Sports gynecology: a new way to improve female athletes care and performance / Ginecología deportiva: una nueva forma de optimizar atención y el rendimiento de la deportist / Ginecologia do esporte: uma nova maneira de otimizar o cuidado e a performance da mulher atleta

ABSTRACT Introduction: Female participation in sports has reached a milestone in 1972 when a constitutional amendment was implemented to ensure equal opportunities for men and women. Since then, the percentage of participants in competitive sports has grown. In this context became necessary to understand menstrual cycle, contraceptive use, and its individual responses. Objective: To investigate menstrual cycle characteristics, physical and mood symptoms related to vaginal bleeding, and contraceptives used by Brazilian Olympic athletes. Also, to assess if these athletes relate that vaginal bleeding influences sportive performance, how they manage it and what can be changed to improve their health care and sportive performance. Additionally, we propose specialized female care by a gynaecologist specialized in sports medicine. Methods: Descriptive observational study was conducted from July to August 2016 and included 118 Brazilian Olympic female athletes, in menacme. The athletes completed a self-administered online questionnaire, adapted from Pre-Participation Gynaecological Examination of female athletes. Results: Participants practiced 28 different sports, mean age 27 ± 4.7 years. For 66% it was their first participation in an Olympic Game. Most used contraceptives (54%), mainly oral (61%). Most (76%) believed that vaginal bleeding influenced sports performance, and 63% preferred to compete after bleeding cessation. Fifty-eight percent would compete at preferred time of their cycle. Anxiety symptoms, bloating, increased appetite, depression, and dysmenorrhea were indicated by 52%. Among these, 49% reported that these symptoms deteriorated their sportive performance. Conclusion: Most in their first Olympic participation, Brazilian athletes used hormone contraceptives, mainly oral ones to manage and adapt their vaginal bleeding to the competition calendar because most of them referred those physical and mood symptoms deteriorated their sportive performance. The presence of a Sportive Gynaecologist as part of the Olympic Medical Staff highlighted the female athletes issues and helped them to improve sportive performance. Level of Evidence IV; Cross-sectional observational study

RESUMEN Introducción: La participación femenina en deportes alcanzó un hito en 1972, cuando se implementó una reforma constitucional para garantizar igualdad de oportunidades entre hombres y mujeres. Desde entonces, el porcentaje de participantes en deportes competitivos ha crecido. En este contexto, se hizo necesario comprender el ciclo menstrual, el uso de anticonceptivos y sus respuestas individuales. Objetivo: Investigar características del ciclo menstrual, síntomas físicos, estado de ánimo, quejas relacionadas con el sangrado vaginal y los métodos anticonceptivos utilizados por atletas olímpicas brasileñas. Evaluar si estas deportistas perciben influencia del sangrado vaginal en el rendimiento deportivo, cómo lo controlan y qué se puede cambiar para mejorar. Además, ofrecemos atención especializada por una ginecóloga especialista en medicina deportiva. Métodos: Estudio observacional, descriptivo, realizado de julio a agosto de 2016, que incluyó 118 atletas olímpicas brasileñas, en menacme. Las atletas respondieron un cuestionario en línea autoadministrado y adaptado titulado "Examen ginecológico previo a la participación". Resultados: Practicaban 28 deportes diferentes, con edad media = 27 ± 4,7 años. Para 66%, era su primera participación en un juego olímpico. Anticonceptivos usados r54%), principalmente orales (61%). La mayoría (76%) cree que el sangrado vaginal influye en el rendimiento deportivo y 63% prefirió competir después del. El 58% de los atletas competiría en su momento preferido de su ciclo. Los síntomas de ansiedad, hinchazón, aumento del apetito, depresión y dismenorrea fueron indicados por el 52%. Entre estas, 49% deterioró su rendimiento deportivo. Conclusión: En su primera participación olímpica, las atletas brasileñas utilizaron anticonceptivos hormonales, principalmente orales, para controlar y adaptar el sangrado vaginal al calendario de competición, ya que la mayoría relató que los síntomas físicos y anímicos perjudicaban su desempeño deportivo. La presencia de una Ginecóloga Deportiva como parte del Equipo Médico Olímpico destacó los problemas de las atletas y las ayudó a mejorar su rendimiento. Nivel de Evidencia IV; Estudio Observacional.

RESUMO Introdução: A participação feminina no esporte teve um marco importante em 1972, quando uma emenda constitucional foi implementada para garantir a igualdade de oportunidades para homens e mulheres. Desde então, o percentual de participantes em esportes competitivos tem crescido. Nesse contexto tornou-se necessário compreender sobre ciclo menstrual, uso de anticoncepcionais e suas respostas individuais. Objetivo: Investigar características do ciclo menstrual, sintomas físicos e de humor, queixas relacionadas ao sangramento vaginal e métodos contraceptivos usados por atletas olímpicas brasileiras. Avaliar se percebem influência do sangramento vaginal no desempenho esportivo, como elas o controlam e o que pode ser mudado para melhorar seus cuidados e desempenho esportivo. Além disso, propõe-se atendimento específico por ginecologista especializada em medicina esportiva. Métodos: Estudo observacional, descritivo, realizado de julho a agosto de 2016 que incluiu 118 atletas olímpicas brasileiras, na menacme. As atletas responderam a um questionário online autoaplicável e adaptado intitulado "Pre-Participation Gynaecological Examination". Resultados: As participantes praticavam 28 esportes diferentes, com média de idade = 27 ± 4,7 anos. Para 66%, foi a primeira participação em um evento olímpico. A maioria usava anticoncepcional (54%), principalmente oral (61%). A maioria (76%) acredita que o sangramento vaginal influencia o desempenho esportivo e 63% preferiam competir após o mesmo. 58% das atletas competiriam no momento preferido de seu ciclo. Sintomas de ansiedade, distensão abdominal, aumento do apetite, depressão e dismenorreia foram indicados por 52%. Entre esses, 49% deterioraram o desempenho esportivo. Conclusão: Em sua primeira participação olímpica, as atletas brasileiras utilizaram anticoncepcionais hormonais, principalmente orais, para controlar e adaptar o sangramento vaginal ao calendário de competição, pois a maioria referiu que os sintomas físicos e de humor prejudicaram o desempenho esportivo. A presença de uma Ginecologista Esportiva como parte da Equipe Médica Olímpica destacou os problemas das atletas femininas e as ajudou a melhorar o desempenho esportivo. Nível de Evidência IV; Estudo Observacional.

Impact of menstrual cycle on smoking cessation: A review / El impacto del ciclo menstrual en el abandono de tabaco: Una revisión

Abstract Background Information on the way menstrual cycle phases can influence the achievement of tobacco abstinence is contradictory. Objective A scope review was conducted to determine the effect of the menstrual cycle on tobacco abstinence, considering the phases of the cycle, hormone levels, and premenstrual syndrome. Method A literature search was conducted in Scopus, PubMed, MEDLINE, and PsycINFO databases. Ten articles comparing the phases of the menstrual cycle or analyzing the association between premenstrual syndrome and a withdrawal condition (length of abstinence or withdrawal symptoms) were included. Results Two main results were identified: 1) there is no difference in withdrawal symptoms and craving between menstrual cycle phases and 2) abstinence rates in the studies were higher during the luteal phase. Discussion and conclusion The advisability of suggesting that women wishing to quit smoking should begin to do so at the start of the luteal phrase is discussed. However, smoking cessation interventions must consider all the symptoms experienced during the luteal phase.

Resumen Antecedentes La información sobre cómo las diferentes fases del ciclo menstrual pueden influir en el logro de la abstinencia de tabaco es contradictoria. Objetivo Se realizó una revisión de alcance con el fin identificar la evidencia relacionada al efecto del ciclo menstrual en la abstinencia de tabaco, considerando las variables fases del ciclo, niveles hormonales y síndrome premenstrual. Método Se llevó a cabo una búsqueda de la literatura en las bases de datos Scopus, PubMed, MEDLINE y PsycINFO. Se incluyeron diez artículos que realizaban comparaciones entre las fases del ciclo menstrual o bien análisis entre el síndrome premenstrual y una condición de abstinencia (tiempo de abstinencia o síntomas de abstinencia). Resultados Se identificaron dos resultados principales 1) no hay diferencia en los síntomas de abstinencia y el deseo por fumar entre las fases del ciclo menstrual y 2) las tasas de abstinencia de los estudios fueron mayores durante la fase lútea. Discusión y conclusión Se discute si en la fase lútea se puede sugerir el inicio de la abstinencia en mujeres que buscan dejar de fumar, sin embargo, las intervenciones para dejar de fumar deben tomar en cuenta todos los síntomas que se experimentan en la fase lútea.

Vacuna contra la COVID-19 y menstruación, desde el desconocimiento a la información: revisión sistemática / Vaccine against COVID-19 and menstruation, from ignorance to information: a systematic review

La creación de una vacuna para enfrentar la pandemia de COVID-19 conllevó un vacío de información sobre las posibles alteraciones del ciclo menstrual. El objetivo fue verificar las posibles alteraciones que se pudiesen haber generado en el ciclo menstrual de las mujeres posterior a la inoculación de la vacuna contra la COVID-19. Se realizó una revisión sistemática en las bases bibliografías Medline, Medline Complete, LILACS, CINAHL y ScIELO, utilizando los descriptores “Women”, “Woman”, “Fertile period”, “Vaccination”, “Mass vaccination”, “Immunization”, “COVID-19 vaccines”, “SARS-CoV-2 infection”, “COVID-19”, “Menstrual cycle”, “Menstruation”, “Endometrial cycle”, “Dysmenorrhea” y “Menstruation disturbances”. Mediante la utilización del protocolo PRISMA, de los 319 artículos localizados, 17 fueron incluidos en el análisis. La mayoría de los estudios incluyeron, principalmente, las vacunas Pfizer, Moderna, AstraZeneca y Johnson&Johnson/Janssen con una a tres dosis administradas. El porcentaje de ciclos menstruales alterados fue del 8,0% al 77,8%, y la alteración con mayor frecuencia referida fue la duración del ciclo menstrual, que fue desde 0,3 hasta 12 días de retraso de la menstruación. Todos los estudios refieren cambios en el ciclo menstrual con diversas prevalencias, con y sin significación estadística; sin embargo, también concluyen que estas alteraciones son reversibles y en un corto periodo de tiempo.

The creation of a vaccine to face the COVID-19 pandemic, led to an information gap on possible alterations of the menstrual cycle. The objective was to verify the possible alterations that could have been generated in the menstrual cycle of women, after the inoculation of the vaccine against COVID-19. A systematic review was carried out in the Medline, Medline Complete, LILACS, CINAHL and ScIELO bibliographic databases, using the descriptors “Women”, “Woman”, “Fertile period”, “Vaccination”, “Mass vaccination”, “Immunization”, “COVID-19 vaccines”, “SARS-CoV-2 infection”, “COVID-19”, “Menstrual cycle”, “Menstruation”, “Endometrial cycle”, “Dysmenorrhea” and “Menstruation disturbances”. Using the PRISMA protocol, of the 319 articles located, 17 were included in the analysis. Most of the studies mainly included the Pfizer, Moderna, AstraZeneca and Johnson&Johnson/Janssen vaccines with one to three doses administered. The percentage of altered menstrual cycles ranged from 8.0% to 77.8%, and the most frequently reported alteration was the length of the menstrual cycle, which occurred from 0.3 to 12 days late in menstruation. All the studies refer to changes in the menstrual cycle with different prevalences, with and without statistical significance; however, the same studies also conclude that these alterations are reversible and in a short period of time.

Características e diferenças nos sintomas dos períodos menstrual e pré-menstrual em mulheres sedentárias / Characteristics and differences in the symptoms of themenstrual and premenstrual periods in sedentary women

Objetivo: estabelecer as diferenças de sintomas físicos e mentais nos períodos menstrual e pré-menstrual em mulheres sedentárias. Métodos: estudo transversal, por questionário, respondido por 77 mulheres saudáveis, de 18 a 35 anos, sedentárias e que não fizessem uso de anticoncepcional continuamente. O questionário incluiu questões sobre dados antropométricos, sintomas físicos e mentais nos períodos menstrual e pré-menstrual. O teste Mann-Whitney comparou os momentos menstrual e pré-menstrual. Resultados: no período menstrual, em uma escala numérica de 0 a 10 pontos, observou-se maiores queixas de dor (7/10), mau humor (7/10), desânimo (8/10), irritabilidade (8/10), ansiedade (7/10), choro (7/10), raiva (9/10) e impacto nas atividades de vida diárias (AVDs) (7/10). Já no período pré-menstrual observou-se queixas de cefaleia (5/10), edema/retenção hídrica (6/10), mau humor (6/10), tristeza (6/10), irritabilidade (7/10), choro (7/10) e raiva (6/10). Quando comparados os períodos menstrual e pré-menstrual, o período menstrual apresentou piores sintomas de dismenorreia (P<0,05), lombalgia (P<0,05), dor nos membros inferiores (P<0,05), dificuldade de concentração (P<0,05), aumento do sono (P<0,05) e desânimo (P<0,05). As voluntárias apontaram 14 sintomas piores, com intensidade igual ou maior que 7 no período menstrual, e apresentaram 9 sintomas com intensidade igual ou maior que 7 no período pré-menstrual. Conclusão: os sintomas no período menstrual são mais intensos quando comparados ao período pré-menstrual e podem afetar AVDs. O presente estudo destaca a importância de análises e cuidados em relação ao período menstrual, já que tem grande impacto nos fatores físicos, mentais e emocionais das mulheres sedentárias.

Objective: to establish the differences in physical and mental symptoms in menstrual and premenstrual periods in sedentary women. Methods: cross-sectional study, through questionnaire, answered by 77 healthy women, aged 18 to 35 years, sedentary and who did not use contraceptives continuously. The questionnaire included questions about anthropometric data, physical and mental symptoms in menstrual and premenstrual periods. The Mann-Whitney test compared menstrual and premenstrual times. Results: in the menstrual period, on a numerical scale from 0 to 10 points, there were more complaints of pain (7/10), bad mood (7/10), discouragement (8/10), irritability (8/10), anxiety (7/10), crying (7/10), anger (9/10) and impact on ADLs (7/10). In the premenstrual period, there were complaints of headache (5/10), edema/water retention (6/10), bad mood (6/10), sadness (6/10), irritability (7/10), crying (7/10) and anger (6/10). When comparing the menstrual and premenstrual periods, the menstrual period had worse symptoms of dysmenorrhea (P<0.05), low back pain (P<0.05), pain in the lower limbs (P<0.05), difficulty concentrating (P<0.05), increased sleep (P<0.05) and discouragement (P<0.05). The volunteers reported 14 worse symptoms, with intensity equal to or greater than 7 in the menstrual period, and 9 symptoms with intensity equal to or greater than 7 in the premenstrual period. Conclusion: the symptoms in the menstrual period are more intense when compared to the pre-menstrual period and can affect the ADLs. This study highlights the importance of analysis and greater care in relation to the menstrual period, as it has a great impact on physical, mental and emotional factors in sedentary women.

Experimental pain thresholds and psychosocial features across menstrual cycle in myofascial orofacial pain compared to healthy individuals: cross-sectional study / Limiares de dor experimental e características psicossociais ao longo do ciclo menstrual na dor miofascial orofacial em comparação com indivíduos saudáveis: estudo transversal

ABSTRACT BACKGROUND AND OBJECTIVES: The hormonal impact on pain perception during the menstrual cycle is a major focus of study, and further elucidation in temporomandibular disorders (TMD) field is necessary. Thus, this cross-sectional study evaluated experimental pain thresholds, psychosocial features, and clinical pain report on TMD women across menstrual cycle versus healthy controls. METHODS: A total of 220 women's clinical files were screened, with 80 selected and divided into control group (healthy individuals, n=40) and TMD group (myofascial pain, n=40). Regarding the menstrual cycle phases, the files were divided into Pre-Luteal and Luteal. The Perceived Stress Scale (PSS), Pain Catastrophizing Scale (PCS), Mechanical Pain Threshold (MPT), Wind-up (WUR), Pressure Pain Threshold (PPT), Conditioned Pain Modulation (CPM) and Visual Analogue Scale (VAS) were analyzed at a 5% significance level, by Two-Way ANOVA test and post hoc Tukey test. RESULTS: PSS and PCS were significantly different between TMD and control group (p<0.001), regardless of menstrual cycle. Healthy individuals in the Luteal phase presented higher MPT values compared to the other phases (p<0.001). PPT showed significant difference across menstrual phases (p=0.022), but no differences in multiple comparisons. VAS values showed no difference between menstrual cycle phases (p=0.376). CONCLUSION: Finally, healthy individuals in the Luteal phase have higher MPT and PPT values on the orofacial region. Pain report in patients with TMD showed no difference throughout the menstrual cycle, showing that small alterations on experimental pain thresholds may not be clinically relevant. The presence of chronic pain seems to be more related to psychosocial features than hormonal fluctuations.

RESUMO JUSTIFICATIVA E OBJETIVOS: O impacto do ciclo menstrual na percepção da dor é um foco importante de estudo, sendo necessária uma maior elucidação na disfunção temporomandibular (DTM). Assim, este estudo transversal avaliou limiares de dor experimental, características psicossociais e relatos de dor em mulheres com DTM ao longo do ciclo menstrual, comparadas com controles saudáveis. MÉTODOS: 220 prontuários de mulheres foram analisados, sendo 80 selecionados para os grupos de controle (saudáveis, n=40) e DTM (dor miofascial, n=40). Nas fases do ciclo menstrual, as pacientes foram divididas nas categorias Pré-Luteal e Luteal. Os instrumentos Escala de Estresse Percebido (PSS), Escala de Pensamentos Catastróficos (PCS), Limiar de Dor Mecânica (MPT), Wind-up Ratio (WUR), Limiar de Dor à Pressão (PPT), Modulação Condicionada da Dor (CPM) e Escala analógica visual (EAV) foram analisados com nível de significância de 5%, pelos testes ANOVA de dois fatores e Tukey post hoc. RESULTADOS: As escalas PSS e PCS foram significativamente diferentes entre os grupos DTM e controle (p<0,001), independentemente do ciclo menstrual. Indivíduos saudáveis na fase luteal apresentaram MPT maior em comparação com outras fases (p,0,001). O PPT mostrou diferença significativa entre as fases menstruais (p=0,022), sem diferença nas comparações múltiplas. Os valores da EAV não apresentaram diferença entre as fases menstruais (p=376). CONCLUSÃO: Indivíduos saudáveis na fase luteal têm MPT e PPTl maior na região orofacial. Os relatos de dor em pacientes com DTM não mostraram diferença ao longo do ciclo menstrual, indicando que pequenas alterações nos limiares experimentais podem ser clinicamente relevantes. A presença de dor crônica parece estar mais relacionada com características psicossociais do que com flutuações hormonais.

Uso de anticonceptivos y conocimiento del periodo fértil del ciclo menstrual en adolescentes

Introducción: La comprensión de los cambios fisiológicos que se presentan en las mujeres adolescentes son fundamentales para el cuidado de su salud sexual. Esto favorece un comportamiento anticonceptivo orientado a la elección de métodos seguros y eficaces. Objetivo: Establecer la asociación entre el uso de métodos anticonceptivos y el conocimiento del periodo fértil del ciclo menstrual en adolescentes peruanas. Métodos: Estudio transversal basado en el análisis secundario de la Encuesta Demográfica y de Salud Familiar del año 2021. La muestra fue de 717 de mujeres adolescentes con registro completo en las bases de datos. Se calcularon recuentos ponderados, no ponderados y se aplicó la prueba ji cuadrado con un 95 % de nivel de confianza. Resultados: El 19 % de las adolescentes reconocen el periodo fértil del ciclo menstrual y 6,3 % refirió que este periodo sucede durante la menstruación. El 80,8 % de las mujeres que cursan la adolescencia temprana, no conocen el momento del periodo. Respecto al uso de anticonceptivos, el 21,5 % era usuaria de preservativos y 16,3 % de inyectables; no obstante, 47 % señaló que no utilizaban ningún anticonceptivo. El 53,5 % de las adolescentes en etapa tardía indicaron que sí utilizan anticonceptivos. Entre las que son usuarias de estos métodos, 86,3 % no reconocen el periodo fértil. Conclusiones: En las adolescentes, el uso de métodos anticonceptivos no se asocia de manera significativa con el conocimiento que tienen acerca del periodo fértil del ciclo menstrual.

Introduction: The understanding of the physiological changes that occur in adolescent women are essential for the care of their sexual health. Thus, this favors a contraceptive behavior oriented to the choice of safe and effective methods. Objective: To establish the association between the use of contraceptive methods and the knowledge of the fertile period of the menstrual cycle in Peruvian adolescents. Methods: Cross-sectional study based on the secondary analysis of the 2021 Demographic and Family Health Survey. The sample consisted of 717 adolescent women with complete registration in the databases. Weighted and unweighted counts were calculated; and the Chi square test was applied at a 95% confidence level. Results: 19% of adolescents recognize the fertile period of the menstrual cycle and 6.3% reported that this period occurs during menstruation. In addition, 80.8% of women in early adolescence do not know the time of their period. Regarding the use of contraceptives, 21.5% were users of condoms and 16.3% of injectables; however, 47% indicated that they did not use any contraceptive. 53.5% of late-stage adolescents indicated that they do use contraceptives. Among those who are users of these methods, 86.3% do not recognize the fertile period. Conclusions: In adolescents, the use of contraceptive methods is not significantly associated with the knowledge they have about the fertile period of the menstrual cycle.

Treatment approach to a patient with catamenial epilepsy. case report

ABSTRACT Introduction: Catamenial epilepsy refers to the worsening or exacerbation of seizures due to hormonal changes during the menstrual cycle. It is thought to be secondary to the neuroactive properties of endogenous steroid hormones and the natural cyclic variation in their serum levels throughout the menstrual cycle. Case presentation: A 31-year-old female patient from Bogotá (Colombia) was admitted to the emergency department due to an episode of tonic-clonic seizure associated with the menstrual period. Since the onset of the seizures was related to menstruation (every 28 days), it was established that the patient had structural focal epilepsy with catamenial features. Advantages of medical vs. surgical treatment were discussed during a multidisciplinary medical board and it was decided to start pharmacological treatment with progestogens, which resulted in complete remission of the seizures as established during a follow-up visit. Conclusions: Catamenial epilepsy should be considered as a cause of epilepsy refractory to antiepileptic medications. Furthermore, it should be approached from a multidisciplinary perspective and its management should be focused on improving the patients' quality of life.

RESUMEN Introducción. La epilepsia catamenial se define como un empeoramiento o la exacerbación de las crisis epilépticas en relación con el cambio hormonal durante el ciclo menstrual femenino. Se cree que esta se produce por las propiedades neuroactivas de las hormonas esteroides endógenas y la variación cíclica natural en sus niveles séricos a lo largo de dicho ciclo. Presentación del caso. Mujer de 31 años de Bogotá (Colombia), quien fue llevada al servicio de urgencias por un episodio de crisis epiléptica con convulsiones tonicoclónicas asociado al período menstrual. Debido a que la aparición de las crisis epilépticas se asociaba con la menstruación (cada 28 días), se estableció que la paciente presentaba epilepsia focal estructural de características catameniales. En junta médica multidisciplinar se discutieron las ventajas del manejo médico y el manejo quirúrgico, y se decidió instaurar tratamiento farmacológico con progestágenos, el cual, tras seguimiento, evidenció supresión total de las crisis. Conclusiones. La epilepsia catamenial debe considerarse como una causa de epilepsia refractaria al tratamiento antiepiléptico. Además, su abordaje debe ser multidisciplinario y su tratamiento debe ir enfocado a mejorar la calidad de vida de los pacientes.

Percepción de cambios en el ciclo menstrual posteriores a la vacunación contra SARS-CoV-2 / Perception of menstrual cycle changes following SARS-CoV-2 vaccination

Resumen OBJETIVO: Identificar si la vacunación contra la COVID-19 se asocia con cambios en el patrón menstrual. MATERIALES Y MÉTODOS: Estudio observacional y transversal anónimo efectuado entre el 4 y 29 de octubre del 2021 en un grupo de mujeres que completaron un cuestionario elaborado para saber si hubo cambios en el ciclo menstrual posteriores a la vacunación. La encuesta se aplicó durante un periodo de cuatro semanas. Para el análisis estadístico se utilizó el programa SPSS. Los cambios antes y después de la aplicación de la primera y segunda dosis de la vacuna contra COVID-19 se evaluaron con una prueba t de muestras pareadas y χ2. RESULTADOS: Se reunieron 4501 pacientes de las que se excluyeron 1815 por no cumplir con los criterios de inclusión; al final quedaron para el análisis 2686. De éstas el 37.9% (n = 1018) tuvieron cambios en el ciclo menstrual posteriores a la vacunación contra COVID-19; en 61.8% (n = 630) fueron en la cantidad del sangrado. De las mujeres que reportaron cambios en el ciclo menstrual, el 64.34% (n = 655) fueron posteriores a la aplicación de vacunas tipo ARN mensajero (35.06%; p = 0.19, IC95%: -0.35-0.19). En relación con la cantidad de dosis aplicadas 72.10% (n = 734) reportaron modificaciones en el ciclo menstrual después de la segunda vacuna (p = 0.01, IC95%: 0.58-0.98). CONCLUSIONES: La vacunación contra COVID-19 se asocia con pequeños cambios en el ciclo menstrual, sin significación estadística. Las mujeres que reciben dos dosis de la vacuna tuvieron cambios en la cantidad del sangrado.

Abstract OBJECTIVE: Identify whether vaccination against COVID-19 is associated with changes in menstrual pattern. MATERIALS AND METHODS: An anonymous observational, cross-sectional to be held from October 4 to 29, 2021 was conducted in a group of women who completed a questionnaire designed to inquire about changes in the menstrual cycle following vaccination. The survey was administered over a four-week period. SPSS software was used for statistical analysis. Changes before and after the application of the first and second doses of COVID-19 vaccine were evaluated with a paired samples t-test and 2. RESULTS: 4501 patients were collected of whom 1815 were excluded because they did not meet the inclusion criteria; in the end 2686 remained for analysis. Of these, 37.9% (n = 1018) had changes in the menstrual cycle following COVID-19 vaccination; in 61.8% (n = 630) it was in the amount of bleeding. Of the women who reported menstrual cycle changes, 64.34% (n = 655) were after application of messenger RNA vaccines (35.06%; p = 0.19, 95%CI: -0.35-0.19). In relation to the number of doses applied 72.10% (n = 734) reported modifications in the menstrual cycle after l second vaccine (p = 0.01, CI95%: 0.58-0.98). CONCLUSIONS: Vaccination against COVID-19 is associated with small changes in the menstrual cycle, without statistical significance. Women receiving two doses of vaccine had changes in the amount of bleeding.

Menstrual cycle among adolescents: girls' awareness and influence of age at menarche and overweight / Ciclo menstrual em adolescentes: percepção das adolescentes e influência da idade de menarca e excesso de peso

Abstract Objective: To characterize the menstrual cycle (regularity and menstrual flow length), the prevalence of dysmenorrhea and self-monitoring of the cycle in students from Lisbon region, and explore the effect of chronological age, age at menarche and body mass index (BMI) on menstrual disorders. Methods: This is a cross-sectional study with 848 girls aged 12-18 years. A questionnaire about the sociodemographic context and characteristics of the menstrual cycle, and weight and height measures were assessed. BMI was classified according to International Obesity Taskforce criteria. A descriptive analysis of the variables was made, and Odds Ratios (ORs) and 95% confidence intervals (95%CIs) were determined. Results: Mean age at menarche was 12.4 years and mean BMI was 22.0kg/m2. Among adolescents, 59% have regular menstrual cycle, 83% have menstrual flow length of ≤6 days. 88% suffered from dysmenorrhea, among which 8,7% declare absenteeism from school and 49% took pain medication, and 65% self-monitor their menstrual cycle. Higher maternal education was associated with a higher self-monitoring of menstrual cycle among the sample (OR 1.60; 95%CI 1.15-2.17). Girls with menarche <12 years-of-age are more likely to have menstrual flow length of >6 days (OR 1.73; 95%CI 1.19-2.51) and dysmenorrhea (OR 1.87; 95%CI 1.11-3.16) than those with menarche ≥12 years-of-age. No significant association between BMI and menstrual cycle variables was observed. Conclusions: The results suggest that menstrual disorders are frequent and may be associated with early menarche, but not with BMI. It is important to encourage self-monitoring of the menstrual cycle to detect menstrual disorders timely and promote health and well-being.

Resumo Objetivo: Caracterizar o ciclo menstrual (regularidade e duração da menstruação), prevalência de dismenorreia e automonitoramento do ciclo em estudantes da região de Lisboa, e explorar o efeito da idade cronológica, idade de menarca e índice de massa corpórea (IMC) nos distúrbios menstruais. Métodos: Este é um estudo transversal com 848 meninas entre 12 e 18 anos. Foi aplicado um questionário sobre contexto sociodemográfico e características menstruais e feita a medição do peso e altura. O IMC foi classificado pelos critérios da International Obesity Taskforce. Fez-se uma análise descritiva das variáveis e determinaram-se Odds Ratio (p<0,005; IC95%). Resultados: A média da idade de menarca foi 12.4 anos e do IMC foi de 22.0kg/m2. Entre as jovens, 59% afirmaram ter ciclo menstrual regular, 83% menstruação com duração ≤6 dias, 88% sofrem de dismenorreia, entre as quais 8,7% faltaram à escola e 49% consumiram analgésicos, e 65% automonitoram o ciclo menstrual. Uma educação materna elevada está associada a maior monitorização do ciclo menstrual entre as jovens (OR 1,60; IC95% 1,15-2,17). Meninas com idade de menarca <12 anos têm maior chance de ter menstruação com duração >6 dias (OR 1,73; IC95% 1,19-2,51) e dismenorreia (OR 1,87; IC95% 1,11-3,16) do que aquelas com menarca ≥12 anos. Não se observou associação entre o IMC e as características menstruais. Conclusões: Os resultados sugerem que os distúrbios menstruais são frequentes nas adolescentes e podem estar associados com a menarca precoce, mas não com o IMC. É importante incentivar a automonitoramento do ciclo menstrual para detectar adequadamente as perturbações menstruais e promover a saúde e bem-estar.

Neumotórax catamenial

RESUMEN Introducción: El neumotórax catamenial es aquel neumotórax espontáneo y recurrente que se presenta relacionado con el ciclo menstrual. Más frecuente en mujeres con edad fértil por encima de los 30 años de edad y a predominio del hemitórax derecho. El diagnóstico primario es difícil y el tratamiento que mejores resultados registra es la cirugía por técnicas de mínimo acceso, asociada a tratamiento hormonal. Objetivo: Presentar un caso de neumotórax catamenial, sus características clínicas y el procedimiento videotoracoscópico empleado. Caso clínico: Paciente de 48 años de edad, con antecedentes de dolor torácico y tos al inicio de la menstruación. Además, dos neumotórax espontáneos derechos anteriores. Ingresó de urgencia con el diagnóstico de neumotórax espontáneo derecho. Se realizó biopsia, frenorrafia y pleurodesis por videotoracoscopía. Conclusiones: Los elementos clínicos y radiológicos inducen a pensar en el diagnóstico de neumotórax catamenial, apoyado por la presencia de fenestraciones diafragmáticas y la no reaparición del cuadro de neumotórax después del cierre de los defectos diafragmáticos y el tratamiento satisfactorio con pleurodesis con talco, por cirugía de mínimo acceso.

ABSTRACT Introduction: The catamenial pneumothorax is that spontaneous and recurrent pneumothorax related with the menstrual cycle. More frequent in women with fertile age above the 30 years of age and predominance of the right hemithorax. The primary diagnosis is difficult and the treatment that best results recorded is the surgery by minimal access techniques associated with hormone treatment. Objective: Present a case of catamenial neumothorax, to describe their clinical characteristics and the videothoracoscopic proceeding used. Clinical case: 48 years old female patient, with history of chest pain and coughing at the beginning of menstruation and having suffered two spontaneous rights pneumothorax. We performed biopsy, phrenorraphy and pleurodesis by videothoracoscopy, after 18 months the symptomatology did not reappear. Conclusions: The clinical and radiological elements induce to think of the diagnosis of catamenial pneumothorax, supported by the presence of diaphragmatic fenestrations and the not reappearance of the pneumothorax frame after the closure of the diaphragmatic defects and satisfactory treatment with talc pleurodesis by minimal access surgery.

Fatores associados à síndrome pré-menstrual e ao transtorno disfórico pré-menstrual em estudantes da área de saúde / Factors associated with premenstrual syndrome and dysphoric disorder in health students

O estudo avaliou a frequência da síndrome pré-menstrual (SPM) e do transtorno disfórico pré-menstrual (TDPM) e fatores associados entre estudantes de cursos da área de saúde em uma universidade no Recife, Brasil. Realizou-se um corte transversal envolvendo 649 estudantes entre 18 e 47 anos, no período de setembro/2016 a março/2017. As estudantes que aceitaram participar do estudo e assinaram o termo de consentimento livre e esclarecido responderam a um questionário autoaplicável com dados sociodemográficos, hábitos de vida e antecedentes ginecológicos, bem como questões relacionadas aos critérios diagnósticos de SPM/TDPM. A maioria das estudantes tinha entre 18 e 24 anos (83,2%), era solteira (92,1%), morava com os pais (77,0%) e não trabalhava (84,4%). A frequência de SPM simples foi de 23,3% e da TDPM, de 26,7%. Os sinais e sintomas físicos foram os mais frequentes (84,1%) entre as estudantes com SPM. As 173 estudantes com TDPM relataram como sintomas mais frequentes a irritabilidade (89,6%) e a ansiedade (87,3%) acentuadas. O teste de qui-quadrado foi utilizado para comparar as proporções entre os fatores associados à SPM e ao TDPM, considerando p < 0,05. Os fatores de risco que tiveram associação estatística com a ocorrência de SPM/TDPM foram o índice de massa corporal (IMC) < 25 (p = 0,01) e irregularidade dos ciclos (p = 0,04).(AU)

This study evaluated the frequency of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) and associated factors among university students in health courses in Recife, Brazil. A cross-sectional study was carried out involving 649 students aged 18 to 47 years between September 2016 and March 2017. Students who agreed to participate in the study and signed a free informed consent form, was invited to answer a self-administered questionnaire with socio-demographic data, lifestyle and gynecological history, as well as issues related to the diagnostic criteria of PMS/PMDD. Most students were between 18 and 24 years old (83.2%), single (92.1%), living with parents (77.0%) and did not have a job (84.4%). The frequency of simple PMS was 23.3% and PMDD was 26.7%. Physical signs and symptoms were the most frequent (84.1%) among students with PMS. The 173 students with PMDD reported more frequent symptoms of irritability (89.6%) and anxiety (87.3%). The Pearson chi-square test was used to compare the proportions of the factors associated with PMS and PMDD, considering p < 0.05. BMI < 25 (p = 0.01) and cycle irregularity (p = 0.04) were the factors who had a statistically significant association with the occurrence of PMS/PMDD.(AU)

Estudo comparativo da qualidade do sono e insônia entre mulheres no climatério e com ciclo menstrual regular / Comparative study of sleep quality and insomnia among women in the climax and with regular menstrual cycle

Climatério é a passagem entre o período reprodutivo e não reprodutivo da mulher, caracterizado pelos fogachos e sudorese que geram alterações em sua qualidade de vida, podendo interferir no sono e nas atividades rotineiras. OBJETIVO: Avaliar a qualidade do sono e nível de insônia de mulheres no climatério e comparar com mulheres de ciclo menstrual regular. MÉTODO: A coleta de dados foi realizada de janeiro a abril de 2018. Foram coletados pessoais, data da última menstruação, uso de medicações, se pratica atividade física, uso de bebida alcoólica ou cigarro, além de dados antropométricos. Aplicou-se 3 questionários: o Índice Menopausal de Kupperman (IMK), aplicado nas mulheres que estavam no climatério; Índice de Qualidade do Sono de Pittsburgh (PSQI-BR) e o Índice de gravidade da insônia. RESULTADOS: A amostra foi constituída por 53 mulheres sendo 30 com ciclo menstrual regular e 23 no período do climatério. A média de idade foi de 45±9 anos, peso de 70±7 kg e altura de 158 ±4 cm. Observou-se que em relação à gravidade da sintomatologia climatérica, 61% das mulheres obtinham sintomas moderados e apresentavam qualidade do sono ruim onde apenas as mulheres no climatério foram avaliadas com presença de distúrbio do sono e 67% das mulheres que estavam no climatério obtinham insônia leve a moderada. Houve diferença significativa entre a qualidade do sono (p=0,001) e a gravidade da insônia (p=0,014) entre os grupos. CONCLUSÕES: Mulheres climatéricas possuem pior qualidade do sono e insônia leve a moderada em comparação com mulheres que menstruam regularmente.

Climacteric is the passage between the reproductive and non-reproductive period of women, characterized by hot flushes and sweating that generate changes in their quality of life, which may interfere with sleep and routine activities. OBJECTIVE: To evaluate the sleep quality and insomnia level of climacteric women and compare with women of regular menstrual cycle. METHODS: Data were collected from January to April 2018. Personal data, date of last menstruation, use of medication, physical activity, alcohol or cigarette use, and anthropometric data were collected. Three questionnaires were applied: the Kupperman Menopausal Index (IMK), applied to women who were in the climacteric; Pittsburgh Sleep Quality Index (PSQI-BR) and Insomnia Severity Index. RESULTS: The sample consisted of 53 women, 30 with regular menstrual cycle and 23 during climacteric. The average age was 45 ± 9 years, weight 70 ± 7 kg and height 158 ± 4 cm. Regarding the severity of climacteric symptoms, 61% of women had moderate symptoms and had poor sleep quality where only women in the climacteric were evaluated with the presence of sleep disorder and 67% of women in the climacteric had insomnia. mild to moderate. There was a significant difference between sleep quality (p = 0.001) and insomnia severity (p = 0.014) between groups. CONCLUSIONS: Climacteric women have worse sleep quality and mild to moderate insomnia compared to women who regularly menstruate.

Acceptability and safety of the menstrual cup: A systematic review of the literature / Aceptabilidad y seguridad de la copa menstrual: revisión sistemática de la literatura

RESUMEN Objetivo: realizar una búsqueda sistemática de la literatura para evaluar la aceptabilidad y seguridad de la copa menstrual como producto de higiene genital femenina. Materiales y métodos: se realizó búsqueda en las bases de datos PubMed, Cochrane Library, Scopus, PopLine y Google Scholar, desde 1966 hasta julio de 2019. Se utilizaron los términos: "Menstrual" AND "Cup" OR "Copa" AND "Menstrual". Se incluyeron estudios cuantitativos, cualitativos y mixtos, series y reportes de caso publicados en inglés y español que hubieran evaluado la copa menstrual en mujeres en edad reproductiva. Los estudios fueron selecciona- dos y los datos fueron extraídos por dos evaluadores de manera independiente. Como resultado primario se evaluó la aceptabilidad y seguridad. La síntesis de información se presenta de manera narrativa. Resultados: se encontraron 737 títulos para revisión inicial. Finalmente, se incluyeron 38 estudios. La copa menstrual tiene una aceptabilidad que varía entre el 35 y el 90 %. Del 10 al 45 % la encontraron difícil de usar. Fue descrita como más cómoda comparada con el tampón y la toalla higiénica de fabricación industrial. La continuidad de su uso está entre el 48 y el 94 %. En cuanto a la seguridad se presentó un caso de síndrome de choque tóxico, uno de atrapamiento mecánico, uno de alergia al producto y mayor riesgo de expulsión en usuarias del dispositivo intrauterino. Conclusión: la copa menstrual es una alternativa cómoda, segura y eficiente para la higiene mens- trual. Se requieren más estudios controlados alea- torizados y cohortes prospectivas a largo plazo para determinar el riesgo de complicaciones por una exagerada colonización bacteriana o menstruación retrógrada.

ABSTRACT Objective: To conduct a systematic review of the literature and assess the acceptability and safety of the menstrual cup as a feminine hygiene product. Materials and methods: A search was conducted in the PubMed, Cochrane Library, Scopus, PopLine and Google Scholar databases for publications be- tween 1966 and July 2019. The terms ("Menstrual" AND "Cup") OR ("Copa" AND "Menstrual") were used. Quantitative, qualitative and mixed studies were included, as well as case series and case reports published in English and Spanish assessing the menstrual cup in women in childbearing age. The studies were selected and the data extracted by two reviewers working independently. Acceptability and safety were assessed as the primary result. The summary of the information is presented in narrative form. Results: Overall, 737 titles were found for initial review and, in the end, 38 studies were included in this work. The acceptability of the menstrual cup ranges between 35 % and 90 %. Between 10 to 45 % of women found it difficult to use. It was described as more comfortable when compared to tampons and pads. Continued use of the cup ranges between 48 and 94 %. In terms of safety, there was one case of toxic shock syndrome, one case of mechanical entrapment, and another case of allergy; and a higher risk of expulsion was found among intrauterine device users. Conclusion: The menstrual cup appears to be a comfortable, safe and efficient option for menstrual hygiene. Further randomized controlled studies and long-term prospective cohort studies are needed in order to determine the risk of complications due to excess bacterial colonization or retrograde menstruation.

A dismenorreia e suas consequências em estudantes universitárias no Rio de Janeiro / Dysmenorrhea and its consequences in university students in Rio de Janeiro

Objetivo: Avaliar a prevalência da dismenorreia e suas consequências em uma população universitária. Métodos: Trata-se de um estudo descritivo, transversal, com 207 mulheres entre 18 e 46 anos de idade, universitárias. Os sujeitos da pesquisa responderam a um questionário desenvolvido para esse estudo. Resultados: A prevalência global de dismenorreia, entre as universitárias, foi de 84,1%; dessas, 58,6% classificaram a dor em intensidade leve a moderada e 41,4%, em intensa. O absenteísmo escolar e a dificuldade para se concentrar nos estudos durante o período menstrual foram significativamente influenciados pela dismenorreia intensa. Entre as estudantes, 60,9% deixaram de fazer atividades físicas ou de lazer e 41% tinham dificuldade para se concentrar e estudar devido à dismenorreia. Conclusão: A dismenorreia tem uma elevada prevalência na população universitária, contribuindo para um aumento do absenteísmo escolar e para um prejuízo social. A maioria utiliza a automedicação e poucas procuram atendimento médico eletivo com a finalidade de resolver esse problema.(AU)

Objective: Evaluate the prevalence of dysmenorrhea and its consequences in a university population. Methods: A cross-sectional descriptive study with 207 female university students between 18 and 46 years. Data collection was performed through a specific questionnaire developed for this study. Results: The overall prevalence of dysmenorrhea among university was 84.1%, of which 58.6% classified the pain intensity as mild to moderate and 41.4% as severe. School absenteeism and a difficulty to concentrate on studies during the menstrual period were significantly influenced by the presence of severe dysmenorrhea, with 60.9% of students interrupting some physical or leisure activity, and 41% reporting that they had difficulty concentrating and studying due to the dysmenorrhea. Conclusion: Dysmenorrhea has a high prevalence in the university population, contributing to a significant increase in school absenteeism and impairing social life. Most students use self-medication and few seek elective medical care to resolve this problem.(AU)

Evaluación de la tasa de blastocistos euploides en fase folicular y lútea (DuoStim) en mujeres con pobre respuesta ovárica: estudio preliminar en México / Euploid blastocyst rate in follicular vs luteal phase (DuoStim) in women with poor ovarian response: Preliminary study in Mexico

Resumen: OBJETIVO: Comparar la tasa de blastocistos euploides obtenida después de la estimulación ovárica en fase folicular con la fase lútea en un mismo ciclo menstrual en pacientes con deficiente respuesta ovárica. MATERIALES Y MÉTODOS: Estudio clínico, prospectivo y comparativo llevado a cabo en el Centro de Reproducción Arcos, Nascere, entre los meses de enero a julio de 2019. Se incluyeron pacientes con pobre respuesta ovárica según los criterios de Bologna y con indicación de PGT-A. Las estimulaciones en fase folicular y lútea se efectuaron con antagonista de la GnRH y FSHr/LHr (2:1) a partir del día 3 del ciclo y 5 días después de la primera recuperación de los ovocitos. Para completar el proceso de maduración ovocitaria se utilizaron análogos de GnRH, se tomó una biopsia de trofoectodermo en día 5-7. RESULTADOS: Se estudiaron 20 pacientes. Al comparar la fase folicular con la lútea la tasa de fertilización fue de 79% (IC95%: 29-46) vs 55% (IC95%: 34-53), la tasa de blastocistos 42% (IC95%: 19-44) vs 45% (IC95%: 24-55) y la tasa de blastocistos euploides 100% (IC95%: 44-53) vs 70% (IC95%: 38-46), respectivamente. Solo la tasa de recuperación de ovocitos en metafase II mostró diferencias significativas entre ambas fases 40% (IC95%: 18-37) vs 59% (IC95%: 31-59), p = 0.0333 en la fase folicular y lútea, respectivamente. CONCLUSIONES: La estimulación ovárica bifásica (folicular-lútea), en el mismo ciclo menstrual (DuoStim), resultó en mayor tasa de recuperación de ovocitos en metafase II durante la fase lútea. Sin embargo, las tasas de desarrollo embrionario a día 5-6 (blastocistos) y de embriones euploides fueron similares entre ambas fases.

Abstract: OBJECTIVE: Euploid blastocyst rate comparison between ovarian stimulation in follicular vs luteal phase performed in the same menstrual cycle in patients with poor ovarian response. MATERIALS AND METHODS: Clinical, prospective and comparative study conducted at Centro de Reproducción Arcos S.C., "Nascere", during january-july, 2019. Patients with PGT-A indication and poor ovarian response according to Bologna criteria were included. Under a short GnRH-antagonist protocol, stimulations, both in follicular and luteal phase were performed using rFSH/rLH (2:1) from day 3 of the cycle and 5 days after the first oocyte retrieval. In addition, ovulation trigger with an GnRH agonist was used, finally, on day 5-6 of embryo development, trophoctoctoderm biopsy was performed. RESULTS: In this study, 20 patients were included; when comparing follicular phase vs luteal phase, we found that fertilization rate was 79% (95%CI 29-46) vs 55% (95%CI 34-53), blastocysts rate was 42% (95%CI 19-44) vs 45% (95%CI 24-55) and euploid embryo rate was 100% (95%CI 44-53) vs 70% (95%CI 38-46). Only the oocyte recovery rate in metaphase II showed significant differences between both phases 40% (IC 95% 18-37) vs 59% (IC 95% 31-59), p=0.0333. CONCLUSION: Biphasic ovarian stimulation (follicular/ luteal) in the same menstrual cycle (DuoStim) resulted in a higher metaphase II ooctye recovery rate during the luteal phase in comparison with the follicular phase. However, the rates of blastocysts and euploid blastocysts were similar between both phases.

Primary dysmenorrhea: assessment and treatment / Dismenorreia primária: avaliação e tratamento

Abstract Primary dysmenorrhea is defined asmenstrual pain in the absence of pelvic disease. It is characterized by overproduction of prostaglandins by the endometrium, causing uterine hypercontractility that results in uterine muscle ischemia, hypoxia, and, subsequently, pain. It is the most common gynecological illness in women in their reproductive years and one of the most frequent causes of pelvic pain; however, it is underdiagnosed, undertreated, and even undervalued by women themselves, who accept it as part of themenstrual cycle. It hasmajor implications for quality of life, such as limitation of daily activities and psychological stress, being one of themain causes of school and work absenteeism. Its diagnosis is essentially clinical, based on the clinical history and normal physical examination. It is important to exclude secondary causes of dysmenorrhea. The treatment may have different approaches (pharmacological, nonpharmacological and surgical), but the first line of treatment is the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and, in cases of women who want contraception, the use of hormonal contraceptives. Alternative treatments, such as topical heat, lifestyle modification, transcutaneous electrical nerve stimulation, dietary supplements, acupuncture, and acupressure, may be an option in cases of conventional treatments' contraindication. Surgical treatment is only indicated in rare cases of women with severe dysmenorrhea refractory to treatment.

Resumo Dismenorreia primária é definida como dormenstrual na ausência de patologia pélvica. Caracteriza-se pelo excesso de produção de prostaglandinas pelo endométrio que provocam hipercontractilidade uterina, resultando em isquemia e hipoxia do músculo uterino e, subsequentemente, dor. É a patologia ginecológica mais comum em mulheres em idade fértil e uma das causas mais frequentes de dor pélvica; contudo, é subdiagnosticada, subtratada, e até desvalorizada pelas próprias mulheres, que a aceitam como parte do ciclo menstrual. A dismenorreia tem grandes implicações na qualidade de vida, como limitação das atividades diárias e estresse psicológico, sendo uma das principais causas de absentismo escolar e laboral. O seu diagnóstico é essencialmente clínico, baseando-se na história clínica e num exame físico sem alterações. É importante excluir causas secundárias de dismenorreia. O tratamento pode ter diferentes abordagens (farmacológica, não farmacológica e cirúrgica), sendo que a primeira linha de tratamento consiste na utilização de anti-inflamatórios não esteroides (AINEs) e, em casos de mulheres que desejem contracepção, no uso de anticoncepcionais hormonais. Tratamentos alternativos, como a utilização de calor tópico, modificação do estilo de vida, estimulação elétrica nervosa transcutânea, suplementos alimentares, acupuntura e acupressão, podem ser uma opção nos casos de contraindicação da utilização dos tratamentos convencionais. O tratamento cirúrgico apenas se encontra indicado em casos raros de mulheres com dismenorreia grave e refratária aos tratamentos.

Intervention for the comprehension of menstrual cycle, body function and pregnancy in adolescents from rural context / Intervención para comprender el ciclo menstrual, funcionamiento del cuerpo y embarazo en adolescentes de contexto rural

Abstract: Objective: To measure the impact of an intervention on adolescents' knowledge of the phase of the menstrual cycle with more likelihood of pregnancy and identify its associated factors. Materials and methods: A quasi-experimental study in two rural communities. Difference-in-differences analyses was performed. Results: There was a 22.1% average reduction in wrong answers on the phase of the menstrual cycle with more likelihood of pregnancy in the intervention group versus the control group (p<0.001). We founded six factors associated with this knowledge: marry and have children, right to receive education and information on sexual and reproductive health; gender equity; use of the condom; condom self-efficacy; emergency and contraceptive pills. Conclusion: There is a prevailing need to improve -among sexuality topics- basic knowledge of reproductive biology, while at the same time insisting on the benefits of using birth control methods provided for practicing responsible sexuality.

Resumen: Objetivo: Medir el efecto de una intervención en el conocimiento de los adolescentes sobre la fase del ciclo menstrual de mayor posibilidad de embarazo e identificar sus factores asociados. Material y métodos: Estudio cuasiexperimental en comunidades rurales. Se realizó un análisis de diferencias en diferencias. Resultados: Hubo una reducción promedio de 22.1% de respuestas incorrectas sobre la fase del ciclo menstrual de mayor posibilidad de embarazo en el grupo intervención vs. control (p<0.001). Se encontraron seis factores asociados con este conocimiento: casarse y tener hijos; derecho a recibir educación e información sobre salud sexual y reproductiva; equidad de género; uso correcto del condón; autoeficacia del uso del condón y pastillas anticonceptivas y de emergencia. Conclusión: Entre las diferentes temáticas de sexualidad, prevalece la necesidad de mejorar los conocimientos básicos sobre biología de la reproducción, insistiendo a la vez sobre los beneficios que conlleva el uso de métodos anticonceptivos para ejercer una sexualidad responsable.

¿Cuál es el punto de corte más significativo de hormona antimülleriana como predictor de la respuesta ovárica, tasa de embarazo y nacido vivo? / What is the most significant cutting point of antimüllerian hormone as a predictor of the ovarian response, pregnancy rate and living born?

Resumen OBJETIVO: Evaluar la eficacia de la hormona antimülleriana en la predicción de la respuesta ovárica, tasa de embarazo y nacido vivo. MATERIALES Y MÉTODOS: Estudio retrospectivo, analítico y observacional efectuado para evaluar los ciclos de estimulación ovárica de pacientes atendidas entre el 1 de enero de 2010 y el 30 de junio de 2017 en el Centro de Reproducción Hisparep. Criterios de inclusión: límites de edad 20 y 44 años y tener ciclos menstruales regulares. Criterios de exclusión: factor masculino alterado, cavidad uterina alterada, trastornos endocrinos, antecedente de daño ovárico. Variables de estudio: concentraciones de hormona antimülleriana, ovocitos recuperados, maduros, fecundados, embriones, tasa de embarazo y nacido vivo. Las variables cuantitativas se analizaron mediante una comparación de medias con t de Student, las variables porcentuales mediante comparación de percentiles. RESULTADOS: Se evaluaron 223 ciclos, divididos en grupos según diferentes puntos de corte. En cualquier punto de corte la hormona antimülleriana predice mayor recuperación de ovocitos maduros y fecundados: 1.25 ng/mL fue el punto de corte más significativo porque predijo mayor obtención de embriones. Se observó relación entre las tasas de embarazo clínico y nacido vivo, aunque su poder predictivo fue débil. Tomar como referencia un punto de corte de 0.5 ng/mL parece predecir bajas probabilidades de nacido vivo. CONCLUSIONES: La hormona antimülleriana fue el mejor marcador de respuesta ovárica; el punto de corte más significativo fue el de 1.25 ng/mL. Hacen falta más estudios para evaluar su eficacia como predictor de bajas tasas de nacido vivo.

Abstract OBJECTIVE: To evaluate the efficacy of antimülleriana hormone in prediction of the ovarian response, pregnancy rate and live birth. MATERIALS AND METHODS: In this retrospective, analytical and observational study, ovarian stimulation cycles were evaluated at the Hisparep Reproduction Center, in a period from January 1, 2010 to June 30, 2017, the inclusion criteria were; Age from 20 to 44 years and regular menstrual cycles. The exclusion criteria; altered male factor, altered uterine cavity, endocrine disorders, antecedent of ovarian damage. The study variables; antimüllerian hormone, oocytes recovered, mature, fertilized, embryos, pregnancy rate and live birth. The quantitative variables were analyzed by means of a comparison of means, using the Student's T test, the percentage variables by means of comparison of percentiles. RESULTS: 223 cycles were evaluated, divided into groups using different cut points. It was determined that Antimullerian Hormone predicts a greater recovery of mature and fertilized oocytes using any cut point, we consider that 1.25 ng / mL was the most significant cutoff point, since it predicts higher embryo obtaining, relationship was observed in pregnancy rates clinical and live birth, although its predictive power is weak, however, using a cutoff of 0.5 ng / mL seems to predict low odds of live birth CONCLUSIONS: Antimullerian hormone is the best marker of ovarian response, we consider that 1.25 ng /mL is the most significant cut-off point, more studies are needed to evaluate its efficacy as a predictor of low rates of live birth.

Do food intake and food cravings change during the menstrual cycle of young women? / A ingestão de alimentos e os desejos por comida mudam durante o ciclo menstrual das mulheres jovens?

Abstract Objective The aim of the present study was to assess the anthropometric measures, food intake and food cravings during the menstrual cycle of undergraduate students of the faculty of nutrition. Methods A cross-sectional study was performed with 27 students from a public university in the state of Mato Grosso do Sul, Brazil, who had their food intake evaluated through a 24-hour food recall, their nutritional status evaluated based on anthropometric measures, and food cravings evaluated using the Food Desire Questionnaire. Data were collected during an evaluation in the follicular phase (between the 5th and the 9th day of the menstrual cycle) and another in the luteal phase (LP) (between the 20th and the 25th day of the menstrual cycle). For food intake variables, the analysis of variance (ANOVA) test was used, followed by the Tukey test. The Mann-Whitney test was used for the analysis of food cravings, considering a significance level of 5% (p< 0.05). Results The desire for foods rich in sugar, salt, and fat, such as chocolate, pastries, snacks and desserts were higher (p< 0.05) during the premenstrual period, although it did not reflect neither a higher energy intake nor an alteration in the distribution of macronutrients. A higher intake of carbohydrates, proteins, fibers, and calcium was observed during the LP; however, without statistical difference between the groups. There were no differences either in the intake of any food group or in the anthropometric measurements (p> 0.05). Conclusion Food cravings of nutrition students differed between the phases of the menstrual cycle; however, with no difference in food intake and in anthropometric measures.

Resumo Objetivo Verificar alterações de medidas corporais, consumo e desejos alimentares durante o ciclo menstrual de acadêmicas de nutrição. Métodos Estudo transversal com 27 estudantes de uma universidade pública do Mato Grosso do Sul, as quais tiveram seu consumo alimentar avaliado por meio de recordatório alimentar de 24 horas, estado nutricional avaliado com base em medidas antropométricas, e desejos alimentares avaliados utilizando-se o Questionário de Desejo Alimentar. Os dados foram coletados durante uma avaliação na fase folicular (entre o 5° e o 9° dia do ciclo menstrual) e outra na fase lútea (entre o 20° e o 25° dia do ciclo menstrual). Para as variáveis de consumo alimentar, utilizou-se o teste análise de variância (ANOVA, na sigla em inglês), seguido pelo teste de Tukey. Já para a análise dos desejos alimentares, utilizou-se o teste de Mann-Whitney. Foi considerado o nível de significância de 5% (p< 0,05). Resultados Os desejos por alimentos ricos em açúcar, sal e gordura, como chocolates, produtos de pastelaria, lanches e sobremesas foram maiores (p< 0,05) no momento pré-menstrual, apesar de não refletirem em maior consumo energético e tampouco em alteração na distribuição de macronutrientes. Observou-se maior consumo de carboidratos, proteínas, fibras e cálcio na fase lútea; no entanto, sem diferença estatística entre os grupos. Não foram encontradas diferenças no consumo de nenhum grupo alimentar, tampouco nas medidas antropométricas (p> 0,05). Conclusão Os desejos alimentares das acadêmicas de nutrição diferiram entre as fases; no entanto, sem diferença no consumo alimentar e nas medidas corporais.