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Concept: Menstruation

152

Yoga classes designed for women with premenstrual syndrome are available, but their efficacy is unclear. We investigated the effects of 12 weeks' yoga exercise (yoga intervention) on premenstrual symptoms in menstruating females in Taiwan. Sixty-four subjects completed the yoga intervention, and before and after the intervention filled out a structured self-report questionnaire about their demographics, personal lifestyle, menstrual status, baseline menstrual pain scores, premenstrual symptoms, and health-related quality of life. Of 64 subjects, 90.6% reported experiencing menstrual pain during menstruation. After the yoga intervention, subjects reported decreased use of analgesics during menstruation (p = 0.0290) and decreased moderate or severe effects of menstrual pain on work (p = 0.0011). The yoga exercise intervention was associated with the improvement of the scale of physical function (p = 0.0340) and bodily pain (p = 0.0087) of the SF-36, and significantly decreased abdominal swelling (p = 0.0011), breast tenderness (p = 0.0348), abdominal cramps (p = 0.0016), and cold sweats (p = 0.0143). Menstrual pain mitigation after yoga exercise correlated with improvement in six scales of the SF-36 (physical function, bodily pain, general health perception, vitality/energy, social function, mental health). Employers can educate female employees about the benefits of regular exercise such as yoga, which may decrease premenstrual distress and improve female employee health.

Concepts: Effectiveness, Exercise, Pain, Menstrual cycle, Employment, Menstruation, Menorrhagia, Premenstrual syndrome

106

Perimenopausal period refers to the interval when women’s menstrual cycles become irregular and is characterized by an increased risk of depression. Use of homeopathy to treat depression is widespread but there is a lack of clinical trials about its efficacy in depression in peri- and postmenopausal women. The aim of this study was to assess efficacy and safety of individualized homeopathic treatment versus placebo and fluoxetine versus placebo in peri- and postmenopausal women with moderate to severe depression.

Concepts: Menopause, Estrogen, Menstrual cycle, Placebo, Endometrium, Menstruation, Homeopathy, Menarche

70

Poor menstrual knowledge and access to sanitary products have been proposed as barriers to menstrual health and school attendance. In response, interventions targeting these needs have seen increasing implementation in public and private sectors. However, there has been limited assessment of their effectiveness.

Concepts: Poverty, Menstrual cycle, Cycle of poverty, Menstruation, Teacher, Sanitary napkin

51

Primary dysmenorrhea is common among women of reproductive age. Non-steroidal anti-inflammatory drugs and oral contraceptives are effective treatments, although the failure rate is around 20-25%. Therefore additional evidence-based treatments are needed. In recent years, the use of smartphone applications (apps) has increased rapidly and may support individuals in self-management strategies.

Concepts: Combined oral contraceptive pill, Non-steroidal anti-inflammatory drug, Anti-inflammatory, Paracetamol, Menstrual cycle, Acupuncture, Menstruation, Dysmenorrhea

33

To identify the prevalence and impact of heavy menstrual bleeding (HMB) in exercising females where anemia may have a significant effect on training and performance a ‘Female Health Questionnaire’ was designed incorporating a validated diagnostic HMB series, demographics, exercise ability data, training status, anemia, iron supplementation and whether the menstrual cycle had affected training and performance. The survey was conducted in two stages; initially online, advertised via social media, and then repeated via face-to-face interviews with runners registered for the 2015 London Marathon. 789 participants responded to the online survey, and 1073 completed the survey at the marathon. HMB was reported by half of those online (54%), and by more than a third of the marathon runners (36%). Surprisingly, HMB was also prevalent amongst elite athletes (37%). Overall, 32% of exercising females reported a history of anemia, and 50% had previously supplemented with iron. Only a minority (22%) had sought medical advice. HMB is highly prevalent in exercising females, associated with self-reported anemia, increased use of iron supplementation and a perceived negative impact on performance. Further research is needed to investigate the impact of HMB, iron deficiency and anemia in exercising females.

Concepts: Menstrual cycle, Ovum, Menstruation, Iron supplements, Menorrhagia

27

Objectives:Deep infiltrating endometriosis (DIE) represents the most complex form of endometriosis and its treatment is still challenging. The coexistence of DIE with other appearances of endometriosis stimulates new studies to improve the preoperative diagnosis. Adenomyosis is a clinical form that shares several symptoms with DIE. The present study investigated the possible presence of adenomyosis in a group of women with DIE and its impact on pre- and postoperative symptoms.Materials and Methods:A group of women (n = 121) undergoing laparoscopic treatment for DIE were enrolled. Clinical and ultrasound evaluations were performed as preoperative assessment. The ultrasonographical appearances of DIE and of adenomyosis were recorded by 2-dimensional ultrasound. The following symptoms were considered: dysmenorrhea, dyspareunia, abnormal uterine bleeding, bowel, and urinary symptoms. Pain was evaluated by the visual analog scale system and menstrual bleeding was assessed by the use of the pictorial blood assessment chart. In a subgroup of women (n = 55), a follow-up evaluation (3-6 months after surgery) was done.Results:A relevant number of patients with DIE showed adenomyosis (n = 59; 48.7%); in this group, dysmenorrhea (P = .0019), dyspareunia (P = .0004), and abnormal uterine bleeding (P < .001) were statistically higher than that in the group with only DIE. After surgery, painful symptoms improved in the whole group but remained significantly higher (P < .001) in the group with adenomyosis.Conclusions:Deep infiltrating endometriosis is frequently associated with adenomyosis, significantly affecting pre- and postoperative symptoms and thus influencing the follow-up management.

Concepts: Combined oral contraceptive pill, Menopause, Menstrual cycle, Endometrium, Menstruation, Endometriosis, Adenomyosis, Menorrhagia

27

The human uterus is composed of the endometrial lining and the myometrium. The endometrium, in particular the functionalis layer, regenerates and regresses with each menstrual cycle under hormonal control. A mouse xenograft model has been developed in which the functional changes of the endometrium are reproduced. The myometrium possesses similar plasticity, critical to permit the changes connected with uterine expansion and involution associated with pregnancy. Regeneration and remodeling in the uterus are likely achieved through endometrial and myometrial stem cell systems. Putative stem/progenitor cells in humans and rodents recently have been identified, isolated and characterized. Their roles in endometrial physiology and pathophysiology are presently under study. These stem/progenitor cells ultimately may provide a novel means by which to produce tissues and organs in vitro and in vivo.

Concepts: Pregnancy, Embryo, Uterus, Menopause, Menstrual cycle, Endometrium, Menstruation, Myometrium

25

Menstruation is the genital sign of systemic endocrine events. Heterogeneity of perimenstrual symptoms is associated with levels of inflammation, triggered by the fall of estrogens at genital and systemic level. Aim of the review is to concisely analyze the evidence on: 1) genital and systemic endocrine and inflammatory events associated with periods and perimenstrual symptoms; 2) rationale of intervention to reduce their intensity and impact on women’s lives. This review of the literature, selected with a clinical perspective, supports the inflammatory basis of the menstrual event, triggered by the estrogens' and progesterone' fall. Moreover, the review analyzes the endocrine and inflammatory basis of perimenstrual pelvic and extrapelvic symptoms such as: menstrual pain, menstrual irregularities, premenstrual syndrome, gastrointestinal symptoms, catamenial headache, depression, perimenstrual myalgia, joint pain, allergies and asthma, heavy menstrual bleeding, associated ironless anemia, brain and behavioral consequences. Inflammation, with increase of cytokines and other markers, is modulated by the degranulation of mast cells at the basal level of the endometrium, in the blood, in all the organs where mast-cell are already activated from local pathologies and within the brain. The shift of inflammation from physiological to a pathologic intensity increases the severity of perimenstrual symptoms. Symptoms persist, moderately attenuated, also during the hormone free interval (HFI) in contraception. The HFI reduction from seven to two days significantly reduces menstrual inflammation and associated symptoms.

Concepts: Immune system, Combined oral contraceptive pill, Menopause, Menstrual cycle, Endometrium, Progesterone, Menstruation, Premenstrual syndrome

24

Female gynaecologic conditions arising from the endometrium are common and depend on a woman’s age, her menstrual history, and the use of medications such as hormone replacement and tamoxifen. Both benign and malignant conditions affect the endometrium. Benign conditions must be distinguished from malignant and premalignant conditions. The most commonly used imaging modality for evaluating the endometrium is pelvic ultrasound with transabdominal and transvaginal techniques. Additional imaging methods include hysterosonography and magnetic resonance imaging. This pictorial essay will review the normal and abnormal appearance of the endometrium and diagnostic algorithms to evaluate abnormal vaginal bleeding and abnormal endometrial thickness.

Concepts: Medical imaging, Menopause, Magnetic resonance imaging, Menstrual cycle, Endometrium, Ultrasound, Endometrial cancer, Menstruation

22

Introduction Fennel has many medicinal properties and is used in the treatment of dysmenorrhea. Given the widespread use of herbal medicine among women for menstrual problems and considering the fact that there has been no study to date about the effect of fennel on menstrual bleeding and duration of menstrual bleeding through systematic review, the present study was conducted to determine the effect of fennel on the amount (primary outcome) and duration of menstrual bleeding and its side-effects (secondary outcomes). Materials All articles, including Persian and English, with no time limit were searched for in the following databases: Medline (through PubMed), Scopus, EMBASE (through Ovid), Cochrane Library, Web of Sciences, Google Scholar, ProQuest, Clininaltrial.gov, SID, Magiran, Irandoc, and Iranmedex, using MeSH terms, including menstrual bleeding, menstruation, severity of bleeding, hypermenorrhea, menorrhagia, fennel, fennelin, Foeniculum vulgare, dysmenorrhea, and painful menstruation, which were searched separately or in combination. Two authors separately reviewed articles to determine the inclusion criteria, and any disagreement was resolved by reaching consensus with a third person. Results A total of 7993 articles were identified through searching the databases, of which 7327 were excluded as duplicates and 666 were screened for inclusion. Six hundread and forty six were excluded by title and abstract based on not being relevant to the review and being conducted on animals. Eventually, six articles were included in the study and four articles entered into the meta-analysis. The results from meta-analysis showed that using fennel caused a significant increase in mean menstrual bleeding in the first cycle after treatment in the intervention group compared to the control (Std. mean difference: 0.46; 95 % CI: 0.18-0.73; p = 0.001; I2 = 9 %). However, it had no significant effect on menstrual bleeding in the second cycle after treatment (Mean difference: 1.44; 95 % CI:-5.09 to 7.96; p = 0.67; I2 = 0 %). Conclusions The results of meta-analysis of four articles showed that in the first cycle after treatment, use of fennel increased menstrual bleeding in the intervention group compared to the control, but meta-analysis of two articles showed no significant difference between intervention and control groups in the amount of menstrual bleeding in the second cycle after treatment. Given the poor quality of articles, conducting clinical trials to determine the effect of fennel on menstrual bleeding appears necessary.

Concepts: Evidence-based medicine, Statistical significance, Menstrual cycle, MEDLINE, Meta-analysis, Menstruation, Menorrhagia, Fennel