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Prevalence and clinical correlates of unsuccessful use of drugs to induce menstruation.

Despite its prohibition, illegal abortion is widely practiced in Brazil, with important adverse health consequences. This report aims to document the prevalence and correlates of the unsuccessful use of drugs to "induce menstrual flow" in a cohort of pregnant Brazilian women. In a cross-sectional study, 6,102 pregnant women between gestation weeks 21 and 28 were interviewed in prenatal clinics of the Brazilian National Health Care System from April 1991 to November 1995. When asked "In order to know if you were pregnant, did you take any medication to induce menstrual flow", 874 (14.4%) responded "yes." The most frequently used drugs were herbal teas (41%), estrogens and/or progestogens (30%), and misoprostol (16%). As demonstrated through logistic regression analysis, independent correlates of such use were unplanned pregnancy (odds ratio [OR] 4.3), low educational attainment (OR 3.3), absence of a husband or partner (OR 1.8), number of children (one or more) (OR 1.5), a history of a previous induced abortion (OR 1.4), and use of oral contraceptives at the time (OR 1.4). Misoprostol use occurred in 2.2% of pregnancies, and showed a very strong association with an unplanned pregnancy (OR 16.0), absence of a husband or partner (OR 3.5), and a history of a previous induced abortion (OR 2.2). It was not associated with a history of menstrual irregularity. In contradistinction, the use of medroxyprogesterone was strongly associated with previous menstrual irregularity (OR = 5.0). The use of drugs and teas, many of which are unknown in terms of fetal risk, in early pregnancy to induce menstrual flow is quite common in women in the Brazilian National Health System. Although the objective of such drug use appears to be varied, analysis of the clinical correlates of use suggest attempted abortion to be the principal aim.

Abortifacient Agents, Nonsteroidal↗

Return of menstruation and normalization of prolactin in hyperprolactinemic women with bromocriptine-induced pregnancy.

Fifty-eight hyperprolactinemic women were followed up for 13 to 108 months after at least one bromocriptine-induced pregnancy for investigation of whether the pregnancy had any adverse long-term effects on the hyperprolactinemic state. Fifteen women had two term pregnancies. The prolactin (PRL) level decreased greater than 50% in 20 women after the pregnancy. Only two women showed a PRL level increase. Spontaneous uterine bleedings returned in 16 women, whereas 42 remained amenorrheic. Thus, bromocriptine-induced pregnancy in women with hyperprolactinemia has no negative long-term effect on PRL secretion.

Adult↗

Luteinizing hormone responses to gonadotropin-releasing hormone and naloxone in menstruating women with type I diabetes of different duration.

Luteinizing hormone (LH) responses to gonadotropin-releasing hormone (GnRH) (100 micrograms injected intravenously (IV)) or naloxone (4 mg injected plus 8 mg infused in 2 hours IV) were evaluated in 29 women with insulin-dependent diabetes mellitus (IDDM) (duration, group I (n = 15): less than 10 years, range 3 to 9 years; group II (n = 14): greater than 10 years, range 11 to 20 years) and in 15 normal controls, on the 22nd days of normal menstrual cycles. Both GnRH- and naloxone-induced LH responses were similar in group I diabetics and normal controls, whereas they were significantly lower in group II than in group I diabetics or normal controls. Positive correlations were found between LH responses to GnRH and naloxone, whereas negative correlations were observed between maximal LH peaks in response to GnRH or naloxone and duration of diabetes. These data indicate that a hypothalamic pituitary disorder affects LH secretion with time after the onset of IDDM.

Adult↗

Hysteroscopic treatment of intrauterine adhesions is safe and effective in the restoration of normal menstruation and fertility.

OBJECTIVE: To assess the safety and efficacy of hysteroscopic adhesiolysis in patients with recurrent pregnancy loss and infertility. DESIGN: Retrospective case report series. SETTING: The obstetrics and gynecology clinic of a medical school. PATIENT(S): Forty women with recurrent pregnancy loss or infertility resulting from intrauterine adhesions. INTERVENTION(S): Hysteroscopic adhesiolysis in patients with recurrent pregnancy loss and infertility. MAIN OUTCOME MEASURE(S): Postoperative adhesion formation, intraoperative complication, conceivement after surgery, pregnancy rate, and pregnancies resulted in term or viable preterm infants. RESULT(S): Most patients with minimal or moderate adhesions were free of adhesions when compared with postoperative control subjects. However, adhesion re-formation was noted in 60% of the patients who initially had severe adhesions. Normal menstrual flow was restored in 81% of the patients. All the patients who had recurrent pregnancy loss conceived after treatment, and 71% of the pregnancies resulted in a term or viable preterm infant. Of the 16 infertile patients treated, 10 (63%) conceived and 6 (37%) were delivered of viable infants. CONCLUSION(S): Hysteroscopic adhesiolysis is a safe and effective procedure for restoring the normal menstrual pattern and fertility. The initial severity of the adhesions appears to correlate best with the reproductive outcome.

Adult↗

Menstruation in young girls: a clinical perspective.

The ACOG has recommended that the initial visit to an obstetrician-gynecologist for health guidance, screening, and provision of preventive services should take place around age 13-15. At this visit, clinicians can provide guidance to young girls and their parents on adolescent physical development based on data that define parameters for normal pubertal development, menarche, and menstrual cyclicity, and address menstrual hygiene and emerging adolescent concerns. Adolescent menstrual cycles are initially variable, but this variability does not imply that there are no useful parameters for menstrual cyclicity. Data indicate that cycles typically range from 21 to 45 days, even in the first few gynecologic years. Individuals with cycles that vary widely from this norm may have significant pathology, most commonly hyperandrogenism or polycystic ovary syndrome. Controversy now exists regarding the lower limits for the onset of pubertal development in girls; data suggest that pubertal growth may be occurring earlier than had previously been described. The age of menarche has remained constant. Clinicians can furnish information about menstrual hygiene and menstrual protection and provide parental and teen guidance with printed patient education materials and suggested Web-based sources of information. The provision of anticipatory guidance and information to young girls and their parents can help ease the transition from childhood through puberty and a healthy adolescence.

Adolescent↗

Increased adverse pregnancy outcomes with unreliable last menstruation.

OBJECTIVE: To estimate the risk of adverse outcomes in women whose first day of the last menstrual period (LMP) was unreliable. METHODS: Among 20,244 singleton pregnancies with measurements of biparietal diameter between 12 and 22 weeks' gestation, LMP was registered as unreliable in 3775 (18.6%) and reliable in 16,469 (81.4%). Adverse outcomes were defined as spontaneous or missed abortions after 12 weeks' gestation, stillbirth or postnatal death within 1 year, preterm birth, birth weight less than 2500 g, and low birth weight (LBW) for gestation (lower than 22% below sex-specific expected weight). Logistic regression analysis and Kaplan-Meier survival analysis were used to analyze the risk of adverse outcomes. RESULTS: The risk of death was doubled in pregnant women with unreliable LMPs compared with those with reliable LMPs (odds ratio [OR] 2.0; 95% confidence interval [CI] 1.5, 2.6). This risk was highest with respect to stillbirth (OR 2.7; 95% CI 1.7, 4.3). The risks of preterm birth, LBW, and LBW for gestation were also significantly increased (ORs 1.5, 1.4, and 1.2; 95% CIs 1.3, 1.7; 1.2, 1.6; and 1. 0, 1.4, respectively). CONCLUSION: An unreliable LMP is associated with increased risk of adverse outcomes, especially fetal death.

Adult↗