Abnormal Uterine Bleeding Research Articles

Endometrial thickness by ultrasonography and its correlation with histopathology in abnormal uterine bleeding among peri and post menopausal women

The endometrium constitutes a dynamic organ in female reproductive years, as it is subjected to hormonal variations in every cycle. Present study was conducted with the aim to correlate the endometrial thickness with the histopathology in the peri-menopausal females presenting with abnormal uterine bleeding (AUB) and to identify cut off value of endometrial thickness in order to reach at some consensus regarding when to intervene so that not a single endometrial pathology will be missed.This was an observational study conducted on 242 peri-menopausal and post-menopausal women ≥40 years of age presenting with abnormal uterine bleeding (AUB).: Based on the ROC curve, the cutoff point that delineates the abnormal histology and normal histology for endometrial thickness was 14.20 mm. Area under the curve (AUC) was 0.783 with 95% CI as 0.686 - 0.880 having sensitivity 71% and specificity 90% (p < 0.001). Heavy menstrual bleeding and frequent cycle were found to be commonly associated with gynecological pathology in these age groups. In all post and peri-menopausal AUB trans vaginal sonography for endometrial thickness is the initial best modality of investigation. Endometrial thickness cutoff in the range of ≥ 14 mm is of prime importance.

Sonographic and histopathological findings endometrium among perimenopausal women with abnormal uterine bleeding- A cross sectional study in north Kerala

: AUB makes a perimenopausal woman to seek medical care. This study evaluated and correlated the endometrial thickness obtained by ultrasonography and histopathological findings of endometrium in perimenopausal women with AUB.A hospital based observational cross-sectional study was conducted in Obstetrics and Gynaecology Department, Baby Memorial Hospital, Calicut for a period of 18 months. Histo-pathologic evaluation of endometrial tissue was done and was correlated with endometrial thickness.: The average age of women enrolled was 47.88 years with standard deviation of 3.729. The average endometrial thickness was 12.40mm. Endometrial hyperplasia without atypia was the leading histopathological finding obtained after analysis of endometrium (21.5%). This study shows that there is a significant relationship between histopathology findings of endometrium and age of participant and between endometrial thickness and menorrhagia. There was no relationship between histopathology findings and endometrial thickness. Perimenopausal AUB should be evaluated in a systematic manner, so that endometrial hyperplasia, carcinoma endometrium could be diagnosed in a very early stage and prompt treatment be given at right time reducing morbidity improving the quality of life.

To study the socio-demographic profile and clinical profile of abnormal uterine bleeding cases attending new civil hospital, Surat, Western India

There are so many concerns and worries about menstruation. With the use of advance method of contraception, women are experiencing more menstrual related problems. Now a days, menstrual related complaints are more common in gynaec clinic. So, we had conducted this study to document the sociodemographic and clinical profile among the attendees of gynaec clinic with menstrual related problem. Observational cross-sectional study carried out in western part of India with 100 patients after their written informed consent. Data were collected on pre-designed semi structured questionnaire which consist of sociodemographic and clinical questions. All data were entered in MS excel spreadsheet and analyzed with the help of SPSS V.20. Current study reported 8% of new Gynaec attendees had problem of abnormal uterine bleeding. Majority of patients were belonging to age group 21 years to 40 years (83%) and most of the patients were multipara (75%). Commonest complains among patients were menorrhagia (80%). Most of the patients were reported haemoglobin of less than 12 mg/dl.: Abnormal uterine bleeding is a distressing problem for women in their reproductive age groups especially in 21 years to 40 years.

Construction and validation of self-reporting menstrual disorder screening questionnaire for Indian population

Dysmenorrhea is defined as difficulty in menstrual flow and refers to painful cramps during menstruation. There are 2 types of dysmenorrhea, primary and secondary dysmenorrhea respectively. Early diagnosis of these conditions which may be responsible for dysmenorrhea is necessary to curb the rising prevalence of infertility. There are no adequate screening questionnaires available for Indian population which can screen dysmenorrhea and differentiate primary and secondary dysmenorrhea.: The objective of phase-1 of this study comprised of constructing menstrual disorder screening questionnaire and content validating the questionnaire and the objective of phase-2 was to administer the developed questionnaire on the targeted population. This was a cross-sectional study in which a questionnaire was developed and content validated by experts. The expert panel was asked to validate each question on a four-point Likert scale for relevance, clarity, ease of comprehension and the question was represented in participants correct section. A pilot study was carried out on 31 participants. A total of 142 participants were participated in the study.Dysmenorrhea was reported by a total of 129 participants i.e. 90.85% whereas only 9.15% reported of having no pain during menstruation. Dysmenorrhea symptoms experienced only sometimes by 56 participants, but 73 participants reported to experience them with each cycle. The questionnaire developed, and content validated in this study can be used as a self-reporting screening tool to detect menstrual abnormalities in the Indian population

Gene expression associated with unfavorable vaginal bleeding in women using the etonogestrel subdermal contraceptive implant: a prospective study

To evaluate gene expression associated with unfavorable vaginal bleeding in users of the Etonogestrel (ENG) contraceptive implant. Prospective study involving 100 women who intended to use the ENG implant. Exclusion criteria included abnormal uterine bleeding, inability to attend a 1-year follow-up, and implant removal for reasons unrelated to vaginal bleeding or loss of follow-up. We obtained endometrial biopsies before implant placement and assessed the expression of 20 selected genes. Users maintained a uterine bleeding diary for 12 months post-implant placement. For statistical analysis, we categorized women into those with or without favorable vaginal bleeding at 3 and 12 months. Women with lower CXCL1 expression had a 6.8-fold increased risk of unfavorable vaginal bleeding at 3 months (OR 6.8, 95% CI 2.21–20.79, p < 0.001), while those with higher BCL6 and BMP6 expression had 6- and 5.1-fold increased risks, respectively. By the 12-month follow-up, women with lower CXCL1 expression had a 5.37-fold increased risk of unfavorable vaginal bleeding (OR 5.37, 95% CI 1.63–17.73, p = 0.006). Women with CXCL1 expression < 0.0675, BCL6 > 0.65, and BMP6 > 3.4 had a higher likelihood of experiencing unfavorable vaginal bleeding at 3 months, and CXCL1 < 0.158 at 12 months. Users of ENG contraceptive implants with elevated BCL6 and BMP6 expression exhibited a higher risk of breakthrough bleeding at the 3-month follow-up. Conversely, reduced CXCL1 expression was associated with an elevated risk of bleeding at both the 3 and 12-month follow-ups.

Long-Term Safety Analysis of the BBV152 Coronavirus Vaccine in Adolescents and Adults: Findings from a 1-Year Prospective Study in North India.

Evidence on the long-term safety of COVID-19 vaccines is scarce. Here, in continuation of our previously published results on short-term safety, we provide data on the long-term safety of the BBV152 vaccine in adolescents and adults. This was a prospective observational study conducted from January 2022 to August 2023. Adolescents and adults receiving the BBV152 vaccine were interviewed telephonically about long-term adverse events of special interest (AESIs) after 1 year of vaccination. Risk factors of AESIs and AESIs persistent for at least 1 month were identified. Out of 1024 individuals enrolled, 635 adolescents and 291 adults could be contacted during the 1-year follow-up. Viral upper respiratory tract infections were reported by 304 (47.9%) adolescents and 124 (42.6%) adults in this period. New-onset skin and subcutaneous disorders (10.5%), general disorders (10.2%), and nervous system disorders (4.7%) were the common AESIs in adolescents. General disorders (8.9%), musculoskeletal disorders (5.8%), and nervous system disorders (5.5%) were the common AESIs in adults. Menstrual abnormalities were noticed in 4.6% of female participants. Ocular abnormalities and hypothyroidism were observed in 2.7% and 0.6% of participants, respectively. Among serious AESIs (1%), stroke and Guillain-Barre syndrome were identified in 0.3% and 0.1% of participants, respectively. Among adolescents, female individuals, those with a history of allergy and post-vaccination typhoid were respectively at 1.6, 2.8, and 2.8 times higher risk of AESIs. The majority of the AESIs persisted at the 1-year follow-up. Female individuals, adolescents with pre-vaccination COVID-19, those with co-morbidities, and those with post-vaccination typhoid had respectively 1.6, 2, 2.7, and 3.2 times higher odds of persistent AESIs. Adults with co-morbidities had more than 2 times higher odds of AESIs and persistent AESIs. The patterns of AESIs developing after BBV152 differed from those reported with other COVID-19 vaccines as well as between adolescents and adults. With the majority of AESIs persisting for a significant period, extended surveillance of COVID-19-vaccinated individuals is warranted to understand the course and outcomes of late-onset AESIs. Serious AESIs might not be uncommon and necessitate enhanced awareness and larger studies to understand the incidence of immune-mediated phenomena post-COVID-19 vaccination. The relationship of AESIs with sex, co-morbidities, pre-vaccination COVID-19, and non-COVID illnesses should be explored in future studies.

The state of the reproductive system of adolescent girls after vaccination against human papillomavirus using a quadrivalent vaccine

Background. Currently, oncological diseases and their possible prevention are being actively studied. Cancer mortality remains high. A national project “Healthcare” has been started in Russia, including the Federal projects “Fighting Cancer” and “Development of Children’s Health Care, including the creation of a modern infrastructure for providing medical care to children”. In a number of regions, girls can be vaccinated against the human papillomavirus (HPV). The main reason for refusing HPV vaccination is an unfounded fear of negatively affecting the fertility and other bad data. The aim of the study is an investigation of the reproductive system of adolescent girls with completed course of vaccination against HPV using quadrivalent vaccine. Methods. We selected 65 schoolgirls in Moscow by analyzing medical documentation data. All of them were vaccinated against HPV and examined by a gynecologist. The state of their reproductive system was assessed. Results. Most girls received the vaccine at the age of 12–13, according to the regional vaccination calendar of the city of Moscow. They were vaccinated with the quadrivalent vaccine twice with an interval of 6 months; no adverse event was noted. The mean period of time since vaccination was 2.7 ± 1.1 years. The mean age of menarche, mean menstrual cycle length, and mean bleeding time were normal in girls vaccinated against HPV. Among menstrual disorders, dysmenorrhea and oligomenorrhea were most often observed, but the data did not differ from the population average. The incidence of abnormal uterine bleeding and breast pathology was lower. No papillomas were detected. Pubertal development corresponded to age of all girls. Conclusion. It has been established that vaccination against the human papillomavirus does not have a negative impact on the reproductive system of teenage girls. However, additional dynamic studies are needed at different age periods of girls and women vaccinated against HPV to confirm the positive effect on the sexual sphere and formation of strong adherence to vaccination.

Case Report: Uterine artery embolization after dysfunctional uterine bleeding due to incomplete abortion in female

Dysfunctional uterine bleeding (DUB), a serious clinical challenge caused by incomplete abortion in female, calls for efficient and minimally invasive therapies to treat symptoms and protect reproductive health. Uterine artery embolization (UAE) has been discovered as a viable therapeutic strategy to treat DUB following an incomplete abortion. The existing information and clinical experience of UAE for this particular indication were thoroughly reviewed. A female’s quality of life may be negatively affected by incomplete abortion, which is defined as residual fetal tissue inside the uterine cavity. This frequently results in heavy and continuous uterine bleeding. Medical procedures and traditional management techniques such as dilatation and curettage (D&amp;C) do not always produce the desired effects or might have inherent dangers. UAE, a less invasive technique first developed for treating uterine fibroids, has shown promise as a substitute solution for DUB caused by an incomplete abortion.

Abnormal uterine bleeding and its associated factors among reproductive-age women who visit the gynecology ward in Dilla University General Hospital, Southern Ethiopia, 2022

BackgroundAbnormal uterine bleeding, a frequent gynecological problem among women of reproductive age, significantly affects their health and quality of life. Despite its problem, research on its extent and contributing factors in Ethiopia is scarce. Hence, this study is designed to determine the magnitude and factors associated with abnormal uterine bleeding among women visiting Dilla University General Hospital, Dilla, Ethiopia.MethodsA cross-sectional study design was conducted with 380 women of reproductive age at Dilla University General Hospital. A systematic sampling method was employed to select the participants for the study. A structured interview administered questionnaire and checklist were used to collect the data. Stata V.14 software was used for cleaning, coding, ensuring completeness and accuracy, and further analysis. Bivariate and multivariable logistic regression analyses were used. Finally, the variables that have a p-value of < 0.05 were considered statistically significant.ResultsIn this study, the magnitude of abnormal uterine bleeding was 24.21% (95% CI, 20.14–28.79). History of sexually transmitted disease [AOR = 1.44, 95% CI: (1.33, 4.75)], history of anemia [AOR = 3.92, 95% CI: (1.20, 12.74)]., history of alcohol consumption [AOR = 2.49, 95% CI: (1.22, 5.06)], and perceived stress level [AOR = 1.30, 95% CI: (1.15, 1.69)] were found to be significantly associated with abnormal uterine bleeding.ConclusionsThe magnitude of abnormal uterine bleeding was 24.2% in the study setting. Factors such as a history of sexually transmitted disease, anemia, alcohol consumption, and perceived stress level were identified as significant risk factors for abnormal uterine bleeding. Addressing these factors is crucial for management. Further research and interventions targeting these risks are needed to enhance health outcomes. The study provides valuable insights for future interventions.

Chinese guidelines on the management of endometrial hyperplasia

• Endometrial hyperplasia can be classified as either hyperplasia without atypia or atypical hyperplasia.• Abnormal uterine bleeding is the most common symptom of endometrial hyperplasia. Transvaginal ultrasound is recommended for initial imaging to evaluate endometrial hyperplasia (evidence level 2+), while transrectal ultrasound is recommended for virgo patients (evidence level 3).• Endometrial biopsy should be used to confirm diagnosis in patients where endometrial lesions are suspected. Effective histological approaches to make definite diagnoses include diagnostic curettage (evidence level 2++), hysteroscopic-guided biopsy (evidence level 2+) and endometrial aspiration biopsy (evidence level 2-).• Progesterone is the preferred medication for the treatment of endometrial hyperplasia without atypia. Compared to oral progestins, placement of a levonorgestrel-releasing intrauterine system (LNG-IUS) has been associated with higher regression rates, lower recurrence rates and fewer adverse events which can be the initial treatment method. (Meta evidence level 1-, RCT evidence level 2+). Ultrasound and endometrial biopsies should be performed every 6 months during treatment to evaluate its effect and treatment should continue until no pathological changes are observed in two consecutive endometrial biopsies. Hysterectomy is not the preferred choice of treatment for patients with endometrial hyperplasia without atypia.• Minimally invasive hysterectomy is indicated for patients with endometrial atypical hyperplasia (evidence level 1+), bilateral fallopian tubes should also be removed (evidence level 2+). In cases where surgery cannot be tolerated, fertility is desired or the patient is younger than 45 years old, medical therapy is recommended (evidence level 3). LNG-IUS is the preferred medical therapy method (evidence level 2+). Endometrial pathologic evaluation should be performed every 3 months during conservative treatments, with adjustments made to dosages or approaches based on observed response to medication. Treatment should continue until no pathological changes are detected in two consecutive endometrial biopsies (evidence level 2++). There is no indication of sentinel lymph nodes biopsy and/or lymphadenectomy for hyperplasia with or without atypia.• Total hysterectomy is recommended to treat patients with recurrent endometrial atypical hyperplasia (evidence level 3); however, medical conservative therapy may be considered for patients hoping to become pregnant in the future.• Patients with fully regressed disease who would like to become pregnant should be advised to seek assistance through assisted reproductive technologies (evidence level 3).• Long-term follow-up is suggested for patients after endometrial hyperplasia treatment (evidence level 2+). Patient education is imperative for improving medication adherence, increasing regression rates and lowering recurrence rates (evidence level 3).

Sexual behaviour among women using intramuscular depot medroxyprogesterone acetate, a copper intrauterine device, or a levonorgestrel implant for contraception: Data from the ECHO randomized trial

Background Contraceptive use has complex effects on sexual behaviour and mood, including those related to reduced concerns about unintended pregnancy, direct hormonal effects and effects on endogenous sex hormones. We set out to obtain robust evidence on the relative effects of three contraceptive methods on sex behaviours, which is important for guiding contraceptive choice and future contraceptive developments. Methods This is a secondary analysis of data from the Evidence for Contraceptive Options and HIV Outcomes (ECHO) randomized trial in which 7,829 HIV-uninfected women from 12 sites in Eswatini, Kenya, South Africa and Zambia seeking contraception were randomly assigned to intramuscular depot-medroxyprogesterone acetate (DMPA-IM), the copper intrauterine device (Cu-IUD) or the levonorgestrel (LNG) implant. Data collected for 12 to 18 months using 3-monthly behavioural questionnaires that relied on recall from the preceding 3 months, were used to estimate relative risk of post-baseline sex behaviours, as well as sexual desire and menstrual bleeding between randomized groups using modified Poisson regression. Results We observed small but generally consistent effects wherein DMPA-IM users reported lower prevalence of specified high risk sexual behaviours than implant users than Cu-IUD users (the ‘&gt;‘ and ‘&lt;‘ symbols indicate statistically significant differences): multiple sex partners 3.6% &lt; 4.8% &lt; 6.2% respectively; new sex partner 3.0% &lt; 4.0% &lt;5.3%; coital acts 16.45, 16.65, 17.12 (DMPA-IM &lt; Cu-IUD); unprotected sex 65% &lt; 68%, 70%; unprotected sex past 7 days 33% &lt;36%, 37%; sex during vaginal bleeding 7.1%, 7.1% &lt; 8.9%; no sex acts 4.1%, 3.8%, 3.4% (DMPA-IM &gt; Cu-IUD); partner has sex with others 10% &lt; 11%, 11%. The one exception was having any sex partner 96.5%, 96.9% &lt; 97.4% (DMPA-IM &lt; Cu-IUD). Decrease in sexual desire was reported by 1.6% &gt; 1.1% &gt;0.5%; amenorrhoea by 49% &gt; 41% &gt;12% and regular menstrual pattern by 26% &lt;35% &lt; 87% respectively. Conclusions These findings suggest that women assigned to DMPA-IM may have a modest decrease in libido and sexual activity relative to the implant, and the implant relative to the Cu-IUD. We found more menstrual disturbance with DMPA-IM than with the implant (and as expected, both more than the Cu-IUD). These findings are important for informing the contraceptive choices of women and policymakers and highlight the need for robust comparison of the effects of other contraceptive methods as well.

Clinicopathological Evaluation of Thyroid Dysfunction in Women with Abnormal Uterine Bleeding

Introduction: Abnormal uterine bleeding describes any variation from normal bleeding patterns in nonpregnant, reproductive-aged women beyond menarche lasting for at least 6 months. Regular cyclic menstruation results the choreographed relationship between the endometrium and its regulating factors. Any type of disturbance between the regulatory mechanism of pituitary ovarian axis or pelvic diseases results in abnormal uterine bleeding. Thyroid hormones play a key role in the menstrual and reproductive function of women. It is recognized universally that menstrual disturbances may accompany clinical alterations in thyroid function. Objectives: To evaluate the thyroid dysfunction in patients with abnormal uterine bleeding. Materials and Methods: This cross sectional study was conducted in Department of obstetrics &amp; gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from April 2023 to December 2023. Women with abnormal uterine bleeding were included in the study. Sample was selected by purposive sampling. Sample size was 100. Detail demographic data were collected from the informant and recorded in structured case report form. Clinical examination and relevant investigation were done meticulously. Data was collected by using a semi-structured questionnaire. Data was processed and analysed with the help of computer program SPSS and Microsoft excel. Quantitative data expressed as mean and standard deviation and qualitative data as frequency and percentage. Result was presented in the form of tables, pie chart, graphs, bar diagrams, histogram &amp; charts etc. Results: In this study, the maximum numbers of cases (43.0%) were between 26-35 years age group. Mean age was 29.57 ± 8.27 years. Large numbers of respondents came from urban area (58%). On evaluation of types &amp; causes of AUB, maximum patient belongs to AUB-L (leiomyoma) group (53%) followed by AUB-A (adenomyosis) (28%); AUB-P (polyp) (8%); AUB-O (ovulatory) (9%) and AUB-M (malignancy) (2%). Present study showed that prevalence of thyroid disorders is 26% in AUB patients. The prevalence of Hypothyroidism was 18% and Hyperthyroidism was 8%. Thyroid dysfunction is associated with menstrual abnormalities in females of all age groups. Conclusion: Abnormal uterine bleeding has a strong association with thyroid disorders. The most common type of disorder is subclinical hypothyroidism. Thus, all patient of AUB must be evaluated for thyroid dysfunction. Medicine Today 2023 Vol.36 (1): 1-6

Diagnosis and management of abnormal uterine bleeding in adolescence

During menarche and adolescence, abnormal uterine bleeding (AUB) may serve as a crucial indicator of a hidden bleeding disorder. When a young woman is suspected of having a bleeding disorder, the obstetrician-gynecologist should collaborate with a hemostasis specialist to arrange the necessary laboratory testing and determine the best course of action. The Italian Society for the Study of Hemostasis and Thrombosis and the Italian Society of Gynecology and Obstetrics jointly offer recommendations on the diagnosis and treatment of AUB. They also suggest diagnostic and therapeutic pathways to decrease diagnostic delay and improve treatment effectiveness and safety.

An Epidemiological Study to Assess the Risk Factors and Symptoms of PCOS

The aim to present this study was to assess the most affected age group of girls from PCOD and to make them aware by our questionnaire in this descriptive study, 200 girls were selected randomly from hostels of MMDU, MULLANA. A questionnaire was formulated to obtain information regarding symptoms, changes, dietary patterns, etc. This data was differentiated, tabulated, and tested. The data collected shows that the majority of the respondents who participated in the survey were on the edge of PCOD. Stein and Leventhal are regarded to have been the first investigators of polycystic ovary syndrome however, in 1721 Vallisneri, an Italian scientist; he described a married, infertile woman with shiny ovaries with a white surface, and the size of pigeon eggs. It was not until early 1990 at a national institute of Health (NIH) sponsored conference on PCOD that formal diagnostic criteria were proposed and afterward largely utilized. Many scientists tried to explain the pathophysiology of PCOS and many studies were made. It is now accepted that it is multifactorial, partly genetic, however, a number of candidate genes have been postulated. Insulin resistance has been noted consistently among many women with PCOS, especially in those with Hyperandrogenism, but it is not included in any of the diagnostic criteria. Now there is strong evidence that cardiovascular diseases risk factors and disturbances in carbohydrate metabolism are all increased in patients with PCOS compared to healthy populations. The criteria was established by a group of experts during a conference in ROTTERDAM held in 2003 are obligatory. The subsequent ROTTERDAM CRITERIA incorporated the size and morphology as determined by an ultrasound of the ovary into the diagnostic criteria. The Center for Disease Control and Prevention, obesity among children in the U.S. has tripled since 1980 due to various factors like bad eating habits, and lack of physical exercise, and many more children are getting more and more obese. Many researchers have found that PCOD findings are increasing with time. Finding insulin resistance in obese adolescents gave a different diagnosis of PCOD. Upon further clinical testing, many other symptoms are found like Hirsutism, acne, and menstrual abnormalities. Emans (2005) described PCOS as a diagnosis related to the diagnosis of insulin resistance, not being overweight. For insulin resistance, females don't need to be overweight, they will have insulin resistance even a normal weight female adolescents also have insulin resistance.

Uterine fibroids: a review

Myomatosis of large elements are benign tumors resulting from the growth of muscular and fibrous tissue, which can be embedded or adhered to the uterine wall and their classification varies between submucosal, intramural or subserous depending on the depth they reach. More frequently, symptomatic patients report the presence of abundant abnormal uterine bleeding, dysmenorrhea, dyspareunia and infertility. This pathology represents 40-60% of all hysterectomies, of the total, 30% in women of childbearing age. Different possible triggers of uterine fibroids have been described, which is why it is considered to be of multifactorial origin. Ultrasound is usually used frequently due to its high availability and low cost, this being the first diagnostic image of choice and the gold standard, through transvaginal ultrasound. The management of myomastomas entails a great social problem, since therapy seeks treatment methods that prevent the recurrence of the disease, and in case of satisfied parity, hysterectomy is the ideal option, but in those patients still of fertile age and with desire of pregnancy, less drastic procedures such as myomectomy will be carried out. Finally, some post-surgical complications have been discussed, among which the generation of adhesions due to the scarring resulting from the surgical intervention was described, which could generate infertility or greater difficulty in conceiving.

Experiences of Women With Medical Abortion Care Reflected in Social Media (VEILLE Study): Noninterventional Retrospective Exploratory Infodemiology Study.

Abortion (also known as termination of pregnancy) is an essential element of women's reproductive health care. Feedback from women who underwent medical termination of pregnancy about their experience is crucial to help practitioners identify women's needs and develop necessary tools to improve the abortion care process. However, the collection of this feedback is quite challenging. Social media offer anonymity for women who share their abortion experience. This exploratory infodemiology study aimed to analyze, through French social media posts, personal medical symptoms and the different experiences and information dynamics associated with the medical abortion process. A retrospective study was performed by analyzing posts geolocated in France and published from January 1, 2017, to November 30, 2021. Posts were extracted from all French-language general and specialized publicly available web forums using specific keywords. Extracted messages were cleaned and pseudonymized. Automatic natural language processing methods were used to identify posts from women having experienced medical abortion. Biterm topic modeling was used to identify the main discussion themes and the Medical Dictionary for Regulatory Activities was used to identify medical terms. Encountered difficulties were explored using qualitative research methods until the saturation of concepts was reached. Analysis of 5398 identified posts (3409 users) led to the identification of 9 major topics: personal experience (n=2413 posts, 44.7%), community support (n=1058, 19.6%), pain and bleeding (n=797, 14.8%), psychological experience (n=760, 14.1%), questioned efficacy (n=410, 7.6%), social pressure (n=373, 6.9%), positive experiences (n=257, 4.8%), menstrual cycle disorders (n=107, 2%), and reported inefficacy (n=104, 1.9%). Pain, which was mentioned in 1627 (30.1%) of the 5398 posts by 1024 (30.0%) of the 3409 users, was the most frequently reported medical term. Pain was considered severe to unbearable in 24.5% of the cases (399 of the 1627 posts). Lack of information was the most frequently reported difficulty during and after the process. Our findings suggest that French women used social media to share their experiences, offer and find support, and provide and receive information regarding medical abortion. Infodemiology appears to be a useful tool to obtain women's feedback, therefore offering the opportunity to enhance care in women undergoing medical abortion.

Traits of intrauterine pathology management in the peri- and postmenopausal period

Increasing number of anovulatory cycles in the perimenopause, leading to relative hyperestrogenism, and persistent hypoestrogenism in postmenopause, increase the proliferative activity and change the endometrium morphology. That is associated with higher rates of intrauterine pathology. The prevalence of atypical hyperplasia and endometrial cancer in women of the peri- and postmenopausal periods reaches its maximum values. Therefore, one of the most important concepts of patient’s management is to exclude malignant and precancerous endometrial pathology. Significant hormonal changes leads to important confounders in diagnostic and therapeutic algorithms. It could lead to both hypo- and hyperdiagnosis. The review analyzes the main causes of abnormal uterine bleeding, the features of their clinical manifestation, taking into account probable iatrogenic causes, extrauterus and extragenital sources of spotting. This article reviews the principles of ultrasound examination, considering menstrual cycle phase, duration of menopause, hormone treatment, as well as indications for endometrial biopsy, in case of inconsistency of clinical presentation, ultrasound results, menopausal status and iatrogenic factors. We describe the relevant principles of medical correction, wait-and-see tactics and surgical treatment of abnormal uterine bleeding, both in the presence of organic pathology of the endometrium, and in its absence.

New options for replenishing the iron stores in patients with abnormal uterine bleeding

Introduction. The high incidence of abnormal uterine bleeding (AUB) (over 30%) among patients of reproductive age is accompanied by the development of iron deficiency anaemia (IDA), which, in turn, is a social problem among global burden diseases throughout the world.Aim. To evaluate the clinical efficacy and compliance with the Vojea complex regimen to prevent IDA in women with abnormal uterine bleeding.Materials and methods. A multicentre clinical observational study was conducted in 6 health care facilities and women’s health clinics in Yekaterinburg and Moscow. The study included 52 patients with latent iron deficiency (serum ferritin level &lt; 15 ng/ml) who were diagnosed with abnormal uterine bleeding (AUB) due to ovulatory dysfunction. All patients received Vojea complex at a dose of 1 tablet QD for 3 months while taking pharmaceutical therapy for AUB. The clinical and laboratory efficacy and medication compliance were assessed at 30, 60 and 90 days after initiation of treatment.Results. Starting from the 1st month of treatment with the study complex, positive trends in clinical and laboratory findings were observed in both groups. After the three-month therapy with Vojea, ferritin levels increased 5.4 times (a clinically significant growth was reported after the two-month intake), plasma folate levels increased 4.9 times and red blood cell folate concentrations increased by 45%. The complex therapy helped reach and maintain the average red blood cell folate concentration &gt;400 ng/ml (906 nmol/l). Side effects included isolated events of gastrointestinal dyspepsia and individual intolerance. All patients reported good and excellent tolerance of the complex, which ensured high compliance with the drug regimen (92%).Conclusion. The three-month therapy with Vojea complex as part of the combination approach to the treatment of AUB in women with latent iron deficiency showed high clinical and laboratory efficacy, as well as good compliance with the drug regimen.

Assessment of profile of patients with Abnormal uterine bleeding

Assessment of profile of patients with Abnormal uterine bleeding

Cutaneous manifestations of hypothyroidism: An observational study in a tertiary care center of Eastern India

Cutaneous manifestations of hypothyroidism: An observational study in a tertiary care center of Eastern India