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- Edlund, Måns
(author)
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Aspects on menstrual physiology, pathology and medical treatment of menorrhagia
- 2003
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Doctoral thesis (other academic/artistic)abstract
- Menstruation is the monthly process by which the endometrium in fertile women is discarded if no pregnancy occurs. The physiology and pathology of menstruation has been extensively studied; still several steps are not fully understood. Menorrhagia, heavy regular menstrual bleeding, is a gynaecological symptom of disease. It is only a symptom of an underlying disease and not an illness in itself. Nevertheless menorrhagia, sometimes without adequate preceding evaluation, has been the reason of surgical interventions such as endometrial ablation or hysterectomy. The aims of this work was to study menstrual physiology in order to find a link between the progesterone withdrawal before menses and the vasoconstriction in endometrial coiled arteries during menses. Furthermore general and local causes of menorrhagia were studied and two medical treatments of menorrhagia were evaluated. The results support a chain of events linking progesterone withdrawal to upregulation of the thrombin receptor, leading to an increased thrombin response and a release of endothelin, in turn leading to constriction in the coiled arteries. This chain of events fits well into existing theories on inflammation and tissue degradation in the endometrium at the time of menstruation. The results also show that there is a high probability of revealing an earlier undiagnosed von Willebrands Disease when properly examining a woman with menorrhagia. In addition to this other causes of increased bleeding often found are platelet dysfunction disorders. Furthermore there was a significant correlation between the amount of menstrual blood loss and the fibrinolytic activity in the menstrual fluid both for women who bleed normally and for women with menorrhagia. Evaluation of medical treatment showed that menstrual blood loss was significantly reduced with up to 41 % during treatment with a new antifibrinolytic drug, an ester prodrug of tranexamic acid. Treatment with desmopressin nasal inhalation and the commercially available form of tranexamic acid also reduced menstrual blood loss with up to 33%. A reduction in menstrual blood loss of 30% during two days was achieved with only desmopressin treatment. In summary, a crucial link in the physiological events regulating onset, duration and cessation of normal menstrual bleeding is presented. Two important facts on the aetiology of menorrhagia have been established. First that undiagnosed bleeding disorders are found to be a common reason for menorrhagia and second that there is a high correlation between the menstrual blood loss and the local fibrinolytic activity in menstrual fluid. And finally two alternative medical treatments for menorrhagia were evaluated. Taken together, these results provide an improved understanding of menstrual physiology and pathology. This may lead to a better evaluation of the symptom menorrhagia as well as a better treatment of the underlying causes, thus reducing the frequency of unnecessary surgical interventions.
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| 2. |
- Lövkvist, Lena, et al.
(author)
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Age-Related Differences in Quality of Life in Swedish Women with Endometriosis
- 2016
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In: Journal of Women's Health. - : Mary Ann Liebert Inc. - 1540-9996 .- 1931-843X. ; 25:6, s. 646-653
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Journal article (peer-reviewed)abstract
- Objective: The purpose of this observational study was to evaluate the impact of endometriosis on quality of life (QoL) in different age groups of Swedish women with endometriosis. Recruitment occurred through the Endometriosis Association (Sweden) (n = 400) and five gynecology departments of five Swedish hospitals (n = 400). All voluntary female members of the patient organization and patients attending specialist clinics due to endometriosis (n = 800) were invited by sending them a questionnaire. An age-and gender-matched sample of the general Swedish population was used as a control group when analyzing SF-36 data. Methods: A postal questionnaire (including SF-36) was distributed to 800 women. The questionnaire was evaluated by using descriptive statistics, and SF-36 was evaluated according to standard methods. Results: Of the 449 (56%) self-administered questionnaires returned, 431 (96%) contained evaluable answers. Women with endometriosis have significantly lower SF-36 scores than the general female Swedish population, and the score depends on the women's age. Younger women experience more symptoms and have a lower QoL score compared with women in the older age group. Conclusion: Women with endometriosis have significantly lower QoL than the general female Swedish population and it depends on the women's age, where younger women express more symptoms and have a lower QoL compared with women in the older age group. Our results highlight that more healthcare resources should be focused on younger women with endometriosis.
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| 3. |
- Söderman, Lisa, et al.
(author)
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Adjuvant use of melatonin for pain management in dysmenorrhea - a randomized double-blinded, placebo-controlled trial
- 2022
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In: European Journal of Clinical Pharmacology. - : Springer Heidelberg. - 0031-6970 .- 1432-1041. ; 78:2, s. 191-196
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Journal article (peer-reviewed)abstract
- Purpose Dysmenorrhea is a common, recurring, painful condition with a global prevalence of 71%. The treatment regime for dysmenorrhea includes hormonal therapies and NSAID, both of which are associated with side effects. A dose of 10 mg melatonin daily has previously been shown to reduce the level of pelvic pain in women with endometriosis. We chose to investigate how this regime, administered during the week of menstruation, would affect women with dysmenorrhea but without any signs of endometriosis, as adjuvant analgesic treatment. Methods Forty participants with severe dysmenorrhea were randomized to either melatonin or placebo, 20 in each group. Our primary outcome was pain measured with numeric rating scale (NRS); a difference of at least 1.3 units between the groups was considered clinically significant. Secondary outcomes were use of analgesics, as well as absenteeism and amount of bleeding. Mixed model was used for statistical analysis. Results Eighteen participants completed the study in the placebo group and 19 in the melatonin group. Mean NRS in the placebo group was 2.45 and 3.18 in the melatonin group, which proved to be statistically, although not clinically significant. Conclusion This randomized, double-blinded, placebo-controlled trial could not show that 10 mg of melatonin given orally at bedtime during the menstrual week had better analgesic effect on dysmenorrhea as compared with placebo. However, no adverse effects were observed.
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