The effect of frankincense (Boswellia serrata,oleoresin) and ginger (Zingiber officinale,rhizoma) on heavy menstrual bleeding: A randomized,placebo-controlled,clinical trial

ObjectivesTo evaluate the effect of frankincense (Boswellia serrata, oleoresin) and ginger (Zingiber officinale, rhizoma) as complementary treatments for heavy menstrual bleeding (HMB) among women of reproductive age.DesignRandomized, placebo-controlled, clinical trial.SettingGynecology outpatient clinics.InterventionsPatients with HMB (n = 102) were randomly assigned to three groups. All patients received ibuprofen (200 mg) and either frankincense (300 mg), ginger (300 mg), or a placebo, which contains 200 mg anhydrous lactose as the filling agent and was similar in appearance to the two other drugs. Patients received the medications three times a day for seven days of the menstrual cycle, starting from the first bleeding day and this was repeated for two consecutive menstrual cycles.Main outcome measuresAmount and duration of menstrual bleeding and quality of life (QOL).ResultsDuration of menstrual bleeding was decreased in the frankincense (−1.77 ± 2.47 days, P = 0.003) and ginger (−1.8 ± 1.79 days, P = 0.001) groups, but not in the placebo group (−0.52 ± 1.86 days, P = 0.42). Amount of menstrual bleeding was decreased in all (P < 0.05), with no difference among the study groups (P > 0.05). More improvement in QOL was observed in the frankincense (−25.7 ± 3.1; P < 0.001) and ginger (−29.2 ± 3.7: P < 0.001) groups compared to the placebo group (−15.07 ± 3.52; P < 0.001) and between the groups, differences were statistically significant (P = 0.02).ConclusionsGinger and frankincense seem to be effective complementary treatments for HMB. Further studies with a larger sample size and longer follow-up are warranted in this regard.     

Spontaneous Sexual Development and Heavy Menstrual Bleeding in 45,X Monosomy and 45,X/47,XXX Mosaic Turner Syndrome and a Review of the Literature

Turner syndrome (TS) is one of the most common sex chromosome disorders and is characterized by short stature and gonadal dysgenesis. A few patients with TS achieve normal sexual development, menarche, and even pregnancy. We encountered two cases of Turner syndrome with spontaneous sexual development and menstruation. The patients had different karyotypes, 45,X monosomy and 45,X/47,XXX mosaic TS, and presented with severe anemia due to excessive menstrual bleeding. Abnormal uterine bleeding patterns are expected in patients with primary ovarian insufficiency; however, the menstrual patterns of patients with TS have not been well described in the literature. Here, we describe these cases along with a brief review of the relevant literature.     

Effect of oral contraceptives on vascular endothelial growth factor, Cox-2 and aromatase expression in the endometrium of uteri affected by myomas and associated pathologies

Background

The study was conducted to evaluate vascular endothelial growth factor (VEGF), Cox-2 and aromatase expression in the endometrium of uteri with myomas and other associated pathologies.

Study Design

Hysteroscopy was performed in 118 women of reproductive age with myomas and menorrhagia, 40 of whom were using a pill containing 75 mcg gestodene+30 mcg ethinylestradiol. Aromatase p450, VEGF and Cox-2 expression was detected using immunohistochemistry. Fisher's Exact Test and the Mann–Whitney test were used in the statistical analysis, with significance established at p<.05.

Results

In patients with myomas and menorrhagia, associated pathologies such as adenomyosis, endometrial polyps and endometriosis were found in 32%, 12% and 17% of cases, respectively. Aromatase, Cox-2 and VEGF expression was greater during the proliferative phase compared to the luteal phase of the cycle or following oral contraceptive use.

Conclusion

Endogenous progesterone or combined oral contraceptives are potent inhibitors of VEGF, aromatase and Cox-2 expression in the endometrium of patients with myomas and menorrhagia.     

左炔诺孕酮宫内缓释系统治疗子宫腺肌病临床效果研究

目的:探讨左炔诺孕酮宫内缓释系统(LNG-IUS)治疗子宫腺肌病的临床疗效。方法:102例子宫腺肌病患者在月经周期第7天放置LNG-IUS,观察放置前,放置后1、3、6、12个月的月经情况,痛经程度及副反应。结果:①放置LNG-IUS后随访102例,其中8例取LNG-IUS终止治疗(5例因月经过少,3例因痤疮),12个月续用率为92.16%(94/102)。②放置后1、3、6、12个月,随时间延长,视觉模拟评分(VAS)和口述评分(VRS)痛经评分逐渐下降,与放置前比较,差异均有统计学意义(P<0.05)。③放置LNG-IUS后出血模式主要表现为月经过少,放置后1个月,68.63%(70/102)患者月经过少;放置后3个月,78.43%(80/102)患者月经过少;放置后12个月,91.49%(86/94)患者月经过少。④主要副反应为不规则出血,放置后1个月不规则出血发生率18.63%(19/102),放置后3个月不规则出血发生率11.76%(12/102),6个月以后无不规则出血。随访12个月闭经发生率6.38%(6/94)。结论:LNG-IUS治疗子宫腺肌病近期疗效显著,不良反应少,临床应用价值高。     

Local excision of uterine adenomyomas: a report of 86 cases with follow-up analyses

Objective

To assess the outcomes of patients who underwent local excision of adenomyoma and to evaluate the effectiveness of the procedure.

Study design

Prospective study of 86 women undergoing local excision of symptomatic uterine adenomyoma at laparotomy. Dysmenorrhea was assessed before and after operation by questionnaire, and the average duration of follow-up was 24 months.

Result(s)

At 6-month follow-up, all 86 patients’ dysmenorrhea grades were reduced by more than 80%. With a mean follow-up of 24 (range 6–60) months, a total of 2 (2.3%) patients finally underwent hysterectomy, 1 (1.2%) received levonorgestrel-releasing intrauterine device therapy, and three patients (11.3%) were subsequently given treatment with oral pain medication alone. The mean time interval between local excision and subsequent treatment was 34 months. Two (2.3%) patients became pregnant after the local excision: one (1.2%) at 2 months after the procedure and one (1.2%) at 3 years after the local excision procedure.

Conclusion(s)

Local excision of uterine adenomyoma remains a safe and effective minimally invasive treatment for women with symptomatic uterine adenomyoma. Local excision can effectively alleviate the dysmenorrhea of adenomyoma.     

左炔诺孕酮宫内释放系统治疗子宫腺肌病的临床观察

目的:探讨左炔诺孕酮宫内释放系统(LNG-IUS;商品名:曼月乐)治疗子宫腺肌病月经过多及痛经的临床疗效。方法:对65例子宫腺肌病所致月经过多及痛经患者,于月经第4～7天放置LNG-IUS,行前后对照:于LNG-IUS放置前及放置后3、6、12个月,分别采用PBAC法及VRS法比较月经量及疼痛评分,同时分别测定血清CA125、月经第3天血清雌二醇(E2)、卵泡刺激激素(FSH)、黄体生成激素(LH)水平。结果:放置左炔诺孕酮宫内释放系统后12个月,月经量的PBAC法评分由放置前(119.6±61.0)分,分别下降为治疗后3、6、12个月时的(55.1±22.8)分、(38.4±17.8)分、(19.6±8.5)分,与放置前比较差异均有统计学意义(P<0.01);痛经的VRS评分由治疗前的(2.2±0.4)分下降为(1.3±0.6)分、(0.5±0.2)分、(0.4±0.3)分,差异均有统计学意义(P<0.01);血清CA125由治疗前的(66±21)kU/L下降为(52±20)kU/L、(35±14)kU/L、(22±11)kU/L,差异均有统计学意义(P<0.01);E2、FSH及LH与放置前比较,差异无统计学意义(P>0.05)。结论:LNG-IUS治疗子宫腺肌病所致的月经过多和痛经效果显著。     

Use of the levonorgestrel-releasing intrauterine system, quality of life and sexuality. Experience in an Italian family planning center

Background

The levonorgestrel-releasing intrauterine system (LNG-IUS) was first marketed in 1990 in Finland. Since then, it has been approved in approximately 120 countries throughout the world, with almost 50 million women-years of cumulative experience to date. Its high contraceptive effectiveness and favorable bleeding profile, leading to significant reduction of menstrual bleeding both in women with idiopathic menorrhagia and in those with normal menstrual bleedings, have been the key to the success of the system. At the same time, women need to be provided adequate preinsertion counseling about changes in menstrual bleeding to be expected. In the Italian context, it is important to highlight during counseling that amenorrhea is not harmful but can lead to health benefits such as an increase in iron blood stores and blood hemoglobin concentration.

Study Design

To evaluate contraceptive efficacy, compliance and the effect of changes in menstrual cyclicity on quality of life and sexuality of the LNG-IUS (Mirena®), 156 women attending the Family Planning Clinic to request contraception were enrolled in the study and inserted with the device.

Results

Menstrual blood flow decreased in all users, in terms of both quantity and duration; although spotting was present in 93.7% of the women, it disappeared within 6 months in the majority of cases. Amenorrhea occurred in 29.5% of all women, with onset within the first six cycles postinsertion. Data from the EuroQuality of Life-5D and Female Sexual Function Index questionnaires showed improvement in the quality of life, with a decrease in intercourse-related pain and an improvement in sexual desire.

Conclusions

Although in Italy intrauterine contraception is poorly accepted, once started on LNG-IUS, women found that the device represents a safe and effective contraceptive modality, with valuable noncontraceptive benefits, especially in the presence of heavy or prolonged bleeding.     

Levonorgestrel-releasing intrauterine system for the management of heavy menstrual bleeding in women with inherited bleeding disorders: long-term follow-up

Background

There are currently limited data on the use of the levonorgestrel-releasing intrauterine system (LNG-IUS) for the management of heavy menstrual bleeding (HMB) in women with inherited bleeding disorders (IBDs) particularly on its long-term (>12 months) efficacy.

Study Design

This study involves a case series of women with IBDs who received the LNG-IUS as treatment for HMB. Menstrual blood loss before its insertion and at the time of follow-up was assessed by the pictorial blood-loss assessment chart (PBAC) and hemoglobin (Hb) concentrations. A questionnaire was used to evaluate quality of life (QOL) during menstruation before and after insertion of the LNG-IUS.

Results

Twenty-six women were included. The median duration of LNG-IUS use at follow-up was 33 months (range, 14–103). The median PBAC score decreased from 255 (range, 134–683) to 35 (range, 0–89) with LNG-IUS use. The median Hb concentrations (11.2 to 13.2 g/dL) and QOL scores (median, 26 to 52) improved significantly with LNG-IUS use (p<.01).

Conclusion

The LNG-IUS appears to be an effective long-term treatment for HMB in women with IBDs.