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Shoupe D. The progestin revolution 2: progestins are now a dominant player in the tight interlink between contraceptive protection and bleeding control-plus more. Contracept Reprod Med 2023; 8:48. [PMID: 37814343 PMCID: PMC10561399 DOI: 10.1186/s40834-023-00249-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
The interlink between bleeding control and contraceptive development has always been an important factor. But after many years of advances in contraceptive technology, this interplay has resulted in development of safer and better contraceptive methods that often offer significantly less bleeding for women with both normal bleeding patterns as well as in those suffering from heavy menstrual bleeding (HMB). Recognition of the success of progestin-only methods, such as the hormonal IUDs, progestin dominant oral contraceptives, and the high dose progestin-only pill in substantially decreasing and controlling menstrual bleeding has led the way. This recognition also led to the development of many [non-contraceptive] protocols to stop acute heavy bleeding as well as manage long-term bleeding [using contraceptive methods as well; as non-contraceptive methods].But even better, there is a new PLUS. The distinct benefit and risk profiles of the many different progestins now available are intentionally being used either in combination contraceptive pills [COCPs] or alone, to add additional benefits, to decrease side effects and risks, and increase effectiveness and bleeding control.
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Affiliation(s)
- Donna Shoupe
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Abstract
This study aimed to evaluate the proportion of contraception users among Lebanese youth, and the extent of knowledge and perception on birth control; and to raise awareness and sensitise young adults to sexual health, which remains taboo in Lebanon. The 30-item questionnaire was broadcasted to students in private and public universities in Lebanon, through social media and it collected information on contraception use and student knowledge. Over 30% of responders were medical students, and 41% have ever used contraceptives (mostly women); among which, 52.1% for contraception versus 47.9% for medical reasons. According to responders, the pill ranked high in terms of effectiveness (72.4% of responders perceive the pill as effective), followed by the male condom (69.1%) and the hormonal intrauterine device (29.6%). Some would not use contraception in the future, for religious reasons (30.8%) or for fear of complications (46.2%); indeed, around a third of contraceptive users (all female) have experienced adverse effects. Finally, students expressed concern about long-term complications of contraceptive use (pulmonary embolism/phlebitis, breast/endometrial/ovarian cancer, stroke, depression and myocardial infarction). Though less frequent than in the Western world, contraception use in Lebanon is non-negligible and gaps in university students' knowledge on contraception were identified; which should prompt sexual education and family planning initiatives in Lebanon.
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Vila Rabell M, Barri Soldevila P. Papel de la histerectomía en el sangrado uterino anormal. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2023. [DOI: 10.1016/j.gine.2022.100815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Zhou H, Lai KF, Xiang Q, Xu Y, Zhang QW, Hu C, Mao XG, Chen C, Huang W, Mi GS, Shen J, Tian Y, Ke FM. Oncological Safety of Diagnostic Hysteroscopy for Apparent Early-Stage Type II Endometrial Cancer: A Multicenter Retrospective Cohort Study. Front Oncol 2022; 12:918693. [PMID: 35814398 PMCID: PMC9259840 DOI: 10.3389/fonc.2022.918693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo study the oncological safety of diagnostic hysteroscopy for women with apparent early-stage type II endometrial cancer.Patients and MethodsA total of 429 women with presumed early-stage type II endometrial cancer were included. The 5-year disease-free survival (DFS) and overall survival (OS) were estimated and compared using the Kaplan-Meier method and the log-rank test among patients diagnosed by Dilation & Curettage (D&C) or diagnostic hysteroscopy. The Cox proportional hazards regression model was employed to adjust for potential confounding factors.Results160 cases underwent D&C and 269 cases were diagnosed by diagnostic hysteroscopy. The 5-year DFS rate was 72.17% in the diagnostic hysteroscopy group and 76.16% in the D&C group, diagnostic hysteroscopy was not associated with deteriorated 5-year DFS rate (HR 1.25, 95% CI 0.84-1.86, P=0.281). The 5-year OS rate was 67.23% in the diagnostic hysteroscopy group and 70.71% in the D&C group, diagnostic hysteroscopy did not increase the risk of all-cause death (HR 1.11, 95% CI 0.78-1.57, P=0.573). Multivariable analysis showed that the method of endometrial sampling was not independently associated with DFS (aHR 1.38, 95% CI 0.92-2.07, P=0.122) and OS (aHR 1.23, 95% CI 0.85-1.77, P=0.272).ConclusionFor apparent early-stage type II endometrial cancer, endometrial sampling by diagnostic hysteroscopy was as safe as D&C.
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Affiliation(s)
- Hui Zhou
- Department of Obstetrics and Gynecology, 363 Hospital, Chengdu, China
- Department of Obstetrics and Gynecology, Chengdu 363 Hospital Affiliated of Southwest Medical University, Chengdu, China
- *Correspondence: Hui Zhou,
| | - Kai-Fa Lai
- Department of Obstetrics and Gynecology, 363 Hospital, Chengdu, China
- Department of Obstetrics and Gynecology, Chengdu 363 Hospital Affiliated of Southwest Medical University, Chengdu, China
| | - Qian Xiang
- Department of Obstetrics and Gynecology, 363 Hospital, Chengdu, China
- Department of Obstetrics and Gynecology, Chengdu 363 Hospital Affiliated of Southwest Medical University, Chengdu, China
| | - Yu Xu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Qian-Wen Zhang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Cui Hu
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xi-Guang Mao
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Cheng Chen
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Wu Huang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Gong-Sheng Mi
- Department of Obstetrics and Gynecology, Mianyang Central Hospital, Mianyang, China
| | - Juan Shen
- Department of Obstetrics and Gynecology, Mianyang Central Hospital, Mianyang, China
| | - Yong Tian
- Department of Obstetrics and Gynecology, Enshi Clinical College of Wuhan University, Enshi, China
| | - Feng-Mei Ke
- Department of Obstetrics and Gynecology, Enshi Clinical College of Wuhan University, Enshi, China
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Factors Influencing on Pain in Patients Undergoing Pipelle Endometrial Biopsy for Abnormal Uterine Bleeding: Why a Personalized Approach Should Be Applied? J Pers Med 2022; 12:jpm12030431. [PMID: 35330431 PMCID: PMC8950507 DOI: 10.3390/jpm12030431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 12/10/2022] Open
Abstract
Objectives. Abnormal uterine bleeding (AUB) is a common complaint of women in different age groups, and endometrial biopsy is widely used to investigate the underlying causes. The aim of this observational study was to assess factors influencing pain in patients undergoing endometrial biopsy for AUB. Methods. Pain intensity before, during, and after Pipelle sampling was evaluated using the numerical rating scale (NRS), where “0” represents no pain at all, “10”—the worst pain ever possible. Pain rating was categorized as 1−6—mild to moderate, 7 and above as severe pain. Results. The study included 160 women who underwent Pipelle biopsy. The median age in the cohort was 42 (34−48) years, 18.1% of women were postmenopausal, 56.3% were either overweight or obese, 30% were nulliparous and 80% reported urban residency. The median pain score during the procedure was 2 (0−4). Pain scores of 5 (4−7) were reported with the junior gynecologist and 2 (0−4) in the senior gynecologist (p < 0.0001). Conclusion. The pain was found to have a strong association with the type of provider performing the endometrial sampling procedure. This fact suggests the need for a personalized approach and that psychological or informational interventions should be scheduled before the procedure to decrease pain and increase satisfaction.
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Hofmeister S, Bodden S. Menstrual Disorders. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Micaily I, Samuelson Bannow BT. VTE and anticoagulation in menstruating women. THROMBOSIS UPDATE 2021. [DOI: 10.1016/j.tru.2021.100088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Husain S, Al Hammad RS, Alduhaysh AK, AlBatly MM, Alrikabi A. Pathological spectrum of endometrial biopsies in Saudi women with abnormal uterine bleeding: A retrospective study of 13-years. Saudi Med J 2021; 42:270-279. [PMID: 33632905 PMCID: PMC7989265 DOI: 10.15537/smj.2021.42.3.20200814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/08/2021] [Indexed: 12/09/2022] Open
Abstract
Objectives: To assess and age stratify the types and frequencies of endometrial pathologies in Saudi women with abnormal uterine bleeding (AUB) that underwent endometrial biopsies, at our hospital over a 13-year period. Methods: In a retrospective study, from 2006 to 2018, all endometrial biopsies from Saudi women with AUB, reported at the laboratory of King Saud University-Medical City, Riyadh, Saudi Arabia, were revisited and analyzed. The women were categorized into <40, between 40-55 and >55 years of age. Results: We analyzed 6458 biopsies. In <40 and 40-55 years’ groups cyclical endometrium was most common followed by endometrial polyps and disordered proliferative endometrium. In the >55 years’ group, atrophic endometrium was most common followed by endometrial polyps. The hyperplasias and malignancies together accounted for 7.2% of the study, majority in the >55 years’ group. Simple hyperplasia without atypia was the most common (3.9%), followed by malignancies (1.9%), complex atypical hyperplasia (0.7%), complex hyperplasia without atypia (0.4%), and simple atypical hyperplasia (0.3%). Conclusion: Awareness of the probable spectrum of endometrial histopathologies in the various ages is useful in guiding management. Endometrial biopsies are valuable in early detection of precancerous and cancerous endometrial lesions especially in women over 40 years.
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Affiliation(s)
- Sufia Husain
- From the Department of Pathology (Husain, Alrikabi), Department of Obstetrics and Gynecology (Al Hammad), Department of Pediatrics Neurology (Alduhaysh), College of Medicine (AlBatly), King Saud University; and from the Department of Pathology (Husain), Department of Obstetrics and Gynecology (Al Hammad), Department of Pediatrics Neurology (Alduhaysh), King Saud University-Medical City, Riyadh, Kingdom of Saudi Arabia.
- Address correspondence and reprint request to: Dr. Sufia Husain, Associate Professor, Department of Pathology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0003-3486-9356
| | - Reema S. Al Hammad
- From the Department of Pathology (Husain, Alrikabi), Department of Obstetrics and Gynecology (Al Hammad), Department of Pediatrics Neurology (Alduhaysh), College of Medicine (AlBatly), King Saud University; and from the Department of Pathology (Husain), Department of Obstetrics and Gynecology (Al Hammad), Department of Pediatrics Neurology (Alduhaysh), King Saud University-Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Aljawhara K. Alduhaysh
- From the Department of Pathology (Husain, Alrikabi), Department of Obstetrics and Gynecology (Al Hammad), Department of Pediatrics Neurology (Alduhaysh), College of Medicine (AlBatly), King Saud University; and from the Department of Pathology (Husain), Department of Obstetrics and Gynecology (Al Hammad), Department of Pediatrics Neurology (Alduhaysh), King Saud University-Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Mada M. AlBatly
- From the Department of Pathology (Husain, Alrikabi), Department of Obstetrics and Gynecology (Al Hammad), Department of Pediatrics Neurology (Alduhaysh), College of Medicine (AlBatly), King Saud University; and from the Department of Pathology (Husain), Department of Obstetrics and Gynecology (Al Hammad), Department of Pediatrics Neurology (Alduhaysh), King Saud University-Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Ammar Alrikabi
- From the Department of Pathology (Husain, Alrikabi), Department of Obstetrics and Gynecology (Al Hammad), Department of Pediatrics Neurology (Alduhaysh), College of Medicine (AlBatly), King Saud University; and from the Department of Pathology (Husain), Department of Obstetrics and Gynecology (Al Hammad), Department of Pediatrics Neurology (Alduhaysh), King Saud University-Medical City, Riyadh, Kingdom of Saudi Arabia.
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Shoupe D. The Progestin Revolution: progestins are arising as the dominant players in the tight interlink between contraceptives and bleeding control. Contracept Reprod Med 2021; 6:3. [PMID: 33517911 PMCID: PMC7849131 DOI: 10.1186/s40834-020-00142-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Since the introduction of the first modern contraceptive methods, the interlink between bleeding control and contraceptive development has been a dominant and critical factor. This interplay has led to the development of safer and better contraceptive methods that are often used to control bleeding in both women with normal bleeding patterns as well as in those suffering from heavy menstrual bleeding (HMB). The success of progestin-only methods, such as hormonal IUDs or progestin dominant oral contraceptives in substantially decreasing and controlling menstrual bleeding, has led to development of multiple progestin-only protocols for the sole purpose of bleeding control. These include protocols designed to stop acute heavy bleeding as well as manage long-term bleeding. Recent publications describe a variety of protocols using high dose oral progestin pills with or without a medroxyprogesterone acetate (MPA) injection that demonstrate high effectiveness and good tolerability. Comparted to many other progestins, MPA is not converted in part into ethinyl estradiol and appears to have a progestin-only advantage. Norethindrone acetate (NET acetate) is converted in part to ethinyl estradiol and therefore is an especially good option for bleeding control in patients with low estrogen levels that would benefit from estrogen replacement (such as in premenopausal women with premature menopause or hypothalamic hypogonadism).
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Affiliation(s)
- Donna Shoupe
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
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Saei Ghare Naz M, Rostami Dovom M, Ramezani Tehrani F. The Menstrual Disturbances in Endocrine Disorders: A Narrative Review. Int J Endocrinol Metab 2020; 18:e106694. [PMID: 33613678 PMCID: PMC7887462 DOI: 10.5812/ijem.106694] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/02/2020] [Accepted: 09/12/2020] [Indexed: 12/20/2022] Open
Abstract
CONTEXT Menstrual cycle is considered the fifth vital sign among women. This study aimed to summarize the menstrual disturbances in different endocrine disorders. EVIDENCE ACQUISITION In this narrative review, relevant studies (up to December 2019) were searched based on the MeSH keywords diabetes, polycystic ovary syndrome, Cushing's syndrome, thyroid dysfunction, hyperprolactinemia, menstrual cycle, uterine bleeding, and menstruation. Databases used for searching articles included Google Scholar, Scopus, PubMed, and Web of science for observational, experimental, and review studies. RESULTS Endocrine disorders trigger the onset of menstrual disturbance across the reproductive lifespan of women. Endocrine glands (pituitary, thyroid, pancreas, adrenal, and ovaries) have a functional role in endocrine regulation of the menstrual cycle. According to available evidence, oligomenorrhea (cycles longer than 35 days) is the most common menstrual disturbance among endocrine disorders (thyrotoxicosis, hypothyroidism, polycystic ovary syndrome, Cushing's syndrome, and diabetes). Complex endocrine pathways play an essential role in a women's menstrual calendar. CONCLUSIONS The menstrual cycle length and amount of bleeding can be indicative of endocrine disorders. Further studies are needed to identify the unknowns about the association between endocrine disorders and the menstrual cycle.
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Affiliation(s)
- Marzieh Saei Ghare Naz
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Rostami Dovom
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Yaşa C, Güngör Uğurlucan F. Approach to Abnormal Uterine Bleeding in Adolescents. J Clin Res Pediatr Endocrinol 2020; 12:1-6. [PMID: 32041387 PMCID: PMC7053441 DOI: 10.4274/jcrpe.galenos.2019.2019.s0200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 12/11/2019] [Indexed: 01/15/2023] Open
Abstract
This article reviews the current understanding and management of abnormal uterine bleeding (AUB) in adolescents. It is hoped that this review will provide readers with an approach to the evaluation and treatment of mild to severe uterine bleeding. AUB is a common problem which has significantly adverse effects on an affected adolescent’s quality of life. The most common underlying condition in AUB in adolescence is anovulation. During the evaluation, pregnancy, trauma and sexually transmitted diseases must be ruled out, regardless of history. It should be kept in mind that AUB during this period may be the first sign of underlying bleeding disorders. Although observation is sufficient in the mild form of AUB, at the other end of the spectrum life-threatening bleeding may necessitate the use of high doses of combined oral contraceptives, intravenous estrogen and/or interventional procedures.
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Affiliation(s)
- Cenk Yaşa
- İstanbul University, İstanbul Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Funda Güngör Uğurlucan
- İstanbul University, İstanbul Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
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Hofmeister S, Bodden S. Menstrual Disorders. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_145-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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