Consecutive use of the 52 mg levonorgestrel-releasing intrauterine system: variations in bleeding patterns / Uso consecutivo do sistema intrauterino de levonorgestrel 52 mg: variações no padrão de sangramento

Abstract Objective Changes in bleeding patterns could influence the decisions of healthcare professionals to change the levonorgestrel-releasing intrauterine system (LNG-IUS) before 7 years of use, the recommended period of extended use. We evaluated changes in the bleeding patterns of users of the 52 mg LNG-IUS at the end of use of the first (IUS-1) and during the second device (IUS-2) use. Methods We performed an audit of the medical records of all women who used two consecutive LNG-IUSs at the Family Planning clinic. We evaluated the sociodemographic/gynecological variables, the length of use, and the bleeding patterns reported in the reference periods of 90 days before removal of the IUS-1 and at the last return in use of IUS-2. We used the McNemar test to compare bleeding patterns. Statistical significance was established at p < 0.05. Results We evaluated 301 women aged (mean ± SD) 32 (±6.1) years, with lengths of use of 68.9 (±16.8) and 20.3 (±16.7) months for the IUS-1 and IUS-2, respectively. No pregnancies were reported. Bleeding patterns varied significantly among women who used the IUS-2 for ≥ 7 months to 6 years when compared the bleeding patterns reported in IUS-1 use. Eighty-nine out of 221 (40%) women maintained amenorrhea and infrequent bleeding; 66 (30%) evolved to bleeding patterns with light flow, and 66 (30%) maintained or evolved to heavy flow patterns (p = 0.012). No differences were observed among the 80 women with ≤ 6 months of use. Conclusion Changes in bleeding patterns occur during the use of LNG-IUS and should not be decisive for the early replacement of the device.

Resumo Objetivo Variações no padrão de sangramento podem afetar a decisão de troca do sistema intrauterino de levonorgestrel (SIU-LNG) antes do período de uso estendido recomendado de 7 anos. Nós avaliamos mudanças no padrão de sangramento de usuárias ao final do uso do primeiro SIU-LNG 52 mg (SIU-1) e durante o uso do segundo dispositivo (SIU-2). Métodos Revisamos os prontuários de todas as mulheres que inseriram consecutivamente o SIU-LNG no ambulatório de Planejamento Familiar. Foram avaliadas as variáveis sociodemográficas/ginecológicas, o tempo de uso, e os padrões de sangramento relatados nos períodos de referência de 90 dias antes da remoção do SIU-1 e no último retorno em uso do SIU-2. Usamos o teste de McNemar para comparar os padrões de sangramento. A significância estatística foi estabelecida em p < 0,05. Resultados Analisamos os dados de 301 mulheres com idade (média ± desvio padrão [DP]) de 32 (±6,1) anos e tempo de uso de 68,9 (±16,8) e 20,3 (±16,7) meses para o SIU-1 e SIU-2, respectivamente. Nenhuma gravidez foi relatada. Os padrões de sangramento variaram significativamente durante o uso do SIU-2 (≥ 7 meses a 6 anos) em relação ao padrão relatado no SIU-1. Oitenta e nove das 221 (40%) mulheres mantiveram amenorreia e sangramento infrequente; 66 (30%) evoluíram para padrões de sangramento com fluxo leve e 66 (30%) mantiveram ou evoluíram para padrões de fluxo intenso (p = 0,012). Não foram observadas diferenças entre as 80 mulheres que utilizavam o SIU-2 há ≤ 6 meses. Conclusão Mudanças nos padrões de sangramento ocorrem durante o uso do LNG-IUS e não devem ser decisivas para a troca precoce do dispositivo.

Could semiquantitative analysis of real-time ultrasound elastography distinguish more liver parenchyma alterations of nonalcoholic fatty liver disease in patients with polycystic ovary syndrome?

ABSTRACT Objective: Nonalcoholic fatty liver disease is the commonest diffuse liver disease, of which women with polycystic ovary syndrome are at an increased risk. The aim of the present study was to assess the diagnostic value of the semiquantitative strain parameters of real-time ultrasound elastography for nonalcoholic fatty liver disease in patients with polycystic ovary syndrome. Subjects and methods: Thirty-five polycystic ovary syndrome patients with nonalcoholic fatty liver disease, 70 polycystic ovary syndrome patients without nonalcoholic fatty liver disease, and 70 healthy female controls of reproductive age were included. All participants underwent ultrasonic examination and semiquantitative analysis of real-time ultrasound elastography of the liver. Results: Main semi quantitative strain parameters, such as average strain value, differed significantly among groups polycystic ovary syndrome with nonalcoholic fatty liver disease, polycystic ovary syndrome without nonalcoholic fatty liver disease, and control (87.02 ± 10.16 vs. 96.31 ± 11.44 vs. 104.49 ± 7.28, p < 0.001). Clinical and laboratory parameters differed significantly between the two subgroups with low or high average strain value. For diagnostic value of average strain value for elevated aminotransferase, the area under the curve was 0.808 (range 0.721-0.895). In multiple linear regression analysis, polycystic ovary syndrome, waist circumference, and metabolic syndrome were stand-alone independent factors associated with average strain value among subjects without nonalcoholic fatty liver disease. Conclusion: Semiquantitative real-time ultrasound elastography analysis could distinguish liver parenchyma alterations in patients with polycystic ovary syndrome more sensitively. The diagnostic value of the proposed method for nonalcoholic fatty liver disease need further research.

Desarrollo y validación del cuestionario específico de calidad de vida relacionada con la menstruación CVM-22 / Development and Validation of the Specific Quality of Life Questionnaire Related to Menstruation CVM-22

Introducción: La menstruación frecuentemente se acompaña de dolor pélvico, nauseas, diarrea o cefaleas que puede afectar la calidad de vida durante la misma. Objetivo: Desarrollar y validar un cuestionario específico para medir la calidad de vida relacionada con la menstruación. Métodos: Se ha confeccionado el cuestionario -CVM-43 para valorar el impacto de la menstruación sobre la calidad de vida de las mujeres durante su periodo. La validez de contenido se llevó a cabo por consenso de seis jueces expertos y aportaciones de 30 mujeres. Tras depurar el cuestionario y pasar la prueba piloto, el CVM-22 se administró a 215 mujeres de 18 a 35 años. La confiabilidad del cuestionario se obtuvo aplicando el 945;Cronbach, la validez de constructo por el análisis factorial y la factibilidad por el porcentaje de ítems respondidos y tiempo de cumplimentación. Resultados: En el análisis factorial exploratorio (KMO= 0,910, X2= 2384,54, df= 231 y plt; 0,000), se identificaron tres factores que fueron posteriormente confirmados por el análisis factorial confirmatorio con una varianza del 53,94 por ciento. La fiabilidad test-retest resultó de 0,9 y la confiablidad total fue de 0,917. El tiempo medio necesario de cumplimentación fue de 2,06 ± 0,37. Conclusión: El CVM-22 presenta una buena factibilidad, confiabilidad y validez para evaluar la calidad de vida de las mujeres menstruantes de habla hispana; no obstante, es preciso realizar nuevos análisis del cuestionario con una población con mayor rango de edad y perfiles sociodemográficos distintos, y evaluar la sensibilidad de la escala, para consolidar la validación del CVM-22(AU)

Introduction: Menstruation is often accompanied by pelvic pain, nausea, diarrhea or headaches that can affect the quality of life during that period. Objective: To design and validate a specific questionnaire to measure the quality of life related to menstruation. Methods: A questionnaire -CVM-43 has prepared to assess the impact of menstruation on the quality of life for women during that period. Content validity was carried out by consensus of six expert judges and contributions from 30 women. After debugging the questionnaire and passing the pilot test, the CVM-22 was ran to 215 women aged 18 to 35 years. The reliability of the questionnaire was obtained by applying #945;Cronbach, construct validity by factor analysis and feasibility by the percentage of items answered and time of completion. Results: Three factors were identified in the exploratory factor analysis (KMO = 0.910, X2 = 2384.54, df = 231 and p lt;0.000), which were later confirmed by the confirmatory factor analysis with 53.94 percent variance. The test-retest reliability was 0.9 and the total reliability was 0.917. The average time of completion was 2.06 ± 0.37. Conclusion: CVM-22 presents good feasibility, reliability and validity to assess the quality of life of Spanish-speaking menstruating women. Nevertheless, it is necessary to perform new analyzes of the questionnaire with older population and different sociodemographic profiles, and to evaluate the scale sensitivity in order to consolidate CVM-22 validation(AU)

Desenvolvimento sexual e maturação puberal / Sexual and puberal development

Os fenômenos do desenvolvimento sexual e puberal são eventos progressivos e coordenados. Dependem de fatores cromossômicos - gênicos, gonadais e hormonais. Tais eventos nos indivíduos do sexo masculino e feminino, sendo sincrônicos, permitirão um conveniente desenvolvimento sexual e puberal. Analisar tais fenômenos é o propósito deste estudo.(AU)

The sexual and puberal modifications are coordinate and progressive during differents life phases. Many factors are involved like genic-chromosomic, gonadal and hormonal. Those events that occurred in males and females are synchronous and to create a perfect development. Our proposal is review those situations.(AU)

Influence of female hormonal fluctuation on maximum occlusal force

Hormonal fluctuations during the menstrual cycle may influence on muscular tensions and probably alter occlusal force. The aim of this study was to evaluate whether hormonal levels affect maximum occlusal force (MOF) of healthy women throughout the different phases of the menstrual cycle. Sixty complete dentate subjects who were not under use of oral contraceptives were selected to participate in this study. MOF was bilaterally evaluated on the molar region, during 3 complete menstrual cycles, using 5.65 mm-wide sensors. Measurements were carried out during each of the following menstrual cycle phases: menstrual, follicular, periovulatory and luteal, presumed by ovulation test. Data were analyzed by one-way ANOVA and Tukey-Kramer test (p<0.05). Comparisons among menstrual cycle phases showed no differences on MOF (p=0.27). Under the conditions of this study, it may be concluded that hormonal fluctuations during the menstrual cycle do not affect MOF of a sample of healthy women.

As flutuações hormonais durante o ciclo menstrual podem influenciar as tensões musculares e possivelmente alterar a força oclusal. O objetivo deste estudo foi avaliar se os níveis hormonais afetam a força máxima oclusal (FMO) de mulheres saudáveis durante as diferentes fases do ciclo menstrual. Sessenta pacientes completamente dentadas que não usavam contraceptivos orais foram selecionadas para participar neste estudo. FMO foi avaliada bilateralmente na região dos molares, durante 3 ciclos menstruais completos, utilizando sensores de 5,65 mm de espessura. As mensurações foram realizadas durante cada fase do ciclo menstrual: menstrual, folicular e lútea periovulatória, identificadas por teste ovulatório. Os dados foram analisados por ANOVA um critério seguido do teste de Tukey-Kramer (p<0,05). As comparações entre as fases do ciclo menstrual não apresentaram diferenças na FMO (p=0,27). Segundo as condições deste estudo, pode-se concluir que as flutuações hormonais durante o ciclo menstrual não afetaram a FMO de mulheres saudáveis.

[Prevalence, characteristics and factors associated with menstrual headaches in students]

Headache is a common complaint in women of reproductive age, and sometimes occurs only during menstruation. This study was carried out to determine the prevalence and characteristics of headaches associated with menstruation in university students. Nine-hundred and four women university students were selected through multistage random sampling. Headaches starting 2 days before menstruation and continuing till the end of the menstrual periods were defined as headaches associated with menstruation. The prevalence and severity of menstrual headaches and associated clinical manifestations were recorded. Mean age of participants was 21 +/- 3.5 years. Prevalence of menstrual headaches was 14.2 percent, 79.7 percent had moderate to severe headaches that caused disruption of daily activities in 4.8% of individuals. Associated symptoms included: irritability, nausea, pulsatile headache, photophobia, increased sensitivity to sounds and loss of appetite. A strong association was found between menstrual headache and the following factors: amount of menstrual hemorrhage, painful menstruation and its severity, PMS and the presence of menstrual headaches in sisters and mothers of the participants, [p<0.05]. Females with BMI higher than normal were more prone to menstrual headaches. The high prevalence of menstrual headaches underscores the need for effective intervention

Haematological and electrocardiographic variations during menstrual cycle

Menstruation coupled periodic bleeding from the blood vessels, at the time of shedding of the uterine mucosa has directed interest, more especially in the haematological changes during different phases of menstrual cycle. The present study was carried out on 30 healthy female medical students in the age group of 18 to 23 years with the normal menstrual cycle of 30 +/- 3 days. The various haematological parameter and electrocardiography were studied on the 2[nd], 11[th], 14[th] and 22[nd] day of menstrual cycle. The study reveals that the total leukocyte count and total platelet count significantly increased [p<0.001] around mid-cycle, however total eosinophil count significantly decreased [p<0.05] during the same period. Differential leukocyte count, bleeding time, clotting time, heart rate, P-R interval and Q-T interval did not show any significant change during different phases of menstrual cycle, although some mild changes were observed. This study was a moderate attempt to determine regular variation in the different haematological parameters and ECG during the different phases of menstrual cycle in normal healthy females and evaluate conflicting reports on the subjects

Acute Kidney Injury due to Menstruation-related Disseminated Intravascular Coagulation in an Adenomyosis Patient: A Case Report

The authors report a case of acute kidney injury (AKI) resulting from menstruation-related disseminated intravascular coagulation (DIC) in an adenomyosis patient. A 40-yr-old woman who had received gonadotropin for ovulation induction therapy presented with anuria and an elevated serum creatinine level. Her medical history showed primary infertility with diffuse adenomyosis. On admission, her pregnancy test was negative and her menstrual cycle had started 1 day previously. Laboratory data were consistent with DIC, and it was believed to be related to myometrial injury resulting from heavy intramyometrial menstrual flow. Gonadotropin is considered to play an important role in the development of fulminant DIC. This rare case suggests that physicians should be aware that gonadotropin may provoke fulminant DIC in women with adenomyosis.

Do all regularly menstruating women ovulate in each cycle?

Women may experience anovular menstruation due to some pathophysiological causes which can be detected either by invasive histological examination as well as noninvasive serial ultrasound test. The women who are regularly menstruating without ovulation in each cycle were identified in this study. In a tertiary level infertility care centre of Bangladesh in Dhaka infertile population was the subject of the study. The serial ultrasound noninvasive procedure is used for diagnosis of anovular menstruation and found very much helpful.

Menstrual cycle worsening of epileptic seizures in women with symptomatic focal epilepsy

INTRODUCTION: Hormonal fluctuation is responsible for worsening of epileptic seizures during the menstrual cycle. OBJECTIVE: To identify irregularities in the menstrual cycles of women with mesial temporal lobe epilepsy (MTLE) and extratemporal focal epilepsy (ETFE) and correlate the frequency of seizures during the menstrual cycles. METHOD: We evaluated prospectively women in the menacme with MTLE and ETFE. Calendars were provided for these patients, and they were asked to mark their seizure frequency according to the menses. Calendars were reviewed in each routine medical appointment. RESULTS: Thirty-nine patients with MTLE and 14 with ETFE were evaluated. We registered 211 cycles in the patients with MTLE and 49 in those with ETFE. Irregular menstrual cycles were found in 28 (28/39, 71.7%) patients with MTLE and 6 (6/14, 42.8%) with ETFE (p=0.052). Premenstrual seizure worsening was observed in 46 (21.8%) patients with MTLE and 9 (18.3%) with ETFE (p=0.596). Menstrual worsening was observed in 47 (22.2%) patients with MTLE and 15 (30.6%) with ETFE (p=0.217). Ovulatory worsening was observed in 36 (17%) patients with MTLE and 13 (26.5%) with ETFE (p=0,126). Catamenial worsening was observed in 58 (27.4%) of the patients with MTLE and in 17 (34.7%) of the patients with ETFE (p=0.315). CONCLUSION: There was no difference between the group of patients with MTLE and ETFE regarding the frequency of irregular cycles and seizure worsening during the premenstrual, menstrual, catamenial or ovulatory periods.

INTRODUÇÃO: Admite-se que a flutuação hormonal seja a responsável para a piora de crises epilépticas no período catamenial. OBJETIVO: Identificar irregularidades nos ciclos menstruais de mulheres com epilepsia de lobo temporal mesial (ELTM) e epilepsia focal extratemporal (EFET); e relacionar a frequencia de crises durante o ciclo menstrual. MÉTODO: Avaliamos mulheres na menacme, que apresentem quadro clínico laboratorial compatível com ELTM e EFET. Foram fornecidos calendários para estas pacientes e instruídas para preenchimento correto da menstruação e das crises epilépticas e serão revistos em cada consulta médica rotineira. RESULTADOS: Foram avaliadas 39 pacientes com ELTM e 14 com EFET. Registramos 211 ciclos nas pacientes com ELTM e 49 nas com EFET. Ciclos menstruais irregulares foram apresentados por 28 (71,7%) pacientes com ELTM e 14 (42,8%) com EFEP (p=0,052). Piora pré-menstrual foi observada em 46 (21,8%) pacientes com ELTM e 9 (18,3%) com EFET (p=0,596). Piora menstrual foi observada em 47 (22,2%) pacientes com ELTM e 15 (30,6%) com EFET (p=0,217). Piora ovulatória foi observada em 36 (17%) pacientes com ELTM e 13 (26,5%) com EFET (p=0,126). Piora catamenial foi observada em 58 (27,4%) das pacientes com ELTM e em 17 (34,7%) das pacientes com EFET (p=0,315). CONCLUSÃO: Não houve diferença entre os grupos de pacientes com ELTM e EFET quanto à freqüência de ciclos irregulares e piora das crises nos períodos pré-menstrual, menstrual, catamenial ou ovulatório.

Epilepsia catamenial / Catamenial epilepsy

La epilepsia catamenial se define como la presencia o el incremento de crisis epilépticas, durante o inmediatamente antes de la menstruación. Su incidencia es variable dado el subregistro de pacientes. Se describen tres patrones: perimenstrual, ovulatoria y luteal, de acuerdo con la etapa del ciclo menstrual en que aparecen. Existen diferentes teorías sobre su fisiopatología: influencia hormonal (efecto proconvulsivante de los estrógenos y anticonvulsivante de la progesterona); posibles alteraciones hidroelectrolíticas, y cambios en la farmacocinética y farmacodinámica de anticonvulsivantes. Para su diagnóstico se requiere de la presencia de crisis, la caracterización del ciclo menstrual, su duración, y niveles de progesterona y biopsia endometrial acorde a la etapa del ciclo. Dentro de las propuestas terapéuticas se encuentran el uso de acetazolamida, ajuste de anticonvulsivantes, adición de benzodiacepinas y terapia hormonal, aunque con los estudios actuales aún no hay suficientes criterios para validar la evidencia

Hormonas y epilepsia / Hormones and epilepsy

Objetivo: evaluar la influencia que tienen los esteroides sexuales sobre la excitabilidad neuronal y por ende sobre la frecuencia y severidad de las convulsiones en mujeres epilépticas. Desarrollo: se realiza una revisión de aspectos relacionados con la síntesis, el metabolismo y los mecanismos de acción de las hormonas esteroideas sobre el tejido neuronal, incluyendo su relación con los principales neurotransmisores excitatorios e inhibitorios, su influencia sobre la sobrevida, diferenciación y regeneración de las neuronas, así como sobre los estados de animo, cognición, respuesta sensitiva, y comportamiento motor, igualmente se explora la influencia que sobre el curso de la epilepsia tienen las fluctuaciones fisiológicas de las mismas a lo largo del ciclo menstrual y de las diversas etapas de la vida reproductiva, las alteraciones endocrinas mas frecuentes en mujeres epilépticas y aspectos relacionados con la epilepsia catamenial. Finalmente se hacen algunas consideraciones sobre el manejo hormonal de la epilepsia y sobre menopausia y epilepsia. Conclusiones: existe evidencia suficiente que soporta la influencia que tienen las hormonas esteroideas sobre el sistema nervioso central. El conocimiento claro de los diferentes aspectos relacionados con dicha interacción permite un acercamiento mas completo e integral al manejo de la mujer epiléptica y abre un vasto campo de investigación en esta área

¿Quién es esta desconocida que me vino?: la menstruación / Who is it this unknown that it came me?: the menstruation

Aborda todo lo relación a los cambios fisiológicos en el cuerpo de la mujer, de cómo influyen estos cambios el que más marca en la vida de la mujer es la llegada de la menstruación, este hecho esta rodeado de valores sociales culturales. Nos explica por qué ocurre, que significa, qué pasa en nuesro cuerpo, cómo podemos tener relaciones sin salir embarazadas, de cómo funciona cada uno de los órganos genitales. Menciona algunas creencias y aclaraciones que se tienen sobre la menstruación y la higiene,la comida, las plantas y la vida social

Sexo y dolor: reacción conductual de los diferentes sexos frente al sufrimiento / Behavioral reaction of the different sexes to suffering

El objetivo de la presente comunicación consiste en destacar la influencia del dolor en los distintos sexos. Numerosos estudios realizados al respecto indican que los dolores más comunes se presentan con mayor frecuencia ene l sexo femenino. Ello parecería obedecer a factores genéticos y hormonales y tanto por esos motivos como por la circunstancia en que lo padecen y además porque ciertos analgésicos no actúan con la eficiencia conque lo hacen en el varón, merece la preocupación de la ciencia pues el hecho de que la mujer pareciera tener una mejor conducta reaccional (umbral de reacción), ello no indica ausencia de sufrimiento

Homocisteína plasmática en pacientes con síndrome de ovarios poliquísticos / Plasma homocysteine to patients with polycystic ovary syndrome

Determinar los niveles de homocisteína en pacientes jóvenes con síndrome de ovarios poliquísticos y resistencia a la insulina no tratadas. 19 pacientes que padecían síndrome de ovarios polisquíticos se incluyeron en nuestro estudio. El grupo control consistió en 10 mujeres, con menstruaciones regulares y ovarios por ultrasonografía normales. Se realizaron pruebas hormonales, perfil lipídico, evaluaciones ecográficas y determinación de homocisteína. Hospital Central "Dr. Urquinaona". Maracaibo. Se encontró evidencia de niveles significativamente altos de homocisteína en pacientes con síndrome de ovarios poliquíticos al compararlas con los controles (12,3 ±3,1 vs. 6,8 ± 1,5 ng/dL; p<0,05). El nivel promedio de insulina sérica fue significativamente mayor (23,3 ± 10,4 vs. 12,4 ±1,2 mUmL; p<0.05) y los niveles de globulina fijadora de hormonas sexuales fueron significativamente menores (1,76 ± 0,6 vs. 3,5 ± 0,9 mg/mL; p<0,001) en los casos de síndrome de ovarios poliquísticos al compararlos con los controles, confirmando una mayor incidencia de este trastorno metabólico en el síndrome. Estas observaciones aportaron evidencia de diferencias significativas en las concentraciones plasmáticas de homocisteína entre pacientes con síndrome de ovarios poliquísticos normales, aunque los niveles promedio de homocisteína dentro de límites normales para ambos grupos.

Porque as mulheres menstruam / Why do women menstruate

O autor apresenta argumentação de ordem evolutiva, fisiológica, biológica, psicodinâmica e sociológica no sentido de explicar a origem, permanência e a utilidade das menstruações no gênero humano. Comenta e critica teorias recentes acerca da inutilidade das mesmas.

Hábitos higiénicos y flujo vaginal recurrente en adolescentes / Hygienic habits and recurrent vaginal flow in adolescents

Se describen las características de los hábitos higiénicos en adolescentes que asisten a una actividad educativa y su relación con el flujo vaginal recurrente. Es un estudio descriptivo realizado durante una actividad educativa llamada Hagamos de la adolescencia un festival. Los resultados se obtuvieron por intermedio de una encuesta contestada antes del módulo educativo sobre prevención del flujo vaginal. Participaron 67 mujeres con edades entre los 10 y 19 años. De ellas, 39 (58,2 por ciento) tenían flujo vaginal recurrente. Las que usaban sólo ropa interior de licra, tenían flujo vagina con más frecuencia (87,5 por ciento) comparadas con las que usaban tanto ropa interior de licra como de algodón (53,19 por ciento). Treinta y tres adolescentes (49,25 por ciento) utilizaban protector diario, y de ellas. 26 (78,78 por ciento) tenían flujo vaginal recurrente; de las 33 (49,25 por ciento) que no la usaban, sólo el 36,34 por ciento lo tenía. De las 47 adolescentes que utilizaban toalla higiénica en algún momento de su período de sangrado menstrual, 29 de ellas (61,7 por ciento tenían flujo vaginal recurrente. En la medida en que se quedaban más tiempo con la toalla higiénica aumentó el porcentaje de pacientes con flujo vaginal recurrente. La mayoría de las asistentes (52,2 por ciento), se hacían aseo perineal de forma inadecuada. Conclusiones: puede existir relación entre los malos hábitos higiénicos y el flujo vaginal recurrente en adolescentes. Para investigar esta relación es necesario hacer un estudio analítico prospectivo

Reproductive outcome following hysteroscopic lysis of intrauterine adhesions: a result of 65 cases at Ramathibodi Hospital.

We reported the reproductive outcome of 65 patients with varying degrees of IUAs who underwent hysteroscopic adhesiolysis between August 1994 and December 1996 at Ramathibodi Hospital. Of the 65 patients treated, 29 had mild adhesions, 26 had moderate adhesions, and 10 had severe adhesions. Adhesions were lysed with hysteroscopic scissors in 25, with biopsy forceps through hysteroscope in 10, with electrosurgery using a monopolar probe in 22 patients, and with resectoscope in 8 patients. The mean duration of the procedure was 15 +/- 2.1 minutes. The mean follow-up was 12 +/- 1.4 months. Of the 44 patients who originally presented with secondary amenorrhea, 40 (90.9%) have normal menses, 4 (9.1%) have hypomenorrhea. Of the 6 patients who had hypomenorrhea, 5 (83.3%) have normal menses. Cyclic abdominal pain disappeared after treatment in all patients. Of the 45 patients with IUAs and infertility, 16 (35.6%) conceived. Two (20%) of the infertile patients with initially severe adhesions conceived. Of the 5 patients with RPL treated, delivered a full term baby and the other delivered a premature baby at 29 weeks of gestation. All 18 patients who delivered, had live births. Adhesion reformation was absent in patients with initially mild and moderate adhesion but occurred in 2 out of 10 (20%) patients with severe adhesions. These two patients initially suffered from secondary amenorrhea but reported hypomenorrhea after surgery. Both of them had tuberculosis of the genital tract. There were no serious complications occurring in all 65 procedures. All 65 patients were discharged a few hours after the operation.

Age et vecu de la puberte chez la jeune fille Tunisienne

The puberty is an important period in woman life. We have tried to determine the age of the puberty, the chronology of its events and the real life of this period of preparation to reproductive life of tunisian girl student by an inquiry. The middle age of puberty is 13 years. It depends of sociological, economic and environmental factors. Knowledges about reproductive life are still insufficient for this age group bracket of high risks of non desired pregnancies and sexually transmittable diseases