scholarly journals The Association between Heavy Menstrual Bleeding and Depressive Symptoms in Adolescents

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4230-4230
Author(s):  
Sanila Sarkar ◽  
Laura Benjamins ◽  
Sudad Kazzaz ◽  
Neethu M Menon
Keyword(s):  
Depressive Symptoms ◽  
Blood Loss ◽  
Young Women ◽  
Adolescent Females ◽  
Heavy Menstrual Bleeding ◽  
Menstrual Bleeding ◽  
Chi Square ◽  
Test Of Independence ◽  
Adolescent Population ◽  
Chi Square Test

Abstract Introduction: Heavy menstrual bleeding (HMB) is a type of abnormal uterine bleeding (AUB) that affects 30% of women of reproductive age and up to 40% of adolescents. Furthermore, 10-40% of adolescents with HMB have an underlying inherited bleeding disorder like von Willebrand disease or platelet dysfunction, requiring management by pediatric hematologists. HMB has been described as more than 80 ml of blood loss during one cycle and clinically, it is defined by several parameters such as the length of each cycle, severity of soaking through pads or tampons, size of clots passed and pictorial blood loss assessment chart (PBAC) score. Studies in adult women show a significant impact of HMB on their psychosocial and financial health. However, little is known about the psychological effects of HMB in adolescent females. In the adolescent population, depression is twice as common in females as it is in males, likely due to a combination of biological and social differences. In this study, we examine the association between heavy menstrual bleeding and depressive symptoms in adolescent girls. Methods: We conducted a retrospective records review of adolescent females aged 10-21 years that were seen as new patients at the Adolescent Medicine and Young Women's Bleeding Disorders clinics at our institution between January 1, 2018 and March 31, 2020. Patients were included in the study if they had started menses, and had a doumented menstrual history as well as a completed Patient Health Questionnaire (PHQ-9), a validated screening tool for depression.Patients with a severe underlying chronic medical disorder (Including but not limited to end stage renal disease, Juvenile Rheumatoid Arthritis, Systemic Lupus Erythematosis, severe eating disorder, previously diagnosed bipolar disorder or psychotic disorders) were excluded. HMB was determined by either a PBAC score of >100 or the presence of two or more of the following criteria: Menses lasting >7days Soaking through pad or tampon <1hr Soaking through bed clothes or changing pads at night Passing large clots Low ferritin < 15ng/ml (indicative of low iron stores) Anemia with Hemoglobin < 12g/dl not due to any other cause (e.g. dietary, immunosuppression, medication induced) Depression was determined by a PHQ-9 score of 9 or greater. The two variables were dichotomized, and a chi-square test of independence was performed to test the association with a significance level of p < 0.05. Results: A total of 203 records were reviewed after meeting inclusion and exclusion criteria. The mean age was 15.94 years (median 16, mode 16) with a range of 12-20years. 42 girls (20.7%) had a PHQ-9 score of >9 and 52 (25.6%) had HMB. Eighteen of the 42 patients (42.8%) with elevated PHQ-9 score had HMB and 34/52 patients (65.3%) with HMB had an elevated PHQ-9 score. Pearson's chi-square test of independence showed a significant relation between HMB and PHQ-9 score of 9 or more with χ 2 (1, n=203) = 8.2618, p = 0.004. After the application of Yates correction, the result was still significant with χ 2 = 7.1603 and p = 0.007. Discussion and Conclusions: This study shows a significant association in the adolescent population between heavy menstrual bleeding and moderate or severe depression as defined by the presence of a PHQ-9 score of 9 or more. This retrospective analysis does not establish causation, but demonstrates a clinically noteworthy finding that has not been described before. The PHQ-9 is used widely across this population to screen for depression, but it is also important to screen young women aged 10-21years for HMB as a contributing factor to depression followed by timely and appropriate management of both problems. Additionally, it may be worthwhile to evaluate all young women with HMB through additional methods to diagnose depression as this patient population appears to be at higher risk. Future prospective studies are needed to better characterize this association. Disclosures No relevant conflicts of interest to declare.

Iron Deficiency and Fatigue in Adolescent Females with Heavy Menstrual Bleeding,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4215-4215
Author(s):  
Wenting Wang ◽  
Tran Bourgeois ◽  
Jennifer Klima ◽  
Elise D. Berlan ◽  
Anastasia N. Fischer ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Blood Loss ◽  
Ferritin Level ◽  
Adolescent Females ◽  
Heavy Menstrual Bleeding ◽  
Menstrual Bleeding ◽  
Menstrual Blood ◽  
Menstrual Blood Loss ◽  
Fatigue Score ◽  
Study Population

Abstract Abstract 4215 Introduction Adolescent females are one of two pediatric populations at greatest risk for iron deficiency. An important risk factor for iron deficiency in adolescent females is excessive menstrual blood loss. Due in part to changes in circadian rhythms and poor sleep hygiene, fatigue is also a pervasive problem in adolescence, and may be exacerbated by iron deficiency secondary to menorrhagia. Clinical trials have shown that non-anemic adult women with low serum ferritin (≤15„30 ng/ml) and unexplained fatigue demonstrate improvement in fatigue with iron supplementation. Similar studies have not been performed in women <18 years of age. Our primary objective was to define baseline ferritin values and fatigue symptoms in a population of young females with a history of heavy menstrual bleeding. Methods The study population included 11,Ÿ17 year old females presenting to an Adolescent Gynecology Clinic or Menorrhagia Clinic for initial evaluation or follow-up of heavy menstrual bleeding. To mirror our clinical practice, the study population included patients who did and did not take iron supplements, as well as those who did and did not use hormonal contraception. To evaluate the degree and effects of menstrual blood loss, we utilized the Ruta Menorraghia Scale (RMS), a subjective measurement of menstrual blood loss and health-related quality of life. Possible responses to each multiple choice question were assigned ordinal scores to produce a total menorrhagia severity score (MSS). We investigated symptoms of fatigue using the Fatigue Severity Scale (FSS), a Likert scale measurement of fatigue's effects, symptoms, and severity (possible responses range from 1 to 7). Hemoglobin and ferritin levels were obtained by venipuncture after the completion of survey instruments. A control population of 12,Ÿ17 year old menstruating females was recruited from a Sports Medicine clinic. These patients completed the RMS and FSS instruments but did not undergo venipuncture. We compared FSS and MSS between the two populations using the Kruskal Wallis test. We evaluated possible predictors of ferritin level (age, body mass index, fatigue scores, and MSS) using generalized linear models. Results A total of 31 adolescents diagnosed with heavy menstrual bleeding and 37 healthy adolescents completed the study. Mean MSS was 39.3 (±17.4) in those with a history of heavy menstrual bleeding, compared to 17.9 (±10.0) in controls (p<.0001). When completing the menorrhagia scale, over two-thirds (71%) of adolescents with heavy menstrual bleeding reported that menses mildly to moderately affected their ability to participate in physical education class or sports, compared to 27% of controls. Thirteen (41.9%) of those with heavy bleeding reported missing at least one day of school with each menses, compared to 8.1% of controls. Mean fatigue score was 4.2 (±1.5) in patients with heavy menstrual bleeding, similar to values reported in adults with sleep-wake disorders. In contrast, the mean fatigue score was 2.98 (±1.1, p=.001) in the control population, similar to values reported in normal healthy adults. Twenty-five of 31 (80.6%) adolescents with heavy menstrual bleeding had ferritin levels ≤30 ng/ml, and ten (32.2%) had ferritin levels ≤15 ng/ml. Our generalized linear models did not identify any significant univariate relationships between ferritin levels and patient age, body mass index, fatigue score, or menorrhagia score. This finding may be due to our small sample size, or the narrow range of ferritin levels in our study population (87% had a ferritin level <40 ng/ml). Discussion Iron deficiency and symptoms of fatigue were common findings in a small population of young women with heavy menstrual bleeding. Fatigue severity scores were significantly higher in our study population as compared to healthy controls. Larger studies are needed to delineate the relationship between menstrual blood loss, fatigue, and ferritin values in adolescents, in order to plan for future intervention trials of iron supplementation. We also identified a high frequency of physical activity limitations and school absence in young women with heavy menstrual bleeding, highlighting the importance of including these types of patient-reported outcomes in the design of clinical trials for this patient population. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Comparative study on levonorgestrel intrauterine system and oral progestogen in women with heavy menstrual bleeding in terms of efficacy, user satisfaction and quality of life using MMAS score

2019 ◽  
Vol 8 (8) ◽  
pp. 3073
Author(s):  
Krishna Dahiya ◽  
Supriya Mahipal ◽  
Archit Dahiya ◽  
Isha Nandal ◽  
Priyanka Narang
Keyword(s):  
Quality Of Life ◽  
User Satisfaction ◽  
Heavy Menstrual Bleeding ◽  
Menstrual Bleeding ◽  
Age Group ◽  
Chi Square ◽  
Group I ◽  
Chi Square Test

Background: To compare the efficacy, safety and user satisfaction of levonorgestrel intrauterine system (LNG-IUS) with oral progestogen in medical management of heavy menstrual bleeding (HMB).Methods: This prospective study was conducted on 80 women with HMB in age group of 35-55 years. Patients were divided into two groups of 40 each and followed for six months. In Group I, LNG-IUS was inserted in post menstrual period and in Group II, patients received oral norethisterone 5 mg twice a day during 5th-25th day of cycle for 6 months. Patients were evaluated about amount and duration of blood loss by pictorial blood assessment chart (PBAC) along with haemoglobin estimation on each follow up visit. MMAS (Menorrhagia Multi-Attribute Scale) score comparison between two groups was done to measure the improvement in quality of life. The results were analysed by using Chi-square test and Student t-test.Results: Percentage reduction in PBAC score after six cycles of treatment was 89.3% in LNG IUS group as compared to 68% in norethisterone group. LNG-IUS was found to be more efficient in correcting anemia, lowering duration of bleeding and improving MMAS score as compared to norethisterone.Conclusions: Present study showed that LNG IUS was superior to oral progestogen in decreasing quantity and duration of bleeding and improving overall quality of life over time. 

scholarly journals Dismenorhoe Incidence In Female Students With Anemia

2018 ◽  
pp. 179-185
Author(s):  
Azrida Machmud ◽  
Suchi Avnalurini Sharief ◽  
Halida Thamrin
Keyword(s):  
Young Women ◽  
Sampling Method ◽  
Sampling Technique ◽  
Deficiency Anemia ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Children And Adolescent ◽  
Chi Square Test ◽  
The Relationship

For children and adolescent girls found many health problems, especially anemia. In women with iron deficiency anemia, the amount of menstrual blood is also more. Most women do not feel the symptoms at the time of menstruation, but some feel heavy in the pelvis or feel pain (dysmenorrhoea). Various studies have shown that the incidence of dysmenorrhoea is still quite high, those who experience severe dysmenorrhoea after taking the drug should rest and it is recommended to limit even leave the school or work for 1-3 days in a month which would certainly be detrimental to women in the activity, especially in young women who are in a period of growth and development. The purpose of this study to determine the relationship between anemia with dismenorhoe incident. The approach taken in this research is quantitative. This type of research used surveyive design with cross sectional approach. In this research the sampling method using Random Sampling technique. The results showed a significant relationship between anemia with the incidence of dysmenorrhoea in UMI midwifery students where the results of Chi Square test of 9,737 with p-value 0.0001 <0,05. It can be concluded that anemia can cause dysmenorrhoea in young women, so the need to increase knowledge about nutrition for young woman to prevent the happening of anemia.          

CERVICAL CANCER AMONG 39 YEARS OR YOUNGER FEMALES IN SOUTH INDIA; A RETROSPECTIVE STUDY

2021 ◽  
pp. 15-17
Author(s):  
B Ramkumar ◽  
Srigopal Mohanty ◽  
Kiranmayee Narapaneni ◽  
Amit Saklani ◽  
J Kannan
Keyword(s):  
Cervical Cancer ◽  
Retrospective Study ◽  
Older Women ◽  
Young Women ◽  
Clinicopathological Characteristics ◽  
Categorical Variables ◽  
Chi Square ◽  
Younger Women ◽  
Ciency Virus ◽  
Chi Square Test

Background: Cervical cancer in young women is rare and disparity exists in its characteristics in the available reports. The study aimed to determine the disease burden and to compare its clinicopathological characteristics with older women. Materials and methods: Retrospective study was performed by retrieving data from the cancer registry for consecutive 843 cervical cancer patients treated in the center between 2017 and 2020. Patients were divided into younger (<40 years) and older (≥ 40 years) age. Statistical analysis was performed using SPSS software version 23 for windows. Chi square test was used for analyzing the categorical variables and P < 0.05 was considered signicant. Results: Cervical cancer in young women constituted 9.4%, with majority (96.2%) belonged to 30-39 years age. Higher prevalence of human immunodeciency virus (HIV) was found among younger compared to older women (P = 0.000). Younger women commonly presented late compared to older women (patients presented after 4 months are 49.4% vs. 18.8% respectively, P=0.000). Squamous cell carcinoma was commonest histology in both the groups and no difference in histology pattern between the two groups. Younger women had higher rate of bulky tumor (>4cm) compared to older (62.2% vs. 44.4%, P = 0.023). Conclusion: Delayed and advanced stage of presentation of cervical cancer in younger women in this region of India warrants promotion of health education, knowledge translation, regular cervical cancer screening for its prevention and early detection

Key issues in the management of adolescents and young women with heavy menstrual bleeding

GYNECOLOGY ◽  
2021 ◽  
Vol 23 (4) ◽  
pp. 370-376
Author(s):  
Elena V. Uvarova ◽  
Irina А. Salnikova ◽  
Elena P. Khashchenko ◽  
Arina P. Sokolova
Keyword(s):  
Young Women ◽  
Heavy Menstrual Bleeding ◽  
Menstrual Bleeding ◽  
Menstrual Blood Loss ◽  
First Line ◽  
High Prevalence ◽  
Underlying Causes ◽  
Key Issues ◽  
Appropriate Therapy

Despite high prevalence of heavy menstrual bleeding (HMB) in adolescents and young women, most recommendations are not specific for this population, which makes the diagnosis and management challenging. Gynecologists should be able to establish underlying causes of HMB, which most common are nonstructural in adolescents, and the severity of bleeding, to provide early diagnosis, using appropriate therapy for improving quality of life and iron deficiency prevention. First line management consists of hormonal therapy approved for HMB treatment, capable to normalize menstrual blood loss and iron metabolism parameters.

Prevalence of Vestibular Dysfunction with Presbycusis among Elderly in Malaysia

2021 ◽  
Vol 15 (12) ◽  
pp. 3478-3480
Author(s):  
Mohammed Amin Onn ◽  
Khairi Md Daud ◽  
Rosdan Salim
Keyword(s):  
Pure Tone Audiometry ◽  
Cross Sectional Study ◽  
Vestibular Dysfunction ◽  
Head Impulse Test ◽  
Video Head Impulse Test ◽  
Chi Square ◽  
Cross Sectional ◽  
Test Of Independence ◽  
Head Impulse ◽  
Chi Square Test

Objectives: This study aims to determine the prevalence of vestibular dysfunction in the Malaysian elderly and its association with presbycusis, age and other associated risk factors. Methods: A cross-sectional study was undertaken in a tertiary otorhinolaryngology department and the community. Adults aged 60 years and above who attended the ORL CLINIC with or without presbycusis were invited to participate. The main outcome measures, including the Malay Version Vertigo Symptoms Scale, pure tone audiometry and vestibular assessment, were obtained using a Video Head Impulse Test (VHIT). Results: The prevalence of vestibular dysfunction with presbycusis in the study population of 135 participants was 46.7 per cent (95 per cent confidence interval, 24.0 to 36.2 per cent). The median age was 68 years (range, 60–86 years). The A chi-square test of independence showed that there was significant association between Presbycusis and Tinnitus, X2 (1, N = 135) = 97.37, p < .001. A chi-square test of independence was performed to examine the relation between presbycusis and dizziness. The relation between these variables was significant, X2 (2, N = 135) = 28.42, p < .001. A chi-square test of independence showed that there was no significant association between presbycusis and VHIT, X2 (1, N = 135) = .01, p = .938. Conclusion: Vestibular dysfunction is independently associated with ageing and presbycusis. More research investigating the advantages of additional screening for vestibular dysfunction in older presbycusis patients is needed. Key words: Elderly; Presbycusis; Vestibular dysfunction; Video Head Impulse Test (VHIT)

Single Level ACCF Combining Single Level Stand-alone ACDF in Treating Cervical Spondylotic Myelopathy

2020 ◽  
Author(s):  
Zhichao Zhang ◽  
Jingxuan Chen ◽  
Wei Shi ◽  
Shengyuan Zhou ◽  
Xiongsheng Chen ◽  
...  
Keyword(s):  
Blood Loss ◽  
Intervertebral Disc Herniation ◽  
Intraoperative Blood Loss ◽  
Postoperative Dysphagia ◽  
Chi Square ◽  
Disc Space ◽  
Single Level ◽  
Chi Square Test ◽  
Vas Scores ◽  
Student’S T

Abstract Objective Single level ACCF combining single level ACDF (AcA) is an ideal way to treat CSM with multiple consecutive cervical intervertebral disc herniation alongside with severe bony narrowing of the spinal canal in between. AcA with the stand-alone technics on the ACDF level and a shorter titanium plate that only covers the ACCF levels (AcAsa) may possess potential advantages than conventional AcA. We performed a retrospective study to evaluate the feasibility, safety and effectiveness of AcAsa procedure. Methods 379 patients with CSM who had conventional AcA or AcAsa were retrospectively reviewed. Related patients factors, disease factors and treatment factors were acquired and subjected into student’s t test, chi-square test and survive analyses. Results Preoperative and postoperative JOA Scores in AcAsa: p<0.001. Preoperative and postoperative VAS Scores in AcAsa: p<0.001. 12months improvement of JOA Score between preoperative VAS Score≥2 and <2 in AcAsa: p=0.002. The amount of intraoperative blood loss between AcAsa and conventional AcA: p=0.011. Incidence of postoperative dysphagia between AcAsa and conventional AcA: p=0.038. Conclusion AcAsa significantly improve patients’ JOA Scores and reduce VAS Scores. Compared with conventional AcA, AcAsa leads to smaller amount of intraoperative blood loss and lower incidence of postoperative dysphagia. The alleviations of neurological symptoms, cervical motions and disc space heights at the ACDF levels are similar between the two types of surgeries. And patients with preoperative VAS less than 2 may benefit more from an AcAsa procedure.

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