Heavy menstrual bleeding clinics for adolescents.

Heavy menstrual bleeding (HMB) is a common symptom in adolescence, often leading to significant disruptions in daily life, such as school absences, shame caused by the stigma surrounding menstruation, and symptoms from iron deficiency. Further, HMB may be the first and/or only sign of an underlying bleeding disorder. Navigating the symptoms, effects, and treatments of HMB during adolescence requires a collaborative approach between the patient, caregivers, and healthcare providers.

Menstrual Health Education: School Health Curriculum Topics by Grade Level Recommended by Specialized Medical Professionals in Menstrual Health Clinics.

Study Objective: Evidence-based menstrual health education is not mandated in any US state or territory. Aspects of normal and abnormal menstruation impact quality of life and educational engagement, but many youths are not prepared to know when to seek medical help. We sought to determine which topics should be included in a third- through eighth-grade school-based menstrual health curriculum.

Unhealthy air quality secondary to wildfires is associated with lower blastocyst yield.

Objective: To study the impact of unhealthy air quality from the 2020 Oregon wildfires on outcomes for patients undergoing in vitro fertilization (IVF) treatment.

Design: A retrospective cohort study.

Setting: A university-based fertility clinic.

A Social Media Survey of US Adolescent Preferences for Menstrual Bleeding Patterns.

Study Objective: To assess preferences for menstrual pattern and acceptability and knowledge about the safety of induced amenorrhea among adolescents and young adults METHODS: We conducted a cross-sectional online survey of US residents aged 14-24 years at least 1 year post-menarche. Online recruitment was conducted via the social media platform TikTok on a teen reproductive health channel. Survey questions focused on menstrual history, menstrual pattern preferences, and demographic characteristics.

Menstrual Health Literacy among Adolescents and Young Adults Who Menstruate: Impact of Christian Family Background and United States Region.

Study Objective: To compare menstrual health literacy among adolescents and young adults on the basis of family religious background and United States region METHODS: We conducted a cross-sectional online survey of post-menarcheal US adolescents and young adults aged 14-24 years who identified their family religious background, including Christian or non-religious, with recruitment via the social media platform TikTok. We asked participants several questions to assess their health literacy regarding common myths about the use of gonadal steroid hormones for menstrual suppression.

Results: From 3250 online survey respondents, 2997 met the criteria for analysis, with 1989 identifying their family as Christian (66.

Nanomedicines for Improved Management of Ectopic Pregnancy: A Narrative Review.

Ectopic pregnancy (EP) - the implantation of an embryo outside of the endometrial cavity, often in the fallopian tube - is a significant contributor to maternal morbidity and leading cause of maternal death due to hemorrhage in first trimester. Current diagnostic modalities including human chorionic gonadotropin (hCG) quantification and ultrasonography are effective, but may still misdiagnose EP at initial examination in many cases. Depending on the patient's hemodynamic stability and gestational duration of the pregnancy, as assessed by history, hCG measurement and ultrasonography, management strategies may include expectant management, chemotherapeutic treatment using methotrexate (MTX), or surgical intervention.

Glutathione-Responsive Methotrexate Polymersomes for Potential Management of Ectopic Pregnancy.

The first-line treatment for ectopic pregnancy (EP), the chemotherapeutic methotrexate (MTX), has a failure rate of more than 10%, which can lead to severe complications or death. Inadequate accumulation of administered MTX at the ectopic implantation site significantly contributes to therapeutic failure. This study reports the first glutathione-responsive polymersomes for efficient delivery of MTX to the implantation site and its triggered release in placental cells.

Hormonal therapies in females with blood disorders: thrombophilia, thrombosis, hemoglobinopathies, and anemias.

There is widespread use of gonadal steroid hormone therapy for a variety of indications throughout the reproductive and postreproductive lifespan. These therapies may have particular benefits and specific risk among those with blood disorders, including inherited or acquired bleeding disorders, thrombophilia, thrombosis, or anemia. This clinical review is intended to provide a guidance for counseling and management of adolescent and adult biologic females with thrombophilic risk factors and/or thrombosis who require hormonal therapy.

Building the foundation for a community-generated national research blueprint for inherited bleeding disorders: research to advance the health of people with inherited bleeding disorders with the potential to menstruate.

Background: People who have or had the potential to menstruate (PPM) with inherited bleeding disorders (BD) face particular challenges receiving appropriate diagnosis and care and participating in research. As part of an initiative to create a National Research Blueprint for future decades of research, the National Hemophilia Foundation (NHF) and American Thrombosis and Hemostasis Network conducted extensive all-stakeholder consultations to identify the priorities of PPM with inherited BDs and those who care for them.

Research Design And Methods: Working group (WG) 4 of the NHF State of the Science Research Summit distilled community-identified priorities for PPM with inherited BDs into concrete research questions and scored their feasibility, impact, and risk.

Nano-Theranostic Modality for Visualization of the Placenta and Photo-Hyperthermia for Potential Management of Ectopic Pregnancy.

Ectopic pregnancy (EP) is the leading cause of maternity-related death in the first trimester of pregnancy. Approximately 98% of ectopic implantations occur in the fallopian tube, and expedient management is crucial for preventing hemorrhage and maternal death in the event of tubal rupture. Current ultrasound strategies misdiagnose EP in up to 40% of cases, and the failure rate of methotrexate treatment for confirmed EP exceeds 10%.

Does a Bleeding Disorder Lessen the Efficacy of the 52-mg Levonorgestrel-Releasing Intrauterine System for Heavy Menstrual Bleeding in Adolescents? A Retrospective Multicenter Study.

Purpose: The aim of this study is to compare the patient-reported bleeding outcomes and complication rates with the use of the 52-mg levonorgestrel-releasing intrauterine system (52-LNG-IUS) for treatment of heavy menstrual bleeding (HMB) among adolescents with and without a diagnosed inherited bleeding disorder (BD) within the first 12 months after insertion.

Methods: Retrospective chart review was conducted of adolescents ages 14-21 years, with and without an inherited BD, who underwent 52-LNG-IUS insertion between September 2013 and February 2020 for the treatment of HMB.

Results: One hundred forty-four 52-LNG-IUS insertions among 139 subjects were evaluated.

A Retrospective Comparison of Time to Cessation of Acute Heavy Menstrual Bleeding in Adolescents Following Two Dose Regimens of Combined Oral Hormonal Therapy.

Study Objective: Although multiple hormonal treatment strategies are effective in decreasing heavy menstrual bleeding (HMB) in adolescents, few studies have compared the relative effectiveness of hormone therapy on the basis of dose.

Design: Retrospective chart review SETTING: Urban tertiary care institution PARTICIPANTS: Adolescents aged 9-19 years with acute HMB and anemia in 2008-2018 INTERVENTIONS: We used billing codes to identify encounters for acute HMB with hemoglobin less than 12 mg/dl and reviewed initial treatment and time until resolution of acute HMB. We excluded patients who had previously used gonadal steroids or did not complete follow-up.

Miles and days until medical abortion via TelAbortion versus clinic in Oregon and Washington, USA.

Background: Medical abortion provided via telemedicine is becoming more widely available, potentially decreasing travel time for in-person abortion evaluation.

Methods: We conducted a retrospective chart review of all outpatient medical abortions from October 2016 through December 2019 at our academic medical centre in Portland, Oregon, USA. Using mifepristone administration logs, we identified patients who underwent abortion via direct-to-patient telemedicine or in clinic.

Expansion of a direct-to-patient telemedicine abortion service in the United States and experience during the COVID-19 pandemic.

Objective: To present updated evidence on the safety, efficacy and acceptability of a direct-to-patient telemedicine abortion service and describe how the service functioned during the COVID-19 pandemic.

Study Design: We offered the study at 10 sites that provided the service in 13 states and Washington DC. Interested individuals obtained any needed preabortion tests locally and had a videoconference with a study clinician.

"False positive" urine pregnancy test results after successful medication abortion.

Objective: To examine the proportion of high-sensitivity urine pregnancy test (HSPT) results that were positive by time after successful medication abortion.

Study Design: We used data from an ongoing study that provides mifepristone and misoprostol for medication abortion by direct-to-patient telemedicine and mail. Providers evaluated abortion outcomes by patient interview and clinical tests per clinical judgment and participant preference.

Serum human chorionic gonadotropin decline following aspiration abortion in early pregnancy less than 42 days gestation.

Objective: To define serum human chorionic gonadotropin (hCG) decline following complete aspiration abortion.

Study Design: We performed a secondary analysis of 86 patients who underwent uncomplicated aspiration abortion for ultrasound-confirmed pregnancy ≤42 days gestation and had serum hCG at the time of aspiration and within 3 days postprocedure.

Results: Median hCG declines were 72.

Heavy menstrual bleeding in women on oral anticoagulants.

Background: Although heavy menstrual bleeding (HMB) is a known complication of anticoagulant therapy, rates of HMB in users of the direct oral anticoagulants (OACs) apixaban and rivaroxaban are largely unknown.

Methods: We performed a retrospective cohort study of menstruating women prescribed rivaroxaban, apixaban and warfarin over a six-year period (2012-2018). The primary outcome was HMB requiring medical or surgical intervention.

Safety and effectiveness of medication and aspiration abortion before or during the sixth week of pregnancy: A retrospective multicenter study.

Objective: To compare adverse outcomes of medication and aspiration abortion among those with intrauterine pregnancy <43 days gestation versus abortions performed at 43-48 days.

Study Design: We conducted a multicenter retrospective chart review study to review all medication and aspiration abortion of visualized pregnancy <49 days gestation at Planned Parenthood Columbia Willamette (Oregon) and Planned Parenthood of Orange and San Bernardino Counties (California) in 2014-2015. We identified incident cases by billing codes and performed chart review for adverse outcomes (ED visits, incomplete abortion), need for further interventions, or complications (hemorrhage, infection, and uterine perforation), captured up to 90 days post-abortion.

TelAbortion: evaluation of a direct to patient telemedicine abortion service in the United States.

Objectives: To evaluate the safety, feasibility, and acceptability of a direct-to-patient telemedicine service that enabled people to obtain medical abortion without visiting an abortion provider in person.

Study Design: We offered the service in five states. Each participant had a videoconference with a study clinician and had pre-treatment laboratory tests and ultrasound at facilities of her choice.

Pregnancy intention screening tools: a randomized trial to assess perceived helpfulness with communication about reproductive goals.

Background: Federal and clinical guidelines support integration of reproductive life planning in the care of female patients to aid in the reduction of unplanned pregnancies. A multitude of tools have been created to help in the counseling component, but further research is needed regarding how and whether they facilitate patient-provider communication.

Research: We performed a randomized controlled trial to evaluate if patients report whether a detailed or simple pregnancy intention screening tool is helpful for communication of reproductive life plans.

Video compared to conversational contraceptive counseling during labor and maternity hospitalization in Colombia: A randomized trial.

Objective: Assess if video-based contraceptive education could be an efficient adjunct to contraceptive counseling and attain the same contraceptive knowledge acquisition as conversation-based counseling.

Study Design: This was a multicenter randomized, controlled trial examining contraceptive counseling during labor and maternity hospitalization regarding the options of immediate postpartum contraception. At two urban public hospitals, we randomized participants to a structured conversation with a trained counselor or a 14-min video providing the same information.