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Alzueta E, Gombert-Labedens M, Javitz H, Yuksel D, Perez-Amparan E, Camacho L, Kiss O, de Zambotti M, Sattari N, Alejandro-Pena A, Zhang J, Shuster A, Morehouse A, Simon K, Mednick S, Baker FC. Menstrual Cycle Variations in Wearable-Detected Finger Temperature and Heart Rate, But Not in Sleep Metrics, in Young and Midlife Individuals. J Biol Rhythms 2024; 39:395-412. [PMID: 39108015 PMCID: PMC11416332 DOI: 10.1177/07487304241265018] [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] [Indexed: 08/23/2024]
Abstract
Most studies about the menstrual cycle are laboratory-based, in small samples, with infrequent sampling, and limited to young individuals. Here, we use wearable and diary-based data to investigate menstrual phase and age effects on finger temperature, sleep, heart rate (HR), physical activity, physical symptoms, and mood. A total of 116 healthy females, without menstrual disorders, were enrolled: 67 young (18-35 years, reproductive stage) and 53 midlife (42-55 years, late reproductive to menopause transition). Over one menstrual cycle, participants wore Oura ring Gen2 to detect finger temperature, HR, heart rate variability (root mean square of successive differences between normal heartbeats [RMSSD]), steps, and sleep. They used luteinizing hormone (LH) kits and daily rated sleep, mood, and physical symptoms. A cosinor rhythm analysis was applied to detect menstrual oscillations in temperature. The effect of menstrual cycle phase and group on all other variables was assessed using hierarchical linear models. Finger temperature followed an oscillatory trend indicative of ovulatory cycles in 96 participants. In the midlife group, the temperature rhythm's mesor was higher, but period, amplitude, and number of days between menses and acrophase were similar in both groups. In those with oscillatory temperatures, HR was lowest during menses in both groups. In the young group only, RMSSD was lower in the late-luteal phase than during menses. Overall, RMSSD was lower, and number of daily steps was higher, in the midlife group. No significant menstrual cycle changes were detected in wearable-derived or self-reported measures of sleep efficiency, duration, wake-after-sleep onset, sleep onset latency, or sleep quality. Mood positivity was higher around ovulation, and physical symptoms manifested during menses. Temperature and HR changed across the menstrual cycle; however, sleep measures remained stable in these healthy young and midlife individuals. Further work should investigate over longer periods whether individual- or cluster-specific sleep changes exist, and if a buffering mechanism protects sleep from physiological changes across the menstrual cycle.
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Affiliation(s)
- Elisabet Alzueta
- Center for Health Sciences, SRI International, Menlo Park,
CA, USA
| | | | - Harold Javitz
- Division of Education, SRI International, Menlo Park, CA,
USA
| | - Dilara Yuksel
- Center for Health Sciences, SRI International, Menlo Park,
CA, USA
| | | | - Leticia Camacho
- Center for Health Sciences, SRI International, Menlo Park,
CA, USA
| | - Orsolya Kiss
- Center for Health Sciences, SRI International, Menlo Park,
CA, USA
| | | | - Negin Sattari
- Department of Psychiatry and Human Behavior, University of
California, Irvine, CA, USA
| | | | - Jing Zhang
- Department of Cognitive Science, University of California,
Irvine, CA, USA
| | - Alessandra Shuster
- Department of Cognitive Science, University of California,
Irvine, CA, USA
| | - Allison Morehouse
- Department of Cognitive Science, University of California,
Irvine, CA, USA
| | - Katharine Simon
- Department of Pediatrics, School of Medicine, UC
Irvine
- Pulmonology Department, Children’s Hospital of
Orange County (CHOC)
| | - Sara Mednick
- Department of Cognitive Science, University of California,
Irvine, CA, USA
| | - Fiona C. Baker
- Center for Health Sciences, SRI International, Menlo Park,
CA, USA
- Brain Function Research Group, School of Physiology,
University of the Witwatersrand, Johannesburg, South Africa
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2
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Mackenzie ACL, Chung S, Hoppes E, Mickler AK, Cartwright AF. Measurement of changes to the menstrual cycle: A transdisciplinary systematic review evaluating measure quality and utility for clinical trials. PLoS One 2024; 19:e0306491. [PMID: 39052601 PMCID: PMC11271926 DOI: 10.1371/journal.pone.0306491] [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: 01/23/2024] [Accepted: 06/18/2024] [Indexed: 07/27/2024] Open
Abstract
Despite the importance of menstruation and the menstrual cycle to health, human rights, and sociocultural and economic wellbeing, the study of menstrual health suffers from a lack of funding, and research remains fractured across many disciplines. We sought to systematically review validated approaches to measure four aspects of changes to the menstrual cycle-bleeding, blood, pain, and perceptions-caused by any source and used within any field. We then evaluated the measure quality and utility for clinical trials of the identified instruments. We searched MEDLINE, Embase, and four instrument databases and included peer-reviewed articles published between 2006 and 2023 that reported on the development or validation of instruments assessing menstrual changes using quantitative or mixed-methods methodology. From a total of 8,490 articles, 8,316 were excluded, yielding 174 articles reporting on 94 instruments. Almost half of articles were from the United States or United Kingdom and over half of instruments were only in English, Spanish, French, or Portuguese. Most instruments measured bleeding parameters, uterine pain, or perceptions, but few assessed characteristics of blood. Nearly 60% of instruments were developed for populations with menstrual or gynecologic disorders or symptoms. Most instruments had fair or good measure quality or clinical trial utility; however, most instruments lacked evidence on responsiveness, question sensitivity and/or transferability, and only three instruments had good scores of both quality and utility. Although we took a novel, transdisciplinary approach, our systematic review found important gaps in the literature and instrument landscape, pointing towards a need to examine the menstrual cycle in a more comprehensive, inclusive, and standardized way. Our findings can inform the development of new or modified instruments, which-if used across the many fields that study menstrual health and within clinical trials-can contribute to a more systemic and holistic understanding of menstruation and the menstrual cycle.
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Affiliation(s)
- Amelia C. L. Mackenzie
- Global Health and Population, FHI 360, Washington, District of Columbia, United States of America
| | - Stephanie Chung
- Global Health and Population, FHI 360, Durham, North Carolina, United States of America
- Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Emily Hoppes
- Global Health and Population, FHI 360, Durham, North Carolina, United States of America
| | - Alexandria K Mickler
- Research, Technology and Utilization Division, United States Agency for International Development and the Public Health Institute, Office of Population and Reproductive Health, Bureau for Global Health, Washington, District of Columbia, United States of America
| | - Alice F. Cartwright
- Global Health and Population, FHI 360, Durham, North Carolina, United States of America
- Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
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Oleka CT, Anderson T, Ackerman KE, Elliott-Sale KJ, Kraus E, Casey E, Stellingwerff T, Donaldson AT, Finnoff JT, Post EG, Adams WM. An update to terminology describing abnormal uterine bleeding in female athletes: facilitating cross-disciplinary health care. Br J Sports Med 2024:bjsports-2024-108261. [PMID: 39025663 DOI: 10.1136/bjsports-2024-108261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Chimsom T Oleka
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia, USA
- Women's Health Task Force, United States Olympic and Paralympic Committee, Colorado Springs, Colorado, USA
| | - Travis Anderson
- Department of Sports Medicine, United States Olympic and Paralympic Committee, Colorado Springs, Colorado, USA
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, Colorado, USA
| | - Kathryn E Ackerman
- Women's Health Task Force, United States Olympic and Paralympic Committee, Colorado Springs, Colorado, USA
- Wu Tsai Female Athlete Program, Boston Children's Hospital; Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kirsty J Elliott-Sale
- Department of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester, UK
| | - Emily Kraus
- Women's Health Task Force, United States Olympic and Paralympic Committee, Colorado Springs, Colorado, USA
- Stanford Female Athlete Science and Translational Research (FASTR) Program, Department of Orthopaedic Surgery, Stanford, California, USA
| | - Ellen Casey
- Women's Health Task Force, United States Olympic and Paralympic Committee, Colorado Springs, Colorado, USA
- Hospital for Special Surgery, New York, New York, USA
| | - Trent Stellingwerff
- Canadian Sport Institute - Pacific, Victoria, British Columbia, Canada
- Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Amber T Donaldson
- Women's Health Task Force, United States Olympic and Paralympic Committee, Colorado Springs, Colorado, USA
- Department of Sports Medicine, United States Olympic and Paralympic Committee, Colorado Springs, Colorado, USA
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, Colorado, USA
| | - Jonathan T Finnoff
- Department of Sports Medicine, United States Olympic and Paralympic Committee, Colorado Springs, Colorado, USA
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, Colorado, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Eric G Post
- Department of Sports Medicine, United States Olympic and Paralympic Committee, Colorado Springs, Colorado, USA
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, Colorado, USA
| | - William M Adams
- Department of Sports Medicine, United States Olympic and Paralympic Committee, Colorado Springs, Colorado, USA
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, Colorado, USA
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
- School of Health, Exercise and Sport Sciences, Loughborough University, Leicestershire, UK
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Tinelli A, Kosmas I, Medvediev MV, Malvasi A, Morciano A, Sparić R, Mynbaev OA. Myomectomy in adult women of reproductive age: a propensity score-matched study for pregnancy rates. Arch Gynecol Obstet 2023; 308:1351-1360. [PMID: 37450263 DOI: 10.1007/s00404-023-07135-0] [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: 08/15/2022] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To study whether it is better to perform or not a myomectomy, in terms of surgical and reproductive outcomes in patients of advanced reproductive age, by an observational prospective study in university-affiliated and Community Hospitals. MATERIALS AND METHODS 40 years and older patients affected by non-submucous symptomatic uterine fibroids and desiring future fertility were enrolled and treated by laparoscopic intracapsular myomectomy by (LIM) or by open laparotomy (OIM), or by a non-surgical management as control group, while attempting to conceive. The primary outcome measures were fibroid characteristics, pre- and post-surgical parameters, pregnancy achievement; the secondary outcome measures were the spontaneous or ART pregnancy outcomes, eventual week of abortion and type of delivery. Propensity scores have been calculated with logistic regression for binary and continuous variables. RESULTS 202 patients completed the study: 112 operated by LIM, 40 by OIM and 50 patients as control group. Patients undergoing OIM have a worse surgical outcome than LIM. No difference was seen in pregnancy either after myomectomy or control group during follow-up. In the LIM group, there were 44 pregnancies (39.2%), and in the OIM group, there were 9 (22.5%) and 16 in the control group (32%). The weeks of delivery were statistically greater for the control group versus the surgical groups, with no difference in Apgar score between the 3 groups. CONCLUSION Patients aged over 40 years did not show substantial differences in reproductive outcome, whether operated or not. Myomectomy in over 40-year-old patients has no detrimental effect on future pregnancy rates and over when compared to expectant management.
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Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology and CERICSAL (Centro di RIcerca Clinico Salentino), "Veris Delli Ponti Hospital", Scorrano, Via Giuseppina Delli Ponti, 73020, Lecce, Italy.
| | - Ioannis Kosmas
- Department of Obstetrics and Gynecology, Ioannina State General Hospital G. Chatzikosta, Ioannina, Greece
| | - Mykhailo V Medvediev
- Department of Obstetrics and Gynecology, Dnipro State Medical University, Dnipro, 49044, Ukraine
| | - Antonio Malvasi
- Department of Biomedical Sciences and Human Oncology, Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Andrea Morciano
- Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
| | - Radmila Sparić
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ospan A Mynbaev
- Moscow Institute of Physics and Technology, 141701, Dolgoprudny, Russia
- New European Surgical Academy, Berlin, Germany
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5
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Kızılcan Çetin S, Aycan Z, Özsu E, Şıklar Z, Ceran A, Erişen Karaca S, Şenyazar G, Berberoğlu M. Evaluation of Abnormal Uterine Bleeding in Adolescents: Single Center Experience. J Clin Res Pediatr Endocrinol 2023; 15:230-237. [PMID: 36794870 PMCID: PMC10448548 DOI: 10.4274/jcrpe.galenos.2023.2022-10-7] [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: 11/02/2022] [Accepted: 02/04/2023] [Indexed: 02/17/2023] Open
Abstract
Objective Abnormal uterine bleeding (AUB) is the most common gynecologic complaint in adolescent girls. The aim of this study was to identify the diagnostic and management differences between those with/without heavy menstrual bleeding. Methods Retrospective data was collected from adolescents aged 10-19 years, diagnosed with AUB. Adolescents with known bleeding disorders at admission were excluded. All girls were classified according to the degree of anemia; group 1 had heavy bleeding [hemoglobin (Hb) <10 g/dL] and group 2 had moderate or mild bleeding (Hb >10 g/dL). Admission and follow-up characteristics were compared between the two groups. Results The cohort consisted of 79 girls with a mean age of 14.3±1.8 years and mean age of menarche of 11.9±1.4 years, with 85% experiencing menstrual irregularity in the two years after menarche, rising to 95.3% in group 1 (p<0.01). Anovulation was evident in 80% of the cohort. Of these 79 girls, 13 (16.5%) had polycystic ovary syndrome and two (2.5%) had structural anomalies (uterus didelphys). Three girls (group 1, n=2) had previously undiagnosed clotting factor VII deficiency; no other clotting deficiencies were diagnosed. Nineteen of 34 (56%) with personal (n=2)/family history of thrombosis had MTHFR mutation. None had venous thromboembolism during follow-up of >6 months. Conclusion The majority of AUB (85%) occurred in the first two years after menarche. A small proportion (3.8%) had undiagnosed clotting factor deficiency. The frequency of MTHFR mutation was 50% in girls with history of thrombosis; however this did not increase the risk of bleeding/thrombosis and so routine evaluation does not appear to be justified.
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Affiliation(s)
- Sirmen Kızılcan Çetin
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Zehra Aycan
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
- Ankara University Faculty of Medicine, Department of Adolescent Health, Ankara, Turkey
| | - Elif Özsu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Zeynep Şıklar
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Ayşegül Ceran
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Seda Erişen Karaca
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Gizem Şenyazar
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Merih Berberoğlu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
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6
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Kumar T, Nee K, Wei R, He S, Nguyen QH, Bai S, Blake K, Pein M, Gong Y, Sei E, Hu M, Casasent AK, Thennavan A, Li J, Tran T, Chen K, Nilges B, Kashikar N, Braubach O, Ben Cheikh B, Nikulina N, Chen H, Teshome M, Menegaz B, Javaid H, Nagi C, Montalvan J, Lev T, Mallya S, Tifrea DF, Edwards R, Lin E, Parajuli R, Hanson S, Winocour S, Thompson A, Lim B, Lawson DA, Kessenbrock K, Navin N. A spatially resolved single-cell genomic atlas of the adult human breast. Nature 2023; 620:181-191. [PMID: 37380767 PMCID: PMC11443819 DOI: 10.1038/s41586-023-06252-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 05/23/2023] [Indexed: 06/30/2023]
Abstract
The adult human breast is comprised of an intricate network of epithelial ducts and lobules that are embedded in connective and adipose tissue1-3. Although most previous studies have focused on the breast epithelial system4-6, many of the non-epithelial cell types remain understudied. Here we constructed the comprehensive Human Breast Cell Atlas (HBCA) at single-cell and spatial resolution. Our single-cell transcriptomics study profiled 714,331 cells from 126 women, and 117,346 nuclei from 20 women, identifying 12 major cell types and 58 biological cell states. These data reveal abundant perivascular, endothelial and immune cell populations, and highly diverse luminal epithelial cell states. Spatial mapping using four different technologies revealed an unexpectedly rich ecosystem of tissue-resident immune cells, as well as distinct molecular differences between ductal and lobular regions. Collectively, these data provide a reference of the adult normal breast tissue for studying mammary biology and diseases such as breast cancer.
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Affiliation(s)
- Tapsi Kumar
- Department of Systems Biology, UT MD Anderson Cancer Center, Houston, TX, USA
- Graduate School of Biomedical Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kevin Nee
- Department of Biological Chemistry, University of California, Irvine, Irvine, CA, USA
| | - Runmin Wei
- Department of Systems Biology, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Siyuan He
- Department of Systems Biology, UT MD Anderson Cancer Center, Houston, TX, USA
- Graduate School of Biomedical Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Quy H Nguyen
- Department of Biological Chemistry, University of California, Irvine, Irvine, CA, USA
| | - Shanshan Bai
- Department of Systems Biology, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Kerrigan Blake
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA, USA
- Math, Computational & Systems Biology, University of California, Irvine, Irvine, CA, USA
| | - Maren Pein
- Department of Biological Chemistry, University of California, Irvine, Irvine, CA, USA
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA, USA
| | - Yanwen Gong
- Department of Biological Chemistry, University of California, Irvine, Irvine, CA, USA
- Math, Computational & Systems Biology, University of California, Irvine, Irvine, CA, USA
| | - Emi Sei
- Department of Systems Biology, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Min Hu
- Department of Systems Biology, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Anna K Casasent
- Department of Systems Biology, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Aatish Thennavan
- Department of Systems Biology, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Jianzhuo Li
- Department of Systems Biology, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Tuan Tran
- Department of Systems Biology, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Ken Chen
- Department of Bioinformatics and Computational Biology, UT MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | | | | - Hui Chen
- Department of Pathology, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Mediget Teshome
- Department of Breast Surgical Oncology, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Brian Menegaz
- Department of Pathology and Immunology, Baylor Medical College, Houston, TX, USA
| | - Huma Javaid
- Department of Pathology and Immunology, Baylor Medical College, Houston, TX, USA
| | - Chandandeep Nagi
- Department of Pathology and Immunology, Baylor Medical College, Houston, TX, USA
| | - Jessica Montalvan
- Department of Pathology and Immunology, Baylor Medical College, Houston, TX, USA
| | - Tatyana Lev
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA, USA
- Math, Computational & Systems Biology, University of California, Irvine, Irvine, CA, USA
| | - Sharmila Mallya
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA, USA
| | - Delia F Tifrea
- Chao Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA
| | - Robert Edwards
- Chao Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA
| | - Erin Lin
- Chao Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA
| | - Ritesh Parajuli
- Chao Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA
| | - Summer Hanson
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | | | | | - Bora Lim
- Department of Medicine, Section of Hematology and Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Devon A Lawson
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA, USA.
| | - Kai Kessenbrock
- Department of Biological Chemistry, University of California, Irvine, Irvine, CA, USA.
| | - Nicholas Navin
- Department of Systems Biology, UT MD Anderson Cancer Center, Houston, TX, USA.
- Graduate School of Biomedical Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Bioinformatics and Computational Biology, UT MD Anderson Cancer Center, Houston, TX, USA.
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7
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Munro MG, Critchley HOD. Our path from abnormal uterine bleeding and iron deficiency to impaired fetal development: A long and winding road. Int J Gynaecol Obstet 2023; 162 Suppl 2:3-6. [PMID: 37538012 DOI: 10.1002/ijgo.14942] [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] [Indexed: 08/05/2023]
Abstract
SynopsisAbnormal uterine bleeding adversely impacts the lives of reproductive‐aged girls and women; furthermore, the resulting periconceptual iron deficiency risks enduring neurological sequelae in the child.
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Affiliation(s)
- Malcolm G Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, The University of California, Los Angeles, Los Angeles, California, USA
- FIGO Committee on Menstrual Disorders and Related Health Impacts (MDRHI), London, UK
| | - Hilary O D Critchley
- FIGO Committee on Menstrual Disorders and Related Health Impacts (MDRHI), London, UK
- Centre for Reproductive Health, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
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8
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Es-haghee Ashteany S, Vahid Dastjerdi M, Tabarrai M, Nejatbakhsh F, Sadati Lamardi SN, Rahmani A, Azizkhani M, Tavoli Z. Effectiveness of Persian Golnar on Excessive Menstrual Bleeding in Women with Abnormal Uterine Bleeding, Compared to Tranexamic Acid: A Triple-Blind, Randomized Equivalence Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2023; 2023:5355993. [PMID: 37520025 PMCID: PMC10374373 DOI: 10.1155/2023/5355993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 06/09/2023] [Accepted: 07/01/2023] [Indexed: 08/01/2023]
Abstract
Introduction Abnormal uterine bleeding (AUB) is a major healthcare problem in females of reproductive age and impacts women's health and quality of life (QoL). This study aimed to test the equivalence of Persian Golnar (PG) and tranexamic acid (TA) for the treatment of excessive menstrual bleeding. Method A triple-blind randomized equivalence trial with parallel design and block randomization technique was performed. A total of 80 patients with AUB were randomly allocated to receive either PG or TA for three consecutive menstrual cycles. Blood loss was measured by the Pictorial Blood Loss Assessment Chart (PBAC). Hematological evaluations were done before the intervention and after treatment. QoL and premenstrual dysphoric disorder (PMDD) as secondary outcomes were assessed using the menorrhagia questionnaire (MQ) and Premenstrual Symptoms Screening Tool (PSST). Statistical analysis was performed using an independent t-test, paired t-test, χ2 test, Mann-Whitney test, and Wilcoxon signed-rank test. Results Seventy-six women completed the 12-week follow-up. Both PG and TA groups experienced a significant reduction in blood loss. Furthermore, the serum level of hemoglobin in the PG group enhanced significantly (P < 0.001). QoL and PMDD scores were significantly improved in both groups (P< 0.001). Conclusion The findings of the current trial supposed that the Golnar product is as effective as tranexamic acid in controlling bleeding and enhancing the quality of life and premenstrual symptoms.
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Affiliation(s)
- Somayeh Es-haghee Ashteany
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Malihe Tabarrai
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Fatemeh Nejatbakhsh
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Azam Rahmani
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Azizkhani
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Zahra Tavoli
- Department of Obstetrics and Gynecology, Ziaeian Hospital, Tehran University of Medical Science, Tehran, Iran
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9
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Shim S, Streich-Tilles T, Gutmark-Little I, Yao M, Shafer J, Breech L, Casnellie L, Backeljauw P. Abnormal Uterine Bleeding during Pubertal Induction with Transdermal Estrogen in Turner Syndrome Individuals. J Pediatr Adolesc Gynecol 2023:S1083-3188(23)00314-5. [PMID: 36934801 DOI: 10.1016/j.jpag.2023.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 01/13/2023] [Accepted: 03/10/2023] [Indexed: 03/21/2023]
Abstract
STUDY OBJECTIVES Incidence of abnormal uterine bleeding (AUB) during pubertal induction among individuals with Turner syndrome (TS) has not been described previously. We estimated the incidence and characterize factors associated with AUB among TS individuals. A secondary objective was to evaluate the management of AUB among this patient population. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTION We conducted a retrospective chart review to evaluate TS individuals undergoing hormone replacement therapy (HRT) for pubertal induction with transdermal estrogen (TDE). A total of 45 participants were identified between January 2007 and June 2019. RESULTS Of the 45 TS individuals included, 16 (35%) experienced AUB. Individuals with AUB most commonly experienced prolonged (44%), prolonged and heavy (25%), and intermenstrual (19%) bleeding. Individuals who experienced AUB were more likely to experience spontaneous bleeding (69% vs. 28%) and a duration of unopposed estrogen greater than 18 months (63% vs. 41%), undergo progestin cycling less often than monthly (69% vs. 0%), use a micronized progestin dose of less than 200 mg (25% vs. 14%), and be noncompliant with HRT (19% vs. 0%) compared to those who did not experience AUB. CONCLUSIONS There is a relatively high incidence of AUB among TS individuals undergoing pubertal induction with TDE. Care providers should consider the clinical factors examined to guide monitoring and management of TS individuals on HRT.
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Affiliation(s)
- Sarah Shim
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Room T5.272, Cincinnati, OH 45229.
| | - Tara Streich-Tilles
- Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Room T5.272, Cincinnati, OH 45229
| | - Iris Gutmark-Little
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Room T5.272, Cincinnati, OH 45229
| | - Michael Yao
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Room T5.272, Cincinnati, OH 45229
| | - Jessica Shafer
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Room T5.272, Cincinnati, OH 45229
| | - Lesley Breech
- Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Room T5.272, Cincinnati, OH 45229
| | - Lori Casnellie
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Room T5.272, Cincinnati, OH 45229
| | - Philippe Backeljauw
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Room T5.272, Cincinnati, OH 45229
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10
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El Sokkary HH, Farahat AAE. Studying Doppler Ultrasound Indices of Uterine Artery in Cases of Endometrial Cancer in Al Shatby University Hospital Patients. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2023. [DOI: 10.1007/s40944-022-00689-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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11
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Palheta MS, Medeiros FDC, Severiano ARG. Reporting of uterine fibroids on ultrasound examinations: an illustrated report template focused on surgical planning. Radiol Bras 2023; 56:86-94. [PMID: 37168038 PMCID: PMC10165971 DOI: 10.1590/0100-3984.2022.0048] [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: 04/19/2022] [Accepted: 08/04/2022] [Indexed: 05/13/2023] Open
Abstract
Uterine fibroids are the most common benign gynecologic tumors in women of reproductive age, and ultrasound is the first-line imaging modality for their diagnosis and characterization. The International Federation of Gynecology and Obstetrics developed a system for describing and classifying uterine fibroids uniformly and consistently. An accurate description of fibroids in the ultrasound report is essential for planning surgical treatment and preventing complications. In this article, we review the ultrasound findings of fibroids, detailing the main points to be reported for preoperative evaluation. In addition, we propose a structured, illustrated report template to describe fibroids, based on the critical points for surgical planning.
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12
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Fisiopatología del sangrado uterino anómalo. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2023. [DOI: 10.1016/j.gine.2022.100814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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13
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Myofascial Pain Syndrome in Women with Primary Dysmenorrhea: A Case-Control Study. Diagnostics (Basel) 2022; 12:diagnostics12112723. [PMID: 36359567 PMCID: PMC9689409 DOI: 10.3390/diagnostics12112723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/22/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
There is limited information on myofascial trigger points (MTrPs) and specific symptoms of chronic pelvic pain and, more specifically, dysmenorrhea. The objective of this study was to determine whether patients suffering from primary dysmenorrhea present alterations in mechanosensitivity and pain patterns, and greater presence of MTrPs in the abdominal and pelvic floor muscles. A case-control study was carried out with a total sample of 84 participants distributed based on primary dysmenorrhea and contraceptive treatment. The sample was divided into four groups each comprising 21 women. Data on pain, quality of life, and productivity and work absenteeism were collected; three assessments were made in different phases of the menstrual cycle, to report data on pressure pain threshold, MTrP presence, and referred pain areas. One-way ANOVA tests showed statistically significant differences (p < 0.01) between the groups, for the Physical Health domain and the total score of the SF-12 questionnaire, and for all the domains of the McGill questionnaire; but no significant differences were found in the data from the WPAI-GH questionnaire. Statistically significant data (p < 0.01) were found for mechanosensitivity in the abdominal area and limbs, but not for the lumbar assessment, within the group, with very few significant intergroup differences. The frequency of active MTrPs is higher in the groups of women with primary dysmenorrhea and during the menstrual phase, with the prevalence of myofascial trigger points of the iliococcygeus muscle being especially high in all examination groups (>50%) and higher than 70% in women with primary dysmenorrhea, in the menstrual phase, and the internal obturator muscle (100%) in the menstrual phase. Referred pain areas of the pelvic floor muscles increase in women with primary dysmenorrhea.
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14
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Vico-Moreno E, Sastre-Munar A, Fernández-Domínguez JC, Romero-Franco N. Motor Control and Regularity of Menstrual Cycle in Ankle and Knee Injuries of Female Basketball Players: A Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14357. [PMID: 36361236 PMCID: PMC9654706 DOI: 10.3390/ijerph192114357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
Inadequate motor control facilitates ankle and knee injuries in female basketball. Although biomechanical analysis could help to detect it, aspects such as irregular menstruation make these associations controversial. We aimed to evaluate associations between 2D biomechanics during landing and proprioception with ankle and knee injuries of female basketball players, considering their menstruation regularity. Seventy-one players participated in this study. In the preseason, participants performed a drop-jump to obtain biomechanics during landing and a weight-bearing proprioception test. During the competitive season, all the non-contact ankle and knee injuries were registered. Data showed that 16% of players sustained an ankle or knee injury, being more frequent in players with irregular menstruation compared to regulars (22% vs. 13%, χ2 = 6.009, p = 0.050, d = 0.6). Players who sustained a left-side injury displayed higher left-side dynamic valgus during landing than uninjured players (χ2 = 25.88, p = 0.006, d = 1.5). The rest of the variables did not show any significant difference (p > 0.05). Monitoring 2D dynamic valgus from a drop-jump could help to detect inadequate motor control that may facilitate ankle or knee injuries of female basketball players, mainly for those with irregular menstruation. Proprioception seems not to be related to injuries.
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Affiliation(s)
- Elena Vico-Moreno
- Nursing and Physiotherapy Department, University of the Balearic Islands, E-07122 Palma de Mallorca, Spain
| | - Andreu Sastre-Munar
- Nursing and Physiotherapy Department, University of the Balearic Islands, E-07122 Palma de Mallorca, Spain
- Sport High Performance Centre of Balearic Islands, E-07009 Palma de Mallorca, Spain
| | - Juan Carlos Fernández-Domínguez
- Nursing and Physiotherapy Department, University of the Balearic Islands, E-07122 Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), E-07120 Palma de Mallorca, Spain
| | - Natalia Romero-Franco
- Nursing and Physiotherapy Department, University of the Balearic Islands, E-07122 Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), E-07120 Palma de Mallorca, Spain
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15
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Tsolova AO, Aguilar RM, Maybin JA, Critchley HOD. Pre-clinical models to study abnormal uterine bleeding (AUB). EBioMedicine 2022; 84:104238. [PMID: 36081283 PMCID: PMC9465267 DOI: 10.1016/j.ebiom.2022.104238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022] Open
Abstract
Abnormal Uterine Bleeding (AUB) is a common debilitating condition that significantly reduces quality of life of women across the reproductive age span. AUB creates significant morbidity, medical, social, and economic problems for women, their families, workplace, and health services. Despite the profoundly negative effects of AUB on public health, advancement in understanding the pathophysiology of AUB and the discovery of novel effective therapies is slow due to lack of reliable pre-clinical models. This review discusses currently available laboratory-based pre-clinical scientific models and how they are used to study AUB. Human and animal in vitro, ex vivo, and in vivo models will be described along with advantages and limitations of each method.
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16
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Munro MG, Balen AH, Cho S, Critchley HOD, Díaz I, Ferriani R, Henry L, Edgar Mocanu, van der Spuy ZM. The FIGO Ovulatory Disorders Classification System. Fertil Steril 2022; 118:768-786. [PMID: 35995633 DOI: 10.1016/j.fertnstert.2022.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Ovulatory disorders are common causes of amenorrhea, abnormal uterine bleeding, and infertility, and are frequent manifestations of polycystic ovary syndrome (PCOS). There are many potential causes and contributors to ovulatory dysfunction that challenge clinicians, trainees, educators, and those who perform basic, translational, clinical, and epidemiological research. Similarly, therapeutic approaches to ovulatory dysfunction potentially involve a spectrum of lifestyle, psychological, medical, and procedural interventions. Collaborative research, effective education, and consistent clinical care remain challenged by the absence of a consensus comprehensive system for classification of these disorders. The existing and complex system, attributed to WHO, was developed more than three decades ago and did not consider more than 30 years of research into these disorders in addition to technical advances in imaging and endocrinology. This manuscript describes the development of a new classification of ovulatory disorders performed under the aegis of the International Federation of Gynecology and Obstetrics (FIGO) and conducted using a rigorously applied Delphi process. The stakeholder organizations and individuals who participated in this process comprised specialty journals, experts at large, national, specialty obstetrical and gynecological societies, and informed lay representatives. After two face-to-face meetings and five Delphi rounds, the result is a three-level multi-tiered system. The system is applied after a preliminary assessment identifies the presence of an ovulatory disorder. The primary level of the system is based on an anatomic model (Hypothalamus, Pituitary, Ovary) that is completed with a separate category for PCOS. This core component of the system is easily remembered using the acronym HyPO-P. Each anatomic category is stratified in the second layer of the system to provide granularity for investigators, clinicians, and trainees using the "GAIN-FIT-PIE" mnemonic (Genetic, Autoimmune, Iatrogenic, Neoplasm; Functional, Infectious and Inflammatory, Trauma and vascular; Physiological, Idiopathic, Endocrine). The tertiary level allows for specific diagnostic entities. It is anticipated that, if widely adopted, this system will facilitate education, clinical care, and the design and interpretation of research in a fashion that better informs progress in this field. Integral to the deployment of this system is a periodic process of reevaluation and appropriate revision, reflecting an improved understanding of this collection of disorders.
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Affiliation(s)
- Malcolm G Munro
- The University of California, Los Angeles, Los Angeles, California, USA.
| | | | | | | | | | | | - Laurie Henry
- Centre Hospitalier Universitaire Liège, University of Liège, Liège, Belgium
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17
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Munro MG, Balen AH, Cho S, Critchley HOD, Díaz I, Ferriani R, Henry L, Mocanu E, van der Spuy ZM. The FIGO Ovulatory Disorders Classification System†. Hum Reprod 2022; 37:2446-2464. [PMID: 35984284 PMCID: PMC9527465 DOI: 10.1093/humrep/deac180] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Indexed: 02/01/2023] Open
Abstract
Ovulatory disorders are common causes of amenorrhea, abnormal uterine bleeding and infertility and are frequent manifestations of polycystic ovary syndrome (PCOS). There are many potential causes and contributors to ovulatory dysfunction that challenge clinicians, trainees, educators, and those who perform basic, translational, clinical and epidemiological research. Similarly, therapeutic approaches to ovulatory dysfunction potentially involve a spectrum of lifestyle, psychological, medical and procedural interventions. Collaborative research, effective education and consistent clinical care remain challenged by the absence of a consensus comprehensive system for classification of these disorders. The existing and complex system, attributed to the World Health Organization (WHO), was developed more than three decades ago and did not consider more than 30 years of research into these disorders in addition to technical advances in imaging and endocrinology. This article describes the development of a new classification of ovulatory disorders performed under the aegis of the International Federation of Gynecology and Obstetrics (FIGO) and conducted using a rigorously applied Delphi process. The stakeholder organizations and individuals who participated in this process comprised specialty journals, experts at large, national, specialty obstetrical and gynecological societies, and informed lay representatives. After two face-to-face meetings and five Delphi rounds, the result is a three-level multi-tiered system. The system is applied after a preliminary assessment identifies the presence of an ovulatory disorder. The primary level of the system is based on an anatomic model (Hypothalamus, Pituitary, Ovary) that is completed with a separate category for PCOS. This core component of the system is easily remembered using the acronym HyPO-P. Each anatomic category is stratified in the second layer of the system to provide granularity for investigators, clinicians and trainees using the 'GAIN-FIT-PIE' mnemonic (Genetic, Autoimmune, Iatrogenic, Neoplasm; Functional, Infectious and Inflammatory, Trauma and Vascular; Physiological, Idiopathic, Endocrine). The tertiary level allows for specific diagnostic entities. It is anticipated that, if widely adopted, this system will facilitate education, clinical care and the design and interpretation of research in a fashion that better informs progress in this field. Integral to the deployment of this system is a periodic process of reevaluation and appropriate revision, reflecting an improved understanding of this collection of disorders.
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Affiliation(s)
- Malcolm G Munro
- The University of California, Los Angeles, Los Angeles, CA, USA
| | | | | | | | | | | | - Laurie Henry
- Centre Hospitalier Universitaire Liège, University of Liège, Liège, Belgium
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18
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Blukacz Ł, Nowak A, Wójtowicz M, Krawczyk A, Franik G, Madej P, Pluta D, Kowalczyk K, Żorniak M. Clinical Usefulness of Non-Invasive Metabolic-Associated Fatty Liver Disease Risk Assessment Methods in Patients with Full-Blown Polycystic Ovary Syndrome in Relation to the MRI Examination with the Ideal IQ Sequence. Biomedicines 2022; 10:biomedicines10092193. [PMID: 36140294 PMCID: PMC9496340 DOI: 10.3390/biomedicines10092193] [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: 08/04/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
The coexistence of polycystic ovary syndrome (PCOS) and liver steatosis has been studied for years. The gold standards for the diagnosis of liver steatosis are liver biopsy and magnetic resonance imaging (MRI), which are invasive and expensive methods. The main aim of this study is to check the usefulness of lipid accumulation product (LAP) and free androgen index (FAI) in the diagnosis of liver steatosis. The Ideal IQ MRI was performed in 49 women with PCOS phenotype A to assess the degree of liver steatosis, which was expressed with the proton density fat fraction (PDFF). Anthropometric examination and laboratory tests were performed, and the LAP and FAI were calculated. The correlation between MRI results and LAP, FAI, and one of the FAI components, sex hormone binding globulin (SHBG), was checked using statistical tests. There is a statistically significant correlation between PDFF and LAP and also between PDFF and FAI. LAP = 70.25 and FAI = 5.05 were established as cut-offs to diagnose liver steatosis. The SHBG is not a statistically significant parameter to predict liver steatosis. The study showed that especially LAP, but also FAI, can be used to predict liver steatosis with high specificity and sensitivity.
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Affiliation(s)
- Łukasz Blukacz
- Department of Gynecological Endocrinology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Artur Nowak
- Gynecological and Obstetrician Polyclinic, 15-435 Białystok, Poland
| | - Mariusz Wójtowicz
- Department of Gynecological and Obstetrics, Women’s and Child Health Center, Medical University of Silesia, 41-803 Zabrze, Poland
| | - Angelika Krawczyk
- Student Scientific Association of Gynecological Endocrinology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
- Correspondence:
| | - Grzegorz Franik
- Department of Gynecological Endocrinology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Paweł Madej
- Department of Gynecological Endocrinology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Dagmara Pluta
- Department of Gynecological Endocrinology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Karolina Kowalczyk
- Department of Gynecological Endocrinology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Michał Żorniak
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Institute of Oncology, 02-781 Warsaw, Poland
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
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19
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Demir A, Hero M, Alfthan H, Passioni A, Tapanainen JS, Stenman UH. Identification of the LH surge by measuring intact and total immunoreactivity in urine for prediction of ovulation time. Hormones (Athens) 2022; 21:413-420. [PMID: 35614178 PMCID: PMC9464748 DOI: 10.1007/s42000-022-00368-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 04/07/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES In our earlier study, we separated three different molecular forms of urinary LH-ir (U-LH-ir) by gel filtration and identified them by immunoassay in urine from regularly menstruating women on periovulatory days. U-LH-ir is composed of intact luteinizing hormone (LH), its free beta-subunit (LHβ), and the core fragment of LHβ (LHβcf), the latter two establishing the non-intact portion of LH-ir. The aim was to determine whether timing of ovulation can be improved by detecting different molecular forms of U-LH-ir in women of reproductive age. METHODS We determined intact and total U-LH-ir in 14 regularly menstruating women on consecutive periovulatory days during the menstrual cycle. Non-intact LH-ir was calculated as the arithmetic difference between total and intact LH-ir. In addition, LH-ir was determined in both serum and urine from four of the women throughout the menstrual cycle. RESULTS During the LH surge, U-LH-ir consisted mainly of intact LH and presented with an abrupt increase. Intact U-LH-ir dropped rapidly within 1 day after the surge, reaching baseline levels at the end of the luteal phase. In contrast, LHβcf in urine increased further 1 day after the surge. After this, most of the U-LH-ir consisted of LHβcf and it remained strongly elevated (over fivefold compared to intact LH) for the first 3 days after the LH surge, moderately elevated (over threefold) thereafter until day + 5, and mildly elevated until day + 7. CONCLUSIONS Total and non-intact LH-ir are potential add-on characteristics which can be utilized in ovulation predictor kits to measure LH-ir in urine beyond the LH surge during a broader time frame, thereby paving the way for more precise prediction of the timing of ovulation than that obtained with currently available products.
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Affiliation(s)
- And Demir
- Pediatric Research Center, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Biomedicum II, 6th floor, Tukholmankatu 8 A, FIN-00290, Helsinki, Finland.
| | - Matti Hero
- Pediatric Research Center, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Biomedicum II, 6th floor, Tukholmankatu 8 A, FIN-00290, Helsinki, Finland
| | | | - Amro Passioni
- Department of Clinical Chemistry, Helsinki University Hospital, Helsinki, Finland
| | - Juha S Tapanainen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Obstetrics and Gynecology, Medical Research Center, PEDEGO Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Ulf-Håkan Stenman
- Department of Clinical Chemistry, Helsinki University Hospital, Helsinki, Finland
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20
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Munro MG, Balen AH, Cho S, Critchley HOD, Díaz I, Ferriani R, Henry L, Mocanu E, van der Spuy ZM. The FIGO ovulatory disorders classification system. Int J Gynaecol Obstet 2022; 159:1-20. [PMID: 35983674 PMCID: PMC10086853 DOI: 10.1002/ijgo.14331] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Ovulatory disorders are common causes of amenorrhea, abnormal uterine bleeding, and infertility, and are frequent manifestations of polycystic ovary syndrome (PCOS). There are many potential causes and contributors to ovulatory dysfunction that challenge clinicians, trainees, educators, and those who perform basic, translational, clinical, and epidemiological research. Similarly, therapeutic approaches to ovulatory dysfunction potentially involve a spectrum of lifestyle, psychological, medical, and procedural interventions. Collaborative research, effective education, and consistent clinical care remain challenged by the absence of a consensus comprehensive system for classification of these disorders. The existing and complex system, attributed to WHO, was developed more than three decades ago and did not consider more than 30 years of research into these disorders in addition to technical advances in imaging and endocrinology. This manuscript describes the development of a new classification of ovulatory disorders performed under the aegis of the International Federation of Gynecology and Obstetrics (FIGO) and conducted using a rigorously applied Delphi process. The stakeholder organizations and individuals who participated in this process comprised specialty journals, experts at large, national, specialty obstetrical and gynecological societies, and informed lay representatives. After two face-to-face meetings and five Delphi rounds, the result is a three-level multi-tiered system. The system is applied after a preliminary assessment identifies the presence of an ovulatory disorder. The primary level of the system is based on an anatomic model (Hypothalamus, Pituitary, Ovary) that is completed with a separate category for PCOS. This core component of the system is easily remembered using the acronym HyPO-P. Each anatomic category is stratified in the second layer of the system to provide granularity for investigators, clinicians, and trainees using the "GAIN-FIT-PIE" mnemonic (Genetic, Autoimmune, Iatrogenic, Neoplasm; Functional, Infectious and Inflammatory, Trauma and Vascular; Physiological, Idiopathic, Endocrine). The tertiary level allows for specific diagnostic entities. It is anticipated that, if widely adopted, this system will facilitate education, clinical care, and the design and interpretation of research in a fashion that better informs progress in this field. Integral to the deployment of this system is a periodic process of reevaluation and appropriate revision, reflecting an improved understanding of this collection of disorders.
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Affiliation(s)
| | | | | | | | | | | | - Laurie Henry
- Centre Hospitalier Universitaire Liège, University of Liège, Liège, Belgium
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21
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Peña AS, Codner E, Witchel S. Criteria for Diagnosis of Polycystic Ovary Syndrome during Adolescence: Literature Review. Diagnostics (Basel) 2022; 12:diagnostics12081931. [PMID: 36010282 PMCID: PMC9406411 DOI: 10.3390/diagnostics12081931] [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: 07/12/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 11/11/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common endocrine conditions in women. PCOS may be more challenging to diagnose during adolescence due to an overlap with the physiological events of puberty, which are part of the diagnostic criteria in adult women. This review focuses on the evidence available in relation to PCOS diagnostic criteria for adolescents. Adolescent PCOS should be diagnosed using two main criteria irregular -menstrual cycles (relative to number of years post-menarche) and hyperandrogenism (clinical and/or biochemical); after excluding other conditions that mimic PCOS. Accurate definitions of the two main criteria will decrease challenges/controversies with the diagnosis and provide timely diagnosis during adolescence to establish early management. Despite the attempts to create accurate diagnostic criteria and definitions, this review highlights the limited research in this area, especially in the follow up of adolescents presenting with one diagnostic feature that are called “at risk of PCOS”. Studies in adolescents continue to use the Rotterdam diagnostic criteria that uses pelvic ultrasound. This is inappropriate, because previous and emerging data that show many healthy adolescents have polycystic ovarian morphology in the early years post-menarche. In the future, anti-Müllerian hormone levels might help support PCOS diagnosis if adolescents meet two main criteria.
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Affiliation(s)
- Alexia S. Peña
- Discipline of Paediatrics, The University of Adelaide Robinson Research Institute, 72 King William Road, Adelaide, SA 5006, Australia
- Endocrinology and Diabetes Department, Women’s and Children’s Hospital, 72 King William Road, Adelaide, SA 5006, Australia
- Correspondence: ; Tel.: +61-881618134
| | - Ethel Codner
- Institute of Child and Maternal Research, School of Medicine, University of Chile, Santiago 836-0160, Chile
| | - Selma Witchel
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15224, USA
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22
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Wongwananuruk T, Rattanachaiyanont M, Dangrat C, Techatraisak K, Indhavivadhana S, Tanmahasamut P. Quality of life in Thai women with various types of abnormal uterine bleeding. Int J Gynaecol Obstet 2022; 159:711-718. [PMID: 35583802 DOI: 10.1002/ijgo.14272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/02/2022] [Accepted: 05/09/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the quality of life (QoL) in Thai women with various types of abnormal uterine bleeding (AUB). METHODS A cross-sectional study was conducted on 353 AUB patients between November 2010 and January 2012. They were grouped according to the duration of symptom: <6 months (acute AUB, n = 122), ≥6 months (chronic AUB, n = 138), and postmenopausal bleeding (PMB, n = 93); and the bleeding pattern: hypermenorrhea (n = 24) and irregular bleeding (n = 236). QoL was determined using the 36-Item Short-Form Health Survey (SF-36) Thai version. RESULTS The acute AUB and chronic AUB groups had a mean age of 43.84 ± 4.87 and 43.81 ± 6.55 years; they were younger than the PMB group (55.62 ± 7.55 years) (P < 0.001). Medical diseases were more prevalent in the PMB than in the acute and chronic groups (66.7% vs. 27.9% and 35.5%, respectively, P < 0.001). Some subscales of the SF-36 were significantly lower in the women with AUB than in those with normative values, in those with chronic AUB or PMB than in those with acute AUB, and in those with hypermenorrhea rather than in those with irregular bleeding. CONCLUSION Thai women with any AUB types have a poorer QoL than general Thai women. QoL tends to be poorer in women with symptoms longer than 6 months or with hypermenorrhea.
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Affiliation(s)
- Thanyarat Wongwananuruk
- Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Manee Rattanachaiyanont
- Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chongdee Dangrat
- Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kitirat Techatraisak
- Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suchada Indhavivadhana
- Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prasong Tanmahasamut
- Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Alshdaifat EH, El-Deen Al-Horani SS, Al-Sous MM, Al-Horani S, Sahawneh FE, Sindiani AM. Histopathological pattern of endometrial biopsies in patients with abnormal uterine bleeding in a tertiary referral hospital in Jordan. Ann Saudi Med 2022; 42:204-213. [PMID: 35658582 PMCID: PMC9167457 DOI: 10.5144/0256-4947.2022.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Abnormal uterine bleeding (AUB) is a symptom that deviates from the normal menstrual cycle. AUB is characterized by changes in the frequency, volume, and duration of the menstrual flow. The etiology of AUB, which varies with age, may be attributed to both structural and non-structural causes. OBJECTIVES Determine the histopathological pattern of endometrial biopsies in patients with AUB across different age and parity groups who have undergone dilation and curettage (D&C), along with the discrepancy between D&C and histopathological findings after hysterectomy. DESIGN Retrospective chart review SETTING: Tertiary referral hospital PATIENTS AND METHODS: We collected data on all patients diagnosed with AUB between January 2015 and December 2020. Histopathological findings of all D&C endometrial biopsy samples were examined after being categorized by age and parity groups. Sensitivity, specificity, positive predictive value, and NPV were calculated to evaluate the diagnostic accuracy of D&C. MAIN OUTCOME MEASURES Histopathological pattern of D&C endometrial biopsies by age and parity groups. SAMPLE SIZE 3233 patients. RESULTS Most patients were in the 18-39 year age group, with normal cyclical findings being the most common histopathological finding. Malignant lesions were observed in 42 patients with a majority being older than 50 years. In 13.3% (42/316) of patients, D&C failed to detect intrauterine disorder that was found on hysterectomy. The overall accuracy of D&C in determining the existence of normal versus pathological findings was 75.60%, the sensitivity was 72.90%, the specificity was 77.90%, the positive predictive value was 73.86% and the NPV was 77.05% in our patients. CONCLUSION Normal cyclic changes account for the highest proportion of histopathological findings. However, hyperplasia and malignancies are important causes of perimenopausal and postmenopausal bleeding. While the use of D&C as a sampling tool for AUB cases remains questionable, the use of D&C in diagnosing premalignant and malignant cases is highly effective. LIMITATIONS Single-center, retrospective design, incomplete medical records, and inter-rater reliability could not be determined. CONFLICT OF INTEREST None.
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Affiliation(s)
| | | | - Majd Mahmoud Al-Sous
- From the Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sharaf Al-Horani
- From Department of Obstetrics and Gynecology, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Amer Mahmoud Sindiani
- From Department of Obstetrics and Gynecology, Jordan University of Science and Technology, Irbid, Jordan
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Recommendations for standardization of bleeding data analyses in contraceptive studies. Contraception 2022; 112:14-22. [DOI: 10.1016/j.contraception.2022.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022]
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Chodankar RR, Munro MG, Critchley HOD. Historical Perspectives and Evolution of Menstrual Terminology. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:820029. [PMID: 36303670 PMCID: PMC9580747 DOI: 10.3389/frph.2022.820029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/24/2022] [Indexed: 01/06/2023] Open
Abstract
Abnormal uterine bleeding (AUB) in the reproductive years in non-pregnant women comprises a group of symptoms that include abnormal frequency and the irregular onset of flow as well as prolonged and heavy menstrual bleeding. It is a common, chronic, and debilitating condition affecting women worldwide with an adverse impact on their quality of life. Until the last decade, the "menstrual" terminology used to describe both normal and abnormal uterine bleeding and its underlying causes was inconsistent, creating considerable confusion. Using standardized terminology may potentially improve clinical management as well as help designing and interpreting basic, translational, epidemiological, and clinical research in women with menstrual problems. In this article, we explore the history and evolution of menstrual terminology and discuss the two International Federation of Gynecology and Obstetrics (FIGO) systems on i.e., (A) menstrual terminology and definitions (B) and the causes of AUB, achieved through international consensus of relevant stakeholders through a long multistage journey.
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Affiliation(s)
- Rohan R. Chodankar
- Department of Obstetrics and Gynaecology, NHS Lothian, Edinburgh, United Kingdom
| | - Malcolm G. Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Hilary O. D. Critchley
- Medical Research Council Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
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Abstract
PURPOSE OF REVIEW The aim of this review is to evaluate biological, life history, environmental, and lifestyle factors and exposures that cause variability in menstrual cycle length (MCL). RECENT FINDINGS Recent literature has detailed a number of factors that influence MCL, with particular emphasis placed on novel environmental exposures, such as air pollution and endocrine disrupting chemicals. SUMMARY MCL varies widely in response to intrinsic and extrinsic inputs and is a useful predictor of reproductive health and fecundability. VIDEO ABSTRACT http://links.lww.com/COE/A28.
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Affiliation(s)
| | - Ariel L. Scalise
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Shruthi Mahalingaiah
- Department of Environmental Health, Harvard T.H. Chan School of Public Health
- Massachusetts General Hospital Fertility Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Nguyen BT, Pang RD, Nelson AL, Pearson JT, Benhar Noccioli E, Reissner HR, Kraker von Schwarzenfeld A, Acuna J. Detecting variations in ovulation and menstruation during the COVID-19 pandemic, using real-world mobile app data. PLoS One 2021; 16:e0258314. [PMID: 34669726 PMCID: PMC8528316 DOI: 10.1371/journal.pone.0258314] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/23/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND As war and famine are population level stressors that have been historically linked to menstrual cycle abnormalities, we hypothesized that the COVID-19 pandemic could similarly affect ovulation and menstruation among women. METHODOLOGY We conducted a retrospective cohort study examining changes in ovulation and menstruation among women using the Natural Cycles mobile tracking app. We compared de-identified cycle data from March-September 2019 (pre-pandemic) versus March-September 2020 (during pandemic) to determine differences in the proportion of users experiencing anovulation, abnormal cycle length, and prolonged menses, as well as population level changes in these parameters, while controlling for user-reported stress during the pandemic. FINDINGS We analyzed data from 214,426 cycles from 18,076 app users, primarily from Great Britain (29.3%) and the United States (22.6%). The average user was 33 years of age; most held at least a university degree (79.9%). Nearly half (45.4%) reported more pandemic-related stress. Changes in average cycle and menstruation lengths were not clinically significant, remaining at 29 and 4 days, respectively. Approximately 7.7% and 19.5% of users recorded more anovulatory cycles and abnormal cycle lengths during the pandemic, respectively. Contrary to expectation, 9.6% and 19.6% recorded fewer anovulatory cycles and abnormal cycle lengths, respectively. Women self-reporting more (32.0%) and markedly more (13.6%) stress during the pandemic were not more likely to experience cycle abnormalities. CONCLUSIONS The COVD-19 pandemic did not induce population-level changes to ovulation and menstruation among women using a mobile app to track menstrual cycles and predict ovulation. While some women experienced abnormalities during the pandemic, this proportion was smaller than that observed prior to the pandemic. As most app users in this study were well-educated women over the age of 30 years, and from high-income countries, their experience of the COVID-19 pandemic might differ in ways that limit the generalizability of these findings.
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Affiliation(s)
- Brian T. Nguyen
- Department of Obstetrics and Gynecology, Section of Family Planning, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
| | - Raina D. Pang
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
| | - Anita L. Nelson
- Department of Obstetrics and Gynecology, Western University of Health Sciences, Pomona, CA, United States of America
| | | | | | - Hana R. Reissner
- Department of Obstetrics and Gynecology, Section of Family Planning, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
| | | | - Juan Acuna
- Department of Epidemiology and Public Health, Khalifa University, Abu Dhabi, United Arab Emirates
- Research and Data Intelligence Support Center, Khalifa University, Abu Dhabi, United Arab Emirates
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Takmaz T, Gundogmus I, Okten SB, Gunduz A. The impact of COVID-19-related mental health issues on menstrual cycle characteristics of female healthcare providers. J Obstet Gynaecol Res 2021; 47:3241-3249. [PMID: 34137123 PMCID: PMC8447072 DOI: 10.1111/jog.14900] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/13/2021] [Accepted: 06/06/2021] [Indexed: 11/30/2022]
Abstract
Aim To investigate the association between menstrual cycle regularity in healthcare providers and COVID‐19 pandemic‐related anxiety, depression, stress. Methods A cross‐sectional study was conducted by administrating online questionnaires to female healthcare workers in Turkey. Women aged 18–40 years with regular menstrual cycles for more than 1 year before the beginning of the pandemic were included in the study and they were divided into two groups according to menstrual cycle regularity during the pandemic. The questionnaires included sociodemographic characteristics, medical and reproductive history, lifestyle information of participants, COVID‐19 Stress Scales (CSS), and a short version of the Depression Anxiety Stress Scale (DASS‐21). Results A total of 952 women were included in the study, 679 had regular menstrual cycles, and 273 had irregular menstrual cycles. The prevalence of irregular menses among Turkish women healthcare workers aged 18–40 years was 28.7%. The CSS subdimensions and total scores were significantly higher in the irregular menstruation group than in women with regular menstruation (p < 0.001). The DASS‐21 depression, anxiety, and stress subdimensions were likewise significantly higher in women with irregular menstruation (p < 0.001). Besides, both the univariable and the multivariable logistic regression results showed the relationship between irregular menstruation and CSS total score. Conclusion The current study showed the association between the COVID‐19 pandemic‐induced anxiety, perceived stress, depressive symptoms, and increased prevalence of menstrual cycle irregularity among healthcare providers.
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Affiliation(s)
- Taha Takmaz
- Department of Obstetrics and Gynecology, Bezmialem University, Faculty of Medicine, Istanbul, Turkey
| | - Ibrahim Gundogmus
- Department of Psychiatry, Kırıkkale Yüksek İhtisas Hospital, Kırıkkale, Turkey
| | - Sabri Berkem Okten
- Department of Obstetrics and Gynecology, Acibadem Health Group, Istanbul, Turkey
| | - Anil Gunduz
- Department of Clinical Psychology, Istanbul Kent University, Istanbul, Turkey
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Medeiros SFD, Barbosa BB, Medeiros MASD, Yamamoto MMW. Morphology and Biochemistry of Ovulation. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:480-486. [PMID: 34318473 PMCID: PMC10411198 DOI: 10.1055/s-0041-1731379] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/19/2021] [Indexed: 10/20/2022] Open
Abstract
The process of ovulation involves multiple and iterrelated genetic, biochemical, and morphological events: cessation of the proliferation of granulosa cells, resumption of oocyte meiosis, expansion of cumulus cell-oocyte complexes, digestion of the follicle wall, and extrusion of the metaphase-II oocyte. The present narrative review examines these interrelated steps in detail. The combined or isolated roles of the follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are highlighted. Genes indiced by the FSH genes are relevant in the cumulus expansion, and LH-induced genes are critical for the resumption of meiosis and digestion of the follicle wall. A non-human model for follicle-wall digestion and oocyte release was provided.
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Affiliation(s)
- Sebastião Freitas de Medeiros
- Department of Gynecology and Obstetrics, Faculdade de Medicina, Universidade Federal do Mato Grosso, Cuiabá, Mato Grosso, MT, Brazil
- Instituto Tropical de Medicina Reprodutiva, Cuiabá, Mato Grosso, MT, Brazil
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Yirsaw MT, Wale MZ. Menstrual related discomfort and associated factors among undergraduate students in Ambo University, Central Ethiopia. SAGE Open Med 2021; 9:20503121211003361. [PMID: 33854774 PMCID: PMC8013909 DOI: 10.1177/20503121211003361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Menstruation is a natural phenomenon which is an indicator of women’s health that occurs throughout the reproductive years of every female. This phenomenon is unique to the females and governed by the girl’s general health condition, genetic, socioeconomic, and nutritional factors. Although it is a normal physiological process, most females experience some degree of pain and discomfort in their menstruation period. Even though there are limited studies so far reported about the issue in some other parts of the country, there is no scientific evidence in the present study area. Objective: To assess menstrual-associated discomfort and associated factors among undergraduate students in Ambo University, Central Ethiopia, 2018. Methods: Institution-based cross-sectional study was conducted at Ambo University from 30 March to 30 April 2018. Stratified sampling technique was used and 748 study participants were randomly selected from faculties using a multi-stage sampling procedure. Only data from 713 study participants were entered into EpiData 3.1 and analyzed using SPSS version 20.0 software. Logistic regression was used to associate factors with menstrual-associated discomfort. All statistical tests were considered as significant at a p-value of < 0.05. Result: The prevalence of menstrual-associated discomfort was found to be 68.6%. The variables age (Being younger) (adjusted odds ratio = 3.9 (95% confidence interval: 1.28, 11.78)), Tigire ethnicity (adjusted odds ratio = 2.4 (95% confidence interval: 1.02, 5.75)), unmarried (adjusted odds ratio = 2.1 (95% confidence interval: 1.21, 3.76)), smokers (adjusted odds ratio = 2.2 (95% confidence interval: 1.12, 4.29)), drinking caffeine (adjusted odds ratio = 1.8 (95% confidence interval: 1.17, 2.74)), amount of flow (adjusted odds ratio = 2.4 (95% confidence interval: 1.28, 4.62)), and duration of pain (adjusted odds ratio = 4.2 (95% confidence interval: 1.93, 9.29)) were significantly associated with menstrual-associated discomfort. Conclusion: This study revealed that majority of the participants was experienced with menstrual-associated discomfort. As the tendency of smoking cigarettes, drinking caffeine, and amount of flow is increased, menstrual associated discomfort is increased. Therefore, specific plan of action and support is urgently needed in order to enlighten and treat menstrual-associated discomfort.
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Affiliation(s)
- Mesenbet Terefe Yirsaw
- Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Mengistu Zelalem Wale
- Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
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Namdev G, Naz S. Association of menstrual pattern with lifestyle factors among female medical students. MULLER JOURNAL OF MEDICAL SCIENCES AND RESEARCH 2021. [DOI: 10.4103/mjmsr.mjmsr_33_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Nabergoj D, Janeš D, Fatur K, Glavač NK, Kreft S. Influence of the Human Menstrual Cycle
on the Perception of Musks and Substances Responsible for Body Odour. J EVOL BIOCHEM PHYS+ 2020. [DOI: 10.1134/s0022093020060095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sandoval-Vivas P. [Safety and acceptability of the 52 mg levonorgestrel-releasing intrauterine system in women with abnormal uterine bleeding in an ambulatory care center in Bogotá, Colombia, 2012-2016]. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2020; 71:247-256. [PMID: 33247888 DOI: 10.18597/rcog.3547] [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: 05/30/2020] [Accepted: 08/22/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To describe safety and acceptability with the use of the 52-mg levonorgestrel-releasing intrauterine system in women with abnormal uterine bleeding. METHODS Retrospective cohort of women 18 years of age and older diagnosed with abnormal uterine bleeding, ultrasound-reported uterine length between 6 and 10 cm and uniform endometrial cavity in its entire length, regardless of structural abnormality, who received treatment with 52-mg levonorgestrel-releasing intrauterine system between 2012 and 2016. Non-probabilistic convenience sampling was carried out. Sociodemographic and clinical baseline variables were measured, as well as patient perception of bleeding and the frequency of failure, amenorrhea, need for hysterectomy and adverse events, over a 12-month follow-up period. Descriptive statistics were applied. RESULTS Overall, 200 patients were assessed. A subjective perception of improvement in terms of bleeding volume and frequency of leave of absence or visits to the emergency department was found; 90 % of the patients had amenorrhea, and 6 % experienced adverse events. CONCLUSIONS The 52-mg levonorgestrel-releasing intrauterine system is a safe option for the management of abnormal uterine bleeding in women with normal uterine size and no submucosal endometrial abnormalities. Local randomized studies are required to assess effectiveness and efficiency in comparison with other management options.
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Gunn HM, Tsai MC, McRae A, Steinbeck KS. Menstrual Patterns in the First Gynecological Year: A Systematic Review. J Pediatr Adolesc Gynecol 2018; 31:557-565.e6. [PMID: 30064002 DOI: 10.1016/j.jpag.2018.07.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/13/2018] [Accepted: 07/22/2018] [Indexed: 01/15/2023]
Abstract
STUDY OBJECTIVE Understanding what constitutes a normal menstrual cycle during the first gynecological year (GY1) is a common concern of adolescents and clinicians. However, limited high-quality evidence exists. We aimed to summarize published literature regarding menstrual and ovulatory patterns in GY1. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Electronic databases (MEDLINE, Pre-MEDLINE, Embase, Web of Science, CINAHL, Cochrane Library) were systematically searched from database inception to 2018. Eligible studies described menstrual cycles, symptoms, or validated ovulatory data in healthy adolescents in GY1. Two authors independently screened studies, extracted data, and assessed methodological quality. RESULTS Twenty-two studies involving more than 2000 adolescents were included. Thirteen recorded menstrual cycle and/or symptom data and 14 measured ovulation. Mean cycle length ranged from 32 to 61 days and decreased throughout GY1. Mean menses length was 4.9 to 5.4 days. Frequent menstrual bleeding was reported in up to 23% of participants, infrequent menstrual bleeding in up to one-third, and "irregular menstrual bleeding" in up to 43%. Dysmenorrhea was reported by 30%-89% of participants. Prevalence of ovulatory cycles identified using luteal phase serum or salivary progesterone or urinary pregnanediol was 0 to 45% and increased throughout GY1. However, all used definitions that would be considered subovulatory in clinical practice. CONCLUSION Menstrual and ovulatory patterns in GY1 are diverse and differ from those of adults. A transitional phase of menstrual and ovulatory immaturity is common. However, ovulation, irregular cycles, and dysmenorrhea are not uncommon. As such, safe sexual practice should be advocated and prompt medical management should be accessible.
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Affiliation(s)
- Harriet Mary Gunn
- Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, New South Wales, Australia; Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia; UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
| | - Meng-Che Tsai
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Paediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Alexandra McRae
- Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, New South Wales, Australia; Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Katharine S Steinbeck
- Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, New South Wales, Australia; Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
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Munro MG, Critchley HOD, Fraser IS. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet 2018; 143:393-408. [PMID: 30198563 DOI: 10.1002/ijgo.12666] [Citation(s) in RCA: 378] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/23/2018] [Accepted: 09/06/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND The International Federation of Gynecology and Obstetrics (FIGO) systems for nomenclature of symptoms of normal and abnormal uterine bleeding (AUB) in the reproductive years (FIGO AUB System 1) and for classification of causes of AUB (FIGO AUB System 2; PALM-COEIN) were first published together in 2011. The purpose was to harmonize the definitions of normal and abnormal bleeding symptoms and to classify and subclassify underlying potential causes of AUB in the reproductive years to facilitate research, education, and clinical care. The systems were designed to be flexible and to be periodically reviewed and modified as appropriate. OBJECTIVES To review, clarify, and, where appropriate, revise the previously published systems. METHODOLOGY AND OUTCOME To a large extent, the process has been an iterative one involving the FIGO Menstrual Disorders Committee, as well as a number of invited contributions from epidemiologists, gynecologists, and other experts in the field from around the world between 2012 and 2017. Face-to-face meetings have been held in Rome, Vancouver, and Singapore, and have been augmented by a number of teleconferences and other communications designed to evaluate various aspects of the systems. Where substantial change was considered, anonymous voting, in some instances using a modified RAND Delphi technique, was utilized.
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Affiliation(s)
- Malcolm G Munro
- Departments of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
- Kaiser Permanente, Los Angeles Medical Center, Los Angeles, CA, USA
| | - Hilary O D Critchley
- MRC Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | - Ian S Fraser
- School of Women's and Children's Health, Royal Hospital for Women, University of New South Wales, Randwick, NSW, Australia
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Akiyama S, Tanaka E, Cristeau O, Onishi Y, Osuga Y. Treatment patterns and healthcare resource utilization and costs in heavy menstrual bleeding: a Japanese claims database analysis. J Med Econ 2018; 21:853-860. [PMID: 29770717 DOI: 10.1080/13696998.2018.1478300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AIMS Heavy menstrual bleeding (HMB) is a highly prevalent condition, characterized by excessive menstrual blood loss and cramping, that interferes with activities of daily life. The aim of this study was to investigate treatment patterns in HMB in Japan, and to assess healthcare resource utilization and costs among women newly-diagnosed with the condition. MATERIALS AND METHODS This study retrospectively analyzed health insurance data available in the Japan Medical Data Center (JMDC) database on women aged 18-49 years who were newly-diagnosed with primary or secondary HMB. Treatment patterns were analyzed, and healthcare utilization and costs were evaluated and compared to matched controls. RESULTS The study included a total of 635 patients, 210 with primary HMB and 425 with secondary HMB. In the primary HMB cohort, 60.0% of patients received one or more pharmacological or surgical treatments, compared with 76.2% in the secondary HMB cohort. The most commonly prescribed medications in all patients were hemostatic agents (28.7%), traditional Chinese medicine (TCM) (12.1%), and low-dose estrogen progestins (LEPs) (10.1%). After adjustment for patient baseline characteristics, healthcare costs were 1.93-times higher in primary HMB cases (p < .0001) and 4.44-times higher in secondary HMB cases (p < .0001) vs healthy controls. Outpatient care was the main cost driver. LIMITATIONS The main limitations of this study are related to its retrospective nature, and the fact that only reimbursed medications were captured in the source database. CONCLUSIONS A substantial proportion of HMB patients did not receive the recommended treatments. Healthcare costs were considerably increased in the presence of an HMB diagnosis.
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Affiliation(s)
- Sayako Akiyama
- a Market Access , Bayer Yakuhin, Ltd , Chiyoda-ku , Tokyo , Japan
| | - Erika Tanaka
- a Market Access , Bayer Yakuhin, Ltd , Chiyoda-ku , Tokyo , Japan
| | | | | | - Yutaka Osuga
- d Obstetrics and Gynecology, Graduate School of Medicine , The University of Tokyo , Bunkyo-ku , Tokyo , Japan
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Abstract
Abnormal uterine bleeding (AUB) is the most common gynecologic complaint of adolescents admitted to hospital. Heavy menstrual bleeding (HMB) is the most frequent clinical presentation of AUB. Anovulatory cycles, owing to immature hypothalamic-pituitary-ovarian axis, is the leading etiology of HMB and there is an accompanying bleeding disorder in almost 20% of patients with HMB. Additionally, endocrine disorders such as hypothyroidism, hyperprolactinemia and polycystic ovary syndrome are possible causes of AUB. Exclusion of bleeding disorders, especially of von Willebrand disease is important for diagnosis and treatment of HMB, particularly in cases with AUB, which has been present since menarche. Management of HMB is based on the underlying etiology and severity of the bleeding. After other causes are excluded, anovulatory heavy bleeding can be treated successfully with combined oral contraceptives and iron supplementation either as an outpatient or in hospital depending on the clinical findings and level of anemia. The epidemiology, clinical presentation, diagnostic approach and treatment of HMB is discussed and our clinical experience in this field is presented in this review.
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Affiliation(s)
- Selin Elmaoğulları
- University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey,* Address for Correspondence: University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey Phone: +90 532 580 88 62 E-mail:
| | - Zehra Aycan
- University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Clinic of Pediatric Endocrinology and Clinic of Adolescent Medicine, Ankara, Turkey
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Bacon JL. Abnormal Uterine Bleeding: Current Classification and Clinical Management. Obstet Gynecol Clin North Am 2017; 44:179-193. [PMID: 28499529 DOI: 10.1016/j.ogc.2017.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abnormal uterine bleeding is now classified and categorized according to the International Federation of Gynecology and Obstetrics classification system: PALM-COEIN. This applies to nongravid women during their reproductive years and allows more clear designation of causes, thus aiding clinical care and future research.
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Affiliation(s)
- Janice L Bacon
- Women's Health and Diagnostic Center, 2728 Sunset Boulevard, Lexington Medical Park One Suite 106, West Columbia, SC 29169, USA.
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Shubham D, Kawthalkar AS. Critical evaluation of the PALM-COEIN classification system among women with abnormal uterine bleeding in low-resource settings. Int J Gynaecol Obstet 2017; 141:217-221. [PMID: 29139552 DOI: 10.1002/ijgo.12388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 09/15/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess the feasibility of the PALM-COEIN system for the classification of abnormal uterine bleeding (AUB) in low-resource settings and to suggest modifications. METHODS A prospective study was conducted among women with AUB who were admitted to the gynecology ward of a tertiary care hospital and research center in central India between November 2014 and October 2016. All patients were managed as per department protocols. The causes of AUB were classified before treatment using the PALM-COEIN system (classification I) and on the basis of the histopathology reports of the hysterectomy specimens (classification II); the results were compared using classification II as the gold standard. RESULTS The study included 200 women with AUB; hysterectomy was performed in 174 women. Preoperative classification of AUB per the PALM-COEIN system was correct in 130 (65.0%) women. Adenomyosis (evaluated by transvaginal ultrasonography) and endometrial hyperplasia (evaluated by endometrial curettage) were underdiagnosed. CONCLUSION The PALM-COEIN classification system helps in deciding the best treatment modality for women with AUB on a case-by-case basis. The incorporation of suggested modifications will further strengthen its utility as a pretreatment classification system in low-resource settings.
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Affiliation(s)
- Divya Shubham
- Department of Obstetrics and Gynecology, NKP Salve Institute of Medical Sciences, Nagpur, India
| | - Anjali S Kawthalkar
- Department of Obstetrics and Gynecology, NKP Salve Institute of Medical Sciences, Nagpur, India
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Abstract
The concept of the ovarian continuum can be understood as a process that occurs during a woman's lifetime and begins during intrauterine life with fertilization. Women start their reproductive years with approximately five hundred thousand follicles containing oocytes, of which only around five hundred will be released during ovulation. Ovulation has been recognized as an event linked with reproduction; however, recent evidence supports the role of ovulation as a sign of health. The use of biomarkers that help women recognize ovulation enables them to identify their health status. This knowledge helps medical healthcare providers in the prevention, diagnosis, and treatment of different pathologies related with endocrine disorders, gynecological abnormalities, autoimmune, genetic, and neoplastic diseases, as well as pregnancy-related issues. The knowledge of the ovarian continuum and the use of biomarkers to recognize ovulation should be considered a powerful tool for women and medical professionals. Summary The ovarian continuum is a process that occurs during a woman's lifetime. It begins during intrauterine life with fertilization and ends with menopause. This process can be greatly affected by different conditions such as changes in hormonal levels and illnesses. Therefore, understanding and promoting the knowledge and use of biomarkers of ovulation in women is a key aspect to consider when evaluating their health status. The knowledge and education about the ovarian continuum should be taken into account as a powerful tool for women and medical professionals.
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Affiliation(s)
- Pilar Vigil
- Biomedical Division, Reproductive Health Research Institute (RHRI), Santiago, Chile.,Pontificia Universidad Católica de Chile, Vicerrectoría de Comunicaciones, Santiago, Chile
| | - Carolina Lyon
- Biomedical Division, Reproductive Health Research Institute (RHRI), Santiago, Chile
| | - Betsi Flores
- Biomedical Division, Reproductive Health Research Institute (RHRI), Santiago, Chile
| | - Hernán Rioseco
- Biomedical Division, Reproductive Health Research Institute (RHRI), Santiago, Chile
| | - Felipe Serrano
- Biomedical Division, Reproductive Health Research Institute (RHRI), Santiago, Chile
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How I treat heavy menstrual bleeding associated with anticoagulants. Blood 2017; 130:2603-2609. [PMID: 29092828 DOI: 10.1182/blood-2017-07-797423] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/24/2017] [Indexed: 12/28/2022] Open
Abstract
Anticoagulant-associated heavy menstrual bleeding (HMB) is an underrecognized but not uncommon problem in clinical practice. Premenopausal women should be advised of the potential effect of anticoagulant therapy on menstrual bleeding at the time of treatment initiation. Consequences of HMB should be assessed and treated on an ongoing basis. In the acute setting, the decision to withhold anticoagulants is based on an individual patient's risk of thrombosis and the severity of the bleeding. For women who require long-term anticoagulation, a levonorgestrel intrauterine system, tranexamic acid (during menstrual flow), high-dose progestin-only therapy, or combined hormonal contraceptives are effective for controlling HMB. The risk of thrombosis during anticoagulant therapy with these treatments is not well studied but is likely to be low. Selection of type of hormonal therapy is based on patient preference, other indications for and contraindications to therapy, adverse effect profile, and ongoing thrombotic risk factors. Women who do not respond to medical treatment or who do not wish to retain their fertility should be considered for surgical management.
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Cheong Y, Cameron IT, Critchley HOD. Abnormal uterine bleeding. Br Med Bull 2017; 123:103-114. [PMID: 28910998 DOI: 10.1093/bmb/ldx027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 07/24/2017] [Indexed: 11/13/2022]
Abstract
INTRODUCTION It is not uncommon for a woman to suffer from abnormal uterine bleeding (AUB) or heavy menstrual bleeding (HMB) at some point during her lifetime. Once pathology is excluded, in practice, management needs to be individualised, taking into account the improvement of the woman's symptoms and quality of life. SOURCES OF DATA Peer-reviewed journals, governmental and professional society publications. AREAS OF AGREEMENT There is now agreement on a structured, universal approach to the diagnosis of AUB, with the aide memoirs PALM (polyps, adenomyosis, leiomyoma, malignancy) and COEIN (coagulopathies, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified). Once malignancy and significant pelvic pathology have been ruled out, medical treatment is an effective first-line therapeutic option, with surgery, including endometrial ablation and hysterectomy, offered when medical management has failed to resolve symptoms and fertility is no longer desired. AREAS OF CONTROVERSY There remains controversy around the management of the types and subtypes of adenomyosis and leiomyoma, and understanding their impact on clinical reproductive outcomes. AREAS CURRENTLY UNDER DEVELOPMENT Standardised assessment tools for measuring outcomes of AUB are being developed. AREAS TIMELY FOR DEVELOPING RESEARCH Novel diagnostic and monitoring tools should be developed to help stratify treatment for women with AUB, particularly relating to 'unclassified' and 'endometrial' causes.
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Affiliation(s)
- Ying Cheong
- Faculty of Medicine, University of Southampton.,University Hospital Southampton NHS Foundation Trust
| | - Iain T Cameron
- Faculty of Medicine, University of Southampton.,University Hospital Southampton NHS Foundation Trust
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Epstein DA, Lee NB, Kang JH, Agapie E, Schroeder J, Pina LR, Fogarty J, Kientz JA, Munson SA. Examining Menstrual Tracking to Inform the Design of Personal Informatics Tools. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2017; 2017:6876-6888. [PMID: 28516176 PMCID: PMC5432133 DOI: 10.1145/3025453.3025635] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
We consider why and how women track their menstrual cycles, examining their experiences to uncover design opportunities and extend the field's understanding of personal informatics tools. To understand menstrual cycle tracking practices, we collected and analyzed data from three sources: 2,000 reviews of popular menstrual tracking apps, a survey of 687 people, and follow-up interviews with 12 survey respondents. We find that women track their menstrual cycle for varied reasons that include remembering and predicting their period as well as informing conversations with healthcare providers. Participants described six methods of tracking their menstrual cycles, including use of technology, awareness of their premenstrual physiological states, and simply remembering. Although women find apps and calendars helpful, these methods are ineffective when predictions of future menstrual cycles are inaccurate. Designs can create feelings of exclusion for gender and sexual minorities. Existing apps also generally fail to consider life stages that women experience, including young adulthood, pregnancy, and menopause. Our findings encourage expanding the field's conceptions of personal informatics.
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Munro MG. Practical aspects of the two FIGO systems for management of abnormal uterine bleeding in the reproductive years. Best Pract Res Clin Obstet Gynaecol 2017; 40:3-22. [DOI: 10.1016/j.bpobgyn.2016.09.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 09/23/2016] [Indexed: 02/01/2023]
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Munro MG, Critchley HOD, Fraser IS. Research and clinical management for women with abnormal uterine bleeding in the reproductive years: More than PALM-COEIN. BJOG 2016; 124:185-189. [DOI: 10.1111/1471-0528.14431] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2016] [Indexed: 12/01/2022]
Affiliation(s)
- MG Munro
- Department of Obstetrics & Gynecology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
- Kaiser Permanente; Medical Center; Los Angeles CA USA
| | - HOD Critchley
- MRC Centre for Reproductive Health; University of Edinburgh; Edinburgh UK
| | - IS Fraser
- School of Women's and Children's Health; Royal Hospital for Women; University of New South Wales; Sydney NSW Australia
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Rafiq N, Niaz S, Khan L, Ullah T, ulHaq F. Discrepancy in Menstrual Cycle Relates to Diverse Profession and Age Cluster of District Mardan Khyber PakhtoonKhwa, Pakistan. BIOMEDICAL RESEARCH AND THERAPY 2016. [DOI: 10.7603/s40730-016-0043-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Javan R, Yousefi M, Nazari SM, Amiri P, Mosavi-Jarrahi A, Modiramani P, Naghedi-Baghdar H. Herbal Medicines in Idiopathic Heavy Menstrual Bleeding: A Systematic Review. Phytother Res 2016; 30:1584-1591. [DOI: 10.1002/ptr.5675] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/15/2016] [Accepted: 06/07/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Roghayeh Javan
- Student Research Committee, Faculty of Traditional and Complementary Medicine; Mashhad University of Medical Sciences; Mashhad Iran
| | - Mahdi Yousefi
- Faculty of Traditional and Complementary Medicine; Mashhad University of Medical Sciences; Mashhad Iran
| | - Seyed-Mohammad Nazari
- Faculty of Traditional and Complementary Medicine; Mashhad University of Medical Sciences; Mashhad Iran
| | - Parastoo Amiri
- Iranian Research on Healthy Aging (IRCHA); Sabzevar University of Medical Sciences; Sabzevar Iran
| | - Alireza Mosavi-Jarrahi
- Department of Health and Community Medicine; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | | | - Hamideh Naghedi-Baghdar
- Student Research Committee, Faculty of Traditional and Complementary Medicine; Mashhad University of Medical Sciences; Mashhad Iran
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Bandi ND, Arumugam CP, Venkata MR, Nannam L. Utility of the PALM-COEIN classification of abnormal uterine bleeding for Indian gynecologists. Int J Gynaecol Obstet 2016; 133:196-8. [DOI: 10.1016/j.ijgo.2015.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 09/29/2015] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
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Töz E, Sancı M, Özcan A, Beyan E, İnan AH. Comparison of classic terminology with the FIGO PALM-COEIN system for classification of the underlying causes of abnormal uterine bleeding. Int J Gynaecol Obstet 2016; 133:325-8. [PMID: 26952349 DOI: 10.1016/j.ijgo.2015.09.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/26/2015] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare classic terminology and the PALM-COEIN (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory disorders, endometrium, iatrogenic, and not classified) classification system among women who underwent surgery for abnormal uterine bleeding (AUB), and to subclassify the components of the PALM group for future studies. METHODS In a retrospective study, data were obtained for nonpregnant women aged 18-55years who underwent hysterectomy, myomectomy, or polypectomy for AUB at a center in Turkey in 2014. The patients were retrospectively classified according to the PALM-COEIN system, and the two terminologies were compared. RESULTS A total of 471 women were included. The term "hypermenorrhea" covered 15 different pathology combinations, "menorrhagia" nine, "metrorrhagia" 14, and "menometrorrhagia" 18. Of 92 patients with polyp, 5 (5.4%) had two polyps and 1 (1.1%) had three. Of 146 patients with adenomyosis, 131 (89.7%) had diffuse adenomyosis and 12 (8.2%) had adenomyoma. Of 309 patients with myoma uteri, 108 (34.9%) had submucous myoma and 201 (65.1%) had other types of myoma. CONCLUSION Classic terminology for AUB is insufficient and confusing with respect to etiologic pathologies among nonpregnant women of reproductive age. Widespread adoption of the PALM-COEIN system for AUB classification will facilitate more meaningful communication among both clinicians and investigators, and clarify the populations that should be evaluated in clinical trials, thereby enhancing communication with patients.
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Affiliation(s)
- Emrah Töz
- Department of Gynecology and Obstetrics, Izmir Tepecik Teaching and Research Hospital, Izmir, Turkey.
| | - Muzaffer Sancı
- Department of Gynecology and Obstetrics, Izmir Tepecik Teaching and Research Hospital, Izmir, Turkey
| | - Aykut Özcan
- Department of Gynecology and Obstetrics, Izmir Tepecik Teaching and Research Hospital, Izmir, Turkey
| | - Emrah Beyan
- Department of Gynecology and Obstetrics, Izmir Tepecik Teaching and Research Hospital, Izmir, Turkey
| | - Abdurrahman H İnan
- Department of Gynecology and Obstetrics, Izmir Tepecik Teaching and Research Hospital, Izmir, Turkey
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