Changes In Menstrual Patterns Research Articles

The direct effect of SARS-CoV-2 virus vaccination on human ovarian granulosa cells explains menstrual irregularities

Following administration of the SARS-CoV-2 vaccine, many women worldwide reported short-term menstrual irregularities. Although menstrual bleeding, “the fifth vital sign”, is experienced by more than 300 million people on any given day worldwide, these changes were only partially studied. Irregular periods are important well beyond fertility and the discomfort they impose; they are associated with the risk of cardiovascular morbidity, chronic diseases, and premature mortality. Pre-clinical examination of the vaccine polymeric envelope indicates its accumulation in the ovaries. The somatic endocrine cells of the ovarian follicle - the granulosa cells (GCs)—participate in the strict hypothalamic-pituitary-ovarian (HPO) feedback loop that governs the menstrual cycle via endocrine and paracrine regulators, as AMH and Inhibins. We aimed to unravel the direct effect of the COVID-19 vaccine on GCs and link their post-vaccine activity to changes in menstrual patterns. Human primary GCs exposed in-vitro to the Pfizer COVID-19 vaccine BNT162b2, demonstrated no change in their viability but altered mRNA transcripts, specifically of the regulatory key factors: InhibinB was upregulated, whereas AMH was downregulated. We further examined pre- and post-vaccination blood samples from individual women and found a 2–3 folds change in the post-vaccination FSH/InhibinB protein level ratio, compared to their pre-vaccination values. This altered expression of InhibinB could significantly impact the HPO axis in vaccinated women and may ultimately influence the endometrium cyclicity, manifested clinically by the commonly reported changes in menstrual bleeding patterns.

The Impact of COVID-19 Infection on Gonadal Hormonal Hunctions in Iraqi Wome

Background: The COVID-19 pandemic has had effects beyond the respiratory system, impacting health and quality of life. Stress-related to the pandemic has led to temporary menstrual pattern changes in around one-third of women. These changes, likely driven by stress and anxiety, can result in problematic heavy bleeding, causing anemia and negatively affecting women's well-being. This also places a substantial socioeconomic burden on individuals, families, healthcare, and society. Objectives: This study examined the impact of COVID-19 infection on the hormone levels (estradiol, prolactin, follicle-stimulating hormone, and luteinizing hormone) and heavy menstrual bleeding in Iraqi premenopausal women infected for at least four months. Patients and Methods: This case-control study was conducted from November 2021 to April 2022, involving 100 married women aged 18 to 40. Participants were divided into two groups: 50 women with heavy bleeding post-COVID-19 infection (infection duration of at least four months) and 50 non-infected women. Results: Comparing the Mean ± SD of the two groups, showed that the LH levels were statistically highly significant in women who suffered heavy bleeding post-COVID-19 infection compared to non-COVID-19 women, with a p-value of 0.000. There was no statistically significant difference in FSH levels between the two groups. The PRL levels were significantly higher for women who suffered substantial bleeding following COVID-19 infection compared to non-COVID-19 women, with a p-value of 0.003. Moreover, The E2 was significantly higher in women who suffered excessive bleeding following COVID-19 infection than non-infected women. Conclusion: This study suggests that COVID-19 may temporarily disrupt menstrual patterns, possibly due to stress and anxiety affecting the hypothalamus-pituitary-ovary axis. This disruption can manifest as elevated levels of gonad hormones (LH, PRL, and E2) and, in some cases, lead to heavy bleeding after a coronavirus infection. Received Oct. 2022 Accepted Oct. 2023 Published Jan. 2024

HUBUNGAN PENGGUNAAN ALAT KONTRASEPSI HORMONAL TERHADAP PENINGKATAN BERAT BADAN DAN GANGGUAN SIKLUS HAID PADA AKSEPTOR KB DI DESA LAMBHEU KECAMATAN DARUL IMARAH KABUPATEN ACEH BESAR TAHUN 2023

Data obtained from WHO 2018, family planning is an action that helps individuals or married couples to obtain certain objectives, avoid unwanted births, get births that are desired, contraceptives around the world mostly use Injectables 35.3%, Pills 30.5%, IUDs 15.2%, Implants 7.3% and other contraceptives 11.7%. The use of hormonal contraceptives causes side effects including changes in menstrual patterns, weight changes. The purpose of the study was to determine the effect of using hormonal contraceptives on weight gain and menstrual cycle disorders in family planning acceptors in Lambheu Village, Darul Imarah District, Aceh Besar Regency in 2023. This research method is Descriptive Quantitative with Linear Regression approach with Purposive sampling technique with a sample size of 87 respondents. This research was conducted on June 11 to 14, 2023 in Lambheu Village, Darul Imarah District, Aceh Besar Regency, with univariate and bivariate analysis. The results showed that there was an effect of the use of contraceptive pills, injections and implants on weight gain with a sig test result of 0.066 and menstrual cycle disorders with a sig test result. 0,057. Conclusion There is an effect of using Hormonal Contraceptives on increasing Body Weight with Linear Regression test Sig value. 0,066 < 0,05. There is an effect of the use of Hormonal Contraceptives on menstrual cycle disorders with a Linear Regression Test Sig value. 0,057 < 0,05.

Ayurvedic treatment regime of Ovarian Cyst: A Case Report

Introduction: Ovarian cysts are fluid-filled sacs that develop on or within the ovaries, which are part of a woman's reproductive system. Most ovarian cysts are benign (non-cancerous) and do not cause any symptoms. However, in some cases, ovarian cysts can grow larger, rupture, become painful, or cause other complications. Hormonal contraceptives and Surgery only the treatment follow by modern system of medicine. A hormonal contraceptive contributes untoward effect. In Ayurveda it can be correlated with Granthi (Kaphaja Granthi). Methods: In this present case study, a 36 years old woman patient consulted to the OPD with the complaint of Pelvic pain come and go, Bloating in the abdomen, Changes in menstrual patterns, and Pain during sexual intercourse. She had also brought her ultrasonography (USG) and finding suggested a right ovarian complex cyst measuring 36mm×36mmx34mm. She was supposed to be treated with traditional ayurvedic formulations; the case was treated for three months with a combination of different traditional Ayurvedic drugs, with the goal of relieving symptoms and dissolving the ovarian cyst. This patient was treated with traditional Ayurvedic formulations like Varunadi Kashyam, Guggulu Panchapala Churnam, Dashmoola Kwatha, Ajmoodadi Choorna. Result: Only Ayurvedic medicines were used during the course of the treatment. Follow-up USG showed complete disappearance of cyst and symptoms also subsided to a great extent. Discussion: The present study emphasizes the role of Ayurveda in bringing a positive result in the management of ovarian cyst.

Menstrual cycle length variation by demographic characteristics from the Apple Women’s Health Study

Menstrual characteristics are important signs of women’s health. Here we examine the variation of menstrual cycle length by age, ethnicity, and body weight using 165,668 cycles from 12,608 participants in the US using mobile menstrual tracking apps. After adjusting for all covariates, mean menstrual cycle length is shorter with older age across all age groups until age 50 and then became longer for those age 50 and older. Menstrual cycles are on average 1.6 (95%CI: 1.2, 2.0) days longer for Asian and 0.7 (95%CI: 0.4, 1.0) days longer for Hispanic participants compared to white non-Hispanic participants. Participants with BMI ≥ 40 kg/m2 have 1.5 (95%CI: 1.2, 1.8) days longer cycles compared to those with BMI between 18.5 and 25 kg/m2. Cycle variability is the lowest among participants aged 35–39 but are considerably higher by 46% (95%CI: 43%, 48%) and 45% (95%CI: 41%, 49%) among those aged under 20 and between 45–49. Cycle variability increase by 200% (95%CI: 191%, 210%) among those aged above 50 compared to those in the 35–39 age group. Compared to white participants, those who are Asian and Hispanic have larger cycle variability. Participants with obesity also have higher cycle variability. Here we confirm previous observations of changes in menstrual cycle pattern with age across reproductive life span and report new evidence on the differences of menstrual variation by ethnicity and obesity status. Future studies should explore the underlying determinants of the variation in menstrual characteristics.

Perbandingan Kejadian Anemia Pada Penggunaan Kontrasepsi Intra Uterine Device (Iud) Dan Suntik Kb 1 Bulan Di Desa Joho, Kecamatan Mojolaban, Kabupaten Sukoharjo, Jawa Tengah

<p><em>Anemia associated with the use of modern contraception causes changes in menstrual patterns that lead to anemia. Modern contraceptives such as sterilization, intrauterine devices (IUD), pills, birth control injections, implants, condoms, the lactation amenorrhea method (MAL) are preferred by married women in Indonesia, the prevalence was recorded at 58.7% in 2018, then 59, 7% in 2022 and the number will continue to grow until it is estimated to reach 61.9% in 2030. Contraception is an effective innovation in the public health sector, enabling family planning and pregnancy prevention, one of which is the Intra Uterine Device / IUD which is divided into four types and 1 month birth control injection which can cause side effects, one of which is anemia. The aim of the study was to analyze the comparative incidence of anemia in the use of intrauterine device (IUD) contraception and 1-month contraceptive injections in Joho Village, Mojolaban District, Sukoharjo Regency, Central Java. This study uses a comparative analysis and a pre-experimental one shot case study approach. the target population is married women or couples and the actual population is mothers using intrauterine contraception devices (IUDs) and 1 month injectable birth control. With a sample requirement of 44 respondents. There is a difference in the incidence of anemia in the use of intra uterine device (IUD) contraception and 1 month contraceptive injection in Joho Village, Mojolaban District, Sukoharjo Regency, Central Java with the average hemoglobin level of 1 month contraceptive injection users being higher than IU users</em></p>

Abstract P6-05-02: PRESENCE OF BRCA MUTATIONS AND PRE-CHEMOTHERAPY SERUM ANTI-MULLERIAN HORMONE LEVELS PREDICT RISK OF AMENORRHEA IN WOMEN WITH BREAST CANCER

Abstract OBJECTIVE: The likelihood of post-chemotherapy (ChT) amenorrhea is still empirically determined. Our aim was to determine the predictors of amenorrhea risk post- ChT in women with breast cancer(ca). As acute amenorrhea (< 12mo post-ChT) can be temporary, we used amenorrhea status 12 and 18 months post-ChT as the primary endpoint. MATERIALS AND METHODS: 102 women aged 18-44, with regular cycles and stage I-III breast ca were prospectively and longitudinally followed for their menstrual pattern changes at 6, 12, and 18mo after the completion of adjuvant ChT with an Anthracycline-Cyclophosphamide-based (AC) or Cyclophosphamide-Methotrexate +5-Fluorouracil regimen on an IRB-approved protocol. Prior ChT, ovarian surgery, pelvic RT, family history of POI, and infertility diagnosis were the exclusion criteria. AMH was measured pre- and immediately post- ChT. Amenorrhea was defined as no bleeding for 4 consecutive cycles. Preand/or post-ChT AMH levels, age and BMI at the onset of ChT, BMI, tamoxifen use, regimen type (AC-based vs. not), and BRCA mutation (m) status (positive vs. not) were evaluated for the prediction of amenorrhea risk. RESULTS: In multivariable-adjusted logistic regression models, age (p=0.03) and AMH (p=0.03) were significant predictors of amenorrhea at 12mo, and BRCAm status (p=0.03) at 18 mo; these models yielded areas under the ROC curve of 0.77 and 0.76, respectively. An undetectable AMH post-ChT was best predictive of amenorrhea with shorter follow-up, but not at 18mo. In longitudinal analysis (with data at 0, 6, 12, and 18 months) estimating ‘time-trends’, a baseline AMH < 2.0 ng/ml (optimal cut-off from ROC curve) and BRCAm status were associated with the risk of amenorrhea. The baseline AMH ≥2.0 group showed attenuated time-trend vs. the AMH < 2.0 ng/ml group (ratio of ORs=0.91, 95% CI=0.86-0.97, p=0.002), while the BRCA-positive group showed a steeper time-trend in the odds ratio (OR) of amenorrhea, compared to the non-positive group (ratio of ORs=1.12,95% CI=1.04-1.20, p=0.003) (Table 1). Sensitivity analyses demonstrated the robustness of these findings, for example, yielding an 8-10% increased risk of amenorrhea for BRCAm carriers, with p-values of 0.008- 0.04. CONCLUSIONS: Age, pre-and post-ChT AMH levels, and BRCAm status are potential predictors of amenorrhea at 12 and 18mo post-ChT. These predictors may help better guide fertility preservation decision-making in women with breast ca. The higher likelihood of amenorrhea in women with BRCAm suggests that they may be more prone to lose their ovarian function post-ChT and should be accordingly counseled. Table 1. Longitudinal analysis at 0, 6, 12 and 18 months for the difference in amenorrhea trend between groups dichotomized by baseline factors. Citation Format: Shari B. Goldfarb, Volkan Turan, Giuliano Bedoschi, Nadia Abdo, Cassandra Chang, heejung Bang, KUTLUK H. OKTAY. PRESENCE OF BRCA MUTATIONS AND PRE-CHEMOTHERAPY SERUM ANTI-MULLERIAN HORMONE LEVELS PREDICT RISK OF AMENORRHEA IN WOMEN WITH BREAST CANCER [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-02.

Does Covid-19 vaccination affect menstruation pattern?

Background: As Millions of people are receiving COVID-19 vaccine around the world, a number of side effects are being reported. Menstrual cycle disturbance is also a side effect reported by hundreds of women on social media. The objective of this study was to assess the association of menstrual abnormalities with COVID-19 vaccination.
 Subjects and methods: This descriptive cross sectional study was conducted in Obstetrics and Gynecology OPD of Mufti Mehmood Hospital D.I. Khan from March 2021 to June 2021. The health care workers who received Sinopharm COVID-19 vaccine and consented were included. Data was collected about change in menstrual cycle pattern after COVID-19 vaccination.
 Results: A total of 80 subjects were included in the study with mean age of 32.6 +7.89 years. There were 36 (45.0%) doctors, 33 nurses (41.25%), 6 (7.5%) paramedics and 5 (6.25%) medical students. According to their marital status, 51 (63.75%) were married and 29 (36.25%) were unmarried. Out of 80 subjects, 16 (20%) reported disturbance in menstrual cycle pattern, 13 (81.2%) after first dose and 3 (18.75%) after both first and second dose. Among these 9 (56.25%) reported heavy menstrual bleeding, 4 (25%) had prolonged bleeding days while 3 (18.75%) had irregular bleeding pattern.
 Conclusion: Menstrual cycle disturbance is a reported side effect of COVID-19 vaccination. It is more commonly reported after first dose and heavy menstrual bleedings is the most common pattern followed by prolonged/irregular bleeding.

Menstrual changes after the thrombo-prophylaxis or anticoagulants used during the COVID-19 infection.

To detect the menstrual changes after the thrombo-prophylaxis or anticoagulants used during the COVID-19 infection. A total of 176 diagnosed with COVID-19 infection, were included in this retrospective study after giving informed consent. Participants were asked to complete an online questionnaire, and the collected participants` data were analysed using the χ2 test to detect the menstrual changes after the thrombo-prophylaxis or anticoagulants used during the COVID-19 infection. The number of participants` number who reported menstrual flow for 2 to < 5 days, and menstrual flow > 7 days after the COVID-19 infection [31/176 (17.6%), and 42/176 (23.9%), respectively] was significantly higher compared to the number of participants` who reported menstrual flow for 2 to < 5 days, and menstrual flow > 7 days before the COVID-19 infection [12/176 (6.8%), and 15/176 (8.5%), respectively], (p = 0.005, and 0.0009, respectively). The use of thrombo-prophylaxis or anticoagulants during the COVID-19 infection was also associated with significant menstrual pattern changes (37.8% increased menstrual flow, 18.5% menstrual flow for 2 to < 5 days, 59.7% menstrual flow > 7 days, 5.9% contact bleeding, and 6.7% abnormal menstrual pattern for one cycle). Significant menstrual changes were observed in this study after the COVID-19 infection infection (17.6% reported menstrual flow for 2 to < 5 days, and 23.9% reported menstrual flow > 7 days). The use of thrombo-prophylaxis or anticoagulants during the COVID-19 infection infection was associated with significant menstrual changes (37.8% increased menstrual flow, 18.5% menstrual flow for 2 to < 5 days, 59.7% menstrual flow > 7 days, 5.9% contact bleeding, and 6.7% abnormal menstrual pattern for one cycle).

Development of an Intrauterine Device Releasing Both Indomethacin and Levonorgestrel During the First Months of Use: Pharmacokinetic Characterization in Healthy Women.

Post-placement menstrual bleeding pattern changes with intrauterine contraceptives (IUCs), including levonorgestrel-releasing intrauterine systems (LNG-IUS), can be a reason for avoidance or early discontinuation. Prostaglandins play an important role in menstrual bleeding and pain. The key drivers of prostaglandin synthesis are cyclooxygenase (COX) enzymes, which are inhibited by non-steroidal anti-inflammatory drugs. In this study, we report the findings from pharmacokinetic (PK) analyses undertaken with an LNG-IUS (LNG-IUS8) modified with an additional reservoir containing indomethacin (IND). The IND/LNG-IUS8 is a proof-of-concept device studied in a phase II proof-of-concept/dose-finding study. IND/LNG-IUS8 contains the same LNG content as the unmodified LNG-IUS8 (13.5 mg) but was prepared with three different IND doses (low, 6.5 mg; middle, 12.5 mg; and high, 15.4 mg), resulting in different daily release rates. Overall, 174 healthy, premenopausal women were randomized to one of the four treatment arms (low-, middle-, high-dose IND/LNG-IUS8 or LNG-IUS 8). Initial and residual IND and LNG content were collected and the amount of IND and LNG released in vivo over the period of use was calculated. A subset of 62 participants underwent dense blood sampling for PK analysis. Concentrations of IND and LNG in plasma were determined by validated liquid chromatography-tandem mass spectrometry methods and plotted over time. Descriptive statistics were calculated for plasma drug concentrations and PK parameters. High-dose IND/LNG-IUS8 initially released much higher levels of IND than expected based on in vitro release data, followed by a steep decline, with the reservoir emptied by 4.5 months. Middle- and low-dose IND/LNG-IUS8 demonstrated steady sustained release of IND over time, emptying after 7.4 and 8.4 months, respectively. Peak plasma concentrations of IND for low- and middle-dose IND/LNG-IUS8 remained below the 20% maximal inhibitory concentration (IC20) values for COX enzymes. The average daily IND release rate in vivo was 49 µg/day for low-dose and 112 µg/day for middle-dose IND/LNG-IUS8. The IND release rate profile and IND plasma concentrations in vitro both decreased steadily over time with low- and middle-dose IND/LNG-IUS8. The LNG release rate profile was comparable for all IND/LNG-IUS8 dose groups and LNG-IUS8. This PK study demonstrates that two different drugs can be released at different rates from an IUS designed with two drug reservoirs. Inclusion of IND does not impact the LNG PK profile. Low- and middle-dose IND/LNG-IUS8 were associated with a systemic IND exposure that should preclude the occurrence of adverse events typically observed after oral IND dosing. ClinicalTrials.gov identifier number: NCT03562624.

THE RELATIONS OF RE-INFECTION OF COVID-19 WITH CHANGES IN MENSTRUAL PATTERNS IN WOMEN OF CHILDBEARING AGE AT THE HEALTH POLYTECHNIC OF THE BENGKULU MINISTRY OF HEALTH IN 2022

Coronavirus Disease 2019 or better known as COVID-19 is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). It is known that this virus can attack the reproductive organs and cause changes in the menstrual cycle in the form of a longer menstrual cycle, heavier blood flow, longer duration and increased pain levels. This study aims to determine the relationship between positive history of COVID-19 and changes in menstrual patterns in women of childbearing age at Poltekkes Kemenkes Bengkulu in 2022. The research design used was observational analytic with a retrospective approach. The research population was all female lecturers and students of the Bengkulu Ministry of Health Poltekkes, totaling 2696 people. The sample in this study was 155 people who were taken by purposive sampling technique. Data were analyzed using chi square test. The results showed that 125 people (80.6%) had a positive history of COVID-19 and most people (54.2%) experienced changes in menstrual patterns. A total of 40 people (25.8%) experienced re-infection with COVID-19. Based on the results of the bivariate analysis using the chi square test, the p value = 0.000 (p-value &lt; 0.05), it means that there is a significant effect for a positive history reinfection with changes in menstrual patterns at the Health Polytechnic of the Ministry of Health Bengkulu.&#x0D; &#x0D;

Clinical study on 2 types of intrauterine stents with different thickness and hardness in the treatment of moderate-to-severe intrauterine adhesions.

Although hysteroscopic adhesiolysis (HA) is the main treatment for intrauterine adhesion (IUA), postoperative management of IUA remains challenging because there is no consensus on how to mitigate the high rate of postoperative adhesions reformation. This study aims to compare the effectiveness and safety of 2 types of intrauterine stents with different thickness and hardness in treating moderate-to-severe IUA. A retrospective clinical study was conducted in the Third Xiangya Hospital of Central South University from November 2020 to July 2021. A total of 191 patients with moderate-to-severe IUA who received surgical treatment and placed intrauterine stents after HA to prevent recurrence of postoperative adhesions were included. According to the hardness and thickness of the intrauterine stents, the participants were divided into a case group (placed the novel thin intrauterine stent, n=62) and a control group (placed the conventional stent, n=129). After 2-3 menstrual cycles, a second-look hysteroscopy was performed, and the intrauterine stents were removed. The postoperative efficacy [the reduction of American Fertility Society (AFS) scores, the adhesions reformation rate, the changes in menstrual pattern, and the pregnancy rate during the follow-up], safety (the adverse events), and applicability (the difficulty of stent removal) were compared between the 2 groups. No significant differences in preoperative clinical characteristics were observed between the 2 groups (all P>0.05). The menstrual volume of all patients was increased after the treatment. The reduction of AFS scores and the menstruation recovery rate were not significantly different between the 2 groups (P=0.519 and P=0.272, respectively). Notably, there was no case of displacement in the case group, while the displacement rate of the control group was 2.3% (P=0.552). Moreover, there was no significant difference in abdominal pain or postoperative abnormal vaginal bleeding between the 2 groups (P=0.823 and P=0.851, respectively). However, the difficulty rate of removing the thinner stents was significantly lower than that of removing the traditional stent (21.0% vs 38.8%, P=0.014). During the follow-up for half a year of the postoperative period, the pregnancy rate did not differ significantly in the case and control groups (45.0% vs 34.6%, P=0.173). The novel intrauterine stent shows noninferior efficacy and had a good safety profile compared with conventional stents in treating moderate-to-severe IUA. Importantly, it was more convenient to be removed without increasing the rate of displacement and detachment. Therefore, it could reduce the amount of damage to the endometrium and has higher applicability than conventional stents.

Feasibility of e-commerce pharmacy provision and acceptability of levonorgestrel 1.5 mg for pericoital use in urban and peri-urban settings in Kenya: a prospective cohort study

IntroductionAn ‘on-demand’ contraceptive pill may suit women having infrequent sex. We assessed the feasibility of e-commerce pharmacy provision and acceptability of levonorgestrel (LNG) 1.5 mg for pericoital use in Kenya.MethodsA...

A study of efficacy, safety, and acceptance of two combined oral contraceptive pills containing 150 mcg Levonorgestrel and 30 mcg Ethinyl Estradiol at Dr. Kariadi Hospital, Semarang, Indonesia

Background: Combine Oral Contraceptives (COCs) pills is one of the many popular contraceptives worldwide, with 100 million women who use contraceptive pills. To increase the choice of oral contraceptives, COCs Novadiol® (Pill A) domestic production, which has the same dosage as Microgynon® (Pill B), are still imported drugs. This study aims to determine Pill A's efficacy, safety and acceptance level compared to Pill B for 3 months. Methods: The study was a randomized control clinical trial, an open-label trial in 200 women of childbearing age who met the inclusion and exclusion criteria from July to November 2015. Data were analyzed using SPSS version 20 for Windows. Results: About 300 participants were selected and 200 met the inclusion and exclusion criteria who participated study from the beginning to the end of the study period. In the first month of observation, 1 complaint of dizziness in pill A and 2 from pill B. One nausea complaint was found in the participant from Pill A. These differences were not statistically significant (p&gt;0.05). In the second month of observation, 1 complained of dizziness from pill B and 1 nausea from Pill A. In the third month, observation found no complaints about using Pill A and pill B. There were changes in menstrual patterns in both pills and bleeding outside the cycle during the use of 3 months, but they were not statistically significant (p&gt;0.05). Conclusion: Pills A has the same efficacy, safety and acceptance when compared to the use of birth control pills B for 3 months.

Canagliflozin combined with metformin versus metformin monotherapy for endocrine and metabolic profiles in overweight and obese women with polycystic ovary syndrome: A single-center, open-labeled prospective randomized controlled trial.

ObjectivesCanagliflozin (CANA), a kind of sodium-glucose cotransporter-2 (SGLT-2) inhibition, study in which the role of CANA monotherapy in polycystic ovary syndrome (PCOS) has been investigated, and it could become a novel option in the PCOS treatment. Nevertheless, trials focused on SGLT-2 combination therapy’s efficacy, and safety in PCOS patients are limited. This randomized controlled trial compared the efficacy and safety of CANA and metformin (MET) combination therapy and MET monotherapy in endocrine and metabolic profiles of overweight and obese women with polycystic ovary syndrome (PCOS).MethodsFifty-one overweight or obese non-diabetic PCOS women between 18 and 40 years old were enrolled. Patients were randomly allocated to receive either CANA/MET or MET treatment. The CANA/MET group received CANA 100 mg once daily plus MET 1000 mg twice daily, while the MET group received MET 1000 mg twice daily for three months. Changes in menstrual pattern, anthropometric parameters, gonadal parameters, glucose and lipid homeostasis, and adverse events (AEs) were evaluated.ResultsCompared with the MET group, women have a significantly lower level of total testosterone (TT), area under the curve for glucose (AUCGlu), and area under the curve for insulin (AUCIns) to AUCGlu ratio in the combination group. There were no significant differences in menstrual frequency, body weight, body mass index, follicle-stimulating hormone, luteinizing hormone, free androgen index, sex hormone-binding globulin, androstenedione, fasting blood glucose, fasting insulin, AUCIns, homeostasis model assessment-insulin resistance (HOMA-IR), triglycerides, total cholesterol, low-density lipoprotein cholesterol, apolipoprotein A1 (Apo A1), apolipoprotein B (Apo B), and APO B/A1 ratio. AEs were seen in 57.70% (15/26) and 68.00% (17/25) of patients in the CANA/MET and MET groups, respectively.ConclusionsIn overweight and obese women with PCOS, CANA and MET combination therapy may be similar to MET monotherapy in improving menstrual frequency, weight control, hyperandrogenemia, and relieving insulin resistance. CANA/MET may have more benefits in reducing TT, AUCGlu, and the AUCIns/AUCGlu ratio within three months than MET monotherapy.Trial registration ClinicalTrials.gov, NCT04973891.

Menstrual Cycle Function Following Concussion In Adolescent Patients

Purpose: This study sought to describe menstrual cycle patterns in acutely concussed adolescents and to investigate if cycle phase at injury influenced post-concussion cycle pattern changes or symptom endorsement. Methods: Data were collected prospectively from patients aged 13-18 years presenting to a specialty care concussion clinic for initial visit within 28 days of concussion and a follow-up visit 3-4 months post-injury. Primary outcomes included changes in menstrual cycle pattern since injury (change/no change), menstrual cycle phase at time of injury, calculated using date of last period prior to injury, and symptom severity, measured by the Post-Concussion Symptom Inventory (PCSI). Fisher’s exact tests were used to determine the association between menstrual phase at injury and change in cycle pattern at follow-up. Multiple linear regression was used to determine if menstrual phase at injury was associated with subsequent PCSI symptom severity, adjusting for age. Results: Five hundred ninety-eight post-menarchal adolescents were enrolled (mean age 15.4 ± 1.4 years) with 136(22.7%) returning for follow-up. At time of injury, 108(18.9%) were in the menstruation phase, 269(47.0%) were in the follicular phase, 105(18.4%) were in the early luteal phase, and 90(15.7%) were in the late luteal phase. Menstrual pattern change was reported in 4% of patients at initial visit and 12.5% of patients at follow-up. At 3-4 months, menstrual phase at injury was not associated with menstrual cycle changes (p = 0.18) but was associated with PCSI severity (p = 0.03). Patients injured in the early luteal phase reported the highest symptom severity at follow-up. Conclusions: One in eight adolescents reporting to clinic at 3-4 months post-concussion had experienced a change in menses. Menstrual cycle phase at time of injury was associated with post-concussion symptom severity, but not a change in menstrual pattern. Leveraging the largest study sample of post-concussion menstrual patterns to date, this study represents important foundational data regarding potential hormonal effects of concussion in adolescents. Supported by NIH R01NS097549 and T32NS043126

Abnormal Uterine Bleeding Among COVID-19 Vaccinated and Recovered Women: a National Survey.

The objective of this research was to characterize menstrual changes including amount, duration, and frequency among COVID-19 vaccinated and infected women. We conducted an online nationwide questionnaire survey on premenopausal, non-pregnant women over 18 years of age in Israel, querying about any changes in their menstrual patterns after COVID-19 vaccination or infection. In total, 10,319 women responded, of which 7904 met the inclusion criteria. Changes in menstrual patterns following COVID-19 vaccination or infection were reported in 3689/7476 (49.3%) women compared with 202/428 (47.2%) women, respectively, (P = .387). The most commonly described menstrual disturbance was excessive bleeding (heavy, prolonged, or intermenstrual) in both the vaccinated and infected groups, (80.6% versus 81.4%, respectively, P = .720). Among women who experienced abnormal uterine bleeding (AUB), in most cases (61.1%), it occurred between the vaccination and the ensuing menstrual period. Menstrual disturbances were similar in type among the vaccinated and infected women. In conclusion, AUB emerged as a side effect of the BNT162b2 vaccine and a symptom of the COVID-19 infection and was characterized mainly by excessive bleeding. Although the precise incidence could not be determined in this study, the type of bleeding disorder as well as the characterization of risk factors including increasing age and a baseline menstrual pattern of prolonged, frequent, and heavy menses are well defined. The incidence and the long-term consequences of the BNT162b2 vaccine on uterine bleeding warrant further investigation.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43032-022-01062-2.

Health Education on Stress Levels Facing Changes in Menstrual Patterns among Adolescents

Introduction: Current health education efforts through counseling are the right and acceptable way to increase young women's knowledge about stress so that it can affect menstrual patterns. Based on the data found, it shows that changes in abnormal menstrual patterns are related to psychological stress. The purpose of this service is to increase respondents' knowledge about how to manage stress when dealing with changes in menstrual patterns. Method: the method used in this service is counseling using Power Point media. which was held at SMA Denpasar with the number of respondents as many as 30 students. The evaluation used is by conducting questions and answers between the presenter and the respondent. Results: the results obtained are that after being given counseling the students better understand how to manage stress levels in dealing with menstrual patterns. From the results of the post test evaluation given, 26 students have understood the health education provided. It is hoped that by doing this counseling the students already have good knowledge and can be applied to everyday life.

Menstrual cycle changes and mental health states of women hospitalized due to COVID-19.

PurposeMany studies have evaluated the impact of the COVID-19 pandemic on women’s mental health and menstrual changes. However, most of these studies only included nonhospitalized COVID-19 patients, while information on hospitalized women is very limited. Thus, this study aimed to examine the mental health status and menstrual changes in hospitalized female COVID-19 patients.MethodsA survey was administered to female COVID-19 patients in the isolation ward of a national referral hospital in Indonesia between January and August 2021, and the women were followed up 3 months after discharge. The survey evaluated menstrual patterns and mental health using the Self Reporting Questionnaire-29 (SRQ-29).ResultsThe study enrolled 158 female patients. There was an increase in patients who had a cycle length of > 32 or < 24 days, and significant increases in menstrual irregularity and heavy menstrual bleeding were noted. Overall, 37.3% of the patients reported a change in menstrual pattern after infection with COVID-19. Based on SRQ-29 scores, 32.3% of the women had neurotic symptoms, 12.7% had psychotic symptoms, and 38.0% had symptoms of posttraumatic stress disorder. Patients with symptoms of mental health disorders were twice as likely to report a menstrual change (OR 2.17, 95% CI 1.12–4.22; p = 0.021).ConclusionMenstrual changes and increased symptoms of mental health disorders occur in hospitalized female COVID-19 patients. The length of isolation was the key factor affecting overall menstrual changes and mental health in hospitalized female COVID-19 patients.

Self-Reported Menstrual Alterations During the COVID-19 Syndemic in Spain: A Cross-Sectional Study.

IntroductionAvailable evidence suggests that there might be an association between the stressors experienced during the COVID-19 syndemic and changes in menstrual patterns. The aim of this study was to assess self-reported menstrual alterations during the COVID-19 syndemic among women and people who menstruate aged 18–55 in Spain.Materials and MethodsA cross-sectional online survey-based study was conducted (March–July 2021). Descriptive statistics were calculated and multivariate logistic regression models were constructed. This study was conducted as part of the “Equity and Menstrual Health in Spain” research project.ResultsAmong participants (N=17,455), 39.4% reported menstrual alterations since the start of the syndemic. Participants self-reporting long COVID-19 presented higher odds of menstrual alterations (aOR: 1.34, 95% CI, 1.15-1.57). In participants with no history of COVID-19, the risk for self-reported menstrual alterations was significantly higher based on employment situation, among participants experiencing financial issues (eg, financial issues always/many times <12 months: aOR: 1.68, 95% CI, 1.48–1.90), poorer self-perceived health (eg, poor: aOR: 2.00, 95% CI, 1.31–3.07), and those diagnosed with polycystic ovary syndrome (aOR: 1.13, 95% CI, 1.02–1.26). Among participants with a self-reported COVID-19 diagnosis, factors that significantly increased the odds for menstrual alterations were experiencing financial strains (eg, financial issues always/many times <12 months: aOR: 1.53, 95% CI, 1.09–2.14), poorer self-perceived health (eg, poor: aOR: 3.09, 95% CI, 1.01–9.52). Overall, factors that decreased the odds of reporting menstrual alterations included age >25, being a carer, not having a gynecological condition and using hormonal contraception.Discussion and conclusionsFindings suggest an impact of the COVID-19 syndemic on menstrual patterns. Social inequities in reporting menstrual alterations were identified. While the risk of reporting menstrual alterations was higher among participants with long COVID-19, evidence is not conclusive. Further research on menstrual health in the context of COVID-19 is needed, also to inform policy and practice.