Metrorrhagia iuvenilis and Premenstrual Syndrome as frequent problems of adolescent gynecology with aspects of diet therapy

Painful menstruation, premenstrual syndrome and metrorrhagia iuvenilis are one of the most common problems related to the sexual cycle in adolescent girls. Metrorrhagia iuvenilis is acyclic bleeding that occurs in adolescents and lasts from over 10 days even up to 3 months. These bleeds are very abundant and have a tendency to relapse. They cause anemia, and severe cases can be life-threatening. Premenstrual Syndrome (PMS) is a cluster of somatic, emotional and behavioural symptoms occurring in the luteal phase of the menstrual cycle. The aetiology of PMS remains unknown. According to strict diagnostic criteria, an estimated 2.5–5% of girls and women are affected by PMS. However, some researchers maintain that the symptoms of PMS may be prevalent in as many as 40–80% of girls and women. This article it has been discussed premenstrual syndrome and metrorrhagia iuvenilis and aspects related to dietotherapy were included

The role of diet and probiotics in prevention and treatment of bacterial vaginosis and vulvovaginal candidiasis in adolescent girls and non-pregnant women

The article raises important issues regarding the use of diet and probiotics in prevention and treatment of vaginitis.Vaginitis is defined as any condition with symptoms of abnormal vaginal discharge. The most common causes of vaginitisare vulvovaginal candidiasis (VVC), trichomoniasis and bacterial vaginosis (BV). Vaginitis has been linked to itching, burning,pain, discharge, irritation and also adverse reproductive and obstetric health outcomes. Moreover, microorganisms thatbuild vaginal flora in the state of bacterial vaginosis are a source of cervicitis and endometritis (often in subclinical forms)and pelvic inflammatory disease (PID)The proper diet and probiotics consumption may influence the composition of the gut microbiota, improve gut integrity,and have an impact on maintaining and recovering the normal vaginal microbiota.Future studies and reviews investigating the role of diet and probiotics in changes to gut and vaginal microbiome need tofocus on deciphering the mechanismus of host bacteria interaction in vulvovaginal health

The relationship between body mass index, body composition and premenstrual syndrome prevalence in girls

Objectives: Premenstrual Syndrome (PMS) is a cluster of physical and emotional symptoms occurring in the luteal phase of the menstrual cycle. The study aim was to determine the relationship between PMS, and state of nutrition expressed as Body Mass Index (BMI) and body composition in 18-year-old females.  Material and methods: The study was conducted on 476 women divided into two groups i.e. those suffering from PMS (n = 233) and those without symptoms (n = 243). The women were examined during their luteal phase using bioelectrical impedance analysis to determine their body composition. Height and weight were measured using digital medical scales with an electronic height rod. BMI was calculated thus: BMI = body mass (weight) (kg)/height (m2). The subjects were di- vided into two sub-groups: BMI < 25 kg/m2 and BMI ≥ 25 kg/m2. Statistical analysis was carried out using STATISTICA 10 PL software and the Mann-Whitney test.  Results: The women with normal BMI suffered from PMS twice as often as the women with BMI ≥ 25 kg/m2 (68.2% vs. 31.8%). There were significantly higher values for Fat Mass (FM) (%) (p < 0.01) and FM (kg) (p < 0.001) in women without PMS, and significantly higher values for Fat-Free Mass (FFM) (%) (p < 0.001) and Total Body Water (TBW) (%) (p < 0.001) in women with PMS. Higher values were reported for FFM (kg) and TBW (kg) (p < 0.05) in girls with PMS and BMI ≥ 25. Conclusions: These results show PMS is more frequent in patients with BMI < 25, and less frequent in patients with higher FM (kg) and FM (%). Moreover, significant frequency of PMS was observed in patients with higher FFM and TBW. Such statistical significance was not confirmed in girls with a BMI < 25.

Evaluation of predictive value of biochemical markers for adverse obstetrics outcomes in pregnancies complicated by cholestasis

Objectives: Intrahepatic cholestasis of pregnancy (ICP) is significantly more often associated with an abnormal perinataloutcome compared to a group of healthy pregnant women.The aim of the study was to analyse the correlation between the adverse perinatal outcome and the biochemical parametersin pregnancy complicated by cholestasis, and to assess their predictive value for neonatal complications.Material and methods: Eighty-six patients with ICP were divided into 3 groups according to their fasting serum bile acidlevel [group I n = 60, 10–39.90 μmol/L; group II n = 20, 40–99.90 μmol /L; group III n = 6, TBA (total bile acids) ≥ 100.00 μmol/L].Linear regression models were created to determine the relation of serum TBA, ALT, and AST concentration with total adverseperinatal outcome, defined as an occurrence of at least one perinatal outcome: stillbirth, preterm birth, spontaneous andiatrogenic preterm birth, presence of meconium in amniotic fluid, Apgar score (< 7 in 5th min), pH from umbilical artery(< 7.1), necessity for NICU admission, the presence of breathing disorders, and the need to perform phototherapy.Results: TBA ≥ 40.00 μmol/L is connected to an elevated risk of the occurrence of total adverse perinatal outcome (OR = 4.17,p = 0.0037, AUC = 0.62, p = 0.046). TBA ≥ 40.00 μmol/L is a predictor of preterm birth (OR 2.3, p = 0.0117), iatrogenic pretermbirth (OR 2.5, p = 0.006), admission to NICU (OR 2.38, p = 0.0094), intubation or assisted ventilation (OR 2.16, p = 0.0301), andphototherapy (OR 2.0, p = 0.0438). The threshold value of TBA for the need for phototherapy was 52.7 μmol/L (AUC = 0.67,p = 0.0089) and for preterm birth, 32.1 μmol/L (AUC = 0.62, p = 0.0251).Conclusions: Pregnant women with ICP and TBA serum level over 40.00 μmol/L have a worse prognosis regarding obstetricoutcomes. The concentration of bile acids is a predictor of the occurrence of adverse perinatal outcomes, although theconcentration of ALT and AST failed to show such a connection

Inflammatory rheumatic diseases and pregnancy

Pregnancy in a patient diagnosed with systemic connective tissue disorder is a challenge that requires a close co-operation between a rheumatologist and gynaecologist. Good control over the activity of the underlying condition and the choice of appropriate time for planning a pregnancy have direct effect on the pregnancy results in these patients. Applying gynaecological supervision adequate to the increased risk of complications is also very important.The aim of this study is to present the current knowledge on the care over pregnant patients with systemic connective tissue diseases and to draw attention to the importance of pregnancy planning in this group of patients

Endometriosis is associated with an increased whole-blood thrombogenicity detected by a novel automated microchip flow-chamber system (T-TAS®)

Objectives: Potential thrombotic and antifibrinolytic influence of endometriosis on haemostasis has been recently reported in the literature, as well as increased cardiovascular morbidity in women suffering from the disease. We performed a pilot study to assess the influence of endometriosis on the thrombus formation process under in vitro flow conditions. Material and methods: This study compared women with confirmed endometriosis (n = 23) surgically and control healthy subjects (n = 10). In both groups, the same exclusion criteria were used: a prior episode of thrombosis diagnosed as acquired or inherited thrombophilia, neoplasm, and an uncertain family history of thrombosis. We evaluated the whole blood thrombogenicity using T-TAS® at a shear rate of 240 s-1 (Total-Thrombus Analysis System, Zacros, Japan).  Results: The blood clot formation initiation time (T10) and occlusion time (OT) were significantly shortened in the endometriosis group (p < 0.05). The area under the curve (AUC30) of blood clot time formation values (BCTF) was substantially higher in the patients suffering from a disease (p = 0.03). An increase in AUC (TTAS) values by 100 increases the risk of developing endometriosis by 1.56-fold [adjusted OR = 1.56 (p = 0.01);(95% CI: 1.10–2.18)]. Inflammatory markers (neutrophil-to-lymphocyte ratio (NLR), and the leucocyte, neutrophil, basophil, and neutrophil concentrations) were also substantially higher in the endometriosis group (p < 0.05).  Conclusions: The alteration of the T-TAS and NLR values supports the thesis of a shift of the equilibrium towards thrombosis in women who have endometriosis. This phenomenon links to a state of chronic inflammation. It is detectable using a novel system for the quantitative assessment of the platelet thrombus formation process under flow conditions in vitro

Application of auxological methods, including dental age estimation, in the assessment of delayed puberty in girls in gynecological practice

Developmental gynecology uses methods practiced in auxology — the science of human ontogenetic development. An important and jointly used concept in gynecology and auxology is the concept of developmental age, which, unlike calendar age, is a measure of the biological maturity of the organism, indicating the stage of advancement in the development of certain features or body systems. Developmental age assessment methods include: a) morphological (somatic) age — body height and weight, b) secondary sex characteristics — breast in girls, genitalia (penis and testes) in boys, and pubic hair in both sexes, c) bone age — hand and wrist x-ray, and d) dental age. An important marker of developmental age is also age at menarche, treated as a late indicator of puberty in girls. All of these methods are useful in the context of assessing regularity and disorders of puberty, such as delayed puberty. The paper discusses developmental age assessment methods that can be used to diagnose delayed puberty as well as the causes of delayed puberty in girls. It should be emphasized that in assessing the process of physical development of a given individual, the cooperation of specialists in the field of developmental gynecology, pediatrics, auxology, dentistry, endocrinology, and dietetics would be the most desirable

Chronic endometritis — is it time to clarify diagnostic criteria?

Chronic endometritis is a persistent, low-intensity inflammation of endometrial mucosa, characterized by the infiltration of plasma cells into the endometrial stroma This immunological alteration is thought to be a consequence of a bacterial infection. For a long time, chronic endometritis was poorly investigated and rarely considered in clinical practice because it is either asymptomatic or presents with no specific symptoms. Its association with adverse effects on fertility and retrospectively reported effectiveness of antibiotic treatment were the main reasons for a growing interest in this endometrial pathology. Chronic endometritis is now a hot topic in recurrent pregnancy loss and recurrent implantation failure research. Nevertheless, there are still no recommendations to include chronic endometritis investigation in a clinical evaluation of infertile patients. The uncertain role of this condition is an effect of significant differences in study results presented by different research groups. One important reason for these inconsistent findings is a lack of standardised chronic endometritis diagnostic methods. We present a review of the literature, focusing on the currently available chronic endometritis diagnostic techniques. The review is subdivided into three parts concerning the diagnostic accuracy of three main diagnostic modalities. Histopathological examination of endometrial tissue, hysteroscopic evaluation of uterine cavity and identification of the bacterial factor. In conclusion, it is of great importance to establish a consensus on the diagnostic criteria for chronic endometritis. This is the only way to enhance international cooperation and create well-design multicenter studies to evidence the role of this endometrial pathology in infertility

The role of visceral therapy, Kegel’s muscle, core stability and diet in pelvic support disorders and urinary incontinence — including sexological aspects and the role of physiotherapy and osteopathy

Proper diet and physical activity are a form of prevention of female genital prolapse disorders. The causal substrate of pelvic floor dysfunction is multifactorial. Fifty percent of women over the age of 50 have pelvic organ prolapse, often accompanied by urinary incontinence. It is a complicated social and medical (urogynecological and sexological) problem. The authors conducted a literature review on the role of visceral therapy, Kegel and core stability exercises and diet in pelvic support disorders and urinary incontinence. The eligible articles provided insights into sexological factors, as well as the role of osteopathy and physiotherapy. These results provide new insights into the relevance of clinical practice. In addition to standard treatment methods used in gynaecology, sexology, physiotherapy and osteopathy (e.g., visceral therapy), Kegel muscle and core stability exercises are becoming increasingly important. The aim of visceral therapy is to restore the mobility of the organs while reducing increased tension and improving blood and lymph circulation. This has the effect of reducing pain sensations, thereby influencing the function of the uterus and ovaries