Material Quality Of Life Research Articles

The Correlation of Hysteroscopy and Histopathology in Evaluating Abnormal Uterine Bleeding: Observations From a Tertiary Care Center.

Abnormal uterine bleeding (AUB) is an important clinical entity, and its subtype, heavy menstrual bleeding (HMB), affects 14%-25% of women of reproductive age, potentially impairing their physical, emotional, social, and material quality of life. However, in addition to prior studies that supported the efficacy of hysteroscopy in identifying AUB, this study determined the overall pattern of abnormalities in AUB and correlated the diagnosis through hysteroscopy and histopathology. Additionally, a comparison of ultrasonography was done in this study. This study helps healthcare providers provide timely diagnosis and, thereby, timely interventions in treating different causes of AUB. This hospital-based prospective observational study was conducted at a tertiary care center, including women aged 20-60 admitted with complaints of AUBbetween September 2022 and June 2024. Participants were selected based on their willingness to participate in the study. A statistical analysis was performed using relevant descriptive statistics andplotting the frequency and percentage. Cohen's kappa was applied to ascertain significant associations and patterns within the dataset. Results: The study included 47 women who were admitted to the hospital for diagnostic hysteroscopy. A majority of clinical symptoms presented as menorrhagia (17, 36.2%). The hemoglobin (g/dL) ranged from 5.9 to 14.7. Overall, on hysteroscopy, 37 (78.7%) women had a normal uterus. On hysteroscopy, 36 (76.6%) participants showed a normal cervical canal and cervix. In terms of histopathology, a majority of the study population (21, 44.7%) had proliferative endometrium. In terms of the correlation between hysteroscopy and histopathology, the two methods agreed in 83% of cases and disagreed in 17% of cases. Thisstudy confirms that hysteroscopy is a crucial tool for assessing patients with AUB, particularly those with a thick endometrium, across all age groups. It does not replace other diagnostic methods; instead, it enhances them. Hysteroscopic-guided biopsy along withhistopathology is now widely regarded as the most reliablemethod and new gold standardfor assessing cases of AUB.

CLINICOPATHOLOGICAL EVALUATION OF ABNORMAL UTERINE BLEEDING IN PERIMENOPAUSAL WOMEN

Objective: Abnormal uterine bleeding (AUB) is defined as any bleeding from the uterus that is deviated from normal in terms of regularity, duration, frequency, and amount of blood loss. It interferes with the woman’s physical, emotional, social, and material quality of life. The prevalence of AUB ranges between 11% and 13% rising to 24% in perimenopausal women. The aim of this study is to analyze the demographic profile and risk factors of AUB in perimenopausal women, to classify the causes of AUB based on PALM-COEIN classification, and to correlate the clinical and sonological findings with post-operative histopathology findings. Methods: A cross-sectional study was conducted in the Department of Obstetrics and Gynecology at GIMSR hospital, Visakhapatnam, for 1 year from September 2022 to September 2023. A total of 151 perimenopausal women with complaints of AUB in the age group of 41–50 years who underwent hysterectomy were included in the study. Results: The most common clinical presentation was heavy menstrual bleeding (HMB) seen in 96 cases (63.5%). Clinically, the PALM component accounted for 61% of cases and the COEIN component accounted for 39% of cases. Ultrasonographically, the PALM component was detected in 76.8% of cases. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for detection of PALM lesions. Conclusion: Leiomyoma was the most common cause clinically, sonologically, and pathologically. Correlation was good for leiomyoma. USG has good specificity for diagnosis of AUB-A and AUB-P but low sensitivity.

Livelihood Information Endowment as a Correlate of Material Quality of Life among Rural Women in Southwest, Nigeria

This study examined the livelihood information endowment as a correlate of material quality of life among rural women in Southwest Nigeria. A multistage sampling procedure was used to select 384 respondents using an interview schedule. Data collected on socioeconomic characteristics, livelihood information endowment (livelihood information sought and sources of information); constraints to livelihood information endowment and material quality of life were analysed with percentages, mean, standard deviation, the Pearson Product Moment Correlation and Chi-square at α0.05. The results showed that most of the respondents were cooperative society members (51.6%) with a mean year of former education being 8.0±4.62 years. The most accessible information sources were mobile phones (3.73±0.90) and husband (3.72±0.82) with livelihood information endowment being high at 55.7%. However, respondents’ prominent constraints to livelihood information endowment were network problem (0.40) and poor rural infrastructure (0.39). The respondents’ material quality of life status was low 52.1%, as most did not possess landed properties (58.1%). A significant relationship existed between respondents’ material quality of life and livelihood information endowment (r=0.134), social group belonged (r=0.153) and constraint to livelihood information endowment (r=-0.017). Constraints to livelihood information endowment inform the respondents’ Material Quality of Life status. Network providers should offer efficient services.

Treatment modalities in the management of cases of puberty menorrhagia admitted in a tertiary care center

Background: Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman’s physical, social, emotional, or material quality of life. Puberty menorrhagia is excessive bleeding occurring between menarche and 19 years. The leading cause of puberty menorrhagia is hypothalamic pituitary-ovarian axis immaturity followed by bleeding disorders and endocrine disorders. Excessive blood loss leading to anemia has a negative impact over the development and quality of life of the adolescent, requiring immediate attention to these cases. The objective is to evaluate the treatment modalities in the management of cases of puberty menorrhagia admitted in a tertiary care center. Aims and Objectives: The aim of the study was to evaluate the treatment modalities in the management of cases of puberty menorrhagia admitted in a tertiary care center. Materials and Methods: A retrospective and observational study was done on adolescents admitted for management of puberty menorrhagia in Kempegowda Institute of Medical Sciences over a period lasting from January 2017 to October 2021 from hospital records. Results: Among the 35 admitted, 42% belonged to the age group 10–14 years. About 62.8% presented with symptoms lasting <6 months. About 20% presented with hemoglobin <4 g, 51.4% with hemoglobin between 4 g and 6 g, 28.6% with 6 g to 8 g. About 57.2% of patients had anovulatory cycles, 25.7% were PCOS, 11.4% had hypothyroidism, and 5.7% had fibroid uterus. About 42% ultrasonographies showed PCOS, 5.7% had fibroid uterus. The approach to managing these patients depends on the presentation of the patient. Severe anemia is treated with blood transfusion for anemia correction. For the cessation of bleeding anti fibrinolytic tranexemic acid, ethamsylate and hormone therapy with medroxyprogesterone and norethisterone is used. Combined oral contraceptives are also used. In our study, 20% received tranexemic acid and hematinics. About 31.42% received blood, hematinics, and tranexemic acid, 11.42% received hematinics, tranexemic acid, and thyroxine, 17.14% received blood, haematinics, tranexemic acid, and progesterone, 8.57% received hematinics, tranexemic acid, and COCs, 11.42% received hematinics, tranexemic acid, and progesterone. Conclusion: Patients with severe anemia required treatment with packed cells while moderate anemia were corrected with parenteral iron. To control bleeding, tranexemic acid and ethamsylate were sufficient but in 45% of them bleeding was persistent and in them, progestins like medroxyprogesterone and norethisterone were required for cessation of bleeding. In cases where hypothyroidism was diagnosed, thyroxine was started. Medical management was successful in all cases.

Iron Deficiency Anemia and Von Willebrand Disease in Women with Menorrhagia

Introduction Von Willebrand disease (VWD) is the most common bleeding disorder in adolescents and adult women that causes heavy menstrual bleeding (HMB) (Blood Adv 2020;13:3209-3216). HMB is defined as bleeding lasting >7 days or > 80 mL of blood per menstrual cycle; a broader definition includes an excessive blood loss that interferes with a woman´s physical, emotional, social and material quality of life; an underlying bleeding disorder should be considered if IDA is present (Am J Obstet Gynecol 2009;201:12.e1-12.e8 and Blood 2018;132:2134-2142). Objective Identify VWD causing HBM in patients with IDA. Materials and Methods Retrospective databased study from 2017 to 2021 of 292 women with IDA due HMB referred to our Institution. HMB was not related to systemic disease, hormonal disorders, renal or hepatic disease. The IDA studies included CBC, iron panel with ferritin levels; diagnosis was based in Clinical Guidelines: Hb< 12 gr/L, transferrin saturation (TS) <20% and ferritin <15 mcg/L (Adv Ther 2021;38:201-225); in all cases sonography was performed to rule out ovarian cyst and fibroma. For VWD, personal and familiar history of bleeding were assessed, studies included bleeding time, fibrinogen, factor VIII, factor XIII, vW antigen and vW activity on first to fourth day of menstruation, all studies were performed twice in different menstrual cycle; diagnosis was based in review articles: vW below 50 IU and bleeding history, including IDA (Hematol Oncol Clin N Am 2021;35:1085-1101). Results From 292 women with IDA, 23 (7.9%) was diagnosed with VWD. Age ranges from 14 to 54 years, median 21. vW antigen levels from 3 to 47 IU, median 28 IU. vW activity 4 to 45 IU, median 27 IU. Eleven patients had vW activity levels below 30 IU and had more significant history of mucocutaneous bleeding: epistaxis 52%, cutaneous bleeding 45%, oral cavity bleeding 42%; compared with 12 patients with vW activity between 31 and 50 IU: epistaxis 35%, cutaneous bleeding 19%, oral cavity bleeding 15%. Both groups had similar frequency of bleeding after surgical and dental procedure, 46% and 44% respectively. Treatment for IDA included oral and IV iron; treatment for HMB included hormonal therapy, desmopressin and tranexamic acid. Discussion VWD has been objectively reported in México in the first systematic analysis (Haemophila 2013;19:231-235); this observation was made mainly in mestizos of Spanish heritage and the true frequency could not be determinate, as is in the case in the majority of studies in countries worldwide; from 133 patients with bleeding disorders, 53 (39.8%) had VWD. In 124 Mexican women with history of postpartum hemorrhage, VWD was diagnosed in 61 (49.2%) (Haemophilia 2020;26:97-105). In a more recently study, VWD rate was estimated in 7.2 per million inhabitants in western Mexico (Haemophilia 2022;21:e78-e87). Our study demonstrates that VWD is present in Mexican population and has almost a rate of 8% in women with HMB, similar to reported in other studies, but this rate may be underrepresented and underdiagnosed as is in general population because lack of hematologists and diagnostic test in smaller cities, and misconception of the disease, as Mexico has heritage from Spain, England and France among other European countries with higher rates of VWD. Our study also compares the levels of VW factors, and found that patients with low levels of VW (31-50 IU) has the same bleeding phenotype as patients with VWD (< 30 IU), supporting that VWD should be diagnosed in patients with bleeding manifestations and VW factor below 50 IU (Hematol Oncol Clin N Am 2021;35:1085-1101). Finally, based in our results we recommend to investigate for VWD in patients with IDA from HMB.

Therapeutic effect of herbal infusion on abnormal uterine bleeding: interventional non-randomized pilot study

Background: Abnormal uterine bleeding-menometrorrhagia due to uterine myomas is a health problem affecting women’s quality of life and it is considered a frequent cause of emergency visits for women. If first line medication fails to treat symptoms, surgical procedures, such as hysterectomy could be indicated, which could interfere with women's physical, social, emotional, and material quality of life. The purpose of this pilot study was to investigate the effect of a mixture of two medicinal plants, Mentha pulegium L and Artemisia abrotanum L, on 13 women with menometrorrhagia, who were candidates for hysterectomy. Methods: The herbs were taken as a tea infusion by the oral route. A total of 5 g of the dried aerial parts of the mixture were added to 100 ml of boiling water and the tea infusion was taken three times a day starting from the onset of menstruation for three consecutive days, and it was repeated for three consecutive months. Results: The study results showed that 10 out of the 13 women involved avoided the surgical procedures. The mean number of bleeding days declined from 11.50 (±3.77) at baseline to 7.60 (±2.11) (p=0.01). Participants confirmed a change in the bleeding intensity, regularization of their menstrual cycle, and improvement in their quality of life. Conclusions: This preliminary study explores a new approach to treat abnormal uterine bleeding- menometrorrhagia, based on tea infusion consumption of a mixture of two medicinal herbs, and it paves the way for future studies. Trial registration: This study is registered with ClinicalTrials.gov NCT05406960 (07/06/2022).

THE EFFECT OF HEAVY MENSTRUAL BLEEDING ON WOMEN'S QUALITY OF LIFE: A CASE CONTROL STUDY

Introduction: Heavy menstrual bleeding (HMB) is dened as excessive menstrual blood loss which interferes with a woman's physical, social, emotional and material quality of life. In India, 16% of the women aged between 15 and 44 are diagnosed with HMB. HMB has signicant effects on personal, social, family, and work life of women and thereby reduces their quality of life Aim And Methods: In this study, we aim to identify menstruation characteristics of the women and the effects of HMB on women's quality of life. The participants are 150 volunteer women who were not pregnant or had menopause at the time the study was conducted and who consulted to the Department of Gynecology and Obstetrics at a Rajarajeswari Medical College and Hospital, Bengaluru between November 2020 and January 2021. The patients who had HMB complaint were included in the case group (฀ = 75) while the relatives of the participants who did not have any specic health problems composed the control group (฀ =75 ). Results: Mean age of the participants in the case group was 45.5 year (p&lt;0.05) . 23.9% women had HMB &gt;3years , frequent cycles noted with average length of cycle being 22.79 days and 53.3% being diagnosed with myoma . We evaluated the participants' quality of life and found that HMB group members were affected more signicantly in all subscales of the SF-36 scale (physical functioning, pain, general health, vitality, social role functioning, emotional role functioning, and mental health) when compared to the women in the control group and was found to be statistically signicant with p &lt; 0.05. Conclusion: HMB has negative effects on women's quality of life. Therefore, quality of life of the women with HMB complaint should be investigated and effective approaches should be designed.

A Pest Intrusion Detection in Chinese Beehive Culture Using Deep Learning

At present, the quality of material life and richness of the Chinese residents have been improved. Some people have high requirements for quality of their personal lives and put forward the problem of health preservation. Honey, as a nutritious food, is deeply loved by people. There are a large number of trace elements in honey, such as VC, VA, VD, VB1, and VB2. The honey from the Chinese honeybee has a very high nutritional value and plays an important role in the pollination and reproduction of some plants. Therefore, the Chinese honeybee plays a very significant role in the ecological environment. Moreover, it is protected as the main species resource of the country, which also fully proves the importance of the Chinese honeybee. Chinese bees can survive in various ecological and geographical environments in China and have strong heat as well as cold resistance. They can survive in the hot environment in the south and withstand the dynamics of severe cold in the north. At the same time, they can make full use of a small number of honey sources and have strong resistance to a variety of diseases and pests. In fact, there will be a variety of insect invasion problems in the beehive culture of Chinese bees, and it is necessary to accurately detect various diseases and pests during the breeding of Chinese bees. However, there are a large amount of insect invasion and various disease sources in the breeding stage of the Chinese bees. Therefore, in this paper, we use a deep learning algorithm to detect the insect invasion of the Chinese beehive culture and analyze the bee colonies in six bee farms in the province of Sichuan. In addition, we measure the common insect and disease indexes of the Chinese bee and analyze the parasitism rate, microsporidia infection rate, virus infection rate, and virus infection titer of bee colonies in overwintering and spring breeding. The experimental results show that the anti-insect invasion situation of bees in the six bee farms is significantly different; however, the antimite ability is basically the same.

A comparative study between the efficacy of tranexamic acid and ibuprofen for treatment of menorrhagia induced by copper T-380A intrauterine device

Background Menorrhagia is menstrual blood loss, which interferes with a woman's physical, emotional, social, and material quality of life, and which can occur alone or in combination with other symptoms. Ibuprofen is one of the most common NSAIDs used for treatment of heavy menstrual bleeding. Tranexamic acid is the best option for those who experience irregular uterine bleeding and plan to become pregnant in the near future. Objective To evaluate and compare the efficacy of tranexamic acid and ibuprofen in controlling menorrhagia induced by copper T-380A intrauterine device (IUD). Patients and methods This prospective randomized comparative parallel study between tranexamic acid and ibuprofen for treating copper-IUD-induced menorrhagia included 100 women who attend outpatient clinic at Al-Hussein University Hospital from October 2019 to March 2020. Results Mean menstrual days in both group 1 and group 2 decreased significantly from the first month after IUD insertion to 6 months after treatment. Conclusion Tranexamic acid as an antifibrinolytic agent and Ibuprofen as an NSAID, at a dosage of 500 mg capsules of tranexamic acid three times a day and 400-mg tablet of ibuprofen three times a day orally, have the same significant effects on copper T-380A IUD-induced menorrhagia. Their effects are on both the volume of blood loss and the duration of menses.

Comparison of MR Hysterography and Sonohysterography in Women with Abnormal Uterine Bleeding: An Interventional Study

Introduction: Abnormal Uterine Bleeding (AUB) is very common and major public health issue. AUB along with its sub-group often affects 14.25% women of reproductive age and have major impact on their physical, social, emotional and material quality of life. It not only has direct impact on the woman and her family, but also on both economy and health services. Aim: To compare Magnetic Resonance (MR) hysterography and Sonohysterography (SSHG) for detection of uterine pathologies in women with AUB. Materials and Methods: An interventional cross-sectional study was conducted over a period from July 2019 to July 2020, among 30 patients with severe AUB. SSHG and MR hysterography were used to assess endometrial pathology, and endometrial pathology was assessed by both the diagnostic modality and considering histopathology as gold standard. We calculate sensitivity, specificity, positive predictive value and negative predictive value for both the diagnostic modalities. Results: Very good agreement was noted in case of the cervical carcinoma whilst fibroid and endometrial hyperplasia showed good and fair agreement respectively by both the diagnostic modality. Sensitivity of fibroid and cervical carcinoma was 100%, polyp was 33.33%, and endometrial hyperplasia was 87.50%. Whereas specificity of fibroid was 91.67%, endometrial hyperplasia was 86.30% and cervical carcinoma was 100%. Polyp and submucosal fibroid both showed 96.30% specificity. For pathology like cervical carcinoma, endometrial hyperplasia, fibroid had very high agreement with kappa value 1, 0.684 and 0.814 respectively, whereas agreement for two tests for pathology like submucous fibroid, dual pathology was less. Conclusion: MR Hysterography and Sonohysterography were having almost equal sensitivity and specificity for abnormal uterine bleeding and can be used as per patient preference, patient discomfort, and availability of investigation.

Role of Suction Pipelle in Diagnosis of Endometrial Lesions in Patients with Abnormal Uterine Bleeding

Background: Abnormal uterine bleeding (AUB) is a major clinical problem among women in the reproductive, perimenopausal and postmenopausal age groups. It may have a significant impact on woman physical, social, emotional and material quality of life. Along with the direct impact on the woman and her family, there are significant costs to both economy and health service. The AUB in women aged 40 and older, especially in peri and postmenopausal age group requires exclusive assessment, to exclude atypical endometrial hyperplasia and carcinoma. Objective: This study aimed to determine the efficacy of suction pipelle in diagnosis of endometrial lesions in cases of abnormal uterine bleeding. Patients and Methods: The current study was designed as cross-sectional study conducted in Zagazig University Maternity Hospitals, Al-Ahrar Teaching Hospital and the Department of Pathology, Zagazig University during the period from April 2018 to July 2019. The study was conducted on 92 patients presented with abnormal uterine bleeding. Results: The 2 methods were 100% matched in diagnosis of secretory endometrium, hormone-dependent endometrium, atypical hyperplasia and EEC grade 1. The pipelle succeeded to diagnose some cases of proliferative endometrial and simple hyperplasia, which were missed by D & C (18.5% and 17.4% by pipelle versus 16.3% and 13% by D & C respectively for proliferative endometrial hyperplasia and 8.7% and 17.4% by pipelle versus 16.3% and 19.6% by D&C for simple hyperplasia respectively). Conclusion: Pipelle had high sensitivity and specificity for diagnosis of proliferative endometrial, secretory endometrium, hormonedependent endometrium, simple endometrial hyperplasia, atypical hyperplasia and EEC grade 1.

Role of Suction Pipelle in Diagnosis of Endometrial Lesions in Patients with Abnormal Uterine Bleeding

Background: Abnormal uterine bleeding (AUB) is a major clinical problem among women in the reproductive, perimenopausal and postmenopausal age groups. It may have a significant impact on woman physical, social, emotional and material quality of life. Along with the direct impact on the woman and her family, there are significant costs to both economy and health service. The AUB in women aged 40 and older, especially in peri and postmenopausal age group requires exclusive assessment, to exclude atypical endometrial hyperplasia and carcinoma. Objective: This study aimed to determine the efficacy of suction pipelle in diagnosis of endometrial lesions in cases of abnormal uterine bleeding. Patients and Methods: The current study was designed as cross-sectional study conducted in Zagazig University Maternity Hospitals, Al-Ahrar Teaching Hospital and the Department of Pathology, Zagazig University during the period from April 2018 to July 2019. The study was conducted on 92 patients presented with abnormal uterine bleeding. Results: The 2 methods were 100% matched in diagnosis of secretory endometrium, hormone-dependent endometrium, atypical hyperplasia and EEC grade 1. The pipelle succeeded to diagnose some cases of proliferative endometrial and simple hyperplasia, which were missed by D & C (18.5% and 17.4% by pipelle versus 16.3% and 13% by D & C respectively for proliferative endometrial hyperplasia and 8.7% and 17.4% by pipelle versus 16.3% and 19.6% by D&C for simple hyperplasia respectively). Conclusion: Pipelle had high sensitivity and specificity for diagnosis of proliferative endometrial, secretory endometrium, hormonedependent endometrium, simple endometrial hyperplasia, atypical hyperplasia and EEC grade 1.

Predictors of life satisfaction in Australia: A study drawing upon annual data from the Gallup World Poll

ObjectiveLargely as a result of national surveys which have monitored the trends of individuals' well‐being from various perspectives, Australia is known to be a country in which people generally experience a high level of quality of life. Beyond the overall trends, this article aims to explore demographic, social, and psychological variables associated with Australians' life satisfaction, and identify important factors in each age and gender group.MethodWe analysed the data from the Gallup World Poll, which has collected nationally representative samples from Australia from 2005 to 2017.ResultsOverall, the data suggest that the relationship between age and life satisfaction is U‐curved. The gender gap remains consistent, favouring women across age groups. Although material quality of life is found to be the prime factor, the study also points to gender‐ and age‐specific factors that influence people's life satisfaction. The relative importance of city/area satisfaction to Australians' sense of well‐being is identified.ConclusionsOur comprehensive analysis implies that there is a need for better income support for people with very low incomes to improve their life satisfaction. Also, it would be of great benefit to Australia for the government and relevant policy makers to pay special attention to the improvement of healthcare services for the country's ageing population.

Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding: ACOG COMMITTEE OPINION SUMMARY, Number 785.

Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman's physical, social, emotional, or material quality of life. If obstetrician-gynecologists suspect that a patient has a bleeding disorder, they should work in coordination with a hematologist for laboratory evaluation and medical management. Evaluation of adolescent girls who present with heavy menstrual bleeding should include assessment for anemia from blood loss, including serum ferritin, the presence of an endocrine disorder leading to anovulation, and evaluation for the presence of a bleeding disorder. Physical examination of the patient who presents with acute heavy menstrual bleeding should include assessment of hemodynamic stability, including orthostatic blood pressure and pulse measurements. The first-line approach to acute bleeding in the adolescent is medical management; surgery should be reserved for those who do not respond to medical therapy. Use of antifibrinolytics such as tranexamic acid or aminocaproic acid in oral and intravenous form may be used to stop bleeding. Nonmedical procedures should be considered when there is a lack of response to medical therapy, if the patient is clinically unstable despite initial measures, or when severe heavy bleeding warrants further investigation, such as an examination under anesthesia. After correction of acute heavy menstrual bleeding, maintenance hormonal therapy can include combined hormonal contraceptives, oral and injectable progestins, and levonorgestrel-releasing intrauterine devices. Obstetrician-gynecologists can provide important guidance to premenarchal and postmenarchal girls and their families about issues related to menses and should counsel all adolescent patients with a bleeding disorder about safe medication use and future surgical considerations.

Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding: ACOG COMMITTEE OPINION, Number 785.

Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman's physical, social, emotional, or material quality of life. If obstetrician-gynecologists suspect that a patient has a bleeding disorder, they should work in coordination with a hematologist for laboratory evaluation and medical management. Evaluation of adolescent girls who present with heavy menstrual bleeding should include assessment for anemia from blood loss, including serum ferritin, the presence of an endocrine disorder leading to anovulation, and evaluation for the presence of a bleeding disorder. Physical examination of the patient who presents with acute heavy menstrual bleeding should include assessment of hemodynamic stability, including orthostatic blood pressure and pulse measurements. The first-line approach to acute bleeding in the adolescent is medical management; surgery should be reserved for those who do not respond to medical therapy. Use of antifibrinolytics such as tranexamic acid or aminocaproic acid in oral and intravenous form may be used to stop bleeding. Nonmedical procedures should be considered when there is a lack of response to medical therapy, if the patient is clinically unstable despite initial measures, or when severe heavy bleeding warrants further investigation, such as an examination under anesthesia. After correction of acute heavy menstrual bleeding, maintenance hormonal therapy can include combined hormonal contraceptives, oral and injectable progestins, and levonorgestrel-releasing intrauterine devices. Obstetrician-gynecologists can provide important guidance to premenarchal and postmenarchal girls and their families about issues related to menses and should counsel all adolescent patients with a bleeding disorder about safe medication use and future surgical considerations.

Cyclical progestogens for heavy menstrual bleeding.

Heavy menstrual bleeding (HMB) is a menstrual blood loss perceived by women as excessive that affects the health of women of reproductive age, interfering with their physical, emotional, social and material quality of life. Whilst abnormal menstrual bleeding may be associated with underlying pathology, in the present context, HMB is defined as excessive menstrual bleeding in the absence of other systemic or gynaecological disease. The first-line therapy is usually medical, avoiding possibly unnecessary surgery. Of the wide variety of medications used to reduce HMB, oral progestogens were originally the most commonly prescribed agents. This review assesses the effectiveness of two different types and regimens of oral progestogens in reducing ovulatory HMB.This is the update of a Cochrane review last updated in 2007, and originally named "Effectiveness of cyclical progestagen therapy in reducing heavy menstrual bleeding" (1998). To determine the effectiveness, safety and tolerability of oral progestogen therapy taken either during the luteal phase (short cycle) or for a longer course of 21 days per cycle (long cycle), in achieving a reduction in menstrual blood loss in women of reproductive age with HMB. In January 2019 we searched Cochrane Gynaecology and Fertility's specialized register, CENTRAL, MEDLINE, Embase, CINAHL and PsycInfo. We also searched trials registers, other sources of unpublished or grey literature and reference lists of retrieved trials. We also checked citation lists of review articles to identify trials. Randomized controlled trials (RCTs) comparing different treatments for HMB that included cyclical oral progestogens were eligible. Two review authors independently selected trials for inclusion, assessed trials for risk of bias and extracted data. We contacted trial authors for clarification of methods or additional data when necessary. We only assessed adverse events if they were separately measured in the included trials. We compared cyclical oral progestogen in different regimens and placebo or other treatments. Our primary outcomes were menstrual blood loss and satisfaction with treatment; the secondary outcomes were number of days of bleeding, quality of life, compliance and acceptability of treatment, adverse events and costs. This review identified 15 randomized controlled trials (RCTs) with 1071 women in total. Most of the women knew which treatment they were receiving, which may have influenced their judgements about menstrual blood loss and satisfaction. Other aspects of trial quality varied among trials.We did not identify any RCTs comparing progestogen treatment with placebo. We assessed comparisons between oral progestogens and other medical therapies separately according to different regimens.Short-cycle progestogen therapy during the luteal phase (medroxyprogesterone acetate or norethisterone for 7 to 10 days, from day 15 to 19) was inferior to other medical therapy, including tranexamic acid, danazol and the progestogen-releasing intrauterine system (Pg-IUS (off of the market since 2001)), releasing 60 mcg of progesterone daily, with respect to reduction of menstrual blood loss (mean difference (MD) 37.29, 95% confidence interval (CI) 17.67 to 56.91; I2 = 50%; 6 trials, 145 women). The rate of satisfaction and the quality of life with treatment was similar in both groups. The number of bleeding days was greater on the short cycle progestogen group compared to other medical treatments. Adverse events (such as gastrointestinal symptoms and weight gain) were more likely with danazol when compared with progestogen treatment. We note that danazol is no longer in general use for treating HMB.Long-cycle progestogen therapy (medroxyprogesterone acetate or norethisterone), from day 5 to day 26 of the menstrual cycle, is also inferior to the levonorgestrel-releasing intrauterine system (LNG-IUS), releasing tranexamic acid and ormeloxifene, but may be similar to the combined vaginal ring with respect to reduction of menstrual blood loss (MD 16.88, 95% CI 10.93 to 22.84; I2 = 87%; 4 trials, 355 women). A higher proportion of women taking norethisterone found their treatment unacceptable compared to women having Pg-IUS (Peto odds ratio (OR) 0.12, 95% CI 0.03 to 0.40; 1 trial, 40 women). However, the adverse effects of breast tenderness and intermenstrual bleeding were more likely in women with the LNG-IUS. No trials reported on days of bleeding or quality of life for this comparison.The evidence supporting these findings was limited by low or very low gradings of quality; thus, we are uncertain about the findings and there is a potential that they may change if we identify other trials. Low- or very low-quality evidence suggests that short-course progestogen was inferior to other medical therapy, including tranexamic acid, danazol and the Pg-IUS with respect to reduction of menstrual blood loss. Long cycle progestogen therapy (medroxyprogesterone acetate or norethisterone) was also inferior to the LNG-IUS, tranexamic acid and ormeloxifene, but may be similar to the combined vaginal ring with respect to reduction of menstrual blood loss.

Significance of endometrial thickness on transvaginal sonography in heavy menstrual bleeding

Background: Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss which interferes with a woman's physical, social, emotional, and/or material quality of life. This is the most distressing complication in perimenopausal women which affects the quality of life. Aims: This study aimed to evaluate endometrial thickness (ET) by ultrasound and histopathological examination and their correlation with HMB in perimenopausal women. Materials and Methods: This retrospective analysis was carried out over 1 year. A total of 120 women of 40–55 years' age group who presented with abnormal bleeding pattern were included in the study. These women underwent clinical examination, investigations and ultrasound examination followed by endometrial biopsy. Results: Majority of the women (47.5%) had menstrual disturbance in the age group of 40–45 years followed by 45.8% of women in the age group of 46–50 years. Menorrhagia was the most common complaint found in 65 (54.2%) women, 10 (8.3%) women suffered from metrorrhagia, 18 (15%) had polymenorrhea, and 22 (18.3%) women had amenorrhea followed by heavy bleeding. Proliferative endometrium was found in 90 (75%), secretory endometrium in 8 (6.7%) and simple hyperplasia without atypia in 3 (2.5%) of the women in the study population. Simple hyperplasia with atypia was observed in 2 women (1.7%), 3 women (2.5%) had complex hyperplasia without atypia, and 1 woman (0.83%) had complex hyperplasia with atypia. Endometritis was present in 5 (4.2%) cases and atrophic endometrium was found in 3 (2.5%)cases and atrophic endometrium was found in 2.5% (3). No endometrial biopsy specimen was suggestive of endometrial carcinoma. Simple hyperplasia with atypia was detected when ET was 11–15 mm and 16–20 mm. Complex hyperplasia without atypia was detected with ET >16–20 mm and >20 mm. Only one case had complex hyperplasia with atypia where ET was >20 mm. No abnormal endometrial pathology was detected when ET was below 11 mm. Conclusions: Increased ET on transvaginal ultrasound had association with abnormal endometrial tissue histopathology in women with HMB.

HEALTH: laparoscopic supracervical hysterectomy versus second-generation endometrial ablation for the treatment of heavy menstrual bleeding: study protocol for a randomised controlled trial

BackgroundHeavy menstrual bleeding (HMB) is a common problem affecting approximately 1.5 million women in England and Wales with a major impact on their physical, emotional, social and material quality of life. It is the fourth most common reason why women attend gynaecology outpatient clinics and accounts for one-fifth of all gynaecology outpatient referrals. Initial treatment in primary care is medical - either by means of oral or injected medication or the levonorgestrel-intrauterine system (Mirena®). If medical treatment fails then surgical treatment can be offered, either endometrial ablation (EA), which destroys the lining of the cavity of the uterus (endometrium), or hysterectomy, i.e. surgical removal of the uterus.While effective, conventional hysterectomy is invasive and carries a risk of complications due to injury to other pelvic structures. The procedure can be simplified and complications minimised by undertaking a ‘supracervical’ hysterectomy where the cervix is left in situ and only the body of the uterus removed. Recent advances in endoscopic technologies have facilitated increased use of laparoscopic supracervical hysterectomy (LASH) which can be performed as a day-case procedure and is relatively easy for the surgeon to learn.HEALTH (Hysterectomy or Endometrial AbLation Trial for Heavy menstrual bleeding) aims to address the question ‘Is LASH superior to second generation EA for the treatment of HMB in terms of clinical and cost effectiveness?’Methods/DesignWomen aged < 50 years, with HMB, in whom medical treatment has failed and who are eligible for EA will be considered for trial entry. We aim to recruit women from approximately 30 active secondary care centres in the UK NHS who carry out both surgical procedures. All women who consent will complete a diary of pain symptoms from day 1 to day 14 after surgery, postal questionnaires at six weeks and six months after surgery and 15 months post randomisation. Healthcare utilisation questions will also be completed at the six-week, six-month and 15-month time-points.DiscussionMeasuring the comparative effectiveness of LASH vs EA will provide the robust evidence required to determine whether the new technique should be adopted widely in the NHS.Trial registrationInternational Standard Randomised Controlled Trials, ISRCTN49013893. Registered on 28 January 2014.

Relationship between subjective well-being and material quality of life in face of climate vulnerability in NE Brazil

In the past decades, Brazil’s federal government has invested in a national anti-poverty program, which is responsible for impressive results in increasing the Human Development Index and decreasing poverty. Yet, despite these significant achievements in their material quality of life, the Northeast of Brazil continues to suffer the hard impacts from severe drought. In this article, we investigate how material quality of life and subjective well-being relate to one another in poor households affected by drought. In particular, we evaluate how and what factors influence subjective well-being, which is connected to both vulnerability and material quality of life, and how households perceive their level of well-being through time and 15 years of anti-poverty intervention. Our findings reinforce the idea that while an anti-poverty program may be necessary to increase subjective well-being, they are not sufficient to significantly reduce overall vulnerability of poor households, and also, despite all the improvement from the anti-poverty program in their material quality of life, subjective well-being may be affected by other factors such health status and safety.

Heavy menstrual bleeding

Essential facts Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss that interferes with a woman's physical, emotional, social or material quality of life. In England and Wales, around 80,000 women a year will be referred for the first time to secondary care, with 30,000 requiring surgical treatment.