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Bitzer J, Bouchard C, Zatik J, Weyers S, Piltonen T, Suturina L, Apolikhina I, Gemzell-Danielsson K, Jost M, Creinin MD, Foidart JM. Effects of E4/DRSP on self-reported physical and emotional premenstrual and menstrual symptoms: data from the phase 3 clinical trial in Europe and Russia. EUR J CONTRACEP REPR 2024; 29:150-159. [PMID: 38904165 DOI: 10.1080/13625187.2024.2359117] [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: 12/16/2023] [Accepted: 05/14/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE To describe the effects of estetrol (E4) 15 mg/drospirenone (DRSP) 3 mg on physical and emotional premenstrual and menstrual symptoms. MATERIALS AND METHODS We used Menstrual Distress Questionnaire (MDQ) data from a phase-3 trial (NCT02817828) in Europe and Russia with participants (18 - 50 years) using E4/DRSP for up to 13 cycles. We assessed mean changes in MDQ-t-scores from baseline to end of treatment in premenstrual (4 days before most recent flow) and menstrual (most recent flow) scores for 4 MDQ domains in starters and switchers (use of hormonal contraception in prior 3 months) and performed a shift analysis on individual symptoms within each domain. RESULTS Of 1,553 treated participants, 1,398(90.0%), including 531(38%) starters, completed both MDQs. Starters reported improvements for premenstrual Pain (-1.4), Water Retention (-3.3) and Negative Affect (-2.5); and for menstrual Pain (-3.5), Water Retention (-3.4), and Negative Affect (-2.7) (all p < 0.01). For switchers, no changes were significant except an increase in premenstrual (+1.0, p = 0.02) and menstrual (+1.5, p = 0.003) Water Retention. We observed a change in symptom intensity in >40% of participants for Cramps, Backache and Fatigue (domain Pain), Painful or Tender Breast and Swelling (domain Water Retention) and Mood Swings and Irritability (domain Negative Affect). CONCLUSION E4/DRSP starters experienced significant improvements in the domains Pain, Water Retention and Negative Affect particularly benefiting those with more severe baseline symptoms. Switchers showed minimal changes.
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Affiliation(s)
- Johannes Bitzer
- Department of Obstetrics and Gynaecology, University Hospital of Basel, Basel, Switzerland
| | | | - János Zatik
- Szent Anna Szuleszeti, Nogyogyaszati es Ultrahang Maganrendelo, Debrecen, Hungary
| | - Steven Weyers
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - Terhi Piltonen
- Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital, Oulu, Finland
| | - Larisa Suturina
- Department of Reproductive Health Protection, Scientific Center for Family Health and Human Reproduction, Irkutsk, Russian Federation
| | - Inna Apolikhina
- National Medical Research Center for Obstetrics, Gynaecology and Perinatology named after Academician V.I. Kulakov, Ministry of Healthcare of Russia, Moscow, Russia
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Maud Jost
- Estetra SRL, an affiliate company of Mithra Pharmaceuticals, Liège, Belgium
| | - Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of CA, Sacramento, California, USA
| | - Jean-Michel Foidart
- Department of Gynaecology and Obstetrics, University of Liège, Liège, Belgium
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Creinin MD, Cagnacci A, Spaczyński RZ, Stute P, Chabbert-Buffet N, Korver T, Simoncini T. Experts' view on the role of oestrogens in combined oral contraceptives: emphasis on oestetrol (E4). Front Glob Womens Health 2024; 5:1395863. [PMID: 38655395 PMCID: PMC11035732 DOI: 10.3389/fgwh.2024.1395863] [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: 03/04/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction The evolution of contraception has been crucial for public health and reproductive well-being. Over the past 60 years, combined oral contraceptives (COCs) have remained an important part of the contraceptive landscape worldwide; continued development has worked toward maintaining efficacy and improving safety. Methods Seven global experts convened to discuss the clinical relevance of the oestrogen in COCs, focusing on the impact of the new oestrogen, oestetrol (E4). Participants then commented through an online forum on the summary content and other participants' feedback. We prepared this report to describe the experts' views, their follow-up from the open forum and the evidence supporting their views. Results Ethinylestradiol (EE) and oestradiol (E2) affect receptors similarly whereas E4 has differential effects, especially in the liver and breast. Adequate oestrogen doses in COCs ensure regular bleeding and user acceptability. EE and E4 have longer half-lives than E2; accordingly, COCs with EE and E4 offer more predictable bleeding than those with E2. Oestrogen type and progestin influence VTE risk; E2 poses a lower risk than EE; although promising, E4/DRSP VTE risk is lacking population-based data. COCs alleviate menstrual symptoms, impact mental health, cognition, libido, skin, and bone health. Conclusion Oestrogens play an important role in the contraceptive efficacy, bleeding patterns, and overall tolerability/safety of COCs. Recent studies exploring E4 combined with DRSP show promising results compared to traditional formulations, but more definitive conclusions await further research.
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Affiliation(s)
- M. D. Creinin
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, United States
| | - A. Cagnacci
- Academic Unit of Obstetrics and Gynecology, DINOGMI, IRCCS-Azienda Ospedaliera Universitaria San Martino di Genova, Genova, Italy
| | - R. Z. Spaczyński
- Collegium Medicum, University of Zielona Gora, Zielona Gora, Poland
| | - P. Stute
- Department of Obstetrics and Gynecology, Bern University Hospital, Bern, Switzerland
| | - N. Chabbert-Buffet
- Gynécologie—Obstétrique et Médecine de la Reproduction—Maternité, Hospital Tenon, Paris, France
| | - T. Korver
- Reprovision Clinical Consultancy, Oss, Netherlands
| | - T. Simoncini
- Division of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Boehnlein C, Boniface ER, Packham AJ, Baldwin MK. A Social Media Survey of US Adolescent Preferences for Menstrual Bleeding Patterns. J Pediatr Adolesc Gynecol 2024; 37:25-32. [PMID: 37935280 DOI: 10.1016/j.jpag.2023.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023]
Abstract
STUDY OBJECTIVE To assess preferences for menstrual pattern and acceptability and knowledge about the safety of induced amenorrhea among adolescents and young adults METHODS: We conducted a cross-sectional online survey of US residents aged 14-24 years at least 1 year post-menarche. Online recruitment was conducted via the social media platform TikTok on a teen reproductive health channel. Survey questions focused on menstrual history, menstrual pattern preferences, and demographic characteristics. The primary outcome was the proportion of postmenstrual individuals who would prefer amenorrhea vs scheduled bleeding. RESULTS From 5113 potential respondents who accessed the eligibility screening, 3001 completed surveys and met the inclusion criteria. Most were aged 14-18 (63.7%), distributed proportionally among all US Census regions. When asked if they could pick their period-bleeding style without any permanent impacts, almost three-quarters chose no bleeding at all (amenorrhea; 71.5%) compared with scheduled periods (28.5%). However, 63.7% agreed or were uncertain when faced with the statement "It might be unsafe if hormone medications stop your period bleeding." After adjusting for age, gender expression, race, religion, heavy bleeding, and frequent bleeding, factors associated with preference for amenorrhea vs regular bleeding were younger age, masculine gender expression, White race, and non-Christian religious background. Baseline bleeding amount and frequency were not associated with preference for amenorrhea. CONCLUSION More than two-thirds of US adolescents and young adults indicated a preference for medication-induced amenorrhea if the method was assured to not have any permanent effects on the body, despite highly prevalent misconceptions about health and safety.
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Nappi RE, Tiranini L, Bosoni D, Cucinella L, Piccinino M, Cumetti A, Perone V, Benedetto C. Women's attitudes about combined hormonal contraception (CHC) - induced menstrual bleeding changes - influence of personality traits in an Italian clinical sample. Gynecol Endocrinol 2023; 39:2189971. [PMID: 36918022 DOI: 10.1080/09513590.2023.2189971] [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] [Indexed: 03/15/2023] Open
Abstract
OBJECTIVES We investigated the attitudes to change the frequency of menstrual bleeding by using combined hormonal contraception (CHC). Personality characteristics were also explored. METHODS We conducted a cross-sectional study in two university hospitals in northern Italy. Current, past and never CHC users (n = 545; age 18-44 years) completed a self-administered semi-structured questionnaire and the Ten-Item Personality Inventory (TIPI). RESULTS Forty-five percent of responders (n = 301) would prefer to change their bleeding frequency by using CHC. A flexible regimen was the preferred choice (n = 80; 33%) followed by extended regimens to bleed every 3 months (n = 54; 22%) or to never bleed (n = 43; 18%). The main positive reasons were to avoid dysmenorrhea (43%) and have more freedom in sexual (36%) and active (35%) life, whereas the main reason for a negative attitude was 'menstrual rhythm is natural' (59%). Age had a significant influence on women's willingness to change menstrual frequency by using CHC [>39 years (57%), 30-39 years (31%) and <30 years (46%)] (χ2: 9.1; p = 0.01). Never users significantly reported a more negative attitude (71%) in comparison with past (51%) and current users (49%) (χ2: 18.7; p = 0.001). Personality traits played a role, with higher scores of openness (p = 0.005) and extraversion (p = 0.001) in women with a positive attitude. CONCLUSIONS Almost half of our study sample reported a preference for changing their menstrual pattern by using CHC. Flexibility was the preferred choice across age and use of CHC. Personality characteristics (openness and extroversion) might influence attitudes toward CHC-induced menstrual bleeding changes.
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Affiliation(s)
- Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Lara Tiranini
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - David Bosoni
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Laura Cucinella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Manuela Piccinino
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Andrea Cumetti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Valeria Perone
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Chiara Benedetto
- Department of Surgical Sciences, Obstetrics and Gynecology I, Ospedale S. Anna, University of Turin, Turin, Italy
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Bougault V, Schiano-Lomoriello S, Castanier C, Buisson C, Ericsson M, Teulier C, Collomp K. Physical activity and combined hormonal contraception: association with female students' perception of menstrual symptoms. Front Physiol 2023; 14:1185343. [PMID: 37265844 PMCID: PMC10230043 DOI: 10.3389/fphys.2023.1185343] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/02/2023] [Indexed: 06/03/2023] Open
Abstract
Aim: The aim of this study was to examine the association between physical activity (PA) and combined hormonal contraceptive (CHC) on female students' self perceptio of their menstrual cycle symptoms. Methods: Healthy French female students (n = 834) completed an online questionnaire to assess their PA level (Group 1: non-active; Group 2: moderate physical activity; Group 3: high physical activity; Group 4: very high physical activity), menstrual status or contraception use, self-reported diet and medication, impact on engagement in some social activities, and self-assessment of perceived mental and physical symptoms during the week prior to menses (PM) for students with a normal menstrual cycle (NMC), and the week of menses (ME) for normal menstrual cycle students and those using combined hormonal contraception. Results: Whatever the conditions (PM and ME, NMC and CHC), fewer self-perceived symptoms and self-reported alteration in fat intake were reported by the students in Group 4, and more analgesic and anti-inflammatory medication use was reported by Group 1. Fewer self-perceived symptoms were also found in CHC vs NMC female students for all physical activity levels, but in a more marked way when associated with very high physical activity. In addition, less university and sports practice absenteeism was observed with high and very high physical activity. Conclusion: In conclusion, the perception of menstrual cycle symptoms was lower with very high physical activity, as with combined hormonal contraception. Moreover, female students training more than 5 h/week also reported less university absenteeism and impairment in physical activities. Further studies are necessary to establish the causal link of physical activity and combined hormonal contraception on menstrual symptoms.
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Affiliation(s)
| | - Sandrine Schiano-Lomoriello
- CIAMS, Université d'Orléans, Orléans, France
- CIAMS, Université Paris-Saclay, Orsay, France
- Sport, Physical Activity, Rehabilitation and Movement for Performance and Health Research Group, Orléans, France
| | - Carole Castanier
- CIAMS, Université d'Orléans, Orléans, France
- CIAMS, Université Paris-Saclay, Orsay, France
| | - Corinne Buisson
- Laboratoire Anti-Dopage Français, LADF, Université Paris-Saclay, Chatenay-Malabry, France
| | - Magnus Ericsson
- Laboratoire Anti-Dopage Français, LADF, Université Paris-Saclay, Chatenay-Malabry, France
| | - Caroline Teulier
- CIAMS, Université d'Orléans, Orléans, France
- CIAMS, Université Paris-Saclay, Orsay, France
| | - Katia Collomp
- CIAMS, Université d'Orléans, Orléans, France
- CIAMS, Université Paris-Saclay, Orsay, France
- Sport, Physical Activity, Rehabilitation and Movement for Performance and Health Research Group, Orléans, France
- Laboratoire Anti-Dopage Français, LADF, Université Paris-Saclay, Chatenay-Malabry, France
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Bastianelli C, Grandi G, Farris M, Brandolino G, Paoni Saccone G, La Barbiera I, Benagiano G. Attitudes towards menstruation: what women want? An Italian National Survey. EUR J CONTRACEP REPR 2023; 28:28-35. [PMID: 36318831 DOI: 10.1080/13625187.2022.2130686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Many women experience negative feelings during menstrual bleeding. Aim of the study was to evaluate the attitudes of Italian women towards menstrual bleeding, their desire to reduce its frequency and knowledge of the existence of methods capable of achieving such an objective. METHODS An internet-based anonymous questionnaire has been sent to women willing to fill it in through different social media (Instagram, WhatsApp, Facebook, Twitter). The survey evaluated, objective parameters such as number of pads, use of painkillers, duration of period and pain intensity. Judgement towards period and knowledge about methods to reduce frequency and amount of menstrual flow were analysed. RESULT 1072 Women aged 18 - 40 years, answered the survey. The level of education of responders was high, with 61.7% having a university degree. 27.5% of respondents viewed positively the occurrence of a menstrual period. Ideal frequency of menstrual cycles was considered 3 months and the perfect duration was considered to be 3 days. Half of the respondents ignored the existence of methods to suppress menstruation or reduce its frequency. 52% of participants stated that they would not use a contraceptive method because they considered it not 'natural'. CONCLUSIONS In our sample, in spite of the discomfort reported by half of the women interviewed, menstruation was considered positively by one fourth as because confirm their fertility. The majority of women did consider bleeding every month a healthy, but they preferred a three-monthly frequency. Knowledge of contraceptive methods capable of reducing the frequency of menstrual bleeding was scarce.
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Affiliation(s)
- Carlo Bastianelli
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Rome, Italy
| | - Giovanni Grandi
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Gabriella Brandolino
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Rome, Italy
| | - Giulia Paoni Saccone
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Rome, Italy
| | - Ilenia La Barbiera
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Rome, Italy
| | - Giuseppe Benagiano
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Rome, Italy
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Fataar K, Zweigenthal V, Harries J. Providers' approaches to contraceptive provision in Cape Town. Front Glob Womens Health 2022; 3:917881. [PMID: 36188423 PMCID: PMC9515548 DOI: 10.3389/fgwh.2022.917881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/05/2022] [Indexed: 12/03/2022] Open
Abstract
Background Health care providers can play a significant role in empowering women to make informed decisions when selecting suitable contraceptive methods during contraceptive counseling. This study explores primary care providers' perspectives and approaches to contraceptive service provision for women attending public sector clinics in South Africa, with the intention of ascertaining established practices and training needs. Methods Ten in-depth interviews were conducted at five primary health care facilities in urban areas in Cape Town, South Africa. Eligible participants included nurses providing contraceptive services and willing to participate in the study. The qualitative software package NVivo was used to sort and manage data. Data was analyzed using a thematic analysis approach. Results Overall, providers emphasized supporting women in contraceptive decision-making. Sexual and reproductive health training increased providers confidence to deliver appropriate contraceptive services. Contraceptive prescribing practices were influenced by women's medical history and preferred bleeding patterns. Providers' concerns about adherence to methods for younger women and suspected adverse events for older women impacted on prescribing. Challenges experienced when providing contraceptive services included: contraceptive stockouts; time constraints of employed women accessing the service; and their work pressure due to providing other health services. Discussion Health care providers play a critical role in facilitating women's right to access high quality contraceptive services. Providers saw themselves as negotiators during contraceptive counseling. They considered both women's preferences and their own recommendations for contraception, to provide information that would enable women to make informed contraceptive decisions. By reinforcing this approach to contraceptive counseling and focusing on shared decision-making, should encourage autonomy in method selection and limit the influence of provider's contraceptive method selection.
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Fernandez H, Barea A, Chanavaz-Lacheray I. Prevalence, intensity, impact on quality of life and insights of dysmenorrhea among French women: A cross-sectional web survey. J Gynecol Obstet Hum Reprod 2020; 49:101889. [PMID: 32781307 DOI: 10.1016/j.jogoh.2020.101889] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 07/30/2020] [Accepted: 08/05/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Determine prevalence and intensity of primary dysmenorrhea in a sample of French women and assess impact on daily life and Quality of Life, care pathway and pain management METHODS: This cross-sectional web-based survey was conducted from December 19th2018 through January 10th2019 among a representative sample of 3001 French women aged 16 to 50. RESULTS 2375 women (79%) reported having pain during menstruation, currently or in the past. 52% reported being currently affected, 27% had been affected in the past and 21% never suffered. Among younger women under 24, 66% reported current dysmenorrhea. Mean rating of pain intensity, evaluated on a visual analog scale from 0 to 10, was 6 + 1.9 in women presently having dysmenorrhea and 42% reported rating between 7 and 10. The impact on daily life was strong and there was a significant reduction of SF-36 scores in women experiencing dysmenorrhea. Among the 79% of women affected by dysmenorrhea, (current or past) 53% never used any medication and respectively 58% and 66% never sought medical advice. CONCLUSION Dysmenorrhea is very frequent in France with a significant impact on daily life and Quality of Life. There is a real inadequacy in the recognition and the management of this pathology, too often considered as common by the patients. There is a strong need for better information of the women and to raise the awareness of first line health-care professionals that any dysmenorrhea and especially severe dysmenorrhea must be accurately assessed and managed with the available therapeutic means.
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Affiliation(s)
- Hervé Fernandez
- AP-HP, Hôpital Bicêtre, GHU Sud, Department of Gynecology and Obstetrics, 94276, Le Kremlin-Bicêtre, France; Inserm, Centre of Research in Epidemiology and Population Health (CESP), U1018, 94276, Le Kremlin-Bicêtre, France; University Paris Sud Orsay, 94276, Le Kremlin-Bicêtre, France.
| | - Anthony Barea
- IPSOS France, 35 rue du Val de Marne, 75628, Paris Cedex 13, France
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Fernández-Martínez E, Onieva-Zafra MD, Abreu-Sánchez A, Fernández-Muñóz JJ, Parra-Fernández ML. Absenteeism during Menstruation among Nursing Students in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:E53. [PMID: 31861698 PMCID: PMC6981649 DOI: 10.3390/ijerph17010053] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/13/2019] [Accepted: 12/16/2019] [Indexed: 12/25/2022]
Abstract
Absenteeism can clearly have a negative impact on academic performance among university students. Certain experiences or symptoms such as menstrual pain are very common in women and can lead to absenteeism. The current study was aimed at examining the presence of menstrual experiences or symptoms and their impact upon absenteeism among healthy (illness-free) female university nursing students in Spain. A total of 299 students participated in this research, which was a descriptive cross-sectional, observational study. An ad hoc online questionnaire was used based on sociodemographic and gynecological data, together with the noted menstrual experiences; the most prevalent of which were bloating, which affected 87.3% of students; dysmenorrhea and irritability, which affected 76.3%; and fatigue, which affected 70.6%. Students with dysmenorrhea had a 6.95 higher (odds ratio (OR) 6.95; 95% confidence interval (CI) 3.39-14.25) odds of absenteeism; in those who reported dizziness, the odds of absenteeism was 4.82 times higher (OR 4.82; 1.76-13.23); in those who manifested nausea and vomiting, the percentage of absenteeism was 3.51 higher (OR 3.51; 95% CI 1.51-8.15); in those who presented sleep alterations, the odds were 2.95 higher (OR 2.95; 95% CI 1.39-6.25); and for those who felt depressed the odds were 2.18 times higher (OR 2.18; 95% CI 1.21-3.94) Absenteeism was found to be more likely in women with dysmenorrhea. However, in addition, higher odds of absenteeism were also found in women with nausea and vomiting, dizziness, sleep disorders, and those who feel depressed. These menstrual experiences can be considered a relevant problem among young women, leading to absenteeism, and a negative influence on academic performance. It is essential to raise awareness of the socioeconomic impact of absenteeism and establish new strategies for improving menstrual experiences.
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Affiliation(s)
| | - María Dolores Onieva-Zafra
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La-Mancha, Ciudad Real, 13071 Ciudad Real, Spain;
| | - Ana Abreu-Sánchez
- Department of Nursing, University of Huelva, 21004 Huelva, Spain; (E.F.-M.); (A.A.-S.)
| | | | - María Laura Parra-Fernández
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La-Mancha, Ciudad Real, 13071 Ciudad Real, Spain;
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Lete I, Calleja J, Pérez-Campos E, de la Viuda E, Lertxundi R, Martínez M, Quesada M, Sánchez-Borrego R. Cross-sectional evaluation of the impact of information on flexible extended regimens of oral contraceptives in the choices made by women seeking contraceptive counselling: the FLEXO study. EUR J CONTRACEP REPR 2018; 23:260-264. [PMID: 30203678 DOI: 10.1080/13625187.2018.1493099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Oral combined hormonal contraceptives (CHCs) are available that limit the number of menses when used in a flexible extended regimen. Our aim was to investigate the decision-making processes of women presented with a flexible extended CHC option. METHODS The FLEXO study is an epidemiological, cross-sectional, multicentre study conducted under typical clinical practice conditions to determine women's acceptance of a flexible continuous CHC regimen versus a cyclical 21/7 day regimen, after receiving standardised information during contraceptive counselling. RESULTS A total of 1350 women were invited to participate, of whom 1156 were enrolled. Of these, 47.2% chose the flexible extended CHC regimen. Their main reason for choosing this regimen was to reduce the number of menses (25.7%), followed by the desire to avoid symptoms related to menstruation (21.6%). The reasons given for rejecting this regimen were the desire to have monthly menstrual cycles (24.9%) and the fear of becoming pregnant and not being aware of it due to the absence of menstruation (18.1%). CONCLUSION Many women chose the extended flexible regimen when they received information about this option. Women primarily chose this pattern to relieve or eliminate discomfort related to menstruation.
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Affiliation(s)
- Iñaki Lete
- a Department of Obstetrics and Gynaecology , University Hospital of Araba , Vitoria-Gasteiz , Spain
| | | | - Ezequiel Pérez-Campos
- c Department of Obstetrics and Gynaecology , Associated University Hospital of Requena , Requena , Spain
| | - Esther de la Viuda
- d Department of Obstetrics and Gynaecology , University Hospital of Guadalajara , Guadalajara , Spain
| | | | - Mercedes Martínez
- f Department of Obstetrics and Gynaecology , Hospital Virgen Macarena , Seville , Spain
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Polis CB, Hussain R, Berry A. There might be blood: a scoping review on women's responses to contraceptive-induced menstrual bleeding changes. Reprod Health 2018; 15:114. [PMID: 29940996 PMCID: PMC6020216 DOI: 10.1186/s12978-018-0561-0] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/15/2018] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Concern about side effects and health issues are common reasons for contraceptive non-use or discontinuation. Contraceptive-induced menstrual bleeding changes (CIMBCs) are linked to these concerns. Research on women's responses to CIMBCs has not been mapped or summarized in a systematic scoping review. METHODS We conducted a systematic scoping review of data on women's responses to CIMBCs in peer-reviewed, English-language publications in the last 15 years. Investigator dyads abstracted information from relevant studies on pre-specified and emergent themes using a standardized form. We held an expert consultation to obtain critical input. We provide recommendations for researchers, contraceptive counselors, and product developers. RESULTS We identified 100 relevant studies. All world regions were represented (except Antarctica), including Africa (11%), the Americas (32%), Asia (7%), Europe (20%), and Oceania (6%). We summarize findings pertinent to five thematic areas: women's responses to contraceptive-induced non-standard bleeding patterns; CIMBCs influence on non-use, dissatisfaction or discontinuation; conceptual linkages between CIMBCs and health; women's responses to menstrual suppression; and other emergent themes. Women's preferences for non-monthly bleeding patterns ranged widely, though amenorrhea appears most acceptable in the Americas and Europe. Multiple studies reported CIMBCs as top reasons for contraceptive dissatisfaction and discontinuation; others suggested disruption of regular bleeding patterns was associated with non-use. CIMBCs in some contexts were perceived as linked with a wide range of health concerns; e.g., some women perceived amenorrhea to cause a buildup of "dirty" or "blocked" blood, in turn perceived as causing blood clots, fibroids, emotional disturbances, weight gain, infertility, or death. Multiple studies addressed how CIMBCs (or menstruation) impacted daily activities, including participation in domestic, work, school, sports, or religious life; sexual or emotional relationships; and other domains. CONCLUSIONS Substantial variability exists around how women respond to CIMBCs; these responses are shaped by individual and social influences. Despite variation in responses across contexts and sub-populations, CIMBCs can impact multiple aspects of women's lives. Women's responses to CIMBCs should be recognized as a key issue in contraceptive research, counseling, and product development, but may be underappreciated, despite likely - and potentially substantial - impacts on contraceptive discontinuation and unmet need for modern contraception.
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Affiliation(s)
- Chelsea B. Polis
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038 USA
| | - Rubina Hussain
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038 USA
| | - Amanda Berry
- Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038 USA
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Características e impacto de la menstruación en la mujer española: el porqué del interés de la posibilidad de supresión de la menstruación. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.medre.2017.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lete I, Lobo P, Nappi RE, Pintiaux A, Fiala C, Häusler G, Chabbert-Buffet N. Male perception about the inconveniences associated with monthly bleeding for their partner - an international survey. EUR J CONTRACEP REPR 2018; 23:1-11. [PMID: 29355396 DOI: 10.1080/13625187.2017.1423284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess men's perceptions about monthly bleeding and associated inconveniences for their partner, as well as men's attitudes regarding the desired menstruation frequency for their partner and knowledge about hormonal contraceptives. METHODS A 15 min quantitative online survey was conducted among 5044 men aged 18-45 years, who had been in a relationship for more than 6 months, across 13 European countries (Austria, Belgium, Czech Republic, France, Germany, Hungary, Italy, Latvia, The Netherlands, Poland, Portugal, Spain and Switzerland). Responses were compared to those obtained in a similar study among European women. RESULTS Most men perceived that their partner considered her menstrual flow as moderate, lasting an average of 5.2 d, slightly longer than previously reported by women. Almost all men reported that their partners experience menstruation-related symptoms. However, prevalence of mood-related symptoms was perceived to be more frequent and physical symptoms less frequent, relative to women's self-reported symptoms. Given the option, 71% of men would choose longer intervals between their partner's periods. Maintaining the couple's sex life, social life and relationship quality were key factors cited in their preference. Overall, 42% of respondents stated that women taking hormonal contraceptives needed to have monthly periods. CONCLUSIONS Men's perception regarding their partner's periods was generally consistent with that previously reported by women. Most men would prefer less frequent bleeding episodes for their partners. Although, the present data suggest that couples are discussing periods, knowledge about contraception could be improved. Health care professionals should intensify counselling to better inform both partners about their contraceptive options.
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Affiliation(s)
- Iñaki Lete
- a Department of Obstetrics and Gynaecology , Araba University Hospital , Vitoria-Gasteiz , Spain
| | - Paloma Lobo
- b Department of Obstetrics and Gynaecology , Infanta Sofia University Hospital , Madrid , Spain
| | - Rossella E Nappi
- c Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, IRCCS San Matteo Polyclinic , University of Pavia , Pavia , Italy
| | - Axelle Pintiaux
- d Department of Obstetrics and Gynaecology , Erasme Hospital, Université Libre de Bruxelles , Brussels , Belgium
| | - Christian Fiala
- e Gynmed Family Planning Clinic , Vienna , Austria.,f Department of Women's and Children's Health , Karolinska Institute , Stockholm , Sweden
| | - Günther Häusler
- g Department of General Gynaecology and Gynaecological Oncology , Medical University of Vienna , Vienna , Austria
| | - Nathalie Chabbert-Buffet
- h Department of Obstetrics and Gynaecology , APHP Tenon Hospital, Pierre and Marie Curie University , Paris , France
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Nappi RE, Lete I, Lee LK, Flores NM, Micheletti MC, Tang B. Real-world experience of women using extended-cycle vs monthly-cycle combined oral contraception in the United States: the National Health and Wellness Survey. BMC Womens Health 2018; 18:22. [PMID: 29347935 PMCID: PMC5774154 DOI: 10.1186/s12905-017-0508-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 12/28/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The real-world experience of women receiving extended-cycle combined oral contraception (COC) versus monthly-cycle COC has not been reported. METHODS Data were from the United States 2013 National Health and Wellness Survey. Eligible women (18-50 years old, premenopausal, without hysterectomy) currently using extended-cycle COC (3 months between periods) were compared with women using monthly-cycle COC. Treatment satisfaction (1 "extremely dissatisfied" to 7 "extremely satisfied"), adherence (8-item Morisky Medication Adherence Scale©), menstrual cycle-related symptoms, health-related quality of life (HRQOL) and health state utilities (Medical Outcomes Short Form Survey-36v2®), depression (9-item Patient Health Questionnaire), sleep difficulties, Work Productivity and Activity Impairment-General Health, and healthcare resource use were assessed using one-way analyses of variance, chi-square tests, and generalized linear models (adjusted for covariates). RESULTS Participants included 260 (6.7%) women using extended-cycle and 3616 (93.3%) using monthly-cycle COC. Women using extended-cycle COC reported significantly higher treatment satisfaction (P = 0.001) and adherence (P = 0.04) and reduced heavy menstrual bleeding (P = 0.029). A non-significant tendency toward reduced menstrual pain (39.5% versus 47.3%) and menstrual cycle-related symptoms (40.0% versus 48.7%) was found in women using extended-cycle versus monthly-cycle COC. Significantly more women using extended-cycle COC reported health-related diagnoses, indicating preferential prescription for extended-cycle COC among women reporting more health problems. Consistent with this poorer health, more women using extended-cycle COC reported fatigue, headache, and activity impairment (P values < 0.05). There were no other significant differences between groups. CONCLUSIONS This real-world observational study supports extended-cycle COC as a valuable treatment option with high satisfaction, high adherence, and reduced heavy menstrual bleeding.
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Affiliation(s)
- Rossella E. Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS Policlinico San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Piazzale Golgi 2, 27100 Pavia, Italy
| | - Iñaki Lete
- Araba University Hospital, Jose Atxotegi Street, Vitoria, Spain
| | - Lulu K. Lee
- Kantar Health, 393 Vintage Park Drive, Suite 100, Foster City, CA USA
| | - Natalia M. Flores
- Kantar Health, 393 Vintage Park Drive, Suite 100, Foster City, CA USA
| | | | - Boxiong Tang
- Teva Pharmaceuticals, 41 Moores Road, Frazer, PA USA
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Lete I, Häusler G, Pintiaux A, Jamin C, Nappi RE, Fiala C, Chabbert-Buffet N, Lobo P. The inconvenience due to women's monthly bleeding (ISY) survey: a study of premenstrual symptoms among 5728 women in Europe. EUR J CONTRACEP REPR 2017; 22:354-359. [PMID: 29157023 DOI: 10.1080/13625187.2017.1400001] [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] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of the ISY study was to investigate the prevalence of menstrual-related symptoms prior to and/or during menstrual or withdrawal bleeding among women from 12 European countries. METHODS A 15-min quantitative online survey was conducted in two waves from February to September 2015 among 5728 women aged between 18 and 45 years, with an equal distribution of women using a combined hormonal contraceptive, including regular combined oral contraceptives (COCs) (CHC group, n = 2739) and women using a non-hormonal contraceptive or no contraceptive (non-HC group, n = 2989). RESULTS The prevalence of at least one menstrual-related symptom was high in CHC users (93%) and in non-HC users (95%) (p < .0001) and the average number of symptoms reported was 5.3 vs. 5.9, respectively, (p < .0001). Pelvic pain, bloating/swelling, irritability and mood swing were reported in more than half of the women in both groups. Although generally modest, symptom severity was higher in non-HC users, except for headache. Overall, during the last four cycles, 60-75% of women did not require a treatment for most symptoms but headaches and pelvic pain. Mood swings/irritability, water retention/weight gain, lack of energy/mood swings and lack of energy/irritability were common symptoms that frequently co-occurred. No associations were reported between symptoms and age, educational qualifications or women's desire to reduce the frequency of menstruation. CONCLUSIONS Premenstrual and menstrual symptomatology was less frequent, less numerous and less severe (except for headache) in women using CHCs; however, it remains a common concern. Reducing the frequency of menstrual periods could reduce withdrawal-related symptoms.
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Affiliation(s)
- Iñaki Lete
- a Department of Obstetrics and Gynecology , Araba University Hospital , Vitoria-Gasteiz , Spain
| | - Günther Häusler
- b Department of Gynaecology and Gynecological Oncology , AKH-Wien , Vienna , Austria
| | - Axelle Pintiaux
- c Department of Obstetrics and Gynecology , Erasme Hospital, Brussels University (ULB) , Brussels , Belgium
| | | | - Rossella E Nappi
- e Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences , University of Pavia , Pavia , Italy
| | - Christian Fiala
- f Gynmed Ambulatorium , Vienna , Austria.,g Department of Women's and Children's Health , Karolinska Institute , Stockholm , Sweden
| | - Nathalie Chabbert-Buffet
- h Department of Obstetrics and Gynecology , APHP Tenon Hospital, Pierre and Marie Curie University , Paris , France
| | - Paloma Lobo
- i Department of Obstetrics and Gynecology , Infanta Sofía University Hospital , Madrid , Spain
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Nappi RE, Lobo Abascal P, Hsieh J, Micheletti MC. Cycle control with an extended-regimen oral contraceptive combining levonorgestrel and ethinyl estradiol that includes continuous low-dose ethinyl estradiol instead of the traditional hormone-free interval. Int J Womens Health 2017; 9:739-747. [PMID: 29042818 PMCID: PMC5633331 DOI: 10.2147/ijwh.s142078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate scheduled and unscheduled bleeding and spotting over 1 year of treatment with 91-day extended-regimen combined oral contraception (COC) providing continuous low-dose ethinyl estradiol (EE) in place of the traditional 7-day hormone-free interval (HFI). PATIENTS AND METHODS This post hoc analysis of a multicenter, open-label, 1-year, Phase 3 study of extended-regimen COC with 30 µg EE/150 µg levonorgestrel (LNG) for 84 days and EE 10 µg for 7 days included 799 sexually active, adult women who completed at least one 91-day cycle of therapy. Subjects recorded bleeding and spotting episodes daily using electronic diaries. Logistic regression analyses are reported as ORs with 95% CIs. RESULTS There was a 10% increase (OR =1.102; 95% CI: 1.006-1.206) in the likelihood of reporting no scheduled bleeding for each additional 91-day cycle completed. From the third 91-day cycle, more than one fifth of women reported no scheduled bleeding (third cycle =23% [121/533]; fourth cycle =22% [97/446]). Among women who reported no scheduled bleeding at Cycle 1 (136/758 [18%]), ≥45% showed sustained lack of scheduled bleeding in later cycles. There were increases of 53% (OR =1.531; 95% CI: 1.393-1.683) and 31% (OR =1.307; 95% CI: 1.205-1.418) in the likelihood of reporting 0 to ≤6 days vs >6 days of unscheduled bleeding and spotting, respectively, for each additional 91-day cycle. By Cycle 2, more than 80% of women reported no unscheduled bleeding or ≤6 days of unscheduled bleeding during each 91-day cycle. CONCLUSION Improved cycle control with decreased bleeding over time was shown during extended-regimen COC with 30 µg EE/150 µg LNG for 84 days and continuous low-dose EE instead of the traditional 7-day HFI. Women considering this regimen should be informed that those who complete at least one 91-day COC cycle will likely experience less bleeding/spotting in future cycles.
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Affiliation(s)
- Rossella E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Paloma Lobo Abascal
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Jennifer Hsieh
- Teva Branded Pharmaceutical Products R&D, Inc., Malvern, PA, USA
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Fiala C, Chabbert-Buffet N, Häusler G, Jamin C, Lete I, Lobo P, Nappi RE, Pintiaux A. Women's preferences for menstrual bleeding frequency in 12 European countries: the Inconvenience Due to Women's Monthly Bleeding (ISY) survey. EUR J CONTRACEP REPR 2017. [PMID: 28650776 DOI: 10.1080/13625187.2017.1334258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Our aim was to assess the level of inconvenience associated with menstrual bleeding and determine how many women across 12 European countries would prefer a bleeding frequency of less than once a month and what would motivate their choice. METHODS A 15-min quantitative online survey was conducted in two waves among 5728 women aged between 18 and 45 years, with an equal distribution of women using a combined hormonal contraceptive (CHC group, n = 2739) and women using a non-hormonal contraceptive or no contraceptive (non-HC group, n = 2989). The first wave was carried out in Austria, Belgium, France, Italy, Poland and Spain, in February 2015, and the results have been published. The second wave was conducted in the Czech Republic, Germany, Hungary, Portugal, Latvia and the Netherlands, between August and September 2015. RESULTS The menstrual period was significantly longer (5.0 versus 4.6 days) and heavier (15 versus 7%) in non-HC users than in CHC users (p < .0001). Given the choice, ∼60% of women would like less frequent menstrual bleeding. There was heterogeneity in the preference across countries. Sexuality, social life, work and sporting activities were key factors affecting women's preference. CONCLUSION The majority of women in the 12 European countries would prefer to reduce the frequency of menstrual periods. Quality of life was the main factor affecting their preference.
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Affiliation(s)
- Christian Fiala
- a Gynmed Clinic , Vienna , Austria.,b Department of Women's and Children's Health , Karolinska Institute , Stockholm , Sweden
| | - Nathalie Chabbert-Buffet
- c Department of Obstetrics and Gynaecology , APHP Tenon Hospital, Pierre and Marie Curie University , Paris , France
| | - Günther Häusler
- d Department of Gynaecology and Gynaecological Oncology , AKH-Wien , Vienna , Austria
| | | | - Iñaki Lete
- f Department of Obstetrics and Gynaecology , Araba University Hospital , Vitoria-Gasteiz , Spain
| | - Paloma Lobo
- g Department of Obstetrics and Gynaecology , Infanta Sofía University Hospital , Madrid , Spain
| | - Rossella E Nappi
- h Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences , University of Pavia , Pavia , Italy
| | - Axelle Pintiaux
- i Department of Obstetrics and Gynaecology , Erasmus Hospital, Free University of Brussels (ULB) , Brussels , Belgium
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