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

Effect of Uterine Arterial Chemoembolization Combined with Ultrasound-Guided Uterine Curettage on Cervical Pregnancy and Influencing Factors

This is a retrospective study to analyze the efficacy of uterine artery chemoembolization (UACE) combined with ultrasound-guided curettage in the treatment of cervical pregnancy and the factors affecting the postoperative outcome. A total of 26 subjects were included in the study and were divided into a control group of 12 and an observer group of 14, all patients with cervical pregnancy diagnosed in our hospital from January 2016 to January 2020. Patients in the control group were treated with methotrexate injection (MTX) combined with ultrasound-guided curettage in our hospital, while the observer group was treated with UACE combined with ultrasound-guided curettage. The efficacy of the two groups was evaluated at 3 months postoperatively, and data on patients’ age, days of menopause, pregnancy frequency, and vaginal bleeding were collected retrospectively. Intraoperative bleeding, time to recovery of serum human chorionic gonadotropin (HCG), hospitalization time, time to return to normal menstruation, time to disappearance of gestational sac, pregnancy frequency, presence of endometrial inflammation, gestational week, maximum diameter of gestational sac, thinnest myometrium, endogenous-exogenous type, gestational sac size, and HCG level were recorded in both groups. Single-factor analysis and multifactor logistic regression models were used to analyze the factors influencing the surgical outcomes of patients. The results of the study showed that the overall efficiency of the observer group was significantly higher than that of the control group, while intraoperative bleeding, hospital stay, time to return to normal menstruation, and time to disappearance of the gestational sac were all lower than those of the control group ( p < 0.05 ). The results of univariate and multifactorial analyses showed that endometrial inflammation, gestational week, maximum diameter of the gestational sac, thinnest myometrium, and endogenous-exogenous type could affect the patients’ postoperative recovery ( p < 0.05 ); gestational week, maximum diameter of the gestational sac, and thinnest myometrium were independent factors affecting the patients’ postoperative recovery ( p < 0.05 ). The above results suggest that UACE combined with ultrasound-guided uterine clearance for cervical pregnancy can significantly improve treatment efficacy, reduce intraoperative bleeding, and improve recovery time from postoperative related symptoms. The treatment efficacy of patients with cervical pregnancy was related to the gestational week, the maximum diameter of the gestational sac, and the thinnest muscle layer.

Risk of Low Energy Availability among Female and Male Elite Runners Competing at the 26th European Cross-Country Championships

Low energy availability (LEA) causes impaired physiological functioning. Cross-country running is a weight-sensitive sport, making athletes more prone to LEA. We aimed to estimate the prevalence of elite European cross-country athletes at risk of LEA using the LEA in Females Questionnaire (LEAF-Q) and to analyze demographic and physical characteristics that are associated with LEA. Athletes ≥ 18 years competing at the 26th European Cross-Country Championships (n = 602) were invited to complete a questionnaire (sociodemographic, training, anthropometric characteristics, and LEAF-Q). A total of 207 valid surveys were collected (83 females, 22.1 (4.0) years, and 124 males, 22.3 (4.1) years), and 16 surveys were excluded. A high prevalence of athletes at risk of LEA (64.3%) was observed, being higher in females than in males (79.5 and 54.0% respectively, p < 0.001). More than half of athletes (54.1%, n = 112) reported bowel movements once a week or more rarely, while 33 female athletes (41.3%) did not report normal menstruation. Overall, cross-country athletes are at high risk of LEA. Moreover, a high prevalence of gastrointestinal and menstrual impairments was reported. Hence, athletes should be followed by multidisciplinary teams to inform, prevent, and treat LEA and its effects.

Pengaruh konsumsi susu kedelai terhadap amenorhoe sekunder pada remaja putri periode late adolescence di Dayah Insan Qur’ani Aceh Besar

Secondary amenorrhea is a menstrual cycle that occurs in women who have menstruated but does not increase menstruation within 3-6 months. The key to the menstrual cycle depends on changes in estrogen levels. Soybeans are the main source of phytoestrogens which play a role in stabilizing estrogen levels in the body, whereas 250 ml of soy milk contains 40 mg of phytoestrogens. The purpose of this study was to determine how to consume soy milk against changes in secondary amenorrhea in young women. This research is a descriptive-analytic conducted cross-sectionally. This type of research is an easy experiment with a non-randomized posttest group design. The research sample is young women who change secondary amenorrhea which is grouped into 2 groups of 17 people each. Data collection was conducted from August 2 to October 19, 2016. The statistical test used was the Wilcoxon test. The results showed that normal menstruation occurs in secondary amenorrhea adolescents after being given soy milk which is equal to 82.4% while in adolescents who are given sweetened condensed milk only by 29,4%. Statistical tests show the results of p= 0,002. The conclusion, there is a change in secondary amenorrhea between the samples gave soy milk, and those given sweetened condensed milk. Suggestions, it is necessary to provide a daily menu for students so that the menstrual cycle is maintained.

UNANI PERSPECTIVE OF OLIGOMENORRHOEA: AN UPDATED LITERARY RESEARCH

Infrequent and scanty menstruation is a common problem in women belonging to reproductive age group. Oligomenorrhoea affects 6-18% of women of reproductive age and is mostly managed by hormone therapy which has got its own side effects. One of the most influential Iranian physician, Avicenna (980-1037 A.D.) in his famous book, Canon of medicine, describes oligomenorrhoea under the title of ihtibas-i-tamth. According to USM, normal menstruation is an indicator of healthy normal reproductive organs. One of the main function of the uterus is to excrete the khūn-i-hayd (menstrual blood) which should be normal in amount and duration. Any kind of imbalance between quwwat-i-masika (retentive faculty) and quwwat-i-dafi‘a (expulsive faculty) of rahim (uterus) causes menstrual irregularities. It is caused by domination of khilt balgham (phlegm) which increases the viscosity of blood. Majoosi stated the cause of qillat-i-tamth is su’i-mizāj bārid of rahim (cold temperament of uterus) and siman mufrit (obesity). Unani physicians have given a line of management based on correction of temperament, menstrual regulation by regimental therapies and emmenagogue drugs.

Laparoscopic combined with hysteroscopic repair or operative hysteroscopy in the treatment of symptomatic cesarean-induced diverticulum

Objective: The postmenstrual bleeding with cesarean-induced diverticulum is a bothersome symptom and can be confused with other abnormal-uterine bleeding disease. The aim of the present study was to evaluate the efficacy and safety of laparoscopic combined with hysteroscopic repair vs operative hysteroscopy in treatment of symptomatic cesarean-induced diverticulum. Methods: Eighty-two women with cesarean-induced diverticulum who underwent either laparoscopic combined with hysteroscopic repair or operative hysteroscopy between January 2012 and September 2015 were retrospectively included in the study. We evaluated the menstrual duration before and after the surgery, the width, length and depth of the niche, operating time, blood loss, complications, and postoperative pregnancy status. Results: 62.2% (51/82) patients started to have postmenstrual bleeding immediately when they gained regular menstruation after their cesarean section. The laparoscopic group has longer operative time and greater blood loss (p<0.001). Both groups have a significant improvement in their menstruation duration ( p< 0.001). The patients in the laparoscopic repair group had a greater improvement in bringing the uterine bleeding into normal menstruation duration (P=0.046) and the same in pregnancy rate (P=0.505). The interval between operation and pregnancy in laparoscopic combined with hysteroscopic group was much longer than the hysteroscopic group (27 vs 10 months, p<0.001). Conclusion: the laparoscopic repair exhibited a better efficiency in bringing the uterine bleeding into normal menstruation duration and in improving the pregnancy rate However, there was not a clear absolute advantage for one of the two type of surgeries. Thus, patients with post-cesarean section diverticulum (PCSD) should choose with caution the type of surgery, considering the residual myometrial thickness (RMT), the age, the desire for further fertility and ovarian reserve capacity.

Hubungan Asupan Zat Gizi Dan Status Gizi Terhadap Kejadian Menstruasi Dini Pada Siswi SMPN 1 Kabaena Timur

Early menstruation in adolescents can be influenced by nutritional status and nutrients consumed by teenagers. This studyaims to determine the relationship of nutrient intake and nutritional status on the incidence of early menstruation at SMPN 1East Kabaena. This research is descriptive analytic with Cross Sectional Study. The population in this study were allstudents of SMPN 1 East Kabaena as many as 94 people. Sampling technique was purposive sampling. Data were obtainedusing a questionnaire and anthropometric measurements. Data were analyzed by using Chi-square test. Results show thatfrom 42 adolescents who consumed enough energy, there were 25 people (59.5%) experienced early menstruation, andfrom 38 adolescents who consumed less protein, there were 29 people (76.3%) experienced early menstruation. While the33 adolescents who consumed less fat, there were 25 people (75.8%) experienced early menstruation, and of 37 teenagerswho consumed more carbohydrates, there were 24 people (64.9%) had normal menstruation, while from 37 teenagers whohad over-nutrition status, there were 24 people (60.0%) had normal menstruation. The results show that there is arelationship between nutritional intake and nutritional status with the incidence of early menstruation in female students atSMPN 1 East Kabaena.

Preliminary study on the changes of ovarian reserve, menstruation, and lymphocyte subpopulation in systemic lupus erythematosus (SLE) patients of childbearing age

Objective The main aim of this study was to investigate the ovarian reserve, menstruation, and lymphocyte subpopulation in systemic lupus erythematosus (SLE) patients of childbearing age. Methods We enrolled 40 SLE patients of childbearing age and 40 age-matched healthy controls. Anti-Müllerian hormone (AMH) was tested by electrochemiluminescence, and lymphocyte subsets were tested by flow cytometry. Menstruation situation was obtained by interview. Results The AMH level of the SLE group was significantly lower than that of the control group ( p < 0.001), which was negatively correlated with erythrocyte sedimentation rate (ESR ( r = −0.316, p = 0.047)) and disease activity (SLEDAI ( r = −0.338, p = 0.033)). The AMH concentration of SLE patients with normal menstruation was higher than those with abnormal menstruation ( p < 0.001). The percentages of CD4+ T lymphocytes and NK (natural killer) cells in the SLE group were significantly lower than those in the control group ( p < 0.001). However, the percentages of B cells and CD8+ T lymphocytes in the SLE group were higher than those in the control group ( p < 0.05). Conclusion Decreased AMH and high incidence of abnormal menstruation indicated that autoimmunity activities of SLE can impair the ovarian reserve of female patients. Lymphocytes in SLE patients were in a state of disorder.

Management of refractory atonic post partum hemorrhage by upper segment compression suture

Aims: The study was undertaken to test the efficacy of Upper Segment Compression Suture(USC Suture) for the control of atonic post partum hemorrhage unresponsive to medical treatment. Study Design: Observational study. Duration:: From March 1998 to March 2003. Setting: Department of Obstetrics & Gynaecology, Lahore General Hospital , Post Graduate Medical Institute, Lahore, Pakistan. Subjects: Fourteen women with atonic PPH refractory to medical treatment. Results:: Fourteen women with severe atonic PPH were managed using uterine massage and utero tonic drugs. Failing these measures, Upper Segment compression suture was used as first line conservative surgical technique. There was no relaparotomy for recurrent PPH. All cases were managed successfully avoiding hysterectomy or other complex surgical procedures. Recovery in all cases was uneventful.Long term follow up was available in four cases. All were having normal menstruation. Two o f them achieved spontaneous pregnancies. Conclusion:: Upper Segment Compression Suture is an effective technique for managing refractory PPH caused by uterine atony.