Day Of Menses Research Articles

Anti-Mullerian Hormone as A new Marker for Diagnosis of Poly Cystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is a complex disease characterized by various endocrine disorders that are the potential cause of anovulation and hyperandrogenism. This heterogeneous syndrome affects about 5– 10% of reproductive-age female population and it can be considered the most common endocrine disorder affecting women during reproductive life. PCOS is a multifactorial polygenic disease. Genes that regulate steroidogenesis and folliculogenesis are interested. Hence, AMH measurement has been found to offer a relatively high specificity and sensitivity as a diagnostic marker. Objectives: The study aimed to assess the accuracy of AMH in the prediction of PCOS in patients admitted to Elsayed Galal and El Hussein University Hospital. Subjects and methods: This was a retrospective study that was done on 130 women, divided into two groups, group I include 100 PCOS patients and group II, 30 control subject. Results: The results of this study showed that there was no significant difference between the two groups regarding age, while there was a significant increase in BMI in patients more than in control. The level of LH showed a significant increase in patients more than in the control. The level of FSH showed a significant decrease in patients less than in the control. The Testosterone showed a significant increase in patients more than in the control. The androstenedione showed a significant increase in patients more than in the control group. The AMH showed a highly significant increase in patients more than in the control and in turn the number of follicles in group II (patients) was significantly higher than in the control. The sensitivity of AMH in diagnosis PCOS was 98.0, specificity was 80.0% and the total accuracy was 93.0 at the cutoff of point 0.911. Conclusion: Additional advantages of AMH as diagnostic tool are that it is biological, objective, quantitative marker not affected by day of menses or OCP intake. So in future, more studies should be undertaken to validate its role as diagnostic tool for PCOS.

Conventional oral and secondary high dose vaginal metronidazole therapy for recurrent bacterial vaginosis: clinical outcomes, impacts of sex and menses.

PurposeOral metronidazole therapy is the standard of care for bacterial vaginosis (BV), yet it has alarming rates of recurrence and refractory responses among recurrent BV (RBV) patients. This study addresses whether high dose vaginal metronidazole therapy (HDM) is beneficial in RBV patients who fail after standard of care (SOC) therapy, whether diagnostic test scores proximal to the HDM predict clinical outcome, and whether menses, coitus, or race influences therapy outcome.Patients and methodsA total of 90 patients with RBV were given SOC and tracked 74 for up to 9 months. Refractory or recurrent patients (57) with symptomatic BV were given HDM and followed for up to 8 months. Patients were evaluated by Amsel criteria, Nugent score, and a qPCR assay that assesses the Lactobacillus content.ResultsHDM achieved at least short-term remission in 68% of the patients who were refractory to or recurred after SOC and provided a 10-day increase in the mean duration of remission among patients who eventually recurred (p=0.027). Patients with prolonged dysbiosis (pH >5 or Amsel 4) before symptomatic recurrence were more likely to recur after subsequent HDM. Most recurrence happened within 10 days of menses, but sex in this cohort was not associated with clinical outcome. Mean diagnostic BV scores of African American patients in remission were inferior to scores of a small cohort of Caucasian patients in remission.ConclusionEncouraging results obtained with HDM justify a prospective, randomized study to determine if follow-up HDM is beneficial among a broader cohort of women failing conventional oral metronidazole therapy.

Combined Letrozole and Clomiphene versus Letrozole with low dose gonadotropin protocol for ovulation induction in infertile clomiphene-resistant women with polycystic ovary syndrome: Comparative study

Objectives: To compare the effect of combined clomiphene citrate (100mg) and Letrozole (5mg) versus Letrozole (5mg) followed by gonadotropin injection for one cycle in CC resistant PCOs patients.Design: Prospective randomized trial.Setting: Infertility Outpatient Clinic and Cytogenetic and Endoscopy Unit of Obstetrics and Gynecology Department of Zagazig University Hospitals.Study group: About 212 PCOs patients with CC resistance (anovulatory response with CC at a dose of 100-150 mg for 3 cycles) were divided into two groups (106 in each group).Intervention: A studied group was randomly divided into two groups. Group A received combined Letrozole 5mg (2 tablets) in the morning and clomid 100 mg (2 tablets) in the evening from the 3rd day of menses for 5 days, group B received Letrozole 5 mg (2 tablets) from the 3rd day of menses for 5 days followed by human menopausal gonadotropin (hMG) injection every other day from cycle day 7. Moreover, ultrasound folliculometry started on cycle day 10 then the dose was adjusted according to follicular size. Both groups received treatment regimen for only one cycle.Results: There was higher ovulation rate (85.8%) in letrozole plus hmG group than in the other group receiving letrozole and CC (80.2%), but with no statistical significant difference (P -value =0.65). But, there was statistical significant difference between both groups regarding stimulation characters including total number of mature follicles (≥18 mm) 2.1 ± 1.01 in combined letrozole and CC was greater in group A than in group B (1.66 ± 0.98) with (P - value = 0.009). Stimulation days were longer in group B (18.2 ± 2.5) than in group A (16.2 ± 2.1). Mean total E2 on the day of hCG administration was significantly higher among patients in the clomiphene-letrozole group as compared with that in the other group of letrozole with hmG ( 650 ± 190.3 and 540 ± 180.5, respectively). Also, higher day 21 serum progesterone in group A (11 ± 1.1) than (9.5 ± 0.9) in group B. But, there was no statistical significant difference in mean endometrial thickness in both groups (A and B) (9.6 ± 1.7 versus 9.8 ± 1.5mm, respectively) (P-value = 0.41). The pregnancy rate did not show any statistical significant difference in both groups (P-value = 0.45) ; 32 patients out of 106 (30.1%) in group A compared with 27 patients (25.4%) in group B. Four cases were aborted in group A compared with 3 cases in group B. Four cases had twin pregnancy in group A with only 3 cases in group B. Also, there was no significant difference between both groups regarding ovarian hyperstimulation ; as there were 2 cases with combined clomid and letrozole group and one case only in letrozole plus hmG group.Conclusion: This study showed that lerozole is an effective medication when combined with CC or sequentially with hmG injection in improving the ovulation and pregnancy rate in CC-resistant PCOs patients with higher results when combined with hmG injection, but did not reach statistical significance.

Effect of Ginger and Novafen on menstrual pain: A cross-over trial

ObjectiveMenstrual pain is a periodic pain which happens during the days of menses. The menstrual disturbances as a health problem among young girls affect not only reproductive, but also psychical health and quality of life. This study was done with the goal of comparing the effect of Ginger and Novafen on the menstrual pain. Materials and methodsThis crossover clinical trial study was done in Iran on 168 single girl students 18–26 years old in Babol University of Medical Sciences with primary menstrual pain. The participants were randomly allocated to two groups receiving the drugs Novafen and Ginger. At the beginning of pain, in the two groups 200 mg capsule was given every 6 h for two serial cycles. Pain severity was measured by the visual scale before treatment, 1 h after consuming the drug (for 24 h) and 48 h after the onset of drug. ResultsThe mean age of participants was 21.83 ± 2.07 years. It has been reported that the intensity of pain from dysmenorrhea decreased in the Novafen and Ginger groups. Before treatment, the average pain intensity in Novafen and Ginger users were 7.12 ± 2.32 and 7.60 ± 1.84, respectively and after treatment pain intensity decreased to 3.10 ± 2.69 and 2.97 ± 2.69, respectively. Differences between two groups each time showed no statistical significance (p > 0.05). ConclusionBoth drugs reduced menstrual pain. Ginger as well as Novafen is effective in relieving pain in girls with primary dysmenorrhea . Therefore, treatment with natural herbal medicine, non-synthetic drug, to reduce primary dysmenorrhea is recommended.

A CLINICAL STUDY ON THE EFFECT OF SHATAVARI CHURNA AND SHATAVARI TAILA UTTARBASTI IN ATYARTAVA

Introduction: Heavy and prolonged bleeding during menses is one of the most common complaints encountered by gynecologists across the globe. The word “Atyartava” literally means excessive bleeding during menstruation which is a cardinal feature in a number of menstrual disorders described in the Ayurvedic classics. Atyartava can be correlated to “Menorrhagia” in modern literature. The aim of the present study was to evaluate “the effect of Shatavari Churna and Shatavari Taila Uttarbasti in Atyartava.” Materials and Methods: A total of 40 patients were selected for the present research work and randomly divided into two groups of 20 patients each. In Group A, patients were treated with 3 g of Shatavari (Asparagus racemosus) Churna orally twice daily for 3 months, while in Group B, patients were given 3 g of Shatavari Churna orally twice daily for 3 months along with Shatavari Taila Uttarbasti on 9th, 10th, and 11th days of menses for 3 consecutive months. After conducting the clinical trial on 40 patients, the data were obtained and analyzed statistically. Results: It was observed that both the groups were significantly effective in ameliorating the symptoms of Atyartava. However, on comparison of both Groups A and B, Group B showed better results. Conclusion: It showed that the specific therapy (Uttarbasti Chikitsa with shatavari oil) along with oral administration of Shatavari Churna was more effective in the treatment of Atyartava, in comparison to Shatavari Churna alone. The effects of Shatavari on menorrhagia were attributed mainly to its phytoestrogenic action.

Tradiational Practices Self Reported by Nursing Studnets to Relieve Dysmenorrhea

Introduction: Child The study aimed to assess traditional practices self-reported by nursing students to relieve dysmenorrhea. The study design was descriptive design. Setting: the study was conducted in nursing technical secondary school at Benha university hospital. Sampling: purposive sample that consisted of 150 students suffered from dysmenorrhea in the three years of the nursing secondary school. Tools of data collection: structured interviewing questionnaire, knowledge assessment sheet and assessment of used traditional practices by nursing students. Results: 64.7%of the studied sample had unsatisfactory knowledge about dysmenorrhea, 37.1% of studied students always used many of traditional practices to relieve dysmenorrheal and 44% of studied sample satisfied with traditional practices used for menstrual pain relief. Conclusion: Less than two thirds of the studied students always used many of traditional practices to relieve dysmenorrhea. The most common traditional method was drinking natural herbs followed by taking a warm bath and massaging the abdomen as reported by females. Recommendations: Encouraging the student females to use traditional methods in the first days of menses for relieving dysmenorrhea.

The Effect of Ibuprofen on Women with Copper Intrauterine Device-Associated Heavy Menstrual Bleeding: A Prospective Cohort Study

Objective: The current study aims to evaluate the effect of ibuprofen on women with heavy menstrual bleeding associated with copper intrauterine devices (CuIUDs). Study design: A prospective cohort study conducted at Assiut Woman's Health Hospital, Egypt, from October 2015 to September 2016 included women complaining of heavy menstrual bleeding with Cu-IUDs. Eligible women received 1200 mg ibuprofen per day for 5 days starting from the first day of menses for three consecutive cycles. The primary outcome was the clinical response of ibuprofen. The secondary outcomes included the observation of its effect on uterine blood flow and the patient's quality of life. Multiple logistic regression was conducted to identify the potential predictors for responsiveness to ibuprofen. Results: One hundred three patients (80.5%) showed response to ibuprofen after three months of treatment. There was a significant decrease in the mean number of bleeding days and sanitary pads after ibuprofen treatment (p=.000). The uterine blood flow was decreased obviously after 3 months following the treatment (p=.000). The bleeding days, uterine volume and uterine pulsatility index were significant predictors for responsiveness to ibuprofen after 3 months of use (p=.003, p=.04, p=.002; respectively). Conclusion: Ibuprofen can effectively decrease the menstrual bleeding associated with Cu-IUDs. This effect may be secondary to the decrease in the uterine blood flow. Satisfactory response to ibuprofen could be anticipated in women with fewer bleeding days, smaller uterine volume and higher uterine pulsatility index at the beginning of treatment.

Relaxin Influences Knee Laxity Changes Across the Menstrual Cycle

Greater knee laxity is associated with an increased risk for anterior-cruciate ligament (ACL) injury, particularly in women. Research suggests that the hormone relaxin may influence the structural integrity of the ACL, rendering a weaker and more lax ligament. PURPOSE: To assess the impact of relaxin on knee laxity once progesterone and testosterone (potential endocrine antagonists) are accounted for. METHODS: College-aged females (166.0±5.7cm, 65.9±8.5kg, 20.8±2.9yr) provided blood samples for the first 6 days of menses and first 10 days of luteal phase of one menstrual cycle. Knee laxity was recorded as anterior knee laxity (AKL; mm), genu recurvatum (GR; °), and general joint laxity (GJL; score, 0-9), and dependent variables were calculated as mean (X), cyclic Δ (max – min), coefficient of variation (CV), and standard deviation (SD). Progesterone (P; ng/ml), testosterone (T; ng/dl), and relaxin (R; pg/ml) were analyzed via ELISA assays. The sum of the 6 greatest hormone concentrations during menses (M) and luteal phase (L) and the change in exposure from M to L (MLΔ) were calculated. Only subjects with captured R and P peak were included in analysis (n=18). M and MLΔ for each hormone were entered into backward stepwise (in: p=.05, out: p=.20) multiple linear regression models to predict each laxity measure. RESULTS: R and P were significantly different between M and L (p<.001, RM=22.2±29.4 vs. RL=147.0±96.3; p<.001, PM=5.8±1.8 vs. PL=89.7±36.6), whereas T was less variable (p=.07, TM=203.8±63.0 vs. TL=222.7±82.6). All laxity showed variation across the menstrual cycle (range [min-max]: AKL=5.9-7.6; GR=2.6-5.6; GJL=.8-2.1). Significant models were observed for GRX (p=.014; R2=.418; GRX=3.501+.1.024RMLΔ-.757RM-.395PMLΔ), GJLMLΔ (p=.044; R2=.253; GJLMLΔ=-.469RMLΔ-.440TM), and GJLX (p=.035; R2=.379; GJLX=-.317RM-.353PM-.440PMLΔ-.507TM). Models for AKLMLΔ, AKLCV, GRΔ, and GJLSD approached significance (all p<.075). CONCLUSION: Once controlling for P and T, R was a significant predictor of knee laxity mean and cyclic changes. These findings would suggest that R, combined with other sex hormones, may affect the structural integrity of the ligament and impact injury risk. Further study is needed to explore potential mechanisms for this association.

Modified natural cycle for embryo transfer using frozen-thawed blastocysts: A satisfactory option

ObjectiveTo describe pregnancy outcomes of frozen-thawed blastocysts cycles using modified natural cycle frozen embryo transfers (NC-FET) and down-regulated hormonally controlled frozen embryo transfers (HC-FET) protocols. Study designThis retrospective cohort study included all patients undergoing either modified NC-FET or down-regulated HC-FET using frozen-thawed day 5 embryos. Cycles with donor blastocysts were excluded. Four hundred twenty eight patients underwent a total of 493 FET cycles. Patients with regular menses and evidence of ovulation underwent modified NC-FET. These patients were given hCG 10,000 IU IM on the day of LH-surge. Vaginal progesterone (P4) was started two days later and blastocyst transfer was planned seven days after detecting the LH surge. Anovulatory patients and some ovulatory patients underwent down-regulated HC-FET. These patients were placed on medroxy-progesterone acetate (10mg) for 10days to bring on menses and were also given a half-dose of GnRH-agonist (GnRH-a) on the third day of medroxy-progesterone acetate. Exogenous estradiol was initiated on the third day of menses. Once serum E2 levels reached >500pg/mL and endometrial lining reached >8mm, intramuscular (IM) P4 in oil was administered. Blastocyst FET was planned 6days after initiating P4. The primary outcomes included clinical pregnancy and delivery rates. ResultsThere were 197 patients in the modified NC-FET protocol and 181 in the down-regulated HC-FET protocol. Mean age (years), day-3 FSH levels (mIU/mL) and percentage of patients with male factor infertility were significantly higher and mean BMI (kg/m2) was significantly lower in modified NC-FET compared to HC-FET, respectively. Analysis of the first cycle pregnancy outcomes revealed no significant differences in clinical pregnancy rate (54.3% vs. 52.5%) and delivery rate (47.2% vs. 43.6%) between modified NC-FET and HC-FET. Logistic regression analysis showed age (OR=0.939, 95% CI 0.894–0.989, p=0.011), number of blastocysts transferred (OR=1.414, 95% CI 1.046-1.909, p=0.024), and the year of FET (OR=1.127, 95% CI 1.029-1.234, p=0.010) were significant factors impacting clinical pregnancy. An age analysis within three age groups (≤35, 36–39, ≥40) was performed, but no significant difference in clinical pregnancy was observed. ConclusionOur data suggests that modified NC-FET protocol has comparable pregnancy outcomes to down-regulated HC-FET when utilizing frozen-thawed day 5 embryos.

Early maladaptive schema domains in the first day of menses and 15 days after the menses in healthy volunteers

IntroductionPremenstrual syndrome (PMS) symptoms may affect the physical, psychological and social lives of many women of the reproductive age group. Most women report being extra-sensitive and have difficulties with emotional regulation and some patients report worsening of their psychiatric symptoms during the premenstrual period. Early maladaptive schemas (EMS) are developed early in childhood and may remain dormant until they are activated by situations relevant to the particular schema.ObjectiveWe hypothesized that some of the psychological symptoms of PMS may be related to EMS activation and that this activation is due to the hormonal changes of the menstrual cycle.AimsOur aim was to measure any changes regarding the EMS domains between the first day of menses and 15 days later.MethodsOne hundred and ten women from an architectural and engineering firm were enrolled in the study. After ruling-out psychopathology with Symptom check-list-90-R, remaining women (n = 65) filled out young schema scale short form (YSS-SF) on the first day of menses and 15 days after menses. The time of probable ovulation was defined as 15 days after the first day of menses.ResultsYSS-SF scores regarding the schemas of defectiveness, insufficient self-control, failure to achieve, vulnerability to harm or illness were significantly decreased by the 15th day of menses (P &lt; 0.05). Abandonment, social isolation, dependency, enmeshment and self-sacrifice schema scores remained similar on the first and 15th days.ConclusionsEMS activation may contribute to the PMS symptoms, therefore schema therapy may be an option for those women suffering from PMS.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The role of Phalaghrita Uttarbasti in the management of Infertility w.s.r. Cervical Factor

Vandhyatva (infertility) has been a long standing problem since ancient times. Many herbal and herbo-mineral formulations are mentioned as treatment of infertility in the ancient texts,but they are not categorized according to the responsible factor of infertility.It is need of the hour to evaluate the efficacy of formulations with respect to various factors . With the above aim a clinical study was conducted to evaluate the efficacy of Phalaghrita Uttarbasti on cervical factor i.e scanty cervical mucus. For clinical trial total 7 patients were selected for this study. Intracervical Uttarbasti of Phalaghrita (3 ml) was administered in every sitting for 6 days after end day of menses subsequently for two cycles. Sims-Huhner and Moghissi cervical mucus Test and post coital test were selected for the diagnosis and for evaluation of efficacy of therapy on cervical factor. Statistically highly significant result were found on spinnbarkeit(p&lt;0.01). and significant result were found in amount and viscosity(p&lt;0.05) and insignificant result were found in cellularity, and ferning (p&gt;0.1). Hence, in nutshell it was concluded that Phalaghrita Uttarbasti showed good results in all the properties of cervical mucus.

The Role of PrajasthapanaYoga and Phalaghrita Uttarbasti in Management of Infertility W.S.R. Cervical Factor

Vandhyatva (infertility) has been a long standing problem since ancient times.Many herbal and herbo-mineral formulations are mentioned as treatment of infertility in the ancient texts,but they are not categorized according to the responsible factor of infertility.It is need of the hour to evaluate the efficacy of formulations with respect to various factors. With the above aim a clinical study was conducted to evaluate the efficacy of Prajasthapana Yoga and PhalaghritaUttarbasti on cervical factor i.e scanty cervical mucus.For clinical trial total 7 patients were selected for this study.4 tab.(2 gm)of Prajasthapana Yogawas given orally thrice a day for 2 month and intracervical Uttarbasti of Phalaghrita(3 ml) was administered in every sitting for 6 days after end day of menses subsequently for two cycles.Sims Huhner and Moghissi cervical mucus Test and post coital testwere selected for the diagnosis and for evaluation of efficacy of therapy on cervical factor.Statistically highly significant result were found on quantity and viscosity(p&lt;0.001) and significant result were found inferning,cellularityand spinnbarkeit(p&lt;0.05). Hence, in nutshell it was concluded that Prajasthapna Yoga and PhalaghritaUttarbasti showed good results in all the properties of cervical mucus.

A young woman with early pregnancy loss

A 27-year-old woman visits her family doctor after having had her third six-week pregnancy loss. She is otherwise well. All pregnancies had been planned, with conception occurring within two to four months for each pregnancy. Her cycles are 28 days long, with 5 days of menses. A dilatation and

The Accuracy of Web Sites and Cellular Phone Applications in Predicting the Fertile Window.

To evaluate the validity of fertility web sites and applications (apps) by comparing the predicted fertile window of these modalities to the actual fertile window of a standard 28-day cycle. This was a descriptive study. The top resulting free web sites and electronic apps downloadable to a cellular phone that provide calendars for fertility and ovulation prediction were assessed. Cycles were standardized to 28 days in length, 4 days of menses, and the last menstrual period was set to January 1, 2015. The predicted date of ovulation and fertility window generated were compared with an actual estimated date of ovulation on cycle day 15, January 15, and a fertile window consisting of cycle day 10 to cycle day 15, the day of ovulation plus the preceding 5 cycle days, January 10-15. Data from 20 web sites and 33 apps were collected. Of all the web sites and apps used, one web site and three apps predicted the precise fertile window. Web sites and electronic apps used by the general public to predict fertile windows are generally inaccurate, although the clinical effect of this inaccuracy is unknown. Although they all include the most fertile cycle day, the range of the fertility window varies widely. Patients who are trying to conceive with the assistance of calendars generated from web sites and electronic apps should be counseled on the inaccuracy of these modalities.

Personalised estimation of a woman’s most fertile days

Objectives: We propose a new, personalised approach of estimating a woman’s most fertile days that only requires recording the first day of menses and can use a smartphone to convey this information to the user so that she can plan or prevent pregnancy.Methods: We performed a retrospective analysis of two cohort studies (a North Carolina-based study and the Early Pregnancy Study [EPS]) and a prospective multicentre trial (World Health Organization [WHO] study). The North Carolina study consisted of 68 sexually active women with either an intrauterine device or tubal ligation. The EPS comprised 221 women who planned to become pregnant and had no known fertility problems. The WHO study consisted of 706 women from five geographically and culturally diverse settings. Bayesian statistical methods were used to design our proposed method, Dynamic Optimal Timing (DOT). Simulation studies were used to estimate the cumulative pregnancy risk.Results: For the proposed method, simulation analyses indicated a 4.4% cumulative probability of pregnancy over 13 cycles with correct use. After a calibration window, this method flagged between 11 and 13 days when unprotected intercourse should be avoided per cycle. Eligible women should have cycle lengths between 20 and 40 days with a variability range less than or equal to 9 days.Conclusions: DOT can easily be implemented by computer or smartphone applications, allowing for women to make more informed decisions about their fertility. This approach is already incorporated into a patent-pending system and is available for free download on iPhones and Androids.

New Breast Pain Chart for Objective Record of Mastalgia.

Mastalgia is the commonest affliction of mammary gland among ladies of the reproductive age group. Since etiopathogenesis and therapy are different for cyclical and noncyclical pain, it is imperative to ascertain the exact type correctly. This is usually done in the breast clinics by advising the patient to fill a pain diary over a period of 2months over two menstrual cycles. The Cardiff pain chart records the severity of pain in the form of a triangle for mild to moderate pain and a square for severe pain. Moreover, Cardiff pain chart does not allow a patient to record the severity of pain on days of menses, as she has to put the letter "P" in the box. These problems have been resolved in the new breast pain chart. In the new pain chart, the lady records pain severity in the form of visual linear analogue scale score on every day of menstrual cycle. She enters her menstrual experience on a separate part of chart, which allows us to visualize the full month's pain severity in an uncluttered way.

Heterotopic respiratory mucosa of the uterine corpus

A 47-year-old, single, Chinese woman presented with pain on the 1st day of menses for more than 30 years. Her dysmenorrhea worsened over years and underwent a total abdominal hysterectomy and bilateral salpingooophorectomy. The myometrium showed trabeculated appearance, and there were adhesions between ovaries and fallopian tubes. A pale solid brownish mass measuring 1.5 cm × 1 cm × 0.6 cm with fibrous whitish cut surfaces was present on the lateral wall of the uterus in the lower uterine segment. Histologically, adenomyosis and left ovarian endometriosis were confirmed. The lateral uterine wall nodule showed a tubular structure lined by ciliated pseudostratified columnar epithelium. Smooth muscle bundles were found around the entire tubular structure. Lobules of salivary type glands containing both serous and mucous cells are present. The pathological diagnosis of heterotopic respiratory mucosa (HRM) was made. To our knowledge, this is the first reported case of HRM of the uterine corpus.

Symptom-Onset Dosing of Sertraline for the Treatment of Premenstrual Dysphoric Disorder: A Randomized Clinical Trial.

Serotonin reuptake inhibitors (SRIs) are efficacious treatments for premenstrual dysphoric disorder (PMDD) when given daily or for half of the menstrual cycle during the luteal phase. Preliminary studies suggest that SRI treatment can be shortened to the interval from symptom onset through the beginning of menses. To determine the efficacy of symptom-onset dosing with the SRI sertraline hydrochloride for treatment of PMDD. A double-blind, placebo-controlled, multisite, parallel-group randomized clinical trial conducted September 1, 2007, to February 29, 2012, at 3 university medical centers. In all, 252 women with PMDD started treatment at symptom onset and continued until the first few days of menses for 6 menstrual cycles. Intent-to-treat analyses were performed February 28, 2014, through April 21, 2015. Placebo or sertraline hydrochloride, 50 to 100 mg/d, during the symptomatic interval. Premenstrual Tension Scale (PMTS) score was the primary outcome measure (score range, 0-36; 36 indicates most severe score). Secondary outcome measures included the Inventory of Depressive Symptomatology-Clinician-Rated (IDS-C) (score range, 0-84; 84 indicates most severe score), Daily Record of Severity of Problems (DRSP) (total and subscale scores; higher scores indicate most severe problems), Clinical Global Impression (CGI) scales (score range, 1-7; 7 indicates most severe symptoms and least improvement), and Michelson SSRI (Selective SRI) Withdrawal Symptoms Scale scores (range, 0-51; higher scores indicate more severe withdrawal symptoms). Among the participants, 125 with PMDD were randomized to sertraline, and 127 to placebo. At baseline the mean (SD) PMTS scores for sertaline and placebo were 22.3 (4.8) and 21.4 (4.5), respectively, which declined to 11.7 (6.8) and 12.0 (6.9), respectively; group mean difference, 1.88 (95% CI, 0.01-3.75; P = .06). The mean (SD) estimated difference in IDS-C scores between baseline (35.4 [10.7] for sertraline; 32.8 [10.4] for placebo) and the end point (15.3 [10.7] for sertraline; 17.8 [11.0] for placebo) favored the sertraline group by 5.14 (95% CI, 1.97-8.31) points (P = .02). Compared with the placebo group, those assigned to sertraline showed greater improvement on the total DRSP score (estimated mean difference, 1.09 [95% CI, 0.96-1.25] points; P = .02) and Anger/Irritability DRSP subscale score (1.22 [95% CI, 1.05-1.41] points; P < .01) and were more likely to respond to treatment (77 of 115 patients [67.0%] for sertraline and 65 of 124 [52.4%] for placebo; χ21 = 5.23; P = .02). The mean (SD) number of symptomatic days before treatment diminished over time (sertraline, -0.7 [3.4] days; placebo, -1.0 [3.2] days), with no group differences in symptomatic days or the Michelson SSRI Withdrawal Symptoms Scale. Depending on the symptom scale, women with PMDD may or may not benefit from SRI treatment during the interval from the onset of premenstrual symptoms through the first few days of menses. Abrupt treatment cessation was not associated with discontinuation symptoms. clinicaltrials.gov Identifier: NCT00536198.

Dehydroepiandrosterone and Muscle Strength during a Menstrual Cycle in Female Athletes

Dehydroepiandrosterone (DHEA) is the common precursor of several reproductive hormones. DHEA-sulfate (DHEA-S) declines during adult aging and has been considered as a strong predictor for human longevity. The purpose of the study was to track the evolution of serum DHEA-S concentration and muscle strength during a menstrual cycle for young athletes. Ten female athletes (21 years of age) were enrolled in this longitudinal observation with hormonal and muscle strength assessments for every 7 days since the first day of menses, including Menses (M), Ovulatory (O), Luteal 1 (L1) and Luteal 2 (L2) periods. Despite total mood disturbance was not changed, muscle strength and serum DHEA-S concentrations were declined simultaneously during L2 period with a significant increase of serum estradiol and progesterone concentrations. Furthermore, during L2 period, sympathetic power mirrored by low-frequency heart rate variability (LF-HRV) and body temperature were relatively greater than the rest of the phases. We conclude that physical but not mental capabilities were compromised during premenstrual period for young female athletes. These findings suggest that circumventing athletic event during premenstrual period may be important to maximize the competition outcome for female athletes. This is probably because of increased consumption of endogenous DHEA for the biosynthesis of reproductive hormones during premenstrual phase.

A randomised controlled trial of oral zinc sulphate for primary dysmenorrhoea in adolescent females.

Primary dysmenorrhoea, the most common gynaecologic problem of adolescent females, is commonly treated with nonsteroidal anti-inflammatory drugs or oral contraceptive pills. To compare the effect of zinc sulphate with that of placebo on the control of pain severity and duration in adolescent girls with primary dysmenorrhoea. In a three-month randomised double-blind placebo-controlled clinical trial, 120 adolescent females with primary dysmenorrhoea were randomly divided into two groups of sixty: an intervention group (zinc) and a control group (placebo). Zinc was administered in the form of a capsule containing 50 mg/day zinc sulphate beginning on the first day of menses and continuing until three days prior to the end of menses. Each month, the duration and severity of primary dysmenorrhoea were determined. Severity scoring was performed by using a 0-10 scaling system. In the first month, the duration of pain was significantly lower in the zinc group compared with the placebo group (P-value = 0.044), while there was no significant difference in pain severity between the groups (P-value = 0.497). In the second and third month, pain severity and duration in the zinc group were significantly lower than the placebo group (P-value <0.001). Both pain duration and pain severity were decreased by taking oral zinc. The results of our interventional study suggests that zinc may be used to treat primary dysmenorrhoea in adolescents.