Menstrual Regulation Research Articles

Synthesis of dydrogesterone by aromatization-dearomatization strategy

Dydrogesterone as an agonist of the progesterone receptor is an important and selective synthetic progesterone used for the treatment of a variety of conditions associated with progesterone deficiency including menstrual cycle regulation, infertility, and prevention of miscarriage. Its manufacturing process employing photochemical reactions remains a significant challenge. Herein we report the first total synthesis of dydrogesterone via a key 10α-substitution-selective dearomative cyclizationfree of photochemical protocols starting from Hajos-Parrish ketone. A gram-scale synthesis is also accomplished from readily available 9-hydroxy-4-androstene-3,17-dione through a novel aromatization-dearomatization strategy of ring A in steroid chemistry. Key synthetic features include a facile chemical aromatization of 9-hydroxy-4-androstene-3,17-dione, efficient ligand-controlled asymmetric dearomative cyclization to install the 10α-Me group, and an effective hydroxyl-directed hydrogenation of sterically congested tetrasubstituted olefin to establish the 8β-H,9β-H stereochemistry.

Characterization of adolescents seen in the menstrual regulation consultation. Pedro Borrás Astorga Polyclinic. 2022- 2023

Introduction: abortion is a health problem that compromises sexual and reproductive health in adolescence. Objective: to characterize the adolescents who attended the menstrual regulation consultation at the “Pedro Borrás Astorga” University Polyclinic in the Pinar del Río municipality during 2022 and 2023. Methods: observational, descriptive and transversal research, with a universe of 574 adolescents who attended that consultation and the sample of 343 according to inclusion and exclusion criteria. The medical records of the adolescents were reviewed and a survey was administered. Descriptive statistical methods were used. Results: adolescents between 14 and 16 years of age predominated, 163 (47.5%), single 245 (71.4%) and who had their first sexual relations between 14 and 16 years, 186 adolescents (54.2%). The main reasons that led adolescents to carry out menstrual regulation were the desire to continue studying in 152 adolescents (44.3%) and the not desire to have children at that time in 123 of them (35.8%) The complication derived from menstrual regulation that occurred most was bleeding in 26 (45.6%). Conclusions: the high demand for menstrual regulation in adolescents constitutes a health problem in the Pinar del Río population, which is why it is necessary to develop health actions that contribute to improving the sexual and reproductive health of this important population segment

Induced Septic Abortion: Clinical Presentation Management and Outcome

Background & objective: Septic abortion still remains one of the most serious threats to the health of women all over the world. Most women indulge in unsafe abortion, for they no longer want children, but failed to take any contraception. The present study was undertaken to describe their clinical presentation, management and outcome including maternal complications and mortality caused by induced septic abortion. Methods: This descriptive study was conducted in the Department of Obstetrics & Gynaecology in Dhaka Medical College Hospital, Dhaka, Bangladesh over a period of 6 months between July 2008 to December 2008. All patients with septic abortion up to 28 weeks of gestation admitted to the Department of Obstetrics & Gynaecology at Dhaka Medical College Hospital (DMCH) were the study population. Patients with induced septic abortion with signs of infection were included in the study. However, patients with inevitable abortion, missed abortion, spontaneous septic abortion and septic abortion with the medical disorder were excluded from the study. A total of 50 patients based on above-mentioned eligibility criteria were included in the study. Data were analyzed to describe their clinical presentation, management and outcome, which among others included maternal complications and mortality. Result: Almost three-fifth of the patients were in their 3rd decade and 26% in their 4th decade of life with mean age of the patients being 27.2 ± 1.6 years. Over 40% were primary level educated and a sizable portion (36%) was illiterate. Majority of the patients was married (96%), house-wife (82%), rural resident (76%) and belonged to poor socioeconomic class (80%). More than 60% of the patients were in 2nd trimester of pregnancy and over two-thirds (68%) were multipara. For initiating abortion, about one-third (32%) used stick inside the vagina, 24% received menstrual regulation, 14% underwent D & C (dilatation & curettage), 22% took oral medication. More than one-third (36%) of the patients aborted for their pregnancy was unwanted, 20% did it because their pregnancy was unplanned. A few patients however mentioned social problem (6%) and husband’s illness (2%) as the reasons of induced abortion. The lower abdominal pain (96%) and per vaginal bleeding (94%) were the predominant complaints of the patients followed by followed by fever (72%), discharge of foul-smelling lochia (68%) and abdominal distension (12%). On examination majority (96%) was found anemic, toxic (56%), feverish (82%), with lower abdominal tenderness (60%) and dehydration (50%). On local examination, 80% exhibited signs of bleeding with tender fornics. Open external os, dirty vulva and foul-smelling discharge were observed in 74, 60 and 30% of the cases respectively. Vaginal and cervical injuries were found in few cases. More than 90% of the patients improved and cured and 8% died of complications like generalized peritonitis (2%) and septicemia with renal failure (6%). Conclusion: Induced septic abortion patients are generally multipara and present in 2nd trimester of pregnancy. In one-third of cases, the stimulus used to initiate abortion is stick inside the vagina. Other procedures adopted are menstrual regulation, D & C, oral ingestion of abortifacient drugs etc. Reasons of abortion include unwanted or unplanned pregnancy. While the cardinal symptoms at presentation are lower abdominal pain and per vaginal bleeding, cardinal signs are anemia, raised temperature and lower abdominal tenderness. Local examination usually exhibits signs of bleeding with tender fornics, open external os. Vaginal and cervical injuries are sometimes present. Majority of the patients cure on conservative treatment. Some however, require operative treatment. Very few patients died of complications (peritonitis and septicemia with or without renal failure) of the disease. Ibrahim Card Med J 2022; 12 (1): 58-63

Toxicological effects of the Curatella americana extract in embryo development of female pups from diabetic rats

Maternal diabetes can influence the development of offspring during fetal life and postnatally. Curatella americana is a plant used as a menstrual cycle regulator and to prevent diabetes. This study evaluates the effects of C. americana aqueous extract on the estrous cycle and preimplantation embryos of adult female pups from diabetic rats. Female Sprague Dawley newborn rats received Streptozotocin or vehicle (citrate buffer). At adulthood, were submitted to the Oral Glucose Tolerance Test, and mated. The female rats were obtained and were distributed into four experimental groups: OC and OC/T represent female pups of control mothers and received water or plant extract, respectively; OD and OD/T represent female pups of diabetic mothers and received water or plant extract, respectively. The estrous cycle was followed for 10 days, the rats were mated and on gestational day 4 was performed preimplantation embryo analysis. Phenolic composition and biogenic amines in the extract were analyzed about the influence of the thermal process. The female pups from diabetic dams exhibited glucose intolerance, irregular estral cycle and a higher percentage of pre-embryos in delayed development (morula stage). After C. americana treatment, OD/T group no present a regular estrous cycle. Furthermore, the infusion process increases phenolic compounds and biogenic amines levels, which can have anti-estrogenic effect, anticipates the early embryonic development, and impair pre-implantation embryos. Thus, the indiscriminate use of medicinal plants should be avoided in any life phases by women, especially during pregnancy.

Assessment of menstrual health in adolescent and young adults with sickle cell disease.

Sickle cell disease (SCD) is associated with hypercoagulability, but adults with SCD also have an increased incidence of bleeding including heavy menstrual bleeding (HMB). HMB is common among adolescent females, but the impact of HMB in pediatric SCD is unclear. The objectives of this study were to examine menstrual health status, knowledge, and quality of life (QOL). We performed a single-institutional multi-clinic cross-sectional study comprised of a five-part survey in pediatric participants with SCD. The survey included the validated Menstrual Bleeding Questionnaire (MBQ) and Self-administered Bleeding Assessment Tool (Self-BAT). Forty-eight participants with a median age of 16years (range: 12-21years) completed the study. The mean age at onset of menarche was 13±1.3years. On the MBQ, 29% reported heavy/very heavy menstrual flow, 61% reported moderate or severe dysmenorrhea, and 96% had menses lasting less than 1week. The Self-BAT revealed that 42% of participants reported a history of HMB. Participants with severe dysmenorrhea or HMB had higher MBQ scores, corresponding to worse QOL. Despite this, less than 20% of participants had attempted any hormonal therapy for menstrual regulation. The odds of hormonal therapy utilization were comparable among participants on hydroxyurea versus not on hydroxyurea (odds ratio 1.58, 95% confidence interval [CI]: 0.33-7.56). The prevalence of HMB and dysmenorrhea is high among adolescents and young women with SCD. Strategies that incorporate menstrual health assessment into routine medical care in this population would help address this important area of pediatric health.

Management of Hirsutism Associated With Obese PCOD - A Case Report

Hirsutism is a condition of abnormal growth of hair on any part of the body irrespective of gender. The reason for hirsutism might be genetic or unhealthy lifestyle which triggers the pathogenesis. Women with PCOD particularly associated with hirsutism, have an increased prevalence of reactive depression and minor psychological abnormalities. The overall quality of life is decreased in hirsute women. This case study helps to plan a treatment protocol for the patient with PCOD having irregular, delayed menses & obesity along with hirsutism. A 19 years old unmarried female patient came to OPD of Streeroga Evum Prasutitantra, with complaints of irregular, delayed menstruation, weight gain, facial hair growth with acne from last 1 year. Bilateral bulky ovaries with PCOD were founded in her USG. Her FSH:LH ratio was altered, and her serum testosterone level was raised. 3 months of treatment protocol was given to patient in which Nitya Virechana with Shamana Aushadhi (Kulatthadi Kashaya and Shatapushpa Churna). Her menses became regular after 3 months of treatment & 8 kg of weight was reduced. Her USG report revealed bilateral normal ovaries and volume became normal. She continued Shamana Aushadhi up to 6 months. Her acne was subsided, facial hair growth became scantier with complete stoppage of new hair growth. Her FSH:LH ratio became normal and serum testosterone as well as S. insulin level became normal. This case will give a new hope in the management of hirsutism associated with PCOD by ayurvedic protocol i. e. Nitya Virechana Karma along with Kulatthadi Kashaya and Shatapushpa Churna, also to explore the probable mode of action of these drugs which helped in menstrual regulation, hirsutism, acne and obesity. KEYWORDS: Hirsutism, PCOD, Irregular menses, Obesity, Kulatthadi Kashaya, Shatapushpa Churna, Nitya Virechana.

Socio-Demographic Characteristics as a Possible Influence for Abortion in Bangladesh

Introduction: Abortion in Bangladesh is illegal under most situations, but menstrual regulation is often used as a substitute. Abortion can be legally performed by a physician in a hospital if it is necessary to save the life of the mother. A person, who performs an abortion under any other circumstances, including a woman who self-aborts, can be punished by a fine and imprisonment under law in many countries, including Bangladesh. While there are some countries that allow legal abortion, the ratio of such countries are quite low. Despite the risk of punishment, Bangladesh still sees an absurd number of abortions, both legal and illegal, per year. The present study was conducted to understand if any socio-demographic factors influence such decision-making process. The aim of the study was to assess the socio- demographic characteristics that may influence abortion among pregnant women. Methods: This cross-sectional descriptive study was conducted at the Department of Gynecology, Gonoshasthaya Nagar Hospital, Dhaka, Bangladesh during the period of January 2018 to December 2018. Informed consent taken from all the study participants. SPSS software used for data analysis. Result: Most of the respondents (43.75%) were below 25 years of age and (15.0%) were above 35 years of age. Respondents’ education status was primary level (33.8%) and SSC level (35.0%). Among the 107 married participants, husband’s education was upto primary level in 45.79%, SSC in 33.64%, HSC in 4.67% and degree and above in 14.95%. Respondent’s monthly family incomes were 10% below 3000 Taka and 20% above 14000 Taka. 33.13% were unmarried, 51.25% were married and 15.62% were divorced. Among the 107 who were married, 79.44% were under 18 years of age at the time of marriage, 10.28% were between the age of 18-25 years, and the remaining 11 were over 25 years of age at time of marriage. Majority of abortions occurred in 1st trimester. About 75% of the abortions happened within <13 weeks of pregnancy,

A Case Report on Ayurvedic Management of Secondary Infertility

Secondary Infertility is defined as the inability to conceive following at least one prior conception. Ovulatory dysfunction contributes 30-40% of infertility. Polycystic ovarian syndrome is a common endocrinopathy typified by oligo/anovulation, signs of androgen excess, and multiple ovarian cysts. In Ayurveda, Vandhyatha (infertility) is considered as a complication of Yoni vyapath and is also considered as Artavavaha srotodushti lakshana. This is a case report of 30 years old lady complaining of inability to conceive a second child, heavy menstrual bleeding and curdy white discharge per vagina associated with itching. On USG, she was diagnosed with Polycystic Ovarian Syndrome. She also had severe allergic complaints and skin rashes. In this case treatment was given primarily to correct the Rakta dushti which was causing Artava dushti in the form of excessive bleeding. For that, initially in the bleeding phase, medicines for Rakta sthambana were given and after the stoppage of bleeding, medicines were given for correction of Rakta dushti. After achieving the menstrual regulation, the patient was given medicines for Vata kapha dushti for treating her Upaplutha condition. For the management of Yoni roga, she was given Sthanika karmas (local treatment) Yoni dhawana and Yoni pichu. Also local application of Nalpamaradi keram was done to reduce her vulval itching. The outcome of the treatment resulted in conception and delivered a full term female baby. So the present case signifies the effect of Ayurvedic management in the field of infertility.

‘Here, the girl has to obey the family's decision’: A qualitative exploration of the tactics, perceived perpetrator motivations, and coping strategies for reproductive coercion in Bangladesh

Reproductive coercion (RC) undermines women's decision-making in reproductive health and negatively impacts women's health and well-being. This qualitative study explored RC in Bangladesh using in-depth interviews (IDIs) and focus group discussions (FGDs) with violence support centre clients, menstrual regulation (MR) and postabortion care (PAC) clients, and MR/PAC providers and pre- and post-procedure counsellors. All IDIs and FGDs were audio recorded, transcribed verbatim, and translated from Bangla to English for thematic analysis. RC was perpetrated primarily by male partners and in-laws and included both pregnancy-promoting tactics (such as contraceptive sabotage and forced continuation of an unwanted pregnancy) and pregnancy-preventing tactics (such as forced contraceptive use and forced MR). Threats and violence were tactics used for pregnancy-promoting and pregnancy-preventing RC. Perceived motivations for RC perpetration included family formation or dissolution, son preference, and a desire to maintain power or control over a woman. The primary motivator for contraceptive sabotage was concern about the safety and side effects of contraception, rather than pregnancy promotion. We classify this as contraceptive-related coercive control rather than RC due to the lack of pregnancy promoting intent. Women's responses to RC and contraceptive-related coercive control ranged from capitulation to active coping strategies such as covert use of contraception and MR, and enlisting providers' help to avoid forced MR. Differences in motivation for perpetration of RC and contraceptive-related coercive control call for distinct intervention strategies to support women's reproductive autonomy.

Menstrual regulation: examining the incidence, methods, and sources of care of this understudied health practice in three settings using cross-sectional population-based surveys

BackgroundMenstrual regulation is a practice that may exist within the ambiguity surrounding one’s pregnancy status and has been the subject of limited research. The aim of this study is to measure the annual rate of menstrual regulation in Nigeria, Cote d’Ivoire, and Rajasthan, India, overall and by background characteristics and to describe the methods and sources women use to bring back their period.MethodsData come from population-based surveys of women aged 15–49 in each setting. In addition to questions on women’s background characteristics, reproductive history, and contraceptive experiences, interviewers asked women whether they had ever done something to bring back their period at a time when they were worried they were pregnant, and if so, when it occurred and what methods and source they used. A total of 11,106 reproductive-aged women completed the survey in Nigeria, 2,738 in Cote d’Ivoire, and 5,832 in Rajasthan. We calculated one-year incidence of menstrual regulation overall and by women’s background characteristics separately for each context using adjusted Wald tests to assess significant. We then examined the distribution of menstrual regulation methods and sources using univariate analyses. Method categories included surgery, medication abortion pills, other pills (including unknown pills), and traditional or "other" methods. Source categories included public facilities or public mobile outreach, private or non-governmental facilities or doctors, pharmacy or chemist shops, and traditional or "other" sources.ResultsResults indicate substantial levels of menstrual regulation in West Africa with a one-year incidence rate of 22.6 per 1,000 women age 15–49 in Nigeria and 20.6 per 1,000 in Cote d’Ivoire; women in Rajasthan reported only 3.3 per 1,000. Menstrual regulations primarily involved traditional or “other” methods in Nigeria (47.8%), Cote d’Ivoire (70.0%), and Rajasthan (37.6%) and traditional or “other” sources (49.4%, 77.2%, and 40.1%, respectively).ConclusionThese findings suggest menstrual regulation is not uncommon in these settings and may put women’s health at risk given the reported methods and sources used. Results have implications for abortion research and our understanding of how women manage their fertility.

Assessment of Menstrual Health and Bleeding Symptoms in Adolescent Girls and Young Women with Sickle Cell Disease

Introduction: Sickle Cell Disease (SCD) is traditionally associated with thrombotic events such as venous thromboembolism and cerebrovascular events. However, adults with SCD have an increased cumulative incidence of bleeding complications by 40 years of age, including heavy menstrual bleeding (HMB). HMB affects 40% of adolescent girls in the general population and is a common reason for referral to pediatric hematology clinics. Whether adolescent girls and young women with SCD are similarly affected by HMB and other bleeding manifestations have not been well described. This purpose of this study was to assess the menstrual health status of this population and to estimate the prevalence of HMB and other bleeding symptoms. Methods: Menarchal adolescent girls and young women aged 12-21 years old, diagnosed with any SCD genotype, and followed in one of three pediatric hematology clinics at a large tertiary care children's hospital were approached for a cross-sectional study. The study consisted of a 5-part questionnaire administered through the Research Electronic Data Capture (REDCap) system. The questionnaire included collection of demographic information, menstrual health knowledge assessment, menstrual bleeding medication rating profile, and validated instruments for patient-reported HMB outcomes and historical bleeding symptoms. The patient-reported outcome instruments consisted of the one-month recall Menstrual Bleeding Questionnaire (MBQ) and Self-Administered Bleeding Assessment Tool (Self-BAT). Statistical procedures involved chi-squared test and Kruskal-Wallis test. Statistical significance was set at p<0.05. Results: To date, 38 participants have completed the questionnaire. The mean age of the study cohort was 15.9 ± 2.3 years. Individuals with SCD genotype HbSS comprised the majority of the cohort and 53% (n = 20) reported hydroxyurea use (Table 1). Mean age of menarche was 13 years (min-max 10-15 years). On the menstrual health knowledge assessment, 6 participants (16%) correctly identified all four characteristics of normal menstruation per American College of Obstetricians and Gynecologists (ACOG) definitions. Specifically, 50% correctly identified the expected duration of menses and 45% identified all of the pharmacologic categories available for menstrual regulation. Parents/guardians were the primary source of menstrual health knowledge (84%), while social media/internet was the predominant secondary source (29%). The mean MBQ score was 14.1 ± 8.5. For comparison, the MBQ validation study performed in adult women with and without HMB reported a mean MBQ score of 30.8 ± 14 and 10.6 ± 8.6, respectively. Approximately 55% of participants reported moderate or severe pain related to menstrual cycles. Pain was not significantly associated with age, hydroxyurea use, or self-reported history of HMB. Ibuprofen (16%) and acetaminophen (11%) were the main medications listed for menstrual pain relief. For the Self-BAT, abnormal bleeding scores are classified as ≥3 in children and ≥6 in women. The cohort mean Self-BAT score was 1.6 (min-max 0-8) and 29% (n = 11) had abnormal bleeding scores. Bleeding symptoms reported were post-surgical/trauma-induced bleeding, epistaxis, prolonged bleeding from small cuts, and bleeding after tooth extraction. Interestingly, 12 participants (32%) reported a history of HMB on the Self-BAT. There were no significant differences in MBQ or Self-BAT scores by age and hydroxyurea use, although individuals with HMB had significantly higher MBQ and Self-BAT scores (Table 2). Six participants (50%) with HMB attempted ≥1 hormonal therapy method for menstrual regulation. One additional participant without HMB received hormonal therapy. Conclusions: In this study, we demonstrate that 32% of adolescent girls and young women with SCD reported a history of HMB and the majority of participants reported moderate/severe pain related to their menstrual cycle. Yet, only 50% with HMB attempted a hormonal therapy. Furthermore, most of the participants had reduced knowledge of normal menstrual health. These findings suggest a critical need for improved education and patient/provider discussion regarding menstruation. Ultimately, incorporating menstrual health assessment into SCD care is important for optimizing patient health and addressing health inequities in the adolescent and SCD population. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Delay in care seeking for menstrual regulation among the women attending a selected clinic

Each year women around the world experience 75 million unwanted pregnancies. Millions of women around the world risk their lives and health to end unwanted pregnancies. This descriptive type of cross-sectional study was conducted among 103 respondents from Mohammadpur Fertility Centre, Dhaka, Bangladesh to find out the factors influencing delay in care seeking for menstruation regulation among the women attending selected MR clinic from March to June 2015. Respondents were enrolled in the study using Purposive sampling technique. Data was collected by face to face interview with a semi-structured questionnaire. Here, 85% gave right answer about Knowing of MR. Respondent's main personal cause for delaying MR was that 37% home abortion by taking gynaecosid or other tablet. About familial causes of delaying MR shows that majority (47%) had in security of the house, 38% resistance by husband/others. The main social causes of delaying MR shows that majority (61%) was due to spiritual bindings and service or service center related causes for delaying MR due to treatment cost, male doctor, complexity of services and rest due to the substandard services. Women had good knowledge about MR and its timing even they make delay due to unawareness of their legal rights, personal, social and service related causes.

Factors influencing menstrual regulation and its socioeconomic inequalities among ever-married women in Bangladesh: Findings from a nationwide cross-sectional survey.

Despite a significant drop in maternal mortality in Bangladesh, unsafe abortion remains a critical maternal health issue that could be reduced by promoting menstrual regulation (MR). This study aimed to investigate the prevalence and determinants of MR use among ever-married women as well as to identify the socioeconomic inequalities in MR use in Bangladesh. The latest Bangladesh Demographic and Health Survey (BDHS) 2017-18 data were used in this study. We used a sub-sample of 12,586 ever-married women aged 15 to 49 years for this study. To identify the determinants of MR, multilevel (mixed-effect) binary logistic regression analysis was used while accounting for potential between-clusters variations. The weighted prevalence of MR was 7.64% (95% CI: 7.19 - 8.12). Women of aged 20-29 years (AOR: 2.50, 95% CI: 1.46, 4.30) and ≥ 30 years (AOR: 4.17, 95% CI: 2.39, 7.26), from urban areas (AOR: 1.24, 95% CI: 1.04, 1.47), having one or two children (AOR: 1.96, 95% CI: 1.25, 3.09) and ≥ 3 children (AOR: 2.26, 95% CI: 1.40, 3.65), who used traditional contraceptive method (AOR: 1.39, 95% CI: 1.12, 1.73), and from Barishal division (AOR: 1.44, 95% CI: 1.08, 1.93) were more likely to have MR. Women were less likely to have MR if they were from Chittagong (AOR: 0.62, 95% CI: 0.46, 0.84) and Mymensingh (AOR: 0.51, 95% CI: 0.36, 0.73) divisions. MR use was found to be higher among higher socioeconomic status (SES) groups as the concentration index (CIX) value was positive and the Lorenz curve lay below the line of equality (CIX: 0.095, p<0.001). Health policy and intervention design should prioritize minimizing socioeconomic inequities concerning MR services.

Dispersion of contraceptive access policies across the United States from 2006 to 2021

Person-centered contraceptive access benefits reproductive autonomy, sexual wellbeing, menstrual regulation, and other preventive health. However, contraceptive access varies by social and geographic position, with policies either perpetuating or alleviating health inequities. We describe geographic and time-trend variation in an index from fewer (less expansive) to greater (more expansive) aggregation of U.S. state-level contraceptive access policies across 50 states and Washington, D.C. (collectively, states) from 2006 to 2021. We collected data from primary and secondary sources on 23 policies regulating contraceptive education, insurance coverage, minor’s rights, provider authority, and more. As of 2021, the most enacted policies expanded contraceptive access through: 1) prescribing authority for nurse practitioners, certified nurse-midwives (n = 50, 98 % of states), and clinical nurse specialists (n = 38, 75 %); 2) Medicaid expansion (n = 38, 75 %); 3) prescription method insurance coverage (n = 30, 59 %); and 4) dispensing authority for nurse practitioners and certified nurse-midwives (n = 29, 57 %). The average overall U.S. policy index value increased in expansiveness from 6.9 in 2006 to 8.6 in 2021. States in the West and Northeast regions had the most expansive contraceptive access landscapes (average index values of 9.0 and 8.2, respectively) and grew more expansive over time (increased by 4–5 policies). The Midwest and South had least expansive landscapes (average index values of 5.0 and 6.1, respectively). Regions with more expansive sexual and reproductive health policy environments further expanded access, whereas least expansive environments were maintained. More nuanced understanding of how contraceptive policy diffusion affects health outcomes and equity is needed to inform public health advocacy and law making.

‘Of course, women will adopt it!’: A qualitative study on the acceptability of medical menstrual regulation in Senegal

ObjectiveMedical menstrual regulation (MMR) may offer a promising way to reach Senegalese women and girls in need of fertility management, especially in rural contexts. To assess the feasibility of introducing a MMR service in Senegal, the study aimed to (1) understand how women and girls manage their menses and fertility, and (2) document acceptability of MMR among women, youth, and health providers. MethodsSix focus group discussions and 34 in-depth interviews were conducted with women, youth, and health providers in Kaolack, Mbour, and Thiès, Senegal. ResultsAll participants characterized the pubescent period by a lack of sexual education, familial support, and access to reproductive health services. Reproductive health service utilization in Senegal was portrayed as highly stigmatized, creating barriers to contraception and reliable information on family planning. Unwanted pregnancy and clandestine abortion were depicted as common occurrences among many participants. Senegalese women and youth perceived MMR services as an acceptable method to manage a missed period with discretion, rid of moral and legal ramifications – and framed MMR as a needed mechanism to prevent abortion and avoid undesired pregnancies. The majority of health providers, with the exception of female health volunteers, were reluctant to endorse the service, comparing MMR to abortion. ConclusionsIn a context fraught with restrictive abortion laws and limited uptake of modern contraception, MMR is an acceptable among potential service users. Nonetheless, introduction and implementation of MMR will be feasible in Senegal only if policymakers approve and support the service and health provider buy-in is achieved.

The association between intimate partner violence and self-managed abortion: a cross-sectional study among women in urban Bangladesh

In Bangladesh, abortion is illegal, except to save a woman's life. However, menstrual regulation (MR) to induce menstruation up to 12 weeks from the last menstrual period is permitted. Although safe and legal MR services are available, many women choose to self-manage their abortions. The prevalence of intimate partner violence (IPV) in Bangladesh is high. Whether IPV is associated with self-managed abortion is unknown. Between January and December 2019 we administered cross-sectional surveys to women presenting for MR or post-abortion care (PAC) services at facilities in six cities in Bangladesh assessing if women had ever experienced IPV and if they attempted to self-manage their abortion. We used multivariable logistic regression to assess the association between IPV and self-managed abortion and multinomial logistic regression to the association between IPV by type: (none, any physical, any sexual, or both) and self-managed abortion. Among 2679 women who presented for MR or PAC care and participated in the survey, 473 (17.7%) had previously attempted to self-manage abortion. Women who had ever experienced any IPV were more likely to attempt self-managed abortion prior to presenting for MR or PAC (adjusted odds ratio (aOR) = 1.52, 95% CI 1.24, 1.87). Women who ever experienced physical IPV were more likely to attempt self-managed abortion (adjusted relative risk ratio (aRRR) = 1.62, 95% CI 1.30, 2.03). Women who have ever experienced physical IPV may be more likely to attempt a self-managed abortion because they seek more covert ways of ending a pregnancy out of fear for their safety, or because of limited mobility or lack of resources. Interventions to support women to safely self-manage abortion should focus on populations with higher rates of IPV.

Analysis of the mechanism of menstrual cycle regulation based on “pivotal movement”

Based on Huang Yuan-Yu's theory of "pivotal movement", the mechanism of menstrual regulation in women of childbearing age was investigated. It is suggested that the spleen-liver-rush-rush-uterus is the key axis of menstrual regulation in women of childbearing age, and the existing theory that the kidney-tiankui-rush-rush-uterus is the main axis of menarche and menopause in women.

The effect of chamomile on menstruation pattern and serum androgens in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is associated with menstrual disorders and hyperandrogenism, which is considered to be a common cause of hirsutism and infertility. Chamomile has been used as a medicinal herb known for its menstrual property. This study aimed to investigate the effect of chamomile on the menstruation pattern and serum androgens in PCOS women. This study was a randomized clinical trial, conducted on 80 women during their reproductive age with PCOS from April 2014 to August 2015. They were divided into intervention and control groups. The intervention group received a chamomile capsule (containing 370 mg dried powder of German chamomile flower) three times a day for 12 weeks, while the control group received placebo (starch-based capsules) with the same prescription order. Menstrual questionnaires as well as the androgens of testosterone and dehydroepiandrosterone were examined before and after 3 months. The primary outcome in the chamomile capsules user group, the number of participants with normal menstrual cycles significantly increased (p<0.001). In addition, a significant improvement in the number of menstrual cycles after the chamomile therapy was observed. A significant decrease was observed in testosterone levels in the intervention group. However, there was no significant change in the level of hormone dehydroepiandrosterone sulfate in both intervention and control groups (P = 0.423). Chamomile can have a significant impact on menstrual regulation and decrease the total testosterone levels in women of reproductive age with polycystic ovary syndrome. It is recommended that careful, large randomized controlled trials should be conducted to understand the mechanisms of action of chamomile and its effects on menstruation process.

A mixed-methods study exploring women\u2019s perceptions of terminology surrounding fertility and menstrual regulation in C\xf4te d\u2019Ivoire and Nigeria

BackgroundWomen use various terms when discussing the management of their fertility and menstrual irregularities and may interpret the experience of ending a possible pregnancy in nuanced ways, especially when their pregnancy status is ambiguous. Our study aims to understand the terminology used to refer to abortion-like experiences (specifically menstrual regulation and pregnancy removal), and the specific scenarios that these practices encompass among women who reported doing something to bring back a late period or ending a pregnancy in Nigeria and Côte d’Ivoire.MethodsOur analysis draws upon surveys with women in Nigeria (n = 1114) and Cote d’Ivoire (n = 352). We also draw upon qualitative in-depth interviews with a subset of survey respondents in Anambra and Kaduna States in Nigeria, and Abidjan, Cote d’Ivoire (n = 30 in both countries). We examine survey and interview questions that explored women’s knowledge of terminology pertaining to ending a pregnancy or bringing back a late period. Survey data were analyzed descriptively and weighted, and interview data were analyzed using inductive thematic analysis.ResultsWe find that the majority (71% in Nigeria and 70% in Côte d’Ivoire) of women perceive menstrual regulation to be a distinct concept from pregnancy removal, yet there is considerable variability in whether specific scenarios are interpreted as referring to menstrual regulation or pregnancy removal. Menstrual regulation is generally considered to be more ambiguous and not dependent on pregnancy confirmation in comparison to pregnancy removal, which is consistently interpreted as voluntary termination of pregnancy.ConclusionsOverall, menstrual regulation and pregnancy removal are seen as distinct experiences in both settings. These findings have relevance for researchers aiming to document abortion incidence and experiences, and practitioners seeking to address women’s reproductive health needs.

Roles of Nitric Oxide in the Regulation of Reproduction: A Review.

Nitric oxide (NO) has attracted significant attention as a stellar molecule. Presently, the study of NO has penetrated every field of life science, and NO is widely distributed in various tissues and organs. This review demonstrates the importance of NO in both male and female reproductive processes in numerous ways, such as in neuromodulation, follicular and oocyte maturation, ovulation, corpus luteum degeneration, fertilization, implantation, pregnancy maintenance, labor and menstrual cycle regulation, spermatogenesis, sperm maturation, and reproduction. However, the mechanism of action of some NO is still unknown, and understanding its mechanism may contribute to the clinical treatment of some reproductive diseases.