Association between menarche age and menstrual disorder with the incidence of uterine fibroid in medan, Indonesia: based on hospital data

Background: Uterine fibroids are benign, monoclonal tumors of the smooth muscle cells found in the human uterus. The incidence of uterine fibroid in Indonesia is between 2.39% - 11.7% in all gynecology inpatient. Despite the fact that their cause is still unknown, there is considerable evidence that estrogens and progestogens proliferate tumor growth, as the fibroids rarely appear before menarche and regress after menopause.Methods: An observational analytic study with case control approach. Total sample from this study was 498 people, with 249 cases and 249 controls. The samples were collected through purposive sampling. The study was conducted in the medical record division of Adam Malik General Hospital Medan. Results from the study were analyzed with chi square.Results: The result of this study demonstrated an association between menarche age with uterine fibroid incidence, with a p-value < 0.05, and odds ratio = 2.487 (CI 1.585-3.902). This indicate that the incidence of uterine fibroid is 2.5 greater in women with menarche age of < 10 years old. P-value < 0.05 and odds ratio = 0.258 (CI 0.178-0.375) were obtained from the association between menstrual disorder and uterine fibroid incidence.Conclusions: The result of this study demonstrates a significant association correlation between menarche age and the development of uterine fibroid. Early menarche age increases risk of uterine fibroid incidence, whereas menstrual disorder is more likely a clinical manifestation of uterine fibroid, rather than a risk factor

When Myoma Causes Infertility

Myoma is a benign neoplasm originated from connective tissues of the uterine smooth muscle. Based on an autopsy, Novak revealed that 27% of 25 aged year women had myoma nests, with a higher prevalence in dark skinned subjects. Uterine myomas have never been reported before menarche, whereas only 10% cases of myomas still develop after menopause. Uterine myomas occur approximately in 20% - 30% of women. In Indonesia, uterine myomas constitute 2,39% - 11,7% of all hospitalized gynecology patients. This tumor is frequently found in subjects aged 35-45 years old (less than 25%) and is less frequently experianced by 20 year aged women and post menopausal women.. A widely excepted opinion indicated that 50% of women with fibroids are completely asymptomatic, where as 30% may present with menorrhagia, with the remaining 20% presented with symptoms caused by supressions, that complicate reproductive assesments. Whether a fibroid is symptomatic or not possibly depends on the size, amount and anatomical site. Sub mucosal myomas may cause menstrual disorders, such as menorrhagia and intermenstrual bleeding. Due to its nature that distorts the uterine cavity, myomas may cause infertility and/or misscariages. Based on these statistics, the author further ellaborated the association between Myoma and infertility, specifically myoma as a causative factor. This paper emphasizes on the causative relationship myoma has with infertility, not on the various approaches availabe to treat such cases. Keywords: Myoma, Infertilit

Stress Levels and Charecteristics of Medical Faculty Students Undergoing Premenstrual Syndrome and its Association with Academic Achievements

This research was conducted in order to determine the association between stress levels and charecteristics of Medical Faculty Students of University Sumatera Utara with Premenstrual Syndrome events reflected by academic achievements, which started on December 2011 until 2012 after obtaining a letter of consent issued by the the Ethical Comittee of the Health Section, Medical Faculty of Univeristy Suymatera Utara. The research used a "cross sectional design" by means of an analytical observational approach. The data were collected at one certain time from one subject group. The sample filtering procces were concluded by an interview and a specified lie test, conducted by using the L-MMPI scale, due to the self-rating nature of the instruments involved. The L-MMPI scale is an integrated part of the MMPI (Minnesota Multiphasic Personality Inventory) validity scale to assess honesty. If the results obtained from the L-MMPI scale questioner assessment concluded that the subjects tends to be dishonest, the subject would not be included furthermore in this research, which would be followed by the recruitment of another subject. The sample category were extracted based on the divison stated on the PSST standard reference according to the Montreal 2010 Consensus that includes Mild Premenstrual Syndrome and moderate-severe premenstrual syndrome, which finally observed an absence of PMDD. In this research, an amount of 50 subjects were obtained, 30 subjects were categorized as Mild Premenstrual Syndrome and the remaining 20 subjects into moderate-severe premenstrual syndrome, which was followed by conducting a statistical analysis on the obtained data. The author also attempted to present the variables of this research and test the association between the dependent and independant variables in order to obtain a comprehensive understanding concerning the relationship between stress levels, charecteristic factors that include age, BMI, Menarche age, menstrual cycle and menstrual lenghth to premenstrual events and its relation to academic achievements as a dependenmt variable. By using stress levels as a trigger to the occurence of Premenstrual Sydrome in Medical Faculty Students, chi-square tests obtained a p value of 0,000, showing a significant association between stress levels based on the adrenal stress degree on Premenstrual Syndrome. A p-value of 0,005 was obtained when determining the association betweem Premenstrual with Academic Index achievement of students undergoing Premenstrual Syndrome, which indicated a significant relationship between Premenstrual Syndrome and academic achievement. The obtained BMI charecteristic p-value was 0,203, obtained menarche age charecteristic p-value was 0,243, obtained menstrual length charecteristic p-value was 0,140, indicating the absence of a significant relationship between all the charecteristics stated above with Premenstrual Syndrome. By means of Spearman's Correlation, an association between BMI and adrenal stress levels of Medical Faculty students in University Sumatera Utara with academic index achievements was obtained, with the p-value of 0,048 and 0,000 respectively. Whereas the menstrual length charecteristic p-value obtained was 0,448. This study concluded an association between stress levels and Medical Faculty students charecteristics to Premstrual Syndrome, and between Premenstrual Syndrome with Academic achievement indexes of students undergoing Premenstrual Syndrome. Key words: Premenstrual Syndrome, Adrenal Stress Levels, Academic achievements, L-MMPI scale

Pregnant Women Empowerment in Improving Knowledge and Attitude on Delivery Method at Private Clinics in Medan City

Introduction : Pregnant women want a smooth labor and give birth to a baby perfectly. Practically, the way of delivery is 80% through vaginal birth and 20% labor caesarean section (CS). However, secular trend towards increased rates of labor CS almost worldwide. Safe delivery is the right of pregnant women, the empowerment of the training and mentoring of pregnant women to the labor elections with an indication of the effort to reduce non-medical CS needs to be done to improve the knowledge, attitudes choose childbirth. Material &amp; Methode : The study used a mixed method research method is quantitative and qualitative. Quantitative : quasi-experimental design with a sample of  25 pregnant women in the intervention group and 25 pregnant women in the control group. Qualitative : Rapid Assessment Procedure (RAP) and the analysis of the theme. Statistic Before the paired t test bivariat and not pairing done, first performed a test average of variable data. If the data still isn't normal (p value &lt; 0.050) Although data transformation has been done by way of a squared, diakar, and Log 10 then test the test become bivariat non parametric. In this research analysis used is the bivariat Wilcoxon. Results : Effect of empowering one for knowledge was 12.28 into 12.88 with p &lt;0.001 and empowerment 2, namely 12.88 into 15.56 with p value &lt;0.0001. Effect of empowerment one of the attitude that was 11.92 into 12.35 with p &lt;0.009, empowerment 2 was 12.35 into 15.28 with p value &lt;0.0001. changes in the value of the average knowledge before (pre-test 1 ^) and after (post-test 1 ^) is 10.08 into 11.56 with p &lt;0.0001, changes in the value of the average knowledge before (pre-test 1 ^) and after (post-test 1 ^) was 10.08 into 11.56 with p &lt;0.0001, the average value change attitudes before (pre-test 1 ^) 9.84 and after (post-test 1 ^) which became 11.72 with p value &lt;0.0001. Effect of empowerment for mothers childbirth obtained significance value (p = 0.001), with Exp (B) 14.636 means that the intervention group had an opportunity to choose a delivery vaginal birth was14 times greater compared with pregnant women in the control group. The quantitative findings are supported by the findings of qualitative expressions of pleasure and empowerment lucky followed by training and mentoring. Recommendation : Pregnant women feel the direct benefits of a normal delivery. Policies to adopt and use methods of empowerment with training and mentoring in the health center and Maternity Clinic. Keywords: Pregnant women, Empowerment, Knowledge and Attitude, Childbirth

Association between Luteinizing Hormone/Choriogonadotropin Receptor Ins18LQ Gene Polymorphism and Polycystic Ovary Syndrome

BACKGROUND: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders of women in the childbearing period. However, its pathophysiology is still unclear. Certain polymorphisms of the luteinizing hormone/choriogonadotropin receptor (LHCGR) genes may lead to changes in the bioactivity of this hormone. The important functional role of LHCGR in the metabolism of androgen and ovulation, the LHCGR gene variant, may be related to the risk of PCOS. AIM: The aim of this study was to evaluate the association between LHCGR Ins18LQ gene polymorphism and PCOS. METHODS: A case–control study was performed in women with PCOS and non-PCOS from May 2019 to October 2019 in HFC IVF Center. We included 50 women with PCOS and 50 healthy controls. Polymorphism of the LHCGR (ins18LQ) gene was genotyped using polymerase chain reaction-restriction fragment length polymorphism. RESULTS: From this study, we found that there was no significant difference in the proportion of ages between the groups (p &gt; 0.05). There were significant differences in the characteristics of body mass index, FSH level, LH level, and LH/FSH ratio between the PCOS and control groups (p &lt; 0.05). We also found that the proportion of heterozygote variant non-ins/ins was higher in the PCOS group compared to the control group, but there was no significant difference between the polymorphisms of the non-ins and non-nonins variants between the PCOS and control groups (p = 0.269). The frequency of ins alleles was higher in the PCOS group compared to the control group. CONCLUSION: There was no significant association between LHCGR ins18LQ gene polymorphism and PCOS

Vitamin D Levels in Women with Polycystic Ovary Syndrome

INTRODUCTION: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. There is some evidence suggested that vitamin D played a role in the incidence of PCOS. Previous research has found vitamin D deficiency in the pathogenesis of PCOS and cohort studies showing the relationship of obesity with decreased levels of 25-hydroxy vitamin D. Therefore, we aim to conduct a study on vitamin D levels in women with polycystic ovary syndrome.OBJECTIVE: To determine the difference of the levels of vitamin D in women with and without polycystic ovary syndrome.METHODS: This study is a comparative analytical study on two unpaired population by using cross-sectional study design. The study was conducted in Halim Fertility Clinic Medan starting in November 2014 through April 2015. Blood samples were taken from 23 women PCOS and 23 non-PCOS women. Further data were tabulated and analyzed.RESULTS: Vitamin D levels are lower in women with PCOS compared to controls. In the PCOS group, the levels of vitamin D were lower in obese women. Vitamin D levels were also lower in PCOS women with WHR&gt; 0.85.CONCLUSION: This study showed a significant lower level of vitamin D in PCOS patient

Correlation between Estrogen Levels with Lipid Profile in Menopause Women in West Sumatera

BACKGROUND: Menopause is a condition where women had not experienced menstruation for 12 consecutive cycles. At menopause period, there is alteration in women reproductive cycle where estrogen decreased and lipid status altered. AIM: This study is aimed to understand the association of estrogen level and lipid status in menopause women. METHODS: This study was an observational study with cross-sectional design underwent in Obstetrics and Gynecology Polyclinic Dr M. Djamil Hospital, Padang to examine estrogen level and lipid level in 107 menopause women aged between 40-60 years old. The study was conducted for 6 months. The relationship between estrogen level and lipid profile was done using correlation test and p-value &lt; 0.05 is significant. RESULTS: There was no significant correlation between estrogen and total cholesterol (p = 0.146), LDL (p = 0.496), HDL (p = 0.172) and triglyceride (p = 0.296) in menopause women. There was negative correlation between estrogen with total cholesterol (r = -0.141; p = 0.146), HDL (r = -0.133; p = 0.172) and triglyceride (r = -0.1; p = 0.296) and a little positive correlation with LDL (r = 0.06; p = 0.496). Estrogen levels are not related to total Cholesterol, LDL, HDL, and triglyceride in menopause women CONCLUSION: Estrogen levels did not correlate with lipid status in menopause women in West Sumatera

CORRELATION BETWEEN ESTRADIOL SERUM LEVELS WITH XEROSTOMIA INVENTORY SCORE ON MENOPAUSAL WOMEN

Objective: Menopause is a condition of permanent cessation of menstruation for 12 consecutive months. This occurs due to the loss of follicular ovarian activity so that estrogen levels decrease in the body. Menopause can occur at various ages, where the average age of menopause is 51-55 y. Menopause can affect oral tissues as well as other organ systems and cause xerostomia. Some of the symptoms of xerostomia include burning feelings, taste abnormalities, dysarthria, dysphagia, dysgeusia, and halitosis. Methods: This study uses a case series design to assess the correlation between estradiol levels and the incidence of xerostomia in menopausal women. The incidence of xerostomia using the Xerostomia Inventory (XI) Score. This research was conducted in several places, namely H. Adam Malik General Hospital Medan and the hospital network of the Department of Obstetrics and Gynecology, Faculty of Medicine, University of Sumatra Utara. The study population was all postmenopausal women at the H. Adam Malik General Hospital in Medan and the Obgyn FK USU network hospital that met the study inclusion-exclusion criteria. This research was conducted in February with a minimum sample of 38 people. Results: In this study, 38 samples were obtained. Based on the results of the study, it was found that the most age groups were in the range of 56-60 y, the duration of menopause in the 5-10 y group, and the highest Body Mass Index (BMI) was obesity. The mean value of estradiol in menopausal women was 23.61±8.37 pg/ml; the mean value of XI score in menopausal women was 24.29±9.44. The correlation of estradiol levels and XI scores in menopausal women is a strong negative correlation that is-0.651 (p value&lt;0.05). Correlation value of XI score and obesity in menopausal women is a low positive correlation with r = 0.342 (p value&lt;0.05) while the value of correlation XI score with menopausal women who are not obese is a strong positive correlation with r = 0.793 (p value&lt;0, 05). Conclusion: Changes in the oral cavity are caused by aging and hypoestrogenism. The mean age of postmenopausal women was 56.98±4.35, with a mean BMI of 28.24±4.41. Estradiol levels in menopausal women are lower than women of reproductive age in each phase of the menstrual cycle. Significant reduction in estrogen production during menopause causes a decrease in salivary flow, leading to hyposalivation and symptoms of xerostomia

Management of abnormal uterine bleeding in perimenarche: diagnostic challenges

An 18-year-old girl—virgin, Indonesian, Bataknese, Moslem, student—was admitted to the Emergency Department of Haji Adam Malik Hospital, Medan, and presented with prolonged menstruation for the past 3 years, volume 5–6 pads/day, lasting for ±3 weeks, dark red, clotting (+), regular menstrual cycles. Vital signs were within normal limits. Physical examination revealed pale inferior conjunctiva palpebral and soft abdomen, with no palpable mass. As the patient was unmarried, speculum and vaginal examinations were not performed. This is apparently a sensitive issue as most eastern countries (including Indonesia), especially Muslim countries, highly value virginity. As the patient refused, a rectal toucher was also not used. Sonographic imaging revealed an anteflexed uterus measuring 7.1× 4.52 × 3.1 cm and endometrial thickness measuring 1.54 cm, suggestive of thickening endometrial wall. Both ovaries were normal sized. Based on these findings the patient was diagnosed with abnormal uterine bleeding and was subsequently administered with oral progesteron based on the recommended dose and duration of administration for three cycles

The relationship between Ramadan fasting with menstrual cycle pattern changes in teenagers

Background: Menstrual cycle plays an important role in female reproductive health. One of many factors contributing to affect variability of menstrual cycle is dietary pattern. During the Ramadan fasting, all dietary pattern, sleep pattern, and daily activities will be altered and thus contributing to menstrual cycle. Objective: To assess the relation between Ramadan fasting and menstrual cycle changes among teenagers. Methods: This is an observational study with cohort prospective approach. 85 female students of 1 Senior High School in Manyak Payed District were enrolled in this study. Respondents were asked to fill the questionnaires regarding menstrual cycle for 4 consecutive months to assess their menstrual cycle. Parameter observed was changes in menstrual cycle which could be in duration, frequency, and menstrual blood volume. For menstrual blood volume, the quantification was using menstrual pictogram questionnaire. Results: Among 85 female students enrolled, 14 students were menorrhagia and 6 students were oligomenorrhea during Ramadan fasting. There was no difference in menstrual cycle abnormalities during Ramadan fasting between the respondents who started fasting in follicular phase or luteal phase (p > 0.05). However, for menstrual blood quantification, there was a significant difference between menstrual blood volume before and during Ramadan fasting marked by the increased mean in menstrual blood volume as much as 13.84 mL with p value < 0.001. Conclusion: During Ramadan fasting, there were changes in teenagers’ menstrual cycle especially in menstrual blood volume. There was significant difference (p < 0.001) in menstrual blood volume before and during Ramadan fasting