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Ailments and Diseases
Published in James Sherifi, General Practice Under the NHS, 2023
Women with stress incontinence (urge incontinence was not recognised as a distinct entity at that time) were basically told by their male doctors to ‘get on with it.’ There were no specific treatments for dysmenorrhoea, menorrhagia, or polymenorrhoea, although the combined oral contraceptive pill, increasingly prescribed, was found to serendipitously benefit these symptoms. Hysterectomies were routinely performed. Drugs such as mefenamic acid were marketed as an improvement on NSAIDs for relieving dysmenorrhoea, but this was not borne out in practice.
Testing the female athlete
Published in R. C. Richard Davison, Paul M. Smith, James Hopker, Michael J. Price, Florentina Hettinga, Garry Tew, Lindsay Bottoms, Sport and Exercise Physiology Testing Guidelines: Volume I – Sport Testing, 2022
Kirsty M. Hicks, Anthony C. Hackney, Michael Dooley, Georgie Bruinvels
Menstrual cycle length is calculated from the first day of a menstrual bleed to the first day of the next menstrual bleed. Due to large inter- and intra-individual variability, the length of a menstrual cycle can range from 21 to 35 days. Consistent deviations from this range might indicate an irregularity (e.g., <21 days polymenorrhoea, >35 days oligomenorrhoea). Hormonal fluctuations throughout the menstrual cycle create three distinct hormonal milieu: the early follicular (low oestrogen and progesterone), late follicular (high oestrogen and low progesterone) and mid-luteal (high oestrogen and high progesterone) phases. However, significant hormonal shifts occur when transitioning between phases, which might be symptomatic. Another essential time point is ovulation – a fundamental marker of a eumenorrheic cycle, which occurs approximately 36 h following the surge in luteinizing hormone.
Thyroid Hormones and Calcium Metabolism
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
Sexual dysfunction may be a symptom of thyroid dysfunction. In men, hypothyroidism may cause loss of libido, whereas hyperthyroidism may cause impotence. In women, hypothyroidism may lead to menorrhagia and polymenorrhoea, whereas hyperthyroidism causes oligomenorrhoea. These varied effects of thyroid dysfunction on sexual function are from direct effects on the gonads and both positive and negative feedback mechanisms on the anterior pituitary controlling sexual functions.
The pressing need for standardization in epidemiologic studies of PCOS across the globe
Published in Gynecological Endocrinology, 2019
Michael Ntumy, Ernest Maya, Daria Lizneva, Richard Adanu, Ricardo Azziz
The methods used to define each feature of the criterion are critical in ensuring the complete detection of the disorder. How OA, HA and PCOM is defined will play a significant role in determining the prevalence of PCOS observed. For example, should OA be defined by the menstrual dysfunction only? Should the degree of oligomenorrhea be defined as cycles (vaginal bleeding episodes) at greater than 35 day intervals, or 45 day intervals (equivalent to 8 or less cycles per year)? Using older epidemiologic data, it seems that cycles >35 days in length are abnormal, which is equivalent to 10 or less cycles per year. However, many studies use <8 cycles per year as the definition of oligomenorrhea, equivalent to cycles >45 days in length. Furthermore, some of the OA may not be detected by overt menstrual dysfunction, and may present as polymenorrhea or eumenorrhea. These oligo-ovulatory patients can be detected only if their late luteal (day 22–24) progesterone levels are assessed.
Evaluating thyroid function in pregnant women
Published in Critical Reviews in Clinical Laboratory Sciences, 2022
K. Aaron Geno, Robert D. Nerenz
Menstrual changes in hypothyroidism include alterations to cycle length and amount of bleeding. Oligomenorrhea and amenorrhea may occur, but polymenorrhea (shortened length between periods) and menorrhagia (heavy menstrual bleeding) have also been observed [6]. Increased bleeding has been attributed to estrogen breakthrough bleeding, although hypothyroidism induces a hypocoagulable state due to decreased expression of coagulation factors VII, VIII, IX, and XI, which may also contribute [35–37]. Studies have typically found rates of menstrual disturbances and irregularities in the area of 60–80%, though one study of 171 hypothyroid women found irregular cycles in only 23% compared to 8% of controls [17,18,35,38,39].
Dydrogesterone indications beyond menopausal hormone therapy: an evidence review and woman’s journey
Published in Gynecological Endocrinology, 2021
A prospective, single-arm, multicenter, observational cohort study reported on 996 women (age 18–40 years) who received dydrogesterone for treatment of irregular menstrual cycles due to progesterone deficiency [18]. The decision to treat was at the discretion of the attending physician. Based on the definition of a regular cycle as 21–35 days, 76% of the women had oligomenorrhea (menstrual cycle > 35 days), 11.5% had polymenorrhea (cycle < 21 days), and 12.5% had undefined irregularity. Oral dydrogesterone 10–20 mg/day was administered on days 11–25 of the menstrual cycle for 3 consecutive cycles, and patients were followed for up to 6 months. More than 99% of patients had ≥ 1 regular menstrual cycle during the 3-month treatment period, and 78.5% maintained regular cycles throughout 6 months of follow-up. Menstrual cycle duration improved significantly versus baseline in all three irregularity subgroups (all p ≤ .0001). An overall median menstrual cycle duration of 28–29 days was achieved at the end of therapy. The median change in menstrual cycle length was +7 days in women with polymenorrhea, −11 days in women with oligomenorrhea, and −2 days for women with undefined irregularity [18]. Results consistent with these findings were reported in another prospective, single-arm, multicenter, observational cohort study (n = 910), in which dydrogesterone (10 mg twice daily from day 11 to 25) was administered for a minimum of 1–6 cycles according to the clinical practice of the treating physician [19]. Cycle regularization was achieved in 96.7% of patients during treatment, and was maintained for up to 6 months after treatment cessation in 94.8% of 788 patients with available data. At end of treatment, mean cycle duration increased by 9.8 days in 188 women who had polymenorrhea at baseline, and decreased by 27.6 days in 609 women who had oligomenorrhea at baseline (both p < .0001).