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Journal of Ayurveda and Integrative... May 2024Dengue fever is one of the most common tropical disease affecting humans. Symptomatic dengue infection causes a wide range of clinical manifestations from mild dengue...
Dengue fever is one of the most common tropical disease affecting humans. Symptomatic dengue infection causes a wide range of clinical manifestations from mild dengue fever to potentially fatal disease such as DHF or DSS. Menorrhagia is rarely presented as a symptom in females with DHF. It is often unnoticed in adolescents who has history of irregular menstruation especially in case of PCOS. This case discusses about an adolescent girl who presented with heavy menstrual bleeding, reddish discolouration of urine, severe abdominal pain, generalised body ache, mild head ache, nausea and fever along with a history of irregular menstruation. Dengue fever along with covid-19 was suspected due to the presentation and the patient revealed a travel history to relative's house. Ayurvedic medicines were administered according to patient's condition. The disease was confirmed as Dengue Haemorrhagic fever by Dengue IgM antibody, Dengue IgG Antibody, NS1 Ag and low platelet count, along with negative RT-PCR for Covid-19. This case serves as a valuable case study in DHF, which can be overlooked by Gynaecologists due to its co-presentation with menstruation, especially in patients with a history of irregular menstruation due to PCOS. Further more this case demonstrates the efficacy of simple, cost effective Ayurvedic interventions, which can be successfully utilized in fatal diseases like DHF with proper monitoring and follow up.
PubMed: 38795577
DOI: 10.1016/j.jaim.2024.100923 -
Medicina (Kaunas, Lithuania) May 2024: This study aims to evaluate the association between the use of oral isotretinoin and menstrual irregularities in acne patients with previously regular menstrual... (Observational Study)
Observational Study
: This study aims to evaluate the association between the use of oral isotretinoin and menstrual irregularities in acne patients with previously regular menstrual cycles. : A prospective observational study was conducted on 58,599 female patients aged 14 to 36 at King Abdullah University Hospital in Irbid, Jordan. The patients were followed for a period of 4.5 to 8 months during treatment and for 2 months post-treatment. Menstrual cycle changes were documented, and statistical analysis was performed to identify any significant associations. : A total of 111 (37.1%) patients, who were previously known to have regular menstrual cycles, complained of menstrual changes while using oral isotretinoin. Ninety-nine of those patients who complained of menstrual changes had their cycles back to normal post-treatment. There is a significant difference in the total accumulative dose between those with changes in menses and those without; -value [0.008]. The most common change that occurred was amenorrhea ( < 0.001), followed by oligomenorrhea and menorrhagia ( < 0.001 and = 0.050, respectively). The duration of treatment was a significant predictor of menstrual irregularities, with an odds ratio (OR) of 5.106 (95% CI: 1.371-19.020, = 0.015), indicating a higher likelihood of menstrual changes with increased treatment duration. The total accumulative dose was also significantly associated with menstrual irregularities (OR = 0.964; 95% CI: 0.939-0.990; = 0.006). Additionally, a family history of PCOS significantly increased the odds of menstrual irregularities (OR = 3.783; 95% CI: 1.314-10.892; = 0.014). : The study identified that 37.1% of the participants experienced changes in their menstrual cycles while undergoing isotretinoin therapy, with the vast majority (89.2%) returning to normal within two months post-treatment. Our logistic regression analysis pinpointed the duration of isotretinoin treatment, the total accumulative dose, and a family history of PCOS as significant predictors of menstrual irregularities.
Topics: Humans; Female; Isotretinoin; Prospective Studies; Adult; Menstrual Cycle; Menstruation Disturbances; Jordan; Adolescent; Young Adult; Administration, Oral; Acne Vulgaris; Dermatologic Agents
PubMed: 38793015
DOI: 10.3390/medicina60050832 -
BMC Medicine May 2024Heavy menstrual bleeding (HMB) is a common menstrual disorder associated with multiple risk factors of cardiovascular disease (CVD) in women. In addition, HMB is often...
BACKGROUND
Heavy menstrual bleeding (HMB) is a common menstrual disorder associated with multiple risk factors of cardiovascular disease (CVD) in women. In addition, HMB is often present with irregular menstruation (IM) which is a risk factor for CVD outcomes. However, the relationship between HMB and CVD outcomes is unexplored in the presence or absence of IM. We determined the association of HMB with multiple CVD outcomes using a nationally representative sample of female hospitalizations in the US.
METHODS
All hospitalizations of females with HMB diagnosis and normal menstrual cycles from ages of 18 to 70 years were extracted from the National Inpatient Sample Database, 2017. The HMB was defined using the International Classification of Diseases (ICD)-10 for excessive and frequent menstruation bleeding and included any current or history of HMB diagnosis. Outcomes including major adverse cardiovascular events (MACE), coronary heart disease (CHD), stroke, heart failure (HF), atrial fibrillation (AF) or arrhythmia, myocardial infarction (MI), and diabetes (DM) were defined using ICD-10 codes. Adjusted logistic regression and prosperity scores-matched logistic regression analyses were conducted to summarize adjusted associations with an odds ratio (OR) and a 95% confidence interval (CI).
RESULTS
Among 2,430,851 hospitalizations, HMB was observed in 7762 (0.68%) females with age ≤ 40 years and 11,164 (0.86%) females with age > 40 years. Among hospitalizations with age ≤ 40 years, HMB was significantly associated with increased odds of CVD outcomes including MACE (OR = 1.61; 95% CI: 1.25, 2.08), CHD (OR = 1.72; 95% CI: 1.10, 2.71), stroke (OR = 1.95; 95% CI: 1.12, 3.40), HF (OR = 1.53; 95% CI: 1.15, 2.03), and AF/arrhythmia (OR = 1.84; 95% CI: 1.34, 2.54). These associations were confirmed in multiple sensitivity analyses. In contrast, HMB was not robustly associated with CVD events among hospitalizations of women with age > 40 years. HMB without IM was strongly associated with DM, HF, AF, and MACE outcomes while HMB with IM was strongly associated with CHD and AF outcomes in hospitalizations of young women.
CONCLUSIONS
HMB is associated with CVD events among US hospitalizations of young women. A routine investigation and screening of menstrual disorders, especially HMB, is useful for CVD risk stratification and management in young women.
Topics: Humans; Female; Adult; Middle Aged; Hospitalization; Cardiovascular Diseases; United States; Menorrhagia; Young Adult; Adolescent; Aged; Risk Factors
PubMed: 38783294
DOI: 10.1186/s12916-024-03426-8 -
BMC Women's Health May 2024Patients with iron deficiency anemia are treated with iron preparations, but gastrointestinal symptoms such as nausea and vomiting occur frequently. These symptoms may...
The quality of life and work productivity are affected by the presence of nausea/vomiting in patients taking iron preparations for heavy menstrual bleeding or anemia: a population-based cross-sectional survey in Japan.
BACKGROUND
Patients with iron deficiency anemia are treated with iron preparations, but gastrointestinal symptoms such as nausea and vomiting occur frequently. These symptoms may negatively affect the quality of life and work productivity in patients with iron deficiency anemia. This study assessed the impact of nausea and vomiting on the quality of life and work productivity of patients taking iron preparations for heavy menstrual bleeding or anemia.
METHODS
An online survey was conducted among patients taking iron preparations for heavy menstrual bleeding or anemia. Demographic data and information about medication use and the health condition were collected. The patients were asked to answer the 5-level EQ-5D version, and work productivity and activity impairment questionnaires. The outcomes were reported by patients in the presences of nausea, vomiting, and nausea or vomiting. The association with the 5-level EQ-5D version utility score for the severity and frequency of the symptoms were also assessed.
RESULTS
A total of 385 patients were enrolled, and 96 were patients with nausea or vomiting, of which 94 were with nausea and 27 were with vomiting. The 5-level EQ-5D version utility scores for the patients with nausea, vomiting, and nausea or vomiting were significantly lower than those of the patients without these symptoms (p < 0.001 for each). The 5-level EQ-5D version utility score was correlated with the severity of nausea and the frequency of vomiting per day (p < 0.001 for each). As for the work productivity and activity impairment, the presenteeism, the overall work impairment, and the activity impairment of the patients with nausea, vomiting, and nausea or vomiting were significantly higher than those without these symptoms (p < 0.001 for each). The absenteeism was slightly higher trend was observed, but not significant.
CONCLUSION
Patients taking iron preparations who have nausea or vomiting experience a significant burden in terms of poorer quality of life and higher work productivity impairment.
TRIAL REGISTRATION
UMIN000045700 ( http://www.umin.ac.jp/ctr/ ). Registered on October 11, 2021.
Topics: Humans; Quality of Life; Female; Japan; Adult; Cross-Sectional Studies; Nausea; Vomiting; Menorrhagia; Middle Aged; Efficiency; Anemia, Iron-Deficiency; Surveys and Questionnaires; Absenteeism
PubMed: 38773463
DOI: 10.1186/s12905-024-03104-0 -
American Journal of Obstetrics and... May 2024The levonorgestrel-releasing intrauterine device (LNG-IUD) is widely used for the treatment of menorrhagia, dysmenorrhea, and for contraception. However, the association...
BACKGROUND
The levonorgestrel-releasing intrauterine device (LNG-IUD) is widely used for the treatment of menorrhagia, dysmenorrhea, and for contraception. However, the association between the use of LNG-IUD and the risk of site-specific gynecologic and breast cancers remains inconclusive.
OBJECTIVE
We aim to address this knowledge gap by investigating whether the use of LNG-IUD is associated with a significant risk of site-specific gynecologic and breast cancers. This will be achieved by accessing the nationwide Swedish Registers, with consideration given to the influence and potential interaction of family history of cancer.
STUDY DESIGN
A total of 514719 women aged 18 to 50 years who have used LNG-IUD between July 2005 and December 2018 were identified from the Swedish Prescribed Drug Register and randomly matched with 1544157 comparisons who did not use LNG-IUD at a ratio of 1:3. The propensity score was calculated and matched among women who used LNG-IUD and the matched comparisons. The follow-up period started from the date of the first prescription of LNG-IUD for users as well as for their matched comparisons and ended at the date of diagnosis of gynecologic and breast cancers, date of death from any cause, and the end of the study period, whichever came first. The Cox proportional hazard model with a competing risk analysis was used to calculate hazard ratios and 95% confidence intervals. Additive interaction was calculated as the relative excess risk for interaction, while multiplicative interaction was calculated by including a product term in the regression model.
RESULTS
The use of LNG-IUD was associated with a 13% higher risk of breast cancer (adjusted HR, 1.13; 95% CI, 1.10-1.17), a 33% lower risk of endometrial cancer (adjusted HR, 0.67; 95% CI, 0.56-0.80), a 14% lower risk of ovarian cancer (adjusted HR, 0.86; 95% CI, 0.75-0.99) and a 9% reduced risk of cervical cancer (adjusted HR, 0.91; 95% CI, 0.84-0.99) compared to women who did not use LNG-IUD. A significant additive interaction between LNG-IUD use and family history of cancer was observed in breast cancer, indicating a relative 19% excess risk for interaction (P < 0.002), and 1.63 additional cases per 10,000 person-years.
CONCLUSIONS
The risk of gynecologic and breast cancers exhibits a site-specific effect among LNG-IUD users. It's important to note that the observed effect is small for breast cancer and the results are limited by the observational study design. Clinical recommendations regarding the use of LNG-IUD should carefully weigh its potential benefits and risks. Close monitoring is advisable for the potential development of breast cancer, particularly among women with a family history of breast cancer.
PubMed: 38759709
DOI: 10.1016/j.ajog.2024.05.011 -
Open Life Sciences 2024Cystic adenomyosis is a rare type of adenomyosis. The main clinical manifestation of uterine cystic adenomyoma is severe dysmenorrhoea, and the condition can be...
Cystic adenomyosis is a rare type of adenomyosis. The main clinical manifestation of uterine cystic adenomyoma is severe dysmenorrhoea, and the condition can be diagnosed by relevant clinical examination. The preferred treatment, with a good prognosis, is lesion resection. The clinical data of a patient with uterine cystic adenomyoma recorded at the Third Hospital of Hebei Medical University are reported herein. A 39-year-old female patient presented with tolerable menstrual pain and aggravated dysmenorrhoea, which she had experienced for 4 years, and menorrhagia, which she had had for approximately 1 year. Ultrasound and tumour marker tests suggested abnormalities, and magnetic resonance imaging confirmed a diagnosis of uterine cystic adenomyoma. A hysteroscopy and intrauterine lesion electrocision were performed, and the results of postoperative pathology tests suggested that the endometriosis cysts had returned to normal after the postoperative intervention. The analysis of the clinical manifestations and diagnosis and treatment of uterine cystic adenomyoma can improve the understanding of the disease and reduce the rates of misdiagnosis and missed diagnoses to ensure early detection with timely diagnosis and treatment.
PubMed: 38756858
DOI: 10.1515/biol-2022-0846 -
Canadian Association of Radiologists... May 2024To assess the current practices surrounding Uterine Fibroid Embolization (UFE) in Canada. An online survey was sent to Canadian Association for Interventional...
To assess the current practices surrounding Uterine Fibroid Embolization (UFE) in Canada. An online survey was sent to Canadian Association for Interventional Radiology (CAIR) members. It included questions on symptoms prompting UFE, patient awareness, investigation, UFE settings, the number of UFE procedures, and post-UFE care. The findings were discussed at CAIR's 2023 annual meeting by an expert panel. Out of 792 surveys sent, 87 were filled (11%). Menorrhagia is the most common indication for UFE (87%). Women's awareness of UFE as a treatment option for fibroids is viewed as poor or average by 94% of our survey respondents. Most respondents see patients in clinics (92%) before the procedure and evaluate fibroids with MRI pre-UFE (76%). There is variability in care post-UFE, with 33% of procedures being performed as day surgery while 67% lead to overnight stay. For pain management, intravenous analgesia (including patient-controlled analgesia) is used in 76% (63/83) of cases while 19% (16/83) of respondents mentioned using epidural analgesia. Finally, there is an even split between embolic agent used; non-spherical polyvinyl alcohol (50%) and spherical particles (50%). Respondents believe patients in Canada still have limited awareness of UFE. Interventional radiologists are increasingly involved in the entire patient care trajectory, overseeing pre-and post-procedure care and hospitalizing patients. For pain management after UFE, it is observed that while epidural analgesia has been demonstrated more effective than alternatives, it is not widely used as the primary method.
PubMed: 38755969
DOI: 10.1177/08465371241252307 -
SAGE Open Medicine 2024Uterine fibroids are the commonest benign tumors of the reproductive tract in women of childbearing age. They are usually asymptomatic but can cause menorrhagia.... (Review)
Review
INTRODUCTION
Uterine fibroids are the commonest benign tumors of the reproductive tract in women of childbearing age. They are usually asymptomatic but can cause menorrhagia. Treatments include myomectomy and uterine artery embolization (UAE). The latter is a relatively new procedure, therefore of special interest.
OBJECTIVES
We conducted a systematic review and meta-analysis of all published studies to provide a comprehensive outlook on the effectiveness of UAE by comparing its outcomes to those of myomectomy. Electronic databases (PubMed and Cochrane Central) were systematically searched from January 2000 to March 2022 for published randomized control trials, observational studies, and meta-analyses that compared UAE to myomectomy for at least one of the pre-specified outcomes, namely re-intervention rates, length of hospital stay, and complications.
METHODS
We shortlisted nine studies for the final analysis. For continuous outcomes, results from random-effects meta-analysis were presented as mean differences (MDs) and corresponding 95% confidence intervals (CIs). Risk ratios (RRs) for dichotomous outcomes were pooled using a random-effects model.
RESULTS
The final analysis consisted of nine studies. Factors like re-intervention, hospitalization, and complications, each with its unique follow-up duration were assessed. Pooled analysis demonstrated significant results for greater re-intervention rates with UAE as compared to myomectomy (RR: 2.16, 95% CI: (1.27-3.66), value 0.004, heterogeneity = 85%). UAE holds a greater but statistically insignificant risk for major complications (RR: 0.62, 95% CI: (0.29-1.33), value 0.22, heterogeneity = 0%) and myomectomy shows a statistically insignificant greater risk for minor complications (RR: 1.72, 95% CI: (0.92-3.22), value 0.09, heterogeneity = 0%). UAE had a shorter but statistically insignificant duration of hospital stay (MD: -1.12, 95% CI: (-2.50 to 0.27), value 0.11, heterogeneity = 96%) (value for subgroup differences = 0.005).
CONCLUSION
Our meta-analysis of approximately 196,595 patients demonstrates that myomectomy results in a significant reduction in re-intervention rate compared to UAE.
PubMed: 38751568
DOI: 10.1177/20503121241236141 -
Journal of Science and Medicine in Sport May 2024Iron deficiency, anaemia, and menorrhagia - or heavy menstrual bleeding - are interrelated conditions that are highly prevalent and commonly underrecognised in...
OBJECTIVES
Iron deficiency, anaemia, and menorrhagia - or heavy menstrual bleeding - are interrelated conditions that are highly prevalent and commonly underrecognised in exercising females of reproductive age. This study utilised a screening tool to identify risk factors and symptoms associated with heavy menstrual bleeding, iron deficiency, and anaemia in this population.
DESIGN
An observational, cross sectional survey study was employed.
METHODS
1042 active females (aged 18-65) completed a comprehensive screening questionnaire and 887 (85 % compliance) provided a fingerprick blood sample for haemoglobin (Hb) concentration measurement. Women that presented as anaemic (defined as a [Hb] < 120 g/L) or deemed to be at risk of iron deficiency (120 < [Hb] < 130 g/L) were asked to complete follow-up blood tests to screen for iron studies.
RESULTS
Average [Hb] was 134.2 ± 12.1 g/L, with 94 individuals considered anaemic (10.6 %). Of the sample, 104 underwent follow-up blood tests; 51 (~49 %) presented with iron deficiency (defined as ferritin <30 μg/L). Based on survey responses, 274 (30.9 %) participants were determined to have heavy menstrual bleeding. Those presenting with heavy menstrual bleeding were younger, exercised fewer hours per week, and were more likely to have a history of iron deficiency or anaemia (all p < 0.05). Participants reporting a history of anaemia or iron deficiency were more likely to have heavy menstrual bleeding (anaemia: 39.7 %; iron deficiency; 36.9 %; both p < 0.05).
CONCLUSIONS
In this cohort of exercising females of reproductive age, the prevalence of anaemia was 10.6 %. There is a strong association between heavy menstrual bleeding and a self-reported history of iron deficiency and anaemia. Greater awareness of heavy menstrual bleeding and its relationship with iron deficiency and anaemia is needed in this population. Non-invasive screening should be conducted to raise awareness and further understand the associated risk factors and symptomatology.
PubMed: 38749874
DOI: 10.1016/j.jsams.2024.04.012 -
Internal Medicine (Tokyo, Japan) May 2024We herein report a 47-year-old woman who developed migraine-like headache with aura and subsequent multiple cerebral infarcts, likely due to severe iron deficiency...
We herein report a 47-year-old woman who developed migraine-like headache with aura and subsequent multiple cerebral infarcts, likely due to severe iron deficiency anemia (IDA) from menorrhagia. The progression from IDA to ischemic stroke involves several pathophysiological mechanisms, including reduction of erythrocyte deformability, reactive thrombocytosis, and anemic hypoxia. We speculate that a microembolus first caused cortical spreading depression without infarcts and that a larger thromboembolus then caused multiple infarcts. This case highlights the transition from migraine-like headache to ischemic stroke. New-onset migraine-like headache is a warning of impending ischemic stroke, and IDA may be a potential underlying cause.
PubMed: 38749725
DOI: 10.2169/internalmedicine.3842-24