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Does Menses Affect the Risk of Blood Loss in Adolescent Idiopathic Scoliosis Patients Undergoing Posterior Spinal Fusion Surgeries?: A Propensity-Score Matching Study

Chiu CK, Gani SMA, Chung WH, Mihara Y, Hasan MS, Chan CYW, et al.

Spine (Phila Pa 1976), 2020 Aug 15;45(16):1128-1134.
PMID: 32205708 DOI: 10.1097/BRS.0000000000003484

STUDY DESIGN: Retrospective propensity score matching study.
OBJECTIVE: To investigate whether menses affect intraoperative blood loss in female adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF) surgeries.
SUMMARY OF BACKGROUND DATA: There were concerns whether patients having menses will have higher intraoperative blood loss if surgery were to be done during this period.
METHODS: This study included 372 females who were operated between May 2016 to May 2019. Fifty-five patients had menses during surgery (Group 1, G1) and 317 patients did not have menses during surgery (Group 2, G2). Propensity score matching (PSM) analysis with one-to-one, nearest neighbor matching technique and with a match tolerance of 0.001 was used. The main outcome measures were intraoperative blood loss (IBL), volume of blood salvaged, transfusion rate, preoperative hemoglobin, preoperative platelet, preoperative prothrombin time, preoperative activated partial thromboplastin time (APTT), international normalized ratio (INR), and postoperative hemoglobin. Postoperative Cobb angle and correction rate were also documented.
RESULTS: At the end of PSM analysis, 46 patients from each group were matched and balanced. The average operation duration for G1 was 140.8 ± 43.0 minutes compared with 143.1 ± 48.3 minutes in G2 (P = 0.806). The intraoperative blood loss for G1 was 904.3 ± 496.3 mL and for G2 was 907.9 ± 482.8 mL (P = 0.972). There was no significant difference in terms of normalized blood loss (NBL), volume of blood salvaged during surgery, preoperative hemoglobin, postoperative hemoglobin, hemoglobin drift, estimated blood volume (EBV), IBL per EBV and IBL per level fused (P > 0.05). No postoperative complications were encountered in both groups. On average, the postoperative hospital stay was 3.5 ± 0.8 days for both groups (P = 0.143).
CONCLUSION: Performing corrective surgery during the menstrual phase in female AIS patients is safe without risk of increased blood loss.
LEVEL OF EVIDENCE: 4.

Matched MeSH terms: Menstruation*
A prospective study of a monophasic oral contraceptive containing 30 mcg ethinyl oestradiol and 150 mcg desogestrel (Marvelon)

Ismail MT

Malays J Reprod Health, 1994 Jun;12(1):43-8.
PMID: 12320338

PIP: Marvelon, a monophasic oral contraceptive (OC) containing 30 mcg of ethinyl estradiol and 150 mcg of desogestrel, has been available to Malaysian women through the national family planning program since 1982. To assess the safety, effectiveness, and side effects associated with this OC, 247 women who requested the pill were enrolled in a multicenter prospective study that included follow-up after the first, third, and sixth cycles of use. 81% of participants had never used any form of contraception before Marvelon. 194 women (79%) completed the 6-month study. There were no pregnancies recorded. Although women reported a slightly increased incidence of nausea, breast tenderness, and headache in the first treatment cycle, these side effects had abated by the end of the third cycle. After six cycles, mean body weight had decreased by an average of 0.4 kg. Both systolic and diastolic blood pressure were unaffected. An unexpected finding was a decrease in the severity of acne with continuous use of Marvelon. Although both spotting and breakthrough bleeding increased slightly in the first two cycles, irregular bleeding returned to pretreatment levels by the third cycle. The length of the withdrawal bleed in the pill-free week was reduced. The incidence of irregular bleeding and other side effects was substantially lower in this sample of Malaysian women than in Asian and Caucasian Marvelon users surveyed in other studies.

Matched MeSH terms: Menstruation Disturbances*
Fulltext Vitamin supplementation as possible prophylactic treatment against migraine with aura and menstrual migraine

Shaik MM, Gan SH

Biomed Res Int, 2015;2015:469529.
PMID: 25815319 DOI: 10.1155/2015/469529

Migraine is the most common form of headache disorder globally. The etiology of migraine is multifactorial, with genetic components and environmental interactions considered to be the main causal factors. Some researchers postulate that deficits in mitochondrial energy reserves can cause migraine or an increase in homocysteine levels can lead to migraine attacks; therefore, vitamins could play a vital role in migraine prevention. For instance, riboflavin influences mitochondrial dysfunction and prevents migraine. Genes such as flavoenzyme 5,10-methylenetetrahydrofolate reductase (MTHFR), especially the C677T variant, have been associated with elevated plasma levels of homocysteine and migraine with aura. Homocysteine catalyzation requires the presence of vitamins B6, B12, and folic acid, which can decrease the severity of migraine with aura, making these vitamins potentially useful prophylactic agents for treating migraine with aura. Menstrual migraine, on the other hand, is associated with increased prostaglandin (PG) levels in the endometrium, indicating a role for vitamin E, which is an anti-PG. Vitamin C can also be used as a scavenger of reactive oxygen species for treating neurogenic inflammation in migraine patients. This paper reviews possible therapies based on vitamin supplementation for migraine prophylaxis, focusing on migraine with aura and menstrual migraine.

Matched MeSH terms: Menstruation*
A comparative study of two low-dose combined oral contraceptives: results from a multicenter trial

Dunson TR, McLaurin VL, Israngkura B, Leelapattana B, Mukherjee R, Perez-Palacios G, et al.

Contraception, 1993 Aug;48(2):109-19.
PMID: 8403908 DOI: 10.1016/0010-7824(93)90002-O

A comparative multicenter clinical trial of two low-dose combined oral contraceptives (OCs) was conducted in Malaysia, Egypt, Thailand, and Mexico. Efficacy, safety and acceptability were investigated in women taking either a norgestrel-based (NG) OC or a norethindrone acetate-based (NA) OC. This paper includes analysis of 892 women, all of whom were at least 42 days but within 26 weeks postpartum and randomly allocated to one of the above OCs. Follow-up visits were scheduled at 1, 4, 8 and 12 months after admission. Baseline sociodemographic characteristics were similar for both groups, as well as compliance. There were nine unintended pregnancies reported; eight of these occurring in the NA group. Adverse experiences were minor with headaches and dizziness being the most common complaints; frequency of reports was similar in both groups. The group taking the NG-based OC had significantly (p < .05) fewer menstrual-related complaints. Discontinuations due to menstrual problems were significantly more common among NA users (primarily amenorrhea). Discontinuations in the NG group were primarily for other personal reasons, e.g. unable to return to the clinic. There was also a significant difference between the two groups for the 11-month gross cumulative life table discontinuation rates due to menstrual problems (p < .01); the NA group had the higher rate.

Matched MeSH terms: Menstruation Disturbances/chemically induced
Menstrual flow duration and spotting following Multiload Copper 250 intra-uterine device insertion

Goh TH, Ang ES, Yip YC

J Obstet Gynaecol (Lahore), 1983 Oct;4(2):127-8.
PMID: 12279948
Matched MeSH terms: Menstruation Disturbances*
A comparative study of Loestrin versus Nordette in Kelantan, West Malaysia

Arshat H

Malays J Reprod Health, 1984 Jun;2(1):25-31.
PMID: 12267518
Matched MeSH terms: Menstruation Disturbances*
Effect of laparoscopic sterilization and insertion of Multiload Cu 250 and Progestasert IUDs on serum ferritin levels

Goh TH, Hariharan M

Contraception, 1983 Oct;28(4):329-36.
PMID: 6667621

Blood haemoglobin and serum ferritin levels were measured at the initial visit and 12 months following sterilization and IUD insertion. Ferritin levels were unaltered in Progestasert users after 12 months but haemoglobin values increased though not significantly. Ferritin levels fell in Multiload Cu 250 users and in sterilized women; haemoglobin levels were also observed to fall but significantly only in the latter group. Iron-deficiency anaemia was prevalent at initial contact and there appeared to be an increased risk subsequently in Multiload Cu 250 users and in those who were sterilized. Screening and monitoring for anaemia is indicated. From the viewpoint of iron status, the Progestasert is preferable to the Multiload Cu 250 but it suffers the major disadvantages of needing frequent replacement and of causing menstrual disturbances which might compromise its acceptability. Menstrual blood loss studies may help explain why anaemia develops after sterilization.

Matched MeSH terms: Menstruation
Rupture of the uterus: treatment by suturing the tear

Thambu JA

Med J Malaya, 1971 Jun;25(4):293-4.
PMID: 4261304
Matched MeSH terms: Menstruation
Fulltext Study on menstrual characteristics, primary dysmenorrhoea, and their association with socio-demographic variables among Chinese undergraduate students in a private university

Teo Jin Yan, Fong Ka Ling, Thulasy Perumal, Lim Pek Hong, Mohammed Abdul Razzaq Jabbar, Thavamalar Paramasivam

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):28-0.
MyJurnal

Introduction: Dysmenorrhoea is the most common gynaecology problems female’s goes through in their life. In Malaysia, the overall prevalence of dysmenorrhoea is 78%. There were studies revealed that there is significant asso- ciation between dysmenorrhoea and quality of life (QoL). Female who is having dysmenorrhoea has a lower quality of life compared to others. However, most female ignore this issue as they feel it is a normal female phenomenon. Nevertheless, health education and interventions should be given to reduce dysmenorrhoea, thus improve QoL. The main aim of this research was to determine the menstrual characteristics, primary dysmenorrhoea, and their associa- tion with selected socio-demographic variables among Chinese undergraduate students. Methods: A cross-sectional study was carried out among 317 participants, aged between 19 to 25 years. Purposive sampling method was uti- lized to recruit the participants. Questionnaire on menstruationwas distributed to collect the information regarding socio-demographic background, menstrual characteristics, and primary dysmenorrhoea. Results: The incidences of primary dysmenorrhoea were reported by 63.4% (n=201)in this study. Only a few socio-demographic variableswere detected to have a significant association with menstrual characteristics and primary dysmenorrhoea. Associations between age and menstrual duration was discovered (p=0.005). Besides, menarche was associated with presence of blood clot during menstruation (P

Matched MeSH terms: Menstruation
Taboo and Malay tradition

Teoh JI

Aust N Z J Psychiatry, 1976 Mar;10(1A):105-10.
PMID: 1065321

According to Malinowski there are no peoples, however primitive, without religion and magic; nor are there any societies lacking either in the scientific attitude or in science (Blumberg 1963). Magic and taboo are resorted to when through the normal use of science, or rational techniques, man is unable to control unpredictable events important to him. Where there is difficulty in predicting the outcome of behaviour, where the results of action are not consonant with effort, where there are great limitions on man's knowledge of vital issues, magical techniques are employed--in short, where circumstances of life are uncertain, uncontrolled and unknown. Magic and animism are systems of thought which give not only the explanation of a single phenomenon, but make it possible to comprehend the totality of the world from one point, as a continuity. Of the three systems of thought--animistic, religious and scientific--animism is perhaps the most consistent and the most exhaustive, the one which explains the world in its entirety.

Matched MeSH terms: Menstruation
Diagnostic pitfalls in the evaluation and management of amenorrhea in adolescents

Azurah AG, Zainuddin AA, Jayasinghe Y

J Reprod Med, 2013 Jul-Aug;58(7-8):324-36.
PMID: 23947083

Amenorrhea is a common menstrual problem seen in adolescents. Amenorrhea has been shown to have a negative impact on adolescents' quality of life. In this paper we discuss the various causes and investigations of amenorrhea in adolescents and address management dilemmas for specific conditions. Specific approaches in dealing with adolescents using the HEADSS (Home, Education, Activity, Drugs, Sexual activity, Suicidal) approach are discussed.

Matched MeSH terms: Menstruation Disturbances/complications
Incidence of chemotherapy-induced ovarian failure in premenopausal women undergoing chemotherapy for breast cancer

Tiong V, Rozita AM, Taib NA, Yip CH, Ng CH

World J Surg, 2014 Sep;38(9):2288-96.
PMID: 24700093 DOI: 10.1007/s00268-014-2542-y

Breast cancer is increasingly reported in young premenopausal women in Asia. Adjuvant chemotherapy improves survival; however, it has a unique consequence of ovarian failure in premenopausal patients.

Matched MeSH terms: Menstruation/drug effects
Value of subcutaneous fat in predicting ovulation day

Jamaludin J, Nordin NM, Mohamad N, Etta KM

Malays J Reprod Health, 1988 Jun;6(1):65-9.
PMID: 12281593

Subcutaneous body fat and Quetelet's Indices (QI) of 52, 18-29 year old normal female volunteers were determined. These body mass indices were then grouped according to the phase of each subject's menstrual cycle, early or late follicular and early or late luteal phase. The subcutaneous body fat is 27.07 +or- 1.0% in the early follicular but drops to 24.68 +or- 1.84% in the late follicular phase. The value then rises significantly higher than that in the late follicular phase to 30.14 +or- 1.15% (P0.02) in the early luteal drops to 27.17 +or- 0.55% towards the level of the early follicular phase (P0.05). Variations in the values of QI during each menstrual cycle exactly mirror those for subcutaneous body fat. The fall in the 2 body mass indices during the late follicular phase coincides somewhat with the established preovulatory LH and FSH surges as well as the high levels of estrogen of this period. On the other hand the significant rise in the 2 parameters during the early luteal phase coincides with the marked rise in the ratio of progesterone to estrogen. Clearly, increased levels of progesterone relative to estrogen appear to cause an increase in the body fat during each menstrual cycle. The implication of this finding for women on contraceptive pills which are predominantly progesterone and those whose normal menstrual cycle is "interrupted" at the early luteal phase by a successful fertilization raises very interesting questions with regards to prediction of ovulation.

Matched MeSH terms: Menstruation