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Querevalú-Pancorbo I, Rojas-Cama LF, Soncco-Llulluy F, Li J, Rosales-Rimache J. Abnormal uterine bleeding and associated factors: a cross-sectional study in high-performance Peruvian athletes. BMJ Open Sport Exerc Med 2024; 10:e001820. [PMID: 38818354 PMCID: PMC11138278 DOI: 10.1136/bmjsem-2023-001820] [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] [Accepted: 04/21/2024] [Indexed: 06/01/2024] Open
Abstract
Background Abnormal uterine bleeding (AUB) is a problem that affects women and can cause outcomes such as anaemia, affecting women's quality of life. In high-performance athletes, this problem can be further exacerbated by intense physical activity, strict nutritional regimens and physical stress. Hypothesis There are factors that increase the risk of occurrence of AUB in high-performance Peruvian athletes. Study design Cross-sectional study. Level of evidence Level 4. Methods We applied an online questionnaire with questions to identify AUB according to the International Federation of Gynecology and Obstetrics criteria, demographic characteristics, sport practised and evaluation of the risk of an eating disorder using the Eating Attitudes Test questionnaire. We used a generalised linear model to identify factors associated with AUB. Results We evaluated 101 participants whose mean age was 22.3±4.3 years. The body mass index had a mean of 22.6±2.4 kg/m2. From the total of athletes, 68.3% (95% CI 58.6% to 76.7%) presented AUB. The bivariate analysis showed that the type of sport and the duration of the sporting activity were associated (p<0.05) with AUB, with AUB frequencies of 76.5% observed in athletes who practised anaerobic sports. The multivariate analysis did not report factors significantly associated with AUB. Conclusion We found a high frequency of AUB in high-performance Peruvian athletes, especially in those who practice anaerobic and resistance sports. Clinical relevance High-performance female athletes health must be evaluated periodically, and immediate actions are taken to control and treat AUB.
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Affiliation(s)
| | | | | | - Jair Li
- Escuela de Posgrado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jaime Rosales-Rimache
- Facultad de Ciencias de la Salud, Escuela de Tecnología Médica, Universidad Continental, Huancayo, Peru
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Sharma R, Johnson V, Pan A, Sellers A, Betensky M, Goldenberg N, Flood VH. Assessment of rare bleeding disorders in adolescents with heavy menstrual bleeding. Haemophilia 2024; 30:490-496. [PMID: 38385952 DOI: 10.1111/hae.14961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/04/2024] [Accepted: 01/11/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION There are a significant number of patients with mucocutaneous bleeding, specifically heavy menstrual bleeding (HMB), who do not have a diagnosed bleeding disorder. These patients receive nontargeted interventions and may have suboptimal treatments. Functional assays, particularly for fibrinolytic and rare platelet function defects, are not robust and not readily available. AIM We aimed to prospectively evaluate the prevalence of genetic defects associated with rare bleeding disorders and describe alterations of coagulation and fibrinolysis in a cohort of adolescents with HMB. METHODS We performed a prospective observational cohort study of patients with HMB and unexplained bleeding. The study utilized a next generation sequencing panel and investigational global assays of coagulation and fibrinolysis. Additionally, specific functional assays were performed to help characterize novel variants that were identified. RESULTS In 10 of the 17 patients (∼59%), genetic variants were identified on molecular testing. Thrombin generation by calibrated thromboelastography was not significantly altered in this patient population. The clot formation and lysis assay showed a trend towards increased fibrinolysis with rapid phase of decline in 23% of the patients. Further corresponding functional assays and study population are described. CONCLUSION Our study describes a unique correlative model in a homogenous cohort of patients with HMB and unexplained bleeding which may inform future diagnostic algorithms, genotype-phenotype correlations as well as aid in specific targeted treatment approaches. Larger future studies may inform risk stratification of patients and improve health related outcomes in patients with HMB.
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Affiliation(s)
- Ruchika Sharma
- Division of Hematology/Oncology/BMT, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Victoria Johnson
- Center for Comprehensive Bleeding Disorders, Versiti Blood Center of Wisconsin, Milwaukee, Wisconsin, USA
| | - Amy Pan
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Austin Sellers
- Institute for Clinical and Translational Research, John Hopkins All Childrens Hospital, St. Petersburg, Florida, USA
| | - Marisol Betensky
- Institute for Clinical and Translational Research, John Hopkins All Childrens Hospital, St. Petersburg, Florida, USA
| | - Neil Goldenberg
- Institute for Clinical and Translational Research, John Hopkins All Childrens Hospital, St. Petersburg, Florida, USA
| | - Veronica H Flood
- Center for Comprehensive Bleeding Disorders, Versiti Blood Center of Wisconsin, Milwaukee, Wisconsin, USA
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Chao M, Menon C, Elgendi M. Menstrual cycles during COVID-19 lockdowns: A systematic review and meta-analysis. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:949365. [PMID: 36303682 PMCID: PMC9580671 DOI: 10.3389/frph.2022.949365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/21/2022] [Indexed: 12/03/2022] Open
Abstract
Coronavirus disease 2019 lockdowns produced psychological and lifestyle consequences for women of reproductive age and changes in their menstrual cycles. To our knowledge, this is the first systematic review to characterize changes in menstrual cycle length associated with lockdowns compared to non-lockdown periods. A search on 5 May 2022 retrieved articles published between 1 December 2019, and 1 May 2022, from Medline, Embase, and Web of Science. The included articles were peer-reviewed observational studies with full texts in English, that reported menstrual cycle lengths during lockdowns and non-lockdowns. Cross-sectional and cohort studies were appraised using the Appraisal tool for Cross-Sectional Studies and the Cochrane Risk of Bias Tool for Cohort Studies, respectively. Review Manager was used to generate a forest plot with odds ratios (OR) at the 95% confidence interval (CI), finding a significant association between lockdown and menstrual cycle length changes for 21,729 women of reproductive age (OR = 9.14, CI: 3.16-26.50) with a significant overall effect of the mean (Z = 4.08, p < 0.0001). High heterogeneity with significant dispersion of values was observed (I 2 = 99%, τ = 1.40, χ2 = 583.78, p < 0.0001). This review was limited by the availability of published articles that favored high-income countries. The results have implications for adequately preparing women and assisting them with menstrual concerns during lockdown periods.
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Affiliation(s)
- Melissa Chao
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Carlo Menon
- Biomedical and Mobile Health Technology Laboratory, Department of Health Sciences and Technology, Zurich, Switzerland
| | - Mohamed Elgendi
- Biomedical and Mobile Health Technology Laboratory, Department of Health Sciences and Technology, Zurich, Switzerland
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Al-Najjar MAA, Al-alwany RR, Al-Rshoud FM, Abu-Farha RK, Zawiah M. Menstrual changes following COVID-19 infection: A cross-sectional study from Jordan and Iraq. PLoS One 2022; 17:e0270537. [PMID: 35767537 PMCID: PMC9242447 DOI: 10.1371/journal.pone.0270537] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/11/2022] [Indexed: 01/10/2023] Open
Abstract
Purpose
COVID-19 infection is normally followed by several post-COVID effects. This study aimed to investigate to evaluate menstrual changes in females following COVID-19 infection, and to evaluate female perception about the effect of COVID-19 on their menstrual cycles.
Methods
During this cross-sectional survey-based study, a convenience sample of 483 women from Jordan and from Iraq, who had infected with COVID-19 were invited to fill-out the study questionnaire.
Results
The study was conducted on the females, with a median age 31 years old. Results showed that 47.2% of them (n = 228) suffered from a change in the number of days between two consecutive periods, as well as from a change in the amount of blood loss. Also, more than 50% of them believed that COVID-19 infection may cause changes in the amount of blood loss during the cycle (n = 375, 56.9%), and changes in the number of days between the two consecutive periods (n = 362, 54.2%).
Regression analysis showed that participants with higher educational level (bachelor or higher) (Beta = -0.114, P = 0.011), and those living in Iraq (Beta = -0.166, P<0.001) believed that COVID-19 has lower tendency to cause menstrual changes. In addition, non-married females (Beta = 0.109, P = 0.017), and those who are current smokers (Beta = 0.091, P = 0.048) believed that COVID-19 has higher tendency to cause menstrual changes.
Conclusion
his study revealed that COVID-19 infection could affect the menstrual cycle for the females. Further prospective studies should be done to confirm these findings and evaluate how long these menstrual irregularities lasted.
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Affiliation(s)
- Mohammad A. A. Al-Najjar
- Faculty of Pharmacy, Department of Pharmaceutics and Pharmaceutical Science, Applied Science Private University, Amman, Jordan
| | - Ruaa R. Al-alwany
- Faculty of Pharmacy, Department of Pharmaceutics and Pharmaceutical Science, Applied Science Private University, Amman, Jordan
| | - Firas M. Al-Rshoud
- Faculty of Medicine, Department of Obstetrics and Gynecology, The Hashemite University, Zarqa, Jordan
| | - Rana K. Abu-Farha
- Faculty of Pharmacy, Department Clinical Pharmacy, Applied Science Private University, Amman, Jordan
| | - Mohammed Zawiah
- Department of Pharmacy Practice, College of Clinical Pharmacy, University of Al-Hodeida, Al Hodeida, Yemen
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sans Malaysia, Penang, Malaysia
- * E-mail:
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Muse K, Mabey RG, Waldbaum A, Gersten JK, Adomako TL. Tranexamic Acid Increases Hemoglobin and Ferritin Levels in Women with Heavy Menstrual Bleeding. J Womens Health (Larchmt) 2012; 21:756-61. [DOI: 10.1089/jwh.2011.3163] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ken Muse
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, Kentucky
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Lukes AS, Freeman EW, Van Drie D, Baker J, Adomako TL. Safety of tranexamic acid in women with heavy menstrual bleeding: an open-label extension study. ACTA ACUST UNITED AC 2011; 7:591-8. [PMID: 21879827 DOI: 10.2217/whe.11.55] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIMS An open-label, extension clinical study was conducted to assess the safety of a novel, oral formulation of tranexamic acid (TA) in women with cyclic heavy menstrual bleeding. PATIENTS & METHODS Eligible patients who completed either a three- or six-cycle double-blinded clinical trial of TA were offered enrollment into a study of nine cycles with TA (1.3 g orally three times/day for a maximum of 5 days per cycle). Safety was assessed by the incidence of treatment-emergent adverse events, ophthalmologic examinations and ECGs, among other evaluations. RESULTS The most commonly reported treatment-emergent adverse events were menstrual discomfort (46.2%), headache (43.9%) and back pain (23.1%). A small proportion of participants (3.8%) reported ocular adverse events, but there was no evidence of ocular toxicity. No prothrombotic effects were observed. CONCLUSION During nine menstrual cycles of treatment, this novel formulation of TA was well tolerated and exhibited a favorable safety profile supporting its use as a therapy for cyclic heavy menstrual bleeding.
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Affiliation(s)
- Andrea S Lukes
- Carolina Women's Research & Wellness Center, Durham, NC 27713, USA.
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Makhzangy IME, Hegab HM, Moiety FS. Oral versus rectal misoprostol in the treatment of menorrhagia. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2010. [DOI: 10.1016/j.mefs.2010.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bese T, Demirkiran F, Guralp O, Sanioglu C, Arvas M. Transtubal Transport of Carcinoma Cells Into the Peritoneal Cavity After Saline Infusion via Transcervical Route in Patients With Endometrial Carcinoma. Int J Gynecol Cancer 2009; 19:682-5. [DOI: 10.1111/igc.0b013e3181a48c7f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Munro MG, Mainor N, Basu R, Brisinger M, Barreda L. Oral Medroxyprogesterone Acetate and Combination Oral Contraceptives for Acute Uterine Bleeding. Obstet Gynecol 2006; 108:924-9. [PMID: 17012455 DOI: 10.1097/01.aog.0000238343.62063.22] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the efficacy of multidose medroxyprogesterone acetate and a multidose monophasic combined oral contraceptive (OC) for hemodynamically stable women with nongestational, acute uterine bleeding. METHODS Hemodynamically stable patients with acute uterine bleeding sufficient to justify immediate medical or surgical intervention were enrolled in an open-label, randomized trial comparing oral medroxyprogesterone acetate 20 mg and a monophasic combination OC containing 1 mg norethindrone and 35 mug of ethinyl estradiol, each administered three times per day. Doses were reduced after 1 week to 20 mg per day and one tablet per day for the next 3 weeks for the medroxyprogesterone acetate and OC groups, respectively. Following baseline assessment, patients completed daily treatment and symptom logs collected at 14 and 28 days after initiation of therapy. RESULTS Forty patients were randomly assigned, 20 in each group; 33 were evaluated at the 14-day visit. Emergency surgical procedures were avoided in 100% of those women taking medroxyprogesterone acetate and 95% of the OC group. Cessation of bleeding had occurred in 88% of the OC group and 76% of those receiving medroxyprogesterone acetate, with a median time to bleeding cessation of 3 days for both groups. Compliance with therapy was higher in the medroxyprogesterone acetate group than the OC group, but there was no overall difference in the incidence of treatment-related nausea and bloating. CONCLUSION This randomized trial is limited by sample size but suggests that both regimens may be effective and reasonably well tolerated. CLINICAL TRIAL REGISTRATION Current Clinical Trials (clinicaltrials.gov, www.clinicaltrials.gov) Identifier: NCT00350480 LEVEL OF EVIDENCE II-1.
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Affiliation(s)
- Malcolm G Munro
- Department of Obstetrics, Kaiser Permanente Southern California Los Angeles Medical Center, Los Angeles, Los Angeles, California, USA.
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10
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Davis SI, Blanck HM, Hertzberg VS, Tolbert PE, Rubin C, Cameron LL, Henderson AK, Marcus M. Menstrual function among women exposed to polybrominated biphenyls: a follow-up prevalence study. Environ Health 2005; 4:15. [PMID: 16091135 PMCID: PMC1201158 DOI: 10.1186/1476-069x-4-15] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2005] [Accepted: 08/09/2005] [Indexed: 05/03/2023]
Abstract
BACKGROUND Alteration in menstrual cycle function is suggested among rhesus monkeys and humans exposed to polybrominated biphenyls (PBBs) and structurally similar polychlorinated biphenyls (PCBs). The feedback system for menstrual cycle function potentially allows multiple pathways for disruption directly through the hypothalamic-pituitary-ovarian axis and indirectly through alternative neuroendocrine axes. METHODS The Michigan Female Health Study was conducted during 1997-1998 among women in a cohort exposed to PBBs in 1973. This study included 337 women with self-reported menstrual cycles of 20-35 days (age range: 24-56 years). Current PBB levels were estimated by exponential decay modeling of serum PBB levels collected from 1976-1987 during enrollment in the Michigan PBB cohort. Linear regression models for menstrual cycle length and the logarithm of bleed length used estimated current PBB exposure or enrollment PBB exposure categorized in tertiles, and for the upper decile. All models were adjusted for serum PCB levels, age, body mass index, history of at least 10% weight loss in the past year, physical activity, smoking, education, and household income. RESULTS Higher levels of physical activity were associated with shorter bleed length, and increasing age was associated with shorter cycle length. Although no overall association was found between PBB exposure and menstrual cycle characteristics, a significant interaction between PBB exposures with past year weight loss was found. Longer bleed length and shorter cycle length were associated with higher PBB exposure among women with past year weight loss. CONCLUSION This study suggests that PBB exposure may impact ovarian function as indicated by menstrual cycle length and bleed length. However, these associations were found among the small number of women with recent weight loss suggesting either a chance finding or that mobilization of PBBs from lipid stores may be important. These results should be replicated with larger numbers of women exposed to similar lipophilic compounds.
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Affiliation(s)
- Stephanie I Davis
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Alanta, GA, 30322, USA
| | - Heidi Michels Blanck
- Graduate Division of Biological and Biomedical Sciences, Emory University, 1462 Clifton Road, NE, Atlanta, Georgia, 30322, USA
| | - Vicki S Hertzberg
- Department of Biostatistics, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, Georgia, 30322, USA
| | - Paige E Tolbert
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Alanta, GA, 30322, USA
- Department of Environmental and Occupational Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, Georgia, 30322, USA
| | - Carol Rubin
- Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-46, Atlanta, Georgia, 30341, USA
| | - Lorraine L Cameron
- Division of Environmental and Occupational Epidemiology, Michigan Department of Community Health, P.O. Box 30195, Lansing, Michigan, 48909, USA
| | - Alden K Henderson
- Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-46, Atlanta, Georgia, 30341, USA
| | - Michele Marcus
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Alanta, GA, 30322, USA
- Department of Environmental and Occupational Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, Georgia, 30322, USA
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Tabibzadeh S. Role of EBAF/Lefty in implantation and uterine bleeding. ERNST SCHERING RESEARCH FOUNDATION WORKSHOP 2005:159-89. [PMID: 15704472 DOI: 10.1007/3-540-27147-3_8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- S Tabibzadeh
- Department of Obstetrics, Stony Brook University, NY 11794, USA.
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Richter HE, Learman LA, Lin F, Varner RE, Hendrix SL, Summitt RL, Washington AE. Medroxyprogesterone acetate treatment of abnormal uterine bleeding: factors predicting satisfaction. Am J Obstet Gynecol 2003; 189:37-42. [PMID: 12861135 DOI: 10.1067/mob.2003.342] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was undertaken to identify the determinants of patient satisfaction with a cyclic regimen of medroxyprogesterone acetate (MPA) for abnormal uterine bleeding. STUDY DESIGN A prospective cohort study of 413 premenopausal women were treated for 3 to 5 months with oral MPA 10 to 20 mg per day for 10 to 14 days per month. We assessed satisfaction with and willingness to continue MPA. Baseline characteristics hypothesized to predict treatment satisfaction were entered into logistic regression analysis. RESULTS Sixty-five percent of subjects (271) completed at least 3 months of MPA, 79% (215) filled out a satisfaction survey, and 57% (123) expressed satisfaction with MPA. Satisfaction was predicted by age 35 years or older (odds ratio [OR] 2.67, CI 1.07-6.7), desire for uterine conservation (OR 1.36, CI 1.11-1.66), perceived importance of stopping bleeding (OR 0.69, CI 0.54-0.87), and tubal sterilization (OR 0.52, CI 0.28-0.96). Neither bleeding history nor parity predicted MPA satisfaction. CONCLUSION These findings underscore the importance of considering patient age, fertility status, attitudes about uterine conservation, and desire for definitive resolution of bleeding when deciding whether to use MPA versus other treatments for abnormal uterine bleeding.
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Affiliation(s)
- Holly E Richter
- University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama 35249-7333, USA.
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Stewart CJ, Campbell-Brown M, Critchley HO, Farquharson MA. Endometrial apoptosis in patients with dysfunctional uterine bleeding. Histopathology 1999; 34:99-105. [PMID: 10064387 DOI: 10.1046/j.1365-2559.1999.00599.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To assess glandular apoptosis in the zona functionalis of proliferative phase endometrium in normal individuals and in patients with dysfunctional uterine bleeding (DUB). METHODS AND RESULTS Routinely processed, haematoxylin and eosin-stained endometrial biopsies were assessed in 26 patients with symptomatic menstrual abnormality, mainly menorrhagia, and in 24 controls. All biopsies were in the proliferative phase and had been reported as within normal limits and consistent with the menstrual cycle dates provided. Apoptotic and mitotic figures were counted in a minimum of 100 transversely sectioned endometrial glands in all cases. In 16 biopsies (12 DUB and four controls) apoptosis was further assessed using the in situ terminal deoxynucleotidyl-transferase-mediated 2'-deoxyuridine-5'-triphosphate (dUTP) nick-end labelling (TUNEL) method. Apoptotic figures were identified in most control biopsies averaging 5.6/100 glands, and were significantly increased in biopsies from patients with DUB averaging 13.9/100 glands. There was no difference in mitotic figure counts. Apoptoses tended to be clustered within adjacent glands in both groups and individual glands exhibited both mitotic and apoptotic activity. Application of the TUNEL method gave broad agreement with morphological assessment although approximately 20-25% of typical apoptotic figures were not labelled. CONCLUSIONS Endometrial glandular apoptosis is present in most normal proliferative phase biopsies and appears increased in some cases of DUB. The significance of this finding is not known but increased apoptosis may serve as a morphological marker of abnormal endometrial development in otherwise normal biopsy specimens.
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Affiliation(s)
- C J Stewart
- Department of Pathology, Glasgow Royal Infirmary, Scotland
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Kothapalli R, Buyuksal I, Wu SQ, Chegini N, Tabibzadeh S. Detection of ebaf, a novel human gene of the transforming growth factor beta superfamily association of gene expression with endometrial bleeding. J Clin Invest 1997; 99:2342-50. [PMID: 9153275 PMCID: PMC508072 DOI: 10.1172/jci119415] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Human endometrium is unique since it is the only tissue in the body that bleeds at regular intervals. In addition, abnormal endometrial bleeding is one of the most common manifestations of gynecological diseases, and is a prime indication for hysterectomy. Here, we report on a novel human gene, endometrial bleeding associated factor (ebaf), whose strong expression in endometrium was associated with abnormal endometrial bleeding. In normal human endometrium, this gene was transiently expressed before and during menstrual bleeding. In situ hybridization showed that the mRNA of ebaf was expressed in the stroma without any significant mRNA expression in the endometrial glands or endothelial cells. The predicted protein sequence of ebaf showed homology with and structural features of the members of TGF-beta superfamily. Fluorescence in situ hybridization showed that the ebaf gene is located on human chromosome 1 at band q42.1. Thus, ebaf is a novel member of the TGF-beta superfamily and an endometrial tissue factor whose expression is associated with normal menstrual and abnormal endometrial bleeding.
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Affiliation(s)
- R Kothapalli
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida 33612, USA
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Tabibzadeh S, Kothapalli R. From steroid signals to local regulatory factors involved in endometrial bleeding. Eur J Obstet Gynecol Reprod Biol 1996; 70:25-7. [PMID: 9031916 DOI: 10.1016/s0301-2115(96)02572-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Ewenstein BM. The pathophysiology of bleeding disorders presenting as abnormal uterine bleeding. Am J Obstet Gynecol 1996; 175:770-7. [PMID: 8828560 DOI: 10.1016/s0002-9378(96)80083-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Abnormal uterine bleeding is often the presenting complaint in women with underlying coagulopathies. A clear understanding of the pathophysiology of common bleeding disorders will help the practicing obstetrician/gynecologist in the diagnosis and treatment of these conditions. The normal hemostatic process can be divided into three phases. The first phase, primary hemostasis, consists of platelet adhesion and aggregation. After vascular injury, proteins in the subendothelium are exposed that promote platelet adhesion. Platelet adhesion is uniquely dependent on von Willebrand factor, a plasma protein that serves as a molecular bridge between components of the vessel wall and the platelet glycoprotein Ib/IX receptor. Activation of the adherent platelets promotes additional platelet recruitment, culminating in the formation of the platelet plug. Quantitative or qualitative defects in either the platelet or von Willebrand factor (von Willebrand disease) lead to defective primary hemostasis. Patients present with a prolonged bleeding time and mucocutaneous bleeding manifestations. In the next phase, secondary hemostasis, the plasma coagulation factors are sequentially activated, which leads to fibrin formation and cross-linking. These reactions take place primarily on the surface of activated platelets and are essential in maintaining the stability of the initial platelet plug. Defective secondary hemostasis arises from congenital or acquired deficiencies in coagulation factors. Although these defects are most often associated with bleeding into joints and soft tissues, other manifestations, including abnormal uterine bleeding, may be present. The prothrombin time and the activated partial thromboplastin time serve as initial screening tests for these coagulation disorders, although more specific tests, including factor levels, thrombin time, clot solubility, and mixing studies, are needed to fully define the defect. In the final phase of normal hemostasis, fibrinolysis, the fibrin clot undergoes an orderly process of degradation. Deficiencies in the normal inhibitors of fibrinolysis, such as alpha 2-antiplasmin or plasminogen activator inhibitor-1, may be underdiagnosed causes of delayed bleeding because they are not identified by the usual coagulation screening tests. Disorders of primary hemostasis, including thrombocytopenia and von Willebrand disease, are particularly important to consider when evaluating women with abnormal uterine bleeding. Patients with acquired or congenital deficiencies of either coagulation factors or the regulators of the fibrinolytic system may also present with menorrhagia. Accurate diagnosis of a bleeding disorder is essential to the design of an appropriate therapeutic regimen and is likely to have important clinical implications beyond that of the presenting gynecologic complaint.
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Affiliation(s)
- B M Ewenstein
- Boston Hemophilia Center, Children's Hospital/Brigham and Women's Hospital, MA 02115, USA
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