Effect of lifestyle modifications on anthropometric, clinical, and biochemical parameters in adolescent girls with polycystic ovary syndrome: a systematic review and meta-analysis.

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of childbearing age. This study aimed to compare the effects of lifestyle interventions on anthropometric, clinical, and biochemical parameters in adolescent girls with PCOS. METHODS: PubMed, Scopus, and Web of Science was systematically searched to retrieve studies investigating the effects of lifestyle modifications in adolescent girls with PCOS, which were published up to December 2019. The primary outcome was Body Mass Index (BMI) and secondary outcomes were all manifestations of PCOS, including clinical, metabolic, and hormonal parameters. Random effect meta-analysis was applied for significant results. Publication bias was assessed using the Egger test. RESULTS: This study showed significant improvements in luteinizing hormone (LH) (Pooled SMD = - 0.1.23; 95% CI, - 2.44 to - 0.03), and Free Androgen Index (FAI) levels (Pooled SMD = - 0.78 95% CI, - 0.1.42 to - 0.13) in adolescent girls receiving lifestyle intervention compared to baseline. This study also revealed that diet modifications alone were associated with a significant decrease in Body Mass Index (BMI) (Pooled SMD = - 0.45; 95% CI, - 0.76 to - 0.13), and FG score (Pooled SMD = - 0.81; 95% CI, - 1.33 to - 0.28). Exercise interventions were associated with significant changes in the menstrual cycles (Pooled SMD = 1.16; 95% CI, 0.72 to 1.61), Ferriman-Gallwey (FG) score (Pooled SMD = - 0.57; 95% CI, - 0.99 to - 0.15), LH (Pooled SMD = - 056; 95% CI, - 0.98 to - 0.14), Anti-Müllerian Hormone (AMH) (Pooled SMD = - 0.81; 95% CI, - 0.1.24 to - 0.38), and Triglyceride (TG) levels (Pooled SMD = - 0.32; 95% CI, - 0.62 to - 0.02). CONCLUSION: This meta-analysis concluded lifestyle interventions, such as diet and exercise, can improve some clinical, metabolic, and hormonal parameters in adolescent girls with PCOS.

The relationship between women's attitude towards menopause and menopausal symptoms among postmenopausal women.

OBJECTIVES: The purpose of this study is to assess the symptoms of menopausal women as well as the relationship between women's attitude towards menopause and menopausal symptoms. METHOD: This studied, following a cross-sectional method, included 349 selected postmenopausal women attending health care centers. The data was collected using the attitude toward menopause (ATM) checklist and Menopause-Specific Quality of Life (MENQOL) questionnaires. RESULTS: The most common menopausal symptoms were physical with joint and muscle pain. The highest mean score belongs to vasomotor symptoms (1.37 ± 1.43), followed by psychosocial (1.32 ± 1.16), physical (1.22 ± 0.96), and sexual (0.91 ± 0.94) symptoms. Attitude toward menopause was significantly influenced by sweat nights, poor memory, and sleeplessness. The marital status and educational level of the husband were the only demographic factors affecting the severity of menopausal symptoms. CONCLUSION: This study provides deeper insights about the relationship between attitudes towards menopause and menopausal symptoms, which can guide health-care professionals towards providing an optimal package.

Effect of sacrum-perineum heat therapy on active phase labor pain and client satisfaction: a randomized, controlled trial study.

AIM: Reduction of labor pain is one of the most important aspects of obstetric care. Heat therapy, typically applied to the woman's back, lower abdomen, groin, and/or perineum during last stage of labor, is an easy pain relief method that does not require highly skilled care. The effectiveness of heat therapy applied to the perineum during the first stage of labor has not been evaluated. This study aimed to evaluate the effectiveness of heat therapy for pain and woman's satisfaction during physiological labor. SUBJECTS AND METHODS: Sixty primiparous women aged 18-35 years old were randomly assigned to heat therapy and control groups. Pain and satisfaction scores were measured by visual analog scale. The measurements of satisfaction were accomplished after birth. Data were analyzed by using the t-test and chi-square RESULTS: Mean pain scores in the heat therapy group were significantly lower than the control group (P < 0.05). The mean satisfaction score in the heat therapy group was significantly higher than in the control group (P < 0.05). CONCLUSION: Heat therapy, an inexpensive complementary treatment with low risk, can reduce the intensity of pain and increase mothers' satisfaction with care during the active phase of labor.

Association between anthropometric indices and quality of life in menopausal women.

OBJECTIVE: To investigate whether body mass index (BMI), abdominal obesity or fat distribution influence the quality of life of postmenopausal women. METHODS: Subjects in this cross-sectional study were 233 postmenopausal women (aged 45-70 years) with an intact uterus and ovaries and who were sexually active and not using hormone therapy. Anthropometric measurements were recorded and subjects were interviewed using a specific health-related quality of life (HR-QoL) instrument, the MENQoL scale. RESULTS: According to BMI values, 31.5% of the women were obese, 42.2% were overweight, 25.8% were normal weight and none were underweight. However, according to the MENQOL scale results, obese women scored significantly higher on symptoms for physical domains. The women with the android pattern of fat distribution had significantly higher scores in the vasomotor and physical domains (p < 0.05). CONCLUSIONS: Obesity did not affect global HR-QoL in postmenopausal women, but appeared to have an influence on the psychical domains. Other anthropometric measurements were not associated with differences in HR-QoL. Keeping the anthropometric indices in the normal/premenopausal might improve the quality of life in menopause women.

"Ferula assa-foetida L" or "Foeniculum vulgare"? Which one is more effective in the management of polycystic ovarian syndrome? A randomized, placebo controlled, triple-blinded.

Objective: There are few evaluation about the effects of Fennel and Ferula on human polycystic ovary syndrome (PCOS). The goals of this study were to evaluate and compare the effectiveness of two medicinal plants of the Apiaceae family (Fennel and Ferula) in management of PCOS. Materials and Methods: The sample size was 47 participants with PCOS who were randomly divided into 3 groups. The Ferula assa-foetida L group received 100 mg of Ferula (n=14), the Foeniculum vulgare group received 46 mg of Fennel (n=15), and the placebo group received placebo twice daily for 3 months (n=14). Results: Before the intervention, there were no significant differences between groups in terms of clinical parameters, endometrial thickness, or ovarian volume. After the interventions, the number of ovarian follicles was decreased in the Ferula and Fennel groups as compared to the placebo group (p<0.05). The number of ovarian follicles in both ovaries in the Ferula and Fennel group decreased and this decrease was significant in the right side as compared to placebo group. Our findings showed significant changes in dehydroepiandrosterone sulfate (DEHAS) and thyroid-stimulating hormone (TSH) levels after the intervention (p<0.03) between the Ferula and Placebo groups. Conclusion: Since use of Ferula could make significant changes in TSH and DEHAS levels and decrease the number of right and left ovarian follicles compared to Fennel and placebo, it can be concluded that this herbal medicine is more effective than Fennel in managing PCOS.

Comparison of the Effect of Fennel and Evening Primrose Oil on Menopausal Problems and Hormonal Levels: A Randomized Controlled Trial.

Background: Using natural oral supplements is one of the methods of complementary medicine that has been widely welcomed in the last decade Since studies have reported contradictory results for effectiveness of herbal medicines during menopause and no other more effective herbal medicine has been suggested yet, the researchers of this study decided to compare the fennel and Evening Primrose Oil (EPO) and their effect on menopause problems and sex hormones. Materials and Methods: The present study was a triple-blinded, controlled clinical trial with 125 participants randomly assigned to. An intervention group received fennel, another intervention group received evening primrose oil, and the placebo group received placebo twice daily for 8 weeks. Pre-intervention and post-intervention results were obtained using hormonal assay and the Menopause Rating Scale (MRS). Results: In this study, the mean follicle-stimulating hormone (FSH) and estradiol levels changed significantly in the fennel and EPO groups compared to placebo (p < 0.001). The difference in the mean FSH score between the fennel group and EPO group was not significant (p = 0.304), but the difference in the mean estradiol level between these groups was significant (p = 0.043). Moreover, there was a significant difference in the mean MRS score between the intervention groups before the intervention (p < 0.05). However, the difference in the mean MRS score between the fennel and EPO groups was not significant after the intervention (p = 0.322). Conclusions: Consumption of fennel and EPO can significantly change FSH, estradiol, and psychological menopausal symptoms in postmenopausal women.

The effectiveness of lifestyle training program promoting adolescent health with polycystic ovarian syndrome: A study protocol for a randomized controlled study.

BACKGROUND: Lifestyle training is of a key important in adolescent age for better life in the future. Healthy lifestyle in adolescents can management of any disease such as diabetes and polycystic ovarian syndrome (PCOS). Schools can provide an important environment to identify and change the lifestyle of students. The aim of this protocol is designing and evaluating the effectiveness of school-based lifestyle training program improving the PCOS of adolescents. MATERIALS AND METHODS: A cluster-randomized controlled trial will be conducted to examine the effectiveness of school-based lifestyle training program in 16 to 18 years old adolescent girls. The healthy lifestyle program will be designed by modification of behavioral habit, dietary intake, and physical activity and educated in eight sessions for adolescents and one session for parents in the intervention groups with sixty participants. RESULTS: Changes in primary and secondary outcomes in PCOS and healthy adolescents before and after intervention in the intervention and control groups will be analyzed for evaluation effectiveness by one-way ANOVA or other nonparametric equivalents. CONCLUSION: The current study will provide information on the effectiveness of school-based lifestyle training programs for adolescents. With increasing numbers of PCOS at risk for long-term and/or late effects of treatment and other chronic diseases, efforts for promoting the healthy lifestyle of this important group are urgently needed. This lifestyle program may provide valuable information relating to the development of other healthy lifestyle interventions for PCOS and result in appropriate behavior change and self-management strategies.

Effects of training based on the health belief model on Iranian women's performance about cervical screening: A systematic review and meta-analysis.

CONTEXT: Pap smear test is one of the most important actions in preventing cervical cancer. This study aimed to perform a meta-analysis on all related literature about the effects of health belief model (HBM)-based training on Pap smear screening test performance of Iranian women. METHODS: The search was performed in Scopus, PubMed, and Web of Science. Eligibility criteria were limited to English and Persian language articles with experimental or semi-experimental methods until October 2019 that evaluated the effect of HBM-based training on Iranian women's performance of Pap smear test. We excluded studies that used both cervical and breast cancer screening together. RESULTS: Twelve studies were performed on totally 1605 participants. This meta-analysis showed that all of Health Belief Model (HBM) constructs improved significantly among HBM-based trained women, perceived susceptibility (standard mean division [SMD] =0.785; P = 0.002; confidence interval [CI] = 0.005 to 1.56; Heterogeneity; P = 0.013; I 2 = 97%)., perceived severity (SMD = 1.14; P = 0.001; CI = 0.66-1.62; heterogeneity; P < 0.001; I 2 = 92%), perceived benefits (SMD = 1.25; P = 0.001; CI = 0.545-0.135 heterogeneity; P = 0.003; I 2 = 97%), perceived barrier (SMD = 0.20; P = 0.001; CI = 0.44-1.24; heterogeneity; P < 0.001; I 2 = 92%) and perceived self-efficacy (SMD = 0.638; P < 0.001; CI =1.76-0.426; heterogeneity; P < 0.001; I 2 = 97%). CONCLUSION: Cervical screening education program based on the HBM can be effective on Iranian women's performance in their perceived susceptibility, perceived severity, perceived barrier, and perceived self-efficacy about Pap smear test.

Effect of Vitamin D on the Vaginal Health of Menopausal Women: A Systematic Review.

Menopause is associated with the onset of climacteric symptoms due to low estradiol levels, which may cause insufficient maturation of the vaginal mucosa. Vitamin D may regulate the growth and differentiation of cells that are adversely affected due to low estradiol levels, thereby restoring vaginal health. The objective of this systematic review, the first on this subject, was to investigate the effect of vitamin D on the vaginal health of menopausal women. PubMed, Embase, Scopus, Web of Science, and Google Scholar databases and reference lists of hand-searched articles were searched for published studies from February 2000 to November 2018. The selection criteria were as follows: randomized or quasi-randomized trials that compared the effects of vitamin D or related compounds, alone or with calcium, on vaginal health (growth and differentiation of epithelial cells, dryness, acidity [pH]) outcomes in menopausal women. The methodological quality of these studies was examined using the Cochrane tool checklist by two independent investigators, following which the data were extracted. Of six examined studies, two showed that vitamin D administration improved the growth and differentiation of vaginal epithelial cells, improved vaginal pH, and decreased vaginal dryness in menopausal women. Although the level of evidence for the effects of vitamin D on vaginal health is low in our study, we concluded that vitamin D may improve the vaginal health of women, especially during menopause.

Psychological empowerment strategies in infertile women: A systematic review.

Infertility requires long-term care and treatments which would influence different aspects of health including the mental health of infertile women. The present study was conducted to determine strategies for psychological empowerment of infertile women. This systematic review was performed on previously conducted clinical trials. To achieve the intended studies, databases of Magiran, Scientific Information Database, Google Scholar, Scopus, PubMed, ProQuest, ScienceDirect, and Web of Science and also Iranian Registry of Clinical Trials website were searched using "infertility and infertile women" as the keywords. The inclusion criteria were being an interventional study and assessing the psychological status of infertile women. Performed studies in Iran with no time limitations were evaluated. Based on the Jadad criteria, studies with a score of 3 or more were enrolled in the systematic review. After assessing the quality of the studies, 21 studies were enrolled in the review for final evaluation. Reviewing the conducted studies showed that educational and counseling interventions could be effective in improving the aspects of psychological well-being of infertile women. Existing evidence revealed that applying coping strategies is effective in improving the quality of life in infertile women, which consequently lead to the improvement of psychological empowerment of infertile women.

A Systematic Review and Meta-analysis on the Effect of Herbal Medicine to Manage Sleep Dysfunction in Peri- and Postmenopause.

OBJECTIVES: Some conventional medications used to treat insomnia, such as benzodiazepine, non-benzodiazepine, and hormone therapy, are associated with side effects. Therefore, there is a growing interest in the use of herbal medicine. The aim of this systematic review is to assess the effects herbal medicines have on sleep disorders of peri- and postmenopausal women. METHODS: Three databases were searched including MEDLINE, Scopus, and the Cochrane Library from inception to March 2018. RESULTS: Six trials assessed the effect of soy on sleep disorders. Forrest plot for 2 studies showed that the standardized mean difference (SMD) of the sleep problems was lower in the soy group than the placebo group (SMD = -0.996; P < 0.001; 95% confidence interval, -1.42 to -0.563). Three trials showed soy had no significant effect on sleep disorders and one study showed a positive effect on sleep disorders. Accordingly, it is difficult to reach a definite conclusion regarding the effects of soy on sleep disorders based on these findings. According to a trial, significant beneficial effect associated with taking Schisandra chinensis. Findings suggested that some herbal medicines like red clover, lavender combined with bitter orange and pin bark extract had attenuating effects on sleep disorders. After intake of 530 mg of valerian twice a day for one month, statistically significant effects were observed regarding the quality of sleep of postmenopausal women. CONCLUSIONS: The present systematic review and meta-analysis found inadequate evidence to draw conclusions regarding the effectiveness of herbal medications, especially soy.

Strategies to improve menopausal quality of life: A systematic review.

BACKGROUND: Menopause and its complications could disturb the sense of well-being and health and affect the quality of life. The present study was performed to review the conducted interventional study related to the quality of life in menopausal women in Iran. METHODS: In the present systematic review, to achieve the intended studies, Iranian Registry for Clinical Trials and Magiran, SID, Google Scholar, Scopus, PubMed, Proquest, ScienceDirect, and Web of Science databases were searched using: menopause" and "quality of life" keywords without any time limitations. Based on Jadad criteria, studies with a score of 3 or more were enrolled in the study. RESULTS: From all the achieved studies at primary search, 12 were selected and enrolled in the study. Reviewing the results of the studies showed that participating physical exercise, using products containing phytoestrogens and isoflavones and participating in educational and counseling sessions have an effective role in the improvement of quality of life in menopausal women. CONCLUSIONS: Evidence indicated that from the existing strategies to improve the menopausal quality of life, using complementary medicine is an efficient method and could be more effective when consumed along with performing physical exercises and participating in educational programs.

The efficacy of Iranian herbal medicines in alleviating hot flashes: A systematic review.

BACKGROUND: Hot flashes are the most common symptoms experienced by women around the time of menopause. Many women are interested in herbal medicines because of fear of side effects of hormone therapy. OBJECTIVE: The aim of this systematic review was to assess the effectiveness of Iranian herbal medicines in alleviating hot flashes. MATERIALS AND METHODS: MEDLINE (1966 to January 2015), Scopus (1996 to January 2015), and Cochrane Central Register of Controlled Trials (The Cochrane Library, issue 1, 2015) were searched along with, SID, Iran Medex, Magiran, Medlib and Irandoc. Nineteen randomized controlled trials met the inclusion criteria. RESULTS: Overall, studies showed that Anise (Pimpinella anisum), licorice (Glycyrrhizaglabra), Soy, Black cohosh, Red clover, Evening primrose, Flaxseed, Salvia officinalis, Passiflora itex Agnus Castus, Piascledine (Avacado plus soybean oil), St. John's wort (Hypericum perforatum), and valerian can alleviate the side effects of hot flashes. CONCLUSION: This research demonstrated the efficacy of herbal medicines in alleviating hot flashes, which are embraced both with people and health providers of Iran Therefore, herbal medicine can be seen as an alternative treatment for women experiencing hot flashes.

Birth ball or heat therapy? A randomized controlled trial to compare the effectiveness of birth ball usage with sacrum-perineal heat therapy in labor pain management.

OBJECTIVE: Labor pain and its management is a major concern for childbearing women, their families and health care providers. This study aimed to investigate the effects of two non-pharmacological methods such as birth ball and heat therapy on labor pain relief. MATERIAL & METHODS: This randomized control trial was undertaken on 90 primiparous women aged 18-35 years old who were randomly assigned to two intervention (birth ball and heat) and control groups. The pain score was recorded by using Visual Analogue Scale (VAS) before the intervention and every 30 min in three groups until cervical dilatation reached 8 cm. RESULTS: The mean pain severity score in the heat therapy group was less than that of in control group at 60 and 90 min after intervention (p < 0.05). In addition there were significantly differences between the pain scores in the birth ball group after all three investigated times in comparison to control group. CONCLUSION: Both heat therapy and birth ball can use as inexpensive complementary and low risk treatment for labor pain.

Effects of red clover on hot flash and circulating hormone concentrations in menopausal women: a systematic review and meta-analysis.

OBJECTIVE: To critically evaluate the effect of red clover on hot flash, endometrial thickness, and hormones status in postmenopausal and peri- and post-menopausal women. MATERIALS AND METHODS: MEDLINE (1966 to July 2014), Scopus (1990 to July 2014), and the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1, 2014) were searched for published randomized controlled Trials (RCTs). RESULTS: Of 183 relevant publication trials, 11 RCTs met the inclusion criteria. The mean hot flashes frequency in red clover was lower than the control groups (MD -1.99; p=0.067). There was larger decrease in FSH (SMD -0.812; CI: -1.93 to 0.312; p=0.157) and SHBG (SMD -0.128; CI-0.425 to 0.170; P=0.4) in red clover group, compared with placebo, which was not however statistically significant. LH (SMD 0.144; CI-0.097 to 0.384, p=0.242), estradiol (SMD 0.240; CI-0.001 to 0.482, p=0.051), testosterone (MD 0.083; CI: -0.560 to 0.726; p=0.901), and endometrial thickness (SDM 0.022; CI: -0.380 to 0.424, p=0.915) showed greater increase in red clover, compared with placebo, although the effect of estradiol was only significant. CONCLUSION: Red clover had a positive effect of alleviating hot flash in menopausal women. Our data, however, suggested very slight changes in FSH, LH, testosterone, and SHBG and significant effect in estrogen status by red clover consumption. However, the interpretation of results of the current study is limited due to methodological flaws of the included studies, menopause status, and large heterogeneity among them. Further trials are still needed to confirm the current finding.

Effect of dance labor on the management of active phase labor pain & clients' satisfaction: a randomized controlled trial study.

BACKGROUND: There are a wide variety of non- pharmacologic pain relief techniques for labor which include pelvic movement, upright position, back massage and partner support during the first stage of labor. The effectiveness of dance labor- which is a combination of these techniques- has not been evaluated. AIM: This study aimed to evaluate the effectiveness of dance labor in pain reduction and woman's satisfaction during the first stage of labor. METHODS: 60 primiparous women aged 18-35 years old were randomly assigned to dance labor and control groups. In the dance labor group, women were instructed to do standing upright with pelvic tilt and rock their hips back and forth or around in a circle while their partner massaged their back and sacrum for a minimum of 30 minutes. In the control group, the participants received usual care during physiologic labor. Pain and satisfaction scores were measured by Visual Analogue Scale. Data were analyzed by using the t. test and Chi-square. FINDINGS: Mean pain score in the dance labor group was significantly lower than the control group (P < 0.05). The mean satisfaction score in the dance labor group was significantly higher than in the control group (P < 0.05). CONCLUSION: Dance labor which is a complementary treatment with low risk can reduce the intensity of pain and increase mothers, satisfaction with care during the active phase of labor.

Effect of birth ball usage on pain in the active phase of labor: a randomized controlled trial.

INTRODUCTION: Anxiety can be a contributor to labor pain, which is known to be multifactorial. Because there is little information available on the efficacy of birth ball use for labor pain management, this study aimed to evaluate the effectiveness of use of a birth ball on labor pain, contractions, and duration of the active phase of labor. METHODS: In this randomized controlled trial, 60 primiparous women aged 18 to 35 years were divided into birth ball and control groups. Pain scores were measured by a visual analogue scale. RESULTS: Mean pain scores in the birth ball group were significantly lower than the mean pain scores in the control group (P < .05). There were no significant differences between duration of the active phase of labor or the interval between uterine contractions in the 2 groups (P > .05). DISCUSSION: Although the use of a birth ball had no effect on the duration of the active phase of labor, the duration of uterine contractions, or the interval between contractions, this complementary treatment could reduce the intensity of pain during the active phase of labor.