Charletta Ayers

Age and the prevalence of bleeding disorders in women with menorrhagia.

OBJECTIVE: A study was conducted to evaluate the frequency and types of hemostatic defects occurring in adolescent and perimenopausal-age women diagnosed with menorrhagia. METHODS: A total of 115 women with a physician diagnosis of menorrhagia, including 25 adolescent women, 25 perimenopausal-age women, and 65 women between the ages of 20 and 44, underwent comprehensive hemostatic testing for possible bleeding disorders. Frequencies of bleeding disorders were calculated and compared. RESULTS: Forty-seven percent of women were found to have hemostatic abnormalities, including platelet dysfunction, von Willebrand’s disease, and coagulation factor deficiencies. Adolescents and perimenopausal-age women with menorrhagia were just as likely to have hemostatic abnormalities as were women aged 20 to 44. CONCLUSION: These results demonstrate that underlying bleeding disorders are frequently found in adolescent, postadolescent reproductive age, and perimenopausal-age women presenting with menorrhagia and suggest that women with menorrhagia should be considered for further hemostatic evaluation. LEVEL OF EVIDENCE: II-2

Development of a screening tool for identifying women with menorrhagia for hemostatic evaluation

OBJECTIVE A study was conducted to develop a short, easy to administer screening tool useful for stratifying women with unexplained menorrhagia for hemostatic testing for underlying bleeding disorders. STUDY DESIGN One hundred forty-six women with a physician diagnosis of menorrhagia underwent comprehensive hemostatic testing for the diagnosis of bleeding disorders, including von Willebrand disease, platelet dysfunction, and coagulation factor deficiencies. A 12 page questionnaire of bleeding symptoms was administered. Bleeding symptoms with high predictive values for laboratory hemostatic abnormalities were combined and used as single variables to calculate sensitivity, specificity, and positive and negative predictive values in order to develop a short screening tool to identify females for testing and evaluation. RESULTS A combination of 8 questions in 4 categories resulted in a sensitivity of 82% (95%CI 75-90) for bleeding disorders. Adding a pictorial blood assessment chart score > 100 increased the sensitivity of the screening tool to 95% (95%CI 91-99). CONCLUSION These results demonstrate the feasibility of a simple questionnaire based screening tool to identify females for testing and evaluation for bleeding disorders.

Screening women with menorrhagia for underlying bleeding disorders: the utility of the platelet function analyser and bleeding time

Summary.  Menorrhagia is a very common clinical problem among women of reproductive age and recent studies have suggested that underlying bleeding disorders, particularly von Willebrands deficiency and platelet function defects, are prevalent in women presenting with menorrhagia. The objective of this study was to determine the utility of the platelet function analyser (PFA‐100) and bleeding time (BT) as initial screening tests for underlying bleeding disorders in women with menorrhagia. In this study, 81 women with a physician diagnosis of menorrhagia underwent PFA‐100 testing, BT and comprehensive haemostatic testing. The effectiveness of the PFA‐100 and BT as screening tools in women with menorrhagia was assessed using results of haemostatic testing for von Willebrands disease (VWD) and platelet dysfunction. In women presenting with menorrhagia, the PFA‐100 had a sensitivity 80%, specificity 89%, positive predictive value (PPV) 33%, negative predictive value (NPV) 98% and efficiency 88% for VWD. For platelet aggregation defects, the PFA‐100 closure time had a sensitivity 23%, specificity 92%, PPV of 75%, NPV of 52% and efficiency 55%. The data suggest that the PFA‐100 may be useful in stratifying women with menorrhagia for further von Willebrand testing; however, neither the PFA‐100 nor the BT tests are effective for purposes of classifying women for standard platelet aggregometry testing in women presenting with menorrhagia.

Topical Alprostadil in the Treatment of Female Sexual Arousal Disorder: A Pilot Study

This study evaluated the efficacy and safety of three doses of topical alprostadil* USP (prostaglandin E 1 ) cream in 8 patients with Female Sexual Arousal Disorder (FSAD). Each patient was administered a single intravaginal dose of placebo followed by escalating intravaginal doses of the active drug at 2-week intervals. Alprostadils effectiveness in enhancing subjective and physiological arousal during visual sexual stimulation was supported by patient ratings and physician assessments of vaginal erythema and transudate volume. Photoplethysmography measurement of vaginal pulse amplitude was not able to demonstrate treatment sensitivity in the present study. Adverse events included mild cases of vaginal itching and burning. The data support further investigation of the use of alprostadil for FSAD.

Prevalence and risk factors for vitamin D insufficiency and deficiency at birth and associated outcome.

BackgroundOccurrence and consequence of cord blood (CB) vitamin D insufficiency/deficiency has not been adequately explored despite rising concern regarding this topic in pediatrics. This study was designed to determine the rate, maternal risk factors, and clinical outcomes in infants in association with vitamin D insufficient/deficient status at birth.MethodsAmerican Academy of Pediatrics (AAP) defined levels (ng/mL) were utilized to categorize the vitamin D status in CB samples as deficient (5–15), insufficient (16–20), and sufficient (21–100). We used descriptive statistics and multiple regression models to identify the rate and factors associated with vitamin D deficiency/insufficiency and related outcomes in the enrolled mother-infant pairs.ResultsThis prospective study was conducted at a single center on postpartum women and their infants. Vitamin D deficiency and insufficiency was recorded in 38.9 and 29.8% respectively of the 265 CB samples. Deficient CB vitamin D levels in infants were associated with maternal Black, Hispanic, or Asian race/ethnicity, younger age, and increased number of pregnancies. The likelihood for infants to be born with an insufficient vitamin D level increases with younger maternal age and the number of pregnancies as well as Asian ethnicity. We did not find an association between the vitamin D status at birth and pre-discharge clinical characteristics of the neonates.ConclusionsThe likelihood for an infant to be born with vitamin D deficiency/insufficiency is relatively high and is related mainly to younger maternal age, gravidity, and non-White race/ethnicity. Our findings raise a question regarding the adequacy of the AAP recommended vitamin D supplementation requirements without knowing the infant’s vitamin D status at birth.

Menopausal women requesting egg/embryo donation: examining health screening guidelines for assisted reproductive technology.

Objective:As more postreproductive women opt to pursue pregnancy with advanced assisted reproductive technologies (ART), the menopausal practitioner will become more involved in counseling, screening, and referral of premenopausal, perimenopausal, and postmenopausal women for these services. This review was conducted with the aim of (1) evaluating ART screening practices as they pertain to postreproductive women, and (2) reviewing the outcomes of ART using oocyte donation in postreproductive women. Methods:A total of 950 unique records were found on PubMed, Clinical Key, and Google Scholar. Of these, 252 records were screened for relevance based on their titles and abstracts. With further review of these 252 records, 93 full-text articles were assessed for eligibility, and 63 were excluded based on relevance to our study. Finally, 30 studies were included in our qualitative synthesis. Results:Despite the increasing use of ART in postreproductive women, there are limited guidelines for determining candidacy with regard to maternal health, the most comprehensive of which are the guidelines from the American Society for Reproductive Medicine (ASRM). Although the American Society for Reproductive Medicine guidelines state that healthy women over 50 who are prepared for parenthood are candidates for ART through oocyte donation, they note that older women should be counseled as to the increased obstetric risk associated with advanced maternal age. With aging, particularly for those women who are menopausal and postmenopausal, the woman and her fetus, however, are at risk of increased morbidity and mortality as compared with younger, healthy pregnant women. Because national trends suggest that women are delaying childbearing, the cohort of postreproductive women looking toward ART using donor oocytes as a fertility option will expand and menopausal practitioners will often participate in the ART counseling of these women. Conclusions:Because maternal and fetal morbidity and mortality increase in postmenopausal women who become pregnant through ART, practitioners caring for this cohort should provide input into developing standardized, comprehensive guidelines for this population so that screening is consistent for all older women seeking this intervention and risks are objectively outlined and considered.

Sonographically guided insertion of intrauterine device: Indications and results

From 2011 to 2015, a total of 67 patients were referred for IUD insertion guided with transabdominal sonography (TAS). Fifty‐six of the 67 patients had successful IUD insertion under TAS guidance. The clinical indications for referral included fibroids, uterine position, previous history of IUD expulsion, and limited tolerance of pelvic examination. Reasons for failed TAS‐guided IUD insertion included patient discomfort, cervical stenosis, and inability to remove and replace an existing device. Ultrasound guidance could help broaden the patient population that may benefit from the therapeutic value of an IUD.

High Intensity Female Sports Participation: Need for Sport-Specific Gynecologic Assessment [21F]

INTRODUCTION: Over the past two decades women have increased their presence in male dominated sports (football-5x, wrestling-14x, baseball and weightlifting-4x in high school athletics). Studies suggest that high intensity vs lower intensity exercise pose specific endocrine and metabolic risks to the female athlete, which gynecologists should address during office visits. METHODS: A PubMed review of articles and web reports was conducted on adverse medical consequences occurring to female athletes engaged in high intensity activities. RESULTS: Weight fluctuations, such as in wrestling or weight lifting, commonly occur. Low energy intake from high protein, low carbohydrate diets for required muscle mass retention and growth may lead to increased risks of developing exercise-related delayed menarche, menstrual dysfunction (ExMD), poor bone health, muscle damage and changes in muscle repair processes, lipid and leptin changes and other adverse endocrine and metabolic changes. Additionally, ExMD has been linked to health consequences such as cardiovascular dysfunction, endothelial dysfunction, and abnormal metabolic hormonal profile. Of greatest immediate concern is the potential muscle damage and alterations in the muscle repair process caused by low estrogen levels, which can hinder athletes from obtaining their highest level of sports performance. CONCLUSION: With several adverse consequences to female athletes resulting from high intensity sports, gynecologists should inquiry about sports participation to determine the type of sport (whether it is high impact, non-contact, etc.) dietary restrictions, body mass, menstrual issues, previous fracture and use of performance-enhancing drugs, hormones and anabolic steroids.

Comment on: Pregnant Women's Preferences for Men's Faces Differ Significantly from Nonpregnant Women

How humans react to another human’s face has been a subject of great interest since antiquity. Who can forget the legion of Helen of Troy who had “The face that launched a thousand ships”? Although we have no verified portrait of Helen’s face, another face that has attracted human attention since the 1500s and is often considered the best known and most visited face in the world is da Vinci’s Mona Lisa. Drawing us to her appears to emanate from her enigmatic expression and a piercing stare. Our interest in, reactions to, and strong attraction to various faces continue to fascinate us, not only in our day-to-day living, but also our interest extends to how artists depict the human face. When looking at Andy Warhol’s depiction of the silk-screened face of Marilyn Monroe, many of us are amazed and positively drawn to the exaggerated colors that depict a modern day “Helen” vs. the repulsion felt on Edvard Munch’s depiction of the agonized expression on the man’s face in his globally famous painting, The Scream. But it is not only artists who are interested in the face and how their audience reacts to them, but scientists as well. Several studies, such as reported by Little and Jones, suggest that humans prefer symmetric faces to asymmetric ones, either because we equate symmetry with health or because symmetry is more easily visually processed by humans [1]. In addition to symmetry, other important traits include averageness (how close the face resembles others in that population), secondary sexual characteristics, skin health and color, facial clues (attractiveness), and other traits such as age, weight, and external alterations such as makeup and hair style [2]. A recent study suggests that economics of the time also are predictive to our reaction to the face. Pettijohn and colleagues looked at facial features of popular U.S. country music singers over time [3]. They found that during times of relative “famine,” artists with more mature facial features were popular whereas in time of relative “feast,” baby-faced artists with larger eyes and a smaller chin were popular. Adding important data to this literature on the face is the current article on how pregnant women and the hormonal shifts that occur during gestation influence facial choice. The conclusions of this research are as expected. Although there is an evolutionary imperative for reproduction aged women who are seeking a male partner to be more attracted to those who have a more masculine face thus increasing their relative risk of conception, this need is nonexistent in the already pregnant woman. Once pregnant, a woman’s reproductive need for coital exchange disappears as successful conception has already occurred. What would be an interesting follow-up to this study is one in which the authors longitudinally follow these women after giving birth and document when their preference for a more masculine face resurfaces. It should most probably coincide with the cessation of lactation in those women who are nursing their infants. However, it would be fascinating to scientifically document this.