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The Cochrane Database of Systematic... Sep 2019Heavy menstrual bleeding (HMB) is an important cause of ill health in premenopausal women. Although surgery is often used as a treatment, a range of medical therapies...
BACKGROUND
Heavy menstrual bleeding (HMB) is an important cause of ill health in premenopausal women. Although surgery is often used as a treatment, a range of medical therapies are also available. Non-steroidal anti-inflammatory drugs (NSAIDs) reduce prostaglandin levels, which are elevated in women with excessive menstrual bleeding and also may have a beneficial effect on dysmenorrhoea.
OBJECTIVES
To determine the effectiveness, safety and tolerability of NSAIDs in achieving a reduction in menstrual blood loss (MBL) in women of reproductive years with HMB.
SEARCH METHODS
We searched, in April 2019, the Cochrane Gynaecology and Fertility specialised register, Cochrane Central Register of Studies Online (CENTRAL CRSO), MEDLINE, Embase, PsycINFO, the clinical trial registries and reference lists of articles.
SELECTION CRITERIA
The inclusion criteria were randomised comparisons of individual NSAIDs or combined with other medical therapy with each other, placebo or other medical treatments in women with regular heavy periods measured either objectively or subjectively and with no pathological or iatrogenic (treatment-induced) causes for their HMB.
DATA COLLECTION AND ANALYSIS
We identified 19 randomised controlled trials (RCTs) (759 women) that fulfilled the inclusion criteria for this review and two review authors independently extracted data. We estimated odds ratios (ORs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes from the data of nine trials. We described in data tables the results of the remaining seven cross-over trials with data unsuitable for pooling, one trial with skewed data, and one trial with missing variances. One trial had no data available for analysis.
MAIN RESULTS
As a group, NSAIDs were more effective than placebo at reducing HMB but less effective than tranexamic acid, danazol or the levonorgestrel-releasing intrauterine system (LNG IUS). Treatment with danazol caused a shorter duration of menstruation and more adverse events than NSAIDs, but this did not appear to affect the acceptability of treatment, based on trials from 1980 to 1990. However, currently danazol is not a usual or recommended treatment for HMB. There was no clear evidence of difference between NSAIDs and the other treatments (oral luteal progestogen, ethamsylate, an older progesterone-releasing intrauterine system and the oral contraceptive pill (OCP), but most studies were underpowered. There was no evidence of a difference between the individual NSAIDs (naproxen and mefenamic acid) in reducing HMB. The evidence quality ranged from low to moderate, the main limitations being risk of bias and imprecision.
AUTHORS' CONCLUSIONS
NSAIDs reduce HMB when compared with placebo, but are less effective than tranexamic acid, danazol or LNG IUS. However, adverse events are more severe with danazol therapy. In the limited number of small studies suitable for evaluation, there was no clear evidence of a difference in efficacy between NSAIDs and other medical treatments such as oral luteal progestogen, ethamsylate, OCP or the older progesterone-releasing intrauterine system.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Contraceptives, Oral, Combined; Dysmenorrhea; Female; Humans; Menorrhagia; Naproxen; Progesterone; Randomized Controlled Trials as Topic
PubMed: 31535715
DOI: 10.1002/14651858.CD000400.pub4 -
Trials Jun 2022For many women, uncomfortable and stressful symptoms accompany the menstrual cycle each month, sometimes in a debilitating manner. Previous studies have reported that...
The effect of a probiotic on gastrointestinal symptoms due to menstruation in healthy adult women on oral contraceptives: randomized, double-blind, placebo-controlled trial protocol.
INTRODUCTION
For many women, uncomfortable and stressful symptoms accompany the menstrual cycle each month, sometimes in a debilitating manner. Previous studies have reported that gastrointestinal symptoms in healthy women significantly differ by the day of the menstrual cycle, but few studies have assessed interventions intended to minimize these symptoms. Probiotics supplements have been shown to attenuate gastrointestinal symptom severity as well as self-reported feelings of stress in various populations. This study evaluates the effect of a probiotic on abdominal pain and gastrointestinal symptoms in healthy women who take an oral contraceptive, have regular menses, and typically experience these symptoms during menstruation with the primary aim being change in abdominal pain intensity related to the menstrual cycle with probiotic versus placebo supplementation.
METHODS AND ANALYSIS
In this randomized, double-blind, placebo-controlled parallel study, participants will receive either a probiotic or placebo supplement. Participants will begin answering questionnaires approximately 7 days before the start of menstruation (i.e., active bleeding), and 3 days later, they will begin consuming the study supplement for 8 weeks. The questionnaires administered will collect data about abdominal pain severity (primary outcome) and duration related to the menstrual cycle, digestive health, dietary intake, stress, and digestion-associated quality-of-life. A subgroup of women will provide weekly vaginal swabs and stool samples to examine the effect of the probiotic supplement on microbiota composition and diversity for exploratory purposes. Two-sided tests using a linear model and a type I error rate of α = 0.05 will be employed to test all hypotheses. Continuous variables will be presented as means with standard errors and categorical variables, as counts or proportions.
ETHICS AND DISSEMINATION
This study was reviewed and approved by the University of Florida Institutional Review Board 01. Written informed consent will be obtained from all participants prior to any study activities. Study findings will be disseminated at scientific conferences and publication in the trial registry or in a peer-reviewed journal. Any protocol amendments will be reported in the final manuscript of this study.
TRIAL REGISTRATION
ClinicalTrials.gov NCT04457401 . Registered prospectively on 07 July 2020. The trial was completed in December of 2021.
PROTOCOL VERSION
V4.0 (11-04-2020) TRIAL STATUS: Currently recruiting. Recruitment began in November 2020 and extend until December 2021.
Topics: Abdominal Pain; Adult; Contraceptives, Oral; Double-Blind Method; Female; Gastrointestinal Diseases; Humans; Menstruation; Probiotics; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 35689274
DOI: 10.1186/s13063-022-06410-w -
Journal of Anesthesia Aug 2020To investigate the impact of menstrual cycle on patients undergoing gynecological endoscopic surgery.
PURPOSE
To investigate the impact of menstrual cycle on patients undergoing gynecological endoscopic surgery.
PATIENTS AND METHODS
220 patients scheduled for gynecological endoscopic surgery under general anesthesia were selected. The patients were divided into three groups based on 3 phases of menstrual cycle which are the follicular phase (Group F), ovulatory phase (Group O) or luteal phase (Group L). It is based on their duration of menstruation and the last day of menstrual bleeding from the date of surgery. Primary outcomes were the incidences of early and late postoperative nausea and vomiting (PONV) in the three patient groups. Preoperative venous blood was taken to determine the estrogen and progesterone levels of the patients.
RESULTS
A total of 207 patients were enrolled. The incidence of early PONV was highest in group O (22.22% vs 43.33% vs 17.86%, P < 0.01). Multivariate logistic regression showed that menstrual cycle (P < 0.01) and sufentanil dosage (P < 0.05) were independent risk factors for early PONV, menstrual cycle (P = 0.03) and intraoperative hypotension (P = 0.03) were independent risk factors for late PONV. After the propensity matching, the incidences of early and late PONV in group O were both higher than that in other two groups (19.23% vs 44.68% vs 16.90%, P < 0.01; 53.80% vs 72.34% vs 45.07%, P = 0.01).
CONCLUSION
The incidence of PONV after gynecological endoscopic surgery was different in patients with different menstrual cycles, with the highest incidence in ovulation.
Topics: Anesthesia, General; Female; Gynecologic Surgical Procedures; Humans; Menstrual Cycle; Postoperative Nausea and Vomiting; Sufentanil
PubMed: 32342186
DOI: 10.1007/s00540-020-02781-z -
Biomedicines Apr 2024Endometrial cancer is the most common gynecologic malignancy in developed countries, and the incidence is rising in premenopausal females. Type I EC is more common than... (Review)
Review
Endometrial cancer is the most common gynecologic malignancy in developed countries, and the incidence is rising in premenopausal females. Type I EC is more common than Type II EC (80% vs. 20%) and is associated with a hyperestrogenic state. Estrogen unopposed by progesterone is considered to be the main driving factor in the pathogenesis of EC. Studies show that BMI > 30 kg/m, prolonged duration of menses, nulliparity, presence of polycystic ovarian syndrome, and Lynch syndrome are the most common causes of EC in premenopausal women. Currently, there are no guidelines established to indicate premenopausal patients who should be screened. This review aims to synthesize current data on the etiology, risk factors, presentation, evaluation, and prognosis of endometrial cancer in this population.
PubMed: 38672240
DOI: 10.3390/biomedicines12040886 -
Journal of Obstetrics and Gynaecology :... Nov 2021This study aimed to examine whether the menstrual cycles of women with regular cycles have been affected by the COVID 19 pandemic. This cross-sectional online survey...
This study aimed to examine whether the menstrual cycles of women with regular cycles have been affected by the COVID 19 pandemic. This cross-sectional online survey study evaluated the menstrual cycle characteristics of women in the reproductive phase of their lives during the COVID-19 pandemic in May 2020. Changes before and after COVID-19 were evaluated with a paired sample -test and chi-square test. A Pearson correlation test was used to show the relationships between variables. The study was completed with 263 participants in total. The average age of the participants was 26.3 ± 6.9 (18-45). Participants' duration of period ( = .003) and pads used per day ( = .002) decreased compared to their experience before the COVID-19 outbreak. The mean total MSQ score was 3.1 ± 0.8 (0-4), mean STAI-1 score was 45.1 ± 9 (20-78) and mean STAI-II score was 43.3 ± 5.9 (30-69). It was found that STAI-I and STAI-II scores showed a positive correlation with MSQ-Somatic subgroup scores( = 0.153, = .013; 0.190, = .002) and MSQ-Total scores (0.144, = .020; 0.175, = .004). With the COVID-19 pandemic, increased anxiety scores increased women's menstrual symptoms while the length of periods and the number of pads used decreased.Impact statement The COVID 19 pandemic, has caused enormous psychological distress potentially resulting in the development of posttraumatic stress disorder. The menstrual cycle is a process that can be affected by psychological stress. This is the first study to examine the relationship between stress caused by the COVID-19 pandemic and the menstrual cycle. The increases in the degree of anxiety and stress as a result of the COVID-19 outbreak was found to be high enough to affect the characteristics of the menstrual cycle in the women surveyed.? In a prospective study intended to be carried out after the outbreak ends in the future, it will be possible to evaluate whether the menstrual cycle parameters return to their former order and consequently this hypothesis will be able to be more definitively confirmed.
Topics: Adolescent; Adult; Anxiety; COVID-19; Cross-Sectional Studies; Female; Humans; Menstrual Cycle; Menstrual Hygiene Products; Menstruation Disturbances; Middle Aged; Psychiatric Status Rating Scales; SARS-CoV-2; Stress, Psychological; Surveys and Questionnaires; Time Factors; Turkey; Young Adult
PubMed: 33955327
DOI: 10.1080/01443615.2021.1907562 -
Journal of Pediatric and Adolescent... Oct 2019Girls with either hypo- or hypergonadotropic hypogonadism need treatment with estrogens to initiate puberty and maintain a normal hormonal milieu. The focus of this... (Review)
Review
Girls with either hypo- or hypergonadotropic hypogonadism need treatment with estrogens to initiate puberty and maintain a normal hormonal milieu. The focus of this review is hormone replacement treatment in girls with hypogonadism, to initiate and progress through puberty, and to maintain a healthy hormonal milieu in women. It also addresses what is known in the literature regarding estrogen levels in girls and women, instructive cases, practical tables for reference and application, and thoughts on future directions in this area. It represents a thorough literature review with author opinions and recommendations. Girls with normal ovarian function begin puberty on average at 10.5 years old, although there is variation according to ethnicity and degree of excess weight gain. The aim of estrogen therapy to initiate puberty is to mimic normal onset and rate of progression. On the basis of the currently available literature, when a diagnosis of hypogonadism is established, we recommend initiating treatment between age 11 and 12 years of age, with dose increases approximately every 6 months until adult levels are reached. In some situations, treatment may be delayed to allow time for diagnosis or permit more time for linear growth, or address unique risks found in girls treated for various cancers or blood disorders. When adult dosing is reached, progestins are also used to protect uterine health. This can be combined sequentially, allowing regular menstruation, or combined continuously when menstrual bleeding is not preferred. Treatment is continued until the average age of menopause, again with various considerations for longer or shorter duration on the basis of risk-benefit ratios. Transdermal estrogens are considered the most physiologic replacement and theoretically might have fewer associated risks. We review what is known about risks and outcomes and areas for future research.
Topics: Adolescent; Child; Estrogen Replacement Therapy; Estrogens; Female; Humans; Hypogonadism; Sexual Maturation
PubMed: 31059821
DOI: 10.1016/j.jpag.2019.04.010 -
European Journal of Paediatric... May 2020To analyze the association between pubertal stage, menstrual cycle and migraine attacks in girls with migraine. In addition, headache frequency, accompanying symptoms,...
PURPOSE
To analyze the association between pubertal stage, menstrual cycle and migraine attacks in girls with migraine. In addition, headache frequency, accompanying symptoms, duration and onset in relation to the specific phase of the cycle were investigated.
METHODS
Girls between 7 and 18 years old, diagnosed with headaches that met "International Classification of Headache Disorders II" diagnostic criteria for migraine without aura, kept a daily headache and menstrual cycle diary over 8 weeks. Ovulatory cycles were identified by weekly progesterone saliva tests.
RESULTS
47 girls participated in the study and were divided into three groups according to Tanner stage and onset of regular menstruation: pre- (n = 16), peri- (n = 19) and post-pubertal (n = 12). A significant difference in migraine frequency was found between pre- and post-pubertal girls (p = 0.005). No significant differences with regard to headache characteristics were detected. Interestingly, a higher frequency of attacks in follicular phase occurred compared to luteal phase in peri- and post-pubertal girls (p = 0.030).
CONCLUSION
During puberty, migraine patterns in girls change to a typical adult pattern of migraine in a stepwise manner not clearly related to menarche. The first sign of this transition phase could be the higher frequency of migraine attacks in post-pubertal girls.
Topics: Adolescent; Child; Female; Humans; Menstrual Cycle; Menstruation; Migraine Disorders; Sexual Maturation
PubMed: 32115367
DOI: 10.1016/j.ejpn.2020.02.006 -
International Journal of Women's Health 2022Primary dysmenorrhea is a common and often debilitating, gynaecological condition.
BACKGROUND
Primary dysmenorrhea is a common and often debilitating, gynaecological condition.
OBJECTIVE
To investigate the effects of specific lifestyle variables on the prevalence and severity of primary dysmenorrhea.
MATERIALS AND METHODS
A cross-sectional study of Jordanian women aged between 18-25 years old utilized a questionnaire as the main instrument of the study.
RESULTS
Primary dysmenorrhea was reported by 660 women out of 1988. It was found that approximately two thirds of them were students. Overall, 54.5% of the participants reported severe dysmenorrhea. A statistically significant correlation was found between severe dysmenorrhea and smoking at value ˂0.001, sleeping less than 7 hours per 24 hours at = 0.005, holding a university degree at = 0.032, non-alcohol consumption at = 0.044, frequent energy, fizzy, tea, coffee drinks and sugar intake. Interestingly, we found that severe dysmenorrhea was statistically significantly associated with women who never eat meat at ˂0.001, cereals and fish consumers and with those who take less than 3 servings of fruit or none at all per week at = 0.006. In addition to the previous variables, water intake of less than 1.0 litre a day, irregular cycles, non-OCP use and positive family history were found significantly associated with severe dysmenorrhea. Severe dysmenorrhea was significantly related to working less hours per week, higher stress level and longer bleeding duration at = 0.021, 0.017 and 0.008, respectively. On the other hand, there was no statistically significant difference found between severe dysmenorrhea and the following variables: age, body mass index (BMI), weekly studying hours and age of menarche.
CONCLUSION
Primary dysmenorrhea is prevalent in the Jordanian population. To overcome severe dysmenorrhea, women should increase their intake of fish and fresh fruits, drinking water and use of oral contraceptive pills. The study concluded that smoking, frequent sugar intake, fizzy drinks, coffee, tea and energy drinks were associated with severe dysmenorrhea. It is also worth mentioning that alcohol consumption had a positive impact on dysmenorrhea.
TRIAL REGISTRATION
Registered in Clinicaltrial.gov (ID: NCT04583943).
PubMed: 35444471
DOI: 10.2147/IJWH.S338651 -
BMC Zoology Feb 2022The Egyptian spiny mouse (Acomys cahirinus) is the only known rodent to exhibit true, human-like menstruation and postpartum ovulation, and is an important new model for...
BACKGROUND
The Egyptian spiny mouse (Acomys cahirinus) is the only known rodent to exhibit true, human-like menstruation and postpartum ovulation, and is an important new model for reproductive studies. Spiny mice do not produce a visible copulatory plug, and calculation of gestational age is therefore restricted by the need to use mated postpartum dams. The current inefficient method of monitoring until parturition to provide a subsequent estimate of gestational age increases study duration and costs. This study addressed this issue by comparing the mating behaviour of spiny mice across the menstrual cycle and proposes a more accurate method for staging and pairing animals that provides reliable estimates of gestational age. In experiment 1, mating behaviour was recorded overnight to collect data on mounting, intromission, and ejaculation (n = 5 pairs per stage) in spiny mice paired at menses and at early and late follicular and luteal phases of the menstrual cycle. In experiment 2, female spiny mice were paired at the follicular or luteal phases of the menstrual cycle to determine any effect on the pairing-birth interval (n = 10 pairs).
RESULTS
We report a broad mating window of ~ 3 days during the follicular phase and early luteal phase of spiny mice. Males displayed a discrete 'foot twitch' behaviour during intromission and a brief copulatory lock during ejaculation. Litters were delivered after 40-43 days if pairing occurred during the mating window, compared with 46-48 days for spiny mice paired in the late luteal phase. When pairing occurred during the late luteal phase or menses no mating activity was observed during the recording period.
CONCLUSION
This study clearly demonstrates an effect of the menstrual cycle on mating behaviour and pregnancy in the spiny mouse and provides a reliable and more effective protocol for estimating gestational age without the need for postpartum dams.
PubMed: 37170145
DOI: 10.1186/s40850-022-00112-1 -
Annals of Cardiac Anaesthesia 2022Cancellation of any scheduled surgery is a significant drain on health resources and potentially stressful for patients. It is frequent in menstruating women who are...
BACKGROUND
Cancellation of any scheduled surgery is a significant drain on health resources and potentially stressful for patients. It is frequent in menstruating women who are scheduled to undergo open heart surgery (OHS), based on the widespread belief that it increases surgical and menstrual blood loss.
AIMS
The aim of this study was to evaluate blood loss in women undergoing OHS during menstruation.
SETTINGS AND DESIGN
A prospective, matched case-control study which included sixty women of reproductive age group undergoing OHS.
PATIENTS AND METHODS
The surgical blood loss was compared between women who were menstruating (group-M; n = 25) and their matched controls, i.e., women who were not menstruating (group-NM; n = 25) at the time of OHS. Of the women in group M, the menstrual blood loss during preoperative (subgroup-P) and perioperative period (subgroup-PO) was compared to determine the effect of OHS on menstrual blood loss.
RESULTS
The surgical blood loss was comparable among women in both groups irrespective of ongoing menstruation (gr-M = 245.6 ± 120.1 ml vs gr-NM = 243.6 ± 129.9 ml, P value = 0.83). The menstrual blood loss was comparable between preoperative and perioperative period in terms of total menstrual blood loss (gr-P = 36.8 ± 4.8 ml vs gr-PO = 37.7 ± 5.0 ml, P value = 0.08) and duration of menstruation (gr-P = 4.2 ± 0.6 days vs gr-PO = 4.4 ± 0.6 days, P value = 0.10).
CONCLUSION
Neither the surgical blood loss nor the menstrual blood loss is increased in women undergoing OHS during menstruation.
Topics: Blood Loss, Surgical; Cardiac Surgical Procedures; Case-Control Studies; Female; Humans; Menstruation; Prospective Studies
PubMed: 35799559
DOI: 10.4103/aca.aca_83_21