Abnormal Uterine Bleeding Research Articles

A Retrospective Descriptive Study on Caesarean Isthmocele: A Delayed and Under-recognised Complication of Caesarean Section

Introduction: A caesarean scar defect (isthmocele) is an indentation that represents myometrial discontinuity in the anterior uterine wall, with the base communicating with the uterine cavity at the site of a previous caesarean section scar. It has been linked to a variety of gynaecological symptoms, including abnormal uterine bleeding and secondary infertility. Aim: To describe the demographic characteristics, clinical presentation, management and outcomes in patients with Caesarean Scar Defect (CSD). Materials and Methods: A retrospective cohort analysis was conducted in the Department of Obstetrics and Gynaecology, Gastrocare Hospital (tertiary care centre), Bhopal, Madhya Pradesh, India, from February 2020 to February 2023. Data were collected from the hospital records of 43 patients who presented with CSD. The recorded variables included demographic details, clinical presentations, prior treatments, diagnostic interventions, types of surgical procedures performed and patient outcomes. Descriptive statistics, such as means, standard deviations and frequencies, were used to summarise patient characteristics and outcomes. All statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) software version 29.0 software. Results: The majority of the women were in the age group of 30-40 years. Out of 43 patients, eight presented with Abnormal Uterine Bleeding (AUB), three had secondary infertility, and 32 presented with Caesarean Scar Ectopic Pregnancy (CSEP) and its complications. All cases were managed either by hysteroscopy or laparoscopy, based on the Residual Myometrium Thickness (RMT). Conclusion: Transvaginal Sonography (TVS) is an effective tool for diagnosing CSD and CSEP. Surgical management can be guided by the RMT as determined by TVS.

Selective Conventional Approach for Management of Bleeding Uterine Arteriovenous Malformation: A Case Report

Uterine Arteriovenous malformation is an abnormal connection between artery and veins in the uterus. Although rare, it is an important cause of abnormal uterine bleeding in women and can lead to life threatening torrential hemorrhage. Traditionally such cases have been managed with medical therapy and hysterectomy. However, selective uterine artery embolization and hysteroscopy guided procedures are the treatment of choices. We hereby report a case of 25 years lady who presented with irregular heavy vaginal bleeding and diagnosed to have uterine arteriovenous malformation by magnetic resonance imaging. She was managed conventionally with condom tamponade during bleeding due to intrauterine procedure and later with hormonal therapy. The patient later had regular cycles avoiding hysterectomy at a young age.The objective of this case report is to share the successful application of uterine balloon tamponade (UBT) for the active management of bleeding uterine arteriovenous malformation which has not been reported so far which can be applied especially in a resource limited setup.

Turning Cramps into Comfort: A Review of Yogas Role in Alleviating Primary Dysmenorrhea and Promoting Reproductive Health

Abstract: Dysmenorrhea, the most frequent menstrual problem in adolescence, is a widespread condition affecting women globally. It is highly prevalent, affecting around 50–90% of the female population, with a global prevalence rate of 71.1% according to a meta-analysis spanning 38 countries. Primary dysmenorrhea (PD) is a common menstrual disorder affecting many women and significantly impacting their quality of life. The symptoms of PD are lower abdominal or pelvic pain, which may radiate to the back or legs, typically starting 6 to 12 months after menarche. Dysmenorrhea caused significant effects, including school absenteeism, poor performance, difficulty in daily activities, and social life disruption. Yoga, as nonpharmacological alternative medical intervention, has been increasingly studied for its potential benefits in managing PD. The purpose of this review is to highlight Yoga therapy as most effective alternative treatment in this cutting-edge era for primary dysmenorrhea. This study reviewed English-language literature published from 2000 to 2024, searching databases like PubMed, Google Scholar, and Scopus using keywords “yoga” and “menstrual pain” or “dysmenorrhea.” Out of 1,453 articles, 12 studies met the selection criteria and were included in the final review. This review of 12 RCTs’ highlights the effectiveness of yoga therapy for managing primary dysmenorrhea. Various yoga practices, including asanas, Yoga Nidra, and pranayama, significantly alleviated pain and improved symptoms. This study concludes the positive effectiveness of yoga therapy in managing primary dysmenorrhea. Yoga practices significantly alleviated pain and improved physical, psychological and social aspects of health, suggesting yoga as a holistic and beneficial treatment for dysmenorrhea.

Inferior epigastric origin of the uterine artery during uterine artery embolization

The uterine artery (UA) originates from the anterior branch of the internal iliac artery (IIA). Several variants within the IIA territory have been described. More distant sites of origin include the superior mesenteric, inferior mesenteric, and external iliac arteries. Specifically, origin from the external iliac artery is extremely rare and we are only aware of one reported case in the literature. Herein, we report a case of a 43-year-old woman who required UA embolization to control abnormal uterine bleeding secondary to cervical cancer that was refractory to medical management and palliative radiation. During the procedure, it was discovered that the left UA shared a common trunk with the left inferior epigastric artery and arose from the external iliac artery.

Oral and topical spironolactone in acne treatment: A meta-analysis of effectiveness and safety.

Acne vulgaris (AV) is a common chronic inflammatory skin disorder that commonly lasts from adolescence to adulthood and has serious social and psychological consequences. Current treatments typically use antibacterial drugs, which contributes to the rise in antibacterial drug resistance. Spironolactone, a potassium-sparing diuretic with anti-androgen effects, has been used off-label to treat acne by lowering sebum production. This systematic review and meta-analysis aims to assess the safety and efficacy of oral and topical spironolactone in acne treatment. Following PRISMA guidelines, a complete search of five databases yielded seven eligible studies (643 individuals) that compared spironolactone to placebo in randomized controlled trials. The total lesion count (TLC), comedones and papule counts, acne severity index (ASI), and adverse events (AEs) were all measured. RevMan was used for statistical analysis, and effect estimates were presented as mean differences (MD) and relative risk (RR), as appropriate. The study found that spironolactone significantly reduced ASI (MD = - 6.53, 95% CI: [- 10.83 to - 2.22], p = 0.003) and had a satisfactory safety profile, particularly in terms of menstruation symptoms. There were no statistically significant variations in TLC, comedone, or papule counts between the 4, 8, and 12-week intervals. Adverse events, including menstrual abnormalities, were similar across groups. Spironolactone, both oral and topical, demonstrated promise in lowering acne severity, particularly in female patients. While larger, long-term trials are required to demonstrate its efficacy and safety, spironolactone is a beneficial option to antibacterial drug therapies for dermatological and cardiovascular issues.

Pattern of abnormal uterine bleeding in a tertiary care hospital

Background: Abnormal uterine bleeding (AUB) is a significant clinical entity. Aim of the study was to observe the pattern of AUB in tertiary care hospital. Methods: All patients attending gynae OPD and ward presenting with AUB were included in the study. Results: A total 640 women had AUB in one year of study period. Highest incidence of AUB is observed in the age group 40-49 years. The most common clinical presentation of AUB was metrorrhagia followed by polymenorrhoea, menorrhagia, menometrorrhagia, oligomenorrhoea and hypomenorrhoea. On ultrasonography the commonest finding was leiomyoma uterus (28.15%) followed by increased endometrial thickness (18.46%). The most common histological pattern was proliferative endometrium (34.10%). According to PALM-COEIN classification the maximum incidence found was of AUB-L followed by AUB-O. Conclusions: The prevalent causes of AUB vary with age. So, all the patients presenting with AUB to gynaecology departments were included in the study irrespective of age. The information presented in this study adds to our understanding of patterns of the AUB.

Mass resection as a candidate treatment for uterine PEComas of uncertain malignant potential: a case report and literature review

BackgroundPerivascular epithelioid cell tumours (PEComas) occurring in the uterus are rare, with surgery being the most recommended primary treatment for malignant cases. This study aims to provide clinical guidance on the clinicopathological features and appropriate treatment options for patients with uterine PEComas of uncertain malignant potential.CasesThis case series summarises the clinical courses of 13 patients diagnosed with uterine PEComas of uncertain malignant potential, including clinical and pathological data as well as their outcomes. We identified one case at our hospital, and data for the other 12 cases were extracted from the PubMed database. The 13 patients were aged 9–75 years, with tumour sizes ranging from 1 to 21 cm, and follow-up times ranging from 2 to 71 months. The most common signs and symptoms included abnormal uterine bleeding (AUB) and abdominal pain. Most of the patients (11/13) were managed surgically without any chemotherapy or radiation therapy. Except for the patients who were lost to follow-up, 11 patients were free of any recurrence or metastasis at their last follow-up. Patients with group A tumours (abundant HMB45 expression) had a longer disease-free survival than those with group B tumours.ConclusionsSurgery alone may be appropriate for uterine PEComas of uncertain malignant potential. Surgical treatment plans should consider the patient’s age, fertility requirements, and personal preferences. Mass resection is a viable treatment option for fertility preservation in reproductive-age patients.

Функціонування фізіологічних систем організму при синдромі професійного вигорання

The article highlights the problem of the formation and development of the syndrome of professional burnout and evaluates its impact on the functioning of the physiological systems of the human body. The analysis of scientific literature is also presented regarding the definition of specific markers of burnout syndrome, which are formed as a result of the influence of its components on the functioning of the individual, the analysis of neuropsychophysiological changes. In burnout syndrome, morphofunctional changes are observed in the form of a decrease in dendritic arborization in such structures of the CNS as: prefrontal and anterior cingulate cortex, caudate nucleus, insula, hippocampus, and pons. Increases in dendritic arborization and spine density in the amygdala lead to impaired attention, reduced working memory, emotional exhaustion, irritability, anxiety, and physical fatigue. Hyperstimulation of the hypothalamic-pituitary-adrenal axis leads to an increase in the secretion of cortisol and catecholamines, which, in combination with the inhibition of nitric oxide production, contributes to the risk of cardiovascular diseases, such as arteriosclerosis, hypertension, and other metabolic disorders. There are changes in the respiratory system, including bronchial hypersensitivity, asthma, increased respiratory symptoms and the risk of developing inflammatory processes. Exhaustion syndrome is accompanied by a malfunction of the organs of the gastrointestinal tract, and narrowing of blood vessels in them, which can be the cause of gastric and duodenal ulcers, irritable bowel syndrome, portal hypertension, and liver necrosis. Along with this, there is a decrease in the bodys resistance to infectious diseases, which manifests in a violation of the ability of the immune system to suppress latent viruses and inflammatory processes. Long-term exposure to stressors leads to a decrease in libido, erectile dysfunction and deterioration of sperm quality in men, as well as menstrual cycle disorders, anovulation and infertility in women. Energy metabolism in the body during burnout syndrome is inhibited, and the ATP levels and mitochondrial respiration decrease. Prospects for further development include additional diagnostics of the above markers, including the determination of the concentration of components of the adenyl system in saliva, which will allow a more objective determination of the presence or absence of this syndrome, and the development of a correctional program aimed at restoring mental health.

Anti-angiogenic therapy as potential treatment for adenomyosis

Adenomyosis is characterized by abnormal uterine bleeding, dysmenorrhea and subfertility. Increased expression of angiogenesis markers in adenomyosis presents a treatment opportunity and was studied in an adenomyosis mouse model. Mice were administered tamoxifen (1 mg/kg) on neonatal days 2–5. At six weeks of age, mice received oral treatment with axitinib 3 mg/kg (‘dose I/AX3’, n = 34), axitinib 25 mg/kg (‘dose II/AX25’ n = 34), or with vehicle-only (‘placebo’, n = 34). The prevalence and severity of adenomyosis were assessed. An adenomyosis severity index was calculated by multiplying mean grade/mouse by the percentage affected surface area. Angiogenesis-related gene expression was evaluated using real-time quantitative PCR. 101 mice completed adenomyosis induction and could be analyzed. The prevalence of adenomyosis was 30/33 (90.0%) in dose I, 29/34 (85.3%) in dose II, and 30/34 (88.2%) in placebo treated mice (p = 0.78). High grade (2/3) adenomyosis was significantly less prevalent in mice treated with axitinib dose II (n = 19, 55.9%) than in the placebo group (n = 27, 79.4%, p < 0.05). The adenomyosis severity index was reduced by 48% in the axitinib-treated groups (dose I, p < 0.05). The expression of angiogenic growth factors was reduced in the dose I and II axitinib-treated groups compared to the placebo-treated group. Following these promising first results, further research should focus on commonality among different angiostatic drugs, potential side effects, as well as the method and timing of application.

Effects of abdominal, vaginal, and laparoscopic hysterectomies on total oxidant/antioxidant levels: A prospective observational study.

This prospective observational study aimed to compare abdominal hysterectomy (AH), vaginal hysterectomy (VH), and total laparoscopic hysterectomy (TLH) in terms of oxidative stress (OS) by measuring serum levels of total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI). Of the 3 groups, namely, AH, VH, and TLH, 22 patients were enrolled in each to investigate the aim of the study mentioned above. Patient demographics, clinical and surgical characteristics, and preoperative and postoperative (0th and 24th hours) serum TAS, TOS, and OSI levels were investigated. The groups differed significantly based on surgical indications (P < .001). While abnormal uterine bleeding was more prevalent in the AH (95.5%) and TLH (77.3%) groups, pelvic organ prolapse (POP) was more prevalent in the VH group (90.1%). The mean age and menopausal patient rates were significantly higher in the VH group than in the AH and TLH groups (P < .001). The groups did not differ significantly in terms of simultaneous bilateral salpingo-oophorectomy rates (P = .10). However, additional POP surgery was performed in 14 patients in the VH group. The mean operative time was significantly shorter in the AH group than in the VH and TLH groups (P = .001). The groups did not differ significantly based on either the preoperative or postoperative serum TAS levels (P > .05). Furthermore, the change in serum TAS levels over time was not significant in any of the groups (P > .05). In contrast, preoperative serum TOS and OSI levels were significantly higher in the VH group than in the AH and TLH groups (P < .05). The groups did not differ significantly in terms of serum TOS and OSI levels at 0th and 24th hours postoperatively (P > .05). Serum TOS and OSI levels increased dramatically over time in the AH and TLH groups (P < .05), but not in the VH group (P > .05). post hoc analysis showed that the changes in serum TOS and OSI values in the AH and TLH groups were between the preoperative and postoperative 0th hour levels (P < .001). Our results indicated that the total antioxidant capacity was preserved in all 3 techniques. However, VH causes less OS than the other hysterectomy techniques.

Effects, Mechanisms of Action and Application of Vitex agnus-castus for Improvement of Health and Female Reproduction.

This narrative review describes the provenance and chemical composition of Vitex agnus-castus, as well as the currently available knowledge concerning its action. To search the related articles, Cochrane Library, PubMed, Web of Science, SCOPUS databases between the years 1995 and 2024, and the keywords "Vitex," "review," "fertility," "ovarian" and "mechanisms" were used in various combinations. The data listed in this review demonstrate that Vitex agnus-castus and its constituents (isoflavones and essential oils) affect a number of physiological actions via multiple extra- and intracellular mechanisms of action. This makes it an efficient drug in both traditional and modern medicine for the treatment of a number of illnesses. The main described target of Vitex agnus-castus is female reproduction. It can up-regulate ovarian cycle and fecundity via a wide spectrum of mediators from hypothalamic, pituitary and ovarian hormones up to intracellular regulators of proliferation, apoptosis, oxidation and dopamine receptors. These effects determine its potential action as protector and medicine against a number of female reproductive disorders and reproduction-related health problems including menstrual disorders, premenstrual syndrome, cyclic mastalgia, corpus luteum insufficiency, abnormal production of progesterone and prolactin, low fertility and infertility, hyperandrogenism and polycystic ovarian syndrome. Nevertheless, further high-quality studies are needed to firmly establish the biological and clinical efficacy of this plant.

Female genital tuberculosis presenting as a protruding anterior vaginal wall mass: a case report

Although pulmonary tuberculosis is a common infectious disease, especially in low-and middle-income countries, female genital tract tuberculosis (TB) is rarely reported. Female genital TB might be asymptomatic or manifest clinically in an unusual way, making an early diagnosis challenging. The most often affected regions of the genital system are the fallopian tubes and endometrium. Menstrual abnormalities, infertility, and chronic pelvic pain are frequent presenting symptoms. Rare reports of vulvar and vaginal TB exist. This case report features a 35-year-old woman who had a bulging tumor in her vagina for a year before being identified with anterior vaginal wall TB, treated with anti-tuberculosis medication, and made improvements.

Ovarian sex cord-stromal cell tumors and the risk of sex hormone-sensitive cancers.

Sex cord-stromal cell tumors (SCST) are rare tumors of the ovary. Some of the SCSTs secrete hormone originating from the sex or stromal cell of the ovaries. Previous studies have indicated an increased risk of breast and endometrial cancers. However, these studies focused only on the SCST-subtype adult granulosa cell tumor, the estimates stem from selected cohorts and lack a well described cohort making it difficult to adjust for possible confounders. We examinined the incidence of other primary hormone sensitive cancers and comparing the risk to a matched cohort of women without SCST. This is a nested cohort study evaluating women diagnosed with sex cord-stromal cell tumors (SCSTs). We established the cohort of women diagnosed with SCSTs using Systematized Medical Nomenclature for Medicine (SNOMED) codes from the Danish Pathology Register. SCST diagnoses were considered valid if the primary diagnosis was established at a tertiary referral center or confirmed by at least two pathologists. A 1:10 matched control group, matched on birth year, was selected from national registries. Variables for follow up of cases and controls were drawn from national registries including assessment of rates of breast, ovarian and endometrial cancer, hormone use, Charlson Comorbidity Index and sociodemographics. Hazard ratios (HRs) for cancer rates were calculated using multivariate Cox proportional hazards models with SCST exposure estimated in early and delayed models to capture cancer rates over time. Standardized incidence ratios (SIRs) for very rare SCSTs were determined using log-linear Poisson models. Among the 1,516 tumors assigned SNOMED codes for SCSTs, 1,387 met the inclusion criteria after pathologic chart review. The majority had benign tumors, primarily thecoma/fibrothecoma (66%), while 26% had adult granulosa cell tumors (aGCTs). Increased rates for breast cancer were found in thecomas (HR: 1.2; 95% CI 1.0-1.4). In the analysis of all SCSTs combined, an increased rate of synchronous endometrial cancer was found (HR: 3.3; 95% CI 2.7-4.1). In sub-group analysis, malignant and benign SCSTs showed significantly higher HRs for synchronous endometrial cancer, notably in aGCTs (HR: 10.7; 95% CI 5.7-20.1). In the model assessing the rates of endometrial cancer two months after surgical removal of the SCST, no increased rates were found. Sertoli cell tumors were linked to an increased incidence of breast cancer (SIR: 18.9; 95% CI 2.7-134). Both Sertoli and Leydig cell tumors were associated with a higher incidence of synchronous endometrial cancer, with SIRs of 41.4 (95% CI 10.4-166) and 44.9 (95% CI 18.7-108), respectively. In conclusion, women with SCSTs have an increased rate of synchronous endometrial cancer and women with benign SCSTs have an increased rate of synchronous ovarian cancer. A marginally increased rate of breast cancer was found in women with thecomas. There is no increased rate of breast cancer among women with aGCT. It is recommended that women diagnosed with hormone-secreting SCSTs and additional risk factors for endometrial cancer (abnormal uterine bleeding and/or abnormal endometrial thickness) undergo an endometrial biopsy to assess for the presence of cancer.

Length of hospital stay in adolescents receiving high-dose oral contraceptive pills with and without conjugated equine estrogen for the treatment of acute abnormal uterine bleeding.

Compare the length of hospital stay of adolescents admitted for severe anemia (hemoglobin ≤ 8 g/dL) due to acute abnormal uterine bleeding (AUB) treated with high-dose combined oral contraceptive pills (HD-OCPs) versus those treated with HD-OCPs and intravenous conjugated equine estrogen, also referred to as dual therapy. This is a single institution retrospective cohort study of adolescents hospitalized for the management of acute AUB and severe anemia between July 1st, 2004, to January 1st, 2020. Subjects were excluded if they were pregnant, had a malignancy, thrombocytopenia, treated with other hormonal therapies, or if bleeding stopped prior to admission. Primary outcome was length of hospital stay. Secondary outcomes were rates of complications and side effects secondary to the hormonal medication. There were 113 subjects included in the study. Seventy-four (65%) received HD-OCPs only, and the remainder received dual therapy. Mean subject age was 13.8 years for both groups. Those who received HD-OCPs alone were hospitalized for an average of 38.4 hours versus 45.6 hours for those who received dual therapy (p=0.0007). The only reported side effect in either group was nausea and/or vomiting, which was higher in the group who received dual therapy than those treated with HD-OCPs alone (85% versus 51.4% respectively, p-value=0.001). Adolescents who received dual therapy had a longer hospital stay than those who received HD-OCPs alone. There were no complications related to the medication regimens in either group, but those receiving dual therapy had significantly higher rates of anti-emetic use.

Chronic Endometritis and Antimicrobial Resistance: Towards a Multidrug-Resistant Endometritis? An Expert Opinion.

Chronic endometritis (CE) is a persistent inflammatory condition of the endometrium characterized by abnormal infiltration of plasma cells into the endometrial stroma. Frequently associated with repeated implantation failure, recurrent pregnancy loss, and infertility, CE significantly impacts women's health, contributing to conditions such as abnormal uterine bleeding and endometriosis. Treatment typically involves antibiotic therapy; however, the efficacy of these treatments is increasingly compromised by the rise of antimicrobial resistance (AMR). This paper examines the critical links between AMR and CE, proposing strategies to enhance clinical management and optimize treatment outcomes.

The clinicopathologic features of uterine inflammatory myofibroblastic tumor: A case report.

Inflammatory myofibroblastic tumor (IMT) is a rare soft tissue neoplasm with low malignant potential. These patients present with a certain probability of malignant potential. The management of IMT has not been standardized, especially for the patients with fertility needs. Thirteen patients with IMT who attended in the Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine were enrolled between 2019 and 2023. The data of the clinical and pathological features was analyzed. The mean age of the patients was 45.31 ± 12.80 years. Seven of the 13 cases (53.85%) had abnormal uterine bleeding. Five of them (38.46%) had a rapidly growing mass, and 2 of them (15.38%) had no obvious symptoms. With regard to surgical strategies, 7 patients underwent hysterectomy, and 6 patients underwent mass resection only. All the patients were alive with no evidence of disease at an average of 9.58 months of follow-up. One of them gave birth to a full-term male infant at 40 weeks of gestation after hysteroscopic resection, without recurrence. Uterine inflammatory myofibroblastic tumor can be diagnosed by the anaplastic lymphoma kinase overexpression. Complete excision under hysteroscopy or laparoscopy seems to be effective and safe. Because there is a certain risk of recurrence and metastasis, conservative surgery should be performed carefully to preserve fertility in patients who can undergo close follow-up.

Analysis and identification of potential biomarkers for dysfunctional uterine bleeding.

Clinical evidence increasingly suggests that traditional treatments for dysfunctional uterine bleeding (DUB) have limited success. In this study, blood samples from 10 DUB patients and 10 healthy controls were collected for transcriptome sequencing. Then, the differentially expressed genes (DEGs) were screened and crossed with the DUB-related module genes to obtain the target genes. These target genes were analyzed for functional enrichment. Further, the biomarkers were screened by protein-protein interaction (PPI) analysis and analyzed by the gene set enrichment analysis (GSEA) and ingenuity pathway analysis (IPA). To explore the pathogenesis of DUB, immune microenvironment analyses were also performed. Potential drugs targeting these biomarkers were predicted for clinical treatment. The expression of these biomarkers was validated using quantitative real-time polymerase chain reaction (qRT-PCR). The results showed that, a total of 754 target genes were found to be related to cell proliferation and senescence. Five biomarkers-CENPE, KIF11, PIK3R1, SMC3, and SMC4-were identified, all of which were down-regulated in the DUB group, and most of these findings were confirmed by qRT-PCR. Notably, CENPE expression showed a negative association with activated NK cells and a positive association with resting NK cells. In addition, 44 potential drugs were predicted for DUB treatment. In conclusion, five DUB biomarkers were identified, enhancing understanding of gene regulation in DUB and providing a theoretical foundation for clinical diagnosis and treatment.

Age did not affect the rate of subsequent hysterectomy following hysteroscopic surgery: A population-based retrospective cohort study from 2000 to 2020.

Previous studies found younger age was associated with an increased risk of hysterectomy after hysteroscopic surgeries (HS) due to abnormal uterine bleeding (AUB). The present study aimed to evaluate the effect of age on the incidence of hysterectomy after HS for treating AUB in Taiwan. This was a nationwide population-based retrospective cohort study which utilized the Taiwan National Health Insurance Database. The present study involved 4150 participants who underwent HS due to AUB. The study focused on females aged ≥40 years diagnosed with AUB who underwent HS between 2000 and 2020. Hysterectomy outcomes were analyzed using the Cox proportional hazards model, and age was categorized into three groups (40-44, 45-49, and 50-55 years). Statistical significance was set at P < 0.05. This study involved 4150 participants with an average age of 46.1 years, categorized into the following age groups: 40-44 years (39.6%), 45-49 years (38.8%), and 50-55 years (21.6%). Approximately 8.1% of participants required hysterectomy treatment; the highest incidence was observed in the 40-44-year age group (8.6%). The median time from HS to hysterectomy varied across age groups, ranging from 0.25-2.78 years. The presence of uterine myoma (adjusted hazard ration [aHR]: 2.11; 95% CI: 1.70-2.64; P < 0.0001) and adenomyosis (aHR: 10.24; 95% CI: 8.17-12.85; P < 0.0001) significantly increased the risk of hysterectomy. Kaplan-Meier survival curves demonstrated a comparable likelihood of hysterectomy across age groups within 5 years post-HS, with most occurrences occurring in the initial 5 years. Our study found no age effect on subsequent hysterectomy after HS. This study contributes to a significant understanding of HS outcomes, aiding information for patients seeking AUB surgical options.

The effect of cervical length on procedure time and VAS pain score in office hysteroscopy

This study aimed to investigate the effect of cervical length on procedure time and VAS pain scores during office hysteroscopy. A cross-sectional study was conducted on 50 patients who underwent office hysteroscopy for various indications such as abnormal uterine bleeding and infertility. Exclusion criteria included active vaginal infection, previous cervical surgery, and chronic pelvic pain. Cervical length was measured via transvaginal ultrasound prior to the procedure. Procedure time and VAS pain scores were recorded and analyzed. Patients with a retroverted uterus had higher post-procedure VAS scores (7.6 ± 0.8) compared to those with an anteverted uterus (4.9 ± 1.9, p < 0.001). Cervical length was found to be a significant predictor of both procedure time (β = 5.711, p < 0.001) and VAS pain score change (β = 0.167, p < 0.001). Procedure time was significantly longer in patients with increased cervical length (R2 = 79.6%, p < 0.001). Additionally, an anteverted uterus was associated with a shorter procedure time (118.2 ± 49.2 s) compared to a retroverted uterus (142.7 ± 46.8 s, p < 0.001). Cervical length was a significant predictor of VAS pain scores (β = 0.167, p < 0.001), with each millimeter increase leading to a 0.167-unit rise. While univariate analysis showed a negative association between age and VAS scores (β = -0.299, p = 0.035), this was not significant in the multivariate model (p = 0.586). Cervical length also significantly prolonged procedure time (β = 5.711, R2 = 79.6%, p < 0.001). Cervical length is a significant factor influencing both the duration and pain experienced during office hysteroscopy. Consideration of cervical length can improve patient comfort and procedural efficiency in clinical practice.

Trillium govanianum (Nagchattri): A promising rare and commercially important medicinal herb from higher altitudes of the Himalayas

Secondary metabolites and bioactive compounds derived from naturally occurring sources have been the prime ingredients in modern health care as well as ancient medicine systems like Ayurveda, Yunani, and traditional folk medicines. A large number of plant species and their extracts are utilized to cure several human ailments. Trillium govanianum, belonging to the genus Trillium (family: Melanthiaceae alt. Trilliaceae), is a traditional medicinal herb of the Himalayan region used to cure joint pains, wounds, boils, dysentery, inflammation, menstrual and sexual disorders. T. govanianum root extracts have analgesic, anti-inflammatory, cancer-preventing, anti-fungal, and wound-healing activities. The main bioactive compounds present in this species are steroidal saponins. Indiscriminate and commercial harvesting in an unsustainable manner, along with various other biotic pressures, have created a synergistically severe menace toward the subsistence of T. govanianum in its natural habitat. Population assessment, conservative and in vitro proliferation methods pertaining to mass multiplication and advancement in ex–situ and in–situ environments are required for sustainable use of this species. In lieu of the significance of this herb, the present study aims at the exploration of phytochemical, ethnomedicinal, ecological, pharmacological, and conservational practices of T. govanianum for a better understanding of medicinal activities and sustainable use of this plant. This review summarised the potential resources of T. govaninanum in terms of biologically active compounds and their dependence on the local population. It focuses on the medicinal utility of T. govaninanum in different diseases and ailments.