Menstrual Cycle Research Articles

Pregnancy dating: Determining gestational age through fetal kidney length-what do we observe?

Accurate gestational age is crucial for obstetric care, pregnancy management, and preterm labor decisions. Ultrasound, based on fetal biometric parameters, is a reliable method for this purpose. This study aims to estimate gestational age in the third trimester using ultrasonographic methods, focusing on fetal kidney length. Gestational age is estimated in the third trimester by measuring fetal kidney length and comparing it with gestational age derived from other biometric parameters (bi-parietal diameter, head circumference, abdominal circumference, and femur length) and the last menstrual period (LMP). A nine-month prospective study was conducted Kozhikode, Kerala, from September 2016 to May 2017. The study involved 200 women in their third trimester of pregnancy, utilizing third-trimester ultrasound to measure and document kidney length along with other biometric parameters (BPD, HC, AC, and FL). Subsequently, the collected data was reviewed and analyzed.: The study revealed a strong positive correlation between fetal kidney lengths (FKL) measured in millimeters and gestational age in weeks during the third trimester. The correlation was significant, with a Pearson's correlation coefficient of 0.87 (p < 0.001). Additionally, FKL exhibited positive correlations with other variables, including abdominal circumference (r = 0.832), head circumference (r = 0.845), bi-parietal diameter (r = 0.838), and femur length (r = 0.837). These findings demonstrated a strong Pearson’s correlation (r= 0.87-0.96, P <0.05) for all the biometric parameters including FKL. A linear relationship exists between fetal kidney length (FKL) and gestational age, allowing FKL to serve as an effective parameter for estimating gestational age during the third trimester. Given its positive correlation with other fetal biometric parameters such as bi-parietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL), incorporating FKL alongside these measurements enhances the accuracy of gestational dating in the third trimester. This combination of parameters improves the prediction of gestational age during this stage of pregnancy.

Menstrual challenges in puberty: Investigating menorrhagia in adolescent girls

Menorrhagia, defined as excessive or prolonged menstrual bleeding, poses a significant challenge during this developmental stage, potentially impacting the health and well-being of adolescent girls. Despite its prevalence, comprehensive studies on menorrhagia in this specific demographic are scarce. This study aims to address this gap by investigating the underlying causes and treatment outcomes of puberty menorrhagia.A six-month observational study involving 50 adolescent girls presenting with menorrhagia was conducted at the Department of Obstetrics and Gynecology in a tertiary care center. The study utilized consecutive enumerative sampling and included a thorough investigation of participants, collecting data on demographic profiles, symptom severity, anemia levels, diagnoses, therapy requirements, and responses to conservative management. Baseline investigations encompassed a range of tests, including pregnancy exclusion, complete blood count, coagulation profile, and hormonal assays.The study cohort of 50 participants revealed varying characteristics: 24% were under 14 years, 34% were between 14-16 years, and 42% were aged 17-19 years. BMI distribution showed 14% below 18.5, 76% between 18.5 and 25, and 10% exceeding 25. Symptom duration included 20% reporting less than 6 months, 34% between 6-12 months, and 46% over 12 months. Etiology analysis indicated 60% with ovulatory dysfunction. Hemoglobin level analysis illustrated the prevalence and severity of anemia. Diverse treatments, including hormonal and non-hormonal interventions, were administered.This study provides insights into the causes of puberty menorrhagia, emphasizing the need for a holistic treatment. Future research should delve deeper into identified associations and clinical variants to enhance our understanding and guide effective interventions. Management should be directed to the cause.

Does the COVID-19 Vaccines Effect on the Menstrual Cycle, Cross-Sectional Study Among Adult Females at King Saud University

COVID-19 vaccinations have been associated with irregularities in the menstrual cycle and symptoms occurring pre and post-menstruation, affecting women’s reproductive health. This study aimed to demonstrate the impact of COVID-19 vaccines on women’s reproductive health by examining the association between COVID-19 vaccines and disturbed menstrual cycles. This cross-sectional survey-based study was conducted among adult females at King Saud University, Saudi Arabia, from April 2022 to August 2022. A total of 380 participants were selected through a stratified random sampling technique. Ethical approval was obtained from the Deanship of Scientific Research at King Saud University. The data were analysed using descriptive statistics and appropriate statistical tests. The results revealed that 53.9% of the participants experienced disturbances in the menstrual cycle after receiving the COVID-19 vaccination. Adult females aged 18-25 showed the highest rate of disorders. Menstrual disruptions were substantially correlated with marital status (p = 0.05), with a significant association between the number of COVID-19 vaccine doses and the occurrence of menstrual disturbances (p = 0.001). The administration of the vaccination during menstruation was linked to a notable occurrence of menstrual disturbances, although the p-value showed no statistical significance. A significant correlation was examined (p < 0.05) between pre-existing menstrual problems and the occurrence of disorders after receiving the COVID-19 vaccine (p < 0.05). The study emphasised the importance of tailored healthcare treatments for women following COVID-19 vaccination and the need for regular evaluation of reproductive health outcomes post-COVID-19 vaccination.

Effect of menstrual cycle phase on physiological responses in healthy women at rest and during submaximal exercise at high altitude

AbstractAs more women engage in high-altitude activities, understanding how ovarian hormone fluctuations affect their cardiorespiratory system is essential for optimizing acclimatization to these environments. This study investigates the effects of menstrual cycle (MC) phases on physiological responses at rest, during and after submaximal exercise, at high-altitude (barometric pressure 509 ± 6 mmHg; partial pressure of inspired oxygen 96 ± 1 mmHg; ambient temperature 21 ± 2 °C and relative humidity 27 ± 4%) in 16 eumenorrheic women. Gas exchange, hemodynamic responses, heart rate variability and heart rate recovery (HRR) were monitored at low altitude, and then at 3375 m on the Mont Blanc (following nocturnal exposure) during both the early-follicular (EF) and mid-luteal (ML) phases. Significant differences were observed between low and high-altitude in ventilation, heart rate and cardiac output. Resting ventilation (15.2 ± 1.9 vs. 13.2 ± 2.5 L.min-1; p = 0.039) and tidal volume (812 ± 217 vs. 713 ± 190 mL; p = 0.027) were higher during EF than ML at high-altitude. These differences between EF and ML were no longer evident during exercise, with comparable responses in oxygen uptake kinetics, cycling efficiency and HRR. The MC had negligible effects on physiological responses to high-altitude. An individualized approach, tailored to each woman’s specific responses to hypoxia across the MC, may be more beneficial in optimizing high-altitude sojourns than general guidelines.

Clinical Effectiveness of Viddha Karma in PCOS: A Case Report

ABSTRACT Polycystic ovary syndrome (PCOS) is a common hormonal disorder affecting women of reproductive age. Ayurveda, an ancient Indian medical system, offers a comprehensive approach to addressing PCOS, including treatments like Viddha Karma. In the case of PCOS, Viddha Karma aims to relieve symptoms and enhance overall well-being. A 27 -year-old unmarried female patient came with complaints of irregular and scanty menses for the past 3-4 years, along with severe abdominal pain during the first 1-3 days of menstruation. She was treated with Shaman Chikitsa and Viddha Karma for 8 months. The patient’s menstrual cycle become regular, the volume of bleeding increased to a normal level, and she experienced a weight reduction of 5 kg. The examination of Viddha Karma principles in the management of PCOS emphasizes its potential as a supplementary treatment that tackles the underlying causes and promotes overall well-being. However, further research and clinical trials are necessary to gain a comprehensive understanding of its effectiveness.

BS O02 - Impact of Bariatric surgery on Obesity Indices and Reproductive Hormones: A Prospective Study in Morbidly Obese Women

Abstract Background Obesity, defined by a BMI of 30 kg/m² or higher, is influenced by genetics, socio-economic, and cultural factors. Genetic predispositions affect metabolism and energy regulation, while environmental factors like sedentary lifestyles and poor food environments worsen obesity. Obesity disrupts hormonal balances, impacting sex hormone levels and menstrual cycles, leading to infertility in women. This hormonal imbalance affects oocyte quality and ovulation. Bariatric surgery offers significant weight loss and metabolic improvements, enhancing reproductive hormone profiles and insulin sensitivity. Our study explores how sleeve gastrectomy affects BMI and hormone levels, aiming to understand its impact on obesity management and reproductive health. Method This prospective observational study examines the effects of laparoscopic sleeve gastrectomy on reproductive hormones and ovarian function in 32 morbidly obese women, adhering to Helsinki Declaration ethics. Participants, aged 18-50 with no menopause or chronic illness, consented to the study. Exclusions included those with polycystic ovary syndrome, recent reproductive organ surgery, or recent infertility medications. The study assessed changes in BMI, antral follicles, anti-Müllerian hormone, and reproductive hormones before surgery and at 6 and 12 months post-surgery. Blood samples and transvaginal ultrasounds were conducted preoperatively and at 6 and 12 months postoperatively to monitor outcomes. Results The study involved participants with an average age of 33 and a mean BMI of 42.12. Significant changes were observed post-sleeve gastrectomy at 6 and 12 months (p < 0.001). At 6 months, BMI decreased by 9.24 units, AMH levels dropped from 3 to 2.5 ng/mL, and antral follicle counts in both ovaries declined. By 12 months, BMI decreased by 16.47 units, AMH levels fell to 2 ng/mL, and antral follicle counts further reduced. Hormonal changes included increases in FSH, LH, and estradiol, while SHBG levels rose, and free testosterone levels decreased significantly. Conclusion Individual hormone responses to weight loss and surgery necessitate personalized obesity treatments. Tailoring surgical approaches and care to hormonal profiles can optimize outcomes and reduce complications. Monitoring AMH levels post-surgery can offer insights into reproductive effects, aiding clinical management and counseling for women with obesity-related infertility. We highlight the significant impact of sleeve gastrectomy on physiological parameters in obese individuals, especially regarding reproductive health and metabolic regulation. The findings enhance understanding of the changes associated with bariatric surgery and its potential benefits for metabolic and reproductive health.

Ayurvedic Approaches to Holistic Management of Polycystic Ovary Syndrome (PCOS)

ABSTRACT The female reproductive system relies on the intact uterine adnexa and the hypothalamic-pituitary-ovarian axis. An imbalance can lead to pathogenesis. PCOS is characterized by ovarian cysts, hyperandrogenism, and irregular ovulation. Over time, it can lead to symptoms such as changes in menstruation, obesity, infertility, depression, and increased risk of diabetes, cardiovascular disease, and endometrial cancer. In Ayurveda, PCOS is a condition affecting Rasa, Rakta, and Medas, the three Dhatus. Rakta, Rasa, and Artavavaha are the Srotas that are implicated in this illness. Symptoms that may appear include Anartava (amenorrhea), Vandhyatwa, Pushpagni, and Abeeja Rutuchakra (an ovular hemorrhage). A 23-year-old woman presented at the outpatient department with complaints of irregular menstruation and rapid weight gain. An ultrasound revealed left-sided polycystic ovary syndrome (PCOS). Palliative treatments such as Kaklarakshak Yog, Trikatu, and Triphala Churna were administered for 2 months. The patient experienced a significant reduction in symptoms and a return to a normal menstrual cycle within two months.

Psychophysiological effects of menstrual cycle in flag football players

Psychophysiological effects of menstrual cycle in flag football players

Autophagy Involvement in Non-Neoplastic and Neoplastic Endometrial Pathology: The State of the Art with a Focus on Carcinoma

Autophagy is a cellular process crucial for maintaining homeostasis by degrading damaged proteins and organelles. It is stimulated in response to stress, recycling nutrients and generating energy for cell survival. In normal endometrium, it suppresses tumorigenesis by preventing toxic accumulation and maintaining cellular homeostasis. It is involved in the cyclic remodelling of the endometrium during the menstrual cycle and contributes to decidualisation for successful pregnancy. Such a process is regulated by various signalling pathways, including PI3K/AKT/mTOR, AMPK/mTOR, and p53. Dysregulation of autophagy has been associated with benign conditions like endometriosis and endometrial hyperplasia but also with malignant neoplasms such as endometrial carcinoma. In fact, it has emerged as a crucial player in endometrial carcinoma biology, exhibiting a dual role in both tumour suppression and tumour promotion, providing nutrients during metabolic stress and allowing cancer cell survival. It also regulates cancer stem cells, metastasis and therapy resistance. Targeting autophagy is therefore a promising therapeutic strategy in endometrial carcinoma and potential for overcoming resistance to standard treatments. The aim of this review is to delve into the intricate details of autophagy’s role in endometrial pathology, exploring its mechanisms, signalling pathways and potential therapeutic implications.

The Bidirectional Relationship Between Sleep and Pain in Crohn’s Disease: A Daily Diary Study

Abstract Background Pain is common in Crohn’s disease (CD) even after endoscopic healing is achieved. Depression, sleep disturbances, fatigue, and worry about pain impact the pain experience. There is a bidirectional relationship between sleep and pain, though it has received minimal attention in CD. Herein, we sought to comprehensively assess this relationship in CD using daily diaries. Method Patients with active symptoms of insomnia and CD were recruited as part of an ongoing clinical trial. Participants completed 14-day diaries on sleep patterns and CD symptoms. Temporal associations between sleep and pain were assessed using cross-lagged path analysis and controlled for age, sex, and menstrual cycle. Results Overall, 26 participants completed 14-day diaries. All assessed aspects of sleep continuity disturbance were associated with worse next-day abdominal pain (Ps < 0.01). When assessed microlongitudinally, sleep onset latency predicted next-day pain (P = 0.07) and vice versa (P = 0.03). Similarly, nightly awakenings predicted next day pain (P = 0.02) and vice versa (P = 0.04). Sleep efficiency (P = 0.003), sleep quality (P < 0.001), and total sleep time (P = 0.04) predicted next-day pain whereas models with pain as the predictor were not significant. Conclusions Sleep continuity and abdominal pain are closely related, with sleep efficiency, total sleep time, and sleep quality potentially driving next-day abdominal pain. As interventions for pain in IBD are limited, it may be important to capitalize on the impact of sleep disturbances on pain to optimize overall wellbeing in people with CD.

A roadmap to reduce the incidence and mortality of breast cancer by rethinking our approach to women’s health

Abstract Despite progress, breast cancer remains the most feared disease among women. In the USA alone, the incidence is now almost 300,000 new cancers per year, a rate that has nearly doubled in the last 30 years. Most women survive, but over 40,000 women a year still die of their disease National Cancer Institute [Internet]. [cited 2024 Nov 4]. Cancer of the Breast (Female) - Cancer Stat Facts. Available from: https://seer.cancer.gov/statfacts/html/breast.html. It is the most diagnosed cancer among women and the second leading cause of cancer death. Important disparities exist in breast cancer outcomes among African American women, where women die of breast cancer at higher rates, are diagnosed younger, and at a more advanced stage. We are proposing a radical shift in our thinking about breast cancer prevention with an aspiration to dramatically lower breast cancer incidence. Most breast cancers are driven by steroid hormones. Throughout the life course, women are offered an array of hormonal treatments for menstrual cycle control, family planning, in vitro fertilization, postpartum weaning, and menopausal symptom management. There are mixed data on the extent to which each of these may contribute to increased or decreased risk for breast cancer. These endocrine manipulations could represent a great opportunity to potentially reduce breast cancer incidence and improve quality of life for survivors. To date, they have not been designed to explicitly reduce breast cancer risk. A new holistic approach will require scientists, drug developers, breast oncologists, obstetricians, gynecologists, endocrinologists, radiologists, and family medicine/internists to work together toward the common goal of reducing breast cancer risk while addressing other critical issues in women’s health.

WD-repeat containing protein-61 regulates endometrial epithelial cell adhesion indicating an important role in receptivity

Abstract Endometrial receptivity is crucial for successful embryo implantation during early pregnancy. The human endometrium undergoes remodeling within each menstrual cycle to prepare or become receptive to an implanting blastocyst in the mid-secretory phase. However, the mechanisms behind these changes are not fully understood. Recently, using hormone treated endometrial organoids to model receptivity, we identified that the transcriptional regulator WD-repeat-containing protein-61 (WDR61) was reduced in organoids derived from infertile women. In this study, we aimed to determine the role of WDR61 in endometrial receptivity. Here we demonstrated that WDR61 immunolocalizes in the nuclei and cytosol of endometrial glandular epithelium, luminal epithelium and stroma. The staining intensity of WDR61 was significantly higher during the receptive mid-secretory phase compared to the non-receptive proliferative phase in fertile women. In a functional experiment to model blastocyst adhesion to the endometrial epithelium, we found that adhesion of cytotrophoblast progenitor spheroids was blocked when siRNA was used to knockdown WDR61 in primary endometrial epithelial cells. Similarly, in Ishikawa cells (a receptive human endometrial epithelial cell line), siRNA knockdown of WDR61 significantly reduced the cell adhesive and proliferative capacities. qPCR revealed that WDR61 knockdown reduced expression of key genes involved in receptivity including HOXD10, MMP2 and CD44. Chromatin immunoprecipitation sequencing demonstrated that WDR61 directly targeted 2,022 genes in Ishikawa cells, with functions including focal adhesion, intracellular signaling and epithelial-mesenchymal transition. Overall, these findings suggest that WDR61 promotes endometrial receptivity by modulating epithelial cell focal adhesions, proliferation and epithelial-mesenchymal transition.

Abstract 4135993: Body Composition and Mortality Throughout the Reproductive Cycle: Findings from the Multi-Ethnic Study of Atherosclerosis

Introduction: Changes in body composition throughout the reproductive cycle accelerate during the 2 years following the final menstrual period (FMP), known as the menopausal transition (MT). During MT, an increase in fat mass (FM) and a decrease in fat free mass (FFM) are usually seen, but the relationship between these changes and cardiovascular events is not well understood. We aim to explore how FM and FFM are associated with cardiovascular events and total mortality across the reproductive cycle in participants of the Multi-Ethnic Study of Atherosclerosis (MESA). Methods: This study included 3439 women from exam 1 of MESA. Outcomes of interest were either MACE (heart failure, myocardial infarction, coronary revascularization, cardiac arrest, or stroke) or all-cause mortality. Equations to determine FM and FFM at exam 1 were validated with the NHANES 2003 population and derived from regression models based on bioelectrical impedance analysis results at exam 5 and anthropometric and demographic measures. Women were divided into 3 groups based on time since FMP: reproductive phase (before FMP), MT phase (<2 years after FMP), and late menopause phase (>2 years after FMP). Adjusted Cox multivariate models assessed the association between FM, FFM and MACE or all-cause mortality. Results: Median follow-up time was 14.1 years. FM was associated with MACE in the late menopause group, whereas FFM was not associated with MACE (Table). With respect to all-cause mortality, FM had a positive association (HR=1.19, P=0.03) while FFM had a negative association (HR=0.68, P=0.04) in the MT phase. The late menopause group showed similar relationships between FM, FFM, and all-cause mortality. The reproductive group showed no significant associations (Table). Conclusion: In this cohort, FM is associated with a higher risk of mortality whereas FFM is associated with a lower risk. We observed these associations to be more pronounced during the MT, a time of accelerated body composition change. Our results suggest and will need further investigation to confirm that the MT may be a critical time in the female lifespan to initiate interventions which positively impact muscle mass with a view to improving survival.

Giant pelvic dermoid cyst in a 17-year-old girl

BACKGROUND: Dermoid cysts in the presacral and retrorectal space in children are relatively rare. However, even more rarely, they have clinical manifestations at patient’s early age and so, can be silent for a long time. CLINICAL CASE DESCRIPTION: The article describes a rare clinical observation — a giant dermoid cyst in the retrorectal space in a 17-year-old girl. The child had a tendency to constipation from her early childhood. Menses started at age 13, painful. During the last year, disorders in her menstrual cycle were noticed. The girl was examined by a gynecologist. Ultrasound examination revealed a cystic formation in the pelvic cavity up to 9 cm in diameter. Non-malignant nature of the process was confirmed by: normal level of cancer markers (α-fetoprotein, β-human chorionic gonadotropin), single node, clearly defined formation capsule, homogeneous nature of its contents, no invasive growth and lesions in the regional lymph nodes. Magnetic resonance imaging with intravenous contrasting defined a true relationship of the cystic formation with other organs and structures of the pelvic cavity. The cystic formation caused deformation of the cervix, vagina, and rectum. The obtained findings allowed to plan surgical intervention correctly. Surgical access-transverse in the coccyx projection up to 10 cm long. The cystic formation was a thin-walled connective tissue capsule with a yellowish content. Due to very large cyst dimensions, first it was opened in a limited area and emptied. Then the capsule was isolated and completely removed. The cyst intimately adhere to rectum, vagina, and cervix walls. Histological conclusion: "Capsule of a dermoid cyst with hemorrhages". The postoperative period was smooth. The patient recovered, all disease manifestations disappeared. She was discharged home in a satisfactory state. Follow-up visits were in 6 and 12 months after surgery. No evidence of possible relapse. CONCLUSION: There are only few descriptions of such cases in the available literature. Ultrasound and MRI examinations allowed to have a full picture of dermoid cyst position and its connection with other pelvic organs due to which surgeons could develop a correct plan for surgical intervention.

HUBUNGAN KOMUNIKASI INTERPERSONAL IBU DENGAN TINGKAT KECEMASAN REMAJA PUTRI MENGHADAPI MENARCHE DI SD NEGERI BUNULREJO 2 KOTA MALANG

Adolescence is a stage of life that stretches between childhood and adulthood begins with hormonal changes followed by the first menstrual period or menarche in girls. Menarche generally occurs around the age of 11 – 14 years. Adolescent girls with minimal knowledge will assume that menarche causes discomfort and pain, causing anxiety. Anxiety about menarche can be removed if the mother is caring and wise in responding to the changes that will occur in adolescent girls. In dealing with menarche, mothers can be the primary source of information about menstruation in interpersonal communication. The aim of this study is to prove the correlation between mothers' interpersonal communication and the anxiety level of adolescent girls facing menarche at SD Negeri Bunulrejo 2 Malang City. In this study, an observational analytic design with a Cross-Sectional Study approach was implemented. The sample was obtained using a total sampling technique, and 53 adolescent girls' respondents at SD Negeri Bunulrejo 2 Malang City fulfilled the inclusion criteria. Mother's interpersonal communication and anxiety levels of adolescent girls facing menarche were measured by the questionnaire that had been tested for validity and reliability. The correlation between the two variables was analyzed using the Spearman rank correlation test. There was a significant negative correlation (Spearman Value = -0.705) between the mother's interpersonal communication and the level of anxiety facing menarche. This study concludes there is a correlation between mothers’ interpersonal communication and anxiety levels of adolescent girls facing menarche at SD Negeri Bunulrejo 2 Malang City. Key words: interpersonal communication, anxiety, menarche, adolescent girl

Association of lifetime lactation and characteristics of menopause: a longitudinal cohort study

Abstract Background Lactation has many established benefits for women’s long-term health; however, its influence on menopause is less clear. This study investigated the association between lifetime duration of lactation and the timing and type of menopause in midlife women. Methods We analyzed survey data on 19,783 parous women aged 40 to 65 years at enrollment in the Alberta’s Tomorrow Project (2000–2022), a prospective community-based cohort study in Alberta, Canada. Duration of lifetime lactation across all births was categorized as: <1 month (reference group; 19.8% of women), 1–3 months (12.1%), 4–6 months (11.7%), 7–12 months (18.8%), and ≥ 13 months (37.7%). Women were classified as premenopause, natural menopause (age at 1 year after the final menstrual period), surgical menopause (age at bilateral oophorectomy), or indeterminate menopause (age at premenopausal hysterectomy with ovarian preservation). Flexible parametric survival analysis and multinomial logistic regression were used to analyze menopause timing and type, respectively, according to lactation status and controlling for birth year, education, parity, hormonal contraceptive use, and smoking. Results In a dose-response manner, longer lactation was associated with reduced risk of natural menopause before age 50 (for ≥ 13 months of lactation, adjusted hazard ratio at age 45: 0.68, 95% CI 0.59–0.78), surgical menopause before age 55 (age 45: 0.56, 0.50–0.63), and indeterminate menopause before age 50 (age 45: 0.75, 0.69–0.82). Longer lactation was associated with lower odds of surgical (adjusted odds ratio 0.54, 95% CI 0.45–0.66) and indeterminate menopause (0.63, 0.55–0.73), compared to natural menopause. Conclusions Optimizing the timing of natural menopause and reducing risks of early surgical and indeterminate menopause may be novel maternal benefits of breastfeeding.

Radiation-induced Ovarian Ablation and Survival in Breast Cancer: A Single-Institutional Evaluation

ABSTRACT Background: Radiation-induced ovarian ablation (ROA) was one of the main modalities in the early years in inducing suppression of hormone levels of estradiol (E2) and follicle-stimulating hormones (FSHs) in estrogen receptor/progesterone receptor-positive breast cancer patients. However, as newer techniques such as medical ovarian suppression (MOS) and laparoscopic oophorectomies (LOs) emerged, ROA began to take a back seat. Nonetheless, ROA remains a valuable option for certain patients with specific indications. It is worth noting that ROA is still as effective as MOS and LO in achieving desired hormonal suppression levels. Materials and Methods: After receiving approval from the institutional ethics committee, we enrolled 41 female breast cancer patients who were scheduled for ROA at our institute between 2016 and 2018. Two patients declined to participate and were, therefore, excluded from the final analysis. Patients were evaluated for pre- and postradiation hormone levels, specifically E2 and FSH, cessation of menstrual periods, radiation-induced toxicity, disease-free survival (DFS), overall survival (OS), and the clinical profile as well. Results: Among 39 patients, 89.74% (n = 35) achieved postmenopausal hormone levels after ROA. Only 17.94% (n = 7) patients were menstruating before radiation exposure to the pelvis (postchemotherapy) and among these, 3 patients (42.85%) attained amenorrhea after ROA. The mean age of patients was 42 years, and the most common stage at presentation was Stage III (n = 15) 38.5%. Her2 positivity was seen in (n = 11) 28.2%. Breast conservation surgery was done in 64.1% (n = 25) and mastectomy was done in 23.1% (n = 9). About 71.7% (n = 28) have received tamoxifen, 43.5% (n = 17) were on letrozole, and 17.9% (n = 7) have received trastuzumab. None had shown any Grade 3 or 4 acute skin toxicity during treatment and late radiation-induced complications during their follow-up. The mean 5-year DFS was 62.2% and the mean 5-year OS was 59%. Conclusion: ROA is not widely used anymore due to its irreversible nature, and there are now reversible and noninvasive methods for ovarian suppression. Observing the effectiveness of ROA, it may still be an option for a selective group of breast cancer patients especially those who have contraindications for MOS or are willing for a short course of treatment.

A Review Article: Effects of Oral Contraceptive Pills on Menstrual Cycle, Pregnancy, and Thyroid Gland

Oral contraceptive pills (OCPs) are often used for both birth control and hormone modulation. They have a substantial impact on the menstrual cycle, pregnancy prevention, and general endocrine function, including the thyroid gland. This review examines how OCPs affect menstrual control, pregnancy prevention, and thyroid hormone levels. Understanding these interactions is critical for doctors managing patients on OCPs and women making informed reproductive health decisions.

Retinal morphology across the menstrual cycle: insights from the UK Biobank

Oestradiol and progesterone levels are higher in menstruating women than men of the same age, and their receptors are present in their neurosensory retina and retinal pigment epithelium. However, the impact of this hormonal environment on retinal physiology in women remains unclear. Using self-reported menstrual cycle phases as a surrogate for fluctuating hormonal levels, we investigated associations with retinovascular indices on colour fundus photograph and retinal thickness in optical coherence tomography across regularly menstruating women in the UK Biobank. We found no differences in retinal thickness across the cycle; however, vessel density, arteriolar and venular, and fractal dimension were higher in the luteal phase than follicular. The calibre of the central retinal vessels did not differ. This study suggests that the menstrual cycle phase might be associated with retinal microvasculature density in non-invasive imaging. It raises awareness for this understudied area, providing insights into neuroscience fields and epidemiological studies.

EFFICACY OF HORMONAL METHODS AS ONE OF THE PILLARS IN THE TREATMENT OF ENDOMETRIOSIS

Endometriosis is a gynecological manifestation of a systemic inflammatory disease that causes chronic pelvic pain and can lead to infertility, characterized by the growth of endometrial tissue outside the uterus. This occurs due to retrograde menstruation, which consists of the leakage of part of the menstrual flow into the pelvis, and is common in 90% of women and eliminated by the immune system. However, in a portion of this population, the endometrial tissue proliferates and enters organs such as the intestine and bladder, growing during the menstrual period, which results in complications, intense pain and incapacity in daily life. It is estimated that between 5% and 10% of women of reproductive age worldwide are affected by this pathology, in addition to being the second most common pelvic disorder and the most frequent cause of female pelvic pain. Endometriosis is believed to be caused by the dysregulation of the female hormones estrogen and progesterone. Thus, the regulation of these hormonal agents through the use of hormonal methods has proven efficacy, as it reduces or even eliminates estrogenic stimulation and consequently improves the quality of life of patients; since this stimulus is the main agent responsible for the growth and permanence of the foci of this disease, which highlights the efficacy of this method as an important pillar in the treatment of endometriosis.