The difficult journey to treatment for women suffering from heavy menstrual bleeding: a multi-national survey.

PURPOSE: Up to 30% of women of reproductive age experience HMB, which has a substantial impact on their quality of life. A clinical care pathway for women with HMB is an unmet need, but its development requires better understanding of the factors that characterise current diagnosis and management of the condition. MATERIALS AND METHODS: This observational, survey-based study assessed the burden, personal experiences, and path through clinical management of women with HMB in Canada, the USA, Brazil, France and Russia using a detailed, semi-structured online questionnaire. After excluding those reporting relevant organic pathology, responses to the questionnaire from 200 women per country were analysed. RESULTS: Around 75% of women with HMB had actively sought information about heavy periods, mostly through internet research. The mean time from first symptoms until seeking help was 2.9 (Standard deviation, 3.1) years. However, 40% of women had not seen a health care professional about the condition. Furthermore, 54% had never been diagnosed or treated. Only 20% had been diagnosed and received appropriate treatment. Treatment was successful in 69% of those patients currently receiving treatment. Oral contraceptives were the treatment most commonly prescribed for HMB, although the highly effective levonorgestrel-intrauterine system was used by only a small proportion of women. CONCLUSIONS: This study provides insight into the typical journey of a woman with HMB which may help patients and health care professionals improve the path to diagnosis and treatment, although further research with long-term outcomes is needed.

Anticoncepción hormonal y COVID-19 / Hormonal contraception and COVID-19

La enfermedad producida por el nuevo coronavirus SARS-CoV-2 se identificó por primera vez en diciembre de 2019 en la ciudad de Wuhan, en la República Popular China, y en pocos meses se convirtió en una pandemia. Desde el comienzo ha sido un desafío mundial, que amenazó la salud pública y obligó a tomar medidas estrictas de aislamiento social. Como consecuencia de la emergencia sanitaria se ha producido una reducción importante de la actividad asistencial, que puso en riesgo el acceso y la continuidad de los métodos anticonceptivos, exponiendo a mujeres a embarazos no intencionales. Los derechos sexuales y reproductivos resultan esenciales y deben garantizarse siempre. (AU)

The disease caused by the new coronavirus SARS-CoV-2 was identified for the first time in December 2019 in the city of Wuhan, in the People's Republic of China, and within a few months it became a pandemic. From the beginning, it has been a global challenge, threatening public health, having to take strict measures of social isolation. As a consequence of the health emergency, there has been a significant reduction in healthcare activity, putting access and continuity of contraceptive methods at risk, exposing women to unintended pregnancies. Sexual and reproductive rights are essential and must always be guaranteed. (AU)

Clinical factors affecting the efficacy of melasma treatment using the Q-switched 1064 Nd: YAG laser mode in a group of Venezuelan female patients.

The influence of melasma risk factors on the effectiveness of laser toning treatment in Venezuelan females was investigated. Clinical evaluation was performed (n = 64) including ultrasound and thyroid hormone profile. All patients underwent face exposure with laser toning, eight sessions weekly. VISIA percentiles corresponding to dark brown spots determined before and after treatment were compared by ANOVA. Differences between percentile values before and after treatment for each patient were calculated and expressed as percentages. An improvement of ≥30% was considered as significant. Spearman rank correlations between improvement and clinical parameters were determined. A significant increase (p > .005) of the median of the percentiles in the overall group was observed. However, only 62.5% of the patients exhibited an improvement of ≥30% at the right malar, 73.4% at the frontal and 71.8% at the left malar areas. Hormonal contraception during treatment (right malar: p < .0001 left malar: p = .0035), thyroid disorders (right malar: p < .0001; frontal: p = .011; left malar: p < .0001) and photoaging (right malar: p = .0235; frontal: p = .0237; left malar: p = .0137) were inversely associated to melasma improvement after treatment. Prolonged use of sunscreen improved significantly (right malar: p < .001; frontal: p = .016 and left malar: p = .025) treatment effectiveness.

Contracepção e desempenho na adolescente atleta / Contraception and performance in teenage athlete

Objetivos: Apresentar os métodos contraceptivos que melhor se adaptam à jovem atleta, correlacionar seus efeitos com possíveis alterações no desempenho atlético ou com os componentes da tríade da atleta (amenorreia, osteoporose e distúrbios alimentares). Método: Foi realizada ampla revisão da literatura, utilizando-se no Medline (PubMed), a estratégia de busca: ("Sports"[Mesh]) AND ("Contraceptive Agents" [Mesh] OR "Contraceptive Agents, Female" [Mesh] AND "Athletic Performance"[Majr])). Foram ainda consultadas as bases: Cochrane Library, SciELO, LILACS e o Google Scholar. Resultados: Somente um de 12 ensaios clínicos para avaliação da relação entre anticoncepção hormonal combinada oral (AHCO) e desempenho atlético sugeriu que o uso do método poderia alterar o desempenho de algumas atletas de elite. O uso contínuo ou estendido da pílula são os preferidos por permitir programar o ciclo menstrual, evitando que sintomas menstruais prejudiquem treinos, competições e viagens, além de prevenir a deficiência de ferro. Conclusões: O AHCO é o método mais usado entre as atletas, sendo o único estudado na literatura para avaliar desempenho atlético. Não foi evidenciada alteração na produção média de energia, composição corporal, frequência cardíaca, pico de captação do oxigênio e glicemia. A escolha do método contraceptivo deve ser sempre individualizada, havendo poucas restrições para adolescentes atletas, permitindo escolha pelo método e regime de administração mais adequado à rotina de vida destas jovens.(AU)

Objective: Introducing the contraceptive methods that are better adapted to the routine and lifestyle of a young athlete and correlate the effects of its use with possible changes in athletic performance or clinical components of the triad (amenorrhea, osteoporosis and eating disorders). Method: An extensive literature review was carried out in national and international digital media. To search in Medline (PubMed), we used the search strategy: (("Sports" [MeSH]) AND ("Contraceptive Agents" [MeSH] OR "Contraceptive Agents, Female" [MeSH] AND "Athletic Performance" [MAJR])). We also consulted SciELO, LILACS and the Google Scholar. Results: Only one study of the 12 clinical trials selected for evaluation of the relationship between oral combined hormonal contraceptives (OCHC) and athletic performance suggested that the use of the method could affect the performance of some elite athletes. The extended-cycle or continuous pill use are mainly preferred for allow programming the menstrual cycle, preventing menstrual symptoms affect training, competitions and travel, and to prevent iron deficiency. Conclusions: The OCHC is the most used method among athletes and it's the only studied in the literature that relates to athletic performance. A change in average production of energy, body composition, heart rate, peak oxygen uptake and glucose was not evidenced. The choice of contraceptive method must be individualized, with few restrictions for teen athletes, allowing the choice of the most appropriate for the routine of life of these young people.(AU)