Sex differences and considerations for female specific nutritional strategies: a narrative review.

Although there is a plethora of information available regarding the impact of nutrition on exercise performance, many recommendations are based on male needs due to the dominance of male participation in the nutrition and exercise science literature. Female participation in sport and exercise is prevalent, making it vital for guidelines to address the sex-specific nutritional needs. Female hormonal levels, such as estrogen and progesterone, fluctuate throughout the mensural cycle and lifecycle requiring more attention for effective nutritional considerations. Sex-specific nutritional recommendations and guidelines for the active female and female athlete have been lacking to date and warrant further consideration. This review provides a practical overview of key physiological and nutritional considerations for the active female. Available literature regarding sex-specific nutrition and dietary supplement guidelines for women has been synthesized, offering evidenced-based practical information that can be incorporated into the daily lives of women to improve performance, body composition, and overall health.

Menstrual blood losses and body mass index are associated with serum ferritin concentrations among female varsity athletes.

Preventing and treating iron deficiency are important components in the nutritional care of female varsity athletes, as these interventions may improve aerobic endurance and athletic performance. We examined the factors associated with ferritin concentration in 30 female varsity athletes (18-30 years) at the University of British Columbia in Vancouver, Canada. Biochemical indicators of iron and inflammation status, dietary intake, supplementation practices, weight, height, and menstrual blood losses were assessed. Iron deficiency prevalence was 20% (n = 6/30; inflammation-adjusted ferritin <15 µg/L). Multiple linear regression was used to assess the associations of a number of independent explanatory variables with log-transformed serum ferritin (µg/L) as the continuous outcome variable. A 1-unit increase in body mass index (BMI; kg/m2) was associated with 22% (95% CI: 9%-37%) higher mean ferritin concentrations, and a 1-point increase in menstrual loss score was associated with 1% (95% CI: 1%-2%) lower ferritin concentrations. Hemoglobin and hepcidin concentrations, inflammation biomarkers, consumption of iron supplements in any form or dose for ≥3 days/week, and age were not significantly associated with ferritin concentrations in the final adjusted model. Novelty Estimated monthly menstrual losses and BMI were associated with serum ferritin concentrations in female athletes in our study. These are easy-to-measure, noninvasive measurements that should be considered in the assessment of risk of iron deficiency in female athletes.

The effect of physical activity on reproductive health outcomes in young women: a systematic review and meta-analysis.

BACKGROUND: In the context of increasing rates of overweight and obesity in young adult women, and the increasing numbers of women seeking help for fertility problems, it is important to understand whether physical activity (PA) could help with management of reproductive health problems, with or without weight loss. OBJECTIVE AND RATIONALE: The primary aim of this systematic review and meta-analysis was to assess the effects of PA on selected reproductive health outcomes in young adult women, in order to inform best practice advice for women in terms of promoting fertility and reproductive health in young adulthood. SEARCH METHODS: An electronic search of PubMed, EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, SportDiscus, and Cochrane was performed for studies published between January 2000 and May 2018. Keywords and Medical Subject Headings terms related to PA, reproductive health, and weight gain were used. Studies were selected if they were intervention studies, if PA was delivered as part of an intervention to pre-menopausal women, and if any reproductive health outcome was reported. Quality analysis was performed using the Tool for the assEssment of Study qualiTy and reporting in EXercise. OUTCOMES: Eighteen studies, with a mix of four types of study design (4 randomized controlled trials (RCTs), 11 randomized comparison trials, 2 non-randomized comparison trials, and 1 single-arm clinical trial), were identified. Comparisons included fertility treatment (four studies) and common treatments for women with polycystic ovary syndrome (PCOS) symptoms (nine studies). Pooled analysis of data from three of the four studies with a control group showed higher pregnancy [risk ratio (RR) 2.10, 95% CI (1.32, 3.35); three studies] and live birth [RR 2.11, 95% CI (1.02, 4.39); two studies] rates in the intervention groups compared with non-therapy controls. Aggregated data from the fertility treatment comparative studies (i.e. those that compared PA with standard fertility treatment such as clomiphene, gonadotrophins, and/or IVF) showed no significant intervention differences: RR 1.46, 95% CI (0.87, 2.45) for clinical pregnancy (four studies) and RR 1.09, 95% CI (0.56, 2.12) for live births (two studies). Pooled analysis from the comparison trials that used pharmaceutical or dietary treatment for PCOS as comparison showed higher pregnancy rates [RR 1.59, 95% CI (1.06, 2.38); five studies] and live birth rates [RR 2.45, 95% CI (1.24, 4.83); two observations] in the PA intervention groups than in the comparison groups. Analysis of other outcomes, such as ovulation rates, menstrual regularity, and conception rates, showed no differences between the PA intervention and comparison groups. WIDER IMPLICATIONS: There is emerging evidence from RCT that PA may improve pregnancy rates in women with reproductive health problems. Comparative studies indicate that PA intervention may be as effective as other commonly used clinical intervention strategies for improving reproductive health outcomes. While the type, intensity, frequency, and duration of optimal PA intervention, and the role of PA independent of weight loss, remain unclear, these preliminary findings suggest that PA may be an affordable and feasible alternative or complementary therapy to fertility treatments.

An Open-Label, Single-Arm, Efficacy Study of Tranexamic Acid in Adolescents with Heavy Menstrual Bleeding.

STUDY OBJECTIVE: Heavy menstrual bleeding (HMB) occurs in up to 40% of adolescent girls, significantly affecting their daily activities. Identifying alternative treatment strategies for HMB is particularly important for adolescents who prefer not to take hormonal contraception. Our objective was to determine whether use of tranexamic acid (TA) would increase health-related quality of life and decrease menstrual blood loss (MBL) in adolescents with HMB. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: In an open-label, multi-institutional, single-arm, efficacy study, patients 18 years of age or younger with HMB were treated with oral TA 1300 mg 3 times daily during the first 5 days of menses and monitored over the course of 4 menstrual cycles (1 baseline; 3 treatment cycles). Assessment of MBL was performed using the Menorrhagia Impact Questionnaire (MIQ) and the Pictorial Blood Assessment Chart. The MIQ includes Likert scale items, validated to assess the influence of HMB on quality of life. In previous studies, a 1-point decrease or more in score correlated with clinically significant improvement. RESULTS: Thirty-two patients enrolled in the study, and 25 had sufficient follow-up data to be deemed evaluable. The mean age of the participants was 14.7 years (range, 11-18 years). There was an overall improvement in all items of the MIQ, with a greater than 1-point improvement in the MIQ perceived blood loss scale. When using TA, mean Pictorial Blood Assessment Chart score improved by 100 points. There were no medication-related serious adverse events. CONCLUSION: Use of TA in female adolescents with HMB is well tolerated and leads to clinically meaningful reduction in MBL.

Serum Brain-derived Neurotrophic Factor Levels Mirror Bone Mineral Density in Amenorrheic and Eumenorrheic Athletes.

Amenorrhea and osteoporosis are strongly associated in female athletes. Amenorrheic women show lower serum levels of brain-derived neurotrophic factor (BDNF) than eumenorrheic women. BDNF is known to regulate bone tissue development and remodeling; thus, athletes with low serum BDNF levels may show low bone mass. This study investigated the associations between serum BDNF, estradiol, and bone mineral density (BMD) in female athletes. This study included 160 elite female athletes (21.7±4.3 years). Serum levels of BDNF and estradiol were in 195 blood samples obtained from 132 eumenorrheic athletes (EA) and 63 amenorrheic athletes (AA). BMD was measured in the radius, lumbar spine, pelvis, and legs using dual-energy X-ray absorptiometry. AA showed significantly lower serum BDNF levels than EA (p=0.017). Serum BDNF levels were positively and significantly associated with both serum estradiol levels (p=0.0004) and the BMD measured at all sites (all p<0.05). 10 AA received transdermal estrogen therapy, and serum BDNF levels were measured at baseline and 6 months after therapy. Hormone-treated AA demonstrated a significant increase in serum BDNF levels after 6 months (p=0.022). Thus, serum BDNF levels may be associated with decreased BMD and serve as an indicator of the therapeutic effect of estradiol supplementation in female athletes with osteoporosis.

Clinical application of stage operation in patients with placenta accreta after previous caesarean section.

To explore the clinical value of stage operation to patients with placenta accreta after previous caesarean section (CS).Nineteen women with medium and late pregnancies diagnosed with placenta accreta after previous CS were enrolled in this retrospective study and all underwent stage operation. Postpartum hemorrhage volume, red blood cells (RBC) transfusion, uterus retention rate, postpartum complications, and menstrual recovery were analyzed to evaluate the value of stage operation in patients with placenta accreta.Four of 19 cases were performed uterus curettage after 63, 38, 56, and 52 days of CS. Total hysterectomy was performed in 2 cases after 44 and 57 days of first-stage CS. Thirteen cases had placenta well discharged after treatment with the traditional Chinese medicine (TCM) Shenghua Decoction. The uterus retention rate was 89.48% (17/19). Mean postpartum hemorrhage volume was 1594.74 ±â€Š1134.06 (400-4500) mL, mean volume of total hemorrhage was 1878.42 ±â€Š1276.96 (400-4500) mL, mean RBC transfusion was 868.42 ±â€Š816.53 (0.00-2400.00) mL. Postpartum bleeding volume showed≤1000 mL in 8 patients and ≤500 mL in 4 patients.Stage operation reduces postpartum hemorrhage volume and cesarean hysterectomy morbidity in patients with placenta accreta. However, infection and late postpartum hemorrhage should be monitored closely.

Electroacupuncture for reproductive hormone levels in patients with diminished ovarian reserve: a prospective observational study.

BACKGROUND: Effective methods for the treatment of reproductive dysfunction are limited. Previous studies have reported that acupuncture can modulate female hormone levels, improve menstrual disorders, alleviate depression and improve pregnancy rates. However, studies of acupuncture for diminished ovarian reserve (DOR) are lacking. OBJECTIVE: To carry out a prospective observational study aimed at assessing the effect of EA on the reproductive hormone levels of patients with DOR seeking fertility support and consider its safety. METHODS: Eligible patients with DOR received EA for 12 weeks: five times a week for 4 weeks followed by three times a week for 8 weeks. The primary outcome was the change in mean follicle-stimulating hormone (FSH) level at week 12. Mean luteinising hormone (LH) and serum oestradiol (E2) levels, FSH/LH ratios and symptom scale scores were simultaneously observed. RESULTS: Twenty-one patients with DOR were included in the final analysis. Mean FSH levels fell from 19.33±9.47 mIU/mL at baseline to 10.58±6.34 mIU/mL at week 12 and 11.25±6.68 mIU/mL at week 24. Change in mean FSH from baseline was -8.75±11.13 mIU/mL at week 12 (p=0.002) and -8.08±9.56 mIU/mL at week 24 (p=0.001). Mean E2 and LH levels, FSH/LH ratios and irritability scores were improved at weeks 12 and/or 24. Approximately 30% patients reported subjective increases in menstrual volume after treatment. CONCLUSIONS: EA may modulate reproductive hormone levels and the effects seem to persist for at least 12 weeks after treatment with no significant side effects. EA may improve the ovarian reserve of patients with DOR, though further research is needed. TRIAL REGISTRATION NUMBER: NCT02229604; Results.

[Theory and application regarding "stage by stage" acupuncture for diminished ovarian reserve].

Based on a considerable number of ancient literature, clinical experience and modern scientific studies, a comprehensive study was performed on the TCM theory and treatment of diminished ovarian reserve. It was summarized that the two causes of diminished ovarian reserve were deficiency of the kidney essence and incoordination between Chong Vessel and Conception Vessel, so the treatment strategy of "stage by stage" acupuncture was proposed. It was pointed out acupoint selection should be in accordance with physiological basis of menstruation and waxing and waning of yin-yang. Therefore, acupuncture at different acupoints and meridians could regulate yin and yang and promote the normal yin-yang transformation, which could store and discharge the uterus. As a result, the function of ovary is recovered. This method has achieved significant clinical efficacy.

Adolescent Experiences With Intrauterine Devices: A Qualitative Study.

PURPOSE: The purpose of this study was to improve understanding of adolescents' reasons for choosing an intrauterine device (IUD) and to explore experiences that led to continuation or discontinuation of the levonorgestrel intrauterine system (LNG-IUS) and the copper IUD (copper IUD). METHODS: We conducted focus groups (FGs) with adolescents and young women who were current or former IUD users stratified by IUD type and 12-month IUD continuation or discontinuation. All subjects were participants from the Contraceptive CHOICE Project. FG data were supplemented with in-depth interviews (IDIs). Data collection was continued until thematic saturation was reached. Transcripts were independently coded by two researchers, and interrater reliability was calculated using a Kappa coefficient. Analysis followed a standard text-analysis approach. RESULTS: Thirteen FGs and seven IDIs were conducted with 43 young women. Effectiveness, duration of use, convenience, and potential bleeding changes emerged as themes for both choosing and continuing IUDs. Some women chose the LNG-IUS to achieve amenorrhea, whereas copper IUD users wanted a nonhormonal method and continued menses. Copper IUD users cited expulsion and bleeding irregularities as reasons for discontinuation, whereas LNG-IUS users reported bleeding irregularities and continued pain as reasons for removal. IUD users noted an adjustment period of weeks to months in which side effects were present before lessening. CONCLUSIONS: Effectiveness, duration of use, convenience, and potential changes in bleeding patterns drove adolescents' choice and continuation of an IUD. Bleeding changes and pain contributed to IUD discontinuation. Discussion of effectiveness, duration and convenience, and anticipatory guidance regarding post-insertion side effects may be important in counseling young women about IUDs.

Dietary intervention restored menses in female athletes with exercise-associated menstrual dysfunction with limited impact on bone and muscle health.

Exercise-related menstrual dysfunction (ExMD) is associated with low energy availability (EA), decreased bone mineral density (BMD), and increased risk of musculoskeletal injury. We investigated whether a 6-month carbohydrate-protein (CHO-PRO) supplement (360 kcal/day, 54 g CHO/day, 20 g PRO/day) intervention would improve energy status and musculoskeletal health and restore menses in female athletes (n = 8) with ExMD. At pre/post-intervention, reproductive and thyroid hormones, bone health (BMD, bone mineral content, bone markers), muscle strength/power and protein metabolism markers, profile of mood state (POMS), and energy intake (EI)/energy expenditure (7 day food/activity records) were measured. Eumenorrheic athlete controls with normal menses (Eumen); n = 10) were measured at baseline. Multiple linear regressions were used to evaluate differences between groups and pre/post-intervention blocking on participants. Improvements in EI (+382 kcal/day; p = 0.12), EA (+417 kcal/day; p = 0.17) and energy balance (EB; +466 kcal/day; p = 0.14) were observed with the intervention but were not statistically significant. ExMD resumed menses (2.6 ± 2.2-months to first menses; 3.5 ± 1.9 cycles); one remaining anovulatory with menses. Female athletes with ExMD for >8 months took longer to resume menses/ovulation and had lower BMD (low spine (ExMD = 3; Eumen = 1); low hip (ExMD = 2)) than those with ExMD for <8 months; for 2 ExMD the intervention improved spinal BMD. POMS fatigue scores were 15% lower in ExMD vs. Eumen (p = 0.17); POMS depression scores improved by 8% in ExMD (p = 0.12). EI, EA, and EB were similar between groups, but the intervention (+360 kcal/day) improved energy status enough to reverse ExMD despite no statistically significant changes in EI. Similar baseline EA and EB between groups suggests that some ExMD athletes are more sensitive to EA and EB fluctuations.

Students' perceptions and doubts about menstruation in developing countries: a case study from India.

Menstrual education is a vital aspect of adolescent health education. Culture, awareness, and socioeconomic status often exert profound influence on menstrual practices. However, health education programs for young women in developing countries do not often address menstrual hygiene, practices, and disorders. Developing culturally sensitive menstrual health education and hygiene programs for adolescent females has been recommended by professional health organizations like the World Health Organization and UNICEF. These programs cannot be developed without understanding existing myths and perceptions about menstruation in adolescent females of developing countries. Thus, the purpose of this qualitative study from India was to document existing misconceptions regarding menstruation and perceptions about menarche and various menstrual restrictions that have been understudied. Out of the 612 students invited to participate by asking questions, 381 girls participated by asking specific questions about menstruation (response rate = 62%). The respondents consisted of 84 girls from sixth grade, 117 from seventh grade, and 180 from eighth grade. The questions asked were arranged into the following subthemes: anatomy and physiology, menstrual symptoms, menstrual myths and taboos, health and beauty, menstrual abnormalities, seeking medical advice and home remedies; sanitary pads usage and disposal; diet and lifestyle; and sex education. Results of our study indicate that students had substantial doubts about menstruation and were influenced by societal myths and taboos in relation to menstrual practices. Parents, adolescent care providers, and policy makers in developing countries should advocate for comprehensive sexuality education and resources (e.g., low-cost sanitary pads and school facilities) to promote menstrual health and hygiene promotion.

[Analysis on relevance between regional acupoint skin temperature and indoor temperature and humidity in healthy female volunteers during menstruation].

OBJECTIVE: To observe the relationship between the cutaneous temperature of the acupoint area and the environmental temperature and humidity in healthy female undergraduate student volunteers. METHODS: Forty-nine healthy female undergraduate student volunteers experiencing menstruation were enrolled in the present study. The cutaneous temperature of the acupoint region was detected for 60 min by using a "dynamic skin temperature detector" and under room temperature of (22.15 +/- 1.47) degrees C and indoor relative humidity of (50.12 +/- 4.52)%. The detected acupoints were Xuehai (SP10), Diji (SP8), Zhongdu (LR 6), Sanyinjiao (SP 6), Taixi (KI 3), Taibai (SP 3), Taichong (LR 3) and Shuiquan (KI 5)which have been well documented in effectively regulating uterine activity, and Xuanzhong (GB 39) and non-meridian acupoint nearby GB 39. The skin temperature measurement was conducted on the first day of menstruation. RESULTS: The skin temperature levels of Xuehai (SP 10), Diji (SP 8), Zhongdu (LR 6), Xuanzhong (GB 39) and non-acupoint near GB 39 were apparently hig-her under higher temperature, showing a significant relevance between the acupoint skin temperature and room temperature (P < 0.05). No significant differences were found between skin temperature levels of Sanyinjiao (SP 6), Taixi (KI 3), Taibai (SP 3), Taichong (LR 3) and Shuiquan (KI 5) and the indoor temperature (P > 0.05), between the skin temperature difference of the bilateral isonym acupoints and the indoor temperature, and between the skin temperature difference and the indoor humidity (P > 0.05). CONCLUSION: The skin temperature of some acupoints is influenced by the environment temperature rather than the indoor humidity.

Specificity of auricular acupoints in reflecting changes of qi and blood measured by diffuse reflectance spectroscopy.

OBJECTIVE: This study aimed to assess the specificity of auricular acupoints in responding to changes of qi and blood which, in traditional Chinese medicine, are considered as the fundamental substances in the human body for sustaining normal vital activity. METHODS: A miniature fiber optic system was used to invasively measure the diffuse reflectance spectra of three auricular acupoints, namely, Uterus (TF2), Gan (CO12) and Neifenmi (CO18), at different stages of menstruation, when the female body exhibits regular changes of qi and blood. The spectra of different acupoints were compared to find their difference in responding changes of qi and blood, especially the reflectivity of absorption peaks of hemoglobin. RESULTS: The reflectivity of the same auricular acupoint during menstruation is higher than that before and after menstruation, and this trend is more obvious for the Uterus point compared with the points Gan and Neifenmi. The average reflectivity of the Uterus point during menstruation was significantly higher than that before or after menstruation (P<0.01). The D-values during and after menstruation of the Uterus point were greater than those of the points Gan and Neifenmi at 544.06 and 577.47 nm, respectively (P<0.05). CONCLUSION: The diffuse reflectance light of auricular acupoints changes as qi and blood fluctuates, and there is relative specificity among different auricular acupoints in reflecting changes of qi and blood. The Uterus point may be the most sensitive auricular acupoint in reflecting uterus function and subsequent changes of qi and blood.

Iron deficiency in women: assessment, causes and consequences.

PURPOSE OF REVIEW: Iron deficiency is the most common nutritional disorder affecting about 20-25% of the world's population, predominantly children and women. There is emerging evidence that depletion of iron stores may have adverse consequences for adults even in the absence of anaemia. This raises issues about the most appropriate method of assessing iron status. RECENT FINDINGS: Although the effects of iron-deficiency anaemia are well characterized, emerging evidence suggests that iron deficiency without anaemia can have negative consequences in adults, particularly for neurocognitive outcomes. Iron deficiency is more likely in women of reproductive age because of menstrual blood loss. However, extremes of blood loss such as regular blood donation, diets of low bioavailability and the challenges of pregnancy all markedly increase the risk of iron deficiency. In addition, the physiological changes in pregnancy affect the normal reference ranges used in laboratory assessment. The use of haemoglobin as a marker of iron deficiency is limited by its low specificity and sensitivity and although the use of alternative biomarkers is becoming more common, interpreting results in conditions of chronic inflammation, including that associated with increased adiposity, needs more investigation. SUMMARY: By understanding the physiology of iron metabolism alongside the limitations and interpretation of biomarkers of iron deficiency, clinicians and nutritionists are better equipped to identify changes in iron balance and to further investigate the functional outcomes of iron deficiency.

[Eecond result and analysis of guidelines to diagnosis and treatment for distending pain in breasts during menstruation in traditional Chinese medicine].

To establish guidelines to diagnosis and treatment for distending pain in breasts during menstruation in traditional Chinese medicine (TCM). With Delphimethod, sent to the second survey questionnaires to 40 gynecology experts in TCM and integrated traditional and western medicine and recovery 35 experts, and the questionnaires were analyzed with SPSS11. 5. The experts' activity and professional level is high. The experts are from all over China and express the typical opinions of all experts in this field. The items in the frame of the guidelines to diagnosis and treatment for distending pain in breasts during menstruation in traditional Chinese medicine are generally recognized. First draft of the guidelines has basically been formed.

True and sham acupuncture produced similar frequency of ovulation and improved LH to FSH ratios in women with polycystic ovary syndrome.

CONTEXT: Acupuncture may represent a nonpharmaceutical treatment for women with polycystic ovary syndrome (PCOS), based on four studies. OBJECTIVE: The objective of the study was to determine whether true, as compared with sham, acupuncture normalizes pituitary gonadotropin hormones and increases ovulatory frequency in women with PCOS. DESIGN: This was a randomized, double-blind, sham-controlled clinical trial (5 month protocol). SETTING: The study was conducted in central Virginia. PARTICIPANTS: Eighty-four reproductive-aged women completed the intervention. Eligibility required a PCOS diagnosis and no hormonal intervention 60 d before enrollment. INTERVENTIONS: Intervention included 12 sessions of true or sham acupuncture (Park sham device) for 8 wk. MAIN OUTCOME MEASURES: Serum LH and FSH at baseline, after intervention, and 3 months later were measured. Ovulation was measured with weekly urine or blood samples. RESULTS: Both arms demonstrated a similar mean ovulation rate over the 5 months (0.37/month among n = 40 true acupuncture and 0.40/month among n = 44 sham participants, P = 0.6), similar LH to FSH ratio improvement (-0.5 and -0.8 true and sham, respectively, P < 0.04 after intervention vs. baseline) and a similar decline in LH over the 5-month protocol (P < 0.05). Neither arm experienced a change in FSH. There were seven pregnancies (no difference by intervention, P = 0.7). Lower fasting insulin and free testosterone were highly correlated with a higher ovulation rate within the true acupuncture group only (P = 0.03), controlling for prestudy menstrual frequency and body mass index. CONCLUSION: We were unable to discern a difference between the true and sham acupuncture protocols for these women with PCOS, and both groups had a similar improvement in their LH/FSH ratio.

Change of BMD after weaning or resumption of menstruation in Chinese women with different FokI VDR-genotypes: a randomized, placebo-controlled, calcium supplementation trial.

OBJECTIVE: To investigate the effect of calcium supplementation on bone mineral density (BMD) in Chinese women with different FokI vitamin D receptor (VDR) genotypes (FF, Ff, and ff) after weaning or resumption of menstruation during lactation. METHODS: A total of 40 subjects with the same FokI VDR genotype were randomly divided into two groups: one received calcium tablet (600 mg once daily as CaCO(3)) and the other placebo tablet once daily for 1 year. At baseline, BMD was measured by dual-energy X-ray absorptiometry at lumbar spine (L2-L4) and at left hip whereas serum PICP, serum OC, and urinary CTX, serum 25(OH)VitD(3), and serum estradiol were measured at weaning and 1 year thereafter. RESULTS: After the intervention, BMD at lumbar spine and at left hip increased significantly in all these women with a trend among different FokI VDR genotypes such as FF > Ff > ff (P<0.05, <0.01, and <0.001, respectively). BMD at lumbar spine in women with FF VDR genotype increased much more rapidly than in those with ff VDR genotype (P<0.05). Compared with the control group women with the FF genotype regained more BMD after calcium supplementation (P<0.05). CONCLUSION: Daily calcium 600 mg supplementation has beneficial effect on the bone health of women with FF VDR genotype.

Menstruation recovery after chemotherapy and luteinizing hormone-releasing hormone agonist plus tamoxifen therapy for premenopausal patients with breast cancer.

PURPOSE: Little is known about the period required for menstruation recovery after long-term luteinizing hormone-releasing hormone (LH-RH) agonist plus tamoxifen therapy following chemotherapy. In this study we investigated the period required for menstruation recovery after the therapy. METHODS: The subjects comprised 105 premenopausal breast cancer patients who had undergone surgery. All patients were administered an LH-RH agonist for 24 months and tamoxifen for 5 years following the postoperative adjuvant chemotherapy, and the status of menstruation recovery was examined. RESULTS: Menstruation resumed in 16 cases (15.2%) after the last LH-RH agonist treatment session. The mean period from the last LH-RH agonist treatment to the recovery of menstruation was 6.9 months. The rate of menstruation recovery was 35.5% in patients aged 40 years or younger and 8.0% in those aged 41 years or older, and it was significantly higher in those aged 40 years or younger. The period until menstruation recovery tended to be longer in older patients at the end of treatment. CONCLUSION: This study showed that menstruation resumed after treatment at higher rates in younger patients. However, because it is highly likely that ovarian function will be destroyed by the treatment even in young patients, it is considered necessary to explain the risk to patients and obtain informed consent before introducing this treatment modality.

[Result and analysis of guidelines to diagnosis and treatment for distending pain in breasts during menstruation in traditional Chinese medicine].

To establish guidelines to diagnosis and treatment for distending pain in breasts during menstruation in traditional Chinese medicine (TCM). With delphi method, survey questionnaires were sent to 40 gynecology experts in TCM and integrated traditional and western medicine, and recovery 35 experts were recoveried which, were analyzed by SPSS 11.5. The experts' activity and professional level was high. The expert's are from all over China and express the typical opinions of all experts in this field. The items in the frame of the guidelines to diagnosis and treatment for distending pain in breasts during menstruation in TCM are generally recognized, but different opinions from the card type, governance, in areas such as prescription standard also exist.