Menstrual Abnormalities and Associated Hormone Profile In Chronic Kidney Disease Stage 5 Patients

Background: Although menstrual abnormalities and associated hormonal dysregulations are very common in the reproductive age group of Chronic Kidney Disease (CKD) patients, this remains a neglected area. This field had been poorly explored in last ten years worldwide and a few research regarding this area in Bangladesh as well. Aim: To evaluate menstrual abnormalities occurring in CKD stage 5 (CKD5)patients undergoing twice-weekly and thriceweekly maintenance hemodialysis (HD) also in non-dialytic CKD5 patients and to provide more detail information on hormone profile (FSH, LH, Prolactin, Estradiol) of these patients. Materials and method: This obsevational study was conducted in the Department of Nephrology, DMCH, the sample population was also collected from BSMMU and NIKDU from April 2017 to March 2018. A total of 51 CKD stage 5 patients were enrolled in this study. Among them, 34 patients were dialytic (17 of them were taking twice weekly HD and 17 of them were taking thrice weekly HD) and 17 non-dialytic patients at reproductive age were evaluated. Detailed menstrual histories, thorough clinical examinations as well as investigations were done in all the patients. Serum FSH, LH, Estradiol, and Prolactin were evaluated using chemiluminescence immunoassay in the Department of Microbiology of BSMMU. Statistical analysis of the study was done by SPSS-24. The confidence interval was considered at 95% level. P-value <0.05 was considered statistically significant. Results: 100% of non-dialytic CKD5 women had menstrual disorders (72% of patients had secondary amenorrhea, 18% had oligomenorrhoea and 10% had menometrorrhagia). And 73.52% of patients in the HD group had menstrual disorders (29% patients had regular menstruation, 28.5% had secondary amenorrhea, 23.5% had oligomenorrhoea and 19% had menometrorrhagia). With continuation of HD amenorrhea disappeared in 43% of patients in the thrice-weekly HD group, also 22.22% patients in the twice-weekly HD group regained menstruation. Serum LH and prolactin levels were significantly higher in the non-HD group compared to the HD group (p<0.05). Estradiol levels were also higher in HD patients than the non-HD patients. LH and Prolactin levels were also higher in the twice-weekly HD group compared to the thrice-weekly HD group. In the secondary amenorrheic group, serum FSH, LH, Prolactin levels were significantly higher than the other groups having menstrual disorder (p<0.05). Conclusion: Menstrual abnormalities and associated hormonal dysregulations were significantly lower in thriceweekly HD patients compared to the twice-weekly HD patients and significantly lower in twice-weekly HD patients compared to the non-dialytic CKD5 patients. Besides, it is suggested that long-duration dialysis might improve menstrual disorders in such patients as prolactin, LH levels gradually decreased with longer duration of dialysis. J Bangladesh Coll Phys Surg 2022; 40: 45-51

Menstrual cycle among adolescents: girls’ awareness and influence of age at menarche and overweight

Objective: To characterize the menstrual cycle (regularity and menstrual flow length), the prevalence of dysmenorrhea and self-monitoring of the cycle in students from Lisbon region, and explore the effect of chronological age, age at menarche and body mass index (BMI) on menstrual disorders. Methods: This is a cross-sectional study with 848 girls aged 12–18 years. A questionnaire about the sociodemographic context and characteristics of the menstrual cycle, and weight and height measures were assessed. BMI was classified according to International Obesity Taskforce criteria. A descriptive analysis of the variables was made, and Odds Ratios (ORs) and 95% confidence intervals (95%CIs) were determined. Results: Mean age at menarche was 12.4 years and mean BMI was 22.0kg/m2. Among adolescents, 59% have regular menstrual cycle, 83% have menstrual flow length of ≤6 days. 88% suffered from dysmenorrhea, among which 8,7% declare absenteeism from school and 49% took pain medication, and 65% self-monitor their menstrual cycle. Higher maternal education was associated with a higher self-monitoring of menstrual cycle among the sample (OR 1.60; 95%CI 1.15–2.17). Girls with menarche <12 years-of-age are more likely to have menstrual flow length of >6 days (OR 1.73; 95%CI 1.19–2.51) and dysmenorrhea (OR 1.87; 95%CI 1.11–3.16) than those with menarche ≥12 years-of-age. No significant association between BMI and menstrual cycle variables was observed. Conclusions: The results suggest that menstrual disorders are frequent and may be associated with early menarche, but not with BMI. It is important to encourage self-monitoring of the menstrual cycle to detect menstrual disorders timely and promote health and well-being.

Knowledge and experiences of abortion among adolescent girls in Asia: a scoping review from 2010 to 2020

It has been estimated that 5.6 million abortions occur each year among adolescent girls aged 15 - 19 years, of which 3.9 million are unsafe. The situation in Asia is particularly complicated compared to other regions due to the distinction in socio-cultural characteristics. This study aimed to describe abortion knowledge and experiences of adolescent girls in Asian countries in the period 2010 - 2020. Among 22 included publications, 41% of the studies were conducted in South-East Asia. The percentage of girls lacked knowledge and had improper perceptions of abortion could be as high as 95.7%. Common reasons for abortion were health conditions and socio-economic pressures, such as poverty and the need to maintain social self-sufficiency. Medical and surgical abortion was common, and while many girls went to hospitals and legitimate health providers, some did it themselves or went to clandestine abortion. Physical complications included menstrual disorders, pain, fever, vaginal bleeding or even septic shock, while feeling guilty and stressed was flagged as emotional consequences. To improve the situation of teenage abortion in Asia, adolescents should be provided with adequate knowledge on abortion laws and care, parents should be more open to this issue and governments should consider permitting legal abortion among adolescents.

A Case Study on Ayurvedic Management in PCOS

Female reproductive system consists of hypothalamo-pituitary-ovarian axis and intact uterine-adnexa which maintains a complex mechanism. In human body all the systems are interrelated to function properly; any imbalance in one system may cause multisystem pathogenesis. Polycystic ovarian syndrome (PCOS) is a common endocrinopathy, which is multifactorial and polygenic condition, manifested as oligoovulation or anovulation, signs of hyperandrogenism and multiple small ovarian cysts. Signs and symptoms vary within individual’s overtime. This adversely affect the reproductive system by menstrual disorders, infertility, obesity, depression, sleep apnea, insulin resistance and in due course may result in diabetes mellitus, endometrial cancer, cardiovascular disease etc. According to Ayurveda PCOS is a disorder which involves the three Doshas, Dhathus like Rasa, Raktha and Medas. The Srothas involved in this condition are Rasa, Rakta and Arthava vaha which eventually manifests features such as Anarthava (amenorrhea), Vandhyathwa, Pushpagni, Abeeja rtuchakra (anovular bleeding). Here is a case report of 19 year old girl who presented with irregular menstruation, rapid weight gain and hair loss. On USG she was detected to have bilateral PCO pattern. Based on the clinical features, treatment principles adopted were Aamapachana, Vata anulomana, Kaphapittahara and Arthava janana. After 2 months of internal medications, symptoms reduced markedly and menstruation was normal. Adherence to Ayurvedic principles is found to be helpful in PCOS for a healthy and fruitful life.

MENSTRUAL HYGIENE AND COMMON ADOLESCENT GYNECOLOGICAL PROBLEMS - A BIRD’S EYE VIEW

Menstrual disorders are a common problem in adolescents the world over. Though the onset of menstruation is part of the normal maturation process, Menstrual disorders form the commonest gynecological complaint (45-58 %) among adolescents. The series of natural changes occurring to the uterus and body starting from the first day(1) of periods until the day before next periods can be called as menstrual cycle. It consists of “menstruation” in which inner layers of uterus sheds along with blood, and “ovulation” in which the ovum is released from the ovary. Men- strual hygiene deals with special healthcare needs and requirements of women during monthly menstruation or menstrual cycle. Unhygienic menstruation is the prime cause of menstrual diseases. Abnormalities in menstrual cycle are increased or decreased menstrual flow and increased or decreased intervals between two menstrual cycles. Menstrual abnormalities are common pathological problems associated with women of puberty age, which is en- hanced by disturbed dietary and daily regimens. It requires early attention and interventions to protect them from having undesired health events in the future. In addition to this appropriate Ayurveda medicines are required to bring the body in a balanced state. Here an attempt is made to compile the ideas of Acharya about menstrual health problems for their proper understanding and treatment through Ayurveda- the science which survived the time. Keywords: Normal menstruation, Menstrual hygiene, Adolescent girls, Menstrual disorders, Treatment and pre- vention, Ayurveda, Ritu

Association between serum 25-hydroxy vitamin D level and menstrual cycle length and regularity: A cross-sectional observational study

Background: Research examining the role of vitamin D deficiency and the development of menstrual disorders in women is of widespread interest. Studies have been published showing that supplementation with high-dose vitamin D can lead to the restoration of the menstrual cycle. We lack adequate information regarding the effect of vitamin D levels on the physiology of menstruation and further on fertility in women of reproductive age due to the contradictory results reported by studies. Objective: To study the association of 25-hydroxy vitamin D with menstrual cycle characteristics including long and short cycle length and cycle irregularity. Materials and Methods: In this cross-sectional study, serum vitamin D levels of 166 women attending an outpatient department with menstrual irregularities after excluding all obvious causes of menstrual disorders (n = 83) between April-June 2019 were measured and were compared with women of similar profiles with complaints other than menstrual irregularities (n = 83). Results: A decreased level of vitamin D was associated with a 13.3 times odds of an irregular cycle (OR (95% CI): 13.30 (5.79-30.60), p < 0.001). 25-hydroxy vitamin D was not associated with age or body mass index. We found a significant difference (p < 0.001) in mean vitamin D levels among the females with irregular cycles vs. regular cycles. Conclusion: Vitamin D plays a role in the physiology of reproduction specific to the menstrual cycle and ovulation. Long-term prospective studies assessing the exact cutoff value and the exact dose of supplementation required are needed. Key words: Menstrual disturbances, Ovulation, Reproductive period, Vitamin D deficiency, Dietary supplements, Polycystic ovarian syndrome.

Association of Menstrual Problems and Psycological Stress in Young Medical Students

Aim: To see if there was a link between menstruation issues and psychological stress among young medical students. Methods: A non-probability convenient sampling method was used to conduct an observational (cross-sectional) study on a sample of 180 university-bound students. Students were assessed for menstrual regularity associating with psychological stress by using Perceived Stress Scale in different universities of Lahore. Results: The study included approximately 92% of females with a regular menstrual cycle and 8% of females with an irregular menstrual cycle.While among irregular menstrual cycles, 5 had high levels of stress, 7 had moderate levels of stress, and 3 had mild levels of stress. The normal menstrual cycle group had 40 females with high levels of stress, 121 females with moderate levels of stress, and four females with low levels of stress. Conclusion: Although fewer students suffered from menstruation difficulties, the majority of them, including those who did not, experienced psychological stress. Keywords: Menstrual disorders, dysmenorrheal, abnormal menstrual cycle, stress

Effect of Wenshentiaojing Decoction on Hormone Level and Follicular Number in Patients with Menstrual Disorder of Polycystic Ovary Syndrome

Objective. To explore the curative effect of Wenshentiaojing Decoction on the treatment of menstrual disorder caused by PCOS. Methods. Patients with menstrual disorders caused by PCOS admitted to our department from January 2020 to January 2021 were selected as the research objects and were divided into a control group and observation group according to the random number table method. The control group was treated with Western medicine, and the observation group was treated with Wenshentiaojing Decoction on the basis of Western medicine. The clinical efficacy of the two groups was compared. Before and after treatment, sex hormones (LH, FSH, LH/FSH, and testosterone (T)), ovarian volume, endometrial thickness, cervical mucus score, follicular number, menstrual conditions (menstrual duration, menstrual cycle, and menstrual volume), and other indicators in both groups were recorded. Results. After treatment, the total effective rate of the observation group (91.1% (41/45)) was higher than that of the control group (77.8% (35/45)), and the difference was statistically significant ( P < 0.05 ). After treatment, the LH, LH/FSH, and T levels in the observation group were lower than those in the control group, while the FSH level was higher than that in the control group ( P < 0.05 ). After treatment, the ovarian volume, endometrial thickness, cervical mucus score, and follicle number in the observation group were higher than those in the control group ( P < 0.05 ). After treatment, the menstrual duration and menstrual volume in the observation group were longer than those in the conventional group, and the menstrual cycle was shorter than that in the conventional group ( P < 0.05 ). Conclusion. For patients with menstrual disorders caused by PCOS, the treatment effect of Wenshentiaojing Decoction assisted with Western medicine is better, which can effectively improve the level of sex hormones, cervical mucus, and menstrual conditions, increase the ovarian volume, endometrial thickness, and follicle number, and improve the treatment effect, with fewer adverse reactions, which is worthy of further promotion and application.