Assessing Student and Patient Perspectives on Pharmacist Prescribed Hormonal Contraceptives.

BACKGROUND: Increasing convenient, accessible, and cost effective contraceptive access is critically important. Two-thirds of US states permit pharmacists to prescribe hormonal contraceptives. Community pharmacies are ideal settings for patients to be offered contraceptive therapeutic options including hormonal contraceptives, emergency contraception (EC), and over-the-counter (OTC) oral contraception. OBJECTIVE: The objective of this study was to assess college student and community pharmacy patients' perspectives on pharmacist prescribed hormonal contraceptives, likelihood of accessing contraceptives from a pharmacist, and perspectives regarding EC and OTC oral contraception. METHODS: The researchers conducted an observational study distributed to college students and patients accessing care at community-based pharmacies from October 2022 to February 2023. The survey population included those who were 18 years or older, English speaking, and recruited both in person and online. Survey questions assessed barriers to contraception access, perspectives towards pharmacist prescribed hormonal contraception, likelihood of receiving pharmacist prescribed hormonal contraception as well as EC and OTC oral contraception at the community pharmacy. Results from the pharmacist and clinician surveys were previously published, therefore this report will focus on the student and patient data. RESULTS: Ninety-one percent of all respondents strongly agreed or agreed with pharmacist-prescribed hormonal contraception. Students and patients reported convenience, time saving, and money saving as reasons for obtaining from their pharmacist. In regard to EC, 36% reported having ever purchased from a pharmacy and 58% were extremely or somewhat likely to purchase OTC oral contraception. CONCLUSIONS: The majority of students and community pharmacy patients surveyed in Rhode Island support pharmacist prescribed hormonal contraceptives. State-level policy advancements with reimbursement for services provide pharmacists an opportunity to provide contraceptive care for all people.

Abnormal uterine bleeding and its causes. Literature review.

Based on the analysis of information from available sources of scientific literature, the article provides an overview of the problem of abnormal uterine bleeding and its causes. Preservation of women's reproductive health is an urgent problem of the whole world. AUB is a debilitating symptom that affects a large number of women and one of the most common gynecological abnormalities. АUB, as a rule, does not threaten a woman's life, but significantly decreases its quality. Menstrual disorders affect all aspects of a woman's life, even increasing the risk of premature death. Women with AUB are more likely to seek medical care due to social and physical factors, while 50% of female patients have mental health problems due to anxiety and depression. Structural causes of uterine bleeding increase as a woman ages, which can affect reproductive health. Extragenital disorders are considered one of the most frequent causes of AUB. This is explained by the features of the endometrium, the state of which is influenced by general changes in a woman's hormonal status and the functional state of some organs and systems. AUB can be caused by diseases of the thyroid gland, uncorrected diabetes, obesity, blood coagulation disorders (most often von Willebrand's disease), infectious diseases, certain drugs (corticosteroids, antipsychotic or antiepileptic drugs), climate change and diet, psychological stress, etc. Management of patients with abnormal uterine bleeding is a complex problem that should include assessment of gynecological status and consultation of related specialists (endocrinologists, cardiologists, etc.).

Influences on ethnic minority women's experiences and access to contraception in the UK: a systematic qualitative evidence synthesis.

BACKGROUND: Accessible contraception is critical for promoting the health and well-being of women and their families. In the UK, contraception is free at the point of access, but only 55% of pregnancies are planned, with negative implications for maternal and infant outcomes. In general, women from ethnic minorities use contraceptives less than white women. Barriers to the uptake of contraceptives have been identified, including perceived poor information from healthcare professionals and concerns about side effects. However, most studies do not include representative proportions of women from ethnic minorities. Evidence suggests that ethnic minority (EM) women feel targeted and coerced by healthcare professionals regarding contraception. METHODS: A systematic search of Medline, Embase, and PsycINFO via Ovid, CINAHL, and Web of Science was conducted to identify primary qualitative and mixed-methods studies exploring ethnic minority women's experience of contraception in the UK. The data were charted using thematic analysis, using both summary and synthesis. RESULTS AND CONCLUSIONS: 16 studies met the inclusion criteria, including the perspectives of 717 participants from an ethnic minority. Four overarching themes were developed: contraceptive knowledge, beliefs, family, and services. Similar to women in general, ethnic minority women have concerns about side effects, especially infertility, value the perspectives of their peers and male partners, and express a preference for female healthcare professionals. Novel perspectives included conflicting ideas about the influence of religion and stereotyping of ethnic minority women. Culturally competent consultations and a better understanding of hormonal hesitancy are essential.

A pioneer of hormonal contraception: Joseph W. Goldzieher.

On 19 July, 2024, at the age of almost 105 years, Joseph W. Goldzieher, the last survivor of the group of pioneers who created oral contraception, peacefully passed away. Here we briefly reconstruct the salient points in his long, productive life, and highlight his achievements in the development of hormonal contraception. His work is indissolubly enshrined in the complex history of hormonal contraception, from the first, fundamental observations, to the first clinical trials, both in the form of combined oestrogen-progestin oral pills and long-acting injectable contraceptives. After Pincus and his Group created an oral contraceptive containing an oestrogen and a progestin, Goldzieher was the second international scientist to conduct clinical trials of the new modality. He teamed-up with investigators in Mexico creating a fruitful, long-lasting collaboration. They produced evidence that ovulation inhibition could be achieved with all the progestins used at the time. Of importance, he was among the first to explore the possibility of using oestrogens to block ovulation, and developed the concept of sequential contraception. For all this lifetime of work, we believe he deserves to be named a 'giant in reproductive endocrinology'.

A randomized phase II trial on the addition of dutasteride to combined androgen blockade therapy versus combined androgen blockade therapy alone in patients with advanced or metastatic salivary duct carcinoma - the DUCT study protocol.

BACKGROUND: Salivary duct carcinoma (SDC) is a rare and aggressive subtype of salivary gland cancer, frequently associated with incurable recurrences and distant metastases (R/M). Proliferation of SDC relies on androgen receptor (AR) signalling, prompting the use of combined androgen blockade (CAB, i.e., luteinizing hormone-releasing hormone agonist and/or AR antagonists) to R/M SDC patients. However, only a subset of patients benefits from such treatments. We have shown that response to CAB is associated with steroid 5α-reductase 1 (SRD5A1) mRNA expression. SRD5A1 catalyses the intracellular conversion of testosterone into the more potent AR-agonist dihydrotestosterone. This conversion can be inhibited by dutasteride, a potent SRD5A1-inhibitor, which is currently prescribed for benign prostatic hyperplasia. We hypothesize that repurposing dutasteride to target AR signalling in SDC could enhance therapeutic response and clinical outcome in SDC patients. METHODS: This prospective, open-label, randomized controlled phase II clinical trial, is designed to investigate whether dutasteride as an adjunct drug to CAB improves response rate and clinical outcome in patients with AR-positive R/M SDC. Patients are divided in two cohorts based on their prior systemic treatments. In cohort A, CAB-naïve patients (n = 74) will be randomly assigned to either a control arm (Arm 1) receiving CAB (goserelin 10.8 mg/3m and bicalutamide 50 mg/OD) or an experimental arm (Arm 2) where dutasteride (0.5 mg/OD) is added to the CAB regimen. In cohort B, patients with disease progression after adjuvant or first-line palliative CAB therapy (max. n = 24) will receive goserelin, bicalutamide, and dutasteride to assess whether the addition of dutasteride can overcome therapy resistance. The primary endpoints are the objective response rate and duration of response. Secondary endpoints are progression-free survival, overall survival, clinical benefit rate, quality of life, and safety. Translational research will be performed to explore molecular target expression differences and their correlation with clinical outcome. DISCUSSION: The DUCT study addresses an unmet medical need by investigating the repurposing of dutasteride to enhance treatment response and improve clinical outcome for patients with R/M SDC, especially those with limited alternative treatment options, such as HER2-negative cases. By repurposing a registered low-cost drug, this trial's findings could be readily applied into clinical practice. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT05513365. Date of registration: August 24, 2022. PROTOCOL VERSION: Current protocol version 4.0, February 21, 2024.

Diabetes screening among women with polycystic ovary syndrome: a descriptive study of commercial claims, 2011-2019.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects 6-12% of United States women of reproductive age. Because women with PCOS are at an increased risk of developing type 2 diabetes, clinical practice guidelines from a number of organizations (e.g. American Diabetes Association, American College of Obstetricians and Gynecologists, US Preventive Services Task Force) recommend that individuals with PCOS are routinely screened for diabetes. Guidelines further indicate that an oral glucose tolerance test (OGTT) should be used for diabetes screening in women with PCOS as opposed to an A1C or fasting plasma glucose test. The purpose of this study is two-fold: 1) to estimate rates of diabetes screening among a nationwide sample of commercially insured women with PCOS and 2) to report the percentage of women screened using each test (OGTT, A1C, fasting plasma glucose) among those who were screened. METHODS: We used the MarketScan Commercial Claims database (2011-2019) to identify a sample of women aged 18-64 years with PCOS who were free from diabetes at baseline and had ≥ 5 years of continuous enrollment in their insurance plan. PCOS was ascertained using International Classification of Disease diagnosis codes (ICD-9: 256.4; ICD-10: E28.2). Diabetes screening was ascertained using Current Procedural Terminology (CPT) codes (A1C: 8303683037; Fasting blood sugar: 82947; OGTT: 82950). Diabetes screening rates were calculated for the overall study sample as well as across subgroups defined by age, overweight/obesity, hypertension, hypercholesterolemia, and vascular disease. RESULTS: In our sample of 191,110 commercially insured women with PCOS, 73.40% were screened at least once for diabetes during a five-year period. Among the women screened, 19.24% were screened using the Androgen Excess Society (AES)-recommended OGTT, 61.58% were screened using A1C, and 23.37% were screened using fasting blood sugar. CONCLUSIONS: In a sample of commercially insured individuals spanning the timeframe 2011-2019, nearly 75% of women with PCOS complied with the ACOG screening guidelines for diabetes. Although OGTT is recommended as the preferred screening tool for women with PCOS it was less commonly used than A1C and fasting blood sugar tests.

Lifestyle Medicine's Role in Common Hormonal Disorders: A Case-Based Discussion.

Hormonal disorders like PCOS (Polycystic Ovary Syndrome), autoimmune thyroid disease (AITD) including Hashimoto's thyroiditis, male hypogonadism are commonly encountered in clinical practice in the US and worldwide, with rising frequency. These typically affect patients during young or middle age, compared with other common chronic illnesses like type 2 diabetes, hypertension, atherosclerotic cardiovascular disease, where onset may usually be in middle or older age. Multiple studies point to the role of disordered lifestyle health behaviors as contributory to these endocrinopathies, and conversely therapeutic lifestyle changes leading to improvement in signs, symptoms, biochemical markers, and sequelae of these conditions. This article presents 3 different real life case studies of the conditions enlisted above and documents the positive impact of lifestyle improvements on their disease condition. Therapeutic lifestyle behaviors are an extremely useful and important component of management of these familiar endocrinologic disorders, and clinicians need to routinely counsel their patients about healthy lifestyle interventions when treating these common syndromes.

Characterization of multiple human papillomavirus types in the human vagina following ovarian hormonal stimulation.

The objective of study was to characterize HPV in vaginal samples from women being seen at the Center for Reproductive Medicine and Infertility at Weill Cornell Medicine before and following ovarian stimulation. A total of 29 women made samples available for analysis by viral metagenomics. Eighteen women were HPV-positive, six (33.3%) at their initial visit and 15 (83.3%) following hormone stimulation (p = 0.0059). Pairwise comparison of nucleotide sequences and phylogenetic analysis showed the classification sequences into two genera: Alphapapillomavirus and Gammapapillomavirus. Sequences were from 8 HPV types: HPV 51 (n = 2), HPV 68 (n = 1), HPV 83 (n = 9), HPV 84 (n = 2), HPV 121 (n = 6), HPV 175 (n = 1) and HPV 190 (n = 1). Additionally, C16b and C30 likely represent new types. In summary, multiple HPV types are present in the vagina of reproductive age women and are induced by hormone used to stimulate ovulation.

Could CT Radiomic Analysis of Benign Adrenal Incidentalomas Suggest the Need for Further Endocrinological Evaluation?

We studied the application of CT texture analysis in adrenal incidentalomas with baseline characteristics of benignity that are highly suggestive of adenoma to find whether there is a correlation between the extracted features and clinical data. Patients with hormonal hypersecretion may require medical attention, even if it does not cause any symptoms. A total of 206 patients affected by adrenal incidentaloma were retrospectively enrolled and divided into non-functioning adrenal adenomas (NFAIs, n = 115) and mild autonomous cortisol secretion (MACS, n = 91). A total of 136 texture parameters were extracted in the unenhanced phase for each volume of interest (VOI). Random Forest was used in the training and validation cohorts to test the accuracy of CT textural features and cortisol-related comorbidities in identifying MACS patients. Twelve parameters were retained in the Random Forest radiomic model, and in the validation cohort, a high specificity (81%) and positive predictive value (74%) were achieved. Notably, if the clinical data were added to the model, the results did not differ. Radiomic analysis of adrenal incidentalomas, in unenhanced CT scans, could screen with a good specificity those patients who will need a further endocrinological evaluation for mild autonomous cortisol secretion, regardless of the clinical information about the cortisol-related comorbidities.

Association of Hormonal Exposures With Grip Strength in Women >45 Years: Data From the CONSTANCES Cohort Study.

Context: Although biological findings show that estrogens are beneficial for muscular mass maintenance and bone resorption inhibition, the association of hormonal exposure with physical performance are controversial. Objective: We investigated the association of reproductive history and exogenous hormone use with hand-grip strength (GS) in women. Methods: Using the data from the CONSTANCES French prospective population-based cohort study, we ran linear mixed models to investigate the association of reproductive history and exogenous hormones use with maximal GS in 37 976 women aged 45 to 69 years recruited between 2012 and 2020. We used multiple imputation by chained equations to control missing values and corrections for multiple testing. Results: The mean age of women was 57.2 years. Mean GS was 26.6 kg. After adjustment for age and confounders, GS increased with age at menarche (ß+1 year = 0.14; 95% CI, 0.10-0.17) and duration of breastfeeding (ß for ≥10 months vs <5 months = 0.39; 95% CI, 0.20-0.59; P for linear trend <.01). Compared to nonmenopausal women, postmenopausal women had significantly lower GS (ß = -0.78; 95% CI, -0.98 to -0.58). GS was negatively associated with hormone therapy (HT) past use (ß = -0.25; 95% CI, -0.42 to -0.07). Conclusion: Our results suggested that menopausal transition was strongly associated with lower GS. However, despite our hypothesis, increased age at menarche and duration of breastfeeding were associated with higher GS and HT past users presented lower GS than HT never users. These findings could help identify women at high risk of poor physical performance.

A prediction model for gestational diabetes mellitus based on steroid hormonal changes in early and mid-down syndrome screening: A multicenter longitudinal study.

BACKGROUND: Steroid hormones (SH) during pregnancy are associated with the development of gestational diabetes mellitus (GDM). Early and mid-Down syndrome screening is used to assess the risk of Down syndrome in the fetus. It is unclear whether changes in SH during this period can be used as an early predictor of GDM. METHODS: This study was a multicenter, longitudinal cohort study. GDM is diagnosed by an oral glucose tolerance test (OGTT) between 24 and 28 weeks of gestation. We measured SH levels at early and mid-Down syndrome screening, respectively. Based on the SH changes, logistic regression analysis was used to construct a prediction model for GDM. Finally, evaluated the model's predictive performance by creating a receiver operating characteristic curve (ROC) and performing external validation. RESULTS: This study enrolled 193 pregnant women (discovery cohort, n = 157; validation cohort, n = 36). SH changes occur dynamically after pregnancy. At early Down syndrome screening, only cortisol (F) (p < 0.05, 95 % CI 4780.95-46083.68) was elevated in GDM. At mid-Down syndrome screening, free testosterone (FT) (p < 0.01, 95 % CI 0.10-0.55) and estradiol (E2) (p < 0.05, 95 % CI 203.55-1784.78) were also significantly elevated. There were significant differences in the rates of change in E2 (Fold change (FC) = 1.3425, p = 0.0072), albumin (ALB) (FC=1.5759, p = 0.0117), and dihydrotestosterone (DHT) (FC=-2.1234, p = 0.0165) between GDM and no-GDM. Stepwise logistic regression analysis resulted in the best predictive model, including six variables (Δweight, ΔF, Δcortisone (E), ΔE2, Δprogesterone (P), ΔDHT). The area under the curve for this model was 0.791, and for the external validation cohort, it was 0.799. CONCLUSIONS: A GDM prediction model can be constructed using SH measures during early and mid-Down syndrome screening.

Anatomical-Radiological Aspects and Their Influence on the Results of Pituitary Adenomas Endoscopic Endonasal Surgery.

Introduction Endoscopic endonasal surgery has globally improved postoperative results in pituitary adenomas. Material and Methods We retrospectively analyzed 101 patients who underwent endonasal endoscopic surgery for pituitary adenomas in the period from 2016 to 2021. Data on epidemiological variables, preoperative radiological factors including tumor volume, tumor appearance, cavernous sinus invasion (modified Knosp scale), degree of extension according to the SIPAP (stands for the five directions in which a pituitary adenoma can extend: suprasellar, infrasellar, parasellar, anterior, and posterior) classification, and preoperative visualization of the healthy gland on magnetic resonance imaging (MRI) were collected as well as intra- and postoperative cerebrospinal fluid (CSF) leak. As variables of interest, data on the degree of tumoral resection and preservation of hormonal function were collected. Results Among the preoperative factors related to greater tumoral resection, we found a lesser tumoral extension according to the SIPAP scale, and the absence of a postoperative CSF leak had a statistically significant relation with greater hormonal preservation. Conclusion The SIPAP classification is a simple-to-measure preoperative radiological variable that could predict the extent of resection, and, conversely, the occurrence of a postoperative CSF leak has been associated with an inferior endocrinological outcome in this type of surgery.

Exploring the Correlation Between Papillary Thyroid Carcinoma (PTC) and the Usage of Oral Contraceptive Pills Among Affected Females.

BACKGROUND: The increasing incidence of papillary thyroid carcinoma (PTC), particularly among women, has prompted an investigation into possible associated factors. The effect of oral contraceptive pill (OCP) usage is debatable, with varying and often conflicting results. It is not confirmed whether OCPs have a protective effect against thyroid cancer or an increased risk. OBJECTIVE: The objective of this study is to investigate the prevalence of OCP usage among females diagnosed with PTC at a tertiary hospital in Saudi Arabia. METHODS: The study included females aged 18 and above diagnosed with PTC. An OCP user was defined as a female exposed to OCPs for at least one month. Data collection involved chart reviews and phone interviews, and statistical analyses were conducted using Excel and SPSS. RESULTS: Among 58 female patients diagnosed with PTC, 29.3% (n=17) reported using OCPs, and 70.7% (n=41) were non-users. The ages of OCP users ranged from 26 to 56 years, with a median age of 44 years. The duration of OCP usage varied from 1 to 72 months, with a median duration of seven months. Additionally, for the non-users of OCPs, the age range was from 21 to 85 years, with a mean age of 46.4 years. The median ages for the total sample, OCP users, and non-users were 43.5, 44, and 43 years respectively. The timing of OCP usage among users varied from 1 to 35, with a mean timing of 13. CONCLUSION: The study found about one-third 29.3% (n=17) of patients diagnosed with PTC reported using OCPs. These results contribute to the ongoing debate within epidemiological studies regarding the association between PTC and various reproductive factors, including OCP use. Further research is needed to clarify this relationship and its implications on public health.

Diagnosis of Kallmann Syndrome in a Young Adult Male.

Kallmann syndrome is an anosmic variety of GnRH (gonadotropin-releasing hormone) deficiency. A young adult male with anosmia since childhood presented with features of failed sexual maturation and underwent an ultrasound of the genital system and an MRI (magnetic resonance imaging) of the brain. MRI revealed absent olfactory bulbs in bilateral olfactory grooves with hypoplastic olfactory sulci on both sides. Ultrasound showed atrophic testes, while the anterior pituitary appeared normal on MRI. The clinical, hormonal, and imaging findings were characteristic of Kallmann syndrome. MRI serves as a crucial tool in its diagnosis.

Nuances of gender affirming therapy for transgender women with spinal cord injury.

CASE DESCRIPTION: 56-year-old transgender woman with new spinal cord injury (SCI) on gender affirming hormonal therapy (GAHT) with estrogen and spironolactone. FINDINGS: After her injury, estrogen and spironolactone were discontinued, for blood clots and hypotension, respectively. Alternative options were explored. CLINICAL RELEVANCE: Little is known about GAHT in SCI for transgender women. Shared decision making should be used to navigate risks, benefits, and alternative options.

Use of systemic hormonal contraception and risk of attempted suicide: a nested case-control study.

Evidence regarding the role of hormonal contraception (HC) as a risk factor for attempted suicide is inconclusive. Thus, this study aimed to assess the associations of use of different types of systemic HC with the risk of attempted suicide in women aged 15-49 years. Data on a population-based cohort (n = 587,823) of HC users and non-users in 2017 was derived from national registers in Finland. In a nested case-control design we examined the risk of attempted suicide in relation to current HC use (past six months) via multivariable conditional logistic regression models. During the follow-up (from 2018 to 2019) there were 1.174,346 million person-years of which 818 cases of suicide attempts were observed (incidence rate: 0.70 per 1000 person-years). Use of HC, especially combined hormonal contraceptives, was not associated with a higher risk of attempted suicide compared to non-use (OR 0.68, 95% CI 0.45-1.02) after controlling for marital status, socioeconomic status, education, chronic diseases, recent delivery, recent psychiatric hospitalizations, and current use of psychotropic medications. In women without psychiatric history, current HC use (OR 0.73, 95% CI 0.58-0.91), especially ethinylestradiol-containing preparations (OR 0.54, 95% CI 0.40-0.73), was associated with a lower risk of attempted suicide. After adjusting for recent psychiatric hospitalizations and use of psychotropic medications, current use of progestin-only preparations was not associated with attempted suicide. In conclusion, current HC use was not associated with an increased risk of attempted suicide in fertile-aged women.

Menstrual Changes in Women Who Undergo Sleeve Gastrectomy in Saudi Arabia.

Introduction Obesity affects over 650 million globally, with rising rates posing significant public health challenges, especially among Saudi Arabian women. Obesity correlates with menstrual irregularities and reproductive health issues such as polycystic ovary syndrome (PCOS). Bariatric surgery (BS), particularly laparoscopic sleeve gastrectomy (LSG), is increasingly used due to its safety and effectiveness in treating obesity-related conditions. This study explores LSG's impact on menstrual cycles and fertility in Saudi women, aiming to optimize patient care and understand surgical effects on hormonal dynamics and reproductive health. Methodology It is a cross-sectional design among Saudi women post-sleeve gastrectomy from December 2023 to May 2024. Variables included age, marital status, and region, with primary outcomes focusing on menstrual cycle changes post surgery. Results Our study includes 387 participants, and demographic characteristics showed a significant proportion aged 26-35 years (n=147, 38.0%) and 36-45 years (n=119, 30.7%), with the majority being married (n=230, 59.4%). Regional distribution highlighted the south as the most represented (n=139, 35.9%), followed by the central (n=74, 19.1%). About 30.2% (n=117) reported chronic conditions. Post surgery, 70.5% (n=273) experienced menstrual changes, with regular cycles being the most common (n=102, 26.3%). Logistic regression indicated younger age as a protective factor against menstrual changes (p=0.028), while pre-surgery menstrual irregularities significantly predicted post-surgery changes (p=0.002). Regional analysis showed no significant association between geographic location and post-surgery menstrual changes (p=0.140). Overall, quality of life post-surgery was rated highly by participants, with 70.8% (n=274) giving ratings of 4 or 5. Conclusion Our study highlights a high prevalence of post-sleeve gastrectomy menstrual changes, predominantly regular cycles. Younger age appears protective, while pre-existing menstrual irregularities strongly predict postoperative changes. Regional differences did not significantly influence outcomes. Overall, participants reported high satisfaction with their quality of life post surgery.

Physiological changes in the mammary glands during a female's life.

The intricate development and physiological dynamics of the mammary glands, orchestrated by a delicate interplay of hormones, are crucial for reproductive function and lactation. Beginning with intrauterine clusters evolving into mature glands, hormonal fluctuations throughout puberty and the menstrual cycle finely tune mammary tissue growth. Oestrogens stimulate the proliferation of epithelial cells, while progesterone orchestrates the formation of lactiferous glands. During pregnancy, oestrogen and progesterone induces hyperplasia of lobules and ducts, preparing the breast for lactation. Prolactin is vital for lactation and stimulates milk production during pregnancy and postpartum. As shown by ultrasonography, physiological changes during lactation reflect glandular tissue transformation for milk secretion. Clinical and physiological changes, including increased blood flow, contribute to mammary growth and firmness, complicating clinical examination. Ultrasonographic findings reveal variability in women's glandular and fat tissue distribution, suggesting that milk production is not solely determined by anatomical factors. Though not directly linked to milk production, blood flow dynamics hint at a threshold for optimal lactation. Understanding these complex hormonal and physiological mechanisms is crucial for comprehending mammary development, function, and clinical assessment.