The Menstrual Disorder of Teenagers (MDOT) Study No. 2: Period ImPact and Pain Assessment (PIPPA) Tool Validation in a Large Population-Based Cross-Sectional Study of Australian Teenagers.

STUDY OBJECTIVE: To validate the Period ImPact and Pain Assessment (PIPPA) self-screening tool for menstrual disturbance in teenagers. DESIGN: Cross-sectional study. SETTING: Three senior high schools in the Australian Capital Territory (ACT), Australia. PARTICIPANTS: A total of 1066 girls between 15 and 19 years of age. INTERVENTIONS AND MAIN OUTCOME MEASURES: A quantitative paper survey collected self-reports of menstrual bleeding patterns, typical and atypical symptoms, morbidities, and interference with daily activities. Multiple correspondence analysis was used to examine associations between PIPPA questions. Generalized linear models compared total score and subscores by validation criteria: pain, school absence, and body mass index (BMI). Receiver operating characteristic curves were used to evaluate the predictiveness of menstrual disturbance indicators by total PIPPA score. RESULTS: Reports of pain, interference, and concern within the PIPPA items and between both the MDOT and PIPPA questionnaires were significantly correlated (P < .0001). The indicator "missing school" was highly associated (P < .0001) with pain and interference. Obesity (BMI ≥30) was associated with higher PIPPA scores, as was underweight (BMI≤18.4). Where 0 = no disturbance, 5 = high disturbance, aggregated PIPPA scores found 75% scoring 0-2 (out of 5) and 25% scoring 3-5 (257/1037). High scores of 4 or 5 (out of 5) were 7% (72/1037) and 3.7% (38/1037), respectively. CONCLUSION: PIPPA is a valid screening tool for pain-related menstrual disturbance that affects functioning in young women. PIPPA subdomains of pain/interference have good validity relative to indicators of pain and interference and are responsive to age, BMI, and school absence differences.

The need for investigations to elucidate causes and effects of abnormal uterine bleeding.

This article describes a modern perspective on the basic investigations for abnormal uterine bleeding (AUB) in low-resource settings compared with a much more detailed approach for high-resource settings, bearing in mind issues of effectiveness and cost effectiveness. AUB includes any one or more of several symptoms, and it should be evaluated for the characteristics of the woman's specific bleeding pattern, her "complaint" and the presence of other symptoms (especially pain), the impact on several aspects of body functioning and lifestyle, and the underlying cause(s), especially cancer. Ideally, the evaluation is comprehensive, considering each of the potential etiological domains defined by the International Federation of Gynecology and Obstetrics PALM-COEIN system for the classification of causes. However, the detail of the questions and the extent of investigations will be significantly influenced by the technologies available and the time allotted for a consultation. In general, investigations should be performed only if they will make a material difference to the management approaches that can be offered. This should be an important consideration when a range of costly high-technology tests is accessible or when certain tests only have limited availability.

Management of abnormal uterine bleeding in low- and high-resource settings: consideration of cultural issues.

In non industrialized countries the incidence of heavy menstrual bleeding (HMB) appears to be similar to that of industrialized countries, although data is scanty. In low-resource settings, women with abnormal uterine bleeding (AUB) often delay seeking medical care because of cultural beliefs that a heavy red menstrual bleed is healthy. Efforts to modify cultural issues are being considered. A detailed history and a meticulous examination are the important foundations of a definitive diagnosis and management in low-resource settings but are subject to time constraints and skill levels of the small numbers of health professionals. Women's subjective assessment of blood loss should be combined, if possible, with a colorimetric hemoglobin assessment, if full blood count is not possible. Outpatient endometrial sampling, transvaginal sonography, and hysteroscopy are available in some non industrialized countries but not in the lowest resource settings. After exclusion of serious underlying pathology, hematinics should be commenced and antifibrinolytic or nonsteroidal anti-inflammatory drugs considered during menses to control the bleeding. Intrauterine or oral progestogens or the combined oral contraceptive are often the most cost-effective long-term medical treatments. When medical treatment is inappropriate or has failed, the surgical options available most often are myomectomy or hysterectomy. Hysteroscopic endometrial resection or newer endometrial ablation procedures are available in some centers. If hysterectomy is indicated the vaginal route is the most appropriate in most low-resource settings. In low-resource settings, lack of resources of all types can lead to empirical treatments or reliance on the unproven therapies of traditional healers. The shortage of human resources is often compounded by a limited availability of operative time. Governments and specialist medical organizations have rarely included attention to AUB and HMB in their health programs. Local guidelines and attention to training of doctors, midwives, and traditional health workers are critical for prevention and improvement in management of HMB and its consequences for iron deficiency anemia and postpartum hemorrhage, the major killer of young women in developing countries.

Associations between psychiatric disorders and menstrual cycle characteristics.

An understanding of the relationship between psychiatric disorders and menstrual characteristics is important to the assessment and care of women. Menstrual cycle regularity and length have significant associations with specific current and lifetime psychiatric disorders. The purpose of this study was to investigate whether psychiatric disorders are associated with menstrual cycle length or regularity. The sample included 628 pregnant Medicaid-eligible women from Women, Infants, and Children's Supplemental Nutrition Program sites in five counties in rural Missouri and the city of St. Louis. Women were assessed for current (12-month) and lifetime psychiatric disorders with the Diagnostic Interview Schedule IV. Menstrual length and regularity were assessed by self-report. Analyses consisted of logistic regression while controlling for race. Independent of the effects of race, (a) women who reported irregular cycles were less than half as likely to have a current anxiety disorder as those that reported regular cycles, and (b) women with shorter cycles (

Care of the overweight adolescent including polycystic ovarian syndrome.

Obstetrician-gynecologists are responsible for promoting healthy eating and physical activity in adolescents during annual screening examinations. Adolescents with a body mass index for age greater than or equal to the 95th percentile should undergo an in-depth health assessment to determine psychosocial morbidity and risk of cardiovascular disease. Further research is needed to determine the most efficacious approach to the prevention and treatment of obesity in adolescents. For now, it is best to extrapolate an approach from data pertaining to children and adults, while being cognizant of the special psychosocial and physical needs of adolescents.

Office gynecology for the primary care physician, part II: pelvic pain, vulvar disease, disorders of menstruation, premenstrual syndrome, and breast disease.

Approaches to patients with pelvic pain, vulvar disease, disorders of menstruation, premenstrual syndrome, and breast diseases are addressed. In the great majority of cases, it is appropriate for the primary care physician to initiate evaluation and management of these problems. It is hoped that the brief introductions contained here suggest a diagnostic approach to each disorder and guide referral to consultants as needed.

Menstrual disorders in women. Social economic consequences of examining women with menstrual disorders for cancer of the body of the uterus.

OBJECTIVE: To explore the health economic consequences of menstrual disorders in Denmark. DESIGN: Analysis of the total costs of menstrual disorders in women, and a cost effectiveness analysis of menstrual disorders in women. SETTING: The analysis is based on retrospective 1991 data from the Danish National Patient Register, and from 1991 national production figures from the Danish National Health Insurance responsible for the primary health care sector. Furthermore, a survey of the incidence of cancer in Denmark in 1988 has been used. SUBJECTS: In the cost analysis all women who experienced menstrual disorders in 1991 are included, and in the cost effectiveness analysis all women with menstrual disorders who were examined by dilatation and curettage in 1991 were included. MAIN OUTCOME MEASURES: In the cost analysis the outcome measure is the total cost of treating and examining women with menstrual disorders in 1991. In the cost effectiveness analysis the outcome measure is the cost of diagnosing one new case of cancer of the body of the uterus in 1991. RESULTS: Menstrual disorders caused a resource use in the health care sector of 150 mill. DKK in 1991, i.e. approximately 0.4% of the total Danish health expenditure, of which at least 33 mill. DKK were spent on the ca. 25,000 dilatations and curettages which were performed in hospitals and the primary sector. Approximately 600 new cases of cancer of the body of the uterus were diagnosed in Denmark in 1991. The cost of finding one woman with cancer of the body of the uterus was on average 54,500 DKK. The cost variation per new case of cancer of the body of the uterus among different age groups was relatively large. The cost was 1.3 mill DKK per new case if the women were less than 40 years because of a low risk of having cancer of the body of the uterus in this age group. The cost per case was 21,500 DKK in women over 50 years. CONCLUSION: This article raised the question whether too many women under 40 years are examined today by dilatation and curettage when the cost effectiveness of examining the woman is considered.

Menstrual dysfunction in athletes: assessment and treatment.

The reported incidence of exercise induced menstrual dysfunction varies among adolescent athletes from 12% to 66%. Women who experience amenorrhea associated with exercise are at risk for irretrievable bone mineral density loss and increased rate of stress fractures. Nurses should provide information to parents, coaches, and athletes about changes in exercise intensity and frequency, dietary modifications, and estrogen and progesterone replacement therapy to minimize the sequelae of exercise induced menstrual dysfunction.

Comparative analysis of three PMS assessment instruments--the identification of premenstrual syndrome with core symptoms.

Premenstrual syndrome (PMS) is a commonly encountered complaint among women. This study compared the PMS Diary (PMSD), which measures core menstrual symptoms (negative affect, water retention, and pain symptoms), with two commonly used self-rating forms, the Menstrual Distress Questionnaire (MDQ) and the Daily Rating Form (DRF). Thirty-seven premenopausal women with documented PMS completed the forms. A multitrait-multimethod analysis was performed to determine overall agreement and reliability. The three instruments and their component scale scores had strong internal consistency. Correlations between overall scores and between scales measuring similar constructs were strong. Correlations were 0.77 between PMSD and MDQ; 0.67 between PMSD and DRF; and 0.81 between MDQ and DRF. The PMSD performs as effectively as more extensive questionnaires in measuring symptoms in women with PMS. The PMS Diary is a concise yet reliable and valid instrument that can be easily administered in ambulatory care and longitudinal research.

The characteristics of the menstrual cycle in Nigerian schoolgirls and the implications for school health programmes.

The present study examines the characteristics of menstrual cycle among 361 Nigerian postmenarcheal schoolgirls derived from seven public secondary schools. Survey questions covered preparation for menstruation, duration of flow, cycle length, regularity, premenstrual syndrome and dysmenorrhea. For the study subjects the mean age (years) at the time of interview, at menarche, and completed since menarche are 16.5 +/- 3.3, 13.7 +/- 2.6 and 2.9 +/- 1.2 respectively. Premenstrual counselling was reported in 84.2%; and 48.6% was provided by parents and guardians, and 23.7% by school teachers. The findings indicate that menstrual flow < or = 2 days, and cycle length < or = 20 days are common; occurring in 20-30% of schoolgirls. Abnormal patterns such as cycle length > or = 38 days, flow duration > or = 8 days and heavy menstruation occurred in less than 5% of study subjects. Irregular menstrual cycles were recorded in 13%, and severe dysmenorrhea in 17.2%. Severe premenstrual syndrome occurred in about 20% of schoolgirls, with symptom-complex mainly of behavioural change, arousal and impaired concentration. The need for a multi-disciplinary school health counselling program that would provide relevant information on menstrual pattern and its common variation, identify abnormal patterns for early referral, provide psychological support and drug relief of distressing menstrual symptoms, and provide information on other contemporary adolescent problems is discussed.

Assessment of the reliability of and the effect of neutral instructions on the symptom ratings on the Moos Menstrual Distress Questionnaire.

The Moos Menstrual Distress Questionnaire (MDQ) Form T, was analyzed for split-half and test-retest reliability. Also, an Experimental Group (N = 47)received neutral instructions to determine if knowledge of the purpose of the questionnaire would affect symptom ratings. Results indicated that the MDQ is internally consistent and does have high test-retest reliability. Also, altered instructions did not significantly affect symptom ratings. However, the MDQ, Form T, was not able to differentiate between Ss who were in different menstrual cycle phases when completing the questionnaire. It is suggested that Form T be used instead as originally intended to compare the ratings of different Ss in different cycle phases.

[Ovarian dysgerminoma: clinical signs, assessment, and therapeutic indications, with reference to 30 observations]. / Les dysgerminomes de l'ovaire. Signes cliniques, bilan, indications thérapeutiques à propos de 30 observations.

Thirty cases of ovarian seminomas in patients aged for the most part between 10 and 20 years were studied at the Gustave-Roussy Institute between 1957 and 1970. In 10 per cent of cases both ovaries were involved. They were revealed by menstrual disorders, acute cystic twisting, signs of abdomino-pelvic compression, or a change in the general state of health. Lymphograms were made for the 25 most recent cases. They showed pathological signs in 35 per cent of cases. The role of the lymphogram is of prime importance in the suveillance of nonirradiated patients, making it possible for them to have remedial treatment. Surgery ensures excision of the tumour and indicates the degree of abdominal extension. During a second operation, it is possible to transpose a healthy ovary to avoid castration. The methods of ganglion irradiation, which should be systematic, are discussed in relation to the results of the operation and of the lymphogram. In 80 per cent of cases, the patients were alive after two years and slightly more than half of them had maintained ovarian function.