Women Of Fertile Age Research Articles

Factores de riesgo reproductivo preconcepcional en mujeres de edad fértil

Introduction: Preconception assessment and counseling provide an opportunity to inform women about fertility and gestational issues, identify pregnancy risks to the mother and fetus, educate about these risks and institute appropriate interventions prior to conception. Objective: to identify preconception reproductive risk factors in women of childbearing age at the 60th Medical Clinic of the 1st of January Polyclinic in the period 2021-2023. Method: a descriptive cross-sectional study was carried out. The universe was constituted by 21 women of fertile age from 15 to 49 years old, being the sample 18 women. Percentage was used as the unit of measurement. Results: The age group 18-35 years was predominant (77,8 %) and overweight with 39 %. Regarding obstetric history, there was a high prevalence of short inter-gestational period (13 %), followed by anemia (9,6 %). There was a high prevalence of bronchial asthma with 25,8 % with 8 patients within the chronic noncommunicable diseases. The predominant harmful substance was smoking with 12 women (38,7 %). As the most used contraceptive method, 17 women were found to use IUD, representing 54,8 %. Conclusions: it is essential to communicate and educate women of childbearing age about the important list of maternal-perinatal risk factors that can be reduced or controlled at this stage.

Cholecystectomy and ERCP in pregnancy: a nationwide register-based study.

The objective was to examine the outcomes of cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy and compare these outcomes with those in nonpregnant women of fertile age. Although both laparoscopic cholecystectomy and ERCP are considered safe and feasible in pregnant patients, there is still concern and uncertainty regarding gallstone intervention during pregnancy. This study aimed to investigate outcomes in pregnant patients compared to outcomes in nonpregnant patients. Data on all female patients aged 18-45 years were retrieved from the Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The patients were divided into groups according to intervention: cholecystectomy, ERCP, or a combination thereof. Differences between pregnant and nonpregnant patients were analyzed. A total of 21328 patients were included, with 291 cholecystectomy and 63 ERCP procedures performed in pregnant patients. At the 30-day follow-up, more complications after cholecystectomy were registered for pregnant patients. However, pregnancy was not a significant risk factor for adverse events when adjusting for previous complicated gallstone disease, intraoperative complications, emergency surgery, and common bile duct stones. There were no differences in outcomes when comparing cholecystectomy among the different trimesters. ERCP had no significant effect on outcomes at the 30-day follow-up. Cholecystectomy, ERCP, and combinations thereof are safe during pregnancy.

Whole-exome sequencing reveals candidate high-risk susceptibility genes for endometriosis

BackgroundEndometriosis is a common, chronic disease among fertile-aged women. Disease course may be highly invasive, requiring extensive surgery. The etiology of endometriosis remains elusive, though a high level of heritability is well established. Several low-penetrance predisposing loci have been identified, but high-risk susceptibility remains undetermined. Endometriosis is known to increase the risk of epithelial ovarian cancers, especially of endometrioid and clear cell types. Here, we have analyzed a Finnish family where four women have been diagnosed with surgically verified, severely symptomatic endometriosis and two of the patients also with high-grade serous carcinoma.ResultsWhole-exome sequencing revealed three rare candidate predisposing variants segregating with endometriosis. The variants were c.1238C>T, p.(Pro413Leu) in FGFR4, c.5065C>T, p.(Arg1689Trp) in NALCN, and c.2086G>A, p.(Val696Met) in NAV2. The only variant predicted deleterious by in silico tools was the one in FGFR4. Further screening of the variants in 92 Finnish endometriosis and in 19 endometriosis–ovarian cancer patients did not reveal additional carriers. Histopathology, positive p53 immunostaining, and genetic analysis supported the high-grade serous subtype of the two tumors in the family.ConclusionsHere, we provide FGFR4, NALCN, and NAV2 as novel high-risk candidate genes for familial endometriosis. Our results also support the association of endometriosis with high-grade serous carcinoma. Further studies are required to validate the findings and to reveal the exact pathogenesis mechanisms of endometriosis. Elucidating the genetic background of endometriosis defines the etiology of the disease and provides opportunities for expedited diagnostics and personalized treatments.

Assisted Reproductive Technology and Disease Management in Infertile Women with Multiple Sclerosis.

Multiple sclerosis (MS) predominantly affects women of fertile age. Various aspects of MS could impact on fertility, such as sexual dysfunction, endocrine alterations, autoimmune imbalances, and disease-modifying therapies (DMTs). The proportion of women with MS (wMS) requesting infertility management and assisted reproductive technology (ART) is increasing over time. In this review, we report on data regarding ART in wMS and address safety issues. We also discuss the clinical aspects to consider when planning a course of treatment for infertility, and provide updated recommendations to guide neurologists in the management of wMS undergoing ART, with the goal of reducing the risk of disease activation after this procedure. According to most studies, there is an increase in relapse rate and magnetic resonance imaging activity after ART. Therefore, to reduce the risk of relapse, ART should be considered in wMS with stable disease. In wMS, especially those with high disease activity, fertility issues should be discussed early as the choice of DMT, and fertility preservation strategies might be proposed in selected cases to ensure both disease control and a safe pregnancy. For patients with stable disease taking DMTs compatible with pregnancy, treatment should not be interrupted before ART. If the ongoing therapy is contraindicated in pregnancy, then it should be switched to a compatible therapy. Prior to beginning fertility treatments in wMS, it would be reasonable to assess vitamin D serum levels, thyroid function and its antibody serum levels; start folic acid supplementation; and ensure smoking and alcohol cessation, adequate sleep, and food hygiene. Cervico-vaginal swabs for Ureaplasma urealyticum, Mycoplasma hominis, and Chlamydia trachomatis, as well as serology for viral hepatitis, HIV, syphilis, and cytomegalovirus, should be performed. Steroids could be administered under specific indications. Although the available data do not clearly show a definite raised relapse risk associated with a specific ART protocol, it seems reasonably safe to prefer the use of gonadotropin-releasing hormone (GnRH) antagonists for ovarian stimulation. Close clinical and radiological monitoring is reasonably recommended, particularly after hormonal stimulation and in case of pregnancy failure.

The use and access to contraception in Sweden during the COVID-19 pandemic period

Purpose Explore perceived access to, the need for, use of, and satisfaction with telemedicine services for contraceptive counselling and prescription-renewal-only during the COVID-19 pandemic, and the impact of the COVID-19 pandemic period on the choice and use of contraceptives. Materials and methods Internet-based e-survey of Swedish women of fertile age, 16–49 years. Results In total, 1016 participants completed the survey. Most participants (69.7%) rated their access to contraceptive services ‘as usual’. Among the remaining participants, a higher proportion rated their access as deteriorated (73.4%) compared to improved (26.6%; p < 0.001). In total, 38.0% reported a need for contraceptive counselling, whereof 14.0% had used telemedicine for counselling and reported high satisfaction. Telemedicine for prescription-renewal-only was used by 15.1% of the total population. Two per cent reported use of another contraceptive than their intended, whereof long-acting reversible contraceptives were the most common intended method. The proportion of current contraceptive users was lower than in 2017 (62.4% vs 71.1%, p < 0.001), and current users of long-acting reversible contraception decreased from 30.6% to 19.3% (p < 0.001). Conclusions During the COVID-19 pandemic period, most women found their access to contraceptive services unaffected, but more women felt that it had deteriorated than improved. The use of telemedicine was low, and the use of contraception overall fell. Efforts are needed to raise awareness of available services, and TM-provided interventions for maintained quality of care and informed decision-making remain to be evaluated. SHORT CONDENSATION The COVID-19 period imposed a change in contraceptive service provision, and efforts are needed to raise awareness of available services, including telemedicine. Access to all contraceptives, including LARCs, is crucial and telemedicine-provided interventions need evaluation.

Maternal Underweight is Associated with Lower Fracture Risk after Pregnancy: A Nationwide Register-Based Study in Finland

Lower body mass index (BMI) is associated with a higher risk for osteoporotic fractures in the postmenopausal population. However, in the fertile-aged population, the association between BMI and risk for fracture is not well studied. Our aim, therefore, is to investigate whether lower BMI (<18.5 kg/m2) affects the risk for fractures requiring hospitalization after delivery in fertile-aged women when compared to women of normal weight (18.5 ≤ BMI < 25 kg/m2). In this nationwide registry-based cohort study, all pregnancies were gathered from the National Medical Birth Register. The data were linked with data from the Care Register for Health Care, which includes information of all fractures leading to hospitalization or treated as outpatients for fertile-aged females (15–49 years), for the period 2004–2018. The annual rate of pregnancies with maternal pre-pregnancy underweight in a high-income country was calculated. Cox regression was used to calculate adjusted hazard ratios (aHR) of lower BMI for the risk for fracture within 5 years after delivery. The association between the risk of fracture and continuous BMI was assessed using logistic regression and presented with adjusted odds ratios (aORs) with 95% CIs. In total, 20,784 women were included in the underweight group and 344,753 in the normal weight group. Women in the underweight group had a lower overall risk for any fractures during the 5-year follow-up (aHR 0.75, CI 0.61–0.94). The odds for all fractures (aOR 1.07, CI 1.04–1.09 per BMI-unit upwards for all fractures) increased as pre-pregnancy BMI increased. Despite previous findings of a higher risk for fractures for underweight patients in the older population, the risk for fractures after pregnancy was lower among fertile-aged women with lower BMI.

A comparison of the portfolio low-carbohydrate diet and the ketogenic diet in overweight and obese women with polycystic ovary syndrome: study protocol for a randomized controlled trial

BackgroundPolycystic ovary syndrome (PCOS) is one of the most frequent endocrine disorders among women of fertile age. Women with PCOS manifest clinical symptoms like menstrual dysfunction, hirsutism, insulin resistance, and hyperinsulinemia. As excessive amounts of insulin levels directly increase ovarian production of androgens, hyperinsulinemia and insulin resistance are considered as the pathogenesis factors of PCOS. The portfolio low-carbohydrate diet (PLCD) is a plant-based diet with 40% carbohydrates combined with five cholesterol-lowering foods and nutrients. On the other hand, the ketogenic diet (KD) is a nutritional protocol with 10% carbohydrates. The purpose of this study is to determine whether PLCD or KD is more effective in alleviating PCOS symptoms.MethodsForty-six overweight or obese women diagnosed with PCOS will be randomly stratified to receive either PLCD or KD for 8 weeks. Measures related to anthropometric and body composition, glucose, and insulin level, HOMA-IR, sex hormones, lipid profile, quality of life, dietary intake, physical activity, and Ferriman-Gallwey score of all participants will be accessed before and after the intervention.DiscussionSince the first line treatment of PCOS is lifestyle adjustment including diet control and exercise, there has not been determined the optimal diet for this population of women yet. Hence, the goal of conducting this study is to determine whether the PLCD or the KD could have more advantageous effects on attenuating PCOS manifestations. The result of this investigation will give us new insight into curing this disease and will provide evidence-based recommendations for prescribing an optimal diet for PCOS women.Trial registrationIRCT20200912048693N3, Trial registered 2022–12-14.https://www.irct.ir/trial/67548

Dynamics of the Prevalence of Diseases Among Fertile Age Women in a Separate Territory of the Krasnoshchyokovo District of the Altai Region Adjacent to the Rocket and Space Activity Zone

Part of the territory of the Altai Region is covered by the contours of the fall areas of the separating parts of launch vehicles during launches from the Baikonur cosmodrome. This paper presents the results of a dynamic analysis of data on the prevalence of diseases among women of fertile age – residents of the Chineta village council of the Krasnoshchyokovo district, as living in the territory adjacent to the fall areas of separable parts of launch vehicles. The data were obtained based on the results of a medical examination of the population of this territory in 2003, 2008, 2013 and 2018 in order to identify the possible negative impact of rocket and space activities on the health of the population. The study revealed the most significant pathology, the overall prevalence of diseases and the frequency of the prevalence of diseases of certain classes in women of fertile age in dynamics.

Penyuluhan Imunisasi Tetanus Toksoid Untuk Calon Pengantin Dan Wanita Usia Subur Di Fasilitas Kesehatan Tingkat Pertama

Tetanus is a serious disease caused by spores of the bacterium Clostridium tetani. Tetanus infection has no boundaries as people of all ages can be infected and it is still a public health problem today, especially for pregnant women and newborns. Neonatal tetanus (TN) is the tetanus infection in infants aged 3 – 28 days after birth and maternal tetanus (MT) is the infection that occurs during pregnancy and up to 6 weeks after delivery. Tetanus infection generally occurs if the delivery is not carried out in health facilities with adequate equipment and is known as one of the most common causes of death during childbirth. The aim of this Community Service activity was to provide counseling about the importance of Tetanus Toxoid (TT) T immunization for prospective brides and WUS who came to the mother and children out-patient clinic at the Primary Health Care. Cadres those bearing an important role in expanding health information for the community were also involved in this program. This Community Service activity held counseling for the prospective bride and fertile-aged women, while the cadres were given refreshing additional knowledge about TT immunization. The results of this activity were increasing the cadres’ knowledge about TT immunization, and those prospective-bride and fertile-aged women were also encouraged to carry out active TT immunization at the Primary Health Care. There is also a need for cross-sector collaboration with the Religious Affairs office in the application of evidence of TT immunization for prospective-bride as a mandatory requirement that could be implemented properly.

The certain aspects of organization of medical care of women in period of pregnancy and delivery in the Republic of Bashkortostan

Health protection of women of reproductive age is a priority direction of state policy. In protection of reproductive health of women no small importance is played by development of organization of primary medical sanitary care and specialized medical care of women during pregnancy and delivery. The study was carried out in the Republic of Bashkortostan and covered period of 2017-2021. It was established that the number of women of fertility age decreased up to 3,9% that became one of causes of reduction of birth rate from 12.1‰ to 9.8‰ respectively. At that, the level of maternal mortality increased up to 8.9 times (from 4.1 to 36.8 per 100,000 born alive). In 2021, out of 37,775 women who completed their pregnancy, 99.3% were examined by therapist and only 92.2% passed such an examination prior to 12 weeks of their pregnancy. On the gestation period of 11-4 weeks, 91.3 % of pregnant women were subjected to ultrasound examination of fetus with detection of maternal serum markers and 94.4% of pregnant women were examined at the 19-21 weeks of pregnancy. Among pregnant women, rate of diseases and pathological conditions that preceded or developed during pregnancy slightly increased. Increasing of morbidity of anemia, diseases of endocrine system, including diabetes mellitus, was noted. The deterioration of particular indicators of organization of medical care of women according to profile "obstetrics and gynecology" occurred during period of COVID-19 pandemic. The implementation of three-level system of organization of medical care resulted in significant reduction of number of obstetric and gynecological hospital beds.

EDUKASI ANIMASI KANKER SERVIKS MENINGKATKAN MINAT WANITA USIA SUBUR TERHADAP PEMERIKSAAN IVA

The low achievement of the target of the visual acid acetate injection examination (IVA) suggests that women of fertile age (WUS) still get little education about cervical cancer. The use of pocketbook media did not show the achievement of IVA inspection targets. The aims to know the impact of cervical cancer animation education on the increased interest of WUS in conducting IVA examinations in Puskesmas Pal Lima. The Method is quasi-experimental research was carried out from April to May 2022 in the UPT Puskesmas Pal Lima work area. The large sample for the research was 30 subjects obtained from the Lameshow formula. Interest scores before and after cervical cancer animation education were measured using a questionnaire of 20 questions. Data analysis using a pair-t test The results of this study showed that giving cervical cancer animation education increased WUS interest in IVA examinations (p = 0,007). The interest score increased by 6.37. Cervical cancer education using animated videos can be used as a midwife to increase WUS interest in IVA examination. Cervical cancer education with audiovisual animation is more efficiently accepted by society than pocket books.

Fertility in Romania: The Delay of the Second Gender Revolution

"Fertility in Romania dropped rapidly after the col lapse of the communist rule, placing the country among those with low fertility rates, and started to grow again after the year 2014. The paper approach es the dynamic of fertility in Romania, focusing on the period when fertility grew again. Using data from the semi-panel conducted by World Values Survey Romanian in 2012 and 2018, the paper looks at the changes in fertility in Romania based on mi cro-level data and studying trends in cohort fertility among women of fertile age and the drivers of these changes. The cohort analysis indicates that birth postponement is the main mechanism leading to the growth in fertility in Romania in the past decade. At the same time, the results provide support to the uncertainty explanation, the fear of job losing having negative impact on the number of children born by a woman. Altogether, the results suggest that Roma nia does not yet reach the second gender revolution, that has gender equality in private sphere at its core, fertility decision relying on traditional factors such as economic uncertainty and patriarchal model, with the male partner being the main breadwinner. "

Primary Ovarian Non-Hodgkin's Lymphoma: An 18-year Retrospective Institutional Study and Review of Literature from India.

Primary lymphomas of the female reproductive tract are rare and the ovarian extranodal presentation of non-Hodgkin's lymphoma (NHL) accounts for only 0.5% of all NHLs and 1.5% of all ovarian malignancies. We retrospectively reviewed the institutional medical oncology database for newly diagnosed NHL cases between 1999 and 2017. We aimed to study the clinical characteristics, pathology, and outcome of primary ovarian non-Hodgkin's lymphoma (NHL) cases presented to our institution. Weidentified three patients (3.7% of extranodal NHLs and 0.85% of all NHL patients) with primary ovarian NHL from 350 NHL patient records. They underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by six to eight cycles of (rituximab, adriamycin, cyclophosphamide, vincristine, prednisolone (R-CHOP/CHOP), and they attained complete remission. Given the heterogeneity of cancer incidence in India and the absence of state-wise cancer registries, our study argues a pressing need to develop a national representative registry for NHL for accurate incidence, mortality, and survival data. Additionally, fertility preservation is an important issue that must be discussed with women of fertile age and the parents of children.

Polycystic ovary syndrome as a gender-specific cardiometabolic risk factor

With aprevalence of 15%, polycystic ovary syndrome (PCOS) is the most common endocrinopathy in fertile-aged women. Insulin resistance and obesity play apivotal role in the pathophysiology of PCOS, modulate the severity of symptoms and are associated with an increased risk for cardiometabolic sequelae such as diabetes, non-alcoholic fatty liver disease and atherosclerotic cardiovascular disease. PCOS should be considered as agender-specific cardiovascular risk factor. Therefore, if traits indicative for PCOS are present, affected women should undergo PCOS diagnostics as afirst step, thereby making it possible to initiate cardiovascular primary prevention strategies in this population of young women at high cardiometabolic risk. In women with known PCOS, screening and treatment of cardiometabolic risk factors and/or diseases should be routinely integrated into the concept of PCOS care. The close link between insulin resistance/obesity and PCOS can be used to improve PCOS-specific symptoms and enhance cardiometabolic health.

Cumulative risk assessment of the dietary heavy metal and aluminum exposure of Finnish adults

While directly comparable toxicological data are unavailable, this pilot study used published toxicological endpoints for neurological damage to weigh the relative importance of cadmium, lead, arsenic, mercury, nickel, and aluminum in the mixture Finnish adults receive from their daily diet. In addition, the effects of a selection of these chemicals on cognition, kidney tubular damage, and fertility were assessed using the toxicological endpoints available in the Chemical Mixture Calculator developed by the Technical University of Denmark. Consumption data from the FinDiet 2012 national survey of 25 to 74-year-olds and occurrence data mainly obtained in national monitoring were used to estimate the cumulative dietary exposure, which was found to be so high that the possibility of neurological damage or kidney effects cannot be ruled out for most of the population, particularly fertile age women. For Finns below the age of 65 years, the main sources of cumulative exposure were bread and other cereals, non-alcoholic drinks, and vegetables. When mean exposure was statistically compared between age groups and genders, women aged 25 to 45 years had a statistically significantly higher exposure than men of the same age (P < 0.05) and women aged 46 to 64 years (P < 0.001).

The Use of Non-Hormonal Contraception in Women of Fertile Age

Long-term use of hormonal contraception has various effects on acceptors. These side effects can be minimized by using non-hormonal contraceptives (condoms, IUDs, MOW) where their use is still very low. The purpose of this study was to determine the factors associated with the use of non-hormonal contraceptives in WUS. The research design is quantitative with a cross sectional approach. The sample of this study was 194 women of childbearing age who were taken by random technique. Data were collected using a questionnaire. The statistical test used was univariate with percentage, bivariate with chi square and multivariate with logistic regression. The results of the bivariate analysis of several variables showed that there was a relationship between age (p = 0.049), service availability (p = 0.000) with the use of non-hormonal contraceptives. While the variables of knowledge, husband's support, parity, family income, information on health workers and access proved to have no relationship with the use of contraceptives.

Cryopreservation of ovarian tissue as fertility preservation in young women with multiple sclerosis before stem cell transplantation.

Women of fertile age who receive autologous hematopoietic stem cell transplantation (AHSCT) due to multiple sclerosis (MS) are at risk of loss of ovarian function and infertility because of the conditioning regimen with alkylating agents. To present our data on fertility preservation by ovarian tissue cryopreservation (OTC) in young women with MS before AHSCT. Retrospective, observational cohort study RESULTS: Eight women had OTC. After AHSCT four had premature ovarian insufficiency (POI), and two of these had autotransplantation of their cryopreserved ovarian tissue. Both women regained ovarian function, and a spontaneous pregnancy was achieved resulting in the delivery of a healthy baby. OTC preserves fertility in young women with MS at risk of POI.

0118 Association between TNF-α G308A Polymorphism (rs1800629) and Insomnia Vulnerability in Fertile Age Women with Primary Dysmenorrhea

Abstract Introduction Higher tumor necrosis factor-alpha (TNF-α) gene expression has been revealed in the peripheral blood monocytes across the menstrual cycle in patients with primary dysmenorrhea (PDM) than in the unaffected control. Sleep quality is affected by environmental factors, endocrine function abnormalities and genetic factors. The aim of this study was to evaluate the effect of TNF-α G308A polymorphism (rs1800629) on the self-reported sleep, health, menstrual pain severity as well as peri-ovulatory serum TNF-α level in women with and without PDM. Methods Sleep, psychological and physiological characteristics and menstrual pain severity were collected with questionnaires and sleep/menstrual diary within a menstrual cycle from a cohort of 43 PDM women and 42 healthy controls (aged 20-30 years, right-handed, non-smoking and non-shift workers without psychiatric, sleep and neurological comorbidity). Chi-square tests were used to check if the genotype proportions of the investigated gene fitted the Hardy-Weinberg equilibrium (HWE) and to evaluate if the genotypic and allelic distribution is associated with PDM. Chi-square tests or analysis of variance were used to examine the effects of genotype, group and/or genotype x group interaction with the sleep, mind and the body health variables. Results Neither allele frequencies nor genotypes of TNF-α G-308A gene could serve as an independent risk factor of PDM in the Taiwanese population. Circulating serum TNF-α did not correspond with the -308 TNF-α promoter polymorphism, either, which might be due to a multifactorial control process. The TNF-α 308 A allele carriers (28.6%) which was less common than the G allele carriers (71.4%), showed lower Beck depression score, lower bodily pain and better physical health and higher subjective sleep quality. Furthermore, in G allele carriers, the PDM group showed higher insomnia severity and lower sleep duration than that of the control group. Conclusion Present results suggested that TNF-alpha polymorphism conferred no prediction to PDM risk and peri-ovulatory serum TNF-α level. However, our findings were evident that the A allele at the TNFα 308 locus, as compared to the more common G allele, was associated to better health and better sleep, with an indication of a genetic underpinning to their better resistance from the risk of PDM. Support (if any)

Significance and Interrelationship of the Symptoms Listed in the DSM Criteria for Premenstrual Dysphoric Disorder.

While premenstrual dysphoric disorder (PMDD) as defined in DSM has become an established diagnosis, and a formal indication for drug treatment, the relative impact of the disparate symptoms named in the criteria, and to what extent they indeed constitute parts of one syndrome, remains insufficiently clarified. We have therefore explored the frequency, impact, and inter-relationship of different PMDD symptoms. Using a web survey, 10,457 Swedish women of fertile age were asked to retrospectively assess if they experience reduced functioning due to symptoms clearly associated with the premenstrual phase. Those responding affirmatively reported presence, severity, and impact of each symptom named in the PMDD criteria. Nine percent reported impairing premenstrual symptoms. Whereas irritability was reported to cause impairment in 77% of those passing the gate questions, somatic symptoms were common but seldom causing impairment. A vast majority reported presence of at least 5 different symptoms, as required to meet the PMDD criteria, but few reported each of 5 different symptoms to be severe or impairing. An analysis of the association between symptoms revealed clear-cut clustering of somatic and mood symptoms, respectively. While retrospective account suggested irritability to be the clinically most important premenstrual symptom, some of the complaints named in the PMDD criteria were not or only weakly associated with mood symptoms and also reported to be of limited clinical significance. It is concluded that regarding all symptoms listed in the DSM criteria as clinically relevant manifestations of one and the same syndrome may be questioned.

Hubungan Pengetahuan Terhadap Deteksi Dini Kanker Leher Rahim Di Kawasan Pesisir Dan Kepulauan Ambalau

Ca Cervix at the fourth rank from all of oncology in women in the word after ca mamae, colorectum and lungs. Early detection use IVA method. Data in 2021, from 390 women in fertile age who have early detection amounted 60 women (15%). This research determine to relationship knowledge with ca cervic early detection with IVA method in coastal and islands area at 2023. This research used analysis description with cross sectional study. 78 women in fertile age as respondent of this research. Instrument of this research used questionnaire. Data processing used SPSS with chi square test. Result of chi square got relationship knowledge with early detection cancer cerviks equal 0,000 p&lt;0,05). Conclution of this research showed there was relattionsgip between knowledge to ca cervix early detection with IVA method in coastal and islands area at 2023.