Laparoscopic treatment of ovarian cysts in adolescents and young adults

Study Objective

To investigate the laparoscopic management of ovarian cysts in adolescents and young adults.

Design

A retrospective chart review study.

Setting

Zekai Tahir Burak Women’s Health Research and Education Hospital.

Participants

A total of 282 females aged 25 years or younger underwent laparoscopic surgery for a presumed benign ovarian cyst. Patients were grouped as adolescents (ages 12–19, n = 79) or young adults (ages 20–25, n = 203).

Main Outcome Measures

Surgical approach, operative findings and the correlation of intraoperative diagnosis with the definitive pathological reports.

Results

The mean age of the patients was 21.2 years. At laparoscopic surgery, 89 patients (31.6%) had endometriomas, 47 (16.7%) had dermoid cysts, and 37 (13.1%) had paraovarian cysts. Ninety-seven patients (34.4%) had simple ovarian cysts. Pathological reports revealed that young adults were more likely to have endometriomas (34.0% vs 7.6%, P < 0.01), but dermoid cysts and simple ovarian cysts were more frequent (20.3% vs 15.3%, P < 0.01 and 60.7% vs 40.9%, P < 0.01, respectively).in adolescents. Eleven of the cases (3.9%) were found to have mucinous cystadenomas and fourteen (5.0%) to have serous cystadenomas. Four cysts were malignant (1.4%). Cystectomy was performed in 205 cases (72.7%), fenestration of cyst wall was performed in 53 cases (18.8%), and aspiration was applied in 22 cases (7.8%). The types of operation were not significantly different among adolescents and young adults (P > 0.05). The operative diagnosis was highly correlated with the final pathological reports (kappa value= 0.901, P < 0.001). There were no operative and postoperative complications in our series.

Conclusion

With a careful preoperative screening, the laparoscopic surgery of ovarian cyst is an efficient and safe treatment for adolescents and young adults.     

The Effects of a Dysmenorrhea Support Program on University Students Who Had Primary Dysmenorrhea: A Randomized Controlled Study

Study ObjectiveThis study aims to determine the results of a cognitive-behavioral approach in a dysmenorrhea support program that covers the symptoms, acquaintance, and attitudes toward menstruation of university students who had primary dysmenorrhea.Design and SettingThis randomized controlled, prospective, experimental study was carried out in a nursing school using a pretest-posttest design.ParticipantsA total of 682 female nursing students and 584 volunteers from the 2017-2018 academic year participated in a study of the prevalence of primary dysmenorrhea (94.0%). Study subjects were first-year female nursing students who scored severe on a visual analog scale for primary dysmenorrhea. As a result of the analysis, 80 female nursing students were assigned to study and control groups. A total of 60 students, 29 in the study group and 31 in the control group, completed the study.InterventionThe study group participated in a 6-session cognitive-behavioral approach in a dysmenorrhea support program. No intervention was administered to the control group. The control group and the study group were followed by using data collection forms during three menstrual cycles.Outcome MeasuresThe Participant Introductory Form (PIF), Dysmenorrhea Follow-up Form (DFF), Dysmenorrhea Information Form (DIF), Functional and Emotional Dysmenorrhea Scale (FEDS), Visual Analog Scale (VAS), and Menstrual Attitude Questionnaire (MAQ) were used to measure outcomes.ResultsIn the case of primary dysmenorrhea, the use of nonpharmacological methods was higher in the study group than in the control group. In the third cycle, although the rate of analgesics use was 20.7% in the study group, it was 50% in the control group. Primary dysmenorrhea symptoms, pain levels, and analgesic use decreased. No change was observed in the attitude toward menstruation.ConclusionA cost-effective, reliable, cognitive-behavioral approach−based dysmenorrhea support program can be used to relieve symptoms, decrease the use of analgesics, and increase knowledge about primary dysmenorrhea.     

Rates of Anovulation in Adolescents and Young Adults with Moderate to Severe Primary Dysmenorrhea and Those without Primary Dysmenorrhea

Study Objective

To evaluate rates of presumptive anovulation in eumenorrheic adolescents and young adults with moderate to severe primary dysmenorrhea and those without primary dysmenorrhea.

Relation Between Dysmenorrhea and Body Mass Index in Adolescents with Rural Versus Urban Variation

Objectives

To find out the relation between the frequency of dysmenorrhea and body mass index in adolescents and to assess the impact of socio-demographic factors, especially rural/urban variation in the frequency of dysmenorrhea.

Methods

Cross-sectional study of 200 urban and 200 rural school going adolescent girls at Udaipur and Bedla Districts, Rajasthan.

Results

Of the 400 girls, the prevalence of dysmenorrhea was found to be very high (81.5 % rural and 76 % urban). In the rural setup, of the total girls with mild dysmenorrhea, 71.84 % had BMI < 16.5, with 27.18 % underweight. All girls with moderate and severe dysmenorrhea had BMI < 16.5. In the urban setup, of all girls with mild dysmenorrhea, 38.05 % had BMI < 16.5 and 54.86 % were underweight. All girls with severe and 80 % with moderate dysmenorrhea had BMI < 16.5. All girls with no dysmenorrhea had normal BMI. There was significant rural versus urban variation.

Conclusions

Relation between dysmenorrhea and BMI was found to be significant (p < 0.01) with increased prevalence in the low BMI group. Hence, improving the nutritional status of adolescent girls may reduce dysmenorrhea.     

Premenstrual syndrome (PMS) in adolescents: severity and impairment

OBJECTIVES: Identify the presence of patients with premenstrual syndrome (PMS) in an adolescent gynecology practice, and evaluate the reported severity, impairment and timing of the symptoms in the menstrual cycle. METHODS: Adolescents ages 13-18 years completed a symptom questionnaire, functional impairment ratings, and a brief medical history questionnaire during an office visit. Teens who responded that they had PMS and reported a premenstrual symptom score at least 50% greater than the postmenstrual score and rated moderate to severe impairment in one or more domains comprised the "PMS" group. Teens who responded that they had PMS but did not meet the symptom and impairment criteria were termed "PMS not supported." Teens who responded that they did not have PMS and did not meet the PMS symptom and impairment criteria were termed "No PMS." RESULTS: Study participants (n = 94) had a mean age of 16.5 years (+/-1.3 SD); 31% met the criteria for the PMS group, 54% said they had PMS but did not meet criteria, and 15% clearly had no PMS. In the PMS group, the most severe symptoms were mood swings, anxiety, and irritability, with the greatest impairment in the home/family domain. Dysmenorrhea and the duration of PMS were significantly associated (P < 0.01) with PMS in univariate and multivariate analyses. CONCLUSIONS: The reports of premenstrual symptoms, their severity, timing and impairment suggest that PMS is common in adolescents. Further study is warranted to confirm these results with prospective assessment of PMS and to evaluate treatments for adolescents who have clinically significant PMS.     

Knowledge of reproduction in teenagers and young adults in Sweden

Objective To investigate the knowledge of reproductive physiology and anatomy among adolescents and young adults in Sweden, and to evaluate the education obtained on these issues.

Methods Two hundred and nine study specific questionnaires were distributed, of which 206 were answered by students in primary school, upper secondary school and at first year of university. A total knowledge score based on 21 out of the 35 questions in the questionnaire was calculated. As only 44 of the 206 respondents answered all the questions a revised score was also calculated, in which partial dropouts were interpreted as wrong answers.

Results The mean of the total knowledge score was 28.7 out of 54 among the 44 respondents answering all questions, and the revised knowledge score was 24.0. The level of knowledge tended to be higher in older age groups, among women, as well as among respondents who had visited a Youth clinic. The time of ovulation was known by 21.4% of men compared to 63.4% of women. Almost 50% of the students knew one mechanism whereby oral contraceptives act to protect against pregnancy. Of the respondents, 77.2% knew of Chlamydia trachomatis but the knowledge of other STIs, like condyloma, was poorer (16.5%). Reasons for infertility were relatively well known among the respondents. Of the respondents, 57.5% stated that they had not received enough information on reproductive issues.

Conclusions The students have not achieved sufficient knowledge concerning sexual and reproductive matters that they, according to the national curriculum, should have attained by the end of the 9th grade. An improvement of the quality of the education, adapted to the students' age and pre-existing knowledge, and a review of the contents of the education is therefore needed.     

Mindfulness in adolescents and young adults with diabetes: An integrative review

Background and purposeType 1 diabetes (T1D), type 2 diabetes, and prediabetes are increasing in incidence. Adolescents and young adults with diabetes experience psychosocial comorbidities at an increased incidence. As such, exploring interventions that can improve psychosocial and glycemic outcomes are needed. The purpose of this integrative review is to examine and synthesize the literature on mindfulness in adolescents and young adults with type 1 or type 2 diabetes or prediabetes.MethodsFour databases were searched during May 2021. Included studies were published between 2000 and 2021, evaluated adolescents and young adults, diagnosed with type 1 or type 2 diabetes or prediabetes. Studies were excluded if they were not in English; not original research; evaluated complementary/alternative therapies as a group. To assess for risk of bias, the National Institutes of Health quality assessment tools and the Cochrane Collaboration's tool were utilized. Whittemore and Knafl's (2005) method for conducting an integrative review was utilized to synthesize results.ResultsWe identified 137 articles in our initial search and 74 articles remained after removing for duplicates. Ten articles were included in the review, with 5 including adolescents and young adults with T1D and 5 including adolescents and young adults with prediabetes. No studies evaluated mindfulness in adolescents and young adults with type 2 diabetes.ConclusionMindfulness is an acceptable intervention in adolescents and young adults with T1D and prediabetes, resulting in positive psychosocial and glycemic outcomes. There were issues with feasibility of the intervention and mobile health technology delivery methods should be evaluated.     

Dysmenorrhea,Absenteeism from School,and Symptoms Suspicious for Endometriosis in Adolescents

Study ObjectiveTo quantify in adolescents the prevalence of dysmenorrhea and other symptoms found to be suggestive of future diagnosis of endometriosis, in particular their impact on monthly absenteeism from school/work, activity impairment, and sexual life and to quantify the awareness of endometriosis in adolescents.DesignCross-sectional study.SettingAcademic institution.PatientsAdolescents (n = 250) aged 14-20 years referring to 3 family Counseling services.InterventionsParticipants completed an anonymous questionnaire.Main Outcome MeasuresPrevalence of dysmenorrhea and absenteeism from school/work during menses. Other outcomes were impairment of daily activities, dyspareunia, and awareness of endometriosis as a pathologic condition.Results68% (170/250) of the participants complain of dysmenorrhea, 12% (30/250) lose days of school/work monthly because of dysmenorrhea, 13% (33/250) complain of intermenstrual pain which limits daily activities, 27% (56/208) of the adolescents who are sexually active complain of dyspareunia, 82% (203/250) have never heard about endometriosis and 80% (200/250) would like to know more about it. A significant association was found between severe dysmenorrhea, absenteeism from school/work, and basic level of education. Absence from school/work during menses showed an adjusted odds ratio for severe dysmenorrhea about 28 times greater than those who did not declare absenteeism (95%CI 7.898-98.920, P<.000).ConclusionsThe rates of dysmenorrhea and school absenteeism caused by dysmenorrhea are high. According to recent studies these patients are at higher risk of further development of endometriosis, whereas the knowledge of the disease is low among the adolescents investigated, so those involved with adolescents both in the health profession and particularly in schools and Family Counseling Services should be educated about endometriosis and its symptoms to reduce the significant lag time between symptoms and diagnosis.     

Birth outcomes in perinatally HIV-infected adolescents and young adults in Manipur,India: a new frontier

Objective The objective was to study birth outcomes in perinatally HIV infected adolescents and young adults.Method Between January 1997 and January 2001, 30 asymptomatic perinatally HIV-infected primigravid pregnancies (Group A, study group) were identified amongst perinatally HIV-infected adolescents and young adults. They were attending the high-risk antenatal clinic at the Government Hospital, Manipur. Pregnancy and birth outcome were assessed. The control group (Group B) consisted of 28 perinatally infected females with no history of pregnancy. Both groups, of tribal origin, were matched for age 1 of the age of the pregnant females: median age 18 years (range: 16–22 years) and socio-economic class, (lower middle socio-economic class).Results The median viral load of the pregnant women were 16,383 copies/ml (range 5,251–65,571 copies/ml) and median CD4 count was 220 cells/mm³ (range: 18–980 cells/mm³. Twenty-seven (90%) of the 30 pregnant women received antiretroviral therapy (ARV) consistently during the pregnancy. Among the 30 pregnancies, 4 ended in elective abortion. The remaining 26 women delivered 26 live born infants (of these, one was a preterm delivery (35.2 weeks). There was no IUFD, IUGR, spontaneous miscarriages, or fetal, infant or maternal deaths.Conclusion Pregnancy in perinatally HIV-infected adolescents and young adults, does not appear to be associated with adverse maternal or fetal outcome if retroviral therapy is taken consistently prior and during the pregnancy. Counseling with respect to sexual activities, pregnancy and birth control is mandatory.     

Relationship between Dysmenorrhea and Posttraumatic Stress Disorder in Japanese High School Students 9 Months after the Great East Japan Earthquake

Study ObjectiveTo determine the relationship between dysmenorrhea and posttraumatic stress disorder (PTSD) among Japanese adolescent girls 9 months after the Great East Japan Earthquake.DesignCross-sectional study.SettingTwo high schools in Sendai, the largest city in northeastern Japan.Participants1489 female adolescents aged between 15 and 18 years.Main Outcome MeasuresImpact of Event Scale-Revised (IES-R), intensity of menstrual pain.ResultsThe intensity of menstrual pain increased according to the comorbidity of PTSD (P < .001). The IES-R subscale and total scores significantly increased according to the severity of menstrual pain.ConclusionsThis study showed a significant association between natural disaster-induced PTSD and the severity of dysmenorrhea.     

Assessing knowledge,exploring needs: A reproductive health survey of adolescents and young adults in Pakistan

Rationale & objective The sexual and reproductive health (SRH) needs of adolescents have increased over the last few years, but are largely unmet. Lack of involvement of youth in the programs and limitations of the mass media in a conservative milieu are some of the issues. Our objectives were to assess the baseline SRH knowledge and to suggest interventions based on needs with regard to SRH promotion, so that the level of existing services could be upgraded.

Methods A cross-sectional survey was conducted in 20 villages of Lahore, in which 400 adolescents and young adults were interviewed using a semi-structured questionnaire. Respondents were equally divided in gender in all villages, using stratified random sampling.

Results Adolescents and young adults do have some knowledge of SRH issues. Males are relatively more knowledgeable than females about puberty (M = 68%; F = 58%), pregnancy (M = 55%; F = 43%), family planning (M = 62%; F = 50%) and sexually transmitted infections (M = 56%; F = 44%). Yet, a large majority needs clarification on their concepts and perceptions. They believe that having sound SRH knowledge will promote mother & child health and family health.

Conclusion Peers, media and a family doctor could be the acceptable source of information on SRH. Life skills programs to increase unmarried girls' cognitive skills and young men's involvement in such programs is a must. Involving families and communities will enhance the effectiveness of youth programs.     

Cervical length in adolescents versus adults

Purpose: Two of the known risk factors for spontaneous preterm birth (sPTB) are short cervical length (CL)?≤?25?mm and adolescence (≤19?years). Our objective was to evaluate whether adolescent women have a higher incidence of short CL compared to their 20–24 year old counterparts.

Materials and methods: Retrospective cohort of nulliparous singleton gestations undergoing universal second trimester transvaginal ultrasound (TVU) CL screening between January 2012 and June 2013. Adolescent women?≤19?years of age were compared to women 20–24?years of age. Primary outcomes were mean CL and incidence of CL?≤25?mm. Secondary outcomes were incidence of PTB?<37 weeks, delivery mode, birth weight, and NICU admission.

Results: One hundred and five adolescents and 236 women 20–24?years underwent TVU CL screening. There was no difference in mean CL (40.6?mm vs. 40.6?mm, p?=?0.51) or incidence of CL?≤25?mm (1.0% vs. 1.7%; OR 0.56 [0.06–5.1]). After controlling for maternal differences, there still was no significant correlation between maternal age and CL. There was no significant difference in PTB, birth weight, or NICU admission between the groups. CL measurements did not significantly differ across all maternal ages (14–42?years).

Conclusions: There is no difference in mean CL or incidence of CL?≤25?mm among adolescents compared to women 20–24?years.     

Unmet Needs and Experiences of Adolescent Girls with Heavy Menstrual Bleeding and Dysmenorrhea: A Qualitative Study

Study ObjectiveTo identify and examine the key areas of need and explore the experiences of adolescent girls with heavy menstrual bleeding and/or dysmenorrhea.Design and SettingQualitative interview study using semi-structured interviews. Gynaecology outpatient clinic at The Royal Children's Hospital, Melbourne, Australia.ParticipantsAdolescent girls (12-18 years; mean age, 14.8 ± 1.5 years) presenting with heavy menstrual bleeding and/or dysmenorrhea at the clinic (N = 30).Interventions and Main Outcome MeasuresIn-depth semi-structured interviews were conducted between May and August 2018. Interview data were thematically analyzed using a grounded theory approach. Themes covered experiences and unmet needs of adolescent girls with heavy menstrual bleeding and/or dysmenorrhea.ResultsA total of 12 themes were identified, and covered the impact of symptoms, experiences, and/or unmet needs of these adolescents. Key themes highlighting experiences and unmet needs related to (1) coordination of healthcare, (2) day-to-day coping, (3) school, and (4) information surrounding menstrual issues. From these themes, 7 unmet needs emerged and were organized under 3 key areas of need: (1) treatment, management, and care, (2) improvements in the school environment, and (3) menstrual health as a gendered issue.ConclusionMenstrual concerns can have a profound physical and psychosocial impact on adolescents. Effective school-based menstrual education programs may be key in reducing stigma, fear, and shame surrounding menstruation, in teaching positive management strategies and in encouraging adolescents to seek help for their menstrual concerns.     

依托孕烯植入剂治疗痛经的疗效及安全性分析

目的:探讨依托孕烯植入剂治疗痛经的疗效及安全性。方法:选择2013年9月至2016年4月在我院埋植依托孕烯植入剂治疗痛经的患者。依托孕烯植入剂植入术后3月、半年、1年进行随访。比较患者术前及术后痛经情况、月经模式、肝肾功能;对子宫腺肌病患者还需比较子宫大小及CA125水平。结果:共73例患者纳入研究,66例术前有中重度痛经,术后3月中、重度痛经者仅10例,占13.7%(χ2=95.312,P=0.000),31例痛经完全消失;3月后痛经情况进一步改善,但与3月比较差异无统计学意义(P0.05)。对于子宫腺肌病患者,术后子宫大小无明显变化(P0.05),术后血清CA125水平显著下降(P0.05)。术后31例(42.5%)患者出现点滴状阴道流血。术后无严重副反应。结论:皮下埋植依托孕烯植入剂是治疗痛经效果确切、较为安全的方法。     

原发性痛经发病机制及治疗的研究进展

痛经是妇科最常见的疾病之一,分为原发性和继发性两大类,前者生殖器官无器质性病变,后者由盆腔器质性病变所引起。而罹患原发性痛经(PD)者占多数,近年国外对其研究不断深入,随着高科技的发展进一步认识到原发性痛经的发病机制如脑代谢异常、子宫肌层血流等,而饮食方面目前是原发性痛经诱发因素的热门研究方向。医学家不断地研究更确切的治疗方案包括神经切除手术,同时替代医学亦提供患者更多适合自己治疗方案的选择。综述原发性痛经发病机制、危险因素以及治疗的新进展。     

Eating disorders in adolescents and young adults

Eating disorders are relatively common and frequently result in gynecologic abnormalities. The gynecologist must appreciate the various manifestations of these complex health problems as well as the biopsychosocial approach needed to help the adolescent or young adult woman recover from these chronic conditions. By recognizing both the medical and gynecologic aspects of eating disorders, the oversimplified viewpoint of considering these conditions as purely psychiatric disorders can be avoided. Open and consistent communication with patients, with a focus on health rather than dysfunction and mental illness, facilitates the acceptance of a comprehensive approach involving the gynecologist, dietitian, and mental health provider.