Irregular Bleeding Research Articles

Влияние дроспиренонсодержащего комбинированного орального контрацептива на антропометрические, ультразвуковые характеристики и показатели углеводного обмена у женщин с синдромом поликистозных яичников

Background: polycystic ovary syndrome (PCOS) is an endocrine disorder affecting 10% of women of reproductive age. Combined oral contraceptive pills (COCP) are effective in PCOS. Drospirenone is a new progestin with properties similar to natural progesterone (including anti-mineralocorticoid and antiandrogenic activities). Aim: to evaluate the effect of drospirenone-containing COCP (20 μg ethinylestradiol and 3 mg drospirenone) on anthropometric and sonographic characteristics, and carbohydrate metabolism parameters in women with PCOS. Patients and Methods: this prospective study enrolled 22 women of reproductive age (mean age 22.1±0.5 years) with PCOS. All females were treated during six cycles (28 days each). At baseline and 6 months after starting treatment, anthropometric (body mass index/BMI, waist-to- hip ratio/WHR) and sonographic (ovary volume) characteristics, and carbohydrate metabolism parameters (plasma insulin, fasting glucose, homeostasis model assessment of insulin resistance/HOMA-IR) were assessed. Results: 6 months after starting treatment, a significant (p<0.05) reduction in BMI (from 22.54±0.43 kg/m2 to 20.86±0.26 kg/m2), WHR (from 0.81±0.01 to 0.78±0.01), and ovary volume (left ovary: from 12.75±0.43 cm3 to 8.05±0.15 cm3; right ovary: from 13.0±0.54 cm3 to 8.63±0.14 cm3) was reported. Meanwhile, no significant (р>0.05) changes in plasma insulin concentration (9.91±0.42 μU/ml vs. 9.52±0.31 μU/ml), fasting blood glucose (4.95±0.08 mmol/l vs. 4.9±0.07 mmol/l), and HOMA-IR (3.2±1.12 vs. 3.06±0.07) compared to baseline levels were reported. The most common side effects were headache or dizziness (n=3, 13.6%), nausea (n=2, 9.1%) and irregular bleeding (n=3, 13.6%). Conclusion: drospirenone-containing COCP has a beneficial effect on anthropometric paramaters and ovary volume but does not affect carbohydrate metabolism. This drug is characterized by excellent compliance. KEYWORDS: polycystic ovary syndrome, drospirenone, body mass index, waist-hip ratio, reproductive age, ovary volume, glucose, insulin, carbohydrates, HOMA-IR. FOR CITATION: Saprykina L.V., Narimanova M.R., Ibragimova D.M. Effect of drospirenone-containing combined oral contraceptive pills on anthropometric and sonographic characteristics and carbohydrate metabolism parameters in women with polycystic ovary syndrome. Russian Journal of Woman and Child Health. 2022;5(2):118–121 (in Russ.). DOI: 10.32364/2618-8430-2022-5-2-118-121.

Effectiveness and follow-up of depot medroxyprogesterone acetate in postpartum and postabortal patients

Background: Contraception is the intentional use of artificial methods or other techniques to prevent pregnancy as a consequence of sexual intercourse. Progesterone only injectables are highly effective in preventing in pregnancy as they do not rely on daily usage of contraceptions as such as oral contraceptive pills and barrier methods. Injection depot-medroxyprogesterone acetate (DMPA) is an effective contraceptive method in lactating mother and postabortal patients. Aims and Objectives: The aims of this study were to study utilization pattern, acceptance, effectiveness, and adverse effects of DMPA in postpartum and postabortal women. Materials and Methods: It was a prospective and observational single-center study and was conducted at tertiary care teaching hospital. The data were collected in patient received Inj. DMPA 150 mg intra muscularly immediately after abortion and delivery before discharge. The follow-up was done after administration of DMPA (usually every 3 months). Results: In this study, 56 (53.34%) patients were in the age group of 18–25 years, while 38 (36.19%) patients were 26–35 years whereas 11 (10.47%) were more than 36 years. Out of 105 patients, 12 patients were administered only one injection, 16 patients administered two injections and 16 patients given three injections of DMPA. Common adverse effects of DMPA are irregular bleeding (43.8%), amenorrhea (22.8%), and heavy bleeding (5.7%). Out of 24 patient who developed amenorrhea, 11 patients after 4th injection, five patients after first injection, and patients after second injection of DMPA. Average time for return of fertility after last injection of DMPA was 9 months. Conclusion: DMPA is very effective contraceptive and apart from menstrual troubles that there are no significant major side (weight gain, mood changes, etc.) effects related to its use. DMPA may cause a delay in the return of fertility, the return of fertility takes 7–10 months from date of last injection, but it is completely reversible.

Color Doppler and Transvaginal Sonography; Accuracy in the Diagnosis of Endometrial Pathologies in Women with Abnormal Uterine Bleeding: A Cross-sectional Study

Introduction: Abnormal uterine bleeding (AUB) can occur at any age in a woman’s life, and it is more prevalent in the premenopausal age group. Although anovulation is the most prevalent endometrial cause, other major reasons include endometrial hyperplasia, endometrial adenomatous polyps and cancer. For patients of all ages, it is one of the most prevalent presentations in Gynecology OPDs. AUB has a major impact on health-related quality of life, necessitating quick intervention. AUB treatment is difficult without a good diagnosis. As a result, pre-menopausal and post-menopausal women with AUB must have a thorough examination to rule out endometrial cancer. Aim: To assess the role of transvaginal ultrasound and color Doppler tomography (CDTU) in irregular uterine bleeding and correlate these findings with histological diagnosis. Methodology: The present study included 92 individuals with abnormal uterine bleeding (AUB), in those TVS, and Color Doppler was used to evaluate the endometrial pathologies. Endometrium, uterine size and any uterine or adnexal disease were evaluated during the TVS. Spiral arteries of the endometrium and uterine arteries were studied for their vascular patterns. The RI and PI of the uterine artery were determined. For PI, a cutoff of 1.83 was used, while for RI, a cutoff of 0.81 was used. The results were then compared to endometrial histology. Results: According to TVS, (see Table 1) the most common causes of AUB were leiomyoma (15.2%), polyp (12%), PCOS (9.8%), adenomyosis (5.43%) and endometrial development (3.3%). The uterine indicators of RI (0.81) and PI (1.83) of the uterine artery by CDTU revealed 11 patients with probable cancer. For AUB M, the TVS with CDTU specificity and sensitivity was 100 percent and 90.77 percent, respectively. The positive predictive value was 45%, whereas the negative predictive value was 100%. Conclusion: The use of vascular impedance and color Doppler of the uterine artery and endometrial spiral arteries improves the diagnostic accuracy of TVS for the prediction of endometrial diseases. It makes screening for malignant and premalignant lesions easier.

Endometrial carcinoma in asymptomatic postmenopausal women with a thickened endometrium

Introduction. The most common clinical manifestation of endometrial cancer is postmenopausal bleeding, as well as irregular uterine bleeding. Far less often, endometrial cancer may also be present in postmenopausal women without bleeding. The aim of our study was to examine the incidence of endometrial cancer in asymptomatic postmenopausal women with a thickened endometrium. Material and Methods. The research included 251 asymptomatic postmenopausal women with endometrial thickness over 4 mm established by ultrasound. Exploratory curettage was performed in all the patients, followed by histopathological examination of the obtained material. Results. The average age of the respondents was 65.38 ? 26.69 years. The average thickness of the endometrium was 15.68 ? 5.06 mm. Of all the patients, 70.13% presented with benign endometrial disease; endometrial polyps were found in 58.18% and simplex hyperplasia of the endometrium without atypia in 11.95%. Endometrial cancer was found in 1.59% of patients, ovarian cancer metastasis in 0.4%, and endometrial hyperplasia with atypia in 1.59% of patients. All cases of endometrial cancer were diagnosed in patients with endometrial thickness over 11 mm. Conclusion. The approach to asymptomatic women with endometrial hyperplasia should be individual. Exploratory curettage/hysteroscopy should be recommended to patients with endometrial thickness over 11 mm in order to detect and evaluate for endometrial cancer. Asymptomatic women with endometrial thickness of 4 - 10 mm should be further examined, especially in case of associated risk factors or other ultrasound parameters that indicate more serious endometrial pathology.

THE EFFECT OF EPIDURAL VOLUME EXTENSION ON SPINAL BLOCK WITH 0.5% HEAVY BUPIVACAINE IN TOTALABDOMINAL HYSTERECTOMY - A RANDOMISED CONTROLLED STUDY

Introduction: One of the indication of total abdominal hysterectomy and bilateral salpingo -oophorectomy is the patient is suffering from menometrorrhagia, excessive or irregular menstrual bleeding that occurs between or during a female's menstrual cycle. Menometrorrhagia is a indication of urogenital malignancy (such as cervical malignancy), uterine broids, hormonal discripancies and endometriosis. Other possible indications for TAHBSO are pelvic inammatory disease,ovarian cyst, cancer of overies, uterus and or cervix. If remains untreated this can lead to anemia. Aims And Objectives: Compare maximum sensory block level in each group (Smax), Period when Smax was rst achieved, Period for 2 segment regression of sensory block from its highest level, Period for block regression to level of T10 dermatome e. Maximum motor blockade achieved, Time to attain maximum motor block, Time for complete regression of motor block(modied Bromage score=6),To compare any difference in haemodynamic parameters(Spo2,mean blood pressure). Materials And Methods Study Setting:This study will be conducted in the gynaecology OTComplex of IPGME&R. Study Period: March 2017-August 2018 Definition Of Problem: Comparative evaluation of the effect of epidural volume extension on spinal block with 0.5% heavy bupivacaine for total abdominal hysterectomy such as Results And Analyses: Our study showed that the distribution of body weight between Group E and Group S. Body weight was normally distributed, it was found that there was no statistical signicance difference between the groups (p=0.4054). Distribution of ASAstatus in groups, In group E 25patient were. Summary And Conclusion: This technique is, however, not without its disadvantages, which draws special attention from an anesthesiologist such as rapid rise of spinal block, accidental migration of catheter in intravascular and intrathecal space along with an increased incidence of meningitis. In future We in subsequent case series will try to highlight the efcacy of this novel technique in patients of different setting with compromised cardiac functional status.

Choriocarcinoma: A Review

Here in his article, we will learn about choriocarcinoma, a highly malignant tumor arising from the chorionic epithelium. Among 3-5% of all patients with molar pregnancies develop choriocarcinoma. All the types of choriocarcinomas and their defining features are discussed below in a view to you to understand better the basic pathogenesis, histology, etiological factors involved. The patient may present with persistent ill-health, irregular vaginal bleeding, continued amenorrhea, and when it is metastasized, it forms lesions which present in the lung as cough, breathlessness, hemoptysis whereas in the vagina as irregular and at times as brisk hemorrhage. It can also have lesions in the cerebral region presenting as headache, convulsions, paralysis. Signs include pallor of varying degrees, and in all, the patient looks ill. Various investigations necessary to identify this disease are chest x-ray, pelvic sonography, diagnostic uterine curettage, etc. also, excisional biopsy, the ratio of HCG levels, CT scan, ultrasonography, chest X-ray can also be done. We also talked about staging in the forthcoming article for gestational trophoblastic tumors. Management of the same has also been discussed below to treat the disease better and cure many patients. It can be preventive as well as curative. Here we have talked about treatment modalities for low-risk and high-risk patients. Also, add treatment for those resistant to the drugs used for low-risk and high-risk patients. Finally, prophylactic chemotherapy and follow-ups are given.

A Study Protocol to Assess the Correlation of Endometrial Morphology with Concerned Hormone Levels in Patients of Abnormal Uterine Bleeding

Background: Abnormal-uterine-bleeding (AUB) is caused due to numerous systemic or functional etiologies. Patients may come with metrorrhagia, menorrhagia, intermenstrual bleeding and polymenorrhea. The underlying pathology can be ascertained by histological variations of endometrium considering the age, the phase of menstrual cycle and the use of any exogenous hormones. This study aims to assess the correlation between endometrial changes and concerned hormone levels.
 Methodology: This will be a Prospective study conducted for two years in Histopathology Department of Pathology, JNMC, Wardha. Total 65 female patients with complaint of irregular uterine bleeding will be included in this study. The histomorphology patterns of endometrial lesions will be studied and classified according to WHO classification. The collected data will be analysed using appropriate statistical methods.
 Results: A Significant correlation is expected between endometrial changes and concerned hormone levels.
 Conclusion: Conclusion will be drawn from the results obtained from the study.

Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery.

Endometriosis is a condition characterised by the presence of ectopic deposits of endometrial-like tissue outside the uterus, usually in the pelvis. The impact of laparoscopic treatment on overall pain is uncertain and a significant proportion of women will require further surgery. Therefore, adjuvant medical therapies following surgery, such as the levonorgestrel-releasing intrauterine device (LNG-IUD), have been considered to reduce recurrence of symptoms. OBJECTIVES: To determine the effectiveness and safety of post-operative LNG-IUD in women with symptomatic endometriosis. We searched the following databases from inception to January 2021: The Specialised Register of the Cochrane Gynaecology and Fertility Group, CENTRAL (which now includes records from two trial registries), MEDLINE, Embase, PsycINFO, LILACS and Epistemonikos. We handsearched citation lists of relevant publications, review articles, abstracts of scientific meetings and included studies. We contacted experts in the field for information about any additional studies. We included randomised controlled trials (RCTs) comparing women undergoing surgical treatment of endometriosis with uterine preservation who were assigned to LNG-IUD insertion, versus control conditions including expectant management, post-operative insertion of placebo (inert intrauterine device), or other medical treatment such as gonadotrophin-releasing hormone agonist (GnRH-a) drugs. Two review authors independently selected studies for inclusion, and extracted data to allow for an intention-to-treat analysis. For dichotomous data, we calculated the risk ratio (RR) and 95% confidence interval (CI) using the Mantel-Haenszel fixed-effect method. For continuous data, we calculated the mean difference (MD) and 95% CI using the inverse variance fixed-effect method. Four RCTs were included, with a total of 157 women. Two studies areongoing. The GRADE certainty of evidence was very low to low. The certainty of evidence was graded down primarily for serious risk of bias and imprecision. LNG-IUD versus expectant management Overall pain: No studies reported on the primary outcome of overall pain. Dysmenorrhoea: We are uncertain whether LNG-IUD improves dysmenorrhoea at 12 months. Data on this outcome were reported on by two RCTs; meta-analysis was not possible (RCT 1: delta of median visual analogue scale (VAS) 81 versus 50, P = 0.006, n = 55; RCT 2: fall in VAS by 50 (35 to 65) versus 30 (25 to 40), P = 0.021, n = 40; low-certainty evidence). Quality of life: We are uncertain whether LNG-IUD improves quality of life at 12 months. One trial demonstrated a change in total quality of life score with postoperative LNG-IUD from baseline (mean 61.2 (standard deviation (SD) 14.8) to 12 months (mean 70.3 (SD 16.2) compared to expectant management (baseline 55.1 (SD 17.0) to 57.0 (SD 33.2) at 12 months) (n = 55, P = 0.014, very low-certainty evidence). Patient satisfaction: Two studies found higher rates of satisfaction with LNG-IUD compared to expectant management; however, combining the studies in meta-analysis was not possible (n = 95, very low-certainty evidence). One study found 75% (15/20) of those given post-operative LNG-IUD were "satisfied" or "very satisfied", compared to 50% (10/20) of those in the expectant management group (RR 1.5, 95% CI 0.90-2.49, 1 RCT, n=40, very low-certainty evidence). The second study found that fewer were "very satisfied" in the expectant management group when compared to LNG, but there were no data to include in a meta-analysis. Adverse events: One study found a significantly higher proportion of women reporting melasma (n = 55, P = 0.015, very low-certainty evidence) and bloating (n = 55, P = 0.021, very low-certainty evidence) following post-operative LNG-IUD. There were no differences in other reported adverse events, such as weight gain, acne, and headaches. LNG-IUD versus GnRH-a Overall pain: No studies reported on the primary outcome of overall pain. Chronic pelvic pain: We are uncertain whether LNG-IUD improves chronic pelvic pain at 12 months when compared to GnRH-a (VAS pain scale) (MD -2.0, 95% CI -20.2 to 16.2, 1 RCT, n = 40, very low-certainty evidence). Dysmenorrhoea: We are uncertain whether LNG-IUD improves dysmenorrhoea at six months when compared to GnRH-a (measured as a reduction in VAS pain score) (MD 1.70, 95%.CI -0.14 to 3.54, 1 RCT, n = 18, very low-certainty evidence). Adverse events: One study suggested that vasomotor symptoms were the most common adverse events reported with patients receiving GnRH-a, and irregular bleeding in those receiving LNG-IUD (n = 40, very low-certainty evidence) AUTHORS' CONCLUSIONS: Post-operative LNG-IUDiswidely used to reduce endometriosis-related pain and to improve operative outcomes. This review demonstrates thatthere is nohigh-qualityevidence to supportthis practice. This review highlights the need for further studies with large sample sizes to assess theeffectivenessof post-operative adjuvant hormonal IUD on the core endometriosis outcomes (overall pain,most troublesome symptom, and quality of life).

An Unusual Imaging of Atypical Polypoid Adenomyoma in a 21-Year-Old Woman

A 21-year-old woman was admitted with a 9-month history of irregular vaginal bleeding, anemia, and an enlarged abdominal mass on examination. The MRI scan showed an intracavitary mass measuring 95 × 45 × 63 mm (Fig. 1A). Hysteroscopy revealed multiple cauliflower-like lesions (Fig. 1B), with biopsies demonstrating an atypical polypoid adenomyoma (APA). Following 3 months of GnRHa treatment, the lesion size decreased to 69 × 49 × 70 mm, and hysterotomy at laparotomy was undertaken to remove the lesion (Fig.

Laparoscopic Resection of a High Grade Serous Ovarian Cancer that Recurred at the Vaginal Stump with Extensive Pelvic Adhesions after Complete Surgical Staging

To show laparoscopic resection of a high grade serous ovarian cancer that recurred at the vaginal stump with extensive pelvic adhesions after complete surgical staging. Stepwise demonstration of the procedure with narrated video footage. University hospital. We reported a case of a 62-year-old woman with a history of complete surgical staging of high grade serous ovarian cancer staged IIB, which consisted of hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node dissection, and omentectomy, about 18 months before this admission. She received 6 courses of carboplatin/paclitaxel combination therapy after complete surgical staging and achieved complete remission. About 12 months after the last course of chemotherapy, she visited the local clinic because of irregular vaginal bleeding. Physical examination revealed a 3×3×2 cm3 mass at the vaginal vault. Biopsy of the mass was performed under colposcopy, and pathological reports showed recurrent high grade serous cancer. Her serum cancer antigen 125 level was in normal range. Positron emission tomographic/computed tomographic imaging (PET/CT) showed no evidence of disease dissemination. A diagnosis of recurrent high grade serous ovarian cancer was made. After the biopsy of the recurrent mass, there were no visible lesions, which made us believe that laparoscopy management would not contribute to intraperitoneal spread of the tumors. Therefore, laparoscopic resection of the vaginal stump was scheduled. The key steps of the procedure were summarized as follows. First, the bowels were released from the side abdominal wall to expose bilateral external iliac vessels. Second, bilateral ureters were identified and mobilized to avoid incidental ureter injuries. Third, we opened the rectovaginal space and detached the rectum from the posterior vaginal wall. Fourth, the posterior vesical wall was separated from the vaginal stump. After exposure of the key anatomic landmarks, laparoscopic resection of the vaginal stump was performed safely. Final pathologic report showed recurrent high grade serous ovarian cancer. The patient received 6 courses of carboplatin/paclitaxel combination therapy, and maintenance therapy with olaparib was suggested, but the patient refused to accept this suggestion. She is still in complete remission 8 months after surgery. Laparoscopic resection of a high grade serous ovarian cancer that recurred at the vaginal stump with extensive pelvic adhesions after complete surgical staging was achieved successfully in a logical way. The critical point of the procedure is to expose the key anatomic landmarks of the pelvis to avoid incidental injuries [1].

Review of PPIUCD at tertiary care centre in Southern Rajasthan

Background: This study was conducted to observe the acceptance rate and safety for PPIUCD as PPIUCD was used as contraceptive method under family welfare program in this institute. Aims and Objectives: To see pattern of acceptance and safety of PPIUCD among women admitted for childbirth. Materials and Methods: A prospective, preformed semi-structured questionnaire-based observational study was conducted between September 2012 and August 2020 in the Government Medical College Kota. CuT380A was used as PPIUCD for insertion. WHO medical eligibility criteria were met along with inclusion and exclusion criteria. After counseling and consent, PPIUCD was inserted post-placentaly and during LSCS. Acceptance rate was calculated along with safety profile. Results: In the present study majority of patients were in the age group of 21–30 years. 44.26% women were second para. 96.35% insertions were uneventful during the study. The most common reason for acceptance and refusal of PPIUCD was reversibility and for refusal was fear of complications, respectively. The acceptance was increasing over the years. On follow-up majority of clients had no complaints. Among those who had complaints, irregular bleeding was most common. Major cause of requesting for removal was irregular bleeding. Continuation rate was found to be 91.91% and 85.30% at 6 weeks and 6 months, respectively. Conclusion: PPIUCD is a safe and effective method of contraception. Acceptance rate is increasing over the years and which can further increase with antenatal, intra natal and postnatal counseling along with counseling of husband/family attendants and management of side effects.

Association between experience of specific side-effects and contraceptive switching and discontinuation in Uganda: results from a longitudinal study

BackgroundThere is substantial evidence that contraceptive side-effects are a major deterrent to consistent use of contraception but few studies in low- or middle-income countries explore the role of specific side-effects on contraceptive use dynamics. This study used population-based, longitudinal data to explore the effect of specific side-effects on contraceptive continuation, discontinuation, and switching in Uganda.MethodsData for this study come from two rounds of survey data collection in Uganda: PMA2020’s sixth cross-sectional survey and a follow-up survey conducted 1 year later. The main outcomes of interest were discontinuation and switching among users of hormonal contraceptive methods (implants, injectables and oral pill) and the IUD at baseline (n = 560). Multivariable logistic regressions assessed the association of experiencing specific side-effects (more bleeding, less bleeding, irregular bleeding, increased dryness/reduced libido, and physical discomfort) with discontinuation and switching 1 year later, adjusting for socio-demographic characteristics, type of method, and length of use. We also examined the differential effects of side-effects between discontinuation and switching risks.ResultsAbout 23% of hormonal and IUD contraceptive users reported experiencing side-effects at baseline survey. Overall, discontinuation and switching were higher among injectables and pill users, compared to IUD and implants users. Reporting more bleeding or less bleeding increased the odds of discontinuation and switching by 2.74 (95% CI 1.00–7.51) and 1.86 (1.04–3.34), respectively. There was no significant difference in discontinuation and switching by side-effects.ConclusionsGreater attention should be paid to understanding the unique contributions of side-effects to contraceptive behavior using population-based data. While about a quarter of women reported experiencing side effects, those who experienced bleeding specific side effects were at higher risk of contraceptive discontinuation and switching. Providing greater individualized care that includes information and counseling about common side-effects, how they may impact daily life, and how tolerable these effects may be is necessary.

Immunohistochemical Analysis of the Expression of the Glycodelin Cytokine in Endometrial Tissue and the Endometrial Polyp, Before and After Hysteroscopy, in Infertile Female Patients

Abstract An endometrial polyp is most commonly a benign, localized proliferation of the glands and the endometrial stroma, covered with epithelium and protruding above the level of the mucosa. These polyps are most often diagnosed during investigation into the causes of irregular menstrual bleeding or infertility. It is produced in the highest concentration during the secretory phase of the endometrial cycle. The level of glycodelin reaches its peak 12 days after ovulation. The aim of this paper was to determine the changes in the immunohistochemical expression of glycodelin at the level of the endometrium and in the tissue of the polyp, before and after hysteroscopic polypectomy, in infertile female patients with an endometrial polyp, and in the endometrial tissue of female patients without an endometrial polyp. The study included 82 infertile female patients. The infertile patients were divided into two groups. The first was the experimental group which included 56 infertile female patients who had an endometrial polyp. The second group was the control group, composed of 26 infertile female patients who did not have an endometrial polyp. The results obtained primarily indicate the existence of changes in the immunohistochemical expression of the cytokine glycodelin in the female patients from both the experimental and the control group, not only prior to but also after hysteroscopy. A larger number of patients who have an endometrial polyp show a lack of glycodelin expression, more pronouncedly so in the bioptate of the endometrium than in the endometrial polyp.

Ayurvedic Management of Endometrial Hyperplasia - A Case Report

Abnormal uterine bleeding is the changes in frequency of menses, duration of flow or amount of blood loss. AUB affects 1/3 of the women of child bearing age. Increased endometrial thickness is a common cause of abnormal uterine bleeding. Unopposed action of estrogen on endometrial tissue cause endometrial hyperplasia. Heavy menstrual bleeding is the main clinical feature of this condition. Premenopausal period is more susceptible to hyperplasia of endometrium. Atypical type of endometrial hyperplasia may lead to endometrial cancer. Medical management with correction of hormone imbalance is the first line of treatment. According to Ayurveda Asrugdara is a condition where there is occurrence of heavy menstrual bleeding. Excess intake of food which are Lavana (salt), Amla (sour), Guru (heavy) Teekshna (pungent) and Snigda (unctuous) etc leads to this condition. There are 4 types Asrugdara. The nature of menstrual bleeding in Kaphaja Asrugdara is Guru (heavy), Seetalam (cold) and Ghanam (dense). In Paithika asrugdara there is excess menstrual bleeding. This is the case report of 40 yr old female subject who came to the OPD of Prasutitantra and streeroga, Govt. Ayurveda college Thiruvananthapuram with complaints of irregular and heavy menstrual bleeding. She had undergone allopathic management both medical and surgical. Her endometrial thickness was 19mm at commencement of treatment. The condition at that time had features of Kapha paithika asrugdara and hence treatment principle of Kapha paithika asrugdara were applied here. The patient got considerable relief in clinical features, reduced number of pads from 15-18/day to 3 pads/day and her duration got reduced from 35 days to 3 days. Hence appropriate Ayurvedic management for Asrugdara with due consideration to Doshas can be effective in conditions like endometrial hyperplasia.

Identification and treatment of primary cervical gestational trophoblastic neoplasia: a retrospective study of 13 patients and literature review

BackgroundPrimary cervical gestational trophoblastic neoplasias (GTNs) are extremely rare ectopic GTNs. Such lesions are difficult to diagnose clinically because of their rarity, with abnormal vaginal bleeding of a non-specific cause being the most common symptom. To that end, this retrospective study aimed to identify the clinical characteristics of cervical GTN and to explore diagnostic and therapeutic strategies.ResultsThirteen patients diagnosed with primary cervical GTN at the Department of Gynecology, Peking Union Medical College Hospital, Beijing, China, between June 1, 1988 and May 31, 2020 were included in the study. All patients had irregular vaginal bleeding, including six who presented with massive bleeding. Seven patients (53.8%) were initially misdiagnosed with a cervical pregnancy. All patients received chemotherapy; 11 (84.6%) also underwent hysterectomy because of chemoresistant lesions or uncontrolled bleeding. All patients achieved complete remission; however, two women (15.4%) experienced a relapse during the median follow-up period of 35 months. A comprehensive review of English-language literature published between 1980 and 2020 identified 22 case reports encompassing 27 patients. The definitive diagnosis was achieved via pathology in 26 of them (96.3%), and hysterectomy was performed in 21 (77.8%).ConclusionsOwing to its rarity and nonspecific symptoms, the diagnosis of primary cervical GTN is challenging and often relies on pathology. The combination of chemotherapy and hysterectomy is the main therapeutic strategy for this disease.

A Clinical Study to Evaluate the Efficacy of Asthapana Basti and Uttar Basti in Asrigdara w.s.r to Abnormal Uterine Bleeding

Regular periods are necessary to maintain good health of women. Any abnormality in Rituchakra leads to excessive and irregular uterine bleeding which is known as Asrigdara which can be correlated to Abnormal Uterine bleeding. In Ayurvedic text, many preparations are described to treat Asrigdara. Samshodhan therapy is mainstay in the management of Artava related disorders of which Basti is supreme to manage Asrigdara. In conventional science, Hormonal therapy is given but chances of recurrence of the disease are high. This study was planned to provide simple, safe, non- hormonal drug for the patients of Asrigdara. Total 40 patients fulfilling the inclusion criteria were selected randomly from Dept. of Stree roga and Prasuti tantra O.P.D.and I.P.D. The total effect of drug was evaluated on the basis of signs and symptoms after completion of therapy. Overall effect of therapy shows in group-I 6 (60%) patients were markedly improved, 11 (61.11%) were partially improved and 1 (5.6%) was not improved and group II- 6 (33.33%) patients were cured, 9 (50%) were markedly improved, 2 (11.1%) were partially improved, and 1 (5.6%) was unimproved. Thus, Basti Chikitsa manifested promising results for the management of Asrigdara, although hormonal pill manifested better cycle but for shorter duration.

Can Plant Product be Substitute for Artificial Oral Contraceptive Pills

Contraceptive methods mean birth control and fertility control methods or devices which used to prevent pregnancy. There are many categories of birth control methods but some having negative influence or risks and some safest and healthiest options. In the present study, we surveyed 269 women from Ahmednagar region and we found that among the 269 women, 179 women were used artificial contraceptives and rest of the women were not used any type of contraceptives. According to the feedback of these women only some having satisfaction and remaining most of women are not satisfactory with these contraceptives, because of high risk of cervical cancer, blood clots, cycle irregularities, irregular bleeding, loss of sexual function, vaginal infection etc. Hence according to survey, we analyse that many women turn to birth control pills because they are not aware that there are safer options available.

Endometrial polyps

A 23-year-old woman presented to our hospital with a 5-month history of irregular vaginal bleeding. She was not sexually active and had no medical problems. The blood laboratory values showed the hemoglobin level to be 5.6 g/dL and white blood cell count to be 5600/mm3, with 70% granulocytes. The coagulation and liver function tests were normal. Ultrasound examination revealed a significantly abnormal uterus.

Machine Learning-Based Head Computerized Tomography Imaging in Diagnosis and Surgery Treatment of Hypertension Cerebral Hemorrhage

The aim of this study was to explore the adoption of computerized tomography (CT) based on machine learning in the diagnosis and treatment of cerebral hemorrhage. A total of 150 patients with hypertensive intracerebral hemorrhage who underwent surgical treatment in hospital in the recent three years were selected. All patients underwent brain CT examination, and image data were collected. FCM, DRLSRE, FCRLS, and other algorithms were utilized to segment the patient’s bleeding region, and the segmentation performance of each algorithm was compared. Based on the FCRLS algorithm segmentation, the bleeding area was calculated by using the function in the MATLAB toolbox. Based on the previous research, a computer-aided diagnosis (CAD) system was designed and verified. The results showed that FCRLS had the best segmentation effect and the fastest segmentation speed for discontinuous and irregular bleeding areas. The CAD system can obtain the information of bleeding site, bleeding amount, midline displacement, and ventricle compression comprehensively and accurately. The accuracy of this system was 94% and 86% for hematoma of patients with rapid bleeding and those with slow bleeding, respectively. The overall accuracy was 91.3%. To sum up, the CAD system based on machine learning and head CT image had good diagnostic effect for patients with hypertensive intracerebral hemorrhage and had high clinical adoption value.

Neuroendocrine Changes during Menopausal Transition

Menopause is the permanent cessation of menstrual cycles following the loss of ovarian follicular activity. Quality of life of postmenopausal woman is the result of a series of psychobiological transformations, that see in the reduction of sex hormones and steroids the etiopathogenetic determinant moment. Symptoms of menopause range from somatic side such as metabolic changes, increased cardiovascular disease, irregular vaginal bleeding, urogenital symptoms, vaginal dryness, osteoporosis and risk of bones fractures to changes of central nervous system as vasomotor symptoms, sleep disruption, mood changes, migraine, sexual dysfunctions. It is fundamental to know the mechanisms underlying changes in the central nervous system during menopause, related to hypoestrogenism, to be able to create appropriate target therapy for patients, improving their quality of life. In fact, the central nervous system is now one of the major targets of sex steroids that cannot be achieved disregard when dealing with the problem of choice of a particular type of MHT.