Menstrual problems in chronic immune thrombocytopenia: A monthly challenge - a cohort study and review.

Immune thrombocytopenia (ITP) may cause menstrual problems. This cross-sectional study assessed menstrual problems in premenopausal chronic ITP women by several questionnaires, including the pictorial bleeding assessment calendar (PBAC; score ≥100 indicates heavy menstrual bleeding [HMB]), and the menorrhagia multiattribute scale (MMAS). Spearman was used for assessing correlations. A literature review was performed in Pubmed. The cohort comprised 37 women (mean age 31 ± 9). A total of 29/37 (78%) had experienced clinical menstrual problems in the present or past. Of the 33 patients who returned the PBAC, 13 (39%) had a score of ≥100. The median MMAS score was 79 (IQR 60-95). The PBAC scores correlated with the MMAS. Both questionnaires were unrelated to the platelet count. Patients with a levonorgestrel intrauterine device (LNG-IUD) had lower PBAC scores than patients with other or no hormonal therapy. MMAS scores were correlated with fatigue. The review identified 14 papers. HMB occurred in 6%-55% at ITP diagnosis and 17%-79% during disease. Menstrual symptoms influenced the quality of life, particularly in patients with a low platelet count. This explorative study suggested that HMB is frequent in women with chronic ITP despite management and platelet counts >50 *109 /l. An LNG-IUD seemed to reduce blood loss significantly.

Understanding Adolescent Gynecological Issues: A Cross-Sectional Study at a Tertiary Care Center.

BACKGROUND AND OBJECTIVES: Adolescence is a crucial phase in a woman's life, as it signifies the beginning of her reproductive journey. During this time, there are notable variations in sexual development and a sense of caution that can present challenges for healthcare providers. The rationale for studying adolescent gynecological problems lies in the need to understand and address the unique reproductive health challenges faced by young girls. By investigating these issues, researchers and healthcare professionals can develop effective strategies for prevention, early detection, and treatment of gynecological conditions in adolescents. This knowledge is crucial for promoting the overall well-being and reproductive health of young girls, ensuring they receive appropriate care and support during this critical stage of development. This study focuses on identifying the most common gynecological issues in teenagers, exploring the root causes, examining the available treatment options, and understanding how they are managed at a tertiary care facility.  Methods: This cross-sectional observational study took place at a tertiary care center and focused on gynecological issues in adolescent females who sought care at the gynecology department from January 2016 to December 2022. The study participants were categorized into three groups: early adolescence (10-13 years), middle adolescence (14-16 years), and late adolescence (17-19 years) for analysis. Ethical approval was obtained for this hospital-based research, which involved examining, investigating, and treating the study participants. RESULTS: Out of the 49,700 new female patients, 2000 (4.02%) fell within the specified age range. The average age of the participants was 16.87±2.16, and the majority of them sought help for menstrual issues (63.45%), followed by abdominal discomfort (15.6%) and vaginal discharge (7.2%). Menstrual disorders were the most common concern, with dysmenorrhea and puberty menorrhagia being prevalent issues. Abdominal pain was caused by various factors, such as urinary tract infections, ovarian tumors, pelvic inflammatory disease, endometriosis, and endometrial tuberculosis. The majority of cases were treated conservatively, with only a small percentage requiring surgical intervention. CONCLUSION: The significance of early detection and intervention in addressing gynecological issues among adolescents is highlighted in the findings of this research, underscoring the necessity for specialized healthcare services that cater to the specific needs of this demographic. Adolescent gynecology plays a crucial role in safeguarding the reproductive health and overall well-being of young women, emphasizing the importance of seeking assistance proactively.

Survey on the Awareness of Menstruation and Menstruation-Related Problems in Athletes among Public High School Physical Education Teachers.

Introduction: In recent years, the activities of female athletes have attracted increasing attention, especially regarding the effect of menstruation on athletic performance. Nevertheless, there are no surveys of these practices among coaches who train non-top-level athletes for general competition. This study aimed to investigate how high school physical education teachers approach the issue of menstruation and the awareness of menstruation-related problems. Methods: This was a questionnaire-based cross-sectional study. The participants were 225 health and physical education teachers from 50 public high schools in the Aomori Prefecture. Participants were asked to answer a questionnaire regarding whether they talk to their female athletes about menstruation, keep track of their menstrual status, or make adjustments for menstruating students. Additionally, we asked for their views on painkiller use and their knowledge of menstruation. Results: The participants included 183 men (81.3%) and 42 women (18.7%); data from 221 participants were analyzed after four teachers were excluded. Teachers of female athletes who communicated with students regarding their menstrual conditions and physical changes were predominantly female (p < 0.01). Regarding the use of painkillers for menstrual pain, more than 70% of respondents said that they recommended their active use. Few respondents reported that they would adjust a game because of athletes with menstrual problems. More than 90% of the respondents knew that there was a change in performance due to the menstrual cycle, and 57% of the respondents understood the relationship between amenorrhea and osteoporosis. Conclusions: Menstruation-related problems are not only issues for top athletes but also important for general competition level athletes. Hence, even in high school clubs, teachers should be educated on how to deal with menstruation-related problems to prevent withdrawal from sports, maximize athletes' abilities, prevent future diseases, and preserve fertility.

A cross-sectional study on prevalence of menstrual problems, lifestyle, mental health, and PCOS awareness among rural and urban population of Punjab, India.

INTRODUCTION: Menstrual cycle gets affected by various modifiable risk factors. To assess prevalence of various types of menstrual problems, lifestyle and mental health status, identification of variables as predictors for menstrual problems and level of polycystic ovary syndrome (PCOS) awareness among rural and urban population of Punjab, the present study has been carried out. METHODS: The study was conducted from November 2019 to July 2020 in the Malwa region of Punjab, India, with 2673 participants (15-25 years). Epidemiological information was collected using predesigned questionnaire along with depression, anxiety and stress (DASS-21) score mental health assessment tool. MS-Excel (2019) and IBM SPSS 18.0 (SPSS Inc., Chicago, IL) was used for statistical analysis. RESULTS: The overall prevalence of different menstrual problems was 60.61%, with dysmenorrhea (50.64%) being most common problem. Body mass index (BMI), menarche age, physical activity, and mental health status are significant (p < 0.05) predictors of menstrual problem both in rural and urban population. Overall, only 3.30% subjects were aware about PCOS. CONCLUSION: Dysmenorrhea is the most common menstrual problem, both in rural and urban population. BMI, sedentary lifestyle, electronic gadgets usage, and mental health are associated with menstrual problems. Low awareness on PCOS indicates need to create awareness as the condition can be easily managed with early intervention.

Impact of COVID-19 Vaccination on Menstrual Cycle: A Cross-Sectional Study From Karachi, Pakistan.

Background The coronavirus disease 2019 (COVID-19) disease triggered a worldwide health catastrophe. To deal with this deadly situation multiple vaccines were developed and a mass immunization program started globally. However, vaccine hesitancy was seen, especially among women of reproductive age, having concerns that the vaccine might affect their menstrual cycle. This study investigated the link between COVID-19 vaccination and menstrual abnormalities. It is essential for us to understand the effects of vaccines on menstruation as menstrual distress can have effects on everyday life, and mental and reproductive health. Methods A cross-sectional study was performed using self-administered online forms to collect data from all over Karachi. The sample included 384 females aged 18 years and above. The data were collected from November 2021 to February 2022. Results Majority of the participants were aged 21 years and had a normal body mass index (BMI). Most were moderately stressed (n=245) with 146 reporting menstrual changes post-vaccination. The difference between the post-vaccine menstruation affected (n=146) and the unaffected cohort (n=238) was significant. Other factors which likely contributed to the post-vaccine menstrual changes included Perceived Stress Scale (PSS) score, strenuous physical activity, and the pre-vaccine menstrual flow. Conclusions Among the women vaccinated for COVID-19, strenuous physical activity and high perceived stress levels affected the menstrual cycle. There is no denying that existing data are inadequate, which is one of the grounds for vaccination apprehension, particularly among menstruating women. To minimize this hesitation, the spread of disinformation about the vaccine's influence on the menstrual cycle must be avoided. In future research and clinical trials, menstruation-related side effects should also be investigated when developing vaccines.

Factors Related to Primary Dysmenorrhea in Turkish Women: a Multiple Multinomial Logistic Regression Analysis.

This study aimed to evaluate the factors related to the severity of menstrual pain in Turkish women with primary dysmenorrhea (PD). The study included 504 women with PD aged 18 years or older. A Visual Analogue Scale (VAS), a self-developed structured questionnaire, the International Physical Activity Questionnaire-Short Form (IPAQ-SF), State and Trait Anxiety Inventory, Beck Depression Inventory, and Nottingham Health Profile (NHP) were used to measure outcomes. Multiple multinomial logistic regression analysis was used to determine the factors related to the severity of menstrual pain. In this model, categorical menstrual pain severity levels (mild, moderate, and severe) were considered as dependent variables and the category of "severe menstrual pain" was determined as the reference category. p value less than 0.05 was considered statistically significant. The individuals were divided into 3 groups according to their VAS scores: mild-pain group (n = 132, 26.19%), moderate-pain group (n = 189, 37.50%), and severe-pain group (n = 183, 36.30%). BMI increase (OR = 1.10 and OR = 1.09), decreased chocolate consumption (OR = 1.88), menstruation duration (OR = 2.48) and menstrual pain duration (OR = 1.33 and OR = 1.61), and increased physical activity level (OR = 1.10) were found to increase the tendency to have less severe pain. The positive family history (OR = 0.35), a decrease in the age of menarche (OR = 0.47), the presence of irregular menstruation (OR = 0.36), and decreased quality of life (OR = 0.98 for NHP pain and emotional reaction) were found to be associated with a reduced likelihood of less severe pain (p < 0.05). In Turkey as well as in the rest of the world, PD is an important public health problem and many factors are associated with menstrual pain in Turkish women.

Menstrual Characteristics and Related Problems in 9- to 18-Year-Old Turkish School Girls.

STUDY OBJECTIVE: To determine the cross-sectional characteristics of menstruating girls, dysmenorrhea, and the frequencies of related problems. DESIGN: Descriptive, cross-sectional study. SETTING: Randomly selected primary, junior, and high schools in the city center of Kayseri. PARTICIPANTS: Two thousand female adolescents of ages between 9 and 18 years. MAIN OUTCOME MEASURES: We used a questionnaire addressing the epidemiological characteristics of menstruation, such as age at menarche, duration of menstrual intervals, average days of bleeding, and any menstrual problems and their frequencies. RESULTS: This study consists of a sufficient number of participants from all age groups. Of the participant (n = 2000) girls, 63.7% (n = 1274) had started menstruating. The mean age at menarche was 12.74 (±1.03) years. With a prevalence of 84.8% (n = 1080), dysmenorrhea was the most prevalent menstrual problem and the average pain score was 5.87 (±2.45). Of the menstruating girls, 34% (n = 439) used painkillers, the most commonly used was acetaminophen; during their period the prevalence of nonmedical methods to relieve pain was 35.2%; the rate of seeking medical help for dysmenorrhea was 9.3% (n = 119). In menstruating participants, 90.8% discussed their menstrual problems with their mothers. The rate of school absenteeism in menstruating girls was 15.9% in general and 18% in those with dysmenorrhea. CONCLUSION: Problems related to menstruation are common in adolescents and these problems affect their social life. In adolescent girls, the most common menstrual problem is dysmenorrhea and it affects school performance and attendance. Girls with menstrual problems showed a low rate of seeking medical help.

The Treatment of Dysmenorrhea.

Menstrual disorders and abnormal uterine bleeding are common concerns of young women. Complaints include menses that are: too painful (dysmenorrhea), absent or occur irregularly (amenorrhea or oligoamenorrhea), or prolonged and heavy (menorrhagia, or excessive uterine bleeding). In providing optimal reproductive care, the medical provider must be able to distinguish between normal developmental patterns or symptoms requiring education and reassurance from pathologic conditions requiring prompt assessment and treatment. This article discusses the normal menstrual patterns seen in adolescent females and provides an evaluation and management approach to primary and secondary dysmenorrhea.

Social impact of menstrual problems among adolescent school girls in rural Tamil Nadu.

Background Adolescence is a period of physiological, psychological and social transition between childhood and adulthood and is characterized by the onset of menstruation in girls. A adolescent girls are naïve about menstruation and they take time to adapt to these changes both socially and psychologically. This study was carried out to assess the psychosocial impact of menstrual problems among schoolgoing adolescent girls. Methods This study is a cross-sectional study carried out in 350 schoolgoing adolescent girls in the year 2012 in the Thiruvallur district of Tamil Nadu. Girls who attained menarche 1 year prior to the data collection were included in the study. Data regarding background characteristics and psychosocial impact of menstrual problems were collected. Data was analyzed using SPSS ver. 15 software. The χ2-test was carried out to assess the statistical significance at the 95% level of significance. Results The mean age of the participants was 14.7 years. In this study, 87.7% of the girls had at least one menstrual problem. Among these, 78.5% could not attend school during menstruation, 51.1% were unable to perform household/sports activities (p < 0.001). It was observed that dysmenorrhea and menorrhagia were at increased risk of absenting the girls from school (p < 0.05). Conclusion The key to a sound adolescent health programme is a holistic approach which also focuses on the psychological and social domain of health. This could be achieved by involving all the stakeholders like parents, teachers, etc. to work as a team. It is also essential to develop adolescent friendly health services at the grass root level.

Prevalence of Menstrual Problems among Adolescent School Girls in Rural Tamil Nadu.

STUDY OBJECTIVE: Adolescent girls face a gamut of problems of which the menstrual problems are the most common. Because menstrual problems are subtle, the problems often are unreported. The objective of this study was to estimate the prevalence of menstrual problems, namely dysmenorrhea, menorrhagia, and irregular menstrual cycles. DESIGN: Cross sectional study. SETTING: School-based study conducted in a rural school of the Thiruvallur district, Tamil Nadu. PARTICIPANTS: The participants were adolescent girls who attained menarche at least 1 year before the data collection period were selected using a simple random sampling method. A total of 350 participants were included in the study. INTERVENTIONS: No interventions were done. A structured, pretested questionnaire was used to collect data. MAIN OUTCOME MEASURES: The main outcome measured in this study was the prevalence of menstrual problems, namely dysmenorrhea, menorrhagia, and irregular menstrual cycles. RESULTS: The mean age of the study participants was 14.74 years. The mean age at menarche was 12.4 years. In this study, 87.7% of the girls suffered from a menstrual problem. Overall, dysmenorrhea was prevalent in 72.6%, and menorrhagia and irregular menstrual cycles were present among 45.7% and 31.7% of the participants, respectively. CONCLUSION: Menstrual problems form an important domain of adolescent health and because these problems go unreported, it is necessary that adequate attention and care is provided. The consequences of the neglect of menstrual problems results in impaired reproductive and sexual health in older women.

Traditional phytomedicines for gynecological problems used by tribal communities of Mohmand Agency near the Pak-Afghan border area

Abstract Medicinal plants play a vital role in the human health care system of tribal communities and in the treatment of various gynecological problems. This study is an effort to document important medicinal flora used for the treatment of gynecological problems by indigenous people living in a tribal region near the Pak-Afghan border. The main objective of the study was to establish a clear profile of indigenous knowledge and practices from the unexplored tribal territory. Data were collected through semi-structured interviews and group discussions. The data were analyzed through Use Value and Factor of Informant Consensus. A total of 52 medicinal plants were recorded from the area; the most widely accepted were Withania somnifera (L.) Dunal (94 Use Value), Foeniculum vulgare Mill. (93 Use Value), Prunus domestica L. (91 Use Value), Myrtus communis L. (91 Use Value), Cannabis sativa L. (91 Use Value) and Nigella sativa L. (90 Use Value). A high consensus factor was recorded for menses-related problems (0.95). The root was the main part used (23% plants), followed by the leaves (20% plants), whole plant (18% plants), fruit (18% plants), and seed (13% plants). A total of 21 plants were used to treat menses-related problems, followed by sexual problems (ten plants), leucorrhea (nine plants), gastric problems (seven plants) and amenorrhea (seven plants). Knowledge related to ethnogynecological treatments is restricted to midwives and traditional healers. In conclusion, the documented flora that is particularly important to medicinal plants may be researched in the future to discover new pharmaceutical, neutraceutical and other pharmacological agents against gynecological complaints.