Questionnaire Study on Menstrual Disorders in Adolescent Girls in Singapore

Study ObjectiveAdolescence, the transitional phase of physical and mental development between childhood and adulthood, is characterized by immense hormonal changes. Owing to the immaturity of the hypo-thalamo-pituitary-ovarian axis, menstrual cycles tend to be rather irregular. This variability poses a dilemma for physicians treating these girls and may result in a delay in the diagnosis and treatment of underlying problems. The purpose of this study was to collect data on the characteristics of menstrual cycles in Singapore adolescents to determine the prevalence of menstrual abnormalities and the pattern of use of medical treatments for these abnormalities.DesignCross-sectional study using a self-administered, 27-point structured questionnaire.SettingSixty-two secondary schools and junior colleges in Singapore from January to December 2004.ParticipantsData from 5561 girls, 12 to 19 years old, were included in the analysis.ResultsOf the 5561 participants, 23.1% reported having irregular cycles. Oligomenorrhea was the most frequently reported problem (15.3%), and polymenorrhea was much less prevalent (2.0%). With increasing body mass index (BMI), there was a significant increase in the prevalence of oligomenorrhea, whereas polymenorrhea was more prevalent in the girls with a low BMI. Dysmenorrhea was a significant problem, with 83.2% respondents reporting it in various degrees and 24% girls reporting school absenteeism owing to it. Dysmenorrhea was severe enough to require analgesics for pain relief in 45.1% of all subjects. In spite of menstrual problems being common, only 5.9% girls reported seeking medical advice for them. Traditional Chinese medications were used most commonly for menstrual cycle problems, and over-the-counter medications for dysmenorrhea. The use of oral contraceptives for menstrual problems was minimal.ConclusionMenstrual problems among adolescent females are common and a significant source of morbidity in this population. However, adolescent girls are reluctant to seek medical treatment, leading to delay in diagnosis and treatment. Appropriate health education measures need to be put into place to prevent this trend.     

Gel Sonovaginography

Gel sonovaginography is a new way of assessing local cervical and vaginal disorders, in which regular transvaginal sonography is known to have limitations. In gel sonovaginography, 20 mL of ultrasound gel is instilled into the vagina, followed by examination with a transvaginal transducer. In a study involving 28 women with known or suspected disorders such as cervical and vaginal cancer, cervical polyps, vaginal septa, and deep infiltrating endometriosis, a substantial improvement in visualization and assessment of local lesions and structures was noted with gel sonovaginography. This simple technique appears to be valuable for accurate diagnosis of local cervical and vaginal disorders.     

Comparison of Low Molecular Weight Heparin (Fragmin) With Sodium Heparin for Prophylaxis Against Postoperative Thrombosis in Women Undergoing Major Gynaecological Surgery

Summary: A randomized controlled trial was undertaken comparing the efficacy and safety of low molecular weight (LMW) heparin (Fragmin) with sodium heparin for prophylaxis against postoperative thromboembolic disease after major gynaecological surgery. Women were randomized to receive subcutaneous injections of 5,000 U of either once daily LMW heparin or twice daily sodium heparin. A total of 566 women were recruited, of whom 552 completed the study. Most women (461) had malignant disease and 430 of these underwent radical surgery. The remainder underwent major, but not radical surgery. There were 5 thromboembolic events in the LMW heparin group and 2 in the sodium heparin group, with no significant difference between these groups. No significant difference was found in the incidence of intraoperative or postoperative transfusion in the 2 groups. The decision of which heparin to use in routine practice cannot be made on clinical grounds.     

Reproductive Performance Following Sleeve Excision Anastomosis Operation for Genital Prolapse

Genital prolapse is a disorder of pelvic support and is one of the most frequent disorders encountered in our gynaecological practice. Our social and cultural background predisposes to this condition to occur at an age which is reported to be earlier than any part of the world. Over a period of 4 years, 1986-1989, 17 cases were studied in whom the Sleeve Excision anastomosis operation was carried out, either at the Lokmanya Tilak Municipal General Hospital, Sion, Bombay, India or in some other hospital. All these patients were either admitted in active labour or as cases of abortions or were being treated for infertility. The incidence of full-term normal vaginal delivery in our study was 66.6% and the incidence of Caesarean section was 8.3%. There was 1 case of posterior wall rupture following previous sleeve excision anastomosis operation. The recurrence rate of prolapse in our series was only 7.7%. The Sleeve excision anastomosis operation has given excellent anatomical and obstetric results in our study and future multicentric trials will be necessary to study its effect on subsequent fertility to arrive at any final conclusion.