduced negative affect during the luteal phase. Finally, an increase in TDEE was associated with reduced concentration symptoms, autonomic reaction symptoms, and negative affect during the menstrual and luteal phases and reduced water retention only during the luteal phase. This study provides insights into the relationship between MRSs and TDEE/MS time, suggesting potential non-therapeutic approaches for symptom management, though further research is needed to substantiate these findings for practical applications.
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Affiliation(s)
- Hazuki Masuda
- Biophysical Engineering Lab, Faculty of Science and Engineering, Ritsumeikan University, Shiga, Japan
| | - Shima Okada
- Biophysical Engineering Lab, Department of Robotics, Faculty of Science and Engineering, Ritsumeikan University, Shiga, Japan
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Belayneh W, Kassaye Z, Arusi T, Abera N, Hantalo A, Melkamu B, Gutulo M. Prevalence of dysmenorrhea and associated factors and its effect on daily academic activities among female undergraduate students of Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1244540. [PMID: 38162010 PMCID: PMC10757849 DOI: 10.3389/frph.2023.1244540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/01/2023] [Indexed: 01/03/2024] Open
Abstract
Background Dysmenorrhea is pain during menstrual flow and is the most common gynecologic complaint in reproductive-age girls. The severity of dysmenorrhea ranges from mild to severe pain during menstruation, which affects their academic activities. Objective To assess the prevalence and associated risk factors of dysmenorrhea and its effects on academic activities among Hawassa University students from April 1-30/2021. Methods A cross-sectional study was conducted and a systematic random sampling technique was used to select 348 study participants. Standardized self-administered questionnaires were used to obtain relevant data. The severity of pain was assessed using a verbal multidimensional scoring system and Numerical Pain Rating Scale (NPRS) methods. The collected data was entered into Epi info version 7 and exported to SPSS version 21 for analysis and then descriptive statistics and logistic regression analysis were performed. Results The prevalence of dysmenorrhea was 80% (277). Of those affected by dysmenorrhea, using the verbal multidimensional scoring system, 47.6% (132) were found to have mild pain, 39.7% (110) had moderate pain, and 12.6% (35) had severe pain. However, using the Numeric Pain Rating Scale (NPRS), 21.7% (60) were found to have mild pain, 33.2% (92) had moderate pain, 37.5% (104) had severe pain, and 7.6% (21) had very severe pain. It was found to have a negative effect on academic activity, such as loss of concentration in class (p = 0.00), disruption of study time (p = 0.00), sleep disturbances (p = 0.00), issues in personal relationships (p = 0.00), and absenteeism (p = 0.00). Associated factors included being sexually active, having a family history of dysmenorrhea, and the presence of depression. Conclusion Dysmenorrhea is prevalent in this study and has a significant impact on academic activities. Family history of dysmenorrhea, being sexually active, and the presence of depression are associated factors.
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Affiliation(s)
- Wondu Belayneh
- Department of Gynecology and Obstetrics, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Zerai Kassaye
- Obstetrics and Gynecology, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Temesgen Arusi
- Obstetrics and Gynecology, Wolkite University College of Medicine and Health Sciences, Wolkite, Ethiopia
| | - Netsanet Abera
- Department of Public Health, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Admassu Hantalo
- Department of Medical Laboratory Sciences, Wolkite University College of Medicine and Health Sciences, Wolkite, Ethiopia
| | - Biruk Melkamu
- Wachamo University College of Medicine and Health Sciences, Hosanna, Ethiopia
| | - Muluken Gutulo
- CDC Coordinator, Wolaita Health Department, Wolaita Sodo, Ethiopia
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29
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Al Kiyumi MH, Al Belushi Z, Al Amri A, Al Musharrafi R, Al Rashdi F, Jaju S, Al Shidhani A, Al Mahrezi A. Effects of a Healthy Diet on Reducing Symptoms of Premenstrual Syndrome and Improving Quality of Life among Omani Adolescents: A Randomized Controlled Open-Label Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7169. [PMID: 38131720 PMCID: PMC10742710 DOI: 10.3390/ijerph20247169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/25/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
Premenstrual syndrome (PMS) continues to impact the health outcomes and emotional well-being of reproductive-age women, globally. Several studies have provided conflicting evidence concerning the role of dietary approaches in improving PMS symptoms. Accordingly, this study aimed to evaluate the possible influence of a healthy diet and motivational strategies on PMS symptoms and health-related quality of life among Omani adolescents. This open-label, randomized, prospective controlled trial was conducted at two randomly selected secondary schools, in Al Seeb Willayah, in Muscat region. Adolescents with PMS symptoms, who were in grade 10 or 11, aged 16 years or above, had regular menstrual cycles, and were not known to have psychiatric disorder were included in this study. Participants in the intervention group received an individual face-to-face dietary consultation and motivational phone consultation. The health outcomes, including the PMS symptoms in both groups, and quality of life, were recorded using the Daily Record of Severity of Problems questionnaire (DRSP) and the 14-item Self-Reporting-Based Perceived Stress Scale tools, respectively. The primary outcome was the difference in the mean premenstrual symptom scores between the two groups. Secondary outcomes included the quality of life and stress levels of participants. The study period was from 1 February and ended 30 June 2021. SPSS was used to analyze the data, and intention-to-treat analysis was utilized. A total of 72 adolescents with PMS were randomized into intervention and control groups (n = 36 each). Both groups were similar at baseline (p-value > 0.05). No significant association was found between a healthy diet and PMS symptoms (p-value > 0.05). In addition, no significant association was found between a healthy diet and quality of life at follow-up (p-value = 0.216). The outcomes of this study refuted any possible relationships between a healthy diet and PMS symptoms. Accordingly, dietary consultations may not facilitate the clinical management of PMS symptoms in adolescent females.
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Affiliation(s)
- Maisa Hamed Al Kiyumi
- Department of Family Medicine and Public Health, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat 123, Oman; (A.A.S.); (A.A.M.)
| | - Zalikha Al Belushi
- Department of Primary Health Care, Ministry of Health, Muscat 100, Oman;
| | - Amal Al Amri
- Ministry of Health, Muscat 100, Oman; (A.A.A.); (F.A.R.)
| | | | | | - Sanjay Jaju
- Department of Family Medicine and Public Health, Sultan Qaboos University, Muscat 123, Oman;
| | - Asma Al Shidhani
- Department of Family Medicine and Public Health, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat 123, Oman; (A.A.S.); (A.A.M.)
| | - Abdulaziz Al Mahrezi
- Department of Family Medicine and Public Health, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat 123, Oman; (A.A.S.); (A.A.M.)
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Lonky NM, Chiu V, Portugal C, Estrada EL, Chang J, Fischer H, Vora JB, Harrison LI, Peng L, Munro MG. Adenomyosis in women undergoing hysterectomy for abnormal uterine bleeding associated with uterine leiomyomas. PLoS One 2023; 18:e0294925. [PMID: 38079406 PMCID: PMC10712893 DOI: 10.1371/journal.pone.0294925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/10/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Uterine leiomyomas and adenomyosis are both common and often associated with abnormal uterine bleeding (AUB), including the symptom of heavy menstrual bleeding (HMB). Understanding the prevalence of adenomyosis in women with uterine leiomyomas could inform clinicians and patients in a way that may improve therapeutic approaches. OBJECTIVE To explore the prevalence of adenomyosis in a group of women who underwent hysterectomy for AUB-L, to determine the prevalence of submucous leiomyomas, and to examine the utility of preoperative ultrasound to detect the presence of adenomyosis. METHODS The Kaiser Permanente Hysterectomy Database (KPHD) was searched for women aged 18-52 undergoing hysterectomy for leiomyoma-associated chronic AUB (AUB-L) in 2018 and 2019. A target sample of 400 comprised those with at least 3 years in the Health System. Radiologists evaluated preoperative pelvic ultrasound images to determine leiomyoma size and level 2 FIGO type (submucous or other), and the linked electronic medical record abstracted for clinical features, including histopathological evidence of adenomyosis. RESULTS Of the 370 subjects that met the study criteria, adenomyosis was identified via histopathology in 170 (45.9%). There was no difference in the adenomyosis prevalence with (47.1%) and without (43.0%) at least one submucous leiomyoma. Subgroup analysis of ultrasound images by an expert radiologist for the presence of adenomyosis demonstrated a positive predictive value of 54.0% and a negative predictive value of 43.4%. CONCLUSIONS Adenomyosis was present in almost half of this AUB-L cohort undergoing hysterectomy and was equally prevalent in those with and without submucous leiomyomas as determined by sonographic evaluation. The imaging findings are in accord with prior investigators and demonstrate that 2-D ultrasound is insensitive to the presence of adenomyosis when the uterus is affected by leiomyomas. Further research is necessary to determine the impact of various adenomyosis phenotypes on the presence and severity of the symptom of HMB.
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Affiliation(s)
- Neal M. Lonky
- Kaiser Permanente Southern California, Orange County, Department of Obstetrics & Gynecology, Anaheim, California, United States of America
| | - Vicki Chiu
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, California, United States of America
| | - Cecilia Portugal
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, California, United States of America
| | - Erika L. Estrada
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, California, United States of America
| | - John Chang
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, California, United States of America
| | - Heidi Fischer
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, California, United States of America
| | - Jamie B. Vora
- AbbVie Inc, North Chicago, Illinois, United States of America
| | - Lawrence I. Harrison
- Kaiser Permanente Southern California, Orange County, Department of Obstetrics & Gynecology, Anaheim, California, United States of America
| | - Lauren Peng
- Department of Radiology, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California, United States of America
| | - Malcolm G. Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
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31
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Rogers SK, Ahamadeen N, Chen CX, Mosher CE, Stewart JC, Rand KL. Dysmenorrhea and psychological distress: a meta-analysis. Arch Womens Ment Health 2023; 26:719-735. [PMID: 37632569 DOI: 10.1007/s00737-023-01365-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 08/14/2023] [Indexed: 08/28/2023]
Abstract
Dysmenorrhea is characterized by pelvic pain associated with menstruation. Similar to people with other pain conditions, females who experience dysmenorrhea report increased psychological distress. However, the pooled magnitude of this association has not been quantified across studies. Accordingly, this meta-analytic review quantifies the magnitude of the associations between dysmenorrhea severity and psychological distress. We conducted a systematic search of the literature using PsycINFO, PubMed, CINHAL, Embase, and Web of Science. Analyzed studies provided observational data on dysmenorrhea severity and anxiety symptoms, depressive symptoms, and/or global psychological distress. A total of 44 studies were included, and three random-effects meta-analyses were conducted, with average pooled effect sizes calculated using Person's r. We found significant, positive associations between measures of dysmenorrhea severity and measures of depressive symptoms (r = 0.216), anxiety symptoms (r = 0.207), and global psychological distress (r = 0.311). Our review suggests that females with greater dysmenorrhea severity experience greater psychological distress. Future directions include defining a clinically meaningful dysmenorrhea severity threshold, understanding the mechanisms and directionality underlying the dysmenorrhea-psychological distress relationship, and designing and testing interventions to jointly address dysmenorrhea and psychological distress.
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Affiliation(s)
- Sarah K Rogers
- School of Science, Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., LD 113A, Indianapolis, IN, 46202, USA.
| | - Naheeda Ahamadeen
- School of Science, Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., LD 113A, Indianapolis, IN, 46202, USA
| | - Chen X Chen
- School of Nursing, Indiana University, Indianapolis, IN, USA
| | - Catherine E Mosher
- School of Science, Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., LD 113A, Indianapolis, IN, 46202, USA
| | - Jesse C Stewart
- School of Science, Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., LD 113A, Indianapolis, IN, 46202, USA
| | - Kevin L Rand
- School of Science, Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., LD 113A, Indianapolis, IN, 46202, USA
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Ramaiyer M, Lulseged B, Michel R, Ali F, Liang J, Borahay MA. Menstruation in the USA. CURR EPIDEMIOL REP 2023; 10:186-195. [PMID: 38275000 PMCID: PMC10810236 DOI: 10.1007/s40471-023-00333-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 01/27/2024]
Abstract
Purpose of review Menstruation touches all spheres of human society, including psychology, education, business, policy, race, and religion. This narrative review aims to describe the relationship menstruation holds with these spaces. Recent findings First, menstruation plays many roles in psychology - premenstrual syndrome affects psychological wellbeing and in turn, psychological stress impacts menstruation. Functional hypothalamic amenorrhea can result when stress hormones inhibit the Hypothalamus-Pituitary-Ovarian axis. Furthermore, menstruation has many implications for all aged individuals, especially adolescents and those who are menopausal. These implications underscore the importance of proper education surrounding menstruation, which can be achieved via social media, school systems, family, and clinicians. However, menstrual health education is highly variable depending on the state and family that someone is raised in. Additionally, menstruation can pose a financial burden as menstrual products can be expensive and access to these products is limited for those who are homeless, incarcerated, and low-income. Recent public policy measures in various states have aimed to achieve "menstrual equity," by requiring public schools to supply free menstrual products in bathrooms. Furthermore, racial disparities exist with menstrual disorders. Uterine fibroids occur more frequently in Black menstruators compared to White menstruators, and Black women experience worse outcomes overall with fibroids and endometriosis management. Finally, analysis of religion and its relationship to menstruation underscores the immense stigma and "impurity" associated with menstruation. Summary Overall, this review highlights the universality of menstruation in society. As a "fifth vital sign", there is significant room for improvement in terms of education, research, and cultural acceptance of menstruation. Future research should explore interventions to reduce these gaps.
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Affiliation(s)
| | | | | | - Fiza Ali
- Johns Hopkins University, Krieger School of Arts and Sciences, Baltimore, MD
| | - Jinxiao Liang
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore MD
| | - Mostafa A. Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD
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Sato A, Fukawa-Nagira A, Sashihara T. Lactobacillus paragasseri OLL2809 Improves Premenstrual Psychological Symptoms in Healthy Women: A Randomized, Double-Blind, Placebo-Controlled Study. Nutrients 2023; 15:4985. [PMID: 38068843 PMCID: PMC10707835 DOI: 10.3390/nu15234985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/17/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
Lactobacillus paragasseri OLL2809 has been shown to ameliorate stress. This study employed a randomized, placebo-controlled, double-blind, parallel-group design to assess the efficacy of continuous ingestion of OLL2809 for managing menstrual symptoms in healthy women. Eighty healthy adult women aged 25-40 years who experienced premenstrual and menstrual symptoms were randomly assigned to either the OLL2809 or placebo group (n = 40 each) and ingested tablets containing OLL2809 or placebo for three menstrual cycles. The OLL2809 group exhibited a significantly greater change in premenstrual 'arousal' scores on the menstrual distress questionnaire compared to the placebo group after the three menstrual cycles. Specifically, changes in the 'activity' subfactor were significantly higher in the OLL2809 group than in the placebo group. Additionally, the OLL2809 group reported significantly lower premenstrual irritability on the visual analog scale than the placebo group. These results suggest that OLL2809 may contribute to enhancing the quality of life of women.
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Affiliation(s)
- Asako Sato
- Food Microbiology and Function Research Laboratories, Division of Research and Development, Meiji Co., Ltd., Hachioji 192-0919, Tokyo, Japan; (A.F.-N.); (T.S.)
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Seidman LC, Handy AB, Temme CR, Greenfield SF, Payne LA. Reflections on the group dynamic in a group cognitive behavioral therapy intervention for young adult women with moderate to severe dysmenorrhea: a qualitative analysis. J Psychosom Obstet Gynaecol 2023; 44:2264486. [PMID: 37800565 PMCID: PMC10640904 DOI: 10.1080/0167482x.2023.2264486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023] Open
Abstract
A recent group cognitive behavioral therapy (gCBT) intervention for dysmenorrhea conducted by our team demonstrated feasibility, acceptability, and preliminary efficacy at reducing menstrual pain. This study aimed to use qualitative analyses to explore participants' reflections about the intervention's group dynamic. Participants included 20 young women ages 18-24 years with average menstrual pain of 8.0 (SD = 1.1) on a 0-10 (0 = none, 10 = worst pain possible) numeric rating scale. Semi-structured individual and group interviews were conducted after the intervention. Researchers then conducted deductive, iterative thematic analysis using a template analysis approach. Two themes were generated: benefit and logistics. The benefit theme included two sub-themes: (1) camaraderie (an emotional, psychological, or social connection between participants); and (2) sharing (information, advice, or experiences). The logistics theme highlighted how the structure of the group influenced the dynamic and was divided into two sub-themes according to the time frame being described: (1) reactions (participants' experiences with how the group dynamic was facilitated); and (2) future (how the group structure could be improved). Results of this study contribute to the growing body of literature related to gCBT for pain conditions. Future research is needed to optimize the group dynamic and evaluate its specific therapeutic role in the treatment.
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Affiliation(s)
| | | | | | | | - Laura A. Payne
- McLean Hospital, Belmont, MA
- Harvard Medical School, Boston, MA
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Sinharoy SS, Chery L, Patrick M, Conrad A, Ramaswamy A, Stephen A, Chipungu J, Reddy YM, Doma R, Pasricha SR, Ahmed T, Chiwala CB, Chakraborti N, Caruso BA. Prevalence of heavy menstrual bleeding and associations with physical health and wellbeing in low-income and middle-income countries: a multinational cross-sectional study. Lancet Glob Health 2023; 11:e1775-e1784. [PMID: 37802092 PMCID: PMC10581908 DOI: 10.1016/s2214-109x(23)00416-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/14/2023] [Accepted: 08/24/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Data on the prevalence of heavy menstrual bleeding in low-income and middle-income countries (LMICs) are scarce. We aimed to assess the validity of a scale to measure heavy menstrual bleeding and calculate its prevalence in southern Asia and sub-Saharan Africa, and to examine associations between heavy menstrual bleeding and health outcomes. METHODS Between Aug 2, 2021 and June 14, 2022, we surveyed 6626 women across ten cities (Meherpur and Saidpur, Bangladesh; Warangal, Narsapur, and Tiruchirappalli, India; Kathmandu, Nepal; Dakar, Senegal; Nairobi, Kenya; Kampala, Uganda; and Lusaka, Zambia), including questions on demographics, health, and the SAMANTA scale, a six-item measure of heavy menstrual bleeding. We conducted confirmatory factor analysis to assess construct validity of the SAMANTA scale, calculated the prevalence of heavy menstrual bleeding, and used regression analyses to examine associations of heavy menstrual bleeding with health outcomes. FINDINGS 4828 women were included in the final analytic sample. Factor analysis indicated a one-factor model representing heavy menstrual bleeding. In the pooled analytic sample, 2344 (48·6%) of 4828 women were classified as experiencing heavy menstrual bleeding, and the prevalence was lowest in Dakar (126 [38·3%] of 329 women) and Kampala (158 [38·4%] of 411 women) and highest in Kathmandu (326 [77·6%] of 420 women). Experiencing heavy menstrual bleeding was significantly associated with feeling tired or short of breath during the menstrual period (risk ratio 4·12 (95% CI 3·45 to 4·94) and reporting worse self-rated physical health (adjusted odds ratio 1·27, 95% CI 1·08 to 1·51), but was not associated with subjective wellbeing (β -3·34, 95% CI -7·04 to 0·37). INTERPRETATION Heavy menstrual bleeding is highly prevalent and adversely impacts quality of life in women across LMIC settings. Further attention is urgently needed to understand determinants and identify and implement solutions to this problem. FUNDING Bill & Melinda Gates Foundation, United States Agency for International Development, National Institutes of Health.
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Affiliation(s)
- Sheela S Sinharoy
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Lyzberthe Chery
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Madeleine Patrick
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Amelia Conrad
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Jenala Chipungu
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Rinchen Doma
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sant-Rayn Pasricha
- Population Health and Immunity Division, The Walter and Eliza Hall Institute, Melbourne, VIC, Australia
| | - Tanvir Ahmed
- Department of Civil Engineering and International Training Network, Bangladesh University of Engineering and Technology, Dhaka, Bangladesh
| | | | | | - Bethany A Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Mahfouz MS, Abdelmageed MM, Alqassim AY, Hakami TKM, Alshekh MM, Hamithi DMA, Alakhdar FDH, Ayyashi NM, Madkhali RMA. Menstrual irregularities associated with COVID-19 vaccines among women in Saudi Arabia: A survey during 2022. Open Med (Wars) 2023; 18:20230804. [PMID: 37829840 PMCID: PMC10566562 DOI: 10.1515/med-2023-0804] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 07/20/2023] [Accepted: 08/31/2023] [Indexed: 10/14/2023] Open
Abstract
Some changes appeared in women's menstrual cycle after receiving the coronavirus disease 2019 (COVID-19) vaccine, but the information about the pattern and characteristics of these symptoms was unclear. This study was conducted to estimate the prevalence of menstruation change and evaluate the association between COVID-19 vaccination and the occurrence of such disturbance. An online web-based survey was conducted during March-April 2022 that targeted 729 COVID-19 vaccinated women aged between 18 and 45 years in the Jazan region of Kingdom of Saudi Arabia. The tool collected demographic information, psychological data, and COVID-19 post-vaccination side effects. The overall prevalence of menstrual change among the women was 60.9% (95% CI 57.3-64.4). 66.3% and 64.1% of women, respectively, in the age group of 25-34 and 35-45 years were more affected. Most of the detected abnormalities were related to delayed menstruation and changes in pain intensity. Menstrual disturbances that occur after immunization are transient and have no long-term implications. Menstrual disorders are prevalent before vaccination, but there is a considerable increase following vaccination. Because there is no apparent cause for these post-vaccine disturbances, and their effects are difficult to anticipate, it is preferable to warn those concerned and encourage them to learn more about the biological changes causing these problems.
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Affiliation(s)
- Mohamed Salih Mahfouz
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan45142, Saudi Arabia
| | - Maha Murtada Abdelmageed
- Obstetrics and Gynecology Department, Faculty of Medicine, Jazan University, Jazan45142, Saudi Arabia
| | - Ahmad Y. Alqassim
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan45142, Saudi Arabia
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Li X, Zhang B, Tan P, Chesney MA, Zhang T, Nie G. The cross-cultural adaptation and psychometric properties of the menstrual symptom questionnaire (MSQ) among Chinese women of reproductive age. Heliyon 2023; 9:e20450. [PMID: 37810819 PMCID: PMC10556762 DOI: 10.1016/j.heliyon.2023.e20450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/29/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023] Open
Abstract
Objective This study reports on a translation of the Menstrual Symptom Questionnaire (MSQ) into Chinese, a cross-cultural adaptation among Chinese women of reproductive age, and an assessment of its reliability and validity. Methods Previously published translation guidelines were followed to translate and cross-culturally adapt the English version of MSQ to produce a Chinese version. This Chinese version was then administered to 2800 Chinese women of reproductive age recruited by convenience sampling method. The reliability of the Chinese MSQ was tested for internal consistency and test-retest reliability. The concurrent and construct validity of the questionnaire was evaluated using correlation and factor analysis. Results The Chinese version of the MSQ showed no linguistic or semantic issues. The internal consistency of the Chinese MSQ Cronbach'α = 0.912, and the test-retest reliability r = 0.911. The exploratory factor analysis identified four factors. The confirmatory factor analysis demonstrated that the four factor structure of the Chinese version of the MSQ (Pain Experience, Emotional Changes, Pain Coping Strategies, and Other Physical Symptoms) is reasonable among Chinese women of reproductive age. There was a significant correlation found between these four factors and both the Pittsburgh Sleep Quality Index and the SF-8 Health Survey. Conclusion The Chinese version of the MSQ achieved semantic equivalence in translation and demonstrated good reliability and validity among Chinese women of reproductive age. Thus, it can serve as an effective tool to assess the experience of menstrual symptoms among Chinese women.
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Affiliation(s)
- Xiuxia Li
- Guangxi Medical University, Nanning 530021, China
| | | | - Peixuan Tan
- Guangxi Medical University, Nanning 530021, China
| | - Margaret A. Chesney
- Department of Medicine, University of California San Francisco, San Francisco, CA 94158, USA
| | | | - Guanghui Nie
- Guangxi Medical University, Nanning 530021, China
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Alsalman M, Alhubail F, Bin Obaid F, Algouf I, Alomair B, Albunyan S, AlMudayris L, Alsalman Z, Khan AS. Impact of COVID-19 Vaccinations on Menstrual Bleeding. Cureus 2023; 15:e47360. [PMID: 38021843 PMCID: PMC10659569 DOI: 10.7759/cureus.47360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Vaccination has a fundamental role in protecting against and modifying the severity of several infectious diseases, including COVID-19. Several immune and non-immune adverse events have been reported post-COVID-19 vaccine. The aim of this study was to assess the effect of the COVID-19 vaccine on women's menstrual bleeding. METHODS A cross-sectional study was conducted among 399 vaccinated women in the Eastern Province of Saudi Arabia. Data were collected using a direct interview-based questionnaire including four sections. RESULTS A total of 399 women were recruited, with a mean age of 25.54 ± 6.177 years. More than half (53.9%) of the participants reported post-vaccination menstrual bleeding abnormality in terms of a heavy or irregular cycle. Out of the total number, 40 (21.4%) women reported having heavy menstrual flow, and 67 (16.8%) had non-menstrual bleeding after receiving the COVID-19 vaccine. Fully vaccinated women were at a greater risk of post-vaccination menstrual bleeding abnormality (p = 0.058). However, there was no correlation between booster shot type and menstrual bleeding abnormality (p > 0.05). In addition, there was no significant association between non-menstrual bleeding and the type of booster shot, the type of the first dose, and prior history of COVID-19 infection (p > 0.05). CONCLUSION Despite vaccination being the most effective way to prevent COVID-19, it does have an impact on menstrual bleeding in terms of menorrhagia and metrorrhagia. Therefore, more studies are needed to understand the mechanism and the long-term impact of COVID-19 vaccines on the hemostatic system.
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Affiliation(s)
- Mortadah Alsalman
- Department of Medicine, College of Medicine, King Faisal University, Al-Hofuf, SAU
| | - Fatimah Alhubail
- Department of Medicine, College of Medicine, King Faisal University, Al-Hofuf, SAU
| | - Fidaa Bin Obaid
- Department of Medicine, College of Medicine, King Faisal University, Al-Hofuf, SAU
| | - Ibtisam Algouf
- Department of Medicine, College of Medicine, King Faisal University, Al-Hofuf, SAU
| | - Bayan Alomair
- Department of Medicine, College of Medicine, King Faisal University, Al-Hofuf, SAU
| | - Sara Albunyan
- Department of Medicine, College of Medicine, King Faisal University, Al-Hofuf, SAU
| | - Lina AlMudayris
- Department of Medicine, College of Medicine, King Faisal University, Al-Hofuf, SAU
| | - Zaenb Alsalman
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al-Hofuf, SAU
| | - Abdul Sattar Khan
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al-Hofuf, SAU
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Duijster JW, Schoep ME, Nieboer TE, Jajou R, Kant A, van Hunsel F. Menstrual abnormalities after COVID-19 vaccination in the Netherlands: A description of spontaneous and longitudinal patient-reported data. Br J Clin Pharmacol 2023; 89:3126-3138. [PMID: 37222170 DOI: 10.1111/bcp.15799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/06/2023] [Accepted: 05/16/2023] [Indexed: 05/25/2023] Open
Abstract
AIMS During the COVID-19 vaccination campaigns, the number of reports of menstrual abnormalities increased rapidly. Here, we describe the nature and potential risk factors associated with menstrual abnormalities based on spontaneously reporting data as well as data from a prospective cohort event monitoring (CEM) study as these are poorly studied. METHODS Reports of menstrual abnormalities received by the Netherlands Pharmacovigilance Centre Lareb in the spontaneous reporting system between February 2021 and April 2022 were summarized. In addition, logistic regression analysis was performed on the reported menstrual abnormalities in the CEM study to assess the association between person characteristics, prior SARS-CoV-2 infection and use of hormonal contraceptives and the occurrence of menstrual abnormalities after vaccination. RESULTS We analysed over 24 000 spontaneous reports of menstrual abnormalities and over 500 episodes (among 16 929 included women) of menstrual abnormalities in the CEM study. The CEM study showed an incidence of 41.4 per 1000 women aged ≤54 years. Amenorrhoea/oligomenorrhoea and heavy menstrual bleeding collectively accounted for about half of all abnormalities reported. Significant associations were observed for the age group 25-34 years (odds ratio 2.18; 95% confidence interval 1.45-3.41) and the Pfizer vaccine (odds ratio 3.04; 95% confidence interval 2.36-3.93). No association was observed for body mass index and presence of most comorbidities assessed. CONCLUSION The cohort study showed a high incidence of menstrual disorders among women aged ≤54 years, and this observation was supported by the analysis of spontaneous reports. This suggests that a relation between COVID-19 vaccination and menstrual abnormalities is plausible and should be further investigated.
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Affiliation(s)
- Janneke W Duijster
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
| | - Mark E Schoep
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Theodoor E Nieboer
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rana Jajou
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
| | - Agnes Kant
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
| | - Florence van Hunsel
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
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Brown N, Martin D, Waldron M, Bruinvels G, Farrant L, Fairchild R. Nutritional practices to manage menstrual cycle related symptoms: a systematic review. Nutr Res Rev 2023:1-24. [PMID: 37746736 DOI: 10.1017/s0954422423000227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Certain nutritional practices may reduce menstrual-related symptoms, but there is no current consensus on what foods/supplements are sufficiently evidenced to warrant promotion to reduce menstrual symptoms of naturally menstruating individuals. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two online databases were searched for published experimental studies that investigated the effects of foods/supplements on menstrual-related symptoms in eumenorrhoeic women. Extracted data and study characteristics were tabulated and grouped on the basis of food/supplement intervention and dosage compared with UK dietary reference values (DRV) and safe upper limits. In total, twenty-eight studies and twenty-one different foods/supplement interventions were included in the review. None of the studies reported a negative effect on symptoms, twenty-three reported a positive effect and five had no effect. Eighteen different ways of measuring menstrual-related symptoms were described across the studies. The results indicate a lack of consistency in studies to confidently provide information to eumenorrheic, naturally menstruating women regarding the use of foods/supplements to reduce menstrual symptoms. Determination of menstrual-related symptoms varied along with dose and duration of food or supplements provided. These data provide some evidence for the use of vitamin D, calcium, zinc and curcumin to reduce menstrual-related symptoms of non-hormonal contraceptive users, on an individual basis; however, further investigation is required prior to implementation with a focus on robust protocols to determine and measure changes in menstrual symptoms, with interventions adhering to DRV and safe upper limits.
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Affiliation(s)
- Natalie Brown
- Applied, Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, SwanseaSA1 8EN, UK
- School of Sport and Exercise Science, Welsh Institute of Performance Science, Swansea, UK
| | - Daniel Martin
- School of Sport and Exercise Science, University of Lincoln, Lincoln, UK
| | - Mark Waldron
- Applied, Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, SwanseaSA1 8EN, UK
- School of Sport and Exercise Science, Welsh Institute of Performance Science, Swansea, UK
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Queensland, Australia
| | - Georgie Bruinvels
- Institute of Sport, Exercise and Health, University College London, London, UK
- Orreco Ltd., Galway, Ireland
| | - Lucy Farrant
- School of Sport and Health Sciences, Department of Healthcare and Food, Cardiff Metropolitan University, Cardiff, UK
| | - Ruth Fairchild
- School of Sport and Health Sciences, Department of Healthcare and Food, Cardiff Metropolitan University, Cardiff, UK
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Mazza E, Troiano E, Mazza S, Ferro Y, Abbinante A, Agneta MT, Montalcini T, Pujia A. The impact of endometriosis on dietary choices and activities of everyday life: a cross-sectional study. Front Nutr 2023; 10:1273976. [PMID: 37810932 PMCID: PMC10559972 DOI: 10.3389/fnut.2023.1273976] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Endometriosis is characterized by ectopic endometrial tissue and severe pain; frequently, women afflicted by this condition resort to non-medical interventions, such as dietary modifications. The aim of this study is to assess the impact of endometriosis on dietary patterns and quality of life. Methods An online survey was conducted among Italian women with endometriosis to gather self-reported demographic, clinical, dietary habit, and daily life data post-diagnosis. Results A total of 4,078 participants were included. Following an endometriosis diagnosis, 66% reported changes in eating habits, and 92% experienced a decline in daily life. Respondents chose dietary interventions: gluten-free (15%), anti-inflammatory (8%), Mediterranean (7.1%), or ketogenic (4%) diets, to improve health and reduce symptoms. The study revealed a shift in eating habits, with increased consumption of vegetables, fruits (10%), cereals, legumes (6.6%), and fish (4.5%), while reducing dairy products (18.4%), soy-containing foods (6.7%), and high saturated fats (8%). Eating habit changes correlated with endometriosis stages and worsened daily life. Educational level, endometriosis stages, years of symptoms, and eating habit changes linked to changes in daily life. Conclusion Our findings emphasize the importance of monitoring eating behaviors to prevent unhealthy habits and malnutrition in women with endometriosis. Further studies are needed to evaluate how different diets impact symptoms and enhance daily life for these individuals.
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Affiliation(s)
- Elisa Mazza
- Department of Medical and Surgical Science, University Magna Græcia, Catanzaro, Italy
- Technical Scientific Association of Food, Nutrition and Dietetics (ASAND), Palermo, Italy
- Clinical Nutrition Unit, University Magna Græcia, Catanzaro, Italy
| | - Ersilia Troiano
- Technical Scientific Association of Food, Nutrition and Dietetics (ASAND), Palermo, Italy
- Direzione Socio-Educativa, Municipio Roma III Montesacro, Rome, Italy
| | - Santino Mazza
- Clinical Nutrition Unit, University Magna Græcia, Catanzaro, Italy
| | - Yvelise Ferro
- Department of Medical and Surgical Science, University Magna Græcia, Catanzaro, Italy
- Clinical Nutrition Unit, University Magna Græcia, Catanzaro, Italy
| | - Antonia Abbinante
- Italian Dental Hygienists Association (AIDI), Aosta, Italy
- Complex Operating Unit of Odontostomatology, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Maria Teresa Agneta
- Italian Dental Hygienists Association (AIDI), Aosta, Italy
- Complex Operating Unit of Odontostomatology, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Tiziana Montalcini
- Clinical Nutrition Unit, University Magna Græcia, Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases, University Magna Græcia, Catanzaro, Italy
- Department of Clinical and Experimental Medicine, University Magna Græcia, Catanzaro, Italy
| | - Arturo Pujia
- Department of Medical and Surgical Science, University Magna Græcia, Catanzaro, Italy
- Clinical Nutrition Unit, University Magna Græcia, Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases, University Magna Græcia, Catanzaro, Italy
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Matsuura Y, Tran NH, Yasui T. The Changes in Menstrual and Menstrual-Related Symptoms among Japanese Female University Students: A Prospective Cohort Study from Three Months to Nine Months after Admission. Healthcare (Basel) 2023; 11:2557. [PMID: 37761754 PMCID: PMC10531057 DOI: 10.3390/healthcare11182557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Menstrual and menstrual-related symptoms can significantly impact an individual's physical and psychological health. Understanding how these symptoms evolve over time is crucial to provide appropriate support and healthcare services to young women. This study aimed to investigate changes in menstrual and menstrual-related symptoms among first-year female university students. A prospective longitudinal design was used to compare the symptom profiles between two time points (three and nine months after admission). Out of 100 female university students, 30 responses were analyzed. Data on menstrual and menstrual-related symptoms were collected using standardized questionnaires focusing on menstrual status and the Menstrual Distress Questionnaire (MDQ); no notable changes occurred between the time points. Approximately half reported having irregular menstruation during the three time periods. Among the sub-scales, premenstrual "impaired concentration" showed a tendency to be lower, whereas menstrual "water retention" tended to be higher in timepoint 2 compared to timepoint 1. "Distractible" was found to be significantly lower in timepoint 2 compared to timepoint 1. There was a significant association between a sleep duration of <7 h and worsened MDQ scores. These findings may underscore the importance of providing comprehensive lifestyle and menstrual education to new university students, along with access to appropriate medical care.
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Affiliation(s)
- Yukie Matsuura
- Department of Reproductive and Menopausal Medicine, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
| | - Nam Hoang Tran
- Research Center for Higher Education, Tokushima University, Tokushima 770-8502, Japan
| | - Toshiyuki Yasui
- Department of Reproductive and Menopausal Medicine, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan
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Furukawa S, Yamamoto Y, Miyake T, Yoshida O, Watanabe J, Kato A, Kusumoto K, Takeshita E, Ikeda Y, Yamamoto N, Saeki Y, Hiasa Y. Menstrual Status Is Associated with the Prevalence of Irritable Bowel Syndrome in a Japanese Young Population: A Cross-Sectional Study. Dig Dis 2023; 41:845-851. [PMID: 37708872 DOI: 10.1159/000533264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/06/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION There is evidence regarding the association between dysmenorrhea and irritable bowel syndrome (IBS), although it is lacking in the Asian population. Therefore, the purpose of this study was to investigate the association between menstrual status and IBS in a young Japanese. METHODS Overall, 4,693 female college students were included in the analysis of this study. Information regarding lifestyle habits, menstrual status (irregularity, pain severity, and medication), and IBS (Rome III criteria) was obtained using a self-reported questionnaire. Age, body mass index, exercise habits, smoking, drinking habits, and anemia were analyzed as potential confounders. RESULTS The prevalence of IBS was 6.1%. Moderate {adjusted odds ratio (OR): 1.89 (95% confidence interval [CI]: 1.27-2.91)} and heavy (adjusted OR: 2.14 [95% CI: 1.42-3.45]) menstrual pain were independently positively associated with IBS (p for trend = 0.001). Using medication sometimes (adjusted OR: 1.41 [95% CI: 1.09-1.84]) and often (adjusted OR: 1.60 [95% CI: 1.13-2.24]) was independently positively associated with IBS. There was no association between menstrual cycle and IBS. In subjects without functional dyspepsia, irregular menstrual cycle was independently positively associated with IBS. CONCLUSION In the young Japanese population, menstrual pain and medications for menstrual pain may have a significant positive association with IBS.
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Affiliation(s)
| | | | - Teruki Miyake
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Osamu Yoshida
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Junichi Watanabe
- Department of Physical Therapy, Faculty of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
| | - Aki Kato
- Health Services Center, Ehime University, Matsuyama, Japan
| | | | - Eiji Takeshita
- Department of Inflammatory Bowel Diseases and Therapeutics, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yoshio Ikeda
- Endoscopy Center, Ehime University Hospital, Toon, Japan
| | - Naofumi Yamamoto
- Faculty of Collaborative Regional Innovation, Ehime University, Matsuyama, Japan
| | - Yuka Saeki
- Health Services Center, Ehime University, Matsuyama, Japan
- Community Health Systems for Nursing, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
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Rogers SK, Galloway A, Hirsh AT, Zapolski T, Chen CX, Rand KL. Efficacy of psychological interventions for dysmenorrhea: a meta-analysis. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1086-1099. [PMID: 37154693 DOI: 10.1093/pm/pnad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
Dysmenorrhea is pelvic pain associated with menstruation and is one of the most common pain conditions among reproductive-age women. It is commonly treated with medications, complementary and alternative medicine, and self-management techniques. However, there is increased focus on psychological interventions which modify thoughts, beliefs, emotions, and behavioral responses to dysmenorrhea. This review examined the efficacy of psychological interventions on dysmenorrhea pain severity and interference. We conducted a systematic search of the literature using PsycINFO, PubMed, CINHAL, and Embase. A total of 22 studies were included; 21 examined within-group improvement (ie, within-group analysis) and 14 examined between-group improvement (ie, between-group analysis). Random-effects meta-analyses were conducted on pain severity and interference, with average effect sizes calculated using Hedges's g. Within-group analyses showed decreased pain severity and interference at post-treatment (g = 0.986 and 0.949, respectively) and first follow-up (g = 1.239 and 0.842, respectively). Between-group analyses showed decreased pain severity at post-treatment (g = 0.909) and decreased pain severity and interference at first follow-up (g = 0.964 and 0.884, respectively) compared to control groups. This review supports the efficacy of psychological interventions for dysmenorrhea, but conclusions are tempered by suboptimal methodological quality of the included studies and high heterogeneity across studies. Additional, rigorous research is needed to determine the clinical utility of psychological interventions for dysmenorrhea.
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Affiliation(s)
- Sarah K Rogers
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Amanda Galloway
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Adam T Hirsh
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Tamika Zapolski
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Chen X Chen
- Indiana University School of Nursing, Indianapolis, IN 46202, United States
| | - Kevin L Rand
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
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Kmiecik MJ, Tu FF, Clauw DJ, Hellman KM. Multimodal hypersensitivity derived from quantitative sensory testing predicts pelvic pain outcome: an observational cohort study. Pain 2023; 164:2070-2083. [PMID: 37226937 PMCID: PMC10440257 DOI: 10.1097/j.pain.0000000000002909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/09/2023] [Indexed: 05/26/2023]
Abstract
ABSTRACT Multimodal hypersensitivity (MMH)-greater sensitivity across multiple sensory modalities (eg, light, sound, temperature, pressure)-is associated with the development of chronic pain. However, previous MMH studies are restricted given their reliance on self-reported questionnaires, narrow use of multimodal sensory testing, or limited follow-up. We conducted multimodal sensory testing on an observational cohort of 200 reproductive-aged women, including those at elevated risk for chronic pelvic pain conditions and pain-free controls. Multimodal sensory testing included visual, auditory, and bodily pressure, pelvic pressure, thermal, and bladder pain testing. Self-reported pelvic pain was examined over 4 years. A principal component analysis of sensory testing measures resulted in 3 orthogonal factors that explained 43% of the variance: MMH, pressure pain stimulus response, and bladder hypersensitivity. The MMH and bladder hypersensitivity factors correlated with baseline self-reported menstrual pain, genitourinary symptoms, depression, anxiety, and health. Over time, MMH increasingly predicted pelvic pain and was the only component to predict outcome 4 years later, even when adjusted for baseline pelvic pain. Multimodal hypersensitivity was a better predictor of pelvic pain outcome than a questionnaire-based assessment of generalized sensory sensitivity. These results suggest that MMHs overarching neural mechanisms convey more substantial long-term risk for pelvic pain than variation in individual sensory modalities. Further research on the modifiability of MMH could inform future treatment developments in chronic pain.
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Affiliation(s)
- Matthew J. Kmiecik
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Frank F. Tu
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Daniel J. Clauw
- Departments of Anesthesiology, Medicine, and Psychiatry, Chronic Pain and Fatigue Research Center, The University of Michigan Medical School, Ann Arbor, MI, United States
| | - Kevin M. Hellman
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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Sharp GC, De Giorgio L. Menarche, Menstruation, Menopause and Mental Health (4M): a consortium facilitating interdisciplinary research at the intersection of menstrual and mental health. Front Glob Womens Health 2023; 4:1258973. [PMID: 37705531 PMCID: PMC10497099 DOI: 10.3389/fgwh.2023.1258973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/14/2023] [Indexed: 09/15/2023] Open
Abstract
Menstrual and mental health form a close relationship that is under-appreciated in scientific research, clinical practice and social policy. This association is extremely complex, involving interactions between biology, psychology and social, political and structural influences on health and wellbeing. Research in these areas has traditionally been siloed: focusing on menstrual or mental health in isolation, or the interrelation from a limited one-dimensional perspective. We recognised the need for a more holistic and comprehensive approach that considers the complex interweaving nature of menstrual and mental health. In 2021, we established the Menarche, Menstruation, Menopause and Mental Health (4M) consortium as a tool to address this gap and to facilitate interdisciplinary research. This paper provides a comprehensive source of information about 4M for researchers and stakeholders who may be interested in joining or working with the consortium.
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Affiliation(s)
- Gemma C. Sharp
- School of Psychology, University of Exeter, Exeter, United Kingdom
| | - Luana De Giorgio
- School of Psychology, University of Exeter, Exeter, United Kingdom
- Public Health and Sports Science, Exeter Medical School, University of Exeter, Exeter, United Kingdom
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Agarwal K, Franks AT, Zhang X, Schisterman E, Mumfordd SL, Joseph PV. Association of inflammation biomarkers with food cravings and appetite changes across the menstrual cycle. Clin Nutr ESPEN 2023; 56:193-199. [PMID: 37344073 DOI: 10.1016/j.clnesp.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023]
Abstract
IMPORTANCE Premenstrual symptoms, including food cravings, are often a regular complaint among menstruating women. However, existing evidence regarding the biological mechanisms by which these food cravings occur remains unclear. Inflammation may play an essential role in the occurrence of these food cravings before menstruation. OBJECTIVE The purpose of the present study was to examine the associations between inflammatory markers and the risk of moderate/severe food cravings while accounting for changes in hormone levels and stress across the menstrual cycle. DESIGN, SETTING, AND PARTICIPANTS The BioCycle Study followed women (n = 259) aged 18-44 for two menstrual cycles. Food cravings (via questionnaire) were assessed up to four times per cycle. Each assessment corresponded to menses and mid-follicular, ovulation, and luteal phases of the menstrual cycle. A wide range of cytokine and chemokine levels (hsCRP, GCSF, GMCSF, IL-4, IL-6, RANTES, MIP1B, etc.) were assessed in blood samples collected at up to 8 visits per cycle, with visits timed using fertility monitors. MAIN OUTCOMES AND MEASURES Cravings for chocolate, sweets, salty, and other foods, and changes in appetite were determined to estimate the odds of moderate or severe cravings. Associations between inflammatory markers and risk of reporting a moderate/severe craving symptom at each cycle visit was determined using weighted generalized linear models (e.g., marginal structural models). Models were adjusted for age, BMI, and race, as well as time-varying covariates such as estradiol, stress, leptin, and total energy intake, and accounted for repeated measures (i.e., multiple cycles per woman). Both inflammatory markers and reports of cravings were modeled to account for variation at each visit. RESULTS An association between higher inflammatory biomarkers such as hsCRP, GCSF, GMCSF, IL-4, IL-6, RANTES, MIP, and increased risk of moderate/severe cravings were identified across the menstrual cycle all risk ratio>1, all CIs range 0.71-2.38. hsCRP retained statistical significance after false discovery rate correction with chocolate, sweet, and salty cravings, while GCSF, GMCSF, IL-6, and RANTES retained significance with chocolate and sweet cravings only. CONCLUSION and Relevance: The results suggest a potential role of inflammation in food cravings and appetite changes across the menstrual cycle.
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Affiliation(s)
- Khushbu Agarwal
- Section of Sensory Science and Metabolism, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, 20892, USA; National Institute of Nursing Research, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, 20892, USA
| | - Alexis T Franks
- National Institute of Nursing Research, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, 20892, USA
| | - Xuemin Zhang
- Division of Statistical Analysis and Reporting (DSAR), Office of Research Reporting and Analysis (ORRA), Office of Extramural Research (OER), National Institutes of Health, Department of Health and Human Services, Besthesda, MD, USA
| | - Enrique Schisterman
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Sunni L Mumfordd
- Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
| | - Paule V Joseph
- Section of Sensory Science and Metabolism, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, 20892, USA; National Institute of Nursing Research, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, 20892, USA.
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Munro MG, Mast AE, Powers JM, Kouides PA, O'Brien SH, Richards T, Lavin M, Levy BS. The relationship between heavy menstrual bleeding, iron deficiency, and iron deficiency anemia. Am J Obstet Gynecol 2023; 229:1-9. [PMID: 36706856 DOI: 10.1016/j.ajog.2023.01.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/09/2023] [Accepted: 01/14/2023] [Indexed: 01/26/2023]
Abstract
For reproductive-aged women, the symptom of heavy menstrual bleeding is highly prevalent and a major contributor to iron deficiency and its most severe manifestation, iron deficiency anemia. It is recognized that these 2 clinical entities are not only highly prevalent, but their interrelationship is poorly appreciated and frequently normalized by society, healthcare providers, and affected girls and women themselves. Both heavy menstrual bleeding and iron deficiency, with or without anemia, adversely impact quality of life-heavy menstrual bleeding during the episodes of bleeding and iron deficiency on a daily basis. These combined issues adversely affect the lives of reproductive-aged girls and women of all ages, from menarche to menopause, and their often-insidious nature frequently leads to normalization. The effects on cognitive function and the related work and school absenteeism and presenteeism can undermine the efforts and function of women in all walks of life, be they students, educators, employers, or employees. There is also an increasing body of evidence that suggests that iron deficiency, even in early pregnancy, may adversely impact fetal neurodevelopment with enduring effects on a spectrum of cognitive and psychological disorders, critically important evidence that begs the normalization of iron stores in reproductive-aged women. The authors seek to raise individual, societal, and professional awareness of this underappreciated situation in a fashion that leads to meaningful and evidence-based changes in clinical guidance and healthcare policy directed at preventing, screening, diagnosing, and appropriately managing both disorders. This manuscript provides evidence supporting the need for action and describes the elements necessary to address this pervasive set of conditions that not only affect reproductive-aged girls and women but also the lives of children everywhere.
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Affiliation(s)
- Malcolm G Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA.
| | - Alan E Mast
- Versiti Blood Research Institute, Milwaukee, WI
| | - Jacquelyn M Powers
- Department of Pediatrics, Baylor College of Medicine, Houston TX; Cancer and Hematology Center, Texas Children's Hospital, Houston, TX
| | - Peter A Kouides
- Mary M. Gooley Hemophilia Center, Rochester, NY; University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Sarah H O'Brien
- Center for Health Equity and Outcomes Research and the Hemostasis and Thrombosis Center, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH; Division of Pediatric Hematology, Oncology & Blood and Marrow Transplant, Nationwide Children's Hospital, Columbus, OH
| | - Toby Richards
- Division of Surgery, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - Michelle Lavin
- National Coagulation Centre, St James' Hospital, Dublin, Ireland; Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Barbara S Levy
- Department of Obstetrics and Gynecology, University of California, San Diego, San Diego, CA; Department of Obstetrics and Gynecology, The George Washington University, Washington, DC
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Cassioli E, Rossi E, Melani G, Faldi M, Rellini AH, Wyatt RB, Oester C, Vannuccini S, Petraglia F, Ricca V, Castellini G. The menstrual distress questionnaire (MEDI-Q): reliability and validity of the English version. Gynecol Endocrinol 2023; 39:2227275. [PMID: 37356456 DOI: 10.1080/09513590.2023.2227275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/06/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Menstrual cycle has a significant impact on women's health from different perspectives, both physically and psychologically. The assessment of menstrual-related distress is of pivotal clinical interest, especially in women with chronic exposure to abnormal bleeding or pain. The Menstrual Distress Questionnaire (MEDI-Q) is a new tool originally developed in Italian that comprehensively evaluates menstrual-related distress. OBJECTIVE To validate the English version of the MEDI-Q in an English-speaking population. METHODS The study consisted of two phases: an initial translation phase of the original Italian version of the MEDI-Q, and a data collection phase to validate the new English version among 288 native English-speaking women. RESULTS The English version of MEDI-Q showed excellent psychometric properties, with high internal consistency (Cronbach's alpha = 0.84) and test-retest reliability (intraclass correlation coefficient = 0.95). Construct validity was supported by significant correlations between MEDI-Q scores and scores on measures of psychological distress and premenstrual symptoms. CONCLUSIONS The English version of the MEDI-Q is a valid and reliable instrument for the assessment of menstrual distress and its impact on psychological well-being. This tool can be utilized in research and clinical settings to comprehensively investigate the impact of menstruation on various populations, identify and monitor menstruation-related disorders promptly and effectively, and to evaluate the effectiveness of targeted treatments for menstrual distress.
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Affiliation(s)
- Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giulia Melani
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Marco Faldi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alessandra H Rellini
- Department of Psychological Science, University of Vermont, Burlington, Vermont, USA
| | - Robert B Wyatt
- Department of Psychological Science, University of Vermont, Burlington, Vermont, USA
| | - Chelsea Oester
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Silvia Vannuccini
- Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Felice Petraglia
- Obstetrics and Gynecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
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50
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Delanerolle G, Yang XJ, Cavalini H, Kurmi OP, Røstvik CM, Shetty A, Saraswat L, Taylor J, Sajid S, Rathod S, Shi JQ, Phiri P. Exploratory systematic review and meta-analysis on period poverty. World J Meta-Anal 2023; 11:196-217. [DOI: 10.13105/wjma.v11.i5.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/18/2023] [Accepted: 05/06/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Period poverty is a global health and social issue that needs to be addressed. It has been reported that many females compromise their education, employment, and social commitments during their menstruation days due to a number of reasons, including lack of access to toilets or menstrual products.
AIM To provide a comprehensive understanding on period poverty, including outcomes associated with menstruation.
METHODS All observational and randomised clinical trials reporting menstruation challenges, menstrual poverty and menstrual products were included. Our search strategy included multiple electronic databases of PubMed, Web of Science, ScienceDirect, ProQuest and EMBASE. Studies published in a peer review journal in English between the 30th of April 1980 and the 30th of April 2022 were included. The Newcastle-Ottawa Scale was used to assess the risk of bias of the systematic included studies. Pooled odds ratios (ORs) together with 95% confidence intervals (CIs) are reported overall and for sub-groups.
RESULTS A total of 80 studies were systematically selected, where 38 were included in the meta-analysis. Of the 38 studies, 28 focused on children and young girls (i.e., 10-24 years old) and 10 included participants with a wider age range of 15-49 years. The prevalence of using disposable sanitary pads was 45% (95%CI: 0.35-0.58). The prevalence of menstrual education pre-menarche was 68% (95%CI: 0.56-0.82). The prevalence of good menstrual hygiene management (MHM) was 39% (95%CI: 0.25-0.61). Women in rural areas (OR = 0.30, 95%CI: 0.13-0.69) were 0.70 times less likely to have good MHM practices than those living in urban areas.
CONCLUSION There was a lack of evidence, especially from low- and middle- income countries. Further research to better understand the scope and prevalence of period poverty should be considered. This will enable the development of improved policies to increase access to menstrual products and medical support where necessary.
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Affiliation(s)
- Gayathri Delanerolle
- Department of Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Xiao-Jie Yang
- School of Statistics and Mathematics, Yunnan University of Finance and Economics, Kunming 650221, Yunnan Province, China
- University College London, London WC1E 6BT, United Kingdom
| | - Heitor Cavalini
- Department of Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Om P Kurmi
- Centre for Intelligent Healthcare, Institute of Health and Wellbeing, Coventry University, Coventry CV1 5LB, United Kingdom
| | - Camilla Mørk Røstvik
- Centre for Contemporary Art, University of St Andrews, Scotland KY16 9AJ, United Kingdom
| | - Ashish Shetty
- University College London, London WC1E 6BT, United Kingdom
- Pain Management Centre, University College London Hospitals NHS Foundation Trust, London W1T 4AJ, United Kingdom
| | - Lucky Saraswat
- Aberdeen Centre for Women’s Health, University of Aberdeen, Aberdeen AB24 3FX, United Kingdom
| | - Julie Taylor
- School of Nursing, University of Birmingham, Birmingham B152TT, United Kingdom
| | - Sana Sajid
- Department of Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Shanaya Rathod
- Department of Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Jian-Qing Shi
- Department of Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
- Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
| | - Peter Phiri
- Department of Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
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