Short and long term clinical outcomes following endometrial ablation in women with heavy menstrual bleeding. Randomised trials evaluating second generation endometrial ablation techniques are discussed and critically reviewed in this thesis. Patterns of referral, socio-demographic and clinical details, primary care treatment, of women referred with heavy menstrual loss are also considered as are three randomised trials of surgical treatments for the treatment of heavy menstrual bleeding. Microwave endometrial ablation (MEATM) and thermal balloon ablation (TBall) both achieved high levels of satisfaction (-1%, 95% CI (-11, 9)). Microwave had a significantly shorter operating time, reduced usage of anti-emetics and opiate analgesia, increased discharge by six hours and fewer device failures. Comparing MEA™ in the postmenstrual phase to MEA™ following standard drug based endometrial preparation there was no significant difference at five years in menstrual outcomes, health related quality of life, or need for subsequent treatment Ten years following MEATM or transcervical resection of the endometrium (TCRE), the hysterectomy rate after ten years was significantly different with 17% in the MEATM and 28% in the TCRE arm (95% CI -0.21, -0.13). In conclusion primary care guidelines should be followed whilst establishing patient preference prior to referral to secondary care. Microwave ablation has been shown to be an effective treatment in the short, medium and long-term. It can successfully be performed in an outpatient setting in the post menstrual phase and is acceptable under local anaesthesia.

Thesis (M.D.) -- College of Medicine of Maryland, 1812. / Half title: An inaugural essay on catamenia. Caption title: On menstruation. Microform version available in the Readex Early American Imprints series.

M.Tech. (Homoeopathy) / This research investigated the individualised treatment of females suffering primary dysmenorrhoea, using homoeopathic medication. Primary dysmenorrhoea is defined as painful menstruation thought to be due to excessive production of hormones known as prostaglandins, as well as ischaemia of the myometrium during menstruation. Treatment focused on the physical manifestations in each participant as an individual, as well as the constitutional and emotional aspects of the individual. Each subject participated in five homoeopathic consultations, over a period of four months. The first consultation took place pnor to a menstrual period, whereas follow-up consultations usually took place after each menstrual period. Using each participant's unique physical, emotional and mental symptoms the researcher used a holistic approach in determining their appropriate homoeopathic remedy, known as the similimum. Participants completed four questionnaires recording the severity of the seven possible symptoms experienced just prior to and during menstruation on a scale of 0 - 10 (with 0 indicating no discomfort and 10 indicating extreme discomfort). During the first menstrual period, participants received no homoeopathic treatment and no placebo, thereby creating a baseline from which the results from the remaining three months of treatment were compared. These results, together with the progression of each participant's symptoms as noted by the researcher at each consultation, were used to determine the effect of the similimum on severity of pain during menstruation and the necessity for allopathic pain medication during the dysmenorrhoea. In striving to abide by the laws and principles of the classical homoeopathic approach, each participant was evaluated as a totality. The intent of this research was to evaluate the effect of the homoeopathic similimum on ten participants with primary dysmenorrhoea. The study aimed to provide a safe and effective alternative therapy for primary dysmenorrhoea. The research results showed that the homoeopathic similimum had a significant effect on reducing the severity and duration of pain as well as associated symptoms of primary dysmenorrhoea. In addition, the need for allopathic pain medication was significantly reduced. The improvements were most significant after two to three months of treatment with the homoeopathic similimum, as opposed to only one month of treatment.

Specific dietary intakes were compared by menstrual status among endurance-trained athletes categorized as either eumenorrheic (EU) (N = 11), oligomenorrheic (OL) (N = 4) or amenorrheic (AM) (N = 5). It was hypothesized that nutrient intakes among endurance-trained women would be significantly different based on menstrual status. No significant differences in nutrient intakes were found among groups. The OL and the AM groups were significantly (p ≤ .05) younger than the EU group and the AM group had a significantly higher percent body fat when estimated by hydrostatic weighing (PFHW) than the EU group. Further comparisons of nutrient intakes were made between EU (N = 10) and AM (N = 4) runners. Zinc intake was significantly lower in the AM runners as compared to the EU runners. The AM runners were also significantly younger and had significantly higher PFHW than the EU runners. In conclusion, energy nutrient intakes appeared to not be significant factors in menstrual status. However, zinc intake was significantly lower (p ≤ .05) in AM runners as compared to EU runners.

Graduation date: 1994

Women with exercise associated amenorrhea display a disturbance in basal and exercise levels of reproductive, anti-reproductive and stress hormones. Co-incident with chronic exercise are other factors, which alone, also affect the menstrual cycle. Therefore, amenorrheic runners (AR), regularly menstruating runners (RMR) and regularly menstruating sedentary controls (RMSC) were compared for plasma progesterone levels, plasma lipid levels, menstrual cycle characteristics, physical characteristics and nutritional adequacy to determine if the difference in menstrual status could be explained, and to determine whether exercise alone could be attributed as the cause of menstrual cycle disturbances.Plasma progesterone levels were significantly lower in the AR group (. 28 + .02 ng/ml) than in the RMR group (.41 + .06 ng/ml) and the RMSC group (.49 + .06 ng/ml) in the follicular phase. Regularly menstruating runners demonstrated lower plasma progesterone levels in the luteal phase (9.76 + 1.05 ng/ml) than RMSC subjects (10.24 + 2.21 ng/ml). Regularly menstruating runners had a significantly shorter luteal phase length relative to their cycle length (.35 + .01) than RMSC subjects (.46 + .01). Mean age, incidence of parity, age of menarche, height, weight, body composition, max V02 and number of miles run per week did not differ between the RMR and AR subjects. Amenorrheic runners took in significantly less fat, red meat, phosphorous and total calories than the RMR subjects. Serum LDL-C was significantly higher in the AR subjects (89.2 + 9.7 mg/dl) than in the RMR subjects in both the luteal (67.8+ 3.4 mg/dl) and follicular (66.8+ 5.6 mg/dl) phases. Serum HDL-C was significantly higher in the RMR subjects in both the luteal (62.9+ 4.1 mg/dl) and follicular (59.2+ 2.9 mg/dl) phase, and in the AR subjects (63.9+ 4.2 mg/dl), than in the RMSC subjects in the luteal (49.2+ 5.9 mg/dl) and follicular (47.2+ 2.4 mg/dl) phase. Serum VLDL-C did not differ between any groups.This investigation demonstrates that hormonal and lipid level alterations with exercise are significantly different in the amenorrheic runner. However, regularly menstruating runners display alterations which may represent and intermediate or potential phase of menstrual cycle disturbances. The nutritional inadequacy or energy imbalance separates amenorrheic runners from regularly menstruating runners. Thus, it appears that exercise alone is not enough to cause the hormonal disturbances that trigger amenorrhea, and, that exercise associated amenorrhea is not unlike other amenorrheas of hypothalamic origin.

Thesis--M.D., University of Hong Kong, 1977. / Typescript.

published_or_final_version / Medicine / Master / Doctor of Medicine

Thesis (M. App. Psych.)--University of Adelaide, Dept. of Psychology, 1991. / Includes bibliographical references (leaves 127-140).

Thesis (M.s.)--Virginia Polytechnic Institute and State University, 1990. / Vita. Abstract. Includes bibliographical references (leaves 125-135). Also available via the Internet.