Hormonal contraception in perimenopausal women.

Menstrual Disorders

National Institutes of Health State-of-the-Science Conference Statement: Management of Menopause-Related Symptoms

Breast cancer, menopause, and long-term survivorship: critical issues for the 21st century

Not all women diagnosed with PCOS share the same cardiovascular risk profiles

Incidence of diabetes mellitus is increasing is worldwide. The incidence of obesity is also increasing among the diabetic people. Sexually active obese women are commonly encountered nowadays due to increase in the global burden of obesity and diabetes mellitus Obesity and diabetes mellitus is associated with many health risks and a pregnant obese diabetic woman has health risks not only for herself but also to the foetus she carries. Thus, an effective birth control method is important to reduce pregnancy related complications. Though most of us are aware of management of diabetes and obesity, we may not be aware of the contraceptive usage among premenopausal women and HRT [hormone replacement therapy] use among perimenopausal women. A study was conducted to find the incidence of obese diabetics among the women attending a religious function. Later the study was extended to find the contraceptive use among the obese diabetic women and HRT usage among obese perimenopausal diabetic women. It has been found that 16/84 are prediabetic 25/84 are diabetic and 35/84 are overweight and 22/84 are obese. Follow up study was done to find out what contraceptive method was used by them and their knowledge about the contraceptive use. 77% (n=364) of the sexually active obese women are using contraception, with most of them using hormonal contraception. We are aware that some of the oral contraceptives will aggravate diabetes and obesity. Introduction: There is global increase in diabetes mellitus together with increasing incidence of obesity among women. This increase in obese diabetic women includes increasing numbers of women of a reproductive age whose reproductive health and contraception need careful consideration. We have conducted a study among obese diabetic women and their contraceptive usage. This study explored the level of knowledge, attitude, and practice of contraception usage of the sexually active obese women. Among the respondents (25.6%) were not aware of the best contraceptive for sexually active obese women. It is noted that 32.1% of obese women with underlying medical illness were still on hormonal contraception. The awareness of health risk associated with hormonal contraceptive usage of the amongst the obese diabetic women is less. This study has revealed that there is a lack of education and counselling with regards to safe and appropriate use of contraceptive to the women who need it for family planning. Objective: This study aims to look at the knowledge, attitude and practice (KAP) in the choice of contraceptives among obese and sexually active women. Methods: This study was conducted at Ministry of Health, health facilities and Private General Practitioners’ Clinics inPeninsular Malaysia. A self-designed questionnaire was used to assess KAP of the participants. A total of 473 respondents participated in the survey. Results: 77% (n=364) of the sexually active obese women are using contraceptives. Majority used hormonal contraceptives (n=204, 56%) and barrier method was the preferred method (39%, n=142) among the others. Women with Hypertension and Type II Diabetes Mellitus have the highest rate of using hormonal contraception (51.6%, n=32, 52.6%, n=30) respectively. Both groups have low awareness on the health risk associated with hormonal contraception which was 69% and 83% respectively. Most of the respondents were satisfied with the method of contraception they use, and majority mentioned ‘Easy to take’ as the reason for using it. 32%(n=152) of the respondents have underlying medical illnesses. 24.5% thought that hormonal contraception is the best. 23.5% choose IUCD as the method of choice. Conclusion: In the first part of the study the incidence of diabetes mellitus and obesity among the women was done. In the second part the study explored the level of knowledge, attitude, and practice, of the sexually active obese women based on their sociodemographic data in the choice of the appropriate contraceptive considering their existing medical conditions and sources of procurement. Majority of obese women used non hormonal contraception and almost half of the rest chose hormonal contraception. A quarter of the respondents claimed that hormonal contraception was the best choice. Many obese women with underlying medical illnesses were on hormonal contraception. It is noted that 32.1% of obese women with underlying medical illness were still on hormonal contraception. The awareness amongst the diabetic and hypertensive respondents on health risk associated with hormonal contraceptive used was noted to be poor, being 38.7% and 42.9% respectively. The use of IUCD as the preferred and appropriate choice for those with medical conditions is very discouraging (less than 3%).

BackgroundSerbian women use contraception in general sporadically and numerous women still undergo induced abortions in case of unwanted pregnancy. This study aimed to investigate the frequency and factors associated with the use of hormonal and emergency contraception among women from Belgrade (Serbia) who had induced abortions.MethodsThis cross-sectional study investigated 433 women aged 15 to 55 years who were having induced abortions at the Clinic for Ob/Gyn, University Clinical Center of Serbia from 2022 to 2024. They filled-in an anonymous questionnaire about their socio-demographic data, general medical and gynecological history. They were specifically asked about the use of hormonal and emergency contraception.ResultsJust 17.6% of the investigated women used hormonal contraception, while 29.8% had used the emergency contraception at least once. Use of hormonal contraception was associated with Serbian nationality and being an atheist, having gynecological illnesses, engaging in regular recreation and drinking alcohol. The use of emergency contraception correlated with younger age, being nulliparous, having higher education, not being in a relationship, engaging in regular recreation and drinking alcohol.ConclusionsOur study confirms that Serbian women rarely use hormonal contraception and if they do, it is mostly as therapy for different gynecological illnesses. Younger women with higher education, who are not in committed relationship and who drink alcoholic beverages, are more likely to use emergency contraception even though it is not recommended for regular use. Global strategies and individualized programs for contraception counseling are necessary to increase the use of contraception in Serbia.Key messages• Few women who underwent induced abortion used either hormonal or emergency contraception.• Emergency is more often used than hormonal contraception, particularly among younger, educated and single women.

Although serum ferritin is considered a reliable indicator of iron stores, there are few data documenting the prevalence of low ferritin in representative samples of young women. To estimate the prevalence of low ferritin and to identify factors associated with low ferritin in young Australian women. Women, aged 18-39 years, living in the eastern states of Australia were recruited by email to a cross-sectional, online questionnaire-based study between November 2016 and July 2017. Participants not pregnant, breast feeding, taking hormonal contraception, using assisted reproduction or postmenopausal were invited to provide a blood sample. Of the 3689 invited participants, 761 (23.1%) provided a sample and 736 women, mean (SD) age 31.7 (±5.6) years, were included in the analyses. The overall prevalence of serum ferritin <30 μg/L was 34.8% (95% confidence interval (CI) 31.4-38.3%), with 41.4% (35.1-48.0%) in NSW, 31.5% (26.4-37.1%) in Victoria and 32.6% (26.8-39.0%) in Queensland. Serum ferritin <30 μg/L was positively associated with the reporting of >2 days of heavy menstrual bleeding (adjusted odds ratio (AOR) 1.73, 95% CI 1.15-2.59), living in New South Wales (AOR 1.57, 95% CI 1.07-2.30), not working outside home (AOR 1.58, 95% CI 1.01-2.49), and inversely associated with never experiencing heavy menses (AOR 0.46, 95% CI 0.23-0.93) and obesity (AOR 0.32, 95% CI 0.21-0.50). This study demonstrates that serum ferritin below 30 μg/L is common amongst young Australian women. Healthcare professionals should note the association between low ferritin and heavy bleeding.

Hormonal contraceptives have been used in perimenopausal women to manage a variety of symptoms and prevent unintended pregnancy. However, it is unclear what contraceptive regimen is best for these women. To evaluate hormonal contraceptive methods in women experiencing perimenopause using two prespecified outcomes: perimenopausal symptom management and long-term effects. A literature search of PubMed and EMBASE databases was performed (January 1990 to October 2021) using search terms "perimenopause" and "contraception." Relevant full-text articles in English were included. Fifteen clinical articles were reviewed: Fourteen were internationally based, and one study was conducted in the United States. Nine articles evaluated symptom resolution, and six of these nine reported statistically significant changes in favor of treating perimenopausal women with hormonal contraceptives compared with no treatment. Seven studies evaluated long-term outcomes including bone loss and metabolic parameters, and six of these seven showed statistically significant improvements with hormonal contraceptives. Based on limited data and a lack of comparative studies, the use of a levonorgestrel intrauterine device with supplemental low-dose menopausal estrogen has positive results for the management of disruptive perimenopausal symptoms and long-term outcomes. Hormonal contraception in perimenopausal women improves symptom management and long-term outcomes if patients do not have contraindications. When selecting a contraceptive for women in perimenopause, clinicians and pharmacists need to address specific patient risk factors, symptom profiles, long-term risks and benefits, and patient preferences.

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

Long-term consequences of polycystic ovary syndrome on cardiovascular risk

Genetic counseling and testing for hereditary cancer risk in young adult women: Facilitating autonomy and informed decision making is key

Performance and acceptability of intrauterine release of levonorgestrel with a miniature delivery system for hormonal substitution therapy, contraception and treatment in peri and postmenopausal women

Background: Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss which interferes with a woman's physical, social, emotional, and/or material quality of life. This is the most distressing complication in perimenopausal women which affects the quality of life. Aims: This study aimed to evaluate endometrial thickness (ET) by ultrasound and histopathological examination and their correlation with HMB in perimenopausal women. Materials and Methods: This retrospective analysis was carried out over 1 year. A total of 120 women of 40–55 years' age group who presented with abnormal bleeding pattern were included in the study. These women underwent clinical examination, investigations and ultrasound examination followed by endometrial biopsy. Results: Majority of the women (47.5%) had menstrual disturbance in the age group of 40–45 years followed by 45.8% of women in the age group of 46–50 years. Menorrhagia was the most common complaint found in 65 (54.2%) women, 10 (8.3%) women suffered from metrorrhagia, 18 (15%) had polymenorrhea, and 22 (18.3%) women had amenorrhea followed by heavy bleeding. Proliferative endometrium was found in 90 (75%), secretory endometrium in 8 (6.7%) and simple hyperplasia without atypia in 3 (2.5%) of the women in the study population. Simple hyperplasia with atypia was observed in 2 women (1.7%), 3 women (2.5%) had complex hyperplasia without atypia, and 1 woman (0.83%) had complex hyperplasia with atypia. Endometritis was present in 5 (4.2%) cases and atrophic endometrium was found in 3 (2.5%)cases and atrophic endometrium was found in 2.5% (3). No endometrial biopsy specimen was suggestive of endometrial carcinoma. Simple hyperplasia with atypia was detected when ET was 11–15 mm and 16–20 mm. Complex hyperplasia without atypia was detected with ET >16–20 mm and >20 mm. Only one case had complex hyperplasia with atypia where ET was >20 mm. No abnormal endometrial pathology was detected when ET was below 11 mm. Conclusions: Increased ET on transvaginal ultrasound had association with abnormal endometrial tissue histopathology in women with HMB.

See related article, pp 694–704 Regardless of age, race, and ethnicity, cardiovascular disease is the number 1 cause of death for women, and its prevalence rises rapidly after menopause.1–4 This postmenopausal increase is believed to result from the loss of endogenous estrogen. Although estrogen replacement therapy (ERT) has long been thought to protect against menopause-associated cardiovascular anomalies, osteoporosis, hot flashes, and thinning of the vaginal epithelium,3–5 findings from the Heart and Estrogen/Progestin Replacement Study and the Women's Health Initiative Study5 do not support the notion that ERT protects the cardiovascular system. Instead, the data indicate just the opposite, that is, increased risk of cardiovascular disease, in addition to the apparent higher risk of breast cancer and deep vein thrombosis.1,2,4 Although results from clinical trials have substantiated the beneficial role of ERT in the management of menopausal symptoms, the unexpected finding of exacerbated cardiovascular function after ERT has made women hesitant to initiate ERT after menopause.1 Further analysis of the clinical trials revealed that the age of a woman and especially the number of years after menopause onset may be primary factors that contribute to the ultimate cardiovascular outcome of ERT. Although estrogen-progesterone therapy was found beneficial in young postmenopausal women, it increased cardiovascular risk when initiated in older postmenopausal women with established coronary artery disease.2,4 It is, thus, recommended that ERT be limited to the shortest duration consistent with treatment goals (eg, relief of menopausal symptoms).1 In contrast to the generalized recommendation for short duration of menopausal hormone treatment,2,4 careful scrutiny of the data from the Women's Health Initiative Estrogen Plus Progestin Trial reveal a reduced coronary heart disease risk after 5 to 6 years of ERT treatment. Accordingly, the …

Puberty, Menarche, and the Menstrual Cycle: What Do We Know, and What Do We Teach?