Changes In Menstrual Bleeding Research Articles

The Evaluation of Menstrual Alterations in Mexican Women After Vaccination Against COVID-19.

Introduction Menstrual changes after COVID-19 vaccination suggest a secondary connection to the immune response to vaccination rather than a specific component of the vaccine. The evaluation of these alterations in women with the same and multiple vaccination schedules will provide valuable information. Methods An observational, cross-sectional study was carried out; data were collected through a survey of 164 vaccinated women at the American British Cowdray (ABC) Santa Fe Medical Center Hospital in Mexico City. The survey was validated by the Delphi method. Results The survey was applied from March 2023 to February 2024. Post-vaccination menstrual alterations occurred in 48.1%; the most frequent alteration was menorrhagia in 20.7%and pain accompanied by menstruation in 27.4%. Fifty-seven percent had a history of previous COVID-19 infection.There were no significant associations between changes in menstrual bleeding after vaccination, history of COVID-19 infection, and age group (p>0.9). However, women who received multiple doses of vaccines had a higher risk of suffering abnormalities in bleeding by 36.6%. Conclusion The incidence of menstrual disordersin this study post COVID-19 vaccinationwas 49%. Menstrual alterations in patients who received multiple doses and a single regimen were similar at 47% and 48%, where there is no statistical significance. The greatest number of menstrual alterations was seen in the first dose at 36%, probably due to the immunity they acquired after the different types of vaccination. Vaccination is a very effective way to prevent the severity of COVID-19 infection; it has an impact on menstrual bleeding in terms of menorrhagia and metrorrhagia. Vaccination against COVID-19 is associated with small changes in the menstrual cycle, without statistical significance. Women receiving the first dose of the vaccine had changes in the amount of bleeding specifically the amount.

The relationship between low energy availability, injuries, and bone health in recreational female athletes.

Low energy availability (LEA) causes pathophysiology of the female athlete's body affecting the bone and reproductive health and was observed to have a high prevalence in recreational female athletes previously. The aim of this study was to analyse the relationship between low energy availability in females questionnaire (LEAF-Q), bone mineral density (BMD), and postural stability in recreational athletes. Recreational female athletes (n = 24, age: 23.71 ± 2.94, Tier I) completed LEAF-Q, postural stability measurement during quiet stance (Zebris platform FDM; GmbH) and their BMD was measured using DXA (Hologic QDR Horizon A). Non-parametric statistical tests were used to analyse the relationships between LEAF-Q, BMD, and postural stability and to compare differences between participants divided by the LEAF-Q score and its subscales. Risk of LEA was observed in 50% of recreational athletes participating in this study. Up to 46% of participants perceived menstrual bleeding changes related to training and 37.50% experienced menstrual dysfunction. Body composition and body weight fluctuations were observed to affect postural stability and BMD. With the risk score for LEA, the BMD and postural stability were not negatively affected in recreational athletes. However, the high number of recreational athletes in the risk score for LEA and menstrual dysfunctions highlights the need for public health programs aimed to increase awareness of LEA and its health consequences and for open communication about the menstrual cycle. Future longitudinal studies observing LEA, BMD, menstrual function, postural stability, and their interrelationship in female athletes are needed to increase the knowledge of this topic.

Women’s attitudes about combined hormonal contraception (CHC) - induced menstrual bleeding changes - influence of personality traits in an Italian clinical sample

Objectives We investigated the attitudes to change the frequency of menstrual bleeding by using combined hormonal contraception (CHC). Personality characteristics were also explored. Methods We conducted a cross-sectional study in two university hospitals in northern Italy. Current, past and never CHC users (n = 545; age 18–44 years) completed a self-administered semi-structured questionnaire and the Ten-Item Personality Inventory (TIPI). Results Forty-five percent of responders (n = 301) would prefer to change their bleeding frequency by using CHC. A flexible regimen was the preferred choice (n = 80; 33%) followed by extended regimens to bleed every 3 months (n = 54; 22%) or to never bleed (n = 43; 18%). The main positive reasons were to avoid dysmenorrhea (43%) and have more freedom in sexual (36%) and active (35%) life, whereas the main reason for a negative attitude was ‘menstrual rhythm is natural’ (59%). Age had a significant influence on women’s willingness to change menstrual frequency by using CHC [>39 years (57%), 30–39 years (31%) and <30 years (46%)] (χ2: 9.1; p = 0.01). Never users significantly reported a more negative attitude (71%) in comparison with past (51%) and current users (49%) (χ2: 18.7; p = 0.001). Personality traits played a role, with higher scores of openness (p = 0.005) and extraversion (p = 0.001) in women with a positive attitude. Conclusions Almost half of our study sample reported a preference for changing their menstrual pattern by using CHC. Flexibility was the preferred choice across age and use of CHC. Personality characteristics (openness and extroversion) might influence attitudes toward CHC-induced menstrual bleeding changes.

Investigating trends in those who experience menstrual bleeding changes after SARS-CoV-2 vaccination.

Early in 2021, many people began sharing that they experienced unexpected menstrual bleeding after SARS-CoV-2 inoculation. We investigated this emerging phenomenon of changed menstrual bleeding patterns among a convenience sample of currently and formerly menstruating people using a web-based survey. In this sample, 42% of people with regular menstrual cycles bled more heavily than usual, while 44% reported no change after being vaccinated. Among respondents who typically do not menstruate, 71% of people on long-acting reversible contraceptives, 39% of people on gender-affirming hormones, and 66% of postmenopausal people reported breakthrough bleeding. We found that increased/breakthrough bleeding was significantly associated with age, systemic vaccine side effects (fever and/or fatigue), history of pregnancy or birth, and ethnicity. Generally, changes to menstrual bleeding are not uncommon or dangerous, yet attention to these experiences is necessary to build trust in medicine.

Recommendations for standardization of bleeding data analyses in contraceptive studies

To address limitations that exist with existing definitions of menstrual bleeding changes that occur with contraceptive methods, we assembled a panel to develop new recommendations for standardization of bleeding data analyses associated with contraceptive use to better inform users, clinicians, investigators, pharmaceutical companies, and regulatory agencies. We propose three criteria for assessing bleeding outcomes: pattern, flow, and duration. The descriptors within each criterion depend on whether the contraceptive is designed to result in a predictable or unpredictable bleeding pattern. Predictable pattern outcomes quantify days of scheduled, unscheduled and no bleeding, while unpredictable pattern outcomes assess frequency. Flow is quantified based on patient comparisons to their typical flow when not using contraception, with spotting representing no menstrual products use. Duration of a prolonged bleeding and/or spotting episode is more than 7 days. Studies should assess bleeding characteristics for a minimum of 12 months for 21/7, 24/4, extended cycle or continuous regimens, two years for injectables, and the full duration of use for long-acting contraceptives. Describing pattern, flow and duration as independent categories allows a fuller understanding of the bleeding outcomes and better future assessments of acceptability and continuation. Standardization of outcomes permits better comparison between studies and data synthesis; standardization will also improve the ability of clinicians and patients to understand differences between products.

Menstrual experiences after COVID‐19 vaccination in a non‐menstruating gender diverse sample

After COVID‐19 vaccination a number of currently and formerly menstruating people reported changes in menstrual bleeding and menstrual symptoms. Media highlighted these experiences, but much of the focus was on changes in regularly menstruating cis‐gendered women and unnecessary concerns about fertility. This was despite ample evidence of vaccine safety for people who were currently pregnant or conceived after vaccination. An overlooked phenomenon was reports of periods, spotting, or other unexpected vaginal bleeding in people who usually do not menstruate, including people assigned female at birth who are transmasculine, trans men, agender, non‐binary, and other gender diverse identities. We present preliminary descriptions of post‐vaccine menstrual experiences of a vaccinated, non‐menstruating, gender diverse sample.MethodsWe conducted an online survey to characterize the menstrual experiences of a diverse group of currently and formerly menstruating people from April 7, 2021 through Oct 7, 2021. From over 160,000 responses, we identified 552 people between the ages of 18 and 45 who 1) reported they usually do not menstruate; 2) reported using testosterone and/or gender‐affirming hormones (some did not specify testosterone); and 3) were not cis women. In addition to demographic characteristics (e.g., age, gender), we asked multiple‐choice and open‐ended questions about current menstrual status (including why they do not menstruate), hormone medications, contraceptive use, and menstrual symptoms after being vaccinated. Here, we combine experiences for both doses of the vaccine for analysis and group period, spotting, and other menstrual bleeding into one category called “breakthrough bleeding”.ResultsIn this sample (n=552, age=25.6 +/‐ 5.7 (mean +/‐SD)), most respondents (84%, 463/552) selected more than one gender, with the most common for this subsample being transgender (n=460), man or man identified (n=373), non‐binary (n=241), and genderqueer/gender non‐conforming (n=124). 33% of respondents (180/552) reported breakthrough bleeding after vaccination, 9% (52/552) reported chest or breast soreness, and 46% (254/552) reported having other symptoms they would usually associate with a period. In response to the open‐ended question about other period related symptoms, respondents reported common symptoms such as cramping and bloating. A number of respondents also used the open‐ended text boxes to report negative mental health in response to their period symptoms, including anxiety, depression, gender dysphoria, panic attacks, and suicidal ideation.ConclusionsMany gender diverse people who received vaccines for COVID‐19 experienced symptoms that are usually associated with menstruation, including unexpected bleeding. Because menstruation is usually considered in relation to fertility, other important aspects of this physiology are overlooked and this impacts people beyond fertile women. Attentiveness to menstruation beyond fertility and more inclusive use of gender in clinical trials is important to prepare people for potential side effects, address medically underserved populations, and reduce vaccine hesitancy.

Measuring experiences and concerns surrounding contraceptive induced side-effects in a nationally representative sample of contraceptive users: Evidence from PMA Ethiopia

ObjectiveOur objectives were to assess the prevalence of specific side-effects experienced by current and recent contraceptive users, describe patterns of side-effects that users were concerned about, and share measurement lessons learned. Study designData come from the PMA Ethiopia 2019 nationally-representative, cross-sectional survey. Our analytic sample included women who were current (weighted n = 2190; unweighted n = 2020) or recent (past 24 months; weighted n = 627; unweighted n = 622) users of a hormonal method or IUD. We provide descriptive statistics of the percentage of current/recent users who report currently/ever experiencing specific side-effects, not experiencing but being concerned about experiencing specific side-effects, and both currently experiencing and being concerned about experiencing specific side-effects. All analyses are stratified by method type (implant, injectable, pill) to explore variation by method. ResultsAmong current users, 648/2190 women (30%) reported experiencing any side-effect, while 252/644 (40%) of recent users reported ever experiencing any side-effect. Bleeding changes were reported most frequently and were higher among implant and injectable users. More recent users reported side-effects that were associated with physical discomfort, such as headaches, than current users. About one-third of current and recent users reported being concerned about at least one side-effect that they had not experienced, with about 15% of current and recent users reporting concerns about bleeding changes (307/2190 and 112/627, respectively) and concerns about physical discomfort (334/2019 and 98/627, respectively). ConclusionsWhile bleeding changes are common, users report a range of side-effects related to physical discomfort underscoring the need for comprehensive counseling. We highlight challenges in measuring side-effects using quantitative tools and pose recommendations for future research and measurement efforts. Implications: Experiencing and fearing contraceptive-induced menstrual bleeding changes and physical discomfort, particularly headaches, is high among hormonal contraceptive and IUD users in Ethiopia. counseling that addresses an array of side-effects is needed. Additional research is also needed to disentangle the effect of experiencing versus fearing side-effects on contraceptive use.

Post-Placental Intrauterine Device Insertion in Brazilian Adolescents: Clinical Outcomes at 12 Months

To assess the acceptability, expulsion and continuation rates, satisfaction, and complications associated with post-placental intrauterine device insertion (PPIUDI) in Brazilian adolescents DESIGN: Prospective cohort SETTING: A single public, tertiary teaching hospital PARTICIPANTS: Adolescents (≤ 19 years) giving birth by vaginal delivery or cesarean section INTERVENTION: PPIUDI MAIN OUTCOME MEASURES: Primary outcomes were PPIUDI acceptability, expulsion, continuation, and user satisfaction. Secondary outcomes were changes in menstrual bleeding and pain, infection, uterine perforation, and repeat pregnancy up to 12 months after PPIUDI. Of 1710 adolescents who delivered during the study period, 294 accepted PPIUDI (acceptability 17.2%). There were no cases of infection or uterine perforation among the 91 adolescents who completed the 12-month follow-up. Overall expulsion rate was 28.6%, and most cases (54%) occurred in the first 6 weeks after insertion. At 12 months, 85.7% of users were satisfied with the method, and continuation rate was 69.2%. At the end of 12 months, there were no repeat pregnancies among the adolescents who remained with the device in place. PPIUDI can be an effective and safe method to reduce repeat unplanned pregnancies in adolescents who have just given birth.

Bleeding changes after levonorgestrel 52-mg intrauterine system insertion for contraception in women with self-reported heavy menstrual bleeding

The levonorgestrel 52-mg intrauterine system has proven efficacy for heavy menstrual bleeding treatment in clinical trials, but few data exist to demonstrate how rapidly the effects occur and the effects in women with self-reported heavy bleeding, as seen commonly in clinical practice. Evaluate changes in bleeding patterns in women with self-reported heavy menstrual bleeding before levonorgestrel 52-mg intrauterine system insertion. A total of 1714 women aged 16-45 years old received a levonorgestrel 52-mg intrauterine system in a multicenter trial evaluating contraceptive efficacy and safety for up to 10 years. At screening, participants described their baseline menstrual bleeding patterns for the previous 3 months. Participants completed daily diaries with subjective evaluation of bleeding information for the first 2 years. For this analysis, we included women with at least 1 complete 28-day cycle of intrauterine system use and excluded women using a hormonal or copper intrauterine contraception in the month prior to study enrollment. We evaluated changes in menstrual bleeding and discontinuation for bleeding complaints per 28-day cycle over 26 cycles (2 years) in women who self-reported their baseline pattern as heavy. We also compared rates of amenorrhea, defined as no bleeding or spotting, within the entire study population in women with subjective heavy menstrual bleeding at baseline compared with those who did not complain of heavy menstrual bleeding. Of the 1513 women in this analysis, 150 (9.9%) reported baseline heavy menstrual bleeding. The majority of women reported no longer experiencing heavy menstrual bleeding by the end of cycle 1 (112/150, 74.7%) with even greater rates by cycle 2 (124/148, 83.8%). At the end of cycles 6, 13, and 26, 129 of 140 (92.1%; 95% confidence interval, 87.7%-96.6%), 114 of 123 (92.7%; 95% confidence interval, 88.1%-97.3%), and 100 of 103 (97.1%; 95% confidence interval, 93.8%-100%) women reported no heavy menstrual bleeding, respectively. After cycles 13 and 26, 63 of 123 (51.2%; 95% confidence interval, 42.4%-60.1%) and 66 of 103 (64.1%; 95% confidence interval, 54.8%-73.3%), respectively, reported their bleeding as amenorrhea or spotting only. A lower proportion of women with baseline self-reported heavy menstrual bleeding reported amenorrhea as compared with women in the overall study cohort without heavy menstrual bleeding at the end of 6 cycles (319 [25.5%] vs 21 [15.0%], P=.005) and 13 cycles (382 [34.4%] vs 26 [21.1%], P=.003); differences were not significant after 19 cycles (367 [37.2%] vs 36 [31.0%], P=.022) and 26 cycles (383 [43.5%] vs 38 [36.9%], P=.21). Only 4 (2.7%) women with baseline heavy menstrual bleeding discontinued for bleeding complaints (2 for heavy menstrual bleeding and 2 for irregular bleeding), all within the first year. Most women who self-report heavy menstrual bleeding experience significant improvement quickly after levonorgestrel 52-mg intrauterine system insertion. Discontinuation for bleeding complaints among women with baseline heavy menstrual bleeding is very low.

Menstrual Bleeding Changes Are NORMAL: Proposed Counseling Tool to Address Common Reasons for Non-Use and Discontinuation of Contraception.

A new family planning counseling tool uses the simple mnemonic device “NORMAL” to help family planning counselors and providers communicate to their clients key messages about menstrual bleeding changes associated with use of hormonal contraception and the copper IUD.

There might be blood: a scoping review on women’s responses to contraceptive-induced menstrual bleeding changes

Concern about side effects and health issues are common reasons for contraceptive non-use or discontinuation. Contraceptive-induced menstrual bleeding changes (CIMBCs) are linked to these concerns. Research on women’s responses to CIMBCs has not been mapped or summarized in a systematic scoping review. We conducted a systematic scoping review of data on women’s responses to CIMBCs in peer-reviewed, English-language publications in the last 15 years. Investigator dyads abstracted information from relevant studies on pre-specified and emergent themes using a standardized form. We held an expert consultation to obtain critical input. We provide recommendations for researchers, contraceptive counselors, and product developers. We identified 100 relevant studies. All world regions were represented (except Antarctica), including Africa (11%), the Americas (32%), Asia (7%), Europe (20%), and Oceania (6%). We summarize findings pertinent to five thematic areas: women’s responses to contraceptive-induced non-standard bleeding patterns; CIMBCs influence on non-use, dissatisfaction or discontinuation; conceptual linkages between CIMBCs and health; women’s responses to menstrual suppression; and other emergent themes. Women’s preferences for non-monthly bleeding patterns ranged widely, though amenorrhea appears most acceptable in the Americas and Europe. Multiple studies reported CIMBCs as top reasons for contraceptive dissatisfaction and discontinuation; others suggested disruption of regular bleeding patterns was associated with non-use. CIMBCs in some contexts were perceived as linked with a wide range of health concerns; e.g., some women perceived amenorrhea to cause a buildup of “dirty” or “blocked” blood, in turn perceived as causing blood clots, fibroids, emotional disturbances, weight gain, infertility, or death. Multiple studies addressed how CIMBCs (or menstruation) impacted daily activities, including participation in domestic, work, school, sports, or religious life; sexual or emotional relationships; and other domains. Substantial variability exists around how women respond to CIMBCs; these responses are shaped by individual and social influences. Despite variation in responses across contexts and sub-populations, CIMBCs can impact multiple aspects of women’s lives. Women’s responses to CIMBCs should be recognized as a key issue in contraceptive research, counseling, and product development, but may be underappreciated, despite likely – and potentially substantial – impacts on contraceptive discontinuation and unmet need for modern contraception.

Information Provided by Nurses to Clients during Family Planning Counselling Sessions and Knowledge of Clients on Chosen Method

BACKGROUND: The fundamental problem which prompted this research study lies in the observation that family planning clients do not receive the required information for decision making on the methods that meet their reproductive needs.OBJECTIVES: To determine family planning information provided to the clients by nurses during family planning counselling sessions in the Khomas region to describe the knowledge of the clients on the specific chosen methodMETHODS: A quantitative research design recruited 184 family planning clients and 65 nurses. Closed ended questionnaire was used for data collection.RESULTS: Majority (89%) of nurses indicated that they always explained the advantages of the method selected to the clients, contrary to the majority (77%) of the clients reported advantages never been explained to them. Ninety five percent of the nurses indicated that they always explained to clients how to use the method they had selected, while the majority (72%) of the clients were in disagreement. The majority of the nurses (78%) indicated that they always explained the possible side effects of the method to their clients while, 63% of the clients indicated that the side effects were not explained to them. Only 22% of the injectable contraceptive users indicated changes in menstrual bleeding as a common side effect, while the majority (66 %) indicated that they did not know.CONCLUSION: According to clients’, information provided to them was inadequate. Equally, the majority of clients had not demonstrated sound knowledge about their method of choice.

Bleeding Associated with Hormonal Contraceptives: Understanding and Managing a Common Problem

Changes in menstrual bleeding are common with hormonal contraceptives, and unfavorable bleeding profiles are leading reasons for method dissatisfaction and discontinuation. Studies suggest that acceptance of menstrual disturbance is highly dependent on appropriate counseling. This review presents an overview of the pathophysiology of uterine bleeding related to hormonal contraceptive use, the expected bleeding profiles of the various hormonal contraceptives, and evidence supporting various management strategies for treatment of unscheduled bleeding. Published trials on treatments for bleeding with hormonal contraceptives are heterogeneous in methodology and outcome measures. Overall, data show mixed results and disappointingly small treatment effects for medications studied to manage unscheduled bleeding. Short courses of NSAIDs and oral estrogen may have modest benefits. Tranexamic acid and mifepristone require larger trials and additional study. Treatment of bleeding associated with hormonal contraception hinges on understanding the bleeding profiles of the hormonal contraceptives, employing anticipatory counseling, and understanding the spectrum and limitations of treatment options for menstrual disturbance.

Mobile Application Vs. Paper Pictorial Blood Assessment Chart to Track Menses in Young Women: A Randomized Cross-over Design

BackgroundHeavy menstrual bleeding (HMB) is the most common symptom for women with bleeding disorders. Major barriers to performing research in this field are difficulties in quantifying and tracking changes in menstrual bleeding, particularly in adolescents. The Pictorial Blood Assessment Chart (PBAC) score is often used to quantify severity of menstrual bleeding1. However, the traditional paper diary PBAC score is fraught with recall bias and compliance issues in adolescents.Utilizing mobile applications (apps) has great potential for improving health by assisting with behavior modification and disease self-management. Additionally, mobile apps can serve as a valuable medical research tool by facilitating rapid reporting.ObjectivesWe developed a mobile app version of the PBAC score to enable adolescents to report and quantify menstrual bleeding. We evaluated patient satisfaction and compliance with mobile app reporting as compared to paper reporting. We hypothesized that adolescents would be compliant with mobile app reporting and would prefer this method over paper reporting.MethodsThis study was a randomized cross-over study of 25 post-menarchal females ages 13-21 years seen in the Hematology Clinics at Nationwide Children's Hospital, Columbus, Ohio. Inclusion criteria included: history of regularly occurring menstrual cycle and possession of a mobile application capable device (smart phone) with continuous service expected. Non-English speaking patients and patients intending to start a hormonal agent that may fully suppress menstrual bleeding were excluded. Subjects agreed to track menstrual bleeding in two consecutive menstrual cycles and were randomized to using the PBAC paper diary or the PBAC mobile app format first. At the end of each cycle, a 10-point response scale satisfaction questionnaire and a system usability scale (mobile app only) assessed the acceptability of the format of the diary used. Weekly email reminders were sent in both groups. Mobile device notifications and reminders were used in the mobile app group. To compare the satisfaction survey results, the Hills and Armitage method for analyzing cross-over data was used which included evaluation of period effect, group effect, and their interaction using a series of independent t-tests.ResultsThe 25 subjects enrolled had a median age of 15 years (range 13-21 years). Eleven (44%) had identified bleeding disorders. Twenty-two (88%) could use phones in school. Subjects’ PBAC scores did not have significant variability between the paper diary (median PBAC=95) and the mobile app (median PBAC=114). There was a median number of 2 entry times per day in both groups. There was no significant difference in the number of app entries subjects reported to study staff and the actual number recorded in the app. For the mobile app, twenty subjects (80%) had high compliance for reporting bleeding symptoms (app entries for >80% of cycle duration). There were no subjects with low compliance (app entries for <50% of cycle duration). All paper diaries received by study staff met definition for high compliance. The most common reasons subjects listed for missing a daily entry were 1) forgetting to enter data or 2) app not working. Results of the cross-over analysis showed that subject satisfaction was significantly higher for mobile app (mean satisfaction score of 9.5/40 with 4/40 being most satisfied) than for the paper diary (mean satisfaction score of 17.8/40) (p <0.001). Twenty (80%) subjects preferred the mobile app over the paper diary. There was no significant period effect or group by period interaction.DiscussionThis study demonstrated that a PBAC mobile app as compared to the PBAC paper diary was the preferred method of recording menstrual bleeding in adolescents and demonstrated feasibility as a research data collection tool. The app received stronger satisfaction scores and overall compliance was high. A PBAC mobile app is unique compared to publicly available apps because it allows girls and women to quantify their heaviness of flow during menses. Most menstrual tracking apps only track length of cycles or use qualitative assessments of bleeding. In a clinical setting, data from the PBAC app can allow providers to see real-time bleeding symptoms allowing for adjustments in therapy.1Higham JM, O'Brien PM, Shaw RW. Assessment of menstrual blood loss using a pictorial chart. Br J Obstet Gynaecol 1990:97(8):734-739. DisclosuresNo relevant conflicts of interest to declare.

Use of the levonorgestrel-releasing intrauterine system, quality of life and sexuality. Experience in an Italian family planning center

Background The levonorgestrel-releasing intrauterine system (LNG-IUS) was first marketed in 1990 in Finland. Since then, it has been approved in approximately 120 countries throughout the world, with almost 50 million women-years of cumulative experience to date. Its high contraceptive effectiveness and favorable bleeding profile, leading to significant reduction of menstrual bleeding both in women with idiopathic menorrhagia and in those with normal menstrual bleedings, have been the key to the success of the system. At the same time, women need to be provided adequate preinsertion counseling about changes in menstrual bleeding to be expected. In the Italian context, it is important to highlight during counseling that amenorrhea is not harmful but can lead to health benefits such as an increase in iron blood stores and blood hemoglobin concentration. Study Design To evaluate contraceptive efficacy, compliance and the effect of changes in menstrual cyclicity on quality of life and sexuality of the LNG-IUS (Mirena®), 156 women attending the Family Planning Clinic to request contraception were enrolled in the study and inserted with the device. Results Menstrual blood flow decreased in all users, in terms of both quantity and duration; although spotting was present in 93.7% of the women, it disappeared within 6 months in the majority of cases. Amenorrhea occurred in 29.5% of all women, with onset within the first six cycles postinsertion. Data from the EuroQuality of Life-5D and Female Sexual Function Index questionnaires showed improvement in the quality of life, with a decrease in intercourse-related pain and an improvement in sexual desire. Conclusions Although in Italy intrauterine contraception is poorly accepted, once started on LNG-IUS, women found that the device represents a safe and effective contraceptive modality, with valuable noncontraceptive benefits, especially in the presence of heavy or prolonged bleeding.

Women kept up appearances and developed multiple coping strategies to deal with menopause

Kittell LA, Kernoff Mansfield P, Voda AM. Keeping up appearances: the basic social process of the menopausal transition. Qual Health Res1998 Sep; 8 : 618 –33 [OpenUrl][1][CrossRef][2][Web of Science][3] Question...

Reason, myths and fantasies: preliminary data and reflections about the Portuguese experience with LNG-IUS-induced hypomenorrhea

Objective To evaluate the efficacy and tolerance of the levonorgestrel-releasing intrauterine system (LNG-IUS) among Portuguese women, with particular emphasis on the implications of changes in bleeding pattern.Study design Forty healthy premenopausal women (average age 42.7 ± 4.5 years) were recruited in each one of the three Portuguese centers (a total of 120) where the LNG-IUS was used as a contraceptive method during a maximum period of 5 years. All women had previously given their informed consent and were informed about the eventual changes in bleeding pattern. Serum ferritin levels and hemogram measurements were performed before and 1 year after the introduction of the IUS. The results were analyzed by the Student t test (raw data and paired test).Results Preliminary data showed a continuation rate of 70% with an excellent efficacy rate (no pregnancies) 1 year after the introduction of the IUS. The hypomenorrhea rate was 35% while 12.5% of the women had amenorrhea. The average increase in serum ferritin level was 13 ng/ml and of hemoglobin 0.4 g/dl. The comparisons of hemoglobin results were statistically significant (p = 0.05, t raw data and p = 0.028, t paired test). Most complaints were related to cultural difficulties in accepting the changes in menstrual bleeding pattern. Conclusion In order to minimize and control the most common menstrual bleeding side-effects that occur when using this IUS, as well as to improve the continuation rate, clinicians must make a judicious choice of potential users, owing to the psychological and cultural implications that menstrual bleeding changes can have, mainly among women of low socioeconomic levels. Moreover, non-contraceptive therapeutic benefits should be emphasized.

Keeping up Appearances: The Basic Social Process of the Menopausal Transition

Sixty-one perimenopausal women experiencing changes in menstrual bleeding were interviewed by phone and were asked about the changes they were experiencing, how they felt about the changes, and how the changes affected their lives. Women's responses indicated that they perceived certain changes (unpredictable or unexpectedly heavy bleeding, intense hot flashes, and sudden emotional outbursts) as potentially embarrassing or disruptive. Women's attempts to conceal and maintain control of changes led to the discovery of the core variable, keeping up appearances. The results of this study emphasize the need for a greater specificity in correlating women's feelings and behaviors with particular changes as well as the need for a better understanding of the ways in which social and cultural expectations influence women's feelings and behavior.

Experiencing Changes in Menstrual Bleeding During the Menopausal Transition

Experiencing Changes in Menstrual Bleeding During the Menopausal Transition

Immunolocalization of endothelin and neutral endopeptidase in the endometrium of users of subdermally implanted levonorgestrel (Norplant).

Subdermally implanted slow-release levonorgestrel (Norplant), a widely used effective contraceptive, has a high rate of discontinuation due to unacceptable menstrual bleeding disturbances. Endothelin (ET), a potent vasoconstrictor, varies across the menstrual cycle in normal endometrium. It has been proposed that ET has a potential paracrine role in the regulation of uterine blood flow. Neutral endopeptidase (NEP), a membrane-bound ecto-enzyme, can inactivate ET and is localized principally in endometrial stroma. We have compared the immuno-localization of ET and NEP in endometrial biopsies from Indonesian women using Norplant with normal controls. Differences were observed in the glandular and luminal epithelium of Norplant-treated subjects, where ET immunostaining was low while NEP immunoreactivity was increased. The latter may represent a local increase in enzyme activity, potentially explaining the reduced ET immunoreactivity. There was no correlation of ET immuno-reactivity with the duration of implant use or total number of bleeding days. The marked differences in the ET immunostaining pattern in Norplant users, with their increased risk of abnormal uterine bleeding, suggest that ET may be important in controlling menstrual bleeding. Whether endometrial epithelial cell ET has a role as a mitogen in endometrial repair and regeneration, or as a vasoconstrictor important in the cessation of bleeding following menstruation, remains to be determined.