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American Journal of Obstetrics and... Nov 2020Women's health concerns are generally underrepresented in basic and translational research, but reproductive health in particular has been hampered by a lack of... (Review)
Review
Women's health concerns are generally underrepresented in basic and translational research, but reproductive health in particular has been hampered by a lack of understanding of basic uterine and menstrual physiology. Menstrual health is an integral part of overall health because between menarche and menopause, most women menstruate. Yet for tens of millions of women around the world, menstruation regularly and often catastrophically disrupts their physical, mental, and social well-being. Enhancing our understanding of the underlying phenomena involved in menstruation, abnormal uterine bleeding, and other menstruation-related disorders will move us closer to the goal of personalized care. Furthermore, a deeper mechanistic understanding of menstruation-a fast, scarless healing process in healthy individuals-will likely yield insights into a myriad of other diseases involving regulation of vascular function locally and systemically. We also recognize that many women now delay pregnancy and that there is an increasing desire for fertility and uterine preservation. In September 2018, the Gynecologic Health and Disease Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development convened a 2-day meeting, "Menstruation: Science and Society" with an aim to "identify gaps and opportunities in menstruation science and to raise awareness of the need for more research in this field." Experts in fields ranging from the evolutionary role of menstruation to basic endometrial biology (including omic analysis of the endometrium, stem cells and tissue engineering of the endometrium, endometrial microbiome, and abnormal uterine bleeding and fibroids) and translational medicine (imaging and sampling modalities, patient-focused analysis of menstrual disorders including abnormal uterine bleeding, smart technologies or applications and mobile health platforms) to societal challenges in health literacy and dissemination frameworks across different economic and cultural landscapes shared current state-of-the-art and future vision, incorporating the patient voice at the launch of the meeting. Here, we provide an enhanced meeting report with extensive up-to-date (as of submission) context, capturing the spectrum from how the basic processes of menstruation commence in response to progesterone withdrawal, through the role of tissue-resident and circulating stem and progenitor cells in monthly regeneration-and current gaps in knowledge on how dysregulation leads to abnormal uterine bleeding and other menstruation-related disorders such as adenomyosis, endometriosis, and fibroids-to the clinical challenges in diagnostics, treatment, and patient and societal education. We conclude with an overview of how the global agenda concerning menstruation, and specifically menstrual health and hygiene, are gaining momentum, ranging from increasing investment in addressing menstruation-related barriers facing girls in schools in low- to middle-income countries to the more recent "menstrual equity" and "period poverty" movements spreading across high-income countries.
Topics: Adenomyosis; Attitude; Biological Evolution; Biomedical Research; Congresses as Topic; Developing Countries; Education; Endometriosis; Endometrium; Female; Global Health; Health Literacy; Humans; Leiomyoma; Menstrual Hygiene Products; Menstruation; Menstruation Disturbances; Mesenchymal Stem Cells; Microbiota; Microfluidic Analytical Techniques; National Institute of Child Health and Human Development (U.S.); Regeneration; Stem Cells; Terminology as Topic; Tissue Engineering; United States; Uterine Hemorrhage; Uterine Neoplasms; Uterus; Women's Health
PubMed: 32707266
DOI: 10.1016/j.ajog.2020.06.004 -
Fertility and Sterility Oct 2022Iron deficiency (ID) and iron deficiency anemia (IDA) are highly prevalent among women across their life span, especially during the reproductive age. An iron-deficient... (Review)
Review
Iron deficiency (ID) and iron deficiency anemia (IDA) are highly prevalent among women across their life span, especially during the reproductive age. An iron-deficient state has been associated with a number of adverse health consequences, affecting all aspects of the physical and emotional well-being of women. Heavy menstrual bleeding, pregnancy state, and the postpartum period are the major causes of ID/IDA. However, despite the high prevalence and the impact on quality of life, ID/IDA among fertile age women remains underdiagnosed and undertreated. The present Views and Reviews provides an overview on IDA in women's health, describing the background on iron metabolism, heavy menstrual bleeding pathogenetic mechanisms, including a focus on uterine disorders, such as uterine fibroids and adenomyosis. Iron replacement therapies, patient blood management, and treatment options for uterine disorders also are explored.
Topics: Anemia, Iron-Deficiency; Female; Humans; Iron; Iron Deficiencies; Menorrhagia; Pregnancy; Quality of Life; Reproductive Health; Women's Health
PubMed: 36182259
DOI: 10.1016/j.fertnstert.2022.08.850 -
American Family Physician Aug 2021Dysmenorrhea is common and usually independent of, rather than secondary to, pelvic pathology. Dysmenorrhea occurs in 50% to 90% of adolescent girls and women of... (Review)
Review
Dysmenorrhea is common and usually independent of, rather than secondary to, pelvic pathology. Dysmenorrhea occurs in 50% to 90% of adolescent girls and women of reproductive age and is a leading cause of absenteeism. Secondary dysmenorrhea as a result of endometriosis, pelvic anatomic abnormalities, or infection may present with progressive worsening of pain, abnormal uterine bleeding, vaginal discharge, or dyspareunia. Initial workup should include a menstrual history and pregnancy test for patients who are sexually active. Nonsteroidal anti-inflammatory drugs and hormonal contraceptives are first-line medical options that may be used independently or in combination. Because most progestin or estrogen-progestin combinations are effective, secondary indications, such as contraception, should be considered. Good evidence supports the effectiveness of some nonpharmacologic options, including exercise, transcutaneous electrical nerve stimulation, heat therapy, and self-acupressure. If secondary dysmenorrhea is suspected, nonsteroidal anti-inflammatory drugs or hormonal therapies may be effective, but further workup should include pelvic examination and ultrasonography. Referral to an obstetrician-gynecologist may be warranted for further evaluation and treatment.
Topics: Contraception; Contraceptives, Oral, Hormonal; Dysmenorrhea; Female; Humans; Ultrasonography
PubMed: 34383437
DOI: No ID Found -
American Family Physician Jul 2019Menstrual patterns can be an indicator of overall health and self-perception of well-being. Primary amenorrhea, defined as the lifelong absence of menses, requires... (Review)
Review
Menstrual patterns can be an indicator of overall health and self-perception of well-being. Primary amenorrhea, defined as the lifelong absence of menses, requires evaluation if menarche has not occurred by 15 years of age or three years post-thelarche. Secondary amenorrhea is characterized by cessation of previously regular menses for three months or previously irregular menses for six months and warrants evaluation. Clinicians may consider etiologies of amenorrhea categorically as outflow tract abnormalities, primary ovarian insufficiency, hypothalamic or pituitary disorders, other endocrine gland disorders, sequelae of chronic disease, physiologic, or induced. The history should include menstrual onset and patterns, eating and exercise habits, presence of psychosocial stressors, body weight changes, medication use, galactorrhea, and chronic illness. Additional questions may target neurologic, vasomotor, hyperandrogenic, or thyroid-related symptoms. The physical examination should identify anthropometric and pubertal development trends. All patients should be offered a pregnancy test and assessment of serum follicle-stimulating hormone, luteinizing hormone, prolactin, and thyroid-stimulating hormone levels. Additional testing, including karyotyping, serum androgen evaluation, and pelvic or brain imaging, should be individualized. Patients with primary ovarian insufficiency can maintain unpredictable ovary function and may require hormone replacement therapy, contraception, or infertility services. Functional hypothalamic amenorrhea may indicate disordered eating and low bone density. Treatment should address the underlying cause. Patients with polycystic ovary syndrome should undergo screening and intervention to attenuate metabolic disease and endometrial cancer risk. Amenorrhea can be associated with clinically challenging pathology and may require lifelong treatment. Patients will benefit from ample time with the clinician, sensitivity, and emotional support.
Topics: Amenorrhea; Diagnosis, Differential; Female; Humans; Medical History Taking; Physical Examination; Practice Guidelines as Topic
PubMed: 31259490
DOI: No ID Found -
Revista Brasileira de Ginecologia E... Aug 2020Primary dysmenorrhea is defined as menstrual pain in the absence of pelvic disease. It is characterized by overproduction of prostaglandins by the endometrium, causing... (Review)
Review
Primary dysmenorrhea is defined as menstrual pain in the absence of pelvic disease. It is characterized by overproduction of prostaglandins by the endometrium, causing uterine hypercontractility that results in uterine muscle ischemia, hypoxia, and, subsequently, pain. It is the most common gynecological illness in women in their reproductive years and one of the most frequent causes of pelvic pain; however, it is underdiagnosed, undertreated, and even undervalued by women themselves, who accept it as part of the menstrual cycle. It has major implications for quality of life, such as limitation of daily activities and psychological stress, being one of the main causes of school and work absenteeism. Its diagnosis is essentially clinical, based on the clinical history and normal physical examination. It is important to exclude secondary causes of dysmenorrhea. The treatment may have different approaches (pharmacological, non-pharmacological and surgical), but the first line of treatment is the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and, in cases of women who want contraception, the use of hormonal contraceptives. Alternative treatments, such as topical heat, lifestyle modification, transcutaneous electrical nerve stimulation, dietary supplements, acupuncture, and acupressure, may be an option in cases of conventional treatments' contraindication. Surgical treatment is only indicated in rare cases of women with severe dysmenorrhea refractory to treatment.
Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Dysmenorrhea; Female; Humans; Life Style; Pelvic Pain; Quality of Life
PubMed: 32559803
DOI: 10.1055/s-0040-1712131 -
International Journal of Environmental... Feb 2020Dysmenorrhea often significantly reduces the quality of women's life and is still an important public health problem. Despite numerous studies, the pathomechanism of... (Review)
Review
Dysmenorrhea often significantly reduces the quality of women's life and is still an important public health problem. Despite numerous studies, the pathomechanism of dysmenorrhea is not fully understood. Previous research indicates the complexity of biochemical reactions between the endocrine, vascular, and immune systems. Prostaglandins play a major role in the pathomechanism of dysmenorrhea. In contrast, cytokines and other proinflammatory factors in primary dysmenorrhea are less studied. In addition to the applied pharmacotherapy, more and more studies proving the effectiveness of non-pharmacological methods appear. Therefore, the present work contains a review of the latest research concerning factors involved in dysmenorrhea, as well as therapeutic options. In the literature search, authors used online databases, PubMed, and clinitrials.gov and browsed through individual gynecology, physiotherapy journals and books.
Topics: Biomarkers; Dysmenorrhea; Female; Humans; Inflammation
PubMed: 32069859
DOI: 10.3390/ijerph17041191 -
International Journal of Environmental... May 2022For 100 years, pelvic endometriosis has been considered to originate from the implantation of endometrial cells following retrograde menstruation or metaplasia. Since... (Review)
Review
For 100 years, pelvic endometriosis has been considered to originate from the implantation of endometrial cells following retrograde menstruation or metaplasia. Since some observations, such as the clonal aspect, the biochemical variability of lesions and endometriosis in women without endometrium, the genetic-epigenetic (G-E) theory describes that endometriosis only begins after a series of cumulative G-E cellular changes. This explains that the endometriotic may originate from any pluripotent cell apart from the endometrium, that 'endometrium-like cells' can harbour important G-E differences, and that the risk is higher in predisposed women with more inherited incidents. A consequence is a high risk after puberty which decreases progressively thereafter. Considering a 10-year delay between initiation and performing a laparoscopy, this was observed in the United Arab Emirates, Belgium, France and USA. The subsequent growth varies with the G-E changes and the environment but is self-limiting probably because of the immunologic reaction and fibrosis. That each lesion has a different set of G-E incidents explains the variability of pain and the response to hormonal treatment. New lesions may develop, but recurrences after surgical excision are rare. The fibrosis around endometriosis belongs to the body and does not need to be removed. This suggests conservative excision or minimal bowel without safety margins and superficial treatment of ovarian endometriosis. This G-E concept also suggests prevention by decreasing oxidative stress from retrograde menstruation or the peritoneal microbiome. This suggests the prevention of vaginal infections and changes in the gastrointestinal microbiota through food intake and exercise. In conclusion, a higher risk of initiating endometriosis during adolescence was observed in UAE, France, Belgium and USA. This new understanding and the limited growth opens perspectives for earlier diagnosis and better treatment.
Topics: Adolescent; Endometriosis; Endometrium; Female; Fibrosis; Humans; Menstruation Disturbances; Peritoneum
PubMed: 35682310
DOI: 10.3390/ijerph19116725 -
International Journal of Environmental... Jul 2021Primary dysmenorrhea (PD) refers to painful cramps before and/or during menstruation. There is a need for emphasis on alternative methods of conservative treatment, so... (Meta-Analysis)
Meta-Analysis Review
Primary dysmenorrhea (PD) refers to painful cramps before and/or during menstruation. There is a need for emphasis on alternative methods of conservative treatment, so as to reduce the dependence on drugs for alleviating the symptoms. The aim was to find out the effectiveness of some physiotherapy techniques in the treatment of PD. A systematic review and meta-analysis was conducted according to PRISMA standards. The descriptors were "dysmenorrhea", "physical the-rapy", "physiotherapy", and "manual therapy". The search was performed in five databases: Scopus, PubMed, PEDro, Web of Science, and Medline, in February 2021. The inclusion criteria were randomized controlled trials over the last six years. Articles not related to the treatment of PD or using pharmacology as the main treatment were excluded. Nine articles met the objectives and criteria, with a total of 692 participants. The most used scale to measure pain was the VAS (visual analogue scale). The main techniques were isometric exercises, massage therapy, yoga, electrotherapy, connective tissue manipulation, stretching, kinesio tape, progressive relaxation exercises and aerobic dance. Meta-analysis shows benefits of physiotherapy treatment for pain relief compared with no intervention or placebo (MD: -1.13, 95% CI: -1.61 to -0.64, I: 88%). The current low-quality evidence suggests that physiotherapy may provide a clinically significant reduction in menstrual pain intensity. Given the overall health benefits of physiotherapy and the low risk of side effects reported, women may consider using it, either alone or in conjunction with other therapeutic modalities.
Topics: Dysmenorrhea; Electric Stimulation Therapy; Exercise Therapy; Female; Humans; Massage; Physical Therapy Modalities
PubMed: 34360122
DOI: 10.3390/ijerph18157832 -
Molecules (Basel, Switzerland) Dec 2021Herbal products are often used as an alternative to pharmacological therapy. Menopausal symptoms and gynecological disorders (such as premenstrual syndrome and... (Review)
Review
Herbal products are often used as an alternative to pharmacological therapy. Menopausal symptoms and gynecological disorders (such as premenstrual syndrome and dysmenorrhea) are the indications where pharmacological therapy may have serious adverse events, hence many women prefer to use herbal products to help with these symptoms. Here, we reviewed plants and derived products, which are commonly used for the abovementioned indications, focusing on clinical data, safely profile and whether or not their use is justified. We noted that limited data are available on the use of some plants for alleviating the symptoms of menopause and gynecological disorders. While black cohosh () and red clover () were consistently shown to help reduce menopausal symptoms in clinical studies, currently available data do not fully support the use of fenugreek (), hops (), valerian (), and soybean ( and ) for this indication. For premenstrual syndrome and premenstrual dysphoric disorder, chaste tree () shows effectiveness, but more clinical studies are needed to confirm such effect upon the use of evening primrose ().
Topics: Dysmenorrhea; Female; Humans; Menopause; Phytotherapy; Plants, Medicinal; Premenstrual Syndrome
PubMed: 34946512
DOI: 10.3390/molecules26247421 -
Revista Brasileira de Ginecologia E... May 2021In a healthy athlete, the caloric intake is sufficient for sports energy needs and body physiological functions, allowing a balance between energy availability, bone... (Review)
Review
In a healthy athlete, the caloric intake is sufficient for sports energy needs and body physiological functions, allowing a balance between energy availability, bone metabolism, and menstrual cycle. On the other hand, an imbalance caused by low energy availability due to a restrictive diet, eating disorders or long periods of energy expenditure leads to multisystemic deregulation favoring the essential functions of the body. This phenomenon, described as the female athlete triad, occurs in a considerable percentage of high-performance athletes, with harmful consequences for their future. The present review was carried out based on a critical analysis of the most recent publications available and aims to provide a global perception of the topic relative energy deficit in sport (RED-S). The objective is to promote the acquisition of more consolidated knowledge on an undervalued theme, enabling the acquisition of preventive strategies, early diagnosis and/or appropriate treatment.
Topics: Amenorrhea; Athletes; Athletic Performance; Energy Intake; Energy Metabolism; Feeding and Eating Disorders; Female; Female Athlete Triad Syndrome; Humans; Menstruation Disturbances; Relative Energy Deficiency in Sport
PubMed: 34077990
DOI: 10.1055/s-0041-1730289