THE MENSTRUAL PATTERN OF AUB IN PERIMENOPAUSE

Background: The Menstrual pattern of AUB in perimenopause. Methods: Prospective interventional study conducted at Kamla Nehru Hospital for State Mother and Child, IGMC Shimla. Results: Menorrhagia was the most common presentation of AUB patients accounting for 65.5% of cases with confidence interval of 58.96-71.64% followed by continuous bleeding per vagina(BPV) accounting for 17.9% with confidence interval of 13.17-23.49% with the least being oligomenorrhea 0.87% with confidence interval of 0.11-3.12%. Conclusion: Abnormal uterine bleeding in perimenopausal patients is a common and important part of clinical practice for health-care providers of women. Keywords: AUB, Menstrual pattern, Bleeding

Assessment of age at menarche and menstrual pattern among secondary school girls in Awka, Southeast Nigeria

Background: Menarche is an important physiological milestone in girls and this usually occurs during their secondary school years. The menstrual pattern may vary in these adolescents. This knowledge may assist in counselling the young girls on reproductive health issues.Methods: A cross-sectional study of female secondary school students from Kenneth Dike secondary school, Awka; Amaenyi girls’ secondary school and community secondary school, Okpuno, all in Awka, Anambra state of Nigeria. All together 545 students were selected following informed consent. The study instrument was a pre-tested, semi-structured and self-administered questionnaire. Data analysis was done with IBM SPSS 20 software. Tests of association between variables were done with Fisher’s exact test and the level of significance set at p≤0.05. Results: The mean age of the 545 respondents was 16.79±1.736 years and majority of them are of the Igbo ethnic group (90.5%). The average age at menarche was 12.77±1.159 years. There is a significant difference between the age at menarche and the father’s occupation. The modal duration of flow was 4 days (48.7%) while 95.2% had a normal cycle length of 21-35 days.Conclusions: The average age of menarche of secondary school girls in Awka was 12.77±1.159 years. Most of the students had normal menstrual flow duration of 2-7 days with a cycle length of 21-35 days.

Levonorgestrel intrauterine system in menorrhagia-an effective and acceptable alternative

Background: To study the efficacy, performance and acceptability of levonorgestrel intrauterine device (LNG-IUS) in treatment of women with menorrhagia.Methods: This was a descriptive, prospective and observational study conducted over a period of January 2015 to September 2020. Seventy-five (75) women presented with heavy menstrual bleeding having no contraindication for device underwent LNG-IUS insertion after consent. Menstrual pattern, pictorial blood loss assessment chart score (PBAC), rate of acceptability and satisfaction were recorded at 3 months, 6 months, 1, 2 and 3 years after insertion of LNG-IUS.Results: The most common bleeding pattern at 3 month post-insertion was inter-menstrual spotting followed by infrequent menses, oligomenorrhea and amenorrhea. LNG-IUS caused 45.19% reduction in menstrual blood loss (MBL) at 3 months, 81.48% at 1 year, 91.85% at 2 years and 97% at 3 years. Hemoglobin levels improved from mean baseline 8.9 mg/l to 12.8 mg/l at 3 years. Majority of women were satisfied with this minimally-invasive treatment with continuation rate of 94.66%. No major side-effects were noted.Conclusions: LNG-IUS is an excellent minimal invasive, highly effective in controlling blood loss and well-tolerated alternative for women with menorrhagia. Its fertility-sparing property makes it an emerging option for young women.

Decision Tree Model Predicts Live Birth after Surgery for Moderate-to-Severe Intrauterine Adhesions

Background: After treatment of intrauterine adhesions, the rate of re-adhesion is high and the pregnancy outcome unpredictable and unsatisfactory. This study established and verified a decision tree predictive model of live birth in patients after surgery for moderate-to-severe intrauterine adhesions (IUAs).Methods: A retrospective observational study initially comprised 394 patients with moderate-to-severe IUAs diagnosed via hysteroscopy. The patients underwent hysteroscopic adhesiolysis from January 2013 to January 2017, in a university-affiliated hospital. Follow-ups to determine the rate of live birth were conducted by telephone for at least the first postoperative year. A classification and regression tree algorithm was applied to establish a decision tree model of live birth after surgery.Results: Within the final population of 374 patients, the total live birth rate after treatment was 29.7%. The accuracy of the model was 83.8%, and the area under the receiver operating characteristic curve (AUC) was 0.870 (95% CI 7.699-0.989). The root node variable was postoperative menstrual pattern. The predictive accuracy of the multivariate logistic regression model was 70.3%, and the AUC was 0.835 (95% CI 0.667-0.962).Conclusions: The decision tree predictive model is useful for predicting live birth after surgery for IUAs; postoperative menstrual pattern is a key factor in the model. This model will help clinicians make appropriate clinical decisions during patient consultations.

Menstrual Pattern and Characteristics of One-Rod and Two-Rod Levonorgestrel Implant Users

Introduction. The maternal mortality ratio (MMR) in Indonesia reaches 359 per 100,000 live births. The long-acting reversible contraceptive (LARC) method is an effective contraceptive choice for reducing MMR. The contraceptive implant is one of the LARCs that has low usage due to lack of education about the side effects. This study aims to compare the menstrual pattern and characteristics between one-rod and two-rod levonorgestrel implant users. Methods. A prospective cohort study was performed in patients at Cipto Mangunkusumo Hospital (RSCM) from March 2016 to May 2018. Subject recruitment was done by consecutive sampling. This study was conducted from March 2016 until May 2019. Statistical analysis was performed on the data using the chi-square test to determine the relationship between menstrual pattern and characteristics, and the use of one-rod or two-rod levonorgestrel implants. Results. A total of 140 subjects participated in the study, comprising 70 (50%) one-rod users and 70 (50%) two-rod users. In the first month, 32.9% one-rod users experienced amenorrhea, 22.9% experienced shortened menstrual period, 30% experienced normal menstrual period, and 14,2 % experienced lengthened menstrual period. In comparison, in the first month, 41.4% two-rod users experienced amenorrhea, 15.7% experienced shortened menstrual period, 32.9% experienced normal menstrual period, and 10% experienced lengthened menstrual period. There was no significant difference in menstrual patterns and characteristics between one-rod and two-rod levonorgestrel implant users. Conclusion. There was no significant difference in menstrual patterns and characteristics between one-rod and two-rod levonorgestrel implant users. Implications. Menstrual patterns and characteristics from levonorgestrel implants user can help clinicians to reduce discontinuation rate from the acceptors. Further research should be conducted to know other side effects aside from menstrual bleeding patterns.

Study of menstrual pattern changes in patients accepting injection depo-medroxyprogesterone acetate versus levonorgestrel intrauterine system

Background: Changes in menstrual bleeding patterns are a major cause of hormonal contraceptive discontinuation. DMPA and LNG IUS both are hormonal contraceptives and are used by most of the women worldwide for various gynaecological conditions. The aim of the present study was to compare menstrual pattern changes in patients accepting injection DMPA and LNG-IUS for various gynaecological indications.Methods: This randomized controlled trial was conducted among 70 women aged 18 years or older with heavy menstrual bleeding in the department of Obstetrics and Gynaecology, Chhatrapati Shivaji Subharti Medical College, Meerut. The study comprised of two groups having 35 patients each i.e. Group 1 (patient who opted for LNG IUS) and Group 2 (patient who opted injection DMPA). The menstrual pattern changes were assessed at 1month, 3month and 6th month interval. Patient were asked to maintain a menstrual calendar wherein she would keep a record of the no. of days along with dates when she has spotting per vaginum/bleeding per vaginum and the amount of blood loss explained to her through the pictorial blood assessment chart.Results: Reduction in median menstrual blood loss was significantly greater in the LNG IUS group (-128.12mL, range -393.6 to 328.5 mL) than in the DMPA group arm -17.8 mL, range -271.5 to+78.6 mL, p<0.001).Conclusions: LNG IUS reduces menstrual blood loss more effectively than DMPA.