Enhancing client engagement and alleviating period product insecurity: A cross-sectional study of community-based period supply banks' distribution of free period products through intermediary partner agencies in the United States.

BACKGROUND: Period products like pads, tampons, and a variety of disposable and reusable hygiene supplies constitute just one facet essential for effectively managing menstruation in a way that allows an individual to feel comfortable carrying out their daily routine. Given the absence of comprehensive public policies ensuring access to period products for economically disadvantaged menstruating individuals, community-based basic needs banks, particularly period supply banks, were established to alleviate the challenges faced by those experiencing period product insecurity. These initiatives specifically aim to furnish essential menstrual products to individuals in need. OBJECTIVES: This study aimed to assess any organizational benefits experienced by community-based organizations distributing period products on behalf of period supply banks. DESIGN: This cross-sectional study is a formative evaluation of the distribution of free period products by period supply banks, which provide access to essential menstrual hygiene products for individuals in need through partnership with community-based partner agencies. METHODS: Staff members at agencies distributing period products were invited to complete an anonymous web-based survey at two different time points about their agency's experiences distributing free period products. All participants provided informed consent via the web-based survey. RESULTS: Agency staff reported that since they started providing period products, clients were more likely to: start a conversation about other needs (66.7%), extend the length of their relationship with the agency (60.0%), keep scheduled appointments (62.1%), ask for assistance with another need (75.0%), communicate between visits (42.4%), participate in other agency programming (55.9%), and seek other agency services (73.5%). Due to a shortage of period products, 41% of agencies have had to turn away clients needing period supplies. CONCLUSION: Period supply banks, in collaboration with community-based partner agencies, enhance access to both menstrual products and the associated support, fostering engagement with diverse resources and opportunities among recipients. However, addressing unmet needs necessitates policies and additional funding to ensure universal access to essential hygiene supplies for everyone to thrive and actively participate in society.

Positive benefits for agencies giving away free period products from a period supply bank in the United StatesWhy we did this study: In the United States, many people with periods cannot afford to buy period supplies when needed. When people do not have enough period products, they may have to stay home from places they want to go, like work, school, or community spaces. Period supply banks want to help ensure everyone has period supplies, so that, they take in donations and buy more supplies. Then, period supply banks partner with other agencies that give period supplies for free to individuals experiencing need.What we wanted to learn: We wanted to know if the agencies that give away free period products through partnerships with period supply banks have any benefits from doing so.What we did: We asked people who work at an agency that gives away free period products received through a partnership with a period supply bank to take an online survey at two different times, when the agency began the collaboration with the period supply bank and after distributing period supplies for several months. Only people who wanted to be in the study did the survey.What we learned: Agencies who give away free period products benefit because clients are more likely to talk to them about other needs they have, enroll in a program or receive another resource from the agency, miss fewer appointments, and stay in an agency program longer. Sometimes, agencies do not have enough products for everyone who needs period supplies. More funding and policies are needed to help period supply banks buy enough period products for everyone who needs them.

Curcuminoid-Piperine Combination Improves Radical Scavenging Activity in Women with Premenstrual Syndrome and Dysmenorrhea: A Post-hoc Analysis of a Randomized Clinical Study.

Oxidative stress maybe involved in the patho-etiology of menstrual-associated complications. Curcuminoids, are polyphenolic natural compounds that have potentially important functional activities. This triple-blind, randomized, placebo-controlled trial was performed to investigate the effects of a curcuminoids on oxidative stress and antioxidant capacity in girls with premenstrual syndrome (PMS) and dysmenorrhea. Eighty young girls with both PMS and dysmenorrhea were randomly given either curcuminoids (500 mg+5 mg piperine) or a placebo daily, for a period from 7 days pre- until 3 days post- initiation of menstrual bleeding for 3 successive menstrual cycles. The total antioxidant capacity and free radical scavenging activity of serum and urine were quantified via ferric reducing/antioxidant power (FRAP) and 1,1-diphenyl-2-picrylhydrazyl (DPPH) methods, respectively. There were no significant differences between the placebo and curcumin groups, with respect to the age, dietary intake and biochemical/anthropometric indices (p>0.05). The curcumin treatment significantly increased the free-radical scavenging activity of serum compared to the treatment with placebo (p=0.031). Although, no significant changes were found in serum and urinary levels of FRAP, DPPH and MDA between the groups (p>0.05). Curcumin treatment did increase free-radical scavenging activity and antioxidant potential in girls with PMS and dysmenorrhea. Investigations with higher doses and duration of curcumin are required to verify our findings.

A pharmacist's role in increasing access to menstrual products: an education and advocacy approach.

Individuals who menstruate grapple with diverse challenges in menstrual and reproductive health. This includes financial burdens, societal stigmas, and negative mental and physical health implications. Period poverty, marked by insufficient access to menstrual products, education, and sanitation, remains a prevalent and poorly addressed issue. Alarming statistics highlight the extent of this problem and shed light on the staggering number of individuals lacking access to essential menstrual products. The discourse extends to the safety and accessibility of a diverse array of menstrual products. A comprehensive comparison of the cost of available period products was conducted using data obtained from various retail websites. The often-overlooked potential indirect expenses and profound impacts on quality of life were also discussed. Amidst other public health initiatives, pharmacists have emerged as pivotal advocates and educators. Pharmacists are poised to drive initiatives that increase access to menstrual products through public health education and advocacy. By providing education on different menstrual product options, pharmacists can empower individuals to make informed decisions based on their needs. This perspective illuminates the complex impacts of menstruation on individuals and proposes that pharmacists can play a role in overcoming barriers to access. The proposed strategies, rooted in education, research, and advocacy, pave the way for enhancing access, reducing stigma, and elevating the quality of life for those navigating the intricate complexities of menstruation.

The association of COVID-19 vaccination and menstrual health: A period-tracking app-based cohort study.

Background: In initial COVID-19 clinical trials, menstrual health was not formally monitored, yet anecdotal reports of menstruation changes surfaced on social media. This study aims to assess the association between COVID-19 vaccines and menstruation using Clue, a period-tracking application. Study design: A survey assessing demographics, menstrual health, stress levels, and COVID-19 vaccination was sent to Clue users between 12/7/2021 and 2/9/2022. Inclusion criteria were (1) 18 years or older (2) currently menstruating (3) not pregnant or breastfeeding since 1/2020. Menstrual data was collected for each participant. Users with cycle lengths more than 90 days were excluded. Cycle lengths were calculated for the 6-month average pre-vaccination (PRIOR), the cycle during which vaccination was administered (DURING), the cycle following DURING (AFTER1), and the cycle following AFTER1 (AFTER2). For periods, individuals were stratified based on whether vaccination was received during their menstrual period (DURING). Period lengths were additionally calculated for the 6-month average pre-vaccination (PRIOR), the first period following vaccination (AFTER1), and the period following AFTER1 (AFTER2). For unvaccinated participants, an index date (4/1/2022) was used to similarly designate menstrual cycles and periods. For each participant, cycle length changes for DURING, AFTER1, and AFTER2 compared to PRIOR were determined. Student's t-test compared the mean of these changes between vaccinated and unvaccinated groups. Results: Of 7,559 participants, 6,897 (91 %) were vaccinated. Compared to PRIOR, individuals vaccinated during their menstrual period demonstrated a statistically significant increase in the DURING period length, but not AFTER1 (p = 0.463) and AFTER2 (p = 0.692). No statistically significant changes were observed in period lengths of those vaccinated in between periods or in cycle lengths overall. Conclusion: A small but statistically significant change in period length was observed only in individuals vaccinated for COVID-19 during their menstrual period. Providers can better counsel menstruating individuals to reduce vaccine misinformation.

Preliminary investigation into long-term stress by isolated captivity-related changes of reproduction hormones in Cynomolgus monkey.

BACKGROUND: Stress profoundly affects physical and emotional well-being, extending its physiological influence to the female menstrual cycle, impeding the hypothalamus-pituitary-gonadal (HPG) axis, and affecting fertility by suppressing sex-stimulating hormones. METHODS: In this study, we meticulously analyzed menstrual cycles and corresponding hormonal fluctuations in three female Cynomolgus monkeys. RESULTS: The preliminary findings indicated lower-than-normal levels of cortisol, follicle-stimulating hormone (FSH), and estradiol. Anovulatory bleeding occurred in one monkey, which could be linked to stress. In contrast to cortisol, alkaline phosphatase (ALP), which is correlated to cortisol levels, was consistently elevated in menstruating monkeys, suggesting its potential as a stress indicator. The non-menstruating group exhibited stress-related weight loss, emphasizing the observed ALP trends. CONCLUSIONS: Non-menstruating monkeys may experience more stress than menstruating monkeys. The implications of this study extend beyond the confines of primate studies and offer a valuable method for enhancing the welfare of female Cynomolgus monkeys.

Müllerian anomalies and endometriosis as potential explanatory models for the retrograde menstruation/implantation and the embryonic remnants/celomic metaplasia pathogenic theories: a systematic review and meta-analysis.

STUDY QUESTION: Does endometriosis prevalence differ in patients with obstructive Müllerian anomalies (OMA) versus those with nonobstructive Müllerian anomalies (NOMA), and in patients with NOMA versus those without Müllerian anomalies? SUMMARY ANSWER: The quantitative synthesis of published data demonstrates a substantially increased prevalence of endometriosis in patients with OMA compared with those with NOMA, and a similar prevalence in patients with NOMA and those without Müllerian anomalies. WHAT IS KNOWN ALREADY: The pathogenesis of endometriosis has not been definitively clarified yet. A higher prevalence of endometriosis in patients with OMA than in those with NOMA would support the retrograde menstruation (RM)/implantation theory, whereas a higher prevalence of endometriosis in the NOMA group than in the group without Müllerian anomalies would support the embryonic remnants/celomic metaplasia hypothesis. STUDY DESIGN, SIZE, DURATION: This systematic review with meta-analysis was restricted to full-length, English-language articles published in peer-reviewed journals between 1980 and 2023. The PubMed and EMBASE databases were searched using the keyword 'endometriosis' in combination with 'Müllerian anomalies', 'obstructive Müllerian anomalies', 'female genital malformations', 'retrograde menstruation', 'infertility', 'pelvic pain', and 'classification'. References from relevant publications were screened, and PubMed's 'similar articles' and 'cited by' functions were used. PARTICIPANTS/MATERIALS, SETTING, METHODS: Studies were selected if they reported the prevalence of surgically confirmed endometriosis in either individuals with OMA compared to those with NOMA, or patients with NOMA compared to those without Müllerian anomalies. Cohort and case-control studies and case series were deemed eligible for inclusion. Noncomparative studies, studies not reporting both the number of individuals with endometriosis and the total number of those with Müllerian anomalies or with other gynecological conditions, those including exclusively data on patients with absent or uncertain menstrual function (e.g. complete Müllerian agenesis category), or with imperforate hymen were excluded. Two reviewers independently abstracted data. The risk of bias was assessed with the Risk of Bias In Non-randomized Studies of Exposures tool. The overall certainty of the evidence was graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. MAIN RESULTS AND THE ROLE OF CHANCE: Seven retrospective studies were included. The overall mean estimate of endometriosis prevalence was 47% (95% CI, 36-58%) in patients with OMA, and 19% (95% CI, 15-24%) in patients with NOMA, with a common odds ratio (OR) of 4.72 (95% CI, 2.54-8.77). The overall mean estimate of endometriosis prevalence in patients with NOMA was 23% (95% CI, 20-27%), and that in patients without Müllerian anomalies was 21% (95% CI, 20-22%), with a common OR of 0.95 (95% CI, 0.57-1.58). The overall certainty of the evidence according to GRADE guidelines was judged as low for both comparisons. LIMITATIONS, REASON FOR CAUTION: Some NOMA subtypes may create a partial obstacle to menstrual efflux and/or generate dysfunctional myometrial contractions that favor transtubal reflux, thus increasing the risk of endometriosis and limiting the difference between OMA and NOMA. As infertility and pelvic pain are strongly associated with endometriosis, women with these symptoms are inappropriate controls. Confounding by indication could explain the lack of difference in endometriosis prevalence between patients with NOMA and those without Müllerian anomalies. WIDER IMPLICATIONS OF THE FINDINGS: The results of this meta-analysis support the validity of the RM theory but do not definitively rule out alternative hypotheses. Thus, RM may be considered the initiator for the development of endometriotic lesions, while not excluding the contribution of both inheritable and tissue-specific genetic and epigenetic modifications as disease-promoting factors. STUDY FUNDING/COMPETING INTEREST(S): No funding was received for this review. P.Ve. is a member of the Editorial Board of Human Reproduction Open, the Journal of Obstetrics and Gynaecology Canada, and the International Editorial Board of Acta Obstetricia et Gynecologica Scandinavica; has received royalties from Wolters Kluwer for chapters on endometriosis management in the clinical decision support resource UpToDate; and maintains both a public and private gynecological practice. E.S. discloses payments from Ferring for research grants and honoraria from Merck-Serono for lectures. All other authors declare they have no conflict of interest. REGISTRATION NUMBER: N/A.

Deciphering the Pharmacological Mechanisms of Wen-Jing-Zhi-Tong Decoction in Treating Primary Dysmenorrhea by UPLC-Q-ExactiveOrbitrap-MS/MS with GC-MS and Network Pharmacology.

BACKGROUND: Primary dysmenorrhea (PDM) is a prevalent menstrual disorder among women, often underreported and undertreated. Wen-Jing-Zhi-Tong Decoction (WJZTD), a patented Traditional Chinese Medicine (TCM) herbal decoction, has shown efficacy in treating PDM. However, the underlying therapeutic mechanism of WJZTD in PDM treatment remains to be elucidated. OBJECTIVE: This study aimed to employ integrative pharmacology and experimental validation to investigate the potential therapeutic mechanisms of WJZTD in treating PDM. METHODS: The bioactive compounds of WJZTD were identified by UPLC-Q-Exactive-Orbitrap MS/MS and GC-MS. Putative targets of WJZTD were obtained from Swiss Target Prediction, STITCH, and BATMAN-TCM databases. Known targets of PDM were retrieved from Gene Cards and Drug Bank databases. Protein-to-protein interactions were constructed to screen key targets using the STRING database. Subsequently, GO and KEGG pathway enrichment analyses were performed based on Metascape. Finally, a PDM rat model was established to validate the potential therapeutic mechanisms of WJZTD using Western Blot, PCR, and ELISA. RESULTS: 390 bioactive compounds in WJZTD were identified through UPLC-Q-ExactiveOrbitrap MS/MS and GC-MS. Network pharmacology revealed 7 key compounds with 20 targets and pathways that are crucial for WJZTD in treating PDM. Behavioral tests confirmed that WJZTD can effectively ameliorate menstrual pain in PDM. WJZTD also inhibited prostaglandin production, thereby relieving uterine smooth muscle contraction. The downregulation of the BDNF/TrkB/ERK/CREB signaling pathway, identified as the key target and pathway through network pharmacology, may be crucial to the anti-nociceptive and anti-inflammatory effects of WJZTD in treating PDM. CONCLUSION: This study provides the first comprehensive analysis of the key compounds, targets, and pathways of WJZTD, laying a solid foundation for future pharmacological studies on PDM. The anti-nociceptive and anti-inflammatory effect may be attributed to the downregulation of the BDNF/TrkB/ERK/CREB signaling pathway.

Assessing the impact of lubricant on liquid-based Pap smear test outcomes: a randomized clinical trial.

Background: Since today cervical cancers are growing, there is an increasing need to use screening and examination methods. Meanwhile, liquid-based Pap smear test is a common screening method for women, which is widely applied today. Studies have found that use of lubricant gel in this test can affect the pathology and cytology results. Accordingly, the authors intended to evaluate the effect of use of lubricant gel on the Pap smear test results. Methods: This study was of single-blind clinical trial, the study population consisted of candidate patients for screening in terms of cervical pathology, for whom liquid-based Pap smear was done. In this study, 506 patients participated, divided into two groups of 253. One group used lubricant gel during the Pap smear, while the other group underwent this test without lubricant. The data were analyzed by SPSS 21. Results: The study results indicated that once the two groups were compared in terms of age, interval of menstruation time and intercourse time from the sampling, no significant relationship was found between the two groups (P>0.05). It was also found that use of lubricant did not affect the cytology and pathology results of patients (P>0.05). Conclusion: The use of lubricant gel in patients can reduce pain in patients during examination and testing, but does not affect the cytological and pathological results of patients.

Intrauterine Device Migration: A Diagnostic and Management Dilemma.

Intrauterine devices (IUDs) are an effective method of contraception, with failure rates comparable to sterilization. In rare cases, IUDs can migrate to other sites, including the bladder, cecum, and fallopian tubes. This case reports a 44-year-old woman who was misdiagnosed with a urachal cyst due to the migration of her IUD into the anterior abdominal wall. A laparoscopic retrieval was successfully performed. To prevent any further serious complications, it is imperative to promptly diagnose and manage migrated IUDs.

Menstrual hygiene management and menstrual problems among adolescent girls in an urban area in north India: A cross-sectional study.

Introduction: Most adolescent women face many restrictions, which become much more severe during menstruation. In India, millions of adolescent girls drop out of school every year due to menstruation-related problems and restrictions. Despite extensive research, a paucity of literature was observed on the level of knowledge, attitude, and practices of adolescent girls regarding menstruation. Hence, we proceeded to undertake the present study, to have a deeper understanding of the menstrual hygiene management of adolescents. Aims: To describe the menstrual hygiene management among adolescent school girls. Objectives: (a) To examine the association, if any, between menstrual hygiene management and school absenteeism during menstruation in adolescent school girls. Materials And Methods: We conducted a school-based cross-sectional analytical study in an urban area in north India. The study population comprised adolescent school girls of all the high schools in the urban area. With a 95% confidence interval, and 5% margin of error, the sample size was calculated to be 369. However, an even larger sample size of 600 was actually studied. The probability proportional to size sampling approach was followed based on the number of adolescent girls in each school class/section. Participants were selected through a stratified proportionate sampling method. Ethical approval was obtained from the ethical committee of the district director of education of the urban area where the study was conducted before the commencement of the study. Confidentiality of the information collected was ensured. The data collected was quantitative in nature, using a pretested self-administered questionnaire consisting of both open-ended and close-ended questions. Data was checked for its completeness, coded, and entered into Microsoft Excel 2021 Spreadsheet. Subsequently, the data was imported into IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. for data analysis. Standard statistical methods were utilized for data analysis. Results: The mean age (standard deviation [SD]) of the study participants was 13.68 (1.29). The mean age (SD) at menarche was 13.29 (0.96). Based on the overall menstrual hygiene management score, 377 (62.83%) of the study participants were engaged in good menstrual hygiene management, while 223 (37.17%) were engaged in poor menstrual hygiene management. The mean score (SD) was 7.80 (±0.43). Compared to those aged 17-19 years, those aged 10-13 years had a 0.36 (95% CI 0.17-0.75) decreased odds of good menstrual hygiene, while those aged 14-16 years had a 0.29 (95% CI 0.14-0.59) decreased odds of good menstrual hygiene. The adjusted odds ratios were 0.32 (95% CI 0.19-0.65) and 0.25 (95% CI 0.12-0.41) respectively. Out of 600 study participants, 229 (38.17%) reported school absenteeism at least once in the last 1 year because of menstruation. The mean (standard deviation) duration of school absenteeism was 2.4 (0.78) days per menstrual cycle. The commonest reason for menstruation-related school absenteeism was pain, wherein 105 (45.85%) study participants reported this reason. Conclusion: In our study, we observed that over two-thirds of the study participants were engaged in good menstrual hygiene practices, while ~40% of them reported menstrual-related school absenteeism. Our study also found evidence that the age of the school girls was associated with their menstrual hygiene management practices. We recommend further research on the impact of menstruation and its management on the academic performance of adolescent school girls. Efforts are also required to develop the capacity of teachers to teach menstrual hygiene education.

Degendering Menstruation: A Scoping Review Exploring the Experiences of Transgender and Non-Binary People.

Menstruation is a biological process experienced by up to 800 million people on any given day. Historically, menstruation has been studied from the female perspective. However, it should be considered that not all who menstruate are women. Therefore, the purpose of this research was to determine the status of evidence on transgender and non-binary individuals' experiences with menstruation. Arksey and O'Malley's (2005) framework for conducting a scoping study was used to guide this review. The authors used five steps of the six-step process to identify the research problem and search strategy, select studies based on defined inclusion and exclusion criteria, extract key information from five selected studies, and chart, summarize, and report the results as themes. The analysis resulted in the identification of four themes: (1) gender dysphoria and the influence on identity; (2) menstrual management and transformation as a turning point; (3) managing menstruation in precarious spaces; and (4) moving toward an open dialogue. Findings suggest a need for awareness of diverse and inclusive menstrual experiences. Inclusive advertising and menstrual products are needed to support transgender and non-binary people and reduce gender dysphoria. Policy initiatives should support the reconceptualization of infrastructure so that bathrooms are safe and comfortable places. Future opportunities for research exploring menstrual management within transgender and non-binary populations with emphasis on global research with diverse cultures and social structures is necessary to address gaps in the existing literature.

How autistic women are aware of their body and take care of their health? Focus on menstruation cycles and gynecological care.

Objective: The combination of femininity and inequality is an increasingly studied in the field of social medicine, even more if the girls or women in question experience conditions of disability or neurodivergence. The onset of menstruation, menarche, constitutes a significant and transformative event in women's lives comprising a true and proper watershed in mental and reproductive health and sexual welfare. The onset of menstruation has a profound effect not just for girls but, in the case of disabled girls, for the whole family. In this scoping review, we have researched the literature in studies which consider the issue of menstruation and autism. The works in scientific literature have been selected which, in the last 5 years, investigated the issue of menstrua-tion for autistic girls and/or women. Results: Selected studies, although few in number, have all equally evidenced the total lack of in-depth understanding of this theme, notwithstanding the fact that females, girls and women with autism would benefit from specialized services if these existed. Families, girls and women involved, moreover, although not experiencing menstruation per se in a negative light, note a deterioration in their condition particularly in respect of sensorial perception and the intensification of anxious depressive instances. This work highlights the need to deepen the aspects concerning the period in autistic girls/women, up to now the question appears to have been little studied, investigated in an uneven way. We propose a social medical program to improve sexual-affective knowledge and body awareness in autistic people.

Implementing menstrual cycle tracking: A pilot concept mapping study investigating considerations of coaches, support staff, and female athletes.

OBJECTIVES: To identify what coaches, support staff, and athletes believe should be considered when implementing menstrual cycle tracking in sport. DESIGN: Concept mapping (mixed-methods participatory approach). METHODS: Participants brainstormed statements in response to the focus prompt "What should be considered when tracking menstrual cycles in sport?" Participants then sorted the statements into groups according to meaning and rated each statement on its importance and feasibility to address. RESULTS: Twenty-six participants (12 athletes and 14 coaches/support staff) generated 53 ideas that the research team synthesised to 57 unique statements. Sixteen participants sorted the statements into an average of 8 (±4) groups. Six clusters were identified as the most appropriate representation of the sorting data following multidimensional scaling and hierarchical cluster analysis: 1) Ethics, 2) Tracking Tools and Methods, 3) Performance and Health, 4) Education, 5) Interpretation and Framing and 6) Communication. Participants rated each statement based on their importance (n = 12) and feasibility (n = 10), respectively. The most important (mean = 3.88 out of 5) and feasible (mean = 3.85 out of 5) cluster was Ethics, whilst the least important (mean = 3.17) and feasible (mean = 3.04) was Communication. CONCLUSIONS: Ethical considerations pertaining to privacy, consent, and scope of practice should be prioritised when tracking menstrual cycles in sport. A low burden method of tracking, which allows for some individualisation based on athletes' preferences or needs, and menstrual health education should also be undertaken to improve the uptake and impact of menstrual cycle tracking.

Determinants of premenstrual dysphoric disorder and associated factors among regular undergraduate students at Hawassa University Southern, Ethiopia, 2023: institution-based cross-sectional study.

BACKGROUND: Premenstrual dysphoric disorder (PMDD) is a condition causing severe emotional, physical, and behavioral symptoms before menstruation. It greatly hinders daily activities, affecting academic and interpersonal relationships. Attention is not given to premenstrual disorders among female students in higher education. As a result, students are susceptible to stress, and their academic success is influenced by various factors, including their menstrual cycle, and the long-term outcomes and consequences are poorly researched. Even though PMDD has a significant negative impact on student's academic achievement and success limited research has been conducted in low- and middle-income countries including Ethiopia, especially in the study setting. Therefore, a study is needed to assess premenstrual dysphoric disorder and associated factors among regular undergraduate students at Hawassa University. METHODS: An institutional-based cross-sectional study was conducted among 374 regular undergraduate female students at Hawassa University, College of Medicine and Health Sciences. A self-administered structured premenstrual symptoms screening tool for adolescents was used to assess premenstrual dysphoric disorder. The collected data were loaded into a statistical package for the social science version 25 and analyzed using it. Both bivariate and multivariate logistic regression were used to identify factors associated with premenstrual dysphoric disorder. Each independent variable was entered separately into bivariate analysis, and a variable with a p-value less than 0.25 were included in the multivariate analysis to adjust the possible confounders. Statistically significant was declared at a 95% confidence interval when variable with a p-value less than 0.05 in the multivariate analysis with premenstrual dysphoric disorder. RESULTS: The magnitude of premenstrual dysphoric disorder in this study was 62.6% (95% CI 57.4-67.5). Having severe premenstrual pain (AOR = 6.44;95%CI 1.02-40.73), having irregular menstrual cycle (AOR = 2.21; 95% CI 1.32-3.70), students who had poor social support (AOR = 5.10;95%CI, (2.76-12.92) and moderate social support (AOR = 4.93;95%CI (2.18-11.18), and students who used contraception (AOR = 3.76;95%CI, 2.21-6,40) were statistically significant factors with the outcome variable. CONCLUSION: The prevalence of premenstrual dysphoric disorder was high as compared to other studies. There was a strong link between irregular menstrual cycle, severe menstrual pain (severe dysmenorrhea), poor social support, and contraception use with premenstrual dysphoric disorder. This needs early screening and intervention to prevent the complications and worsening of the symptoms that affect students' academic performance by the institution.

Association of heavy menstrual bleeding with cardiovascular disease in US female hospitalizations.

BACKGROUND: Heavy menstrual bleeding (HMB) is a common menstrual disorder associated with multiple risk factors of cardiovascular disease (CVD) in women. In addition, HMB is often present with irregular menstruation (IM) which is a risk factor for CVD outcomes. However, the relationship between HMB and CVD outcomes is unexplored in the presence or absence of IM. We determined the association of HMB with multiple CVD outcomes using a nationally representative sample of female hospitalizations in the US. METHODS: All hospitalizations of females with HMB diagnosis and normal menstrual cycles from ages of 18 to 70 years were extracted from the National Inpatient Sample Database, 2017. The HMB was defined using the International Classification of Diseases (ICD)-10 for excessive and frequent menstruation bleeding and included any current or history of HMB diagnosis. Outcomes including major adverse cardiovascular events (MACE), coronary heart disease (CHD), stroke, heart failure (HF), atrial fibrillation (AF) or arrhythmia, myocardial infarction (MI), and diabetes (DM) were defined using ICD-10 codes. Adjusted logistic regression and prosperity scores-matched logistic regression analyses were conducted to summarize adjusted associations with an odds ratio (OR) and a 95% confidence interval (CI). RESULTS: Among 2,430,851 hospitalizations, HMB was observed in 7762 (0.68%) females with age ≤ 40 years and 11,164 (0.86%) females with age > 40 years. Among hospitalizations with age ≤ 40 years, HMB was significantly associated with increased odds of CVD outcomes including MACE (OR = 1.61; 95% CI: 1.25, 2.08), CHD (OR = 1.72; 95% CI: 1.10, 2.71), stroke (OR = 1.95; 95% CI: 1.12, 3.40), HF (OR = 1.53; 95% CI: 1.15, 2.03), and AF/arrhythmia (OR = 1.84; 95% CI: 1.34, 2.54). These associations were confirmed in multiple sensitivity analyses. In contrast, HMB was not robustly associated with CVD events among hospitalizations of women with age > 40 years. HMB without IM was strongly associated with DM, HF, AF, and MACE outcomes while HMB with IM was strongly associated with CHD and AF outcomes in hospitalizations of young women. CONCLUSIONS: HMB is associated with CVD events among US hospitalizations of young women. A routine investigation and screening of menstrual disorders, especially HMB, is useful for CVD risk stratification and management in young women.

Is Neonatal Uterine Bleeding Involved in Early-Onset Endometriosis?

BACKGROUND: There has been considerable progress in our understanding of endometriosis, but its pathophysiology remains uncertain. Uncovering the underlying mechanism of the rare instances of endometriosis reported in early postmenarcheal years and in girls before menarche can have wide implications. METHODS: We conducted a literature review of all relevant articles on Medline. RESULTS: In the review, we explore the pathogenetic theories of premenarcheal endometriosis, the role of retrograde menstruation in the adult and its potential role in early-onset disease, as well as the factors that argue against the existence of a link between early-onset endometriosis (EOE) and neonatal uterine bleeding (NUB). CONCLUSIONS: As with endometriosis in adult women, the pathogenesis of early-onset disease remains unclear. A link between NUB and EOE is plausible, but there are considerable challenges to collating supporting evidence. The state of our understanding of early uterine development and of the pathophysiology of NUB leaves many unknowns that need exploration. These include proof of the existence of viable endometrial cells or endometrial mesenchymal stem cells in NUB, their passage to the pelvic cavity, their possible response to steroids, and whether they can reside within the pelvic cavity and remain dormant till menarche.

Hypoxia and the endometrium: An indispensable role for HIF-1α as therapeutic strategies.

Hypoxia-inducible factor 1 alpha (HIF-1α) is a major molecular mediator of the hypoxic response. In the endometrium, local hypoxic conditions induced by hormonal fluctuations and endometrial vascular remodeling contribute to the production of HIF-1α, which plays an indispensable role in a series of physiological activities, such as menstruation and metamorphosis. The sensitive regulation of HIF-1α maintains the cellular viability and regenerative capacity of the endometrium against cellular stresses induced by hypoxia and excess reactive oxygen species. In contrast, abnormal HIF-1α levels exacerbate the development of various endometrial pathologies. This knowledge opens important possibilities for the development of promising HIF-1α-centered strategies to ameliorate endometrial disease. Nonetheless, additional efforts are required to elucidate the regulatory network of endometrial HIF-1α and promote the applications of HIF-1α-centered strategies in the human endometrium. Here, we summarize the role of the HIF-1α-mediated pathway in endometrial physiology and pathology, highlight the latest HIF-1α-centered strategies for treating endometrial diseases, and improve endometrial receptivity.

Kisspeptin expression during menstruation in PCOS patients undergoing ovulation induction and the correlation with early pregnancy.

PURPOSE: To examine the pattern of kisspeptin expression throughout the menstrual cycle in polycystic ovary syndrome (PCOS) patients under the ovulation induction and identify any possible associations with early pregnancy. MATERIALS AND METHODS: A prospective cohort of 80 PCOS women who expressed the desire for fertility was enrolled in this study. All of them received the ovulation induction by using letrozole. Levels of kisspeptin, luteinizing hormone (LH), and estradiol (E2) were measured at three different time points during menstruation. The early pregnancy rate was recorded for the study participants after three ovulation cycles. RESULTS: Kisspeptin levels varied regularly during the menstrual cycle, reaching a peak on the day of hCG injection and decreasing after ovulation. There was no significant correlation between kisspeptin and LH levels. Basal kisspeptin levels decreased after letrozole treatment without a significant difference while LH and E2 levels decreased significantly. PCOS participants who became pregnant early had higher basal kisspeptin levels compared to non-pregnant PCOS patients, which had a significant difference (P = 0.006). And the average basal kisspeptin level in pregnant patients was 2293.0 ± 398.7 pg/ml, with a 95% confidence interval of 1511.5-3074.5 pg/ml. CONCLUSION: Kisspeptin levels in PCOS women undergoing ovulation induction showed a regular variation, which was similar with the healthy women reported in previous studies. The use of LE may result in PCOS endocrine improvement and fertility achievement. In a certain range, kisspeptin might be a potential predictor for early pregnancy in PCOS patients as people with slightly higher basal kisspeptin levels seemed more likely to be pregnant.

Comparing Pilates and Gym Ball Exercises for Primary Dysmenorrhea Management: An Empirical Study.

BACKGROUND: Primary dysmenorrhea, commonly known as menstrual cramps, is a prevalent gynecological issue that impacts many women in their childbearing age. It manifests as reoccurring, cramp-like lower abdominal pain, usually commencing right prior to or during the menstrual period. These painful sensations can be severe, extending to the lower back and upper thighs can greatly disrupt a woman's daily life and overall well-being. The optimal exercise approach is needed for individuals seeking relief from primary dysmenorrhea, allowing healthcare providers and women themselves to make informed decisions regarding their treatment options. Though many forms of exercise interventions exist in the treatment of primary dysmenorrhea, this study aims to compare two forms of intervention namely pilates and gym ball exercises on pain and menstrual distress among women with Primary Dysmenorrhea. METHODS: This experimental comparative study was carried out with 30 young female participants over a 12-week period. Participant recruitment was done through a simple random sampling method. The criteria of inclusion encompassed young females aged 17-25 years, those in good health, and those experiencing primary dysmenorrhea. Exclusion criteria included secondary dysmenorrhea, medication use, polycystic ovarian syndrome, bleeding disorders, positive pregnancy tests, breastfeeding, and other medical conditions. Group A received Pilates exercises, while Group B underwent Gym ball exercises. The assessment of both groups' menstrual distress levels was conducted using the Moos Menstrual Distress Questionnaire (MDQ) and pain scores using the Visual Analog Scale (VAS). RESULT: In the statistical analysis, Group A (Pilates Exercises) showed a significantly lower mean value (2.60) on the VAS compared to Group B (Swiss Ball Exercises) (5.46), with both groups experiencing a notable reduction in post-test scores (p ≤ 0.001). Additionally, on the MOOS MDQ score, Group A (Pilates Exercises) achieved a lower mean value (79.33) compared to Group B (Swiss Ball Exercises) (103.26), with both groups demonstrating a significant decrease in post-test scores (p ≤ 0.001). CONCLUSION: In conclusion, this study underscores the significance of exercise therapy, particularly Pilates exercises, as a holistic approach to addressing primary dysmenorrhea, improving physical well-being, and enhancing the overall quality of life.

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.