Idiopathic hemochromatosis. Report of a case in a menstruating woman.
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We studied the menstrual patterns of 258 patients before and after laparoscopic sterilization by bipolar diathermy. The observed changes were obtained were mainly related to the kind of contraception used before sterilization. The frequency of menstrual disorders after sterilization were compared to those in a control group of non-sterilized women matched for age and parity: 12--42 months after the operation, the sterilized women did not have more irregular cycles, menorrhagia, metrorrhagia, hysmenorrhea or dyspareunia than the control group but the sterilized women did have a slightly higher incidence of polymenorrhea (p less than 0.05) and menses lasting less than 3 days (p less than 0.01). We conclude that interval laparoscopic sterilization by bipolar diathermy can be recommended for patients with normal menstrual cycles.
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A personal series of 60 vaginal hysterectomies performed in nulliparous mentally retarded women is presented. This is the largest series published in the literature. The advantages of the vaginal route in performing hysterectomies in these patients is discussed and the technique is described.
The majority of women with dysfunctional uterine bleeding ovulate and have normal cyclical changes in gonadotrophins, oestrogen and progesterone. To investigate whether the hormonal milieu at tissue level is different in these women, we measured the endometrial concentration of oestrogen and progesterone receptors at various stages of the menstrual cycle in women with normal menstrual loss (< or = 80 ml/cycle, n = 40) and dysfunctional uterine bleeding (> 80 ml/cycle, n = 44). Menstrual blood loss was measured using the alkaline haematin method. Receptor levels were measured in nuclear and cytosol extracts of endometrium using solid phase immunoassays, based on monoclonal antibodies against receptor protein, which measure the bound and unbound fractions of the receptors. We found endometrial oestrogen (P < 0.01) and progesterone (P < 0.05) receptor levels were higher in the late secretory phase in women with dysfunctional uterine bleeding compared with women with normal menstrual loss. The receptor levels were the same in both groups at all other stages of the menstrual cycle. There was a strong positive correlation between the level of late secretory endometrial oestrogen receptor and measured menstrual blood loss (r = 0.81, P < 0.01). Increased local oestrogen effect is present in the premenstrual endometrium in dysfunctional uterine bleeding.
This monograph has presented a review of menstrual disorders in adolescents. It has been emphasized that health care professionals who deal with youths should consider a comprehensive approach that places the youth with a menstrual problem within the framework of her adolescent and pubertal development. Thus, a discussion of psychologic growth as well as important aspects of puberty were presented. A thorough medical history and carefully done pelvic examination remain the basis for any evaluation of these young women even in this age of rapidly-advancing medical technology. Many of the menstrual dysfunction problems are related to the sequential, physiologic events of puberty and can be effectively handled by the well-trained general clinician. Specific, complex situations should be referred to the appropriate specialist, preferably someone with an understanding of adolescence. Three basic types of menstrual disorders have been considered: dysmenorrhea, dysfunctional uterine bleeding and amenorrhea. Our conclusion is that there is much the general clinician can do for the adolescent who presents with menstrual dysfunction.
High DDE and DDT concentrations were found to be associated with shortened menstrual cycle length in Laotian immigrants to the United States. We examined this issue in a sample of young Chinese women. A total of 60 women aged 20-24 years were enrolled in three maternal and child health clinics (20 from urban, 20 from suburban, 20 from rural) in Shanghai, China, and vicinity, in 1998. Of these women, 47 who did not use hormonal contraceptives and had valid menstrual cycle characteristics were included in the analysis for associations among serum DDE and DDT concentration and menstrual cycle length, duration of menses, and heaviness of menstrual flow. In univariate analysis, higher p,p'-DDE concentration was associated with longer menstrual cycle length (0.66 day per 10 microg/L, 95% confidence interval [CI]: 0.21, 1.11 day). With adjustment for age, body mass index, education, occupation, and resident location, the estimate was 0.42 day (95% CI: -0.35, 1.19 day). p,p'-DDE was not associated with duration of menses or heaviness of menstrual flow. Neither p,p'-DDT nor o,p'-DDT were associated with menstrual cycle length, duration of menses or heaviness of menstrual flow. The study largely suggests no association between DDE and DDT concentrations and menstrual cycle characteristics in young Chinese women, though the weak-to-no correlation of DDE with menstrual cycle length merits further study.
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