1.  Peer Reviewed Title: Menstrual blood loss in women using the frameless FibroPlant LNG-IUS. Author: Andrade A; Wildemeersch D Source: Contraception. 2009 Feb;79(2):134-8. Abstract: BACKGROUND: This study was conducted to report on a menstrual blood loss (MBL) study and iron stores in women with and without heavy menstrual bleeding using the frameless FibroPlant levonorgestrel-releasing intrauterine system (LNG-IUS) for contraception. STUDY DESIGN: An open, prospective, noncomparative MBL study, using FibroPlant releasing 14 mcg of LNG/day for contraception. MBL was assessed by the quantitative alkaline hematin (QAH) technique. RESULTS: The MBL study was conducted in 40 heavy and normally menstruating Brazilian women seeking contraception. MBL was reduced from a mean baseline menstrual volume of 29.7 mL to a mean volume of 1.5 mL after 24 months, while ferritin values increased from a mean value of 31.1 ng/mL (at baseline) to a mean level of 72.5 ng/mL (after 24 months of use). Differences were highly significant (p<.0005). There were no significant differences between those who had normal menstrual bleeding and the heavy bleeders. The heavy bleeders had comparable MBL to thenormal bleeders 3 months after insertion, and by 24 months post-insertion, their ferritin levels were comparable to those of the normal bleeders. Amenorrhea occurred in 80% of women out of 40 after 24 months of use. No pregnancies were recorded. CONCLUSION: The LNG-IUS is effective in reducing MBL in normally menstruating women as well as in women with heavy menstrual bleeding. The authors agree with the recommendations by the UK National Institute for Clinical Effectiveness and the new Finnish guidelines for heavy menstrual bleeding that the LNG-IUS should be positioned as first-line treatment prior to endometrial ablation or hysterectomy. Language: English Keywords: BRAZIL | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | MENSTRUATION | SERUM IRON LEVEL | IUD, HORMONE RELEASING | LEVONORGESTREL | MENORRHAGIA | TIME FACTORS | AMENORRHEA | PREVALENCE | CONTRACEPTIVE EFFECTIVENESS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Studies | Economic Development | Economic Factors | Reproduction | Hemic System | Physiology | Biology | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Menstruation Disorders | Diseases | Population Dynamics | Demographic Factors | Population | Measurement Document Number: 331016 |
| 2. Title: Adolescents' cortisol responses to awakening and social stress; effects of gender, menstrual phase and oral contraceptives. The TRAILS study. Author: Bouma EM; Riese H; Ormel J; Verhulst FC; Oldehinkel AJ Source: Psychoneuroendocrinology. 2009 Jul;34(6):884-93. Abstract: Studies on the influence of sex hormones on cortisol responses to awakening and stress have mainly been conducted in adults, while reports on adolescents are scarce. We studied the effects of gender, menstrual cycle phase and oral contraceptive (OC) use on cortisol responses in a large sample of adolescents. Data come from TRAILS (TRacking Adolescents' Individual Lives Survey), a prospective population study of Dutch adolescents. This study uses data of 644 adolescents (age 15-17 years, 54.7% boys) who participated in a laboratory session including a performance-related social stress task (public speaking and mental arithmetic). Free cortisol levels were assessed by multiple saliva samples, both after awakening and during the laboratory session. No significant effects of gender and menstrual phase on cortisol responses to awakening were found, while girls using OC displayed a slightly blunted response (F(1, 244)=5.30, p=.02). Cortisol responses to social stress were different for boys and free-cycling girls (F(3, 494)=9.73, p<.001), and OC users and free-cycling girls (F(3, 279)=15.12, p<.001). Unexpectedly, OC users showed no response at all but displayed linearly decreasing levels F(1, 279)=19.03, p<.001) of cortisol during the social stress test. We found no effect of menstrual cycle phase on cortisol responses to social stress (F(3, 157)=0.58, p=.55). The absence of a gender difference in the adolescents' cortisol awakening response found in this study is consistent with previous reports. Our results further suggest that adolescent OC users display slightly blunted cortisol responses after awakening, and that gender differences in cortisol responses to social stress during adolescence are comparable to those described for adult populations, that is, stronger responses in men than in women. Whereas previous work in adults suggested blunted stress responses in OC users compared to men and free-cycling women, adolescent OC users showed no cortisol response. Effects of type of OC could not be studied because of low numbers of OC that were only progestin based. Language: English Keywords: NETHERLANDS | RESEARCH REPORT | PROSPECTIVE STUDIES | ADOLESCENTS | GENDER ISSUES | MENSTRUATION | ORAL CONTRACEPTIVES | STRESS | HORMONES | TRANSCORTIN BOUND CORTISOL ALTERATIONS | Europe, Western | Europe | Developed Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Sociocultural Factors | Reproduction | Contraceptive Methods | Contraception | Family Planning | Psychological Factors | Behavior | Endocrine System | Physiology | Biology | Hematological Effects | Hemic System Document Number: 342582 |
| 3. Peer Reviewed Title: Use of combined oral contraceptives post abortion. Author: Gaffield ME; Kapp N; Ravi A Source: Contraception. 2009 Oct;80(4):355-62. Abstract: BACKGROUND: Providing combined oral contraceptives (COCs) following surgical or medical induced abortion offers women an opportune moment to initiate a reliable contraceptive method. STUDY DESIGN: We conducted a systematic review, searching MEDLINE and The Cochrane Library for articles in any language concerning COC use following spontaneous, induced (medical or surgical) or septic abortion, from 1966 through June 2008. Seven articles were identified and evaluated using the United States Preventive Services Task Force system. RESULTS: Immediate COC initiation after first-trimester medical or surgical induced abortion did not increase side effects or prolong vaginal bleeding compared with use of a placebo, copper-bearing intrauterine device (IUD), nonhormonal contraceptive method or COC initiation at a later time. Initiating COCs after first-trimester surgical abortion produced small increases in coagulation parameters compared with IUD use; although they are statistically significant, their clinical relevance is unlikely. No study examined second-trimester induced or spontaneous abortion, or septic abortion. CONCLUSIONS: Evidence shows that COCs can be safely initiated immediately following surgical and medical abortion in the first-trimester of pregnancy. Language: English Keywords: GLOBAL | LITERATURE REVIEW | ABORTION | ABORTION, SPONTANEOUS | PREGNANCY, FIRST TRIMESTER | POSTABORTION CARE | ORAL CONTRACEPTIVES, COMBINED | CONTRACEPTIVE SAFETY | MENSTRUATION | ORAL CONTRACEPTIVES, SIDE EFFECTS | BLOOD COAGULATION EFFECTS | Fertility Control, Postconception | Family Planning | Pregnancy Complications | Diseases | Pregnancy | Reproduction | Health Services | Delivery of Health Care | Health | Oral Contraceptives | Contraceptive Methods | Contraception | Safety | Public Health | Hematological Effects | Hemic System | Physiology | Biology Document Number: 342771 Notification |
| 4. Title: Extended cycling or continuous use of hormonal contraceptives for female adolescents. Author: Gold MA; Duffy K Source: Current Opinion In Obstetrics and Gynecology. 2009 Jun 12; Abstract: PURPOSE OF REVIEW: The purpose of this review is to present the most recent data on extended cycling and continuous use of hormonal contraception for female adolescents. RECENT FINDINGS: Since 2003, several new products have been US Food and Drug Administration approved to provide extended cycling or continuous use of hormonal contraception. Clinical trials have been conducted with adult women of 18 years and older and not with adolescents under age of 18 years. Studies find successful menstrual suppression using extended cycling and continuous-use regimens that are safe and effective without negative effects on the endometrium or hemostasis. Extended cycling and continuous use improves menstrual symptoms attributed to the hormone-free interval in traditional cyclic regimens. Adolescent health providers report prescribing extended cycles of contraception with increasing frequency to adolescents. It is unknown how well female adolescents tolerate breakthrough bleeding, but data suggest that bleeding is the main reason for discontinuing. Supplementation with intermittent estrogen or instituting a 4-day hormone-free interval in response to persistent bleeding may decrease this side effect; adolescents should be counseled about these options. SUMMARY: Extended cycling or continuous use of hormonal contraception offers adolescents an opportunity to decrease, delay or suppress monthly menstruation for health or personal reasons. Language: English Keywords: UNITED STATES OF AMERICA | CRITIQUE | ADOLESCENTS, FEMALE | CONTRACEPTIVE METHODS | HORMONES | ADMINISTRATION AND DOSAGE | MENSTRUATION | PRODUCT APPROVAL | USFDA | COUNSELING | CONTRACEPTIVE SAFETY | CONTRACEPTIVE AGENTS, SIDE EFFECTS | Developed Countries | North America | Americas | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Contraception | Family Planning | Endocrine System | Physiology | Biology | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproduction | Legislation | Political Factors | Sociocultural Factors | USPHS | Government Agencies | Organizations | Clinic Activities | Program Activities | Programs | Organization and Administration | Safety | Public Health | Contraceptive Agents Document Number: 341708 |
| 5. Title: Valproate and lamotrigine level variation with menstrual cycle phase and oral contraceptive use. Author: Herzog AG; Blum AS; Farina EL; Maestri XE; Newman J; Garcia E; Krishnamurthy KB; Hoch DB; Replansky S; Fowler KM; Smithson SD; Dworetzky BA; Bromfield EB Source: Neurology. 2009 Mar 10;72(10):911-4. Abstract: OBJECTIVE: To determine whether 1) combined oral contraceptive (COC) use affects serum levels of valproate (VPA) as well as lamotrigine (LTG) and 2) the naturally occurring high (mid-luteal) and low (early-mid follicular) reproductive steroid level phases of the menstrual cycle might affect antiepileptic drug levels as well. METHODS: This investigation compared serum antiepileptic drug levels at two timepoints during a single menstrual cycle in four groups of women with epilepsy: 12 on VPA, 12 on VPA plus COC (VPA-COC), 12 on LTG, and 12 on LTG plus COC (LTG-COC). RESULTS: Both VPA and LTG levels were lower (p < 0.01) on active COC than on inactive pill with median declines of 23.4% for the VPA-COC group and 32.6% for the LTG-COC group. Serum LTG levels showed a notable but not significant 31.3% median decline during the mid-luteal phase compared to the early-mid follicular phase in the non-COC group. The non-COC valproate group showed the least change of any group between the two measured timepoints with a decline of 8.3% (p = NS). CONCLUSIONS: The findings suggest that valproate (VPA), like lamotrigine (LTG), has substantially and significantly lower serum levels while women take active combined oral contraceptives as compared to inactive pills. Larger sample sizes will be required to determine whether LTG levels may drop significantly also during the luteal (high steroid) phase of natural menstrual cycles and whether VPA levels may show greater stability in levels across the phases of the menstrual cycle. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | WOMEN | NEUROLOGIC EFFECTS | ORAL CONTRACEPTIVES, COMBINED | DRUGS | DRUG INTERACTIONS | MENSTRUATION | Developed Countries | North America | Americas | Demographic Factors | Population | Physiology | Biology | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproduction Document Number: 330553 |
| 6. Peer Reviewed Title: Serum levonorgestrel levels and endometrial thickness during extended use of the levonorgestrel-releasing intrauterine system. Author: Hidalgo MM; Hidalgo-Regina C; Bahamondes MV; Monteiro I; Petta CA; Bahamondes L Source: Contraception. 2009 Jul;80(1):84-9. Abstract: BACKGROUND: The levonorgestrel-releasing intrauterine system (LNG-IUS) is a contraceptive method approved for five years of use. However, there is some evidence that its life span may be longer. The aim of the study was to evaluate serum levonorgestrel (LNG) and estradiol (E(2)) levels and endometrial thickness every 6 months from 7 to 8 1/2 years after insertion. STUDY DESIGN: At the end of the approved 5-year life span, no replacement devices were available; therefore, 86 women were allowed to retain the same device for a further 2 years. At the 7-year follow-up visit, the women who consented were again allowed to retain the same device for a further 18 months and were followed-up at six-monthly intervals. At each visit, vaginal sonography was performed to measure endometrial thickness, and a blood sample was taken to measure LNG and E(2). RESULTS: Eighty-four months after insertion, 67 women aged 34.3+/-0.8 years (mean+/-SEM) (range, 25-49 years) returned for follow-up. Mean+/-SEM LNG levels decreased from an initial 253+/-27 pg/mL (range, 86-760) during the first 2 months following insertion to 137+/-12 (range, 23-393) at 84 months and 119+/-9 pg/mL (range, 110-129) at 102 months of use (+/-SEM). At 84 months of use, mean+/-SEM endometrial thickness was 2.8+/-0.1 mm, increasing to 3.8+/-0.5 mm at 102 months of use. The incidence of amenorrhea decreased from 41.8% at 84 months to 31.5% at 102 months of use. No correlation was found between LNG levels and bleeding patterns; however, a weak correlation was found between high body mass index (kg/m(2)), high weight, and low serum LNG levels. E(2) levels were similar to those of the follicular phase of the menstrual cycle of regularly menstruating women. CONCLUSIONS: During extended use of the LNG-IUS, serum LNG levels were nearly half those found in the first 2 months of use (Wilcoxon signed rank test); serum E(2) levels were normal. Despite the very thin endometrium, menstrual bleeding was reinstated in many cases. At the end of its 5-year life span, there is a window for changing the LNG-IUS, and physicians and users should not be concerned about delaying replacement of the device for a short time beyond the approved life span; however, maintaining the same device long after its approved life span cannot be recommended. Language: English Keywords: BRAZIL | RESEARCH REPORT | FAMILY PLANNING ACCEPTORS | IUD, HORMONE RELEASING | LEVONORGESTREL | ESTRADIOL | ENDOMETRIUM | TIME FACTORS | ULTRASONICS | HEMATOLOGIC TESTS | AMENORRHEA | INCIDENCE | MENSTRUATION | South America, Eastern | South America | Latin America | Americas | Developing Countries | Family Planning Programs | Family Planning | IUD | Contraceptive Methods | Contraception | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Estrogens | Hormones | Endocrine System | Physiology | Biology | Uterus | Genitalia, Female | Genitalia | Urogenital System | Population Dynamics | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Laboratory Procedures | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Menstruation Disorders | Diseases | Measurement | Research Methodology | Reproduction Document Number: 342787 |
| 7. Title: Menstrual cycle characteristics and offspring sex ratio [letter] Author: James WH Source: Epidemiology. 2009 Sep;20(5):782. Abstract: This letter to the editor argues with the suggestion that the length of women's menstrual cycle relates to the sex of their offspring. It suggests rather that menstrual regularity may be a better variable regarding offspring sex ratio. Language: English Keywords: UNITED KINGDOM | CRITIQUE | WOMEN | SEX RATIO | MENSTRUATION | TIME FACTORS | TESTOSTERONE | PREGNANCY | Developed Countries | Europe, Western | Europe | Demographic Factors | Population | Sex Distribution | Sex Factors | Population Characteristics | Reproduction | Population Dynamics | Androgens | Hormones | Endocrine System | Physiology | Biology Document Number: 342518 |
| 8. Title: [Long-cycle treatment in oral contraception] Langzyklus bei Ovulationshemmern. Author: Kuhl H; Birkhauser M; Mueck A; Neulen J; Thaler C Source: therapeutische Umschau. Revue therapeutique. 2009 Feb;66(2):101-8. Abstract: Surveys show that most women desire a change in their menstrual pattern in the sense that they would prefer less menstruations or even amenorrhea. On this behalf, there is no difference between women having spontaneous natural cycles and women taking the pill. The main reasons are less menstrual bleedings, better hygienic conditions, a better quality of life and less blood loss. In women wanting regular monthly periods, the opinion is dominant that suppression of menstrual bleedings is "unnatural". It is therefore primordial to inform women that contraceptive safety is even increased in users following the long-cycle principal and that a fertility decrease has not to be feared. The benefit of the long-cyle OC is a reduction of the hormonal fluctuations induced by the pill-free interval with its consecutive somatic and mental symptoms, as well as an increased contraceptive safety. The following cycle- and menstruation-dependent symptoms as listed as an indication for the long-cycle use: Endometriosis, hypermenorrhea, dysmenorrhea, hemorrhagic diathesis, uterine fibroma, polyzystic ovary syndrom, migraine due to estrogen-deficiency in the pill-free interval as well as premenstrual syndrome. Language: German Keywords: RESEARCH REPORT | SURVEYS | WOMEN | AMENORRHEA | MENSTRUATION | BLEEDING | QUALITY OF LIFE | CONTRACEPTIVE SAFETY | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Menstruation Disorders | Diseases | Reproduction | Signs and Symptoms | Social Welfare | Economic Factors | Safety | Public Health | Health Document Number: 329572 |
| 9. Peer Reviewed Title: Analysis of pain and satisfaction with office-based hysteroscopic sterilization. Author: Levie M; Weiss G; Kaiser B; Daif J; Chudnoff SG Source: Fertility and Sterility. 2009 Aug 13; Abstract: OBJECTIVE: To assess pain and patient satisfaction with office-based hysteroscopic sterilization. DESIGN: This prospective, observational study was designed to assess patient pain perception and satisfaction with office-based hysteroscopic sterilization using the Essure device (Conceptus, Mountain View, CA). SETTING: Faculty practice office at an inner-city urban medical center. PATIENT(S): Women seeking hysteroscopic sterilization. INTERVENTION(S): Office hysteroscopic sterilization under local anesthesia. MAIN OUTCOME MEASURE(S): Pain assessed at the time of the procedure by a 0-10 visual scale and satisfaction by a 1-5 scale. RESULT(S): From June 2003 to June 2006, 209 patients were recruited. The mean scores for average procedural pain, most procedural pain, and average menstrual pain were 2.6 +/- 2.1, 3.3 +/- 2.5, and 3.6 +/- 2.6, respectively. Standardized pain scores revealed that 149 subjects (70%) experienced average pain that was less than or equal to the pain experienced with their menses. Mean satisfaction rating for the procedure was 4.7 +/- 0.71. CONCLUSION(S): Office-based hysteroscopic sterilization performed with local anesthesia alone is well tolerated, and patients are satisfied with this method for permanent sterilization. Language: English Keywords: UNITED STATES OF AMERICA | CALIFORNIA | RESEARCH REPORT | PROSPECTIVE STUDIES | CLIENTS | PAIN | SATISFACTION | HEALTH SERVICES | STERILIZATION, SEXUAL | MENSTRUATION | Developed Countries | North America | Americas | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Signs and Symptoms | Diseases | Psychological Factors | Behavior | Delivery of Health Care | Health | Family Planning | Reproduction Document Number: 342551 |
| 10. Title: Reproductive factors, exogenous hormone use and risk of lymphoid neoplasms among women in the National Institutes of Health-AARP Diet and Health Study Cohort. Author: Morton LM; Wang SS; Richesson DA; Schatzkin A; Hollenbeck AR; Lacey JV Jr Source: International Journal of Cancer. 2009 Jun 1;124(11):2737-43. Abstract: Reasons for higher incidence of lymphoid neoplasms among men than women are unknown. Because female sex hormones have immunomodulatory effects, reproductive factors and exogenous hormone use may affect risk for lymphoid malignancies. Previous epidemiologic studies on this topic have yielded conflicting results. Within the National Institutes of Health-AARP Diet and Health Study cohort, we prospectively analyzed detailed, questionnaire-derived information on menstrual and reproductive factors and use of oral contraceptives and menopausal hormone therapy among 134,074 US women. Using multivariable proportional hazards regression models, we estimated relative risks (RRs) for 85 plasma cell neoplasms and 417 non-Hodgkin lymphomas (NHLs) identified during follow-up from 1996 to 2002. We observed no statistically significant associations between plasma cell neoplasms, NHL, or the 3 most common NHL subtypes and age at menarche, parity, age at first birth, oral contraceptive use or menopausal status at baseline. For menopausal hormone therapy use, overall associations between NHL and unopposed estrogen and estrogen plus progestin were null, with the potential exception of an inverse association (RR = 0.49, 95% CI, 0.25-0.96) between use of unopposed estrogen and diffuse large B-cell lymphoma (DLBCL), the most common NHL subtype, among women with a hysterectomy. These data do not support an important role for reproductive factors or exogenous hormones in modulating lymphomagenesis. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | COHORT ANALYSIS | MULTIVARIATE ANALYSIS | WOMEN | PREVALENCE | CANCER | ORAL CONTRACEPTIVES | HORMONE REPLACEMENT THERAPY | MENOPAUSE | MENSTRUATION | REPRODUCTIVE HEALTH | RISK ASSESSMENT | RISK FACTORS | Developed Countries | North America | Americas | Research Methodology | Data Analysis | Demographic Factors | Population | Measurement | Neoplasms | Diseases | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproduction | Evaluation Document Number: 330982 |
| 11. Peer Reviewed Title: Daily variation of brain-derived neurotrophic factor and cortisol in women with normal menstrual cycles, undergoing oral contraception and in postmenopause. Author: Pluchino N; Cubeddu A; Begliuomini S; Merlini S; Giannini A; Bucci F; Casarosa E; Luisi M; Cela V; Genazzani AR Source: Human Reproduction. 2009 Jun 2; Abstract: BACKGROUND Plasma brain-derived neurotrophic factor (BDNF) levels are associated with the hormonal status of women. Moreover, the suprachiasmatic nucleus appears to be implicated in the modulation of BDNF central levels. We aimed to investigate whether BDNF circadian rhythms exist in women and if there is a relationship with cortisol circadian rhythmicity. Moreover, we aimed to establish whether the hormonal status influences BDNF diurnal variations. METHODS A total of 30 women were studied: 10 fertile ovulatory women, 10 women undergoing oral contraceptive (OC) therapy and 10 post-menopausal women. Basal BDNF and estradiol levels were assayed in blood samples collected after overnight fasting at regular intervals (08:00, 12:00, 16:00, 20:00, 24:00). BDNF and cortisol levels were measured in samples collected during the follicular and luteal phases in ovulatory women and once a month in OC and post-menopausal women. RESULTS Luteal BDNF levels were significantly higher than follicular levels in fertile women (P < 0.001). In OC women, BDNF levels were similar to the follicular BDNF levels, whereas in post-menopausal women, they were significantly lower (P < 0.001). BDNF showed a diurnal rhythm in the follicular phase and in women undergoing OC, although the diurnal rhythm was blunted in the luteal phase. In post-menopausal women, BDNF and cortisol levels significantly decreased during the day. CONCLUSIONS BDNF has a diurnal variation in women that is somewhat analogous to cortisol variation; however, the amplitude of the variation in BDNF levels appears to be influenced by ovarian function. Interactions between BDNF, the hypothalamus-pituitary-adrenal axis and sex steroids might play a critical role in the human homeostasis and adaptation. Language: English Keywords: ITALY | RESEARCH REPORT | WOMEN | MENOPAUSE | ORAL CONTRACEPTIVES | MENSTRUATION | TRANSCORTIN BOUND CORTISOL ALTERATIONS | Developed Countries | Europe, Southern | Europe | Demographic Factors | Population | Reproduction | Contraceptive Methods | Contraception | Family Planning | Hematological Effects | Hemic System | Physiology | Biology Document Number: 341570 |
| 12. Peer Reviewed Title: Development of leadership self-efficacy and collective efficacy: adolescent girls across castes as peer educators in Nepal. Author: Posner J; Kayastha P; Davis D; Limoges J; O'Donnell C; Yue K Source: Global Public Health. 2009 May;4(3):284-302. Abstract: Local nongovernmental organizations developed a peer education program in three districts of Nepal that paired girls from different castes and different educational levels. The program sought to increase peer educators' (PE) leadership and collective efficacy for informing peers and adults about the effects that menstrual restrictions and HIV awareness and prevention have on women and girls. In total, 504 girls were selected and trained as PEs. They conducted targeted discussion sessions with other girls and organized mass awareness events, reaching 20,000 people. Leadership self-efficacy, which was a central theoretical construct for the program, provided a strong predictor of both increased HIV knowledge and of practicing fewer menstrual restrictions. The project demonstrated that girls from different castes and educational backgrounds are able to work together to change individual behavior and to address socio-cultural norms that affect their lives and well-being within their communities. Language: English Keywords: NEPAL | RESEARCH REPORT | ADOLESCENTS, FEMALE | PEER EDUCATORS | HIV PREVENTION | MENSTRUATION | TABOO | SELF ESTEEM | LEADERSHIP | CASTE | HINDUISM | PROGRAM EVALUATION | Developing Countries | Asia, Southern | Asia | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Education | HIV Infections | Viral Diseases | Diseases | Reproduction | Culture | Sociocultural Factors | Psychological Factors | Behavior | Organization and Administration | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Religion | Programs Document Number: 341392 |
| 13. Peer Reviewed Title: Follicular development in a 7-day versus 4-day hormone-free interval with an oral contraceptive containing 20 mcg ethinyl estradiol and 1 mg norethindrone acetate. Author: Rible RD; Taylor D; Wilson ML; Stanczyk FZ; Mishell DR Jr Source: Contraception. 2009 Mar;79(3):182-8. Abstract: BACKGROUND: Combined oral contraceptive (COC) formulations with 20 mcg ethinyl estradiol (EE) have a greater incidence of ovarian hormone production and follicular development, which can be managed by shortening the number of hormone-free days per COC cycle. This study evaluates differences in follicular development during a 7-day versus 4-day hormone-free interval in a COC regimen with 20 mcg EE and 1 mg norethindrone acetate. STUDY DESIGN: Forty-one healthy women were randomized in an open-label fashion to this formulation in either a 24/4 or a 21/7 day regimen for three cycles. Estradiol, progesterone, follicle-stimulating hormone, luteinizing hormone and inhibin B were measured daily from Cycle 2, Day 21 to Cycle 3, Day 3 and on Day 7 of Cycle 3. Follicular diameter and Hoogland score were calculated on Cycle 2, Days 21, 24 and 28 and Cycle 3, Days 3 and 7. RESULTS: Sixty-six percent of subjects in the 21/7 group and 70% of the subjects in the 24/4 group developed a follicle greater than 10 mmdiameter. Ovarian steroid hormone levels, Hoogland scores and bleeding patterns were not statistically significant between the groups. CONCLUSION: In contrast to prior studies, this analysis suggests no difference in follicle development or bleeding patterns among women receiving a 21/7 or 24/4 regimen of a 20-mcg EE/1-mg norethindrone acetate COC. Language: English Keywords: CALIFORNIA | RESEARCH REPORT | CLINICAL RESEARCH | CASE CONTROL STUDIES | COMPARATIVE STUDIES | WOMEN | FOLLICLE STIMULATING HORMONE | ORAL CONTRACEPTIVES, COMBINED | ETHINYL ESTRADIOL | NORETHINDRONE | ADMINISTRATION AND DOSAGE | MENSTRUATION | TIME FACTORS | United States of America | North America | Americas | Developed Countries | Research Methodology | Studies | Demographic Factors | Population | Gonadotropins, Pituitary | Gonadotropins | Hormones | Endocrine System | Physiology | Biology | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Agents, Progestin | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproduction | Population Dynamics Document Number: 330059 |
14.  Title: Trials of Improved Practices (TIPs): Determining feasible water and feces management small doable actions for HIV programs in Ethiopia. Author: Seumo EF; Tesfay M; Rosenbaum J; Bery R Source: Washington, D.C., Academy for Educational Development [AED], USAID Hygiene Improvement Project, 2009 Feb. 61 p. (Trials of Improved Practices (TIPs)USAID Contract No. GHS-I-00-04-00024-00) Abstract: Diarrheal disease is the most common opportunistic infection in people living with HIV / AIDS (PLWHA) in resource limited settings. Diarrhea is very debilitating and negatively affects the PLWHA's quality of life. Household members and especially children are at risk of contracting diarrhea from PLWHA suffering from bouts of diarrhea. Improving water, hygiene, and sanitation (WASH) helps prevent diarrhea in PLWHA and their households and enhances the quality of life. The major challenge is how to integrate WASH into HIV programs. To address this challenge, USAID / HIP worked with NGOs providing home-based care services in Ethiopia to design and carry out a trial of improved practices (TIPs) to help identify the water, hygiene, and sanitation small doable actions (SDA) to be integrated into HIV programs. A rapid assessment was carried out in Amhara Region in December 2007. The SDA were reviewed with NGOs partners in Addis to identify the WASH behaviors to be explored in the TIPs. Water and feces management were the two areas that required more information and were thus selected for the TIPs. Further, despite the high risk of HIV transmission associated with menstrual blood, very little is known about HIV-positive women's hygiene practices during menstruation. To fill this gap, USAID / HIP also included this topic in the TIPs. For seven weeks trained data collectors and home-based care workers visited 62 PLWHA in Adama, Addis, Alemtena, and Wonji -- urban, peri-urban, and rural sites in the Oromo Region. USAID / HIP reviewed the findings from the Oromo and Amhara regions and developed recommendations on the WASH SDA to be integrated in the home-based care programs in Ethiopia. (Excerpts) Language: English Keywords: ETHIOPIA | RESEARCH REPORT | DATA COLLECTION | PERSONS LIVING WITH HIV/AIDS | WATER QUALITY | HYGIENE | SANITATION | BEHAVIOR CHANGE | HOME CARE | INTEGRATED PROGRAMS | DIARRHEA | MENSTRUATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | HIV Infections | Viral Diseases | Diseases | Water | Natural Resources | Environment | Public Health | Health | Behavior | Care and Support | Health Services | Delivery of Health Care | Programs | Organization and Administration | Reproduction Document Number: 331415 |
| 15. Title: [Influence of premenstrual syndrome and oral contraceptive effects on food choice during the follicular and luteal phase of the menstrual cycle] Influencia del sindrome premenstrual y el uso de anticonceptivos orales en la Author: Tucci SA; Murphy LE; Boyland EJ; Halford JC Source: Endocrinologia Y Nutricion. 2009 Apr;56(4):170-5. Abstract: BACKGROUND AND OBJECTIVE: Food intake and motivation for food varies according to the phase of the menstrual cycle. These changes seem to be more marked in women with premenstrual syndrome (PMS) and may be modified by the use of oral contraceptives (OC). This study examined the effect of menstrual cycle, PMS and OC use on the intake and hedonic rating of sweet and savory snack foods. MATERIAL AND METHODS: Fifty-five women were recruited and assigned to either a PMS group or a control group. In addition, based on OC use, the women were assigned to an OC-user or non-user group. During the luteal and follicular phases, the participants were asked to consume and rate sweet and savory snacks. RESULTS: The luteal phase induced greater caloric intake from sweet foods. PMS sufferers did not consume significantly more calories in either phase. There was a significant interaction between phase, flavor, PMS status and OC use. OC users consumed more calories from sweet foods in the follicular phase. CONCLUSIONS: Food intake is increased in the luteal phase. This effect was modulated by both PMS and OC use. OC use seems to eliminate cyclic fluctuations in caloric intake. Language: Spanish Keywords: GLOBAL | RESEARCH REPORT | WOMEN | MENSTRUATION | CALORIC INTAKE | FOOD AND BEVERAGE | ORAL CONTRACEPTIVES | PREMENSTRUAL TENSION | Demographic Factors | Population | Reproduction | Nutrition | Health | Contraceptive Methods | Contraception | Family Planning | Menstruation Disorders | Diseases Document Number: 342131 |
| 16. Peer Reviewed Title: Contraceptive failure related to estimated cycle day of conception relative to the start of the last bleeding episode. Author: Wiebe ER; Trussell J Source: Contraception. 2009 Mar;79(3):178-81. Abstract: BACKGROUND: The objective of this study was to estimate the menstrual cycle day of conception in women presenting for abortion. STUDY DESIGN: This was a retrospective chart survey in two urban free-standing abortion clinics. RESULTS: There were 913 charts reviewed of women presenting for an abortion at less than 63 days' gestation as determined by endovaginal ultrasound who were "sure" of the date of their last normal menstrual period. The estimated mean cycle day of conception determined by sonographically estimating length of gestation was 14.6. There were 26 (26.3%) of 99 women using cyclic hormonal contraception who conceived before 10 days after the onset of withdrawal bleeding compared to 100 (14.7%) of 679 who conceived before 10 days after the onset of their last menstrual period who were using all other forms of contraception, including "none" (p=.005). No other differences in the proportions conceiving early in the cycle were observed with respect to age, ethnicity or obesity. CONCLUSION: These data suggest that there is a sizeable subset of women who ovulate earlier after onset of withdrawal bleeding when using 21/7 hormonal contraceptives than after onset of menses when not using hormonal contraception. It is possible that women using hormonal contraceptives may have a higher risk of pregnancy if they ovulate sooner after the onset of bleeding. Language: English Keywords: NORTH AMERICA, NORTHERN | UNITED KINGDOM | RESEARCH REPORT | CLINICAL RESEARCH | RETROSPECTIVE STUDIES | WOMEN | URBAN POPULATION | ABORTION | CONTRACEPTION FAILURE | MENSTRUATION | TIME FACTORS | CONTRACEPTIVE PREVALENCE | OVULATION | Americas | Developed Countries | Europe, Western | Europe | Research Methodology | Studies | Demographic Factors | Population | Population Characteristics | Fertility Control, Postconception | Family Planning | Contraceptive Usage | Contraception | Reproduction | Population Dynamics Document Number: 330060 Notification |
| 17. Title: Is it OK to fool Mother Nature? Source: Consumer Reports. 2008 Nov;73(11):13. Abstract: Reduced PMS. Fewer periods. No periods. These are the respective marketing promises of the makers of Yaz, Seasonique, and Lybrel, a trio of oral contraceptives currently starring in TV, Web, and print ads. They're called "extended-cycle" contraceptives because they either shorten or reduce the number of hormone-free (placebo) intervals that produce withdrawal bleeds, or periods. Lybrel, the newest of the three, is the first pill approved to eliminate placebo days-and thus periods-completely. Is it safe to use pills to suppress menstruation? Yes, according to most of the 375 obstetricians/gynecologists and primary-care doctors surveyed by the Consumer Reports National Research Center. We surveyed only doctors who prescribed birth-control pills, and 85 percent of them had prescribed an extendedcycle drug in the past year. But the majority of those had also had patients use conventional birth-control pills in longer cycles to achieve the same effect. (excerpt) Language: English Keywords: SUMMARY REPORT | WOMEN | HORMONES | MENSTRUATION | ORAL CONTRACEPTIVES | PREMENSTRUAL TENSION | Demographic Factors | Population | Endocrine System | Physiology | Biology | Reproduction | Contraceptive Methods | Contraception | Family Planning | Menstruation Disorders | Diseases Document Number: 329810 |
| 18. Title: Improving contraceptive access with a simple job aid to help rule out pregnancy. Author: Family Health International [FHI] Source: [Research Triangle Park, North Carolina], FHI, 2008. [2] p. (Research Utilization Case StudiesUSAID Cooperative Agreement No. GPO-A-00-05-00022-0) Abstract: Research consistently showed that menstruation requirements in several countries prevented women from accessing their desired methods of family planning. Using criteria endorsed by the World Health Organization (WHO), Family Health International (FHI) developed, introduced, and trained health care providers to use a simple checklist to help rule out pregnancy in women who are not menstruating. The evidence-based tool has been requested by health professionals in approximately 20 countries. At least seven ministries of health have endorsed the checklist, and it is being incorporated into family planning guidelines and national training materials to help improve contraceptive access. Language: English Keywords: DOMINICAN REPUBLIC | DEVELOPING COUNTRIES | SUMMARY REPORT | WOMEN | MENSTRUATION | FAMILY PLANNING | PREGNANCY | CONTRACEPTION | PROGRAM ACCESSIBILITY | Caribbean | Americas | Demographic Factors | Population | Reproduction | Program Evaluation | Programs | Organization and Administration Document Number: 331528 |
| 19. Title: Offering the TwoDay Method within family planning services in Peru. Author: Georgetown University. Institute for Reproductive Health Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Feb. [98] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00) Abstract: This study was the first introducing the TwoDay Method (TDM) into regular reproductive health service delivery programs. It tested the feasibility of counseling for TDM use later in the menstrual cycle than the first week (the protocol at the time of the study) and determined if this affected correct use, continuation, acceptability, partner participation, user satisfaction, and management of fertile days. It also tested the protocol, training curriculum, and job aids supporting integration of the TDM into diverse settings. In conclusion, providers can offer the method equally well to clients at any point in their menstrual cycle and clients can use the method correctly, regardless of when they learned to use it. Continuation rates and satisfaction were not affected by the time in their cycle in which women were counseled. Results suggest that providers and clients liked the method. The one-day training workshop was sufficient, and job aids were appropriate. (Excerpts) Language: English Keywords: PERU | RESEARCH REPORT | CLIENTS | WOMEN | COUNSELING | FAMILY PLANNING | HEALTH SERVICES | DELIVERY OF HEALTH CARE | CONTRACEPTIVE USAGE | MENSTRUATION | SATISFACTION | CONTRACEPTIVE METHOD ACCEPTABILITY | PARTICIPATION | TRAINING ACTIVITIES | Developing Countries | South America, Western | South America | Latin America | Americas | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Clinic Activities | Health | Contraception | Reproduction | Psychological Factors | Behavior | Social Behavior | Training Programs | Education Document Number: 331602 |
| 20. Title: Sexuality and life-skills: Participatory activities on sexual and reproductive health with young people. Author: International HIV / AIDS Alliance; Planned Parenthood Association of Zambia; Young, Happy, Healthy and Safe; Zambia. Ministry of Health; Zambia. Ministry of Education Source: Brighton, United Kingdom, International HIV / AIDS Alliance, 2008 Feb. 169 p. Also available from: http://www.crin.org/docs/Sexuality_and_lifeskills.pdf Abstract: This toolkit is written for anyone who wants to facilitate participatory learning activities with young people to equip them with the knowledge, positive attitudes and skills to grow up and enjoy sexual and reproductive health and well-being. This includes peer educators and leaders, outreach workers, teachers, community workers and others. It aims to assist facilitators to: provide accurate and complete factual information to young people; plan appropriate educational activities for groups of young people that enable them to: analyse their own situations, resources and needs; apply new knowledge to their own lives; increase awareness of their own values and attitudes; develop their self-esteem and confidence; develop life skills, for example, communication and assertiveness skills, problem-solving and decision-making; build trust and take collective action as a group; follow up and evaluate their work. (excerpt) Language: English Keywords: DEVELOPING COUNTRIES | MANUAL | EVALUATION | ADOLESCENTS | SEXUALITY | SEX EDUCATION | HEALTH EDUCATION | PUBERTY | MENSTRUATION | INTERPERSONAL RELATIONS | SEX BEHAVIOR | SEXUALLY TRANSMITTED DISEASE PREVENTION | HIV PREVENTION | CURRICULUM | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Personality | Psychological Factors | Behavior | Education | Reproduction | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | HIV Infections | Viral Diseases Document Number: 326007 |
| 21. Peer Reviewed Title: Perceptions and practices on menstruation amongst Nigerian secondary school girls. [Perceptions et pratiques concernant la menstruation chez les étudiantes du secondaire] Author: Adinma ED; Adinma JI Source: African Journal of Reproductive Health. 2008 Apr;12(1):74-83. Abstract: This Cross-sectional descriptive study was conducted amongst 550 secondary school girls in southeastern Nigeria to determine their perceptions, problems, and practices on menstruation. Majority of the students, (75.6%), were aged 15-17 years. Only 39.3% perceived menstruation to be physiological. Abdominal pain/discomfort, (66.2%), was the commonest medical problem encountered by the respondents, although 45.8% had multiple problems. Medical problems were most commonly discussed with the mother, (47.1%), and least commonly discussed with the teachers, 0.4%. Analgesics, (75.6%), were most commonly used to relieve menstrual pain. Only 10% of respondents used non-pharmacologic remedies. Unsanitary menstrual absorbents were used by 55.7% of the respondents. Menstruation perceptions are poor, and practices often incorrect. A multi-dimensional approach focusing on capacity building of mothers, and teachers on sexuality education skills; using religious organizations as avenues for sexuality education; and effectively using the Mass Media as reproductive health education channels are recommended towards improving adolescents' perceptions and practices on menstruation. French Abstract: Cette étude descriptive transversale a été menée au sein des 550 étudiantes du secondaire au sud du Nigéria afin de déterminer leurs perceptions, leurs problèmes et leurs pratiques concernant la menstruation. La majorité des étudiantes (75,6%) aient âgées de 15 - 17 ans. Seules 39,3% ont perçu la menstruation comme physiologique. La douleur / gêne abominable (66,2%), était le problème médical le plus commun auquel ont fait face les participantes, bien que 45,8% avaient des problèmes multiples. Les problèmes médicaux ont été les plus communément discutés avec la mère (47,1%) et les moindre discutés avec les professeurs (0,4%). Les analgésiques (75,6%) ont été les plus communément utilisés pour soulager la douleur menstruelle. Seules 10% des participantes utilisaient des remèdes non pharmacologiques. 55% se sont servies des absorbants non-sanitaires parmi les participantes. Les perceptions de la menstruation était mauvaise et les pratiques étaient souvent incorrectes. Nous préconisons une approche multi-dimensionelle qui met l'accent sur le renforcement de la capacité des mères et des professeurs sur des compétences de l'éducation sexuelle ; se servant des organisations religieuses comme moyens de l'éducation sexuelle, et se servant effectivement des médias comme des voies pour l'éducation de la santé de reproduction, vers l'amélioration des perceptions et des pratiques des adolescentes à l'égard de la menstruation. Language: English Keywords: NIGERIA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | ADOLESCENTS | SECONDARY SCHOOLS | PERCEPTION | MENSTRUATION | ABDOMINAL CRAMPS | SIDE EFFECTS | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Schools | Education | Psychological Factors | Behavior | Reproduction | Signs and Symptoms | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 322427 |
| 22. Title: Hormonal contraception: present and future. Author: Benagiano G; Bastianelli C; Farris M Source: Drugs of today. 2008 Dec;44(12):905-23. Abstract: The original form of hormonal contraception ("the Pill") has developed into a variety of modalities administered through different routes: oral, intramuscular, subcutaneous, transdermal, intrauterine or intravaginal, and intranasal (abandoned). At present, two separate methods of hormonal contraception exist; one is used to prevent fertilization and the other to prevent pregnancy. From a pharmacological point of view, hormonal methods utilize either a combination of estrogen and progestin or progestin alone. Today all combined methods contain ethynylestradiol, and over the years there has been a substantial reduction in its dosage from almost 80 microg to as low as 15 microg. On the other hand, a variety of progestins are currently utilized that belong to two main chemical families: derivatives of progesterone and derivatives of 19-nortestosterone or gonane. These compounds, developed over a period of 50 years, can be distinguished in four successive "generations". Recent developments include new oral regimens intended to change the 7-day medication-free interval and new commercial preparations; the latter utilize the progestins drospirenone and dienogest. In addition, an oral contraceptive containing chlormadinone has also been marketed. Besides the oral route, contraceptive systems exist or are under development that employ the intramuscular, transdermal and intravaginal routes; they deliver both an estrogen and a progestin. Several patches and vaginal rings are also marketed. A variety of long-acting methods delivering only a progestin are also available. They use the subcutaneous route or are released from an intrauterine system, both of which provide optimal contraceptive protection and, depending on the system, can last up to 5 years (and probably more). Finally, progestin-releasing vaginal rings are under investigation. The second type of hormonal contraception, called "emergency contraception", utilizes progestins and antiprogestins and to be effective should be taken as soon as possible after unprotected intercourse. Language: English Keywords: ITALY | HISTORICAL REVIEW | CONTRACEPTIVE AGENTS, FEMALE | CONTRACEPTIVE METHODS | CONTRACEPTIVE MODE OF ACTION | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTIVE AGENTS, SIDE EFFECTS | EMERGENCY CONTRACEPTION | MENSTRUATION | Developed Countries | Europe, Southern | Europe | Contraceptive Agents | Contraception | Family Planning | Reproduction Document Number: 330078 |
| 23. Title: From convenience to hazard: a short history of the emergence of the menstrual activism movement, 1971-1992. Author: Bobel C Source: Health Care for Women International. 2008 Aug;29(7):738-754. Abstract: In this article, I explore the early history of contemporary menstrual activism in the United States by looking through the lens of the first seven editions of the feminist women's health classic, Our Bodies, Ourselves (OBOS). This analysis illustrates the development of a critical menstrual consciousness as three key phases of the emerging movement, offers a representation of the dynamic nature of feminist health consciousness, and highlights the importance of linking current activism to its past. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | MENSTRUATION | FEMINISM | ADVOCACY | CHANGES | TOXIC SHOCK SYNDROME | Developed Countries | North America | Americas | Reproduction | Sociocultural Factors | Communication | Social Change | Infections | Diseases Document Number: 308019 |
| 24. Title: Peritoneal fluid flow influences anatomical distribution of endometriotic lesions: Why Sampson seems to be right. Author: Bricou A; Batt RE; Chapron C Source: European Journal of Obstetrics, Gynecology and Reproductive Biology. 2008 Jun;138(2):127-134. Abstract: Endometriosis is a frequent pathology for which the dominant signs and symptoms are pelvic pain and infertility. The physiopathology remains the subject of controversy. Four physiopathological hypotheses have been put forward: regurgitation, metaplasia, induction and (vascular and lymphatic) embolization. The anatomical distribution of endometriotic lesions would appear to be fundamental for a better understanding of Sampson's menstrual regurgitation theory of endometriosis. Analysis of the results in the literature and comparison with our experience clearly shows that the distribution of endometriotic lesions is asymmetrical in several respects. Abdominopelvic anatomy and peritoneal fluid flow can explain this asymmetrical distribution of endometriotic lesions in the great majority of cases. These observations are a very strong argument in favour of the crucial role played by tubal regurgitation and the peritoneal fluid in the physiopathology of endometriosis. The similarity in anatomical distribution of endometriomas, superficial and deeply invasive endometriotic lesions would tend to indicate a common origin for these different types of lesions. (author's) Language: English Keywords: GLOBAL | CRITIQUE | ENDOMETRIOSIS | GYNECOLOGY | ANATOMY | MENSTRUATION | PELVIS | FALLOPIAN TUBES | PERITONEAL DISEASES | Diseases | Medicine | Health Services | Delivery of Health Care | Health | Biology | Reproduction | Genitalia, Female | Genitalia | Urogenital System | Physiology Document Number: 327204 |
| 25. Peer Reviewed Title: Occurrence of menses or pregnancy after cessation of a continuous oral contraceptive. Author: Davis AR; Kroll R; Soltes B; Zhang N; Grubb GS Source: Fertility and Sterility. 2008 May;89(5):1059-1063. Abstract: The objective was to evaluate the time to return to spontaneous menses in women after 1 year of daily continuous levonorgestrel (LNG) 90 mg/ethinyl E2 (EE) 20 mg. The design used was an observational study. The setting was gynecologic and primary care practices. The patients studied were women aged 18-49 years with a history of regular menstrual cycles. After participation in an openlabel, continuous oral contraceptive (OC) trial for at least 6 months, participants agreed to enroll in a separate study of the return to menses or pregnancy. The main outcome measure was the time to return to spontaneous menses or pregnancy. The 198 subjects had a mean age of 30.4 plus or minus 6.6 years with 72% white, 13% Hispanic, and 7% African American. The mean duration of continuous LNG/EE treatment before enrollment was 349 plus or minus 41 days. Of the 187 (94%) subjects who completed this study, 181 returned to spontaneous menses and 4 became pregnant within 90 days after the last dose of LNG 90 mg/EE 20 mg.The median time to return to menses in the completer population was 32 days, and the incidence of spontaneous menses or pregnancy at day%90 was 98.9%. The duration of amenorrhea during continuous LNG/ EE use before stopping treatment was unrelated to the time to the return to menses. Spontaneous menses or pregnancy occurred in 98.9% of women after cessation of continuous LNG/EE. (author's) Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN | ORAL CONTRACEPTIVES | ORAL CONTRACEPTIVES, SIDE EFFECTS | MENSTRUATION | MENSTRUAL CYCLE | PREGNANCY | REVERSIBILITY | TIME FACTORS | Developed Countries | North America | Americas | Research Methodology | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Contraceptive Safety | Safety | Public Health | Health | Reproduction | Population Dynamics Document Number: 326994 |
| 26. Title: Elements of the menstrual suppression debate. Author: Hitchcock CL Source: Health Care for Women International. 2008 Aug;29(7):702-19. Abstract: In this article I review common arguments and frameworks used by participants in the debate about extended use of combined hormonal contraceptives (CHCs; usually oral contraceptive pills) for menstrual suppression. I examine the way in which menstruation is described and the scope of risks considered. I consider the role of the pharmaceutical industry, personal and clinical experience, and concerns about the contraceptive effectiveness of contraceptive formulations with lower doses. I also address public consequences of the debate, including the possibility of inciting a pill scare, and increasing product awareness and off-label practice. Language: English Keywords: CANADA | RESEARCH REPORT | CRITIQUE | MENSTRUATION | RISK FACTORS | BREAST CANCER | CONTRACEPTIVE SAFETY | ORAL CONTRACEPTIVES, SIDE EFFECTS | WOMEN'S HEALTH | North America, Northern | Americas | Developed Countries | Reproduction | Biology | Cancer | Neoplasms | Diseases | Safety | Public Health | Health Document Number: 328619 |
| 27. Title: Menstrual cycle and oral contraceptive use do not modify postexercise heat loss responses. Author: Kenny GP; Leclair E; Sigal RJ; Journeay WS; Kilby D; Nettlefold L; Reardon FD; Jay O Source: Journal of Applied Physiology. 2008 Oct;105(4):1156-65. Abstract: It is unknown whether menstrual cycle or oral contraceptive (OC) use influences nonthermal control of postexercise heat loss responses. We evaluated the effect of menstrual cycle and OC use on the activation of heat loss responses during a passive heating protocol performed pre- and postexercise. Women without OC (n = 8) underwent pre- and postexercise passive heating during the early follicular phase (FP) and midluteal phase (LP). Women with OC (n = 8) underwent testing during the active pill consumption (high exogenous hormone phase, HH) and placebo (low exogenous hormone phase, LH) weeks. After a 60-min habituation at 26 degrees C, subjects donned a liquid conditioned suit. Mean skin temperature was clamped at approximately 32.5 degrees C for approximately 15 min and then gradually increased, and the absolute esophageal temperature at which the onset of forearm vasodilation (Th(vd)) and upper back sweating (Th(sw)) were noted. Subjects then cycled for 30 min at 75% Vo(2 peak) followed by a 15-min seated recovery. A second passive heating was then performed to establish postexercise values for Th(vd) and Th(sw). Between 2 and 15 min postexercise, mean arterial pressure (MAP) remained significantly below baseline (P < 0.05) by 10 +/- 1 and 11 +/- 1 mmHg for the FP/LH and LP/HH, respectively. MAP was not different between cycle phases. During LP/HH, Th(vd) was 0.16 +/- 0.24 degrees C greater than FP/LH preexercise (P = 0.020) and 0.15 +/- 0.23 degrees C greater than FP/LH postexercise (P = 0.017). During LP/HH, Th(sw) was 0.17 +/- 0.23 degrees C greater than FP/LH preexercise (P = 0.016) and 0.18 +/- 0.16 degrees C greater than FP/LH postexercise (P = 0.001). Postexercise thresholds were significantly greater (P < or = 0.001) than preexercise during both FP/LH (Th(vd), 0.22 +/- 0.03 degrees C; Th(sw), 0.13 +/- 0.03 degrees C) and LP/HH (Th(vd), 0.21 +/- 0.03 degrees C; Th(sw), 0.14 +/- 0.03 degrees C); however, the effect of exercise was similar between LP/HH and FP/LH. No effect of OC use was observed. We conclude that neither menstrual cycle nor OC use modifies the magnitude of the postexercise elevation in Th(vd) and Th(sw). Language: English Keywords: CANADA | RESEARCH REPORT | WOMEN | MENSTRUATION | BODY TEMPERATURE | FITNESS | ESTROGENS | PROGESTERONE | North America, Northern | Americas | Developed Countries | Demographic Factors | Population | Reproduction | Physiology | Biology | Health | Hormones | Endocrine System | Progestational Hormones Document Number: 328846 |
| 28. Peer Reviewed Title: Effects of continuous versus cyclical oral contraception: a randomized controlled trial. Author: Legro RS; Pauli JG; Kunselman AR; Meadows JW; Kesner JS Source: Journal of Clinical Endocrinology and Metabolism. 2008 Feb;93(2):420-429. Abstract: Context: Continuous oral contraception may better suppress the ovary and endometrium, lending itself to the treatment of other medical conditions. Objective: Our objective was to determine the effects of continuous vs. cyclical oral contraception. Design: This was a randomized double-blind trial. Setting: This trial was performed at an academic medical center in Pennsylvania. Patients: A total of 62 healthy women with regular menses were included in the study. Intervention: Cyclical oral contraception (21-d active/7-d placebo given for six consecutive 28-d cycles) vs. continuous (168-d active pill) therapy using a monophasic pill (20 ug ethinyl estradiol and 1 mg norethindrone acetate) was examined. Main Outcome Measures: The primary outcome was vaginal bleeding, and secondary outcomes included hormonal, pelvic ultrasound, quality of life, and safety measures. Results: There was no statistically significant difference in the number of total bleeding days between groups, but moderate/heavy bleedingwas significantly greater with the cyclical regimen [mean 11.0 d (SD 8.5) vs. continuous 5.2 d (SD 6.8); P=0.005], with both groups decreasing over time. Endogenous serum and urinary estrogens measured over six cycles were significantly lower (P = 0.02 and 0.04, respectively) in the continuous group than the cyclical group. Women in the continuous group also had a smaller ovarian volume and lead follicle size over the course of the trial by serial ultrasound examinations. The Moos Menstrual Distress Questionnaire showed that women on continuous therapy had less associated menstrual pain (P = 0.01) and favorable improvements in behavior (P = 0.04) during the premenstrual period. Conclusions: Continuous oral contraception does not result in a reduction of bleeding days over a 168-d period of observation but provides greater suppression of the ovary and endometrium. These effects are associated with improved patient symptomatology. (author's) Language: English Keywords: PENNSYLVANIA | RESEARCH REPORT | CLINICAL TRIALS | DOUBLE-BLIND STUDIES | WOMEN | ORAL CONTRACEPTIVES | ADMINISTRATION AND DOSAGE | ETHINYL ESTRADIOL | PAIN | MENSTRUATION | QUALITY OF LIFE | BLEEDING | ULTRASONICS | CONTRACEPTIVE SAFETY | NORETHINDRONE ACETATE | Developed Countries | United States of America | North America | Americas | Clinical Research | Research Methodology | Studies | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Contraceptive Agents | Signs and Symptoms | Diseases | Reproduction | Social Welfare | Economic Factors | Safety | Public Health | Norethindrone | Contraceptive Agents, Progestin Document Number: 327773 |
| 29. Peer Reviewed Title: The levonorgestrel intrauterine system (Mirena) for treatment of idiopathic menorrhagia. Assessment of quality of life and satisfaction. Author: Lete I; Obispo C; Izaguirre F; Orte T; Rivero B; Cornellana MJ; Bermejo I Source: European Journal of Contraception and Reproductive Health Care. 2008 Sep;13(3):231-7. Abstract: OBJECTIVES: To evaluate patient satisfaction and improvement in quality of life (QoL) among women with idiopathic menorrhagia treated with the levonorgestrel intrauterine system (LNG-IUS). STUDY DESIGN: Prospective-observational study with one-year follow-up in which 225 women were enrolled who had a LNG-IUS inserted for control of idiopathic menorrhagia. Bleeding, tolerability, user satisfaction, and health-related QoL (by means of the SF-36 QoL questionnaire) were assessed. RESULTS: There was a statistically significant reduction in the amount of bleeding, an increase of haemoglobin and ferritin levels, and an improved QoL score. A high degree of satisfaction was reported by over 98% of patients. CONCLUSIONS: The LNG-IUS is an effective and well-tolerated treatment modality in idiopathic menorrhagia. The QoL of women treated with the LNG-IUS is markedly improved, causing high levels of patient satisfaction. This IUS can be regarded as a first-choice therapy in idiopathic menorrhagia. Language: English Keywords: SPAIN | RESEARCH REPORT | PROSPECTIVE STUDIES | WOMEN | MENORRHAGIA | LEVONORGESTREL | IUD, HORMONE RELEASING | BLEEDING | SATISFACTION | CONTRACEPTIVE METHOD ACCEPTABILITY | MENSTRUATION | QUALITY OF LIFE | TREATMENT | Europe, Southwestern | Europe | Developed Countries | Studies | Research Methodology | Demographic Factors | Population | Menstruation Disorders | Diseases | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | IUD | Contraceptive Methods | Signs and Symptoms | Psychological Factors | Behavior | Contraceptive Usage | Reproduction | Social Welfare | Economic Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 329683 |
| 30. Peer Reviewed Title: The effects of Implanon on menstrual bleeding patterns. Author: Mansour D; Korver T; Marintcheva-Petrova M; Fraser IS Source: European Journal of Contraception and Reproductive Health Care. 2008 Jun;13 Suppl 1:13-28. Abstract: The objectives were to evaluate an integrated analysis of bleeding patterns associated with use of the subdermal contraceptive implant Implanon (etonogestrel, Organon, part of Schering-Plough) and to provide physician guidance to optimize patient counselling. Data from 11 clinical trials were reviewed (N = 923). Assessments included bleeding-spotting records, dysmenorrhoea, and patient-perceived reasons for discontinuation. Bleeding patterns were analysed via reference period (RP) analyses. Implanon use was associated with the following bleeding irregularities: amenorrhoea (22.2%) and infrequent (33.6%), frequent (6.7%), and/or prolonged bleeding (17.7%). In 75% of RPs, bleeding-spotting days were fewer than or comparable to those observed during the natural cycle, but they occurred at unpredictable intervals. The bleeding pattern experienced during the initial phase predicted future patterns for the majority of women. The group of women with favourable bleeding patterns during the first three months tended to continue with this pattern throughout the first two years of use, whereas the group with unfavourable initial patterns had at least a 50% chance that the pattern would improve. Only 11.3% of patients discontinued owing to bleeding irregularities, mainly because of prolonged flow and frequent irregular bleeding. Most women (77%) who had baseline dysmenorrhoea experienced complete resolution of symptoms. Implanon use is associated with an unpredictable bleeding pattern, which includes amenorrhoea and infrequent, frequent, and/or prolonged bleeding. The bleeding pattern experienced during the first three months is broadly predictive of future bleeding patterns for many women. Effective preinsertion counselling on the possible changes in bleeding patterns may improve continuation rates. (author's) Language: English Keywords: GLOBAL | RESEARCH REPORT | LITERATURE REVIEW | CLINICAL TRIALS | CONTRACEPTIVE IMPLANTS | CONTRACEPTIVE AGENTS, FEMALE | CONTRACEPTIVE AGENTS, PROGESTIN | MENSTRUATION | MENSTRUATION DISORDERS | BLEEDING | CONTRACEPTIVE AGENTS, SIDE EFFECTS | CONTRACEPTION CONTINUATION | Clinical Research | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents | Reproduction | Diseases | Signs and Symptoms | Contraceptive Usage Document Number: 325040 |
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