Teaching menopause to health care professionals

The menopause is a stage in the life cycle that affects all women. Managing perimenopausal and postmenopausal health is therefore a key issue for all healthcare professionals, not just gynecologists. The curriculum should include terminology and definitions, assessment, diagnosis and evidence-based management strategies. Healthcare professionals should be aware that women have different perceptions and experiences of the menopause which may be determined by: age and type of menopause, pre-existing health conditions, disability, employment and adverse childhood events. Specialist services may be required for some. These include women with chronic disease, premature ovarian insufficiency or early menopause or pre-existing health conditions and disability, as well as transgender and gender-nonconforming people. The COVID-19 pandemic has changed the mode of delivering healthcare from face-to-face only to include virtual consultations. Teaching now needs to include both types of consultations. A holistic approach is required and teaching should be provided by an accredited expert. Rees M, Abernethy K, Bachmann G, et al. The essential menopause curriculum for healthcare professionals: A European Menopause and Andropause Society (EMAS) position statement. Maturitas. 2022;158:70-77. doi: https://doi.org/10.1016/j.maturitas.2021.12.001Copyright © 2023

A Cross- Sectional Assessment of Impact of COVID-19 Vaccine on Menstrual Cycle of Pharmacy and Medical Students of Qassim University, Saudi Arabia

Objectives: To determine the relationship between the COVID-19 vaccine and the menstruation and to determine the factors associated with menstrual abnormalities after COVID-19 Vaccine. Method(s): Female students from the Unaizah College of Pharmacy and Medicine at Qassim University who were over the age of menarche, had received the vaccine, were not pregnant or nursing, were not using contraceptives, did not have a history of primary ovarian insufficiency, hypothalamic menopause, or had undergone a hysterectomy were invited to participate. A universal sampling method was used to collect the data using an online method. Consequently, a total of 299 enrolled students participated in the survey. Result(s): Out of 329 registered students, 299 agreed to participate, giving a response rate of 90.88%. The mean age of the participants was 22.1 +/- 1.70, majority were unmarried (n=255;85.3%) and were from PharmD (n=206;69.8%). A total of 70(26.1%) reported to have COVID-19 infection. About 258(86.2 %) reported menstrual symptoms post-vaccination, of which 108(41.8%) reported irregular, 94(36.4 %)length of menstruation changed, for 56(21.7%) mensuration completely stopped. Only 16(6.20%) required a hospital visit to resolve post COVID vaccination menstrual symptoms. Previous COVID 19 infection significantly influenced the incidence of mensural abnormalities (p=0.03). After the second dose of the vaccine, Pfizer-BioNTech (91.3%) followed by Johnson and Johnson (66.7%), there were significant variations in the menstrual abnormalities across different vaccination types (p = 0.014). Conclusion(s): The study showed a possible link between the COVID-19 vaccine and menstrual abnormalities which needs further investigation regarding its impact on their quality of life.Copyright © 2023

An outpatient service evaluation in a UK tertiary referral centre for paediatric and adolescent gynaecology

Background: Pressure on waiting lists prompted this service evaluation in a tertiary referral centre for paediatric and adolescent gynaecology (PAG). The service is located in Bristol in England. The centre is one of 11 commissioned by NHS England to provide care for patients with congenital gynaecological anomalies, as well as seeing patients with other PAG presentations from aged 2 upwards. Alongside general PAG clinics, there is a quarterly multi-disciplinary transition clinic for children with differences in sex development and a monthly joint adult endocrinology / gynaecology clinic where patients with Turner Syndrome are seen annually. Aim(s): To collect and analyse data pertaining to the pre-Covid PAG outpatient service, to inform1 anticipated service developments aimed at reducing waiting list times for new patients and streamlining of services for certain patient groups Methods: This service evaluation was registered with the local clinical audit team (GYNAE/SE/2020-21-11). We performed a retrospective review of the electronic notes of every PAG appointment from 1st March 2019 - 29th February 2020 (pre-Covid-19 UK restrictions). A database of PAG clinics was created and then the team manually went through each appointment's notes / letters and extracted the relevant data which was entered into a Microsoft Excel spreadsheet. Result(s): There were 385 appointments during this time period. There was data available for 376 appointments and 338 of these were filled by PAG patients. 72 appointments were (21%) for primary ovarian insufficiency (POI) of late effects of childhood cancer, 53 (16%) were for patients with Turner syndrome and 48 (14%) for heavy menstrual bleeding, of which 23 (48%) were new referrals, with this being the most common reason for referral to the team. The remaining appointments were for a variety of conditions. Conclusions and Actions: Our services would benefit from streamlining to maximise capacity and reduce waiting times. To this end: - A second endocrinologist has been recruited to double capacity for the Turner Syndrome clinic2. - An adolescent heavy menstrual bleeding clinic3,4 has been set up to streamline care for these patients. This is a one-stop face-to-face clinic offering a transabdominal pelvic ultrasound scan and a telephone follow-up 3 or 6 months later - To consider a POI / late effects of childhood cancer service to run alongside the menopause and reproductive medicine clinics with psychology support5 PAG constitutes a wide range of diagnoses, and a regular assessment is helpful to ensure care can be offered as efficiently as possible.Copyright © 2023

22nd International Congress of Iranian Society for Reproductive Medicine

The proceedings contain 158 papers. The topics discussed include: the success of various endometrioma treatments in infertility: a systematic review and meta-analysis;cell therapy accompanied by natural biomaterials, a novel therapeutic strategy for primary ovarian insufficiency treatment;ovarian hyperstimulation syndrome: a new look at an old problem;role of doppler ultrasonography and 3D ultrasound in female infertility;clinical outcome of artificial oocyte activation following intracytoplasmic sperm injection;the research priorities in infertility;how old is too old for infertility treatment?;the role of sexual dysfunction in men's health;recombinant follicle-stimulating hormone in treatment of sperm DNA fragmentation;the effect of zinc on tetrahydrocannabinol-induced Sertoli cells apoptosis;and detection of SARS-CoV-2 in follicular and endocervical fluid of in vitro fertilization candidates with positive polymerase chain reaction tests.

Covid 19 Vaccine And Menstrual Symptoms In Egyptian Adolescent Female Cross Sectional Study

Objectives The study's goal is to look into the effect of COVID-19 vaccines on adolescent female menstrual cycles. Methods From October 2021 to May 2022, a cross-sectional online self-administered survey was used for the study. Adolescent females above the menarche who had received the vaccine, were single, and without a previous history of primary ovarian insufficiency were the target population (language secondary school and first year student at faculty of physical therapy Kafrelsheikh university). Regional distribution of the survey was done through social media. Results a total of (270) female with mean age ranged from 16 to 18 years, with a mean of (16.98+/- 1.796). Overall, 66.6% of female didn't feel any changes in the period after vaccination, (10.7%) had Menstrual Cramps, (9.6%) irregular menstruation, (5.9%) increase the duration of the menstruation, (7.8%) Increased amount/abundance of bleeding, (4%) Increased period frequency and (5.19%) Worsening of premenstrual symptoms, (1.4%) intermenstrual bleeding, (37%) post menstrual bleeding. there was a significant relationship between duration of menstrual cycle in days and covid -19 vaccination p = 0.014, symptoms appearance in relation to dose p =.001, severity of vaccine side effect p=.023. Conclusion The study described a bearable link between the COVID-19 vaccine and the menstrual irregularities that have negatively impacted the women's quality of life. Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.

Five-Year Assessment of Multiple Gene Variants Associated with Bone Marrow Hypocellularity, Reduced Bone Density, and Ovarian Insufficiency in Adolescence.

This study covers the 5-year interval prior to COVID-19 admission for an otherwise healthy 46,XX adolescent expanding the developmental characterization of an unusual convergence of amenorrhea and genetic mutations. The patient experienced rapid collapse of endogenous estradiol output followed by secondary amenorrhea at 13 years of age. Euploid, diffusely hypocellular bone marrow was present on biopsy, although anemia or reduced total immunoglobulin production was not identified. Bone density was 1.5 years below mean; multiple dental anomalies were also documented. While alterations in "master regulator" genes RUNX2, SALL1, and SAMD9 are usually diagnosed in early childhood when missed milestones, dysmorphic features, or chronic infection/immune impairment warrant cross-disciplinary evaluation, this study is the first known report to associate ovarian failure with adolescence with such variants. Immunoglobulin patterns, osseous histomorphology, dentition, hematology/renal screening, pelvic anatomy, ovarian reserve data, and thyroid findings are also correlated. Although severe pathology is typically encountered when any of these genes are disrupted alone, this longitudinal survey reveals that a mild phenotype can prevail if these 3 variants occur simultaneously. Periodic monitoring is planned given the unclassified status of this unique mutation set.

COVID-19 AS A CAUSE OF COMA IN ADULT ONSET VANISHING WHITE MATTER DISEASE

A 34 year old female presented with fever, diarrhoea, confusion, and a decline in mobility, having recently tested positive for COVID-19. Her medical history included patent foramen ovale, primary ovarian failure and leukoencephalopathy which had been investigated in her 20s leading to a clinical diagnosis of Vanishing White Matter disease (VWM). On admission she deteriorated rapidly with decreased GCS requiring frequent critical care review. MRI demonstrated mild progression of the cerebral atrophy and slight increase in the 'cystic' changes in the white matter. Lumbar puncture was unremarkable. EEG demonstrated widespread cerebral dysfunction with frontotemporal emphasis but without seizure activity. She was managed with supportive care recovering to her baseline function within days. VWM is a leukodystrophy caused by recessive mutations in eukaryotic initiation factor 2B (eIF2b) complex. Adult onset presentations have been described which have a slowly progressive course. Patients with VWM are known to rapidly decline with fever, and mild head injury occasionally resulting in coma. Our case high-lights the potentially devastating effects of a neurotropic virus such as COVID-19 in VWM, and the need to consider rare genetic disorders in adult patients presenting with extensive white matter abnormalities on MRI and premature ovarian failure.

Premature Ovarian Failure Related to SARS-CoV-2 Infection.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is known to have a wide spectrum of effects on the respiratory, cardiac, neurological, hematopoietic, gastrointestinal, ocular and urological systems, but there is very little information on its effects on the human ovary. Our aims are to describe a unique case that developed amenorrhea during and after SARS-CoV-2 infection and to push researchers to do more researches to understand the effects of SARS-CoV-2 infection on the ovaries. A 27-year-old female patient presented with amenorrhea. She had fever on the second day of the menstrual cycle, and her cycle had been interrupted on the same day. The patient had a sub-febrile temperature, myalgia, fatigue, sweating, loss of appetite, and mild sleep disorder. Based on clinical, laboratory, and reverse transcription polymerase chain reaction (RT-PCR) data of a nasopharyngeal swab sample, she had a positive result for SARS-CoV-2 infection. Till now there are limited publications on the effect of SARS-CoV-2 infection on the ovaries. In particular, the potential adverse effects of SARS-CoV-2 infection on fertility are unclear. Coronavirus disease 2019 (COVID-19) patients need to be followed up for a long time, and clinicians need to pay attention to menstrual disturbances, especially in young female patients. More evidence, through both epidemiologic and clinical studies, as well as long-term follow-up studies, is needed to understand the impact of this infection on the human ovary, especially in reproductive-aged women.

Bargain with the tooth fairy - The savings accounts for dental stem cells.

Despite the hard times COVID-19 has imposed on us, the Biomedical Journal strives to provide fresh and compelling reading material - to be enjoyed safely from home. In this issue, we glance behind the scenes of dental stem cell preservation for potential therapeutic use, and discover that cancer cells hijack podoplanin expression to induce thrombosis. Moreover, we learn how the helicase DDX17 promotes tumour stemness, how genetic defects in meiosis and DNA repair cause premature ovarian insufficiency, and that the brain-derived neurotrophic factor is associated with several psychiatric diseases. Further accounts relate the role of miR-95-3p in colorectal cancer, the protective power of eggplants against mercury poisoning, and the predictive value of inhibin A for premature delivery. Finally, the very rare case of adenoid cystic carcinoma in the external auditory canal receives some attention, and we get to read up on how 3D imaging and modelling combines functional and aesthetic repair of cleft lip and palate cases.