The measurement properties of the menorrhagia multi-attribute quality-of-life scale: a psychometric analysis

Menorrhagia, or heavy menstrual bleeding (HMB), is a common gynaecological condition. As the aim of treatment is to improve women's wellbeing and quality of life (QoL), it is necessary to have effective ways to measure this. This study investigated the reliability and validity of the menorrhagia multi-attribute scale (MMAS), a menorrhagia-specific QoL instrument. Participants (n = 431) completed the MMAS and a battery of other tests as part of the baseline assessment of the ECLIPSE (Effectiveness and Cost-effectiveness of Levonorgestrel-containing Intrauterine system in Primary care against Standard trEatment for menorrhagia) trial. Analyses of their responses suggest that the MMAS has good measurement properties and is therefore an appropriate condition-specific instrument to measure the outcome of treatment for HMB.     

The impact of cancer treatment on reproductive health in young women

The diagnosis of cancer can precipitate a re-evaluation of life at all ages. In children, adolescents and young adults, a cancer diagnosis and its treatment poses specific challenges that can affect all aspects of reproductive health resulting in considerable physical, psychological and psychosexual burden. Improved survival means that this cohort of patients is expanding and with an improving life span, the resulting morbidity is also extended. The demands of this group of patients are often not fully integrated in the operational functions of the health service with considerable variation in care. This review discusses the common reproductive morbidities amongst survivors of childhood, adolescent and young adult cancer whilst planning, delivering and following cancer treatment. This includes the current issues on the assessment of ovarian reserve and preservation of fertility.     

Age and the prevalence of bleeding disorders in women with menorrhagia

OBJECTIVE: A study was conducted to evaluate the frequency and types of hemostatic defects occurring in adolescent and perimenopausal-age women diagnosed with menorrhagia. METHODS: A total of 115 women with a physician diagnosis of menorrhagia, including 25 adolescent women, 25 perimenopausal-age women, and 65 women between the ages of 20 and 44, underwent comprehensive hemostatic testing for possible bleeding disorders. Frequencies of bleeding disorders were calculated and compared. RESULTS: Forty-seven percent of women were found to have hemostatic abnormalities, including platelet dysfunction, von Willebrand's disease, and coagulation factor deficiencies. Adolescents and perimenopausal-age women with menorrhagia were just as likely to have hemostatic abnormalities as were women aged 20 to 44. CONCLUSION: These results demonstrate that underlying bleeding disorders are frequently found in adolescent, postadolescent reproductive age, and perimenopausal-age women presenting with menorrhagia and suggest that women with menorrhagia should be considered for further hemostatic evaluation.     

The impact of surgical treatment on the mental health of women with obstetric fistula

Obstetric fistula is estimated to affect 2 million women worldwide and has considerable social and psychological effects on affected individuals. In this prospective study, 51 consecutive women with obstetric fistula admitted to the Barhirdar Hamlin Fistula Centre in the north of Ethiopia were screened using the General Health Questionnaire (GHQ-28) for potential mental health disorder before and 2 weeks after fistula surgery. Prior to surgery, all women screened positive. By 2 weeks after, this had dropped to 36% ( P = 0.005). 27% of the 45 women who were cured of their incontinence screened positive, while all 6 of those with severe residual incontinence continued to screen positive. We conclude that surgical treatment of obstetric fistula results in marked improvements in mental heath.     

Helping women and their families cope with the impact of gynecologic cancer

The impact of gynecologic cancer on the woman and her family depends on psychosocial factors and cancer-specific factors. Family assessments determine how the family is adapting to the woman's illness. Nursing interventions that families say are helpful include providing physical care, providing information, and giving support. Strategies used by families to cope with the stress and emotional strain of caregiving include taking time for themselves, maintaining a sense of humor, and focusing on the present.     

Perceptions and experiences of motherhood,health and the husband's role among Thai women in Australia

OBJECTIVE: to discuss the perceptions and experiences of motherhood among Thai immigrant women in Australia. DESIGN: ethnographic interviews and participant observation were used to elicit information. SETTING: Melbourne Metropolitan Area, Victoria, Australia. PARTICIPANTS: 30 Thai women who are now living in Australia. FINDINGS: becoming a mother meant different things to these women. Motherhood had both positive and negative aspects. Women believed that their health became worse as a result of becoming a mother. The contributing causes of their health status were multi-faceted, including their age, the demanding tasks of motherhood, the depletion of their strength and energy from childbirth, and in not following Thai traditional confinement practices. The findings in this paper support previous literature that motherhood has a profound effect on the life of many women. We, however, found that cultural beliefs and practices have an effect on women's perceptions and experience of motherhood. We also found that the 'presence' of the husband when a woman becomes a mother is important. The ethnicity of their husbands also played a significant role in their motherhood role and the ways in which they mothered their children. IMPLICATIONS FOR PRACTICE: understanding the social and cultural environment in which immigrant women try to be a mother is important if we are to provide culturally sensitive assistance and care to women who choose to become a mother in their new homeland.     

The impact of female genital cutting on health of newly married women.

OBJECTIVE: To detect the rate of female genital cutting among a sample of newly married women in Benha city, and make a comparison between circumcised and non-circumcised women regarding long-term health problems. METHODS: Randomly selected (264) newly married women were the subjects of this work. RESULTS: Circumcised group constitutes 75.8% of the sample. All non-circumcised women were living in an urban area. Dysmenorrhea was more common among circumcised rather than non-circumcised, with statistically significant difference (P<0.01). Marital problems (dyspareunia, loss of libido, failure of orgasm and husband's dissatisfaction) had statistically different levels of significance among circumcised women. Obstetric problems such as tears, episiotomy and consequently distressed babies were more events among circumcised mothers with statistical significance. Circumcised females had significant mental problems such as somatization, anxiety and phobia (P<0.001). CONCLUSION: Female genital cutting remains a widely practiced custom in our society. Grave complications of circumcision may last throughout women's life particularly the time of consummation of marriage and the time of childbirth.     

Lower urinary tract symptoms and their impact on women with anorexia nervosa

Anorexia nervosa is a condition which is associated with extremely low body weight and endocrine problems including persistent anovulation and a hypo-oestrogenic state. As the lower urinary tract is oestrogen sensitive, it is possible that women suffering from anorexia nervosa may experience similar distressing urinary problems. Of 29 anorexic women assessed, the majority had significant irritative urinary symptoms of which frequency, urgency and nocturia were the most common. These symptoms also had an unfavorable impact on their quality of life.     

Perceptions of women on workloads in health facilities and its effect on maternal health care: A multi-site qualitative study in Nigeria

Objectiveof the study was to explore women's perception of maternal health care providers’ workload and its effects on the delivery of maternal healthcare in secondary and tertiary hospitals in Nigeria.Research Design, setting, participantsfive focus groups discussions (FGDs) were conducted with women in each of eight secondary and tertiary hospitals in 8 States in four geo-political zones of the country. In all, 40 FGDs were held with women attending antenatal and post-natal clinics in the hospitals. We elicited information on women's perceptions of workloads of maternal health providers and the effects of the workloads on maternity care. The discussions were audio-taped and transcribed while thematic analysis was carried out using Atlas.ti computer software.Findingsthe majority of the participants submitted that the health providers are burdened with heavy workloads in the provision of maternal health care. Examples of heavy workload cited included complaints from health providers, evidence of stress and strain in care provision by providers and the sheer numbers of patients that are left unattended to in health facilities. Poor quality care, insufficient time to carry out necessary investigations on patients, and prolonged waiting time experienced by women in accessing care featured as consequences of heavy workload, with the secondary result that women are reluctant to seek care in the health facilities because of the belief that they would spend a long time in receiving care.Key conclusions and implications for practicewe conclude that women are concerned about heavy workloads experienced by healthcare providers and may partly account for the low utilization of referral health facilities for maternal health care in Nigeria. Efforts to address this problem should include purposeful human resource policy development, the development of incentives for health providers, and the proper re-organization of the health system.     

Fertility assessment in non-infertile HIV-infected women and their partners

The objective of the study was to assess the fertility of non-infertile couples seeking pregnancy in whom the woman was HIV infected. Therefore, a cross-sectional study was conducted between January 1998 and March 2005. A standardized fertility assessment was performed in all the included couples. A total of 130 women and 121 men were evaluated. Their median age was 34 years (range 22-43). Only 7.2% of the women were severely immunocompromised. The majority of women had regular cycles. Only one woman had an active sexually transmitted disease at the time of evaluation. A tubal occlusion on hysterosalpingogram was present in 27.8% of the women with no proven fertility. In 50.5% of the women, hepatitis C virus co-infection was present. One-third of the male partners (38/121) was infected with HIV. Abnormal semen parameters were observed in 83.4% of HIV-infected and 41.7% of HIV-uninfected partners (OR = 7; 95% CI = 2.1-23). It is concluded that the great majority of the HIV-infected women seeking pregnancy had a good infection status. Because in many of the couples, the women presented unexplained tubal occlusions and the men presented semen alterations, a hysterosalpingography and semen analysis should be part of the preconceptional investigations.     

Medium-term follow-up of women with menorrhagia treated by rollerball endometrial ablation

BACKGROUND: To assess medium-term efficacy of rollerball endometrial ablation in a district general hospital. METHOD: From March 1992 to June 1997, 91 women underwent rollerball endometrial ablation for uncontrolled menorrhagia unresponsive to medical treatment. Each was sent a detailed questionnaire after at least 18 months (range 18-55). There was an overall response rate of 88% (80/91). Case notes were reviewed to collect additional data related to pre-operative management and actual operative procedure. The main outcome measures included treatment satisfaction, relief of symptoms, improvement in health related quality of life, at least 18 months after surgery. RESULTS: Thirty-five of the 80 women (44%) had achieved amenorrhea. Ten women required further treatment; of these seven had a hysterectomy (9%). None of the non-responders had a hysterectomy. Following rollerball endometrial ablation, many women reported improvement in cyclical pelvic pain (73%), pre-menstrual symptoms (65%), ability to do housework (85%), and an improved sexual life (96%). Seventy-nine (99%) women were able to return to normal work within 4 weeks following surgery. The majority of them remained satisfied with treatment (79%) and they would recommend it to a friend (91%). CONCLUSIONS: Rollerball endometrial ablation is a simple, effective, and acceptable procedure for the treatment of menorrhagia in selected cases. Longer-term follow up is still needed to establish the ultimate effectiveness of the procedure.     

Empowering older women: strategies to enhance their health and health care

Older persons, especially older women, report that often their needs are not met in health care encounters. Lack of active participation by the patient is a major reason for this dissatisfaction. This article reviews research on older women's socialization that discourages them from challenging the status quo in interactions with others. It suggests ways that health care providers can empower female patients: They can encourage active participation during health care encounters, and they can help patients prepare for encounters so they can have their needs met.     

Fetal health assessment using prenatal diagnostic techniques

PURPOSE OF REVIEW: The assessment of fetal health has occupied our professional attention for many years. As the development of technologies for prenatal diagnostic techniques has progressed, applications of such technologies have aided in the overall assessment of fetal well-being. RECENT FINDINGS: Fetal heart-rate monitoring remains the main form of fetal assessment for high-risk pregnancies. The additional assessments afforded by the analysis of ST and T-wave changes of the fetal electrocardiogram hold promise for improving the predictive value of fetal heart-rate assessments. Ultrasound has been invaluable for assessment of fetal anatomy, and the use of Doppler ultrasound has given insight into fetal cardiovascular responses to such conditions as intrauterine growth restriction and fetal anemia caused by red blood cell alloimmunization. SUMMARY: As prenatal diagnostic techniques evolve, their application to the assessment of fetal well-being offers insight into pathophysiologic mechanisms of fetal disease, innovative tools to assess fetal health, and fertile ground for future investigation.