Factors influencing menstrual regularity among female workers: a cross-sectional analysis study.

BACKGROUND: Regularity of menstrual cycles is an important indicator of women's health and fertility, and female workers are exposed to several factors, such as sleep disorders, stress, and shift work, that affect their menstrual regularity. This makes it necessary to comprehensively identify the determinants of menstrual regularity. Therefore, this study identified the factors affecting menstrual regularity among female workers from physiological, psychological, and situational dimensions based on the theory of unpleasant symptoms. METHODS: This was a secondary analysis of the 2010-2012 Korea National Health and Nutrition Examination Survey and utilized the data of 2418 female workers. Based on the theory of unpleasant symptoms, physiological factors included age, age at menarche, childbirth experience, body mass index, and sleep duration. Psychological factors included stress level, depressive mood, and suicidal ideation. Situational factors included education level, household income, consumption of alcohol, engagement in smoking, and work schedule. The χ²-test and hierarchical logistic regression analysis were performed, reflecting the complex sample design. RESULTS: Age at menarche, childbirth experience, and body mass index among physiological factors and education level and work schedule among situational factors were found to be related to menstrual regularity. A higher risk of menstrual irregularities was found among those who had given birth (versus those who had not), had a high age at menarche (versus those with a low age at menarche), were obese (versus those who had a normal body mass index), had elementary school-level or lesser educational achievements (versus those with college graduate-level or higher educational achievements), and who had a shift work schedule (versus those with a fixed schedule). CONCLUSIONS: Intervention is needed for female workers who have these risk factors, and special attention must be paid to female workers who have a shift work schedule. Additionally, since body mass index can be controlled, intervention concerning body mass index is necessary to reduce menstrual irregularity.

The effect of perceived stress on menstrual complaints in university students.

Studies have examined the effect of stress on dysmenorrhea and premenstrual syndrome. For this reason in this study, it was aimed to determine the impact of stress on menstrual symptoms (adverse effects, abdominal pain, and coping methods). This descriptive and correlational study was conducted with 351 university students in Turkey by sharing the link to the questionnaire on online social media platforms. It was determined that those whose income was equal to their expenses had lower menstrual symptoms, having a chronic disease and smoking increased menstrual symptoms (F = 3.19/p = .04; t = 2.33/p = .02; t = 3.96/p = .00). The study identified that there was a positive low-level correlation (r: 0.25, p < .01) between the Perceived Stress Scale-14 and the Menstruation Symptom Questionnaire, and the 6.5 percent change in menstrual symptoms was explained by perceived stress. In the study, it is thought that stress affects the experience of menstrual symptoms. Therefore, it is believed that by providing training on stress and effective coping methods by midwives and nurses, menstrual symptoms can be reduced, contributing to women's health. For future studies, it is recommended to examine the effects of stress coping methods training on stress and menstrual complaints.

Factores que impactan sobre la percepción de la menstruación en las adolescentes / Factors that impact on the perception of menstruation among female adolescents

Introducción. Se ha descrito que la menstruación se percibe como un evento natural pero molesto, con un impacto negativo en la vida diaria de la mujer. El objetivo del estudio fue identificar la percepción de la menstruación en adolescentes y los factores que podían influir sobre esta.Material y métodos. Estudio transversal observacional comparativo en adolescentes posmenárquicas con y sin enfermedades crónicas, en 2 hospitales pediátricos y 2 escuelas de nivel primario y secundario. Se recabaron los datos de edad, escolaridad, tipo de población, fecha de menarca y presencia de dismenorrea. Se aplicó un cuestionario previamente validado para evaluar la percepción sobre la menstruación.Resultados. Se incluyó un total de 346 adolescentes. Se encontró que la percepción más frecuente hacia la menstruación fue la negativa en un 65,6 % (n = 227), positiva en el 16 % (n = 55), sigilosa en el 13 % (n = 45) e indeterminada en el 5,4 % (n = 19). La presencia de enfermedad crónica demostró ser un factor protector de la percepción negativa de la menstruación (odds ratio 0,4 [intervalo de confianza del 95 %: 0,20-0,78], p = 0,007).Conclusiones. Más de la mitad de las adolescentes presentaron una actitud negativa hacia la menstruación, pero la presencia de una enfermedad crónica la mejoró

Introduction. It has been described that menstruation is perceived as a natural but cumbersome event, with a negative impact on women's daily life. The objective of this study was to identify the perception of menstruation among female adolescents and the factors that may affect it.Material and methods. Observational, cross-sectional, comparative study in postmenarcheal adolescents with and without chronic conditions in two children's hospitals and two primary and secondary schools. Age, education level, type of population, date of menarche, and presence of dysmenorrhea were recorded. A previously validated questionnaire was administered to assess the perception of menstruation. Results. A total of 346 female adolescents were included. The most common perception of menstruation was negative in 65.6 % (n = 227), positive in 16 % (n = 55), discreet in 13 % (n = 45), and indefinite in 5.4 % (n = 19). The presence of a chronic condition demonstrated to be a protective factor against a negative perception of menstruation (odds ratio: 0.4 [95 % confidence interval: 0.20-0.78], p = 0.007).Conclusions. More than half of female adolescents had a negative attitude toward menstruation, but the presence of a chronic condition improved it.

Knowledge and menstrual hygiene practice among adolescent school girls in southern Ethiopia: a cross-sectional study.

BACKGROUND: Menstruation is a normal physiological process of females at their reproductive age. However, it is surrounded with social taboos and supernatural beliefs. The poor knowledge and understanding of menstruation may lead to unsafe hygienic practice that intern increases the risk of reproductive and genito-urinary tract infections, cervical cancer, school drop-out, poor academic performance and overall poor quality of life. Despite such clinical and academic effects, the knowledge and hygienic practice of adolescent girls towards menstruation is not well addressed in Ethiopia, particularly among school adolescent girls. Therefore, the main objective of this study was to assess the knowledge and menstrual hygiene practice among adolescent school girls in southern Ethiopia. METHODS: This was an institutional based cross-sectional study conducted at Gedeo zone high schools among 791 randomly selected adolescent girls using multi stage sampling technique. Data were collected using interviewer administered questionnaire. The collected data were entered to EPI-INFO (soft ware) and exported to SPSS version 20 for analysis. Bivariable and multivariable logistics analyses were computed to identify factors associated with the poor menstrual hygienic practice. During bi-variable analysis, variables with P-values of less than 0.25 were entered to multivariable model for further analysis. In the final model, P-value of less than 0.05 was used as a base to identify factors having a statistically significant association with poor menstrual hygiene practice at corresponding 95% confidence interval. RESULT: From a total of 791 adolescent girls participated in this study, 68.3% had poor knowledge of menstruation. About 48.1% of school girls used absorbent materials, and 69.5% clean their external genitalia. Generally, 60.3% of girls had poor menstrual hygienic practice. Age less than 15 years [OR = 1.71:95% CI (1.22, 2.39)], longer days of menstrual flow [OR = 2.51:95% CI (1.66, 3.80)] and poor knowledge of menses [OR = 1.48:95% CI (1.04, 2.1)] had a significantly associated with poor menstrual hygiene practice. CONCLUSION: Majority of adolescent school girls had poor knowledge regarding menstruation and their hygienic practices are incorrect. This demonstrates a need to design acceptable awareness creation and advocacy programs to improve the knowledge and promote safe hygienic practice of adolescent school girls during menstruation.

A percepção de mulheres sobre a menstruação: uma questão de solidariedade / Women's perception of menstruation: a question of solidarity / La percepción de mujeres sobre la menstruación: una cuestión de solidaridad

Objetivo: descrever a experiência de mulheres em relação à menstruação. Metodologia: estudo qualitativo baseado no método de análise de conteúdo temática. O cenário foi o campus de uma universidade pública no Rio de Janeiro. Participaram 23 mulheres entre 20 e 72 anos de idade. Os dados foram obtidos entre julho/2015 e julho/2016 através da entrevista semiestruturada. Resultados: foi identificada, como tema central/categoria, a questão da solidariedade entre mulheres quando o assunto é menstruação. Emergiram quatro sub-categorias: A conexão das mulheres com a menstruação; A experiência de menstruar afetando umas às outras; A influência e o suporte proveniente das mães e/ou de outras mulheres; e A transferência. Conclusão: a menstruação causa sentimentos ambíguos nas mulheres, resultando em predomínio de sentimentos negativos, como medo e sensação de vergonha. Ao mesmo tempo pode ser percebida como motivo de felicidade e tranquilidade. A solidariedade entre mulheres pode influenciar positivamente a percepção da mulher sobre a menstruação, sendo elemento de empoderamento.

Objective: to describe women's experience of menstruation. Methodology: this qualitative study was based on the thematic content analysis method. The setting was a public university campus in Rio de Janeiro. Twenty-three women from 20 to 72 years old participated. Data were obtained between July 2015 and July 2016 by semi-structured interview. Results: the central theme/category was identified as solidarity among women with regard to menstruation. Four subcategories emerged: women's connection with menstruation; one's experience of menstruating affects others; influence and support from mothers and/or other women; and transference. Conclusion: menstruation causes ambiguous feelings in women, with negative feelings, such as fear and a sense of shame, predominating. At the same time, it can be seen as a reason for happiness and tranquility. Solidarity among women is a factor of empowerment, and can influence women's perception of menstruation positively.

Objetivo: describir la experiencia de mujeres en relación con la menstruación. Metodología: estudio cualitativo basado en el método de análisis de contenido temático. El escenario fue el campus de una universidad pública en Río de Janeiro. Participaron 23 mujeres cuya edad estaba entre 20 y 72 años. Los datos se obtuvieron entre julio/2015 y julio/2016 a través de entrevista semiestructurada. Resultados: se identificó, como tema central/categoría, la solidaridad entre mujeres en relación con la menstruación. Surgieron cuatro subcategorías: la conexión de las mujeres con la menstruación; la experiencia de menstruar, afectando unas a las otras; la influencia y el apoyo de las madres y/o de otras mujeres; y la transferencia. Conclusión: la menstruación causa sentimientos ambiguos en las mujeres, resultando en predominio de sentimientos negativos, como el miedo y la sensación de vergüenza. Al mismo tiempo, podría percibirse como un motivo de felicidad y tranquilidad. La solidaridad entre mujeres puede influir positivamente en su percepción sobre la menstruación, siendo un elemento de empoderamiento

Defining Menstrual Literacy With the Aim of Evaluating Mobile Menstrual Tracking Applications.

For the estimated 75 million people in the United States who menstruate, understanding menstrual health as a critical "vital sign" is an important aspect of managing personal health. Unsurprisingly, in the past decade, menstrual tracking applications have become increasingly popular, with more than 300 applications available for download and an estimated 200 million downloads worldwide. This study had two purposes. The first was to formulate a definition for menstrual literacy-a baseline of knowledge and skills for understanding anatomical and biological facts of menstruation, caring for the menstruating body, and completing menstrual care tasks-by building on prior work about health literacy and by conducting content analysis of eight Web sites containing information about menstruation. The second was to evaluate a maximum variation sample of 17 menstrual tracking applications; here, features and functions related to the concepts about menstrual literacy identified in a content analysis were compared. These applications had insufficient support for facilitating menstrual literacy, especially for teen and perimenopausal users. The article discusses these disconnects and subsequent design opportunities for menstrual tracking applications to facilitate more robust support of menstrual literacy and overall health of people who menstruate.

Promoção da saúde da mulher indígena: contribuição da etnografia das práticas de autoatenção entre os Munduruku do Estado do Amazonas, Brasil / Health promotion with indigenous women: the contribution of ethnography on self-care practices among the Munduruku people in the Amazonas State, Brazil / Promoción de la salud de la mujer indígena: contribución de la etnografía de prácticas de autoatención entre los Munduruku del estado de Amazonas, Brasil

Resumo: A longevidade, a saúde e o bem-estar coletivo e individual figuram entre as expectativas socialmente compartilhadas pelos Munduruku que habitam a Terra Indígena Kwatá-Laranjal, Amazonas, Brasil. A condução da vida diária, em um cosmo pleno de seres, é cercada de perigos que ameaçam essas expectativas, cujas agências podem resultar em doença e morte. A partir de etnografia, conduzida por meio da observação participante e narrativas, analisamos as práticas de autoatenção voltadas à construção do corpo da mulher Munduruku, valorizando a perspectiva e o papel ativo das pessoas "leigas" nesse processo. Essas práticas iniciam-se na gestação e estendem-se ao longo da vida, em um processo contínuo de construção do corpo, manutenção da saúde e aquisição de habilidades, marcado pela interação entre pessoas de diferentes idades. O foco das práticas de atenção Munduruku não é o corpo no sentido dado pelo paradigma biomédico, mas a participação deste, como pessoa, nas relações sociais e cosmológicas, por meio de experiências que articulam corpo, saúde e ambiente. A perspectiva Munduruku sobre esse processo apresenta diferenças radicais em relação ao individualismo moderno e à noção biomédica de corpo excessivamente reducionista. A compreensão da perspectiva indígena contribui para promover melhorias na qualidade da atenção diferenciada, conforme preconizado pela Política Nacional de Atenção à Saúde dos Povos Indígenas.

Abstract: Longevity, health, and collective and individual well-being are among the socially shared expectations of the Munduruku people who live on the Kwatá-Laranjal Indian Reservation in Amazonas State, Brazil. Daily life in a cosmos full of beings is surrounded by dangers that threaten these expectations, and whose agencies can result in disease and death. Based on ethnography, through participant observation and narratives, we analyze the self-care practices dedicated to the construction of the Munduruku woman's body, valuing the perspectives and active role of "lay" persons in this process. These practices begin in pregnancy and extend throughout life in an ongoing process of construction of the body, maintenance of health, and acquisition of skills, marked by interaction between persons of different ages. The focus of Munduruku practices is not the body in the sense determined by the biomedical paradigm, but its participation as a person in social and cosmological relations, through experiences that link body, health, and environment. The Munduruku perspective on this process displays radical differences in relation to modern individualism and the biomedical notion of the body, excessively reductionist. An understanding of the indigenous perspective can help promote improvements in the quality of differentiated care, as recommended by the Brazilian National Healthcare Policy for Indigenous Peoples.

Resumen: La longevidad, la salud y el bienestar colectivo e individual figuran entre las expectativas socialmente compartidas por los Munduruku, que habitan la Tierra Indígena Kwatá-Laranjal, en el Amazonas, Brasil. El quehacer de la vida diaria, en un cosmos lleno de seres, está rodeado de peligros que amenazan las expectativas mencionadas anteriormente, cuyas vicisitudes pueden resultar en enfermedad y muerte. A partir de la etnografía, realizada mediante observación participante y narraciones, analizamos las prácticas de autoatención, dirigidas a la construcción del cuerpo de la mujer Munduruku, valorando tanto la perspectiva, como el papel activo de las personas "no especialistas" en este proceso. Estas prácticas se inician en la gestación y se extienden a lo largo de la vida, en un proceso continuo de construcción del cuerpo, mantenimiento de la salud y adquisición de habilidades, marcado por la interacción entre personas de diferentes edades. El foco de las prácticas de atención Munduruku no es el cuerpo, tal y como lo entiende el paradigma biomédico, sino la participación de este, como persona, en las relaciones sociales y cosmológicas, mediante experiencias que articulan cuerpo, salud y ambiente. La perspectiva Munduruku sobre este proceso presenta diferencias radicales, respecto al individualismo moderno y la noción biomédica de cuerpo, excesivamente reduccionista. La comprensión de la perspectiva indígena contribuye a promover mejorías en la calidad de la atención diferenciada, conforme lo preconizado por la Política Nacional de Atención de la Salud de los Pueblos Indígenas.

[Analysis of characteristics and influence factors of diagnostic delay of endometriosis].

Objective: To access the influence factors of diagnostic delay of endometriosis. Methods: We designed a questionnaire of diagnostic delay of endometriosis. From February 2014 to February 2016, 400 patients who had dysmenorrhea and diagnosed with endometriosis by surgery in Peking University Third Hospital were surveyed retrospectively. Time and risk factors of diagnostic delay were analyzed. Results: The diagnostic delay of 400 patients was 13.0 years (0.2-43.0 years), 78.5%(314/400) patients thought pain was a normal phenomenon and didn't see the doctor. Patients who suffered dysmenorrhea at menarche experienced longer diagnostic delay than those who had dysmenorrhea after menarche (18.0 vs 4.5 years; Z=191.800, P<0.01) . Patients who suffered aggravating dysmenorrhea experienced shorter delay time than those who suffered stable or relieving dysmenorrhea (11.0 vs 12.5 vs 18.0 years; Z=8.270, P<0.05) , with the difference statistically significant, single factor analysis shows. Severe dysmenorrhea, deep infiltration endometriosis (DIE) , family history of dysmenorrhea or endometriosis, previous surgical history of endometriosis, high stage, with infertility, adenomyoma or other symptoms, could help to shorten diagnostic delay with no significant difference (P>0.05) . By multiple logistic regression analysis, the results shown that whether have dysmenorrhea at menarche and clinical diagnosis time were the independent factors affecting delayed diagnosis (P<0.01) . Conclusions: Diagnostic delay of endometriosis is common and the mean delay time is 13.0 years mainly due to the unawareness of dysmenorrhea. Dysmenorrhea at menarche, clinical diagnosis time and dysmenorrhea intensity are the factors affecting time of diagnostic delay.

Aspectos subjetivos de la mujer con dismenorrea primaria / Subjective aspects of women with primary dysmenorrhea

En el presente trabajo estudiamos la dismenorrea primaria, un cuadro bastante aparatoso para el que se han venido postulado numerosas hipótesis, predominando las de índole biológica. No obstante, una serie de autores se han referido a la intervención de factores psicológicos en el cuadro. El objetivo que nos mueve consiste en descubrir cuáles son los componentes subjetivos que favorecen la aparición y/o mantenimiento del dolor en estas mujeres, más allá de las directrices biológicas. Para lograrlo tomamos un grupo de jóvenes (entre 17 y 25 años) que, aunque consultaron por otros problemas, el dolor menstrual era un síntoma importante, y a las que se trató mediante psicoterapia. Las entrevistas realizadas con ellas, aparte de ayudarlas a mejorar, nos permitieron obtener un material verbal que era expresivo del síntoma. Este proceder nos permitió desentrañar los diferentes aspectos subjetivos propios de la alteración, entre ellos destacan: la escasa tolerancia al dolor, la respuesta emocional exagerada y, sobre todo, el rechazo referido a la maduración como mujer y a los desempeños propios de ésta. Estos últimos factores se sostienen en significados personales erróneos y sustentados en los mensajes recibidos por la paciente y aceptados como propios.

In this paper we study primary dysmenorrhea, a rather cumbersome disorder for which numerous hypotheses have been postulated, predominantly of biological nature. However, a number of authors have referred to the intervention of psychological factors in these clinical symptoms. The goal that moves us is to find out which subjective components favor the appearance and maintenance of pain in these women, beyond the biological guidelines. To achieve this we take a group of young women (between 17 and 25 years old). Although they consulted for other problems, the menstrual pain was an important symptom, and they were treated with psychotherapy. The interviews realized with them, apart from helping them to get better, allowed us to obtain a verbal material that was expressive of the symptom. This procedure allowed us to unravel the different subjective aspects own of the alteration. Among them are stand out: the low tolerance to pain, the overreacted emotional answer and, above all, the rejection of the development as woman and the assumption of her corresponding role. The last factors mentioned are sustained by those erroneous personal meanings in the patient that were accepted as own.

Neuroprotection via Reduction in Stress: Altered Menstrual Patterns as a Marker for Stress and Implications for Long-Term Neurologic Health in Women.

Individuals under chronic psychological stress can be difficult to identify clinically. There is often no outwardly visible phenotype. Chronic stress of sufficient magnitude not only impacts reproductive function, but also concomitantly elicits a constellation of neuroendocrine changes that may accelerate aging in general and brain aging in particular. Functional hypothalamic amenorrhea, a phenotypically recognizable form of stress, is due to stress-induced suppression of endogenous gonadotropin-releasing hormone secretion. Reversal of functional hypothalamic amenorrhea includes restoration of ovulatory ovarian function and fertility and amelioration of hypercortisolism and hypothyroidism. Taken together, recovery from functional hypothalamic amenorrhea putatively offers neuroprotection and ameliorates stress-induced premature brain aging and possibly syndromic Alzheimer's disease. Amenorrhea may be viewed as a sentinel indicator of stress. Hypothalamic hypogonadism is less clinically evident in men and the diagnosis is difficult to establish. Whether there are other sex differences in the impact of stress on brain aging remains to be better investigated, but it is likely that both low estradiol from stress-induced anovulation and low testosterone from stress-induced hypogonadism compromise brain health.

Patrón de sangrado uterino en adolescentes usuarias de implante anticonceptivo subdérmico de etonogestrel / Uterine bleeding patterns of adolescents using the long term etonogestrel contraceptive implant

Objetivo: Describir las características del patrón sangrado uterino de las adolescentes que usan el implante anticonceptivo sudérmico de etonogestrel (IASE) que concurren a un centro especializado en salud sexual y reproductiva de adolescentes en Santiago, Chile, y su asociación con variables biopsicosocial. Método: Estudio de cohorte retrospectiva de las usuarias de IASE. Los datos fueron analizados utilizando la ecuación de estimación generalizada, análisis de sobrevida de Kaplan Meier y test de log-rank. Resultados: La cohorte incluyó a 62 adolescentes. La media de edad fue de 16,2 años. Las participantes recibieron asesoramiento anticonceptivo antes de la inserción del IASE, y fueron seguidas durante tres años. Los patrones de sangrado más frecuentes durante el primer año fue el de amenorrea (40,5%) y el sangrado aceptable (27,1%), mientras que el menos frecuente fue prolongado y/o sangrado frecuente (15,8%). De acuerdo con el análisis de sobrevida, la única variable biopsicosocial asociado con patrón prolongado y/o sangrado frecuente fue condición médica previa. Cinco adolescentes (8%) se retiraron el IASE. Conclusiones: El IASE es una opción anticonceptiva segura y altamente eficaz para las adolescentes, independientemente de la paridad. La consejería es de gran importancia para fomentar la tolerancia y la adhesión al implante.

Objectives: To describe uterine bleeding patterns of adolescents using the long term etonogestrel contraceptive implant (ENG implant) attending a specialized adolescent sexual and reproductive health centre in Santiago, Chile, and test their association with bio-psychosocial variables. Methods: A retrospective cohort study of ENG implant users was conducted and data were analysed using the Generalized Estimating Equation, Kaplan Meier Survival Analysis and Log-Rank Test. Results: The cohort included 62 adolescents with and average age at inclusion of 16.2 years. Participants received contraceptive counselling prior to insertion of an ENG implant, and were followed up for three years. The most frequent bleeding patterns during the first year were amenorrhea (40.5%) and acceptable bleeding (27.1%), whilst the least frequent was prolonged and/or frequent bleeding (15.8%). According to the survival analysis, the only bio-psychosocial variable associated with prolonged and/or frequent bleeding was prior medical condition. Five adolescents (8%) withdrew from the treatment. Conclusions: The ENG implant is a safe and highly effective contraceptive option for adolescents, regardless of parity. Counselling is of great importance to foster tolerance and adherence to the ENG implant.

Creencias y vivencias de mujeres adultas sobre la menstruación en el municipio de Cota, Colombia / Beliefs and experiences of menstruation on adult women in cota municipality, Colombia / Crenças e vivências de mulheres adultas sobre a menstruação no município de cota na, Colômbia

Objetivo: Conocer y documentar las connotaciones culturales, las prácticas de cuidado y los estilos de vida en torno a la menstruación, en mujeres adultas del municipio de Cota. Métodos. Se llevó a cabo una investigación cualitativa dentro de un contexto individual y sociocultural, caracterizada por un enfoque teórico etnográfico y fenomenológico. Se incluyeron 28 mujeres voluntarias, entre 48 y 97 años, que fueron referenciadas por reconocimiento de la comunidad y seleccionadas por muestreo de tipo “bola de nieve”, a quienes se les hizo una entrevista semiestructurada analizada por edición. Resultados. Existe un cuerpo de conocimientos que cimenta el saber de la medicina tradicional en el municipio de Cota, los cuales incluyen prácticas que han prevalecido a lo largo de los años y que hacen énfasis en cuatro áreas: la dieta, el cuidado del cuerpo con el equilibrio frío-calor, el uso de plantas medicinales y las restricciones sociales. Para ofrecer un cuidado culturalmente congruente, se deben conocer las creencias y prácticas relacionadas con la menstruación, lo cual facilita la interacción en el cuidado y la intervención en la atención de los servicios de salud, con base en sus propias creencias y valores.

Objective: To learn and document life styles, beliefs, practices and therapeutic treatments regarding menstrual care, used by women from the municipality of Cota, Colombia. Methods: A qualitative investigation characterized by a theoretical ethnological and a phenomenological approach was carried out, within an individual and socio-cultural context. Twenty eight voluntary women between 48 and 97 years of age were included, refe- rred through community recognition and selected by snowball sampling. Additionally, semi-structured inter- views were applied to all the participants and analyzed through edition or classification. Results: In the municipality of Cota, Colombia, a body of knowledge exists that supports traditional ancestral medicine and wisdom, within which there are practices and customs that have prevailed through the years and that emphasize or focus on four areas: diet, taking care of the body using heat and cold balancing methods or practices, and social restrictions or taboos. In order to offer culturally congruent medical care, the physician must acknowledge and become familiar with the traditional ancestral practices and beliefs regarding women’s menstrual care, so that in the future he/she can determine which of them are important to preserve, adapt and restructure, facilitating interaction during both the care and the intervention phases accomplished by health service institutions and personnel, by taking into consideration the patient’s beliefs and values.

Objetivo: Documentar as conotações culturais, práticas de cuidado e estilos de vida a respeito da menstruação entre mulheres adultas no município de Cota. Métodos: Pesquisa qualitativa fenomenológica que incluiu entrevistas semiestruturadas, analisadas por edição, a 28 mulheres voluntárias com idades ente 48 e 97 anos, amostra referenciada por Bola de Neve. Resultados: Existe no município de Cota, um saber baseado na medicina tradicional que inclui práticas antigas que se focam em quatro aspectos: dieta, cuidado do corpo (balance frio-calor), uso de plantas medicinais e restrições sociais. Para oferecer e facilitar um cuidado médico culturalmente coerente é importante conhecer as crenças populares sobre este período da mulher.

Hormone withdrawal-associated symptoms: overlooked and under-explored.

Women using combined oral contraceptives (COCs) report hormone withdrawal-associated symptoms (HWaS), including bloating, headaches and pelvic pain, which might be due to withdrawal of exogenous hormones and fluctuations in endogenous estrogen during the hormone-free interval (HFI). The prevalence of HWaS is not yet well studied, but these symptoms may lead to reduced user satisfaction and quality of life, and sub-optimal adherence to, and discontinuation of, COCs. HWaS are often confused with treatment-related adverse events because the timing of symptom occurrence is seldom considered. Publications on HWaS are lacking, with few guidelines and no clear consensus on the best treatment option(s). Reported treatments include continuous or extended hormonal COC regimens, which extend the time of the active hormone. Although extended-cycle regimens can cause unpredictable bleeding patterns, user satisfaction is high, with several studies reporting improvement in HWaS. Shortening the HFI is also a well-tolerated and effective method of reducing HWaS, and confers a more predictable bleeding pattern than extending the active hormone period. This may improve acceptance and long-term use of COCs. Future prospects include estradiol-based contraceptive combinations with a shortened HFI and more stable estradiol levels throughout the menstrual cycle.

The monthly rhythm of incidence and age at menarche: thirty five years of research: The circa-vacation-study expectancy rhythm of incidence and age at menarche

The hypothesis that the vacation-study-expectancy scholar regime produces most of the monthly rhythm of the age at menarche (AaM) was tested. Studies on monthly menarche incidence (MI) refuted climatic factors as a main factor in this rhythm, and indicated that the main factor of this rhythm is the succession of expectancies of study (Stu-months) or vacation (Vac-months) months within a year. Thus the hypothesis of seasonal circa-annual rhythm should be modified to the circa-[vacation (fiesta)]-[study (non-fiesta)]-expectancies rhythm for the MI and age at menarche annual rhythms. In several countries Vac-months had higher MI than Stu-months. The high MI of Vac-months was followed by a large decrease when girls started their studies and a MI increase occurred as vacations approached. The hypothesis proposes that at the end of vacations and at the beginning of the study period the AaM should be lowest, and then the mean of AaM should increase because of the menarche delay of girls whose menarche was arrested by the initiation of school work. This pattern was found in four independent samples, from Chile, Colombia, USA and Brazil. The probability that this result be due to random fluctuation of means is extraordinarily low (P<10-8). I conclude that the influence of the expectancy of vacation and study periods on the monthly rhythm of the age at menarche is a real process that accounts for most of this rhythm.

Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences.

STUDY QUESTION: What is the length of the diagnostic delay for endometriosis in Austria and Germany, and what are the reasons for the delay? SUMMARY ANSWER: The diagnostic delay for endometriosis in Austria and Germany is surprisingly long, due to both medical and psychosocial reasons. WHAT IS KNOWN ALREADY: Diagnostic delay of endometriosis is a problematic phenomenon which has been evaluated in several European countries and in the USA, but has not been reported for Germany and Austria. STUDY DESIGN, SIZE, DURATION: A cross-sectional, questionnaire-based multicentre study was conducted in tertiary referral centers in Austria and Germany. From September 2010 to February 2012, 171 patients with histologically confirmed endometriosis were included. PARTICIPANTS, SETTING, METHODS: Patients with a previous history of surgically proven endometriosis, internal diseases such as rheumatic disorders, pain symptoms of other origin, gynecological malignancy or post-menopausal status were excluded from the analysis. Patients with histologically confirmed endometriosis completed a questionnaire about their psychosocial and clinical characteristics and experiences. Of 173 patients, two did not provide informed consent and were excluded from the study. MAIN RESULTS AND THE ROLE OF CHANCE: The median interval from the first onset of symptoms to diagnosis was 10.4 (SD: 7.9) years, and 74% of patients received at least one false diagnosis. Factors such as misdiagnosis, mothers considering menstruation as a negative event and normalization of dysmenorrhea by patients significantly prolonged the diagnostic delay. No association was found between either superficial and deep infiltrating endometriosis or oral contraceptive use and the prolongation of diagnosis. LIMITATIONS AND REASONS FOR CAUTION: There was a possible selection bias due to inclusion of surgically treated patients only. WIDER IMPLICATIONS OF THE FINDINGS: Several factors causing prolongation of diagnosis of endometriosis have been reported to date. The principal factors observed in the present study are false diagnosis and normalization of symptoms. Teaching programs for doctors and public awareness campaigns might reduce diagnostic delay in Central Europe. STUDY FUNDING/COMPETING INTEREST(S): No competing interests exist.

Adolescent users of an online contraception selection tool: how user preferences and characteristics differ from those of adults.

STUDY OBJECTIVE: The objective of this study was to report user statistics of an online contraception selection tool over a 6-month period, comparing preferences and characteristics of adolescents to those of adults. SETTING: Choosing Wisely, available on the website www.SexualityandU.ca, is an interactive program that helps women select an ideal birth control method. DESIGN: Answers to the online questionnaire were logged for a 6-month period. Answers of adolescent users were retrospectively reviewed for responses to questions regarding personal preferences and compared with those of adults. PARTICIPANTS: Participants of the study included users who self-identified as first-time users of Choosing Wisely. RESULTS: 3178 adolescents (age ≤19) and 4206 adults self-identified as new users and completed the software module. Adolescents less commonly reported weighing over 198 pounds or to be smokers. 61% of adolescents would prefer to avoid menses (vs 52% of adults) and 83% of adolescent would find a pregnancy devastating (vs 64% of adults). 1720 (54%) of the adolescents had menstrual complaints; of these 500 (29%) did not believe they could reliably take a pill daily. The majority of both adolescents (73%) and adults (71%) claimed to be willing to use a contraceptive method that required interruption of intercourse. CONCLUSIONS: Choosing Wisely is attracting large numbers of teens and adults, whose responses provide insight into the characteristics of those seeking contraception. Our data corroborate the need for contraceptive options such as combined contraceptives that do not require daily pill-taking and contraceptives that offer menstrual management. However, the magnitude of these statistically significant differences was not always as impressive clinically.

Characterization of consistent triggers of migraine with aura.

OBJECTIVE: The aim of the present study was to characterize perceived consistent triggers of migraine with aura (MA). METHOD: Questionnaires specifically designed to characterize various trigger factors were sent to 181 participants identified in an earlier study. All participants had formerly identified at least one factor that often or always triggered an MA attack. They only answered questions regarding this or these factor(s). RESULTS: The response rate to the questionnaire was 70% (126/179). A number of subtype triggers were mentioned by a high proportion of patients: too much work (under the stress category 54/64), reflected sunlight (under the light category 35/44), too little sleep (under the sleep category 19/24), red wine (under the alcohol category 20/22), passive smoking (under the smoke category 11/11), menstruation (under the menstruation or break from the pill category 12/14) and perfume (under the fumes/heavy scents category 12/15). Hormones, light and stress were reported to cause at least 50 % of MA attacks in 62%, 47% and 42% of participants, respectively. No participants reported alcohol to be the trigger of 50% or more of their attacks. In the groups of participants with "light", "fumes/heavy scents", "smoke" or "physical effort" as triggers, nearly all patients reported that an exposure time to the trigger of less than 3 hours (90-100% of patients) was necessary to trigger an attack and a latency to onset of attack of less than 3 hours (90-100% of patients). CONCLUSION: Our study has provided new knowledge about factors that in particular patients consistently trigger MA. In daily routine practice this information should be helpful in identifying factors to avoid. Patients with trigger factors that always or usually trigger attacks of MA will be highly useful for imaging and other experimental studies.

Menstrual symptoms in adolescent girls: association with smoking, depressive symptoms, and anxiety.

PURPOSE: Dysmenorrhea affects quality of life and contributes to absenteeism from school and work, thereby diminishing opportunities for successful psychosocial and cognitive development during adolescence. In adults, depression, anxiety, and smoking have an impact on menstrual cycles and dysmenorrhea. Associations between these problems have not been examined in adolescents. The purpose of this study was to examine relations between depressive symptoms and anxiety with menstrual symptoms. Smoking was examined as a moderator of this association. METHODS: This study enrolled 154 postmenarcheal girls from a sample of 207 girls age 11, 13, 15, and 17 years (mean = 15.4 years [+/-1.9]). Self-reported measures included the Menstrual Symptom Questionnaire (MSQ), Children's Depression Inventory, State-Trait Anxiety Inventory, and smoking behavior. Generalized linear regression modeled MSQ outcomes separately for depressive symptoms and anxiety. RESULTS: More depressive symptoms/anxiety were related to higher numbers of menstrual symptoms (r = 0.23-0.44, p < .05). Smoking status (ever) was related to higher MSQ scores. Moderating effects of smoking and depressive symptoms or anxiety on menstrual symptoms were consistent across most MSQ factors where effects were stronger in never smokers. CONCLUSION: This is the first study in adolescents showing smoking status and depressive symptoms/anxiety are related to menstrual symptoms, and that the impact of depressive symptoms/anxiety on menstrual symptoms is stronger in never smokers. The dynamic and complex nature of smoking, moods, and dysmenorrhea cannot be disentangled without longitudinal analyses. Efforts to reduce menstrual symptoms should begin at a young gynecological age and include consideration of mood and smoking status.